Archived: Silver Birches Residential Home

Silver Birches residential home is registered with the Care Quality Commission to provide accommodation and to support people with their personal care. The home is registered to support up to ten people. There were eight people living at the home at the time of the inspection.

There was a registered manager in position. This person had previously been deputy manager at Silver Birches residential home and had achieved registered manager status since the last 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 our last inspection in January 2016 we found breaches of regulations in relation safety and good governance. On this inspection we found actions had been taken to achieve compliance in these areas.

People living at the service told us they felt safe and staff we spoke with confirmed this. Staff had received safeguarding training and although unsure about what might constitute abuse, told us they would report concerns they had to the registered manager.

Some improvements had been made in the way medicines were managed and we found systems for receipt, storage and administration of medicines were safe.

Accidents and incidents were documented and the registered manager was working on developing an accident analysis matrix to help identify trends and reduce the risk of recurrence.

Risk assessments and personal emergency evacuation plans were in place but were not always a true reflection of people’s circumstances.

The premises were clean, well maintained and appropriate safety checks were in place.

Effective recruitment processes were in place and staff training was up to date. Staffing arrangements needed to be kept under review, particularly in view of the recent changes in staff and current vacancies. Regular staff supervisions had taken place and the registered manager had introduced a programme for annual appraisals.

People were supported to have choice and control of their lives. However it was not clear how people’s consent was obtained in relation to care planning and sharing information with relatives.

Some people had experienced weight loss and we could not be assured systems were in place to make sure people received the diet they needed.

People had access to health care professionals as they needed.

Staff respected people and their belongings. We saw a number of caring interactions between staff and people who lived at the home. People demonstrated fondness towards staff.

Person centred care plans were in place; however staff did not routinely look at these.

People had access to activities, reading materials and music of their choice.

A complaints procedure was in place but this needed updating to reflect current management arrangements.

People had confidence in the registered manager. At the time of our visit the registered manager was having to cover staff vacancies and therefore did not have the time they needed to dedicate to managerial duties. They were confident this situation would be resolved as more staff were appointed.

Some auditing of the quality of the service was being done. However there was a lack of overview at provider level.

We found the provider was in breach of regulation 14 in relation to meeting nutritional and hydration needs.

You can see what action we told the provider to take at the back of the full version of the report.

Silver Birches residential home is registered with the Care Quality Commission to provide accommodation and to support people with their personal care. The home is registered to support up to ten people. There were eight people living at the home at the time of the inspection.

There was a registered manager in position. The registered manager was on leave at the time of the inspection and was intending to step down from this position. An acting manager was on duty on the day of the inspection and had recently commenced employment. The acting manager were currently working alongside the deputy manager to gain management experience before applying to the Care Quality Commission to become registered as a manager. 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.

We found a number of areas which demonstrated that the premises was not entirely safe and secure such as some fire doors being wedged open and hot water temperatures in some areas exceeding the recommended safe levels. We also found that sufficient measures were not always in place to control the spread of infection.

We found appropriate systems in place for recording receipt and administration of medicines. However we identified some unsafe practices in how medicines were stored and managed, such as taking tablets from boxes and adding them in to the monitored dosage system.

The service was not doing everything possible to assess and mitigate risk. For example, there was no evidence that accidents were reviewed to help identify any possible patterns or themes.

We recommend the provider maintains a close audit of people’s needs in relation to staffing levels at the home to make sure people are safe. We also recommend that on-call arrangements are formalised and reflected on the duty rota.

A system of staff training was in place but improvements were required to ensure it was comprehensive and effective.

The manager demonstrated an understanding of their role protecting the rights of the people they cared for. However care records required improvement to ensure they provided robust information relating to people’s capacity to make decisions.

We saw people were supported to consume a balanced diet and were weighed monthly so that any changes in weight could be identified and followed up with relevant healthcare professionals.

Staff supported people to see other health care professionals so they could maintain good health and we saw examples where staff had made referrals where they were concerned about someone’s health and wellbeing.

People told us staff treated them with dignity and respect. It was clear staff respected people and their belongings. We saw many caring interactions between staff and people who lived at the home. It was clear that staff knew people well and were attentive to people’s individual care needs.

There was an ongoing programme of improvement with people’s care files. We found some lacked specific detail. However, there was greater evidence of person centred care in the updated care files we reviewed. We also saw that revised care files were well laid out and easy to understand.

Whilst we saw good examples of person centred care, there were still some practices which needed to be reviewed to ensure the service delivered fully person centred care. For example, we saw occasions where people’s relatives rather than the person themselves were asked for permissions regarding care and we also saw a bath chart which showed what day’s people should have a bath. This suggested a rigid rather than person centred approach to care.

We saw little evidence of a programme of activities in the home and our discussions with people and observations showed people would have benefitted from more stimulation and meaningful occupation. The acting and deputy managers told us they would look into arranging activities in these areas.

We saw a complaints procedure and policy was in place and saw the procedure had been followed with complaints responded to in a timely manner.

The acting and deputy manager were open and transparent and understood where improvements were required. However, we identified some shortfalls in the management of the service. The Commission had not been informed of certain incidents which had occurred at the service and some areas for improvement were identified by the Commission, rather than through the service’s own quality assurance processes. We were also concerned that private and confidential records were not always kept securely.

We identified two 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.

We spoke to five people who use the service and four visitors. People who use the service said that they were given choices about how they spent their days. One person said 'I get up usually about nine but if I have had a lousy night I will sleep longer'. Another person said 'It's a wonderful place it's like being at home and the food is really nice'. All of the people we spoke to and their visitors spoke very highly of the staff.

Care records recorded information on people's daily routine. They described what time people liked to get up and go to bed, what they liked to drink and eat, and how they liked to spend their day. There was information on the social activities people liked to get involved in.

People said they were very happy with the care they received and that the staff were wonderful. One person said 'The staff are very helpful and obliging' another said 'It's very nice here we are well looked after'. Another said 'The food is really nice, you couldn't wish for a better place'.

During our visit we looked at three sets of care records for people who use the service. Each record had information on an assessment being carried out prior to admission to the home and a further assessment once someone was admitted to the home. We did note however that some of the assessments had not been dated.

All of the staff we spoke with during our visit were familiar with safeguarding procedures. We saw from the training records that the majority of staff had received training in safeguarding and were able to demonstrate a clear understanding of their learning.

None of the care records examined had information on mental capacity assessments being carried out. A review by the local social services contracting team made the point that staff members in the home would benefit from training on the five principles of the Mental Capacity Act 2005 subsequently be able to write care plans to contain the required level of decision making in the relevant sections.

We looked at all the training files for the staff which showed that staff had received training in infection control, health and safety, moving and handling, safeguarding, medication, first aid, food safety, and communication. Other examples of training included induction, dementia, palliative and end of life care.

The home carried out an annual service review which covered areas such as care and support, staffs behaviour towards people, meals, medical care, complaints and environment. Comments from the survey include 'It is very pleasant here, it's smashing', 'and It is first class' and 'A nice environment'.