Birch Heath Lodge

Birch Heath Lodge is a residential care home providing personal and nursing care to 30 people aged 65 and over at the time of the inspection. The service can support up to 38 people. Accommodation is provided across two buildings with shared garden and communal facilities.

People’s experience of using this service and what we found

Processes in place to effectively monitor risk and provide appropriate support were not robust which put people at risk of harm. We discussed our concerns with staff and the manager during the inspection who acted immediately to investigate the concerns raised and reduce the risk.

Systems in place were not always robust to demonstrate that physical health was being monitored by the management team and required support provided to people was taking place. We raised this to the manager who took step to address the concerns raised during the inspection.

We received mix responses from people and relatives regarding staffing levels. The provider was able to demonstrate a dependency tool which assessed the amount of staff needed. During the inspection we saw people having support when they requested it, however people informed us they needed to be patient at times. We discussed this with the manager and have made a recommendation about monitoring how staff are deployed across the service in line with people’s dependency.

Although processes were in place to assess people under the principles of the Mental Capacity Act (MCA) we found that the service was not always working in line with this. We spoke to the manager regarding our concerns and recommended they reviewed information held on people.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service were not always followed to supported this practice.

Safe recruitment processes were followed. Staff received on-going training and development to support them in their roles.

Staff spoke positively about the management team and felt supported to develop in their roles .

People who lived in the service overall spoke positively about the staff in the service and the support they received.

The manager was open and proactive during the inspection regarding identified concerns and proactive to address risk.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 27 February 2021) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations. The service remains requires improvement. This service has been rated requires improvement for the last 2 consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement based on the findings of this inspection.

Enforcement and Recommendations and update

At our last inspection we identified a breach of Good governance. At this inspection we found the provider was still in breach of this regulation

We identified a further breach that systems were not robust enough to demonstrate people were supported safely and that risk was managed.

We recommended the provider reviews how staff are deployed in the service in line with people's needs.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Birch Heath Lodge on our website at www.cqc.org.uk.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Birch Heath Lodge is a residential care home providing personal and nursing care to 30 people aged 65 and over at the time of the inspection. The service can support up to 38 people. Accommodation is provided across two buildings with shared gardens and communal facilities.

People’s experience of using this service and what we found

Governance systems to monitor the quality of care being delivered to people required improvement. Existing systems failed to always identify shortfalls in care recording and when care plans needed updating. This placed people at risk of receiving poor care.

Checks were in place to ensure people lived in a safe environment. Ongoing refurbishment and redecoration of the home were being planned. We have made a recommendation to consider the needs of people living with dementia in any planned environment improvements.

We were assured the provider had effective measures in place to reduce the risks of infection and manage the impact of the COVID-19 pandemic. However, we did identify some shortfalls in the staffing levels of domestic staff on a number of occasions; and one instance where national guidance had not initially been followed for visiting. Both of these issues were raised with the provider and assurances provided.

Staff were recruited safely. Appropriate checks were undertaken for all temporary (agency workers).

Although we found some improvements were needed, we did observe positive and caring interactions between staff and people living at Birch Heath Lodge. Staff demonstrated an understanding of people’s need and preferences.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. The communication needs of people were clearly documented, and people had access to appropriate healthcare services.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 14/02/2020) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been made and the provider was still in breach of one regulation. This service has been rated requires improvement for two consecutive inspections.

Why we inspected

We received concerns in relation to staffing levels and concerns about how the service was being managed. As a result, we undertook a focused inspection to review the key questions of safe, effective, responsive and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key question. We therefore did not inspect it. Ratings from previous comprehensive inspections for that key question was used in calculating the overall rating at this inspection.

The overall rating for the service has remained the same. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the Safe and Well-Led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

During the inspection the registered manager took action to mitigate risks and address the issues we found. However, systems to monitor the risks to people's physical health needed to be more robust.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Birch Heath Lodge on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to Good Governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Birch Heath Lodge is a care home providing personal and nursing care to up to 38 people residing in two separate buildings. At the time of the inspection, there were 26 people living in the home, some of whom were living with dementia.

People’s experience of using this service and what we found

The systems in place to monitor the quality and safety of the service were not always effective in identifying areas of the service that required improvement, or the areas of concern we highlighted during the inspection. This is a breach of regulation. The manager took responsive actions to address issues we raised during the inspection. Feedback regarding the service was positive and staff told us they enjoyed their jobs.

Not all care plans contained sufficient, person centred detail and some contained inconsistencies and this was a breach in regulation. Many of these were reviewed and updated by the end of the inspection. It was clear that people or their relatives had been involved in the development of care plans.

Although systems were in place, people’s consent was not always sought and recorded in line with the principles of the Mental Capacity Act and this is a breach of regulation. We found however, that people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The environment would benefit from being adapted to help ensure the needs of people living with dementia could be met. Staff were supported in their roles through induction, training and regular supervisions. There was a choice of meal available each day, as well as regular drinks and snacks.

There was a range of activities available to people, both within the home and in the local community. Friends and relatives were able to visit the home at any time and were always made welcome. There was a complaints policy available and people knew how to make a complaint if they needed to.

Staff knew the people they supported well, including their preferences regarding care and people told us staff treated them well. They spoke about people with warmth and compassion. People told us staff provided support in ways that protected their dignity and encouraged their independence. Confidential records regarding people’s care were stored securely to protect people’s privacy.

