Birch Hall Care Centre

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to safe management of medicines, risks, infection prevention and control and safe environments.

This service scored 50 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Most people and relatives told us they were happy to raise safety concerns and that they would be acted on. Staff discussed the process of dealing with incidents and accidents. There was evidence of lessons learned in relation to safeguarding and actions recorded as a result of these. An accident and incident log and falls analysis was taking place to support monitoring.
 

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People and relatives mostly said they were involved in the assessment on admission to the home. One person told us, “Yes, they asked me questions.” Care records had information in them about the involvement of professionals and preadmission and further assessments were seen.

Professionals told us they were involved in assessments. Staff understood the process of admissions to the service. They told us, “Seniors inform care staff, we first do a body map to check for any sores or pressure areas. Clothes sent to laundry for labelling. Senior staff advise on new people and their needs” and, “We are informed about new admissions during handover and by reading the resident's care plan and risk assessments before providing care.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Most people and relatives fedback that they felt safe and cared for, but not all relatives confirmed this. People were treated with kindness by staff. One said, “I feel safe here, there are minor things that would happen wherever you are, but it is good around here.”

Staff knew about safeguarding and acting on abuse and had undertaken relevant training, they told us they felt people were safe. The management knew how to act on safeguarding concerns, we discussed the challenges of obtaining outcomes of investigations from partners. Information about how to act on concerns was on display around the home.

Safeguarding records were noted with evidence of the investigation process and the actions taken. A tracker had been completed to ensure the progress of investigations were monitored. We discussed a safeguarding concern raised by a family member with the senior team they told us about the actions they were taking to investigate and act on the concern.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Areas of refurbishment in the service had not been kept safe to protect people from potential risks. And a cupboard in 1 unit to safely secure thickener products had been left open and accessible to all.The provider took action to address these concerns following our findings.

No concerns were raised in relation to the management of risks and needs. Staff discussed people’s individual needs and risks and measures to keep them safe. The management told us they had developed environmental risk assessments in relation to the changes taking place in the service. Leaders understood people’s risks. However, we saw periods of time where communal areas were left unsupervised. This increased people’s risks of harm. Individual risks assessment were seen but some had not been reviewed to ensure they reflected people’s current needs.

The provider did not always detect and control potential risks in the care environment. They did not make sure that equipment, facilities and technology supported the delivery of safe care.

A number of risks were identified in relation to the environment. These included worn carpets, paintwork, staining to ceilings in some bedrooms and, broken ceiling tiles in a corridor.The provider had refurbishment plan and were working to make improvements to the environment. There was also a satellite kitchen in disrepair, hoists and wheelchairs were left in corridors despite some of these waiting to be removed as they were no longer in use. There was also clutter in a number of ensuite bathrooms and an unsecured lounge area with building work ongoing. Whilst the provider acted on some of the environmental risks, this was only undertaken as a result of our findings.

No concerns in relation to the environment were noted from people and relatives. However, concerns were raised about the current arrangements and the mix of people in the communal areas and bedroom placement. A relative told us, “I am not happy about the merging of the young disabled unit they have very different needs.” It was difficult to establish what the plans were in relation to the changes in the service and how this had been agreed and discussed with people to advise that this was a temporary arrangement. The provider told us and we saw records with feedback to confirm the planned changes had been discussed with family.

No staff raised concerns about the environment however, others commented on the storage arrangements. One told us, “I feel the environment is safe, clean and well maintained, with equipment checked regularly to help keep residents safe.”

A refurbishment programme was ongoing and there was a detailed development plan. However, these would benefit from regular reviews and shared with people, relatives and staff to ensure they knew about the changes and the plans for the units, once completed. Hazardous chemicals and personal toiletries were being stored safely. Fire safety checks were ongoing, but the personal emergency evacuation plans (PEEPs) summary in the entrance to the service had the incorrect numbers of people living in the service recorded. This record was updated but only as a result of our findings.

