All inspections: Silver Birches - Care Quality Commission

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.

The inspection took place on 18 and 19 July 2016. Silver Birches is a residential care home that can accommodate up to 27 people with dementia or other mental health conditions. At the time of the inspection there were 15 people living there.

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.

At our last inspection of this service on 26, 27 and 30 March 2015 we found breaches of legal requirements in relation to people’s consent to medicines, premises, supporting staff, dignity, care and welfare and clinical governance. Following the inspection the provider wrote and told us they planned to meet the requirements of the regulations by the end of August 2015. At this inspection we found the provider had met the requirements of the regulations.

Procedures were in place to ensure if people required medicines covertly then the correct legal processes would be followed to protect people’s human rights. Staff had undertaken medicines training and had their competency assessed to ensure they could administer medicines safely.

People were safe as staff understood their roles and responsibilities in relation to safeguarding. Safeguarding alerts had been made to the relevant authorities as required to ensure people were safeguarded against the risk of abuse.

Processes were in place to identify and manage risks to people safely. If people experienced an accident or incident then it was documented and reviewed to check if any further action was required to ensure the person’s safety.

Records demonstrated there were sufficient staff rostered to meet people’s needs safely. Appropriate recruitment checks had been undertaken in relation to staff to ensure their suitability to work with people.

Most staff had undertaken training in how to care for people with dementia or this had been arranged for them. The registered manager had identified that care staff would benefit from further training on working with people whose behaviour could challenge and this was being arranged. Staff underwent a suitable induction to their role and received on going support through supervision. Staff were supported with their on going professional development.

Since the last inspection the registered manager had made improvements to the layout of the service and they had taken measures to make the environment more suitable to meet the needs of people living with dementia. Not all of the works had been completed and further time was required to fully complete this work and to evaluate its effectiveness for people. Areas of the service were also being re-furbished and this work needed to be completed.

Staff had either undertaken training on the Mental Capacity Act 2005 or this was booked for them to attend. Legal requirements had been met where people were deprived of their liberty.

People were supported by staff to eat and drink sufficient for their needs. Staff understood that people living with dementia who are mobile may require extra calories and these were provided through additional snacks and smoothies. Lunch was a pleasant experience for people.

Staff arranged for people to be seen by a variety of health care professionals to maintain their health.

Staff understood how to uphold people’s privacy and dignity. Staff were observed to interact in a caring and kindly manner with people across the course of the inspection. Staff understood the importance of making people feel valued. Staff consulted people about decisions they were able to participate in and people were supported by staff to exercise choices about their care.

A person told us “Yes, I enjoy the activities.” The activities co-ordinators had established what interested people and activities were arranged to meet people’s needs. An activities coordinator was seen to spend time across the inspection with different people engaging them with a range of activities to stimulate them.

We found that not all people’s care plans had been reviewed as frequently as required by the provider. The registered manager had already identified this issue and was in the process of introducing a new care planning format and reviewing process for people. They were also taking action to ensure people’s relatives were involved in reviewing the content of their care plans.

Staff understood who was resistant to receiving personal care and were taking reasonable steps to attempt to engage people with this aspect of their care. Staff were balancing people’s rights and wishes whilst not placing them at potential risk of neglect.

People’s complaints had been dealt with in accordance with the provider’s policy and any required action taken. Complaints were used as an opportunity to improve the service for people.

There were processes both within the service and externally to monitor the quality of the service provided and to drive service improvement. If any improvements were required these were documented on the service improvement plan and action was taken to address the issue for people.

People’s care was underpinned by a philosophy of care which staff applied in their work. The service had an open and transparent culture where staff were encouraged to speak out about any concerns they might have had.

People and staff told us there was good leadership of the service. There was a clear senior management structure and management at all levels of the service was visible and accessible.

Silver Birches is a residential care home that supports up to 27 people with dementia or other mental health conditions. When we visited 15 people were living there. There was no registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. Management responsibilities were being shared by a registered manager from another home under the same provider; the deputy and another manager from the organisation.

One of the managers had submitted an application to be registered as the new registered manager.

At our previous inspection on 8 July 2014 the provider was in breach of a number of regulations. People were not supported by staff who were regularly supervised, there were not always suitably trained staff on duty to safely administer medicines and significant incidents, which

happened in the home, were not always being consistently recorded or reported to CQC.

After the inspection the provider sent us an action plan which detailed steps they would take to meet the requirements of the three breaches identified.

We received information of concern from healthcare professionals and the general public. We were told staff were not adequately trained to deliver effective dementia care and there was a lack of meaningful activities in the service. Other concerns raised related to the environment, equipment used to support people with their mobility, staff knowledge and risks related to helping people with their medicines. We were told the service did not have an open and transparent culture that supported staff and relatives to raise concerns about poor practice. We used this information and the provider’s action plan to help us conduct this inspection.

Best interest decisions about how people took their medicines were not properly assessed or in line with the Mental Capacity Act 2005 (MCA). Care plans did not document how people took their medicines and staff were not knowledgeable about how to assess and document people’s capacity to make specific decisions.

The general maintenance, environment and decoration at Silver Birches was not suitable for people who had been diagnosed with dementia and did not support them to maintain their independence. Staff consistently told us the environment was not dementia friendly.

Staff were not adequately trained or competent to deliver effective dementia care. Not all staff had completed dementia training and some could not tell us how they supported people with behaviours that challenge others.

Interactions between staff and people were not always supportive and people were not always treated with dignity and compassion. People were not always supported to maintain their independence.

People were not supported to participate in meaningful activities. Staff, relatives and healthcare professionals told us the service did not provide activities specific to people’s needs. Some people were left for long periods of time without interaction or stimulation.

