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Reports


Inspection carried out on 13 February 2018

During a routine inspection

This inspection took place on the 13, 14 and 15 February 2018. The first day was unannounced.

Birch Hall Care Centre provides accommodation and both nursing and personal care for up to 84 people. The home is divided into different areas to care for people with nursing and personal care needs. There are two further 'units' which cater for older people with dementia and younger adults. People can be admitted for long or short term. There are communal areas and private bedrooms on each unit. The home is situated in Darwen within the Lancashire area. There were 75 people being supported during our inspection.

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

The service was managed by a registered manager who had been registered with CQC since 29 January 2016. 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.

At our last inspection of 3 November 2015 we found a breach of Regulation 15 (1) (E) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of maintaining the environment and we made a recommendation in respects of a dependency tool to determine staffing levels. The overall rating for the service was Good, with Safe being rated as requires improvement.

Following the last inspection, we asked the provider to complete an action plan to show what they would do to improve the service and by when. We checked the action plan had been actioned during this inspection and found significant improvements had been made and have rated this service as Good overall.

People who used the service told us staff were extremely kind, caring and respectful towards them. We found evidence that staff had gone above and beyond what would usually be expected from care staff to help people who used the service achieve their goals and aspirations. During the inspection we observed staff members interacted with people in a very person centred way and were extremely caring.

Whilst looking at compliments and feedback the service had received, we noted that a member of the public had written in to state how impressed they were with a young male member of staff that had taken people into a pub they were in.

We noted there was a strong emphasis in the service on promoting people’s independence. All the people we spoke with told us they were encouraged to remain as independent as possible. There was an abundance of equipment available which supported and promoted people’s independence.

Staff members we spoke with fully understood the importance of acknowledging people’s diversity, treating people equally and ensure that they promoted people’s rights. We saw people’s ethnicity and sexual orientation was discussed and recorded in their care plans.

We found overwhelming evidence that staff members went above and beyond their role to ensure that all the people who used the service were engaged and involved in activities and interests to keep them stimulated.

New furniture and soft furnishings had been purchased throughout the service. There had been a programme of re-decoration which people who used the service were able to tell us about. This had made a positive impact on the atmosphere of the service, which felt comfortable and relaxing.

People who used the service, relatives and staff members all told us that staffing levels were adequate within the service. The registered manager informed us they had recruited new staff members and staffing had been increased on nights, on days on the residential unit and on

Inspection carried out on 03 November 2015

During a routine inspection

Birch Hall Care Centre is a detached building and registered to provide care for up to 84 people. The home is divided into different areas to care for people with nursing and personal care needs. There are two further 'units' which cater for older people with dementia and younger adults. People can be admitted for long or short term. There are communal areas and private bedrooms on each unit. The home is situated in Darwen within the Lancashire area.

We last inspected this service on 10 June 2015 when the service met all the regulations we looked at.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During this inspection we found one breach in the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. You can see what action we have told the provider to take at the back of the full version of the report.

Some areas of the home needed to be decorated and we found some furniture was broken and was unsafe to use. Other areas of the home had been redecorated.

There were no complaints from people who used the service or family members about staff shortages. Some staff had raised a concern that staffing was minimal. It was recommended that the registered manager look for a best practice tool for staff to service user ratio’s according to their dependency to ensure there are enough staff to meet people’s needs.

People who used the service said they felt safe at this care home. Staff had been trained in safeguarding topics and were aware of the need to report any suspected issues of abuse.

Recruitment procedures were robust and ensured new staff should be safe to work with vulnerable adults.

We found the ordering, storage, administration and disposal of medication was safe.

There were systems in place to prevent the spread of infection. Staff were trained in infection control and provided with the necessary equipment and hand washing facilities to help protect their health and welfare.

New staff received induction training to provide them with the skills to care for people. All staff were well trained and supervised regularly to check their competence. Supervision sessions also gave staff the opportunity to discuss their work and ask for any training they felt necessary.

The manager was aware of her responsibilities of how to apply for any best interest decisions under the Mental Capacity Act (2005) and followed the correct procedures using independent professionals. From the records we hold we saw that we had been notified of any applications that had been made.

People were given a nutritious diet and had choices in the food they were offered.

Electrical and gas appliances were serviced regularly. Each person had an individual emergency evacuation plan and there was a business plan for any unforeseen emergencies.

We observed there was a good interaction between staff and people who used the service. We observed the good relationships staff had formed with people who used the service and how they responded well to any questions or advice people wanted.

We observed that staff were caring and protected people’s privacy and dignity when they gave any care. We did not see any breaches in people’s confidentiality on the day of the inspection.

We saw that the quality of care plans gave staff sufficient information to look after people accommodated at the care home and were regularly reviewed. People had been involved in developing the plans of care and had signed their agreement to show their wishes had been respected.

Staff were being trained in end of life care and we saw that people’s wishes had been recorded to help ensure their wishes were met at this difficult time.

During the tour of the building we saw the dementia unit had been adapted for use for people with memory problems.

Inspection carried out on 10 June 2014

During a routine inspection

We spoke with three people who used the service, the registered manager and two staff members during this inspection. We also looked at the quality assurance systems and records. This helped answer our five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found.

Was the service safe?

