Archived: Silver Birches

Updated 9 June 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on 8 and 9 May 2017 and was unannounced. The inspection team included an inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert by experience had experience of caring for older people including those living with dementia.

Before the inspection, we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. Due to technical problems a PIR was not available and we took this into account when we inspected the service and made the judgements in this report.

During the inspection we spoke with eight people, six relatives and a community psychiatric nurse. We also spoke with two care staff, the deputy manager, the chef, the registered manager and the general manager. Not everyone was able to share with us their experiences of life at the service. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We reviewed records which included three people’s care plans, three staff recruitment and supervision records and records relating to the management of the service.

The service was last inspected in July 2016 and no concerns were identified.

Updated 9 June 2017

The inspection took place on 8 and 9 May 2017 and was unannounced. Silver Birches is a residential care home that can accommodate up to 27 people living with dementia or other mental health conditions. At the time of the inspection there were 12 people accommodated, including one person who was in hospital.

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.

People and their relatives told us there was a lack of social stimulation and that they were bored. People said they were not supported to follow their interests. Staff did not all appreciate the need to regularly engage with people besides when providing their practical care. The registered manager had taken action to fill the vacant activities co-ordinators post. However, the interim arrangements were not sufficiently robust to ensure people’s needs for social stimulation were sufficiently met.

Staff had undergone safeguarding training and had access to policies and guidance to enable them to safeguard people from the risk of abuse.

The risks to people from falls and other risks had been regularly assessed. Although some people had experienced a number of falls the correct actions had been taken to decrease the likelihood of repetition for people or to accommodate them in an alternative environment if the risks to them of falling again had become too high.

People and their relatives told us they did not think there were sufficient staff rostered. The staffing level provided did not demonstrate how variations in people’s care needs, which resulted in some people requiring support from two care staff on occasions; would be met, especially at weekends. Adequate consideration had not been given as to how staff could best be deployed during shifts to ensure they were available to meet people’s needs. Appropriate recruitment checks had been undertaken in relation to staff to ensure people’s safety.

There were processes for the safe ordering and disposal of medicines. Staff told us they had undertaken medicines training and had their competency assessed, which records confirmed. Staff were provided with the relevant information to administer peoples’ medicines safely. We observed one incident of potentially unsafe medicines administration which the registered manager took immediate action to address for people’s safety.

People were supported by staff who received an appropriate induction to their role. The registered manager had initiated regular supervisions with staff, who reported they felt well supported in their role. People were supported by staff who had received sufficient training relevant to their role.

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 had dietary care plans in place which identified their nutrition and fluid requirements. Staff were observant as to whether people had eaten or drunk sufficiently for their needs. People appeared to enjoy their lunch and some people interacted with each other as they ate around the large communal dining table.

Staff identified if people had health care needs and ensured these were addressed for them.

Attention had been given to the environment for people to ensure there were items of interest for people to look at and touch on the walls of the corridors as they walked around the service.

Relatives told us people were happy and well treated. Staff were caring towards people when interacting with them. Staff were familiar with people’s personal life histories, their passions and interests. People’s individual communication needs had been identified and responded to in the provision of their care.

Staff received guidance about people’s ability to make decisions for themselves and this was followed to ensure people were offered opportunities to make decisions about their care. People’s rights to exercise choices about their care were respected. Staff ensured people were treated with dignity and respect.

People’s care plans were clear and identified their personal care needs. A process was in place to ensure people’s care was regularly reviewed with them and their relatives where possible. Staff had a good knowledge of people’s preferences about how they liked their care to be provided and were regularly updated regards changes to people’s care needs.

People were provided with details of how to make a complaint and when complaints were received; appropriate action was taken. Processes were in place to enable people to provide feedback on the service provided.

The provider had a philosophy of care for the service; the aim was to provide people with a home that was safe and where their wishes were respected. There was a positive culture amongst the staff team.

People and relatives provided mixed feedback on the leadership of the service. Staff provided very positive feedback about the new registered manager. The registered manager had not been in post for sufficient time to enable them to address the issues within the service or for them to be able to consistently demonstrate good leadership over time.

Aspects of record keeping required improvement to ensure that they were completed contemporaneously and accurately reflected the care offered to people. The registered manager has informed us staff will be receiving training in this area.

The service was regularly audited and the results used to improve the service for people.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the providers to take at the back of the full version of the report.