• Care Home
  • Care home

Archived: The Birches

Overall: Good read more about inspection ratings

187 Station Road, Mickleover, Derby, Derbyshire, DE3 9FH (01332) 516886

Provided and run by:
Mrs M Ghouze

Important: The provider of this service changed. See new profile

All Inspections

1 February 2017

During a routine inspection

The inspection took place on 1 February 2017, and the visit was unannounced.

The Birches provides residential care to older people. The Birches is registered to provide care for up to 19 people. At the time of our inspection there were 14 people living at the home.

A registered manager was 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 of the service on 20 June 2016 we asked the provider to make improvements in how consent was sought from people. We received an action plan from the provider which outlined the action they were going to take. This advised us of their plan to be compliant with the regulations by October 2016. We found that improvements had been made. People were asked for their written consent to care following their admission to the home. This was in addition to staff agreeing their actions prior to each caring intervention. However the provider had not sought the views of people or their relatives about the installation of CCTV cameras. This demonstrated that the need for consent had not been fully recognised by the provider.

At the last inspection we asked the provider to take action to ensure people were safeguarded from abuse, and improper restraint. We found that improvements had been made and the registered manager had made applications to the local authority to legally deprive people of their liberty. The registered manager and care staff had been trained in the Mental Capacity Act (MCA) 2005. They were also aware of best interests meetings to ensure peoples treatment was in line with the MCA and Deprivation of Liberty Safeguards.

Staff received induction and on-going training for their specific job role, and were able to explain how they kept people safe from abuse. Staff were aware of whistleblowing and what external assistance there was to follow up and report suspected abuse. Staff were subject to a thorough recruitment procedure that ensured staff were qualified and suitable to work at the home.

The provider had a clear management structure within the home, which meant that the staff were aware who to contact out of hours if an equipment repair was necessary. The provider carried out quality monitoring checks in the home supported by the registered manager and home’s staff. The provider had developed opportunities for people to express their views about the service. These included the views and suggestions from people using the service, their relatives and health and social care professionals.

People were provided with a choice of meals that met their dietary needs. The catering staff were aware of people’s dietary needs, and sought people’s opinions about the menu choices to meet their individual dietary needs and preferences. A range of activities tailored to people’s interests were provided by staff on a regular basis. Staff had had access to information and a good understanding of people’s care needs. People were able to maintain contact with family and friends and visitors were welcome without undue restrictions.

Relatives we spoke with were complimentary about the registered manager and staff, and the care offered to their relations. People were involved in the review of their care plan, and when appropriate their relative’s views were included. We observed staff positively interacted with people at lunch, where people were offered choices and their decisions were respected. Staff had access to people’s care plans and received regular updates about people’s care needs. Care plans were being re-written to ensure they were easy to read and described the care and assistance people required. Care plans included changes to peoples care and treatment and people were offered and attended routine health checks, with health professionals both in the home and externally.

Staff were aware of the reporting procedure for faults and repairs and had access to the maintenance to manage any emergency repairs.

We received positive feedback from the staff from the local authority with regard to the improved care and services offered to people at The Birches.

20 June 2016

During a routine inspection

The inspection took place on 20 June 2016 and was unannounced.

The Birches is a residential home which provides care to older people including some people who are living with dementia. The Birches is registered to provide care for up to 19 people. At the time of our inspection there were 15 people living at the home.

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 our previous inspection in February 2016, we rated the home as inadequate and that the service was placed into special measures.

We asked the provider to take action to make improvements. They sent us an action plan that all the improvements would be in place by 31 March 2016.

At this inspection we looked to see if the provider had responded to make the required improvements; we found some areas of improvement, however in some areas further improvement is needed to ensure compliance with some regulations. We found there was a lack of management oversight by the provider to check delegated duties had been carried out effectively. The quality monitoring systems included reviews of people’s care plans, health and safety checks and checks on medicines management. These checks and systems were not reviewed by the provider or registered manager to ensure people received a quality of service. Accidents, incidents and falls were recorded but not analysed to prevent further incidents from happening. Improvements were required in assessing risks to people and how staffing levels were determined to ensure safe levels of care were maintained to a standard that supported people’s health and welfare.

