Birchmere House

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.

At our last assessment we rated this key question good. 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.

People’s needs were assessed, reviewed and monitored regularly, and staff worked with them and those important to them to ensure care was planned in a personalised and meaningful way.

People’s needs were assessed effectively, and reviews were carried out regularly through the provider’s Resident of the Day initiative. This process involved staff from different departments and ensured that care plans were kept up to date. One resident told us, “I’ve been resident of the day a number of times… there have been changes as a result. If I feel something needs doing, I would tell them.” Care reviews were clearly documented, with staff explaining that they discussed care plans with people and took action where concerns were identified.

People and most relatives felt involved in care planning and decision making. One resident said they felt their needs were met, and a relative shared that they were involved in discussions about care and any changes needed. Risk assessments, including those for falls, were completed and updated monthly. Staff, relatives and professionals told us that staff knew residents well and could describe their needs and preferences with confidence. Specific care plans, such as those for diabetes, were detailed and included clear guidance on monitoring requirements and what actions to take if a person’s health changed. Professionals noted improvements in some residents’ wellbeing following admission, reflecting effective assessment and ongoing review.

The provider did not always ensure care and treatment was delivered in line with evidence‑based guidance, and records did not always reflect people’s assessed needs accurately.

Care plans and risk assessments were in place but were not always sufficiently detailed, consistent, or reflective of people’s needs. For example, one person’s skin integrity and pressure area care plans contained conflicting information about repositioning, and records alternated between describing pressure damage as active and healed without a clear, current management plan. Although the provider showed that staff recorded when repositioning took place, not all entries included the person’s position, and the recorded frequency of repositioning did not always align with the care plan. Other care plans lacked essential practical guidance, such as how staff should safely support individuals during transfers. Care planning and monitoring for hydration, nutrition and catheter care were also inconsistent. Fluid monitoring targets were not clearly documented despite known risks, and catheter care plans did not consistently reflect re‑catheterisation dates recorded in review notes.

People also described mixed experiences regarding mealtimes. Some residents reported limited menu variety, delays in food being served, and occasions where agency staff were not clear about dietary requirements. One person shared, “They just need more staff in the dining room... We have to wait quite a while for food”. One staff member explained that they felt there were limited options for people who were vegetarian or required a soft diet. A relative also reported occasions where unsuitable food had been offered and felt this occurred when agency staff who were less familiar with people’s needs were supporting.

However, mealtimes were observed to be calm and unhurried. One resident praised the chef for working closely with them to meet their specific dietary needs. Permanent staff demonstrated good awareness of people’s dietary requirements, and the kitchen had clear systems in place, including detailed allergen and dietary information, labelled storage areas, and separate preparation zones. All kitchen staff had received allergen training. Dining areas were well organised with nicely set tables, and residents could choose from the menu or request alternatives. One person said, “They will do special food for us if we don’t want what’s on the menu”. Snacks and homemade cake were available throughout the day in the bistro, and residents had access to small kitchenettes to make their own drinks and snacks if they wished. Good food safety practices were observed, including temperature probing and covers placed on meals delivered to rooms.

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.

A pharmacist visited every Wednesday to help manage medicines stock and address any queries, and a GP attended weekly, usually the same clinician, which supported continuity and a good understanding of people’s needs. Care plans included contact details for key health professionals so staff knew who to contact if they had concerns.

Health professionals spoke positively about the communication and joint working they experienced with the service. One commented, “We have a good relationship with everyone, including the managers… if they need to be told anything, I tell them.” Another said staff were knowledgeable and well prepared, sharing, “They know their residents and can access the information I need straight away.”

There was clear evidence that when medical concerns arose, staff recorded these promptly, documented the actions taken, and contacted the appropriate health services. Staff worked cooperatively with external professionals and kept the person at the centre of conversations, ensuring care remained coordinated when support from multiple services was required.

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 were supported to maintain and improve their health and wellbeing, and both relatives and professionals spoke positively about the progress people made after moving into the service. Relatives felt staff knew their loved ones well, and one resident told us, “Staff always ask me if I am okay,” reflecting staff awareness of day‑to‑day wellbeing. Another resident felt some staff were more task‑focused than others, but this did not impact the overall positive views about how health needs were supported. Health professionals also reported good outcomes. One professional told us, “Residents who come here have a tendency to improve. After a few months you see a visible difference… they look better, have gained weight and seem to be more engaged. They become different people… this shows you the quality of care.” This demonstrated that people experienced improvements in their physical and emotional wellbeing over time.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and

consistent, or that they met both clinical expectations and the expectations of people themselves.

While care plans included ‘goals’, these were not always personalised or meaningful to the individual. For example, some eating and drinking care plans included goals such as “to promote healthy nutrition and hydration,” which is generic and does not identify what the person themselves wishes to achieve, missing opportunities to align care with people’s priorities and measure progress against specific, person‑centred aims.

Monitoring to evidence outcomes was inconsistent. Staff could talk through people’s needs and risks; however, there was a lack of clear guidance and oversight around fluid monitoring. We saw no agreed fluid targets in records, including for people identified as at risk of dehydration or urinary tract infections. It was also unclear when staff should be recording fluid intake and when it was not required. For two individuals at risk, fluid charts showed fluctuating intake without effective oversight or review against targets. The lack of guidance and poor monitoring of peoples fluid intake meant people were at risk of poor hydration outcomes.

There were also inconsistencies between assessed risk and ongoing monitoring. One person had a MUST score of 2 (high risk of malnutrition), yet review notes stated fluid charts were not required as the individual’s weight had increased and remained stable. This was not clearly reconciled with their ongoing risk profile and did not demonstrate a robust approach to monitoring or improving outcomes.

However, staff were knowledgeable about people and could describe needs and recent changes in health, and care reviews were held. However, the absence of specific, person‑centred outcomes and consistent clinical monitoring limited the ability to evidence progress and adjust care proactively.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

Consent was not always informed or sought in a person‑centred way. Some residents told us they did not fully understand the purpose of their medicines, which meant they may not have been able to give informed consent. One person said that “Sometimes staff will ask between themselves if [I] want a wash rather than ask me,” indicating that staff did not always check consent directly with the person.

However, people generally described that their day‑to‑day choices were respected. For example, when someone declined personal care, staff would try again later, which reflected a respectful approach to immediate decisions.