The provider did not always make sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

People and relatives commented on the skills and knowledge of the staff team or the staff numbers, but not all relatives were confident in the skills of staff team and some fed back they had to sometimes wait for assistance when they pressed their buzzer. Comments included, “I think they need more staff, especially at night” and, “There have been so many staff changes from when they came here.”

Some staff told us there was sufficient staff, but others raised concerns about the numbers of staff and their deployment across the service. Staff said agency staff were used to cover gaps in the staffing numbers. Comments included, “Generally yes (There is enough staff). If staff are absent, we use bank staff, agency staff or existing staff may cover shifts safely”, “(There is) enough staff, agency staff is reducing and we are employing more permanent staff. Training is online and tomorrow we have face to face induction training. We also do face to face moving and handling and 1st aid, it is interactive."

Staff training was ongoing both online and in person, further training to support specialist needs of some people in the service was planned. Supervisions were taking place and a training matrix identified the topics covered and the staff completion statistics. The manager had recently opened a dedicated training room to support face to face training for the staff team.

Recruitment was ongoing with inductions taking place on commencement to roles. The nominated individual provided evidence of the safe recruitment where staff had been promoted to more senior roles. The provider had completed risk assessments where gaps in the recruitment process for established staff were noted, this needed improving. The manager discussed the ongoing challenges in staffing and the actions they had taken to ensure suitable staff were working in the service.

Staff were seen supporting people where 1:1 support was needed. Staff were seen across all units in the service, but some communal areas were left unsupervised at times, this placed people at risk.

The provider did not assess or manage the risk of infection. They did not detect and control the risk of it spreading.

We identified a number of cleanliness and infection risks. These included dirt and food debris in a satellite kitchen, dirty and dusty grab rails, skirting boards, radiator grills and dirty mobile hoists and wheelchairs. A number of ensuites were cluttered with items left on the floor. Carpets were stained, dirty with some areas frayed and lifting, a sluice door was left open, and products and equipment had been left on the floor. We saw and the manager told us new chairs were being introduced into communal areas, but 1 person’s bedroom and a communal area had dirty stained chairs in them. This was despite a number of new chairs seen stored in a lounge. The manager took action to change these and act on the concerns, but this was only after we had identified the concerns.

No one raised concerns about the cleanliness of the service. A relative told us, “There's always somebody in cleaning it always smells fresh.” One staff member told us, “PPE is always available and we follow infection prevention procedures.” Staff were confident in the cleanliness of the service, but we received feedback that the cleanliness of the service during the refurbishment work could be improved. A head housekeeper had been introduced in the service to help with management and oversight of infection control and cleanliness.

Cleaning records were seen but these had not been completed in full and some dates identified cleaning had not been undertaken. Audits in relation the infection control had been completed. Policy and guidance was in place and staff training in infection prevention and control was in place. The management took action to address the significant cleanliness concerns however; this was only as a result of our findings.

Housekeeping staff were seen undertaking duties in the service and responding to the concerns we identified at the assessment. Records of walk around checks confirmed these were undertaken but these failed to identify the concerns we found at the assessment. Staff were seen wearing personal protective equipment as needed. The management engaged with the local infection and control team to establish plans to improve infection risks in the service.

The provider did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. People were not involved in planning.

Medicines were not always managed safely. We found a number of issues from the previous inspection had not been addressed. When people were prescribed a medicine to be given when they were displaying an emotional reaction, such as agitation or distress, the reason for the administration of the medicine was not clearly documented.

When people were prescribed ‘when required’ medicines, there was not always person-centred information to support staff to know when to give the medicines. When people were prescribed topical preparations such as creams, we found they were not applied as prescribed. When people required support with complex medical needs, this was not always provided in line with professional guidance.

Medicines were not always stored safely or in line with manufacturer’s instructions. The provider’s medicine policy did not reflect the service and did not support staff to safely manage medicines. The service completed audits; however, they had not been effective in identifying the concerns found during the inspection.