The provider did not have effective systems in place to assess, monitor and improve the quality of care. There was no system by the provider to supervise or oversee the registered manager and how they ensured people were safe in the home.

Health and safety checks were not always completed to ensure risks to people’s safety were minimised. We identified some health and safety issues to the registered manager and the provider on the day of our inspection visit where we had immediate concerns to people’s safety.

Risks to people’s health and welfare were identified but not effectively managed and where people were at risk of harm, actions had not been taken to keep people safe. Care plans provided information for staff that identified people’s support needs and associated risks. However, some care plans and risk assessments required information to be updated to ensure staff provided consistent support that met people’s changing needs.

There were not enough staff on duty at night to respond to people’s health needs and to keep people safe and protected from risk. The registered manager had no dependency tool to establish safe staffing levels so there was no effective formula that calculated what those safe staffing levels should be. Further improvement was still required in staff recruitment procedures to ensure people were cared for by staff who had been assessed as safe to work with people.

At the previous inspection in February 2016, we found people were not supported in line with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). At this inspection there were some improvements in how people’s capacity was determined, but further improvements were still required. Mental capacity assessments were completed but these were not always decision specific and records of those involved were not always completed. One person had a DoLS in place at the time of our inspection.

Staff knew how to keep people safe from the risk of abuse. People told us they felt safe living at The Birches and visiting relatives felt their family members were safe and protected from abuse.

People felt cared for by a caring staff group. Staff understood people’s needs and abilities and received updated information at shift handovers. Staff training was completed, but not all staff had received training to update their skills. Staff that identified a training need did not have this provided.

People were provided with meals that met their cultural and dietary needs. Health professional advice was sought for all those at risk of malnutrition and dehydration. Staff ensured people obtained advice and support from health professionals to maintain and improve their health.

People said staff provided the care they needed. Care was planned to meet people’s individual needs and abilities. Care plans were reviewed although some information required updating to ensure staff had the necessary information to support people as their needs changed.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

12 February 2016

During a routine inspection

We inspected The Birches on 12 February 2016 and the visit was unannounced. We last inspected the service in February 2015. At that inspection, we found breaches of legal requirements in four areas; the reporting of incidents and accidents, assessing risk, good governance and safeguarding people who use services from abuse.

We asked the provider to take action to make improvements. They sent us an action plan that all the improvements would be in place by 31 July 2015.

On this visit we found that there were continued breaches in assessing risk, protecting people from harm, providing safe care and good governance. There were further breaches in staff recruitment, medicines administration and providing adequate infection control.

The service has a registered manager in post.

Risks to people’s health and safety was not overseen, managed or reviewed. We found a number of infection control issues throughout the home.

There were not always sufficient numbers of staff to keep people safe and meet their needs.

Staff recruitment procedures not adequate to ensure people were cared for by staff who had been assessed as safe to work with people.

The legal requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) were not being followed. The MCA is designed to protect people who can't make decisions for themselves or lack the mental capacity to do so. The DoLS safeguards should ensure that people are not unlawfully restricted.

People’s basic human rights were not fully respected, though their privacy and dignity was upheld and respected and people were called by their preferred name.

People were provided with meals that met their cultural and dietary needs. Health professional advice was not sought for all those at risk of malnutrition and dehydration.

People’s care plans lacked detail about people’s individual care needs and meaningful activities, but included details about people’s cultural and spiritual wellbeing.

There was limited information relating to people’s health needs and associated risks with diagnosed conditions.

The provider did not have effective systems in place to assess, monitor and improve the quality of care.

The provider had not appointed and registered a manager who had the appropriate skills, experience and qualification to ensure the effective governance of, and safety of those in the home.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

10 February 2015

During a routine inspection

This inspection took place on 10 February 2015 and was unannounced.

