Archived: The Birches

Updated 14 December 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This focussed inspection visit took place on 25 September 2018 and was unannounced. This inspection was carried out to check that improvements to meet legal requirements planned by the provider after our focussed inspection of May 2018 had been made.

We inspected the service against two of the five key questions we ask about services; is the service 'safe' and is the service 'well-led'. This was because the provider was not meeting some legal requirements.

The inspection team consisted of two inspectors.

Before the inspection, we reviewed information we held about the service, which included notifications they had sent to us. A notification is information about significant events or incidents within the service that the provider is required to send us by law. We also spoke with commissioners from the local authority, responsible for funding some of the people using the service, to obtain their views about the care provided at the service. We used this information to plan this inspection.

During the inspection we spoke with three relatives of people using the service, two visiting health and social care professionals, the cook and three care staff. We also spoke with the registered provider by telephone. We reviewed care records and associated risk assessments for two people. We reviewed records relating to the day to day management of the service, including staffing, medicines and quality assurance.

Updated 14 December 2018

We undertook this unannounced, focussed inspection on 25 September 2018. The inspection was prompted, in part, by information shared with the Care Quality Commission which indicated potential concerns regarding the health, safety and wellbeing of people using the service. This inspection examined these concerns and potential risks to people's safety. We inspected the service against two of the five questions we ask about services: 'Is the service Safe?' and 'Is the service Well Led?' This was because the information shared was relevant to these two key questions and the service was not meeting some legal requirements in these areas.

The Birches is a residential home which provides care to older people including some people who are living with dementia. The Birches is registered to provide care for up to 19 people. At the time of our inspection there were 11 people using the service.

The Birches 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.

Our last comprehensive inspection of this service was carried out on 21 November 2017. Two breaches of the legal requirements were found and we issued a warning notice. We rated the service as Requires Improvement. We asked the provider to submit an action plan but they did not submit one. You can read the report from our last comprehensive inspection by selecting 'all reports' link for The Birches on our website at www.cqc.org.uk.

We undertook a focussed inspection on 27 March 2018 to check that the provider met the legal requirements. We found two continued breaches of the legal requirements. We issued a Notice of Proposal to impose positive conditions on the provider, placed the service in special measures and rated the service as Inadequate. We asked the provider to submit an action plan but they did not submit one.

Services in special measures are kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

At this inspection, we found the provider had not made significant improvements and the rating remained Inadequate.

People's safety was being compromised in a number of areas. People were not protected from the risks of the spread of infection in the service. The provider had not ensured sufficient numbers of suitably competent, skilled and knowledgeable staff were available to keep people safe and meet their needs. The provider had not followed safe recruitment procedures for all staff working in the service.

Risks associated with the premises had not been effectively assessed or monitored. The provider had not taken action to address priority concerns from fire and electrical reports, which placed people and staff at risk in the event of a fire. Maintenance was not provided in a timely manner to ensure the premises were safe and fit for their intended purpose.

Risks associated with people's health conditions and care were not consistently reviewed and care plans did not reflect people's current needs. Risk assessments lacked accurate, detailed information regarding the measures staff needed to take to keep people safe. Falls and incidents were not analysed or monitored to prevent the risk of further harm for people.

Safe systems were not consistently in place to ensure people received their medicines as prescribed. there were insufficient numbers of staff employed who had completed the necessary training to administer medicines. Medicine errors were not identified or reported in a timely manner.

The service was not well led. The provider had not adequately monitored the service to ensure it was safe and they had not identified the areas of concern that we found during our inspection. The provider had not made adequate arrangements to ensure effective leadership and governance or oversee the day-to-day running of the service in the absence of a manager.

The provider had not made the significant improvements required since our last inspection to meet the requirements of the regulations and to keep people safe from harm.

We found continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.