People living in the service, their visitors and health care professionals were not always complimentary about the quality of care and the management of the home. The service did not have, and keep under review, a clear vision and a set of values that included involvement, compassion, dignity, independence and respect.

Improvements had been made in respect of the breaches identified at our last inspection. New staff completed an induction programme that provided learning and development opportunities. Records showed they had received supervision with their line manager and discussed their progress. Notifications of incidents were submitted to the local authority and CQC when required and the provider had suitably trained staff to administer medicines during the day and at night.

The provider did not have effective governance and auditing systems to monitor and drive improvement.

People who required help to eat and drink were appropriately assessed and supported to eat and drink sufficient amounts.

The provider had safe recruitment practices in place. Staff were subject to various security checks before they were begun work.

Health and safety checks were regularly conducted and plans were in place to deal with emergencies.

Staff were appropriately deployed to respond to people’s needs.

Checks to ensure equipment for supporting people with their mobility were frequently undertaken.

The provider had made the required improvements from our last inspection, however at this inspection we identified six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponded to six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have asked the provider to take at the back of this report.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

We visited unannounced on 8 July 2014.

Silver Birches is a residential care home which supports up to 27 people with dementia or other mental health conditions. Some people had behaviour which was challenging to others. Most people were mobile. When we visited 19 people were living there. The registered manager had just left. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider . Management responsibilities were being shared by a registered manager from another home under the same provider; the deputy and another manager from the organisation. We spoke to a manager when we visited and they said they intended to submit an application to be registered as the new manager.

During this inspection we saw a lot of evidence to show staff were caring. Staff were friendly and had a good rapport with people and with their relatives. Staff had a good understanding of people’s needs, wishes and interests and used this knowledge to help people to be calm when they were becoming distressed. People were given food they wanted, when they wanted to eat it. Staff contacted and worked productively with health and social care professionals when they needed additional support and when they needed further guidance about people’s health and social care needs. Family members were encouraged to take part in the life of the home and to be involved in their relative’s care.

There were two specific breaches of the Health and Social Care Act 2008 and one breach of the Care Quality Commission (Registration) Regulations 2009 and we have told the provider they must make improvements. We required these improvements because people were at risk of not receiving a service that was safe, effective, responsive or well led. The improvements required were: The service needed to notify CQC of adverse incidents; the management of medicines needed to be improved and staff needed more regular training and supervision. You can see what action we told the provider to take at the back of the full version of the report.

Other improvements to enhance the experience of people living at the home were, the provider needed to be more consistent in following the Mental Capacity Act to protect people who were unable to make their own decisions about their care. this would help to demonstrate staff were always acting in people’s best interest. People who had falls needed to be more closely monitored to see why they were happening and to see if it was possible to reduce the risk of them happening again. Two sofas in the home needed to be looked at because they were too low and people had difficulty getting up from them. Records relating to people’s care and the management of the home also needed to be improved upon.

When we visited 24 people were in residence. People who lived at Silver Birches were not able to tell us what they thought about the care and support they received because of their cognitive impairment. We observed staff providing people with simple choices and interacting positively with them.

Visitors we spoke with were happy with the service. One person for example said "Its a good family like home." Another said "I couldn't have wished for a better place." Regular visitors said that the home was always clean and we saw that there were effective systems in place for infection control. A visiting health care professional said that staff liaised with them appropriately when additional support and guidance was needed.

There were clear systems in place to ensure that the service could demonstrate that they were acting in the best interest of people who lacked capacity to consent to their care. People's health and care needs, interests and preferences were clearly documented and staff we spoke with had a good understanding of them.

Staff in general felt that they had sufficient time to care and support people although they said that they would like more time to spend with each person. We observed that although staff were very busy they responded promptly when people needed assistance.

The home was well managed and there were appropriate systems in place to assess and monitor the quality of the service provision.

The purpose of the visit was to follow up on two areas of non compliance identified during our visit in September 2012. These related to how the service assessed and managed risk to people's care and welfare and to how the service administered "as required " medicines on people's behalf.

During this visit we did not speak with people who lived at Silver Birches about their care or welfare because they could not verbally express their views. We observed, however, that staff responded to people quickly and appropriately. We looked at people's records and found that any identified risk to their care or welfare had been identified. Staff had a good understanding of people's care needs and followed written guidance to help to ensure that people were given safe and consistent care.

Written guidance was available for staff to help them to administer "as required" medication to people when they needed it. We judged therefore that the provider was now meeting the two outcome areas that we reviewed at this inspection

We spoke with two people who lived at Silver Birches. They said that they were well looked after and told us that they were given choices about their daily routines and what they ate. Most people who lived at Silver Birches were not able to tell us in any detail about their thoughts on the care and support they received. We used the Short Observational Framework for Inspection(SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We observed that staff interacted with people in a friendly and respectful way. People were given appropriate support when they needed it but were also encouraged to do as much as they could for themselves.

There was information available in different formats to tell people about the service.

Everyone who lived at Silver Birches had their needs assessed, however we had concerns that written information was not always accurate. We were also concerned that staff had not always been given clear guidance about how to support people when a risk to a person's wellbeing or safety had been identified. Arrangements were in place to assist staff to manage medicines safely. However staff did not have consistent guidance about when to administer medicines that had been prescribed 'as required' This was an issue because people who lived at Silver Birches were mainly unable to tell staff when they needed this medication.

Staff were provided with a range of training to help them to carry out their responsibilities. There was a good system of quality assurance within the service.

Archived: Silver Birches

All Inspections

8 May 2017

During a routine inspection

18 July 2016

During a routine inspection

26,27 and 30 March 2015.

During a routine inspection

8 July 2014

During an inspection looking at part of the service

13 November 2013

During a routine inspection

30 January 2013

During an inspection looking at part of the service

24 September 2012

During a routine inspection