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. The registered manager audited any incidents and used the information to improve the service. People who used the service said, "I know I can talk to the manager or whoever is in charge if I had any complaints but I don’t have any", "I know who I can talk to if I have any concerns and also my family" and "My family and friends visit regularly. I can speak to them if I have any concerns but I do not have any problems here". This reduced the risks to people and helped the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made and how to submit one.

The service was safe, clean and hygienic. There were policies and procedures for the control of infection. There were dedicated domestic staff to clean the home. Three people who used the service told us, "It is wonderful here. My room is lovely. The home is clean and tidy", "I have a lovely room. It is always clean and tidy" and "The home is always clean and tidy". The laundry was run by dedicated staff and was operated in a way which reduced possible cross infection. All three people we spoke with said they thought the laundry service was good.

Was the service effective?

People's health and care needs were assessed with them if possible, and they were involved in writing their plans of care. We saw that all four plans of care we looked at had been agreed to and signed by people who used the service. Three people who used the service told us, "The staff talk to me about my care and care plan", "I get the same care staff to look after me so they know what they are doing. It makes life easier. They talk to me about my care to see if it what I expect. They do a lot for me and treat me privately and with dignity" and "The staff talk to me about my care. They make sure I am all right".

Specialist dietary, mobility, skin care and community support needs had been identified in care plans where required. Specialist equipment was provided such as pressure relieving devices or mobility aids.

The manager and other key staff audited the effectiveness of the systems they used. This included medication, the environment, infection control and mental capacity. The information was used to improve the service.

Was the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. There was a friendly atmosphere within the home and we observed that staff chatted to people who used the service throughout the day. Three people who used the service told us, "All the staff are very kind to me", "The staff have been very good to me since I have been here. The staff are kind and approachable" and "I am very happy with the way staff treat me. The staff are all good to me".

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. People who used the service were encouraged to provide as much information about their past lives and what they liked or did not. This information gave staff the knowledge to treat people as individuals.

People lived in a comfortable environment and were able to personalise their rooms to make them feel more at home. Three people told us, "I like my room. I have a lot of new furniture which I chose", "I have a lovely room. I have a lot of my own photographs of family and other things to make it like my own place" and "My room is lovely".

Was the service responsive?

People completed a range of activities in and outside the service regularly. Each person had their known hobbies and interests recorded. There was a minibus which had been adapted for wheelchair users. Three people who used the service told us, "I like to read. I don’t want to join in the activities and they respect that. I have been here six years and have loved every minute", "I like to play dominoes but especially like the quizzes. I also watch a lot of television. Quiz shows and a lot of sport" and "I like to listen to music, watch television and join in the activities I like. I like going shopping. We have been to Blackpool and I am going again later in the year for another holiday".

The registered manager and key staff held regular meetings with people who used the service. There was a staff meeting held at least once a week for various grades. Each day staff attended a 'handover' meeting to ensure they were up to date and unit managers met to discuss any problems or if they needed to plan for events like somebodies birthday. Staff were able to voice their opinions. We saw that results from questionnaires had been very positive.

Was the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. There was a system for providing information to other providers in an emergency.

Records we looked at were up to date and policies and procedures had been reviewed by the registered manager. The records were stored securely and easily available for inspection.

The service had good quality assurance systems. The registered manager undertook regular audits of the service. Records seen by us showed that identified shortfalls were addressed promptly and as a result the quality of the service was continually improving.

Two staff members we spoke with told us of their involvement with care plans which was suitable for their roles. They said they had been well trained and the home was clean and tidy. They said, "We get well supported from our unit managers but we can also speak to the registered manager if we want to" and "I like working here. It is a good home. As far as nursing homes go it is a good home".

Inspection carried out on 11 June 2013

During a routine inspection

We spoke with several people throughout the day and three people in depth. We were told the food was good, staff were caring and people were satisfied at the home. Three people who used the service told us, "I am reasonably happy. I just miss my dog and long walks", "I am very happy here" and "I like living here. It is fine for me".

Three people who used the service told us, "I could not manage so I had to come in here. I had a look around and they told me what to expect. I found it difficult to begin with but they did their best to help me settle. They give me a lot of freedom and ask me what I want to do. I can give my consent for any care or for what I want to do", "They talk to me about my care. They discuss how I am and I have agreed to what they do for me" and "They talk to me about my care. I cannot sign my plan but I understand it". Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

We found people were able to raise their concerns if they wished and felt they were listened to.

Staff received sufficient support and training to competently look after the people accommodated at the home.

Inspection carried out on 16 August 2012

During a routine inspection

We looked at records, observed care, talked to five people who used the service, two visitors and two staff members during this inspection.

People said they had choices within the routines of the home. People who used the service and family members were particularly pleased with the activities and outings on offer.

People who used the service said they felt safe at the care home.

People who used the service or their family members thought the care home was meeting their expectations. People told us, "I don’t think I could get a better home", "I am very happy here. I was once asked if I would like to move somewhere else but I told them no. I am happy here" and “I am happy here”. Visitors said, "We cannot fault the home" and "I come here every day. Staff are very welcoming. I have nothing but praise for them".

People who used the service thought they were involved in making decisions about their care and treatment. They told us they sat down with staff to discuss care issues or attended meetings to air their views about food, activities and social events.

People who used the service or their family members thought there were enough staff to meet their needs and staff were 'competent' in carrying out their duties.