Archived: Sue Ryder - Birchley Hall

As part of this inspection, we spoke with seven people who lived at the home, four relatives, the manager, four staff, the infection control nurse, a dietician and the local authority.

We considered our inspection findings to answer questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found.

Is the service safe?

The majority of people, relatives and staff we spoke with told us that they were 'happy' living in the home. We saw that risks were not always recognised and suitable actions taken to protect people from potential harm.

The care of a person was identified as insufficient to keep them safe from harm or abuse. The manager was requested to make a safeguarding referral to the local authorities safeguarding team for action. This was investigated as an expression of concern by the local authority and substantiated. We were informed by the infection control nurse that due to an outbreak of an infection the manager should not admit any further people to the home. We were informed by the manager that this action had not taken place as a result people's safety was not maintained.

Is the service effective?

On our previous inspection of the service in 18 and 22 October 2013, we found the provider's arrangements to monitor the service and provide quality of care were not effective. We had asked the provider to take action. At this inspection we found that systems to monitor the quality of the service overall had not improved sufficiently to ensure people using the service received good care.

Is the service caring?

On our previous inspection of the service in 18 and 22 October 2013, we found people's care was not always effectively planned or actions taken to deliver care that met people's assessed care needs. At this inspection we saw that improvements in the planning of care had not been made.

Our observations of the staff showed that they demonstrated a kind attitude and tried to support people appropriately. However communication between staff and people who used the service was not always effective.

Most of the people we spoke with said staff were kind. We observed one occasion when staff breached the dignity and the rights of a person living in the service.

The majority of people and relatives we spoke with said staff were kind and understood their needs. The staff we spoke with demonstrated an overview understanding of people's needs and the care they required.

Is the service responsive?

On our previous inspection of the service in 18 and 22 October 2013 we saw that the people living in the service had expressed dissatisfaction with some of the services this included activities available as an example.

We asked the provider to submit an action plan outlining the improvements they intended to make. We found during this visit that insufficient progress had been made.

We saw that when people's needs changed staff did not always contact external professionals in a timely manner. We also saw that medical professional advice was not always followed.

Is the service well led?

We reviewed the quality monitoring audits that were undertaken to monitor the quality and safety of the service provided. We found that there were limited audits that identified the risks or shortfalls in the home performance. There were no arrangements in place to address these shortfalls.

The service did not have a registered manager and has had three different managers in the last 12 months as a result consistent management has not been available.

The service did not always take individuals mental capacity into account or follow their own policy as to how to support people with fluctuating mental capacity.

A review of records and a discussion with staff showed that the provider checked for their fitness to work in the service before they were employed. We were told by both staff and people living in the service that generally there was sufficient staff to meet their needs.

People living in the service told us staff were, 'lovely', 'kind' and 'very caring'. Some people told us that there was not enough to do and they could get 'bored'. This information was reflected in the completed surveys, people had completed.

Checks on the quality of the service either relied on out of date information from care records or had not all been done to check on the quality of the service. We saw that checks on the environment and equipment in the service were in place to maintain the safety of people, staff and visitor's safety.

They told us that, 'Staff are really lovely, its a very nice place to live',

'I am happy living here. I am glad I choose to come here',

'If there's a problem they call a doctor',

'They really look after me well',

'If I was worried they would listen and sort it all out'.

People also told us that they thought the staff were, 'lovely', 'kind' and 'wonderful'.

We saw that people using the service, relatives and staff were given the opportunity to influence the care and support available. Communication systems such as meetings, questionnaires or talking to the manager were in place.

Birchley Hall checked the quality of the service they have in place and undertook action to maintain or improve the service provided.