Archived: Birkin Lodge

We found the following examples of good practice.

The provider had implemented measures to reduce the risk of infection. There was an up to date infection control policy in place and regular audits were carried out. Staff were observed wearing appropriate Personal Protective Equipment (PPE) and regular training was provided to staff.

The service was clean and hygienic and additional cleaning schedules had been implemented since the beginning of the pandemic, which included regular cleaning of high-touch areas. People told us their rooms were kept clean.

The provider had acted to minimise risks to people who used the service and staff. Temperatures were taken as people entered the service and visitors were required to wear PPE. A COVID-19 questionnaire was completed for track and trace. When people were admitted to the service, they were supported to isolate in their rooms for a period of 14 days. Staff uniforms were washed on site and left at the service. PPE stations and disposal bins were placed around the service to support good IPC practice.

Staff had weekly COVID-19 testing and staff were required to self-isolate if they displayed symptoms or tested positive. People who lived at Birkin Lodge also had access to regular testing. If people displayed symptoms or tested positive for COVID-19 they were supported to isolate in their rooms and barrier nursed. Other people were also encouraged to remain in their rooms to minimise the risk of spreading any infection.

Due to a recent outbreak of COVID-19 at the service, people’s families were unable to visit.. Some window visits had taken place and other contact was made through social media or telephone calls. Additional activities staff had been recruited to help reduce people’s anxieties or isolation during the pandemic.

Management had good links with local health care professionals and sought advice and input from Public Health England in relation to any positive test results or outbreaks. Staff said they had received support throughout the pandemic.

Further information is in the findings below.

We found the following examples of good practice.

The registered manager had appointed a nominated visitor champion to greet visitors on arrival. The visitor champion helped visitors to follow the procedures in place to prevent the spread of infection. The registered manager had designated an empty room within the home as a visitor’s room. The visitor's room had guidance on hand-washing, sanitising procedures and personal protective equipment (PPE) for visitors to use.

The activity co-ordinator had set up a closed Facebook group for relatives. The group contained information about events and photos of people. Relatives could use the photos as a talking point during lockdown and one relative told the registered manager, “It is almost like I am there.”

The registered manager had taken a person-centred approach to people’s COVID-19 care planning. For example, the registered manager had made allowances for a person whose well-being had been severely affected by restrictions on visiting.

The registered manager had linked with a home treatment team which allowed referrals for people who were unwell. Doctors and nurses visited the service and provided health care support, such as setting up intravenous drips. The registered manager told us this had reduced the risk of people picking up infections outside of the home by preventing hospital admissions.

Further information is in the detailed findings below.

Birkin Lodge is registered as a care home with nursing for 50 older people. There were 43 people living in the service at the time of this inspection visit.

People's experience of using the service and what we found

People and their relatives were positive about the service. A person said, “I get on fine with the staff and they’re friendly.” A relative said, "The staff are very good in my eyes and are genuinely kind people.”

People were safeguarded from the risk of abuse and received safe care and treatment. Medicines were managed in the right way, there were enough staff on duty and safe recruitment practices were in place. Accidents and near misses had been analysed so lessons could be learned to help avoid preventable accidents. Infection was prevented and controlled and people had been helped to quickly receive medical attention when necessary.

People were supported to have maximum choice and control of their lives and care 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 accommodation met people’s needs and expectations. People were treated with kindness and compassion, their privacy was respected and confidential information was kept private.

People were consulted about their care, had been given information in a user-friendly way and were supported to avoid the risk of social isolation. There were arrangements to resolve complaints and people were treated with compassion at the end of their lives so they had a dignified death.

Quality checks had been completed and people had been consulted about the development of the service. Good team work was encouraged and joint working was promoted.

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

Rating at last inspection

At the last comprehensive inspection the rating for this service was Good (report published 22 November 2018).

We completed a focused inspection after this because we had received concerning information people were not consistently being kept safe. At the focused inspection we looked at our key questions ‘is the service safe’ and ‘is the service well-led’. The rating for the service was Requires Improvement (published 15 February 2019). The registered provider completed an action plan to show what they would do and by when to improve.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

Birkin Lodge is registered to provide accommodation, nursing and personal care for 50 older people. There were 33 people living in the service at the time of our inspection visit.

