Birch Hall Care Centre

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

The last rating for this key question was good on 26 April 2018. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 63 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

Information in care records that supported the delivery of effective care was not always in place. One person’s care record was not reflective of their current care needs, this meant staff did not have access to up to date information to support them safely. There was an electronic care recording system. Whilst some of the information to support people’s care delivery was detailed, not all contained up to date information in them and were at times contradictory. The manager told us they were in the process of transferring all people’s records on to the electronic care recording system and staff had access to paper records as required in the interim.

People told us their needs were met in the service. One told us, “It meets all my needs; I haven’t had an upset with any of them.” However, other people and relatives could not confirm they had been involved in assessments and care plan development.

Staff told us, “Care plans are updated regularly. We are encouraged to read them so we can continue to deliver safe, effective and person-centred care that reflects each person’s current needs” and, “Care plan development are undertaken by the nurses or senior carers, if a person has capacity we sit with them and write it, if not we speak to families. We have monthly reviews ‘resident of the day’ to make any necessary changes.”

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

The kitchen required action to ensure is was safe to use, this included; a leaking sink and safe storage of food items in the fridge. We saw records to confirm kitchen safety checks were ongoing, but they had not been signed off to confirm they had been reviewed.

We observed not all people were supported effectively during the meal service. Some kind caring interactions were seen but this was not consistent across all areas. Staff offered most people choices and where people required a special diet this was provided. Meals for the day were on display in dining areas. Kitchen staff knew people’s nutritional needs and provided meals according to these. The feedback we received about the meals was mixed. Whilst some told us they enjoyed the food, not all liked the food. They told us, “If I want something I can have it anytime. I like the food. most of the time” and, “The only thing I think needs improvement is the food.” A relative fedback a concern in relation to their meal and that it was cold. A relative fedback a concern in relation to their family members meal.

Staff told us they knew about people’s needs. They said, “I understand tools such as MUST (Malnutrition Universal Screening Tool) for nutrition and waterlow for pressure ulcer risk. I know people’s dietary requirements and support them appropriately at mealtimes.” and, “People’s dietary requirements are on the electronic system. We have enough time at meal times to help and encourage people. If people are eating and they change their mind and don’t like it, we ask the chef to make an alternative such as a sandwich or toast.”

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

People and relatives told us professionals such as the GP were involved as required. One person told us, “The doctor comes here, if I have to go out of the home, one of the staff goes with me. If I have any appointments either one of the staff or my relative will take me.”

The management told us a range of professionals were engaged and involved in the service and people’s assessed needs. Partners said they visited the service and raised no concerns regarding the engagement with them. Care records included evidence that professionals had been involved in people’s assessments and reviews for their care.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People and relatives told us the service accessed professionals if they needed it. The management team told us, structured handovers were, ‘ongoing with personalised care planning and collaborative working ensure continuity of care while protecting people from discrimination and supporting equal access to high-quality care.’ Staff said that information was shared at handovers and daily handovers and, we observed these taking place. Handover records were completed using the information in the electronic care system.

Daily records and monitoring charts were completed but alerts in the electronic system identified some of these required updating were seen and not all records identified that care had been provided in line with 1 person’s care need.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

People said that they were supported with accessing health professionals. One person talked about how the service was linking in with local professionals to take action on a health need.

Staff told us about what they would do to support and improve outcomes. One said, “Sometimes we take people into the garden for fresh air and people are encouraged to do chair exercises. When we have time, we can sit and chat to people and ask how they are feeling and talk about their families.”

Information about accessing professionals in relation to people’s care was available. The registered manager told us the service was looking at introducing specific hospital passport for people with a learning disability. Electronic systems were in place, and plans were ongoing to move more monitoring systems into electronic formats to support effective monitoring and oversight.

The provider did not always respect their rights when delivering care and treatment, but they told people about their rights around consent.

It was difficult to establish that relevant deprivation of liberty safeguards (DoLS) and mental capacity assessments (MCA) assessments had been completed and reflected the individual needs for people to ensure people were protected from unlawful restrictions. DoLS applications had been completed and the progress of these was followed. However, not all of these were on the electronic system. Some detailed care planning and capacity assessments had been completed in records we reviewed but this was not consistent in all of the records.

The management and staff team talked about how to support DoLS restrictions and ensuring consent was obtained where people were able to agree to care and support. We saw staff knocking on people’s doors and waiting to be invited in and asking permission for some tasks, but this was not consistently the case.

People and relatives discussed that the staff supported and discussed their needs. Staff understood the need to seek consent and how they ensured people were not being unlawfully restricted. One told us, “Consent is always sought before providing care. I have completed MCA and DoLS training and consent is documented within care plans.”