Birchmere House

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has remained good.

This meant people’s needs were met through good organisation and delivery.

This service scored 68 (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 were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Some care plans lacked sufficient person‑centred detail to guide staff practice. For example, choking guidance for some people conflicted with their ReSPECT documentation until this was addressed during the inspection. A ReSPECT form is a document that records a person’s wishes about their care in an emergency, including what treatments they would or wouldn’t want, so staff can act quickly in line with their preferences. Several personal care plans described what support was required and what mattered to the person, but did not clearly explain how staff should provide care, such as steps in the person’s routine, mobility considerations during personal care, or whether continence products were used. Care plans also did not always record people’s food preferences, despite residents telling us what they liked or disliked. Some people also shared that their preferred routines were not always supported. One resident said they would “like to go to bed much earlier,” but added that staff “don’t come until late.”

However, people’s preferences and interests were generally well understood by staff, and the service offered a broad range of meaningful activities that reflected different needs and interests. Relatives told us they were informed promptly when changes occurred, such as medication adjustments, and people said their families could visit whenever they wished. Staff also described how they promoted choice in day‑to‑day care, telling us, “Person‑centred care means always asking the person what their preferences are. It’s about giving them the choice”.

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported continuity.

Residents and health professionals described positive relationships and improvements under the current management. One resident told us, “This place is better than home to me.” A health professional shared, “Since the management has changed, we have much better engagement. They call us for advice and signposting. Our relationship now, is better than we have ever had.”

Health professionals also described strong collaboration, “When someone moves in, we meet with them, go through all their medication and go through everything that needs checking”. They told us they routinely asked about people’s history, current needs and any outstanding concerns, which helped support safe and consistent transitions into the service. Other health professionals praised the communication and responsiveness of staff, describing “good relationships with everyone and the managers.” One professional highlighted joint work on palliative care, including mass training arranged with Macmillan nurses to improve staff understanding of end‑of‑life documentation and support. They reported that communication was “very good” and said staff followed guidance and remained proactive.

Professionals also commented positively on the competence of the nursing team, saying staff were able to answer questions confidently and access information quickly because they knew residents well. Several noted improvements under the new management structure, describing the approach as “refreshing” and expressing hope that these strengthened relationships would continue.

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Residents received a monthly newsletter which included updates about new staff members, employee‑of‑the‑month recognition and important upcoming events in the home. People were given a handbook and information guide when they moved in, which included photographs of different staff uniforms to help them identify who was who. Information around the home was also made accessible. Some signage near staircases was provided in braille, and an Alexa device was available in the bistro, with instructions on how to use it should residents wish to access information or entertainment independently. Staff and leaders described personalised communication support for individuals where needed. For example, one resident used a laminated A–Z card with key words to aid communication with staff. These approaches supported people to stay informed, navigate the environment and be involved in daily life in ways that suited their preferences and communication styles.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

People had mixed experiences of being listened to and involved in decisions. Some people who lived at the service told us they were “not asked for their views or opinions,” while another said they did not know that resident meetings took place. One person commented, “I do go to the residents’ meetings, but I don’t think they’re very useful,” and another told us, “I do go to the resident’s meetings. I think sometimes they are useful but other times they don’t take much notice.” Some people felt that although staff listened, actions were not always taken, with one resident saying, “They listen to what I say, but whether anything gets done is another matter.”

Concerns about staffing levels also influenced how listened to people felt. One person said the change they would like to see is “that there would be more staff and I don’t have to wait so long when I press my call bell.” These experiences showed that not everyone felt action was taken when they did raise concerns.

However, other residents and relatives described positive experiences. During resident meetings, some people said they could speak up and share ideas, and some changes were made as a result. For example, when someone suggested activity schedules should be delivered directly to people’s rooms rather than only displayed on noticeboards, this was actioned. One resident told us, “I ask for help if I need it. I’m comfortable asking… they listen to me.” Relatives said concerns were dealt with promptly and communication was very good. They also confirmed that minutes from residents’ meetings were shared with them. Complaints were investigated thoroughly and reviewed by senior management, with evidence of actions taken in response. People told us they would feel confident to raise a complaint if needed.

The provider made sure that people could access the care, support and treatment they needed when they needed it.

Staff arranged appointments promptly and supported people to attend them. For example, staff ensured an interpreter was booked for a resident who required language support when attending GP appointments. Another resident, who was Jewish, had access to someone they could speak with for religious reasons, helping maintain their cultural and spiritual needs.

People told us they were kept well informed about changes in their care, including updates to medication, and relatives described an inclusive and welcoming culture where they could visit freely. The garden was well‑maintained, accessible and provided a calm outdoor space for residents to relax, meet visitors or spend time engaging in gentle activity. Some residents described enjoying barbecues in the garden, which supported social interaction and enhanced wellbeing.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

All staff had completed equality and diversity training, with 100% compliance at the time of inspection. This helped ensure staff understood the different factors that might affect people’s experiences or outcomes and supported them to respond sensitively to individual needs.

A relative told us their family member struggled to use the call bell, so staff provided a neck alarm instead, as this was a familiar and accessible option for them. This ensured the person could reliably call for help and feel safe. One resident shared that they sometimes felt embarrassed when supported with personal care by male carers and said they would like to have a shower but “not with a man watching.” Staff were aware of this concern, and leaders recognised the need to consider gender preferences when planning personal care to support people’s comfort, dignity and emotional wellbeing. However, this was not consistently achieved in practice, as some residents told us they did not always receive support from staff of their preferred gender.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

A DNAR is a document that explains a person’s choice not to have CPR if their heart or breathing stops, so staff know not to attempt resuscitation. Pre‑assessment forms asked whether DNAR or ReSPECT documentation was in place. ReSPECT forms were stored in a central file at the nurses’ station, on the electronic system and in people’s rooms so they were easily accessible in an emergency. Advanced care planning discussions were recorded within the electronic documentation. Staff worked closely with the GP, palliative care services, pharmacists, specialist teams and local spiritual support to coordinate care and ensure plans remained current and reflective of people’s wishes. In some cases, people who had moved into the home for palliative care had improved due to the support they received. We reviewed an end‑of‑life care plan which clearly detailed the person’s wishes, including their preference to remain at the home rather than go into hospital, alongside plans for comfort and symptom management. Anticipatory medicines were prescribed and available when needed. Documentation was clear, well‑completed and demonstrated compassionate planning.