Archived: Silver Birch

Silver Birch is a residential care home providing personal care for up to five people with learning and physical disabilities who require a short break (respite) with specialised facilities. At the time of the inspection there were two people staying there.

The home is on one level with accessibility to secure gardens. The home has been specially equipped to ensure people can access all areas of the home with ease. The bedrooms all have assistive technology, televisions, several have ceiling tracking hoist systems, and all have adaptive mobility ensuite washrooms.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that while people use the service they can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties in the area. However. the size of the service having a negative impact on people was lessened by the building design fitting into the residential area. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.

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

There were sufficient numbers of suitably qualified staff to meet people’s needs. Staff training was ongoing and people had received sufficient training to safely support and care for people. Staff were supported by the manager through regular staff meetings, supervision and appraisals.The provider had policies and procedures to support the safe recruitment of staff. .

We saw the service worked with a variety of external agencies and health professionals to provide appropriate care and support to meet people’s physical and emotional health needs.People received support to maintain good nutrition and hydration in line with their personal choice. People’s healthcare needs were well understood and met promptly.

Where safeguarding concerns or incidents had occurred, these had been reported by the manager to the appropriate authorities and we could see records of the actions that had been taken by the service to protect people.

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's communication needs were thoroughly assessed and understood by staff. This helped to support people's communication needs and the Accessible Information Standard (AIS).

The manager displayed knowledge and understanding around the importance of openness and working closely with other agencies and healthcare professionals to make sure people had good care. Hazards to people’s safety had been identified and managed. People were supported to access activities that were made available to them and pastimes of their choice. A relative told us, “The service focusses on meeting all of our relative’s needs in a safe and homely environment.”

People were treated with respect and their dignity and privacy were actively promoted by the staff supporting them. A relative told us, “This is a fantastic service which results in our relative being settled and happy during their visits.”

Governance and quality assurance systems allowed the service to demonstrate effectively the safety and quality of the provision. The manager and staff used recognised monitoring tools to analyse trends and highlight areas they could work on to improve support for people. Staff felt valued and respected by their manager and were included in decisions about service development.

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

Rating at last inspection

The last rating for this service was good published (23 January 2017)

Why we inspected

This was a planned inspection based on the previous rating.

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

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.

This inspection took place on 15 December 2016 and was unannounced. Our inspection team consisted of one inspector.

We checked the information we held about the service and provider. This included the notifications that the provider had sent to us about incidents at the service and information we had received from the public. We used this information to formulate our inspection plan.

On this occasion we did not ask the provider to send us a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. However we offered the provider the opportunity to share information they felt relevant with us.

Some people who used the service had complex needs and were unable to communicate verbally with us. We spent time observing how staff provided cared for people to help us better understand their experiences of the care and support they received. We spoke with two relatives and three members of care staff. We did this to gain people’s views about the care and to check that standards of care were being met.

We observed how the staff interacted with people who used the service.

We looked at three people’s care records to see if their records were accurate and up to date. We also looked at records relating to the management of the service including quality checks. We reviewed information from commissioners of the service and quality reports.

Silver Birch is registered to provide accommodation for up to five people with a learning and physical disability for respite care. At the time of our inspection, four people were using the service. This was the first inspection of this service.

The service had a registered manager. 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 chose how to spend their time and staff sought people’s consent before they provided care and support. Some people did not have capacity to make certain decisions. It was not clear how some decisions had been made and whether people should make the decision for themselves. We saw some people may have restrictions placed upon them as they were not able to go out alone and may not have the capacity to make a decision about their safety. Applications to ensure these restrictions were lawful had not been made. You can see what action we told the provider to take at the back of the full version of the report

People told us they felt safe at the home and when out. People were supported by staff who knew how to reduce avoidable risk to prevent harm and understood how to recognise and report any abuse.

Staffing levels were sufficient and flexible to support people when they received respite care and to provide them with opportunities to pursue their interests. People had opportunities to develop their living skills in the home as well as engage in activities of their choosing. People could help to prepare their meals and received support where necessary and could choose to eat out.

People were supported with their medicines safely and systems were in place to make sure that at the beginning of each stay, correct information about people’s support and the medicines they needed was available.

Staff knew people well and were trained and competent to meet people’s needs. Staff were supported and supervised in their roles by the manager and senior staff. When new staff started working in the service, they were able to get to know people and supported by the staff team.

People had developed good relationships with staff. The staff were kind and caring in their approach and people’s privacy and dignity were respected. People were supported to be as independent as possible during their respite stay.

People were involved in the planning and review of their care and support and family members continued to play an important role. Where people had any concerns they were able to make a complaint and this was responded to.

Systems were in place to assess and monitor the quality of the service. People and staff were encouraged to raise any views about the service to review how improvements could be made. The manager promoted an open culture which put people at the heart of the service.