We inspected Birkin lodge on 14 and 15 December 2016 and the inspection was unannounced. Birkin lodge provides accommodation, personal care and nursing care for up to 50 older people. There were 27 people using the service at the time of our inspection. Whilst the registered provider was registered for 50 people they told us that, following refurbishment works, they only accommodated a maximum of 41 people.
This was the first inspection of Birkin lodge since it was registered on 2 August 2016. The service is registered under the provider Alliance Care (Dale Homes) Limited. This is part of the Brighterkind group of care homes. However, whilst the service was previously registered under a different provider, Brighterkind had been managing the service on a day to day basis during 2016.
There was a manager in post who had been in post since the service was registered. The manager was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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.
There were insufficient numbers of staff to meet people’s personal care needs within a reasonable timeframe and in a personalised way. People and their relatives told us that the staff were not always responsive to their needs within a reasonable timeframe. One person told us, “There are not enough staff, they don’t come and see me and we have to wait ages for our wash.” People had not been consulted about the time they would like to be supported to get washed and dressed in the morning. During our inspection we saw that some people waited an unreasonable length of time for their care which did not promote their dignity. Where people refused care, staff did not always ensure that care was offered again within a reasonable timeframe. Some people waited a long time for their meals to be served.
Staff had not completed all the training they required to enable them to carry out their roles effectively and training had not always been updated when training certificates had expired. Staff were not supervised regularly in line with the registered provider’s policy.
Staff did not understand and correctly apply the principles of the Mental Capacity Act 2005 (MCA). This meant that people’s right to make their own decisions was not always respected.
People told us that there had been a recent decrease in the frequency and quality of social activities provided in the service. People were enabled to spend their time how they wished, but there were not sufficient social activities provided to ensure people were occupied in a meaningful way. Staff had worked with people, during the assessment process, to gather information about their life history, but this information had not always been used to develop a personalised plan for meeting people’s social needs.
The most recent customer survey showed that people were generally satisfied with the service they received. The areas where improvements were required had been collated into an action plan. However, we found that the required improvements had not been successfully implemented.
Records about the care provided to people and their wellbeing were not consistently completed. Records were not always completed accurately to enable the registered provider to monitor the quality and safety of the service.
People told us they felt safe using the service. One person told us, “The staff make me feel safe.” Staff understood how to recognise and respond to the signs of abuse. The registered manager had not used learning from a safeguarding investigation to make improvements across the service. We have made a recommendation about this.
Risks to people’s safety and welfare were managed appropriately to ensure they were minimised. However, the fluid intake for people at risk of dehydration was not effectively monitored. We have made a recommendation about this.
People’s medicines were managed safely, but the time it took for nursing staff to administer everyone’s medicines meant that some people did not receive their morning medicines until 11am. We have made a recommendation about this.
The premises were kept clean and hygienic. Staff understood and followed safe practice to reduce the risk of infection spreading in the service.
People told us they enjoyed the meals and had sufficient choice and variety of foods. People's dietary needs and preferences were catered for. People had access to hot and cold drinks and snacks at all times of the day.
Health and social care professionals were involved in people’s care. People had their health needs met.
People had positive relationships with the staff that supported them. Staff were kind and patient when talking with people and when providing support. One person told us, “The carers are wonderful.”
Staff respected people’s privacy and people’s records were stored confidentially. Some people had their bedrooms doors open whilst they were in bed in their nightwear. Staff told us that this was people’s preference as they liked to see staff coming and going. This had not been discussed with people and recorded in their care plan. We made a recommendation about this.
Staff encouraged people to retain their independence. People were provided with equipment, where needed, to enable them to move around independently, for example walking frames and handrails.
Clear information about the service was provided to people and their relatives. A brochure was provided to people who wished to move into the service. People and their relatives were aware of how to make a complaint. They told us they were confident to talk to staff or the registered manager about any concerns.
The service was not well led. Systems for checking and improving the quality and safety of the service were not always effective. The registered provider had identified that the system for allocating staff to care for people each shift was ineffective, but appropriate action had not been taken to ensure improvements were made to ensure that people received their care when they preferred. The registered manager had not developed a person centred culture in the service. There was a lack of clear and strong leadership in the service. The registered manager had not yet established effective management systems. However, staff told us that they were confident to raise concerns with the registered manager or the regional support manager. One staff member told us, “I love it here; they’re so supportive.”
You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.
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.