Birchwood Care Services

Birchwood Care Services is a domiciliary agency providing the regulated activity of personal care. Not everyone who used the service received personal care. The Care Quality Commission (CQC) only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of the inspection 8 people were using the service.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

People were supported by a small team of regular staff. Agency staff were used to cover sickness. The number of missed or late calls had reduced, however there had still been several calls cancelled by the provider due to staff sickness. This was an area for improvement. People told us they were contacted if their care calls were running late or needed to be cancelled.

Risks to people’s health and safety had been assessed. Risk assessments, to make sure staff had the guidance to provide the right support, had been implemented. People received their medicines safely and staff competencies were checked to make sure they followed best practice.

Checks and audits, to monitor the quality and safety of the service, had been implemented. Some of these had been introduced in March and needed to be embedded into day-to day practice.

People were supported by staff who had been recruited safely. Staff met with a manager for one-to-one supervision to discuss their performance and any developmental needs.

People were involved in the planning of their care. People told us staff were supportive and encouraging. People felt the communication had improved.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 17 January 2023). There were breaches of regulation.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 17 January 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We undertook this inspection to check whether the Warning Notice we previously served in relation to Regulations 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

People’s experience of using this service and what we found

People were not consistently supported by staff who knew them well. People’s calls were late or had been cancelled at short notice, relying on people’s families to support their loved ones. The service was using agency care staff as a contingency; however, calls were still late. Following the inspection, action was taken to hand back several care packages to the local authority commissioning team reducing the number of people supported to 13.

Risks to people’s health, safety and welfare were not adequately assessed. There was a lack of information for staff about how to provide the right support.

The provider had not promoted a positive culture that was person-centred, open, inclusive and empowering and achieved good outcomes for people.

There was a lack of oversight, scrutiny and governance by the manager and nominated individual. Checks and audits were not effective and / or not completed to monitor the quality and safety of the service. People and staff had provided feedback to the manager; however, no action had been taken to analyse this or take any action.

People were supported by staff who had been recruited safely. Staff completed training to keep their knowledge up to date. Staff met with the manager for one to one supervision, however this had only begun since the manager started in September 2022.

We could not be assured people were supported to have their medicines as prescribed. Due to the lateness and / or short notice cancellation of calls, there was a risk people may not receive their medicines on time.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff wore personal protective equipment, such as face masks, in line with current guidance. Staff told us they had plenty of stock when they needed it.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 20 December 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to the service being short staffed, resulting in late and / or cancelled care calls; risks to people’s safety not being consistently assessed, monitored and reviewed, and poor oversight and leadership. CQC served warning notices on the provider in relation to safe care and treatment, staffing and good governance.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good and met all relevant fundamental standards.

Why the service is rated Good

Staff knew how to recognise and respond to the signs of abuse. Risks to individuals’ safety and wellbeing were assessed and minimised. Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced. Medicines were managed safely.

There was a sufficient number of staff deployed to meet people’s needs. Staff received the training and support they needed to meet people’s individual needs. Robust recruitment procedures were followed to ensure staff were of suitable character to carry out their role. We made a recommendation to review the way staff are deployed to take account of user feedback about receiving a specified call time.

Staff knew each person well and understood how to meet their needs. People told us that staff communicated effectively with them and treated them with kindness and respect. People were supported to make their own decisions and remain as independent as possible. Staff supported people in the least restrictive way possible and the policies and systems in the service supported this practice.

People were promptly referred to health care professionals when needed. Staff knew about and provided for people’s dietary preferences and restrictions. Personal records included people’s individual plans of care, life history, likes and dislikes and preferred activities. These records helped staff deliver personalised care.

The registered manager and the provider were open and transparent in their approach. They placed emphasis on continuous improvement of the service. There was a system of monitoring checks and audits to identify any improvements that needed to be made. Action had been taken as a result of these checks to improve the quality of the service and care. Records were maintained accurately to allow the registered manager to monitor care delivery.

Further information is in the detailed findings below.

We saw that people's care plans were reviewed regularly and updated when changes were identified. One person who used the service told us, "We discuss any changes together and the workers are simply brilliant, I cannot fault them". Another person said, "My care workers give me excellent on-going care, I simply cannot praise them highly enough". When risks were identified we found clear action plans were in place to minimise the risks. We found that the staff quickly recognised when people who used the service became ill and immediately responded to meet their needs.

The main work of the extension where the agency was accommodated had just been completed. The manager told us, 'This is really lovely and such an improvement. We now have more space and the way the offices are designed mean that I can interact more with the team throughout the day'. We found that the premises were suitably designed and laid out to meet people's needs.

We saw that the provider had an effective system of internal audits in place to monitor the quality of the service provided.

Staff records, people's files and other records relevant to the management of the services were accurate and fit for purpose. All records were kept for the appropriate period of time and destroyed securely.

The service had a strong safeguarding policy and clear procedures in place. The staff had received all updated training relevant to their roles and could access additional training. One member of staff told us "I will always look out for them [people] and will act according to the code of practice, they are our primary concern".

The service operated effective recruitment procedures to ensure that staff were suitable for their role, provided appropriate training, supervision and appraisals, and encouraged them to improve their knowledge, skills and qualifications. One care worker said "I have opportunities to develop and improve my practice with working, learning and studying". Another member of staff stated "I feel really supported and listened to".

The service took people who used the service's comments and complaints into account when delivering care, treatment and support. One person commented "Very friendly, patient staff, very obliging, but sometimes overstretched".

We found that the manager was actively involved with monitoring the service to ensure that good standards of care were provided and upheld.