The service was run by a company who was the registered provider. The former registered manager had left their post shortly before the inspection. The registered provider had appointed a new manager who was in post and who was in the process of applying to the Care Quality Commission to become the 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 carried out an unannounced comprehensive inspection of this service on 20 September 2018 and 24 September 2018. After that inspection we received concerns in relation to the way people were supported to avoid preventable accidents so that they consistently received safe care and treatment. As a result we undertook a focused inspection to look into these concerns. We looked at our domains ‘safe’ and ‘well led’. This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk.

We found that there were two breaches of the regulations. The first breach was because there were shortfalls in the arrangements that had been made to provide people with safe care and treatment. Suitable provision had not been made to prevent avoidable accidents and to learn lessons when things had gone wrong. There were also shortfalls in the management of medicines. Furthermore, there were two oversights that had reduced the level of fire safety protection in the service. In addition to this, robust steps had not been taken to prevent and control infection. The second breach was because the right systems and processes had not been used to monitor and improve the service by addressing the shortfalls described above. You can see what action we have told the registered provider to take at the end of the full version of this report.

We also raised another concern with the manager in relation to which we have made a recommendation. This was because there was a shortfall in the deployment of staff.

Our other findings were as follows: Background checks on two new care staff had not been completed in the right way to ensure that they were suitable to be employed in the service. People were safeguarded from situations in which they may be at risk of experiencing abuse. Nurses and care staff had not been fully supported to ensure that regulatory requirements were met. However, they had been enabled to speak out if they had concerns about the wellbeing of a person living in the service. The registered provider had submitted notifications to the Care Quality Commission about important events that occurred in the service in line with our guidelines. The manager was actively working in partnership with other agencies to support the development of joined-up care. The registered provider had conspicuously displayed the quality rating we gave the service at our last comprehensive inspection both in the service and on their website.

Birkin Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

Birkin Lodge is registered to provide accommodation, nursing and personal care for up to 50 people. It can accommodate older people and people who live with dementia. There were 31 people living at the service at the time of our inspection.

At the last comprehensive inspection on 19 July 2017, the service was rated ‘Requires Improvement’ overall with safe and well-led rated as Requires Improvement. Effective, caring and responsive were rated as Good. We told the registered persons that the improvements they had made following the inspection in December 2016 needed to be used consistently and embedded. At this inspection we found that the improvements had been sustained and the service was now rated ‘Good’ overall.

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. The registered manager worked at another of the providers locations and had added Birkin Lodge to their registration. The registered manager had split their time between the two services whilst the recruitment of a new manager commenced. The new manager had started in post in the week of the inspection and was completing their induction.

People felt safe and were protected from the potential risk of harm and abuse. Nurses and care staff had been trained to understand the potential signs of abuse and knew the action to take if they had suspicions. Potential risks to people to maintain their safety had been assessed and mitigated. The premises were well maintained and equipment had been regularly serviced to ensure it was in good working order.

People’s safety in the event of an emergency had been assessed, with guidance to inform staff how to keep people safe. Accidents involving people were monitored with action taken to prevent the risk of reoccurrence. People were protected from the risk of infection with cleaning schedules in place to promote the prevention and control of infection.

There were suitable numbers of nurses and care staff deployed to meet people’s needs. Staff were recruited safely following the provider’s policy and procedure. Nurses and care staff received the appropriate training, skills and knowledge to meet people’s needs. Staff received support from the management team to fulfil their role and meet people’s needs.

Medicines were observed to be administered safely by registered nurses. Systems were in place for the ordering, obtaining and returning of people’s medicines. Nurses had received training in the safe administration of medicines and their competency had been assessed by the clinical lead. Medicines requiring additional safe storage were stored safely and securely.

People’s needs were assessed prior to them receiving a service. People received a personalised, person centred service which was responsive to their needs. People were involved in the development and review of their care plan. Guidance was in place to inform staff of how to meet people’s needs whilst encouraging and promoting their independence.

People were supported to maintain contact with people that mattered to them. People’s diversity was recorded with action taken to ensure people’s rights were promoted and maintained. People were encouraged to make their own choices about their lives. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported to maintain their nutrition and hydration. Appropriate referrals were made to health care professionals when concerns had been identified. The management team worked in partnership with external organisations to ensure people remained as healthy as possible.