The Birches is a residential care home which provides care and support for up to 19 older people who require personal care. Some of these people are living with dementia. At the time of our inspection there were 17 people using the service. The service is located in Mickleover in Derbyshire and accommodation is provided over two floors.

There was a registered manager in post at the time of our inspection. 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 on 02 April 2014, we asked the provider to take action to make improvements in relation to the premises people were living in and in relation to how to the service was respecting and involving people in their care. We found that there was a lack of suitable bathing and showering facilities and that the provider had not ensured that the building was properly secure and adequately maintained. We also found that there were limited opportunities for people to participate in organised social activities or to promote their independence and involvement in their local community.

The provider sent us an action plan outlining how they would make improvements.

At this inspection we found that some improvements had been made. However, we found that some further improvements were needed and additional concerns were identified. We found some further improvements were needed to the premises. We also found some concerns in relation to how people’s care was planned and delivered and in relation to how the quality of the service was being monitored.

People’s consent was not being obtained. We found that current legislation in relation to people’s mental capacity was not being followed. Mental capacity assessments had not always been carried out where needed and no best interest meetings and decisions had been documented. People’s care plans did not document their consent to their plan of care or the agreement of their representative on an on-going basis.

Although the service did offer a choice of nutritious meals to people we found that one person was not being adequately supported to eat and drink as they may have required. We found this to be having an impact this person as they were not receiving their meals as required.

We found that improvements were needed in relation to how people’s risks were identified and managed at the service to ensure that people were receiving safe care.

Systems were not in place to monitor the quality of the service being delivered. Although audits were being carried out in relation to people’s care plans, these did not always reflect changes to people’s care needs. The quality of care at the service was not being monitored consistently and further improvements were needed in relation to ensuring quality care was being delivered to ensure people’s safety.

Staff told us that they felt supported, however, some did not seem clear on what formal supervisions were and we saw no evidence of these taking place.

There was a lively and positive atmosphere at the home with a lot of activity going on. There was a programme of activities people could be involved with should they choose to. People interacted with each other and we observed that staff treated people with kindness. We observed positive interactions between staff and people using the service. We saw that staff understood people’s individual needs.

Staff had received training in key areas of delivering safe and effective care and staff told us that they felt adequately trained and well supported by the registered manager.

We found that people’s medication was being managed safely.

People felt safe and staff understood how and when to report any safeguarding concerns. Risks to people had been assessed and documented in their care plans and guidance was in place for staff to help them minimise those risks to people.

We found that Deprivation of Liberty Safeguards (DoLS) had been applied for appropriately at the service and that the registered manager had a good understanding of when these should be considered to protect people using the service from being unlawfully deprived of their liberty

We found that there was a system in place to manage complaints and that there were sufficient numbers of staff to meet people’s needs. Referrals were made to appropriate health care professionals.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which correspond to the relevant regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as referenced in this report. You can see what action we told the provider to take at the back of the full version of this report.

2 April 2014

During a routine inspection

The inspection was carried out by an inspector for adult social care. We set out to answer five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a short summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and from looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us that they were looked after safely by the staff who supported them.

The building was not kept securely locked. There was a lack of suitable bathing and showering facilities which meant that people had limited choice in the way their personal care needs were met.

CQC monitors the operation of the Deprivation of Liberty Safeguards which apply to care homes. No applications had needed to be submitted but relevant staff had been trained to understand when an application should be made.

Arrangements for the storage, handling and administration of medicines worked effectively.

Is the service effective?

People told us that they were satisfied with the care and support they received. It was clear from our observations that staff were familiar with people's individual needs and knew how to communicate with them effectively. One person told us, 'I have nothing but praise for the home.'

The views of people who used the service, and their relatives or representatives, had been taken into account when their assessments and care plans had been completed.

People's mobility and other needs had been taken into account as there was clear signage, hand rails and a stair lift to enable to move around the building freely and safely.

Is the service caring?

People were supported by kind and attentive staff. Staff were patient and gave people the opportunity to make choices.

