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Inspection Summary


Overall summary & rating

Outstanding

Updated 31 October 2018

The inspection took place on 8 and 22 August 2018. The inspection was unannounced and carried out by one adult social care inspector.

We last visited the service in December 2015 where we rated the service as good. At this inspection we found the provider continued to meet all of the regulations we inspected against and had introduced a number of changes and improvements. We have rated the effective and well led key questions as outstanding so the overall rating for the service is outstanding.

Birch Hill is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection. Birch Hill accommodates up to 24 people, most of whom are living with dementia. There were 23 people living in the home at the time of the inspection.

There was an experienced registered manager in place. 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.

The service was extremely effective. Bespoke and innovative training was provided to staff to help them to understand the experiences of people living with dementia. Relatives were also supported to gain a greater understanding of how people might be affected by their dementia related condition. They learned about the person centred model staff followed to minimise behavioural disturbance and distress and maximise potential, quality of life and wellbeing.

Changes in practice and the environment showed staff had taken training and advice regarding dementia care best practice on board. Steps had been taken to minimise noise and improve lighting and there was great attention to detail in order to maximise the comfort of people living in the home.

Staff received regular supervision and appraisals and were well supported to carry out their roles effectively.

The nutritional needs of people were extremely well supported through personalised ordering of meals and flexibility in the provision of food and drinks. Snack shacks and hydration stations ensured people had access to food and drinks throughout the day, and food was available at all times of the day and night.

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

In addition to routine audits and quality assurance systems, the registered manager and deputy continuously looked at ways to develop the service and enhance the experience of people living in Birch Hill. The outcome of this was an extremely well-led service. They accessed various forums and networks to help them find new ways of working with the aim of improving care. There were numerous examples of new ideas being put into practice seen during our inspection. Staff felt extremely well supported and morale was good in the home. There was an ever present shared sense of purpose with all staff demonstrating that the needs and wishes of people living in Birch Hill were paramount.

People told us they felt safe at Birch Hill and systems were in place to monitor the safety of the premises and equipment. Medicines continued to be managed safely and there were suitable numbers of staff on duty.

Staff were caring and courteous. We observed numerous examples of compassionate care during the inspection and observed the privacy and dignity of people was maintained.

A range of activities were available and people were involved and included in decisions about the home wherever possible. The individual needs and preferences were taken into account when planning activities inclu

Inspection areas

Safe

Good

Updated 31 October 2018

The service was safe.

Safe procedures were in place for the ordering, receipt, storage and administration of medicines.

Risks to people were assessed and plans were in place to mitigate these, Risks relating to the premises and equipment were also assessed and regular checks were carried out to keep people safe.

A safeguarding procedure was in place. Staff had received training in safeguarding of vulnerable adults and were aware of the action to take in the event of concerns.

There were suitable numbers of staff on duty and safe recruitment practices were followed to keep people safe.

Effective

Outstanding

Updated 31 October 2018

The service was extremely effective.

People were cared for by highly skilled staff who knew them exceptionally well.

Training was provided which was innovative and imaginative and supported staff to meet the needs of people in a very person centred way.

Nutritional needs were extremely well met. Mealtimes and food choices were highly personalised and flexible to meet the individual needs and preferences of people.

The environment was in the process of refurbishment. Decoration to date took evidence based best practice into account when designing environments to support the needs of people living with dementia.

Caring

Good

Updated 31 October 2018

The service was caring.

We observed numerous very kind and caring interactions between people and staff. Staff treated people as equals and there were a number of comments about the warm and friendly atmosphere in the home.

The privacy and dignity of people was maintained and staff received training in equality and diversity and provided highly individualised care.

People were supported to remain as independent as they could for as long as possible.

Responsive

Good

Updated 31 October 2018

The service was responsive.

Person centred care plans were in place which were up to date and kept under review.

A variety of activities were available to people. Staff knew people's individual needs and preferences well and tailored activities to meet these.

A complaints procedure was in place. The registered manager used feedback to learn and make improvements to the service.

Well-led

Outstanding

Updated 31 October 2018

The service was exceptionally well-led.

People, staff and relatives spoke highly of the registered manager and senior staff in the home. The registered manager was a passionate advocate for people and the improvements made in the home were due to their vision and commitment to continuous improvement.

The registered manager was inclusive in their management style. They had built strong relationships with relatives and visiting professionals and worked hard to develop a shared vision of person centred care.

The registered manager put people at the heart of all decisions made in the home and this ethos permeated throughout the staff team. Morale was good in the home and staff were proud to work in the service.