Archived: Birchlands

Birchlands is a care home without nursing and accommodates up to 52 people in one adapted building. The building is divided into seven different living areas each with its own communal lounge, dining area and bathrooms. There is also a large communal area on the ground floor. The service supports adults requiring care and support due to their physical health and those living with dementia. At the time of our inspection there were 21 people living at the service

People’s experience of using this service and what we found

Risks to people’s safety were assessed and staff were aware of the precautions to take to keep them safe. People were protected from potential abuse as systems were in place to help identify concerns and ensure they were reported in a timely way. Robust recruitment processes were followed. Staff received effective training and supervision to support them in their roles.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People and their relatives were involved in planning their care and guidance on meeting people’s needs was available for staff. People had access to a range of healthcare professionals and staff understood the importance of requesting support promptly.

People were supported by staff who knew them well and used this knowledge to ensure their support was person-centred. People’s dignity and privacy were respected and staff understood the importance of maintaining people’s independence. There were a range of activities available which were personalised to people’s interests.

There was a positive culture within the service and staff felt supported in their roles. Quality assurance systems were effective in ensuring continuous improvement. The provider was open and honest when things went wrong and relatives told us communication was good. The management team had support from the organisation to ensure improvements made were embedded into practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 9 October 2020). This was a focussed inspection looking at the areas of Safe and Well-led to review risks identified in our previous fully comprehensive inspection (published 7 May 2020). At both previous inspections breaches of regulations were identified. The provider completed an action plan following both inspections to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Birchlands is a care home without nursing and accommodates up to 52 people in one adapted building. The building is divided into seven different living areas each with its own communal lounge, dining area and bathrooms. There is also a large communal area on the ground floor. The service supports adults requiring care and support due to their physical health and those living with dementia. At the time of our inspection there were 32 people living at the service.

People’s experience of using this service and what we found

Risks to people’s safety were not always assessed and monitored. Whilst improvements from the last inspection had been made in this area, further development was required to ensure people received consistently safe care. Records did not always contain sufficient guidance for staff to follow and reports completed following accidents and incidents did not always contain sufficient details to enable prompt and robust action.

Staff had developed a clear understanding of their responsibility in protecting people from the risk of abuse. Safeguarding concerns were submitted promptly to the local authority and risk management systems had been developed to reduce the number of safeguarding concerns. However, when additional information was requested from the service this was not always received promptly. We have made a recommendation in relation to this.

There was a greater degree of management oversight in the service since the last inspection although further work was required in this area to ensure systems were effective and embedded into practice. Staff felt supported and received training and guidance in their roles. The provider had ensured a range of resources were available to support the team in making improvements to the service.

Staff were effectively deployed and had time to spend with people. Regular agency staff were used and had access to support, guidance and training. This helped to ensure people received support from a consistent staff team. Effective infection control measures were in place and staff had received training in relation to protecting people during the COVID-19 pandemic.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Inadequate (published 6 May 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made in the majority of areas. The provider was still in breach of one regulation.

This service has been in Special Measures since 6 May 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We carried out an unannounced comprehensive inspection of this service on 27 February 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements in relation to people’s safe care and treatment, safeguarding service users from abuse and improper treatment, staffing and good governance. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Birchlands on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to how risks to people’s safety were managed at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Birchlands is a care home without nursing and accommodates up to 52 people in one adapted building. The building is divided into seven different living areas each with its own communal lounge, dining area and bathrooms. There is also a large communal area on the ground floor. The service supports adults requiring care and support due to their physical health and those living with dementia. At the time of our inspection there were 40 people living at the service.

People’s experience of using this service and what we found

There was a lack of provider and management oversight of the service. Safeguarding concerns, accidents and incidents and complaints were not robustly managed which led to the same concerns happening again. Quality assurance processes were not effective in driving improvement and there was a lack of joint accountability regarding actions being completed. Audits were not completed regularly and where concerns were identified these were not always acted upon. Values and a positive ethos were not consistent which led to clear differences in people’s experience throughout the service.

Risks were not always identified and safeguarding concerns were not always reported promptly to minimise risks to people’s safety. There was a shortage of permanent staff which meant agency staff covered over 60% of shifts. Strategies had not been implemented to minimise the impact of this and ensure that staff worked well together as a team. Staff did not always receive the training and supervision required to support them in their roles.

People did not always receive person-centred care. Staff were not always aware of people’s backgrounds and there was a lack of interaction in some areas of the service. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the systems in the service did not support this practice.

In other areas of the service we found that staff treated people with kindness and respect. There was a range of activities available to people which they told us were enjoyable. This included the opportunity to go out in the local community. People’s religious and cultural needs were respected and there was regular access to church services. A relatives’ group was active in organising social events for people.

People told us they enjoyed the food provided although improvements were required in making mealtimes more pleasurable in some areas of the service. People had access to healthcare professionals when required. People’s rooms were personalised and in some areas of the service pictures and information about people’s life histories were displayed on bedroom doors to aid conversation.

People, relatives and staff told us they found the registered manager approachable, kind and hard working.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Rating at last inspection

The last rating for this service was Good (published 22 August 2017). Since this rating was awarded the provider of the service has changed. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected

The inspection was prompted in part due to concerns received about the care people both directly from the service and from contact with relatives. A decision was made for us to inspect and examine those risks.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Enforcement

We have identified breaches in relation to the action taken in relation to safeguarding concerns, how risks to people’s safety were managed and the deployment of skilled and experienced staff. Person-centred care was not embedded into practice, people’s dignity was not always respected and the principles of the Mental Capacity Act 2005 were not upheld. Complaints were not reported and acted upon and there was a lack of management oversight of the service.

Please see the action we have told the provider to take at the end of this report.