Staff were kind and caring towards people. We observed that people felt comfortable in the presence of staff. Staff respected people’s privacy and dignity. Staff knew people well and had knowledge about people’s histories, likes and dislikes.

People were supported to take part in a range of activities to meet their needs and interests.

People were supported to express their views and were involved in the development of the service they received. Complaints were investigated and responded to in line with the providers policy.

The registered manager and management team worked in partnership with external organisations to promote best practice.

It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the service where a rating has been given. This is so that people, visitors and those seeking information about the service can be informed of our judgements. We found the provider had conspicuously displayed their rating on a notice board in the entrance hall and on their website.

We previously inspected this service on 14 December 2016 when we found breaches of the Health and Social Care Act 2008 (regulated activities) Regulations 2014 and the overall rating for the service was Inadequate. The breaches of regulation related to person centred care, dignity and respect, consent, governance and staffing. We took enforcement action to impose a condition on the registered provider’s registration to ensure they reviewed and updated people’s care plans and informed us about the action they had taken to improve care. We issued a warning notice in respect of staffing. The service was placed in special measures with an expectation that the necessary improvements would be made within six months. We found that the provider and manager had taken action to meet all breaches at this inspection.

There was not a registered manager in post who 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. The registered manager had left the service since our last inspection and a new manager had been appointed. They had not yet applied to be registered, but told us they intended to do so.

At this inspection we found that the provider had ensured there were sufficient numbers of staff working in the service to meet people’s needs and respond to their requests. The registered provider ensured effective recruitment procedures to ensure that staff were safe to work with vulnerable adults.

The provider had systems in place to identify and minimise risks to the safety and welfare of people using the service and for the staff. There were regular safety checks on equipment that was being used. The provider had ensured that the environment was safe for people by carrying out safety checks on water, gas and electrical appliances. The provider had an infection control policy in place that was implemented in practice. People living at the service and their visitors told us that the premises were kept clean and tidy. However, relevant risk assessments had not been completed for bed rail safety. We have made a recommendation about this in our report.

People were protected from abuse by trained staff who understood how to recognise the signs of abuse and how they should report it. Staff received training that gave them the confidence and knowledge to provide effective care.

Medicines were being managed safely by trained staff. Medicines were being stored securely and there were appropriate auditing and checking tools used to quickly identify any shortfalls.

There were sufficient numbers of staff on duty at all times to meet people’s needs in a safe way. The registered provider had systems in place to ensure that staff were recruited safely. Staff received training that gave them the necessary skills to provide effective care. All staff received regular supervisions and yearly appraisals.

Staff sought and obtained people's consent before they helped them. People's mental capacity was assessed when necessary about particular decisions. Meetings were held, when needed, to make decisions in people's best interests, following the requirements of the Mental Capacity Act 2005.

Care records showed that people’s dietary needs were being documented and known by kitchen staff. There was an option of two choices of meal per day and alternatives were available if someone did not like or want one of the main options. People had the equipment they needed so they could eat independently. If someone required assistance with eating this was provided by staff.

People received care that maintained their privacy and dignity. Staff demonstrated good knowledge about methods to ensure that privacy was maintained at all times and this was applied in practice. Staff promoted people's independence and encouraged people to do as much as possible for themselves. There were assessments that highlighted the tasks they could carry out for themselves, and any areas in which they would require assistance.

There were a range of activities available. People could go on regular outings, enjoy on site activities as groups or individually with staff. There were no restrictions in place on when friends and family could visit people living at the service.

People were involved in making decisions about their care and treatment. People provided their feedback on the quality of the service through residents and relatives’ meetings, and a yearly satisfaction survey.

The manager was seen to be open and approachable. The visions and values of the service were focussed on providing person centred care. People and staff understood and spoke positively about the culture of the service. The manager had ensured that there were effective systems in place to check the quality of the service and make improvements. Audits included checks on care plans, care delivery and medicines.

The registered provider had met the requirement to notify the Care Quality Commission of any significant events such as safeguarding concerns and Deprivation of Liberty Safeguards authorisations.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

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.