Birchmere House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.Birchmere House provides residential and nursing care to older people. The home has three floors accommodating up to 76 people in one adapted building. On the day of our visit 53 people lived at the home and two of these people were in hospital. The home is located in Solihull, West Midlands.
Recently, the service provision changed. The provider for the home is now two separate companies with joint responsibility for the home. The name of the service also changed from 'Birchmere', to 'Birchmere House'. The changes in registration delayed the publication of this report.
Our last inspection took place on 29 September and 17 October 2016. This inspection was a focussed responsive inspection where we looked at the key questions of 'safe' and 'well-led'. This was in response to information we had received in relation to people's safety and how risks were managed, particularly in the reminiscence area for people living with dementia. However, since that inspection the providers have closed the reminiscence area of the home and the maximum occupancy at the home has reduced from 131 to 76. Prior to this, our last comprehensive inspection where we looked at all five key questions of safe, effective, caring, responsive and well-led, was March 2016.
At the focussed inspection we found there was one continued breach of regulation 17 (Good governance) associated with the Health and Social Care Act 2008. (Regulated Activities) Regulations 2014. The home was rated as 'Requires Improvement'. This was because further improvements were required to establish systems and processes and to complete accurate and up to date records of each person's care and treatment.
The provider sent us an action plan which stated all the required improvements would be completed by 20 May 2017. During this inspection we checked whether the improvements had been made and we found sufficient action had been taken in response to the breach in regulation.
There was a registered manager at the home. They had started work at the home in June 2017 and registered with us in December 2017. 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 felt safe living at Birchmere House and there were enough staff to support their care needs in a timely way. Procedures were in place to protect people from harm. The staff and the registered manager understood their responsibilities to keep people safe. Staff had received training in 'safeguarding adults' to protect people from harm and described to us the signs which might indicate someone was at risk.
Processes were in place to keep people safe in the event of an emergency. People had personal fire evacuation plans and staff understood the actions they needed to take in the event of an emergency. Accidents and incidents that happened in the home were monitored and action was taken to reduce the risk of reoccurrence. Checks took place to ensure the environment and equipment was safe to use.
The provider's recruitment procedures minimised risks to people's safety. Recruiting new staff had been one of the provider's priorities over the previous six months to ensure people received consistent care from familiar staff. New staff received effective support and training when they started working at the home. Staff had completed the training they needed to be effective in their roles.
Risk assessments identified potential risks to people's health and wellbeing. Staff had a good knowledge of the risks associated with people's care and how these were to be managed.
People received their medicines as prescribed. People confirmed they received effective care, support and treatment from health professionals to maintain their health.
People's needs were met by the design of the building. The home was warm, clean and well maintained. Staff understood their responsibilities in relation to infection control which protected people from the risks of infection.
The providers were working within the requirements of the Mental Capacity Act (2005). The registered manager and staff demonstrated they understood the principles of the Act. Staff had received MCA training and sought people's consent before providing assistance.
People spoke positively about the food provided at the home and had opportunities to be involved in creating menus. Staff, including the chef, demonstrated good knowledge of people's individual dietary needs.
The atmosphere at Birchmere House was warm and friendly. People told us the staff were caring and showed them kindness.
People were supported to maintain relationships with those closest to them. Staff and the registered manager understood the importance of promoting equality and human rights as part of a caring approach. People received care that was responsive to their needs and personalised to their preferences. Each person had their needs assessed before they moved into the home and people planned and reviewed their care in partnership with the staff.
People's care plans included their life history and information about their preferred routines, lifestyle choices and achievements. This supported staff to provide person centred care. Care plans detailed people's future wishes for end of life care. When needed staff worked in partnership with other healthcare professionals to ensure people had a comfortable and pain free death.
People maintained positive links with their community. A variety of activities took place at the home and people had opportunities to take part in activities which supported them to pursue their hobbies and interests.
People knew how to make a complaint and felt comfortable doing so. The registered manager told us they used complaints as an opportunity to drive continuous improvement in the home.
People spoke positively about the home and the registered manager. Staff told us Birchmere House was a nice place to work. The registered manager and the providers were committed to recognising the contribution individual staff members made to benefit people. Staff had regular opportunities to attended meetings with the management team and they received regular supervision and an annual appraisal of their work performance.
The registered manager promoted an open and transparent culture. Staff told us communication in the home was good and recent positive changes had been made to drive improvements. Staff attended daily meetings to share information about people. This meant staff had the information they needed to provide the care and support people required.
The registered manager felt supported by the provider. They used different methods to ensure they kept their knowledge of legislation and best practice up to date. The provider supported the registered manager to further develop their skills to support the values of the organisation.
Effective systems were in place to monitor and review the quality of the home. People and their families had opportunities to put forward their ideas and suggestions to improve the service they received. The feedback received was analysed and used to drive forward improvements.