Care plan documents showed that people had been asked for their views and explained their routines, likes and dislikes. There was also information about people's life histories, interests and hobbies.

Is the service responsive?

There were limited opportunities for people to participate in organised social activities or to promote their independence and involvement in their local community. Although staff led recreational activities in the home there was no regular timetable for these and opportunities were infrequent.

People felt they could raise any concerns or comments with the manager of the service.

Is the service well led?

Systems were in place to help capture the views of people who used the service. Results from a recent quality survey showed that overall satisfaction levels were good.

There was evidence that action was taken in in response to incidents and concerns, which helped to minimise the risk of future incidents occurring.

There was a complaints procedure in place to ensure that any complaints would be handled and responded to in a consistent way.

2 October 2013

During an inspection looking at part of the service

There were 14 people living at the service at the time of our inspection visit. We carried out this inspection to see if the provider had made improvements following our inspection in June 2013. We did not speak to any of the people living at the service as part of this follow up visit.

This visit showed that the majority of the staff had received training in safeguarding vulnerable adults, mental capacity act and deprivation of liberty.

We found that the provider still did not have effective procedures in place to manage medicines safely, which did not ensure people received medicines in a safe way.

We found that following our last visit progress had been made in recruitment procedures. Heath declarations forms had now been completed by most of the staff, copies of proof of identity had now been obtained and retained on a person's recruit file which were not in place at our previous visit.

28 June 2013

During a routine inspection

There were 16 people living at the service at the time of our inspection visit. We spoke with eight people at the service, three staff and a visiting professional.

People we spoke with told us they were generally happy with the service they received. They stated the food was good and told us they enjoyed their meals.

We saw that people's needs were assessed, and care plans were in place. This meant they received support in a way they preferred and that met their needs.

People were supported to access health care services when they needed. A visiting professional, spoke positively about the service. They confirmed that advice given was followed by the staff and that the service had been supportive of their input.

The provider did not have effective procedures in place to manage medicines safely, which did not ensure people received medicines in a safe way.

Recruitment procedures were not effective. This meant that the provider had not taken all the steps to ensure there were no adverse reasons in a person's employment history, which may impact on a person's suitability to work at the service.

People who use the service were not protected from the risk of abuse because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Not all staff had received training in this area.

During a check to make sure that the improvements required had been made

We have received written evidence from the registered manager which demonstrated staff had undertaken training since our last visit. Formal supervision has commenced. Quality assurance systems were put into place to obtain the views and opinions of people using the service and their representatives regarding the service received

16 May 2012

During a routine inspection

We spoke with four people who used the service and asked them for their views about the care and support they receive. One person told us 'It's rather good, I enjoy it here, the people are nice'. Another said 'I am quite happy here, well looked after.' One person said 'In essence, this is home, you do what you want. I am very happy here, nice crowd of girls, they look after us well.'

People we spoke with had an understanding of their needs and were able to tell us about the care and support the service and care workers provided for them. One person told us 'We get to make decisions all the time, it's up to us what time we get up or got to bed'. We observed a number of people chose to stay in their rooms for the majority of the time.

We asked people if they knew about their care plans and whether care workers discussed the plans with them. One person spoken with was aware of their care plan, but told us care workers did not discuss the plan with them. People told us care workers asked them on a daily basis what support they required from staff. People told us care workers support them to remain as independent as possible.

People told us care workers respected their privacy and dignity. They told us care workers knock on bedroom doors prior to entering, and answer the staff call system when people request assistance.

During our visit we asked people about activities. People told us activities were not organised on a regular basis but occasionally care workers would organise games, or a trip out. One person told us care workers did try to organise activities but people did not want to join in with these. We observed people sitting in both lounge areas, either watching the television, or reading magazines or the newspaper. We did not observe any activities during our visit. Records supported that activities were organised but this was on an infrequent basis.

We asked people if they were asked for their views about their care and treatment and the day to day running of the service. When asked, people we spoke with were not aware of 'resident meetings' taking place. These meetings offer people the opportunity to make suggestions about how the service was run.