Birchy Hill Care Home

We found the following examples of good practice.

• Visits to the home were by appointment only to manage numbers. The provider policy stated one person at a time per family allowed to visit. There was ample outside space to enable socially distanced visits within each separate area of the garden in proximity to each individual unit. People were also able to keep in touch with friends and family via Skype. Computers were made available within the home with instructions and support on how to use them.

• Each of the five units was treated as a separate entity, described by the registered manager as five ‘homes’ within the home. Staff only worked on one unit, which included cleaning staff, to reduce risks of cross infection between units. Staff took breaks individually and in designated areas, including outdoors in the garden.

• Vulnerable staff were risk assessed and supported to manage any health conditions or to shield if required. Staff were asked if they would like to be re-deployed to non-contact duties to reduce risks.

Further information is in the detailed findings below.

Birchy Hill Care Home provides care for up to 70 people who require residential or nursing care. The service cares for people with a variety of needs, including complex needs associated with chronic and acute medical conditions and provides specialised dementia care. Accommodation for people is arranged over three floors and five living units. There was a well maintained sensory garden that provided safe, accessible areas for people to enjoy. There were 59 people living at the service at the time of the inspection.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated Good.

Is the service safe?

People were protected from potential abuse and avoidable harm by staff who were knowledgeable about recognising and reporting different signs of abuse. There were sufficient numbers of appropriately qualified staff available on each shift to ensure people were cared and supported safely. Risks to people were well managed and medicines were generally stored appropriately and managed effectively. People were protected by the prevention and control of infection. There was a system in place to review and learn from incidents when things went wrong.

Is the service effective?

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. People’s needs were fully assessed and they had access to a variety of health care professionals who commented positively on the care and support given to people at the home. Staff received a range of quality training which they found effective, useful and well delivered. Staff felt supported with a clear system of supervision meetings and annual appraisals. People were given a choice of nutritious, home cooked meals that they enjoyed. Meals were well presented and people were offered a choice of food and drink throughout the day. People’s independence and well being was enhanced by the environment of the home.

Is the service caring?

People and relatives told us they found the staff to be kind, caring, professional, friendly and patient. Staff spoke knowledgeably about people and showed they knew how people preferred to be given their care and support. People were treated with dignity and respect and supported to make their own choices about how they spent their day. People’s privacy was respected. Staff, people and relatives told us communication within the home was effective and people and relatives felt fully involved in their care.

Is the service responsive?

People received person centred care from a team of staff who knew them and their health needs well. People’s needs were re-assessed when their health needs changed and relatives were kept informed and included. There was a varied, planned programme of interesting activities that enhanced people’s sense of well-being and prevented social isolation. People knew how to complain if they needed to. Complaints were thoroughly investigated and people felt any complaint would be actioned and they would be properly listened to. There were systems in place to support good end of life care which respected people's wishes and requests.

Is the service well led?

There was an open, honest, friendly culture and people told us they had confidence in the management team and the staff which they said were approachable and respected. People and their relatives were consulted and involved in their care and support. There was an effective programme of quality checks and governance systems and audits to ensure the quality of the service was maintained. We have made a recommendation about the service notifying CQC of all required notifications as required by the regulations

Further information is in the detailed findings below.

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.

The provider had systems in place to respond and manage safeguarding matters and make sure that safeguarding alerts were raised with other agencies.

People who were able to talk with us said that they felt safe in the home; and if they had any concerns they were confident these would be quickly addressed by the

staff or manager

Assessments were in place to identify risks that may be involved when meeting people’s needs. Staff were aware of people’s individual risks and were able to tell of the strategies in place to keep people safe.

Staff knew each person well and had a good knowledge of the needs of people, especially those people who were living with dementia.

There were sufficient numbers of qualified, skilled and experienced staff deployed to meet people’s needs. Staff were not hurried or rushed and when people requested care or support, this was delivered quickly. The provider operated safe and effective recruitment procedures.

Medicines were stored and administered safely. Clear and accurate medicines records were maintained. Training records showed that staff had completed training in a range of areas that reflected their job role.

Staff received supervision and appraisals were on-going, providing them with appropriate support to carry out their roles.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. At the time of our inspection applications had been submitted by the managing authority (care home) to the supervisory body (local authority) and had yet to be authorised. The manager understood when an application should be made and how to submit one. They were aware of a recent Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty.

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests.

The food menus offered variety and choice. They provided people with nutritious and a well-balanced diet. The chef prepared meals to meet people’s specialist dietary needs.

People were involved in their care planning, and staff supported people with health care appointments and visits from health care professionals. Care plans were amended to show any changes, and care plans were routinely reviewed every month to check they were up to date.

People were treated with kindness. Staff were patient and encouraged people to do what they could for themselves, whilst allowing people time for the support they needed. Staff encouraged people to make their own choices and promoted their independence.

People knew who to talk to if they had a complaint. Complaints were passed on to the registered manager and recorded to make sure prompt action was taken and lessons were learned which led to improvement in the service.

People’s needs were fully assessed with them before they moved to the home to make sure that the home could meet their needs. Assessments were reviewed with the person their relatives and where appropriate other health and social care professionals.

People were encouraged to take part in activities and leisure pursuits of their choice, and to go out into the community as they wished.

People spoke positively about the way the home was run. The management team and staff understood their respective roles and responsibilities. The registered manager was approachable and understanding to both the people in the home and staff who supported them.

There were effective systems in place to monitor and improve the quality of the service provided. We saw that various audits had been undertaken.

People's diversity, values and human rights were respected. We saw that most of the bedrooms were single occupancy. We saw that people were able to express their individuality by having personal possessions such as small items of furniture and ornaments to personalise their bedrooms. This demonstrated that people were offered the opportunity to make choices about their lifestyle.

During our inspection, we spoke with relatives of two people who used the service. Both were very complimentary regarding the service provided to their relative with comments such as "we are both happy with the home" and "I am just so thankful that they are her. I could not do what the staff do for them".

Relatives we spoke with said they felt their family member was safe in the home and said they were confident that staff would respond appropriately to any concerns they raised.

The provider had an effective system to regularly assess and monitor the quality of service that people receive. The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

A relative told us that the way that the service obtained consent to care was 'a very thorough process'. People's needs were assessed and care was planned and delivered in line with their individual care plan. One relative said: 'I like the approach here, it's very holistic' and told us: 'Everybody is treated as an individual'. There were systems in place to protect people from the risk of abuse. One relative said: 'Staff are very kind. I've never seen any ill treatment of anyone'. People were cared for by suitably qualified, skilled and experienced staff. A relative told us that staff were: 'All good, they all seem to know their jobs'. Another relative said they were: 'Happy with the quality of staff. They remember my husband's name, even the new staff'. There was an effective system to regularly assess and monitor the quality of service. One relative said: 'I never have to seek out staff to ask things, they keep me informed about what is happening'. Another relative said: 'By and large it's very well run'.