Staff had been recruited safely and were knowledgeable about safeguarding procedures. Risk to people had been assessed and measures were in place to reduce identified risks. Accidents were reviewed to help prevent recurrence and medicines were managed safely. Staff were aware of emergency procedures, including evacuation of the building.

Rating at last inspection

The last rating for this service was good (published 15 February 2017). There was also an inspection on 12 and 13 August 2019 however, the report following that inspection was withdrawn as there was an issue with some of the information that we gathered.

Why we inspected

This is a planned re-inspection because of the issue highlighted above.

Enforcement

We have identified breaches in relation to gaining people’s consent and the governance of the service.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service provides accommodation with both personal and nursing care for up to 38 people and is located within a detached property in a residential area of Christleton close to local amenities. The service is based in two units: Birchwood is in the main house and Greenwood in the extension. Access to Greenwood is via the outside court yard. At the time of our visit there were 36 people using the service.

The previous inspection took place on the and we found that there was a breach of the Health and Social Care Act 2008 (Regulated Activities) 2014. On this return visit, we found that improvements has been made to meet all of the relevant requirements.

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.’

People told us the staff were kind, caring and treated them well. Staff had time for people and treated them with respect. People received care in a dignified manner that protected their privacy and promoted their independence.

Staff knew people well and responded to their wishes promptly. People had been involved in planning the care and support they received from the service. Their needs had been identified, assessed and reviewed on a regular basis. People's care plans were very detailed and which meant that staff were able deliver a personalised support.

The service worked with other healthcare professionals to ensure people's health and wellbeing needs were met. People received prompt medical and wellbeing services and staff assisted them to ensure that any recommendations in relation to their health were met.

A range of activities were on offer for people to participate in if they wished. People were given the opportunity to maintain links with their local community and to attend events outside of the service.

People received their medication safely and action taken to minimise any risk to a persons health and wellbeing.People were protected from the risk of abuse as staff could demonstrate they understood what constituted potential abuse or poor care. Staff knew how to report any concerns and they felt confident the service would address these appropriately.

Staff had been employed following appropriate recruitment checks that ensured they were safe to work in health and social care. We saw that staff recruited had the right values and skills to work with people who used the service. Staff rotas showed that the staffing remained at a levels required to ensure all peoples needs were met and helped to keep people safe.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS). People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Staff told us they worked as part of a team and that the service was fantastic place to work. Staff said they felt supported, that morale was good and they were very happy in their work. Staff received the training and on-going support that they required to be confident and competent in their roles.

People had confidence in the management team and met them on a regular basis. People who used the service and staff reported that the manager was approachable, supportive and available as required. People felt listened to and told us they had confidence that any concerns they may have would be addressed.

The registered provider and the registered manager continuously assessed and monitored the quality of the service, including obtaining feedback from people who used the service and their relatives. Records showed that systems for recording, managing and investigating complaints, safeguarding concerns and incidents/ accidents were managed well.

The service provides accommodation with both personal and nursing care for up to 38 people and is located within a detached property in a residential area of Christleton close to local amenities. The service is based in two units: Birchwood is in the main house and Greenwood in the extension. Access to Greenwood is via the outside court yard. At the time of our visit there were 34 people using the service.

The service had a registered 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 that there was a breach of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see the action we have told the provider to take at the end of the report.

Care records gave basic information about a person’s needs and how they wished their support to be delivered. However, they were not all personalised to give a real picture of a person’s wishes, preferences and personal history. Care Plans and risk assessments were not always updated in a timely manner to reflect significant changes in need and to direct staff in managing certain aspects of a person’s care. This meant that staff who were unfamiliar with people at the service would not know how their support needed to be delivered .We found that records in relation to the assessment and treatment of pressure ulcers and the monitoring of weight were not accurate and up to date. This meant that there was a risk that a person may not receive the care that they required.

People told us that the building was clean, warm and comfortable. People and their relatives made positive comments about the care received and were complimentary about the food. They said that the care staff and the registered manager were always available and would have no hesitation in going to them with worries and concerns. Observations indicated that people were happy at the service and there were warm and friendly interactions with staff. Staff knew the people that they supported well and could tell us about their support needs.

Where people were not able to indicate what they wanted, staff knew them well enough to anticipate their needs. The requirements of the Mental Capacity Act 2005 were met and staff helped people to express themselves and to seek consent. People told us that they were given choices, allowed to take risks and staff included them in decision making. Applications had been made under the Deprivation of Liberty Safeguards where it was felt a person’s liberty was being restricted or deprived.

People told us that staff came to them when they called but sometimes they felt that they had to wait longer than they would like. People and relatives were concerned that staff were, “Busier than ever.” We found that the dependency levels of people who used the service had increased and the registered provider had recently taken steps to increase the staff on duty.

Staff were aware what was required in order to keep people safe and they were confident to report matters of concern. People received care and support from staff that had been through robust recruitment procedures to ensure that they were of suitable character to work in this setting. Staff also underwent an induction programme to equip them with the appropriate knowledge and skills to support people. Staff received on-going training and support to ensure that they remained competent and confident to carry out their roles.

The registered manager and registered provider ensured that audits were carried out on a regular basis in order to monitor the quality, safety and effectiveness of the service. They responded in a timely manner to any complaints or concerns and were open and transparent where issues had arisen.