Birkdale Residential Home

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We identified one breach of the legal regulations. Quality checks in place were not sufficient to ensure that equipment was maintained when needed and to ensure actions to keep people safe had been addressed. For example, systems had failed to identify that the fire risk assessment actions remained outstanding which placed people at risk of substantial harm. Quality checks of records did not always identify where clinical risk assessments were missing or where documentation was contradictory such as information relating to people’s mental capacity. Systems in place for recruitment were not always thorough. Some staff did not have references on their recruitment files prior to beginning employment and there were gaps in employment history and interviews. The registered manager delegated a high number of tasks to deputy managers which meant responsibility was not always taken and there was a lack of accountability for oversight of the service. The provider did not always apply their learning to ensure people received optimum care. Systems were not in place to get feedback from relatives and improvements were not always made when needed and identified. Partners who worked alongside the home provided positive feedback regarding their involvement with the home and told us referrals were appropriate and advice was followed. There was a person centred culture at the home. Staff found the registered manager to be approachable and confirmed there was an open door policy at the home. Staff told us they were treated fairly and the registered manager was compassionate to their needs most of the time.

This service scored 39 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff told us the culture of the organisation focused on the needs of people. One staff member said, “The staff focus on the residents, it's more like a family here.” The registered manager told us, "We do have visions or values in place. It's just to make sure everyone is comfortable, safe. We want to make people's lives as fulfilled as possible.” Staff told us the registered manager was generally fair and approachable, but that staff morale was not always good as staff felt rushed. Despite receiving positive feedback from staff, we found evidence that people's care was not always provided in a person centred way due to the provider's failure to minimise risk to them by taking essential action to maintain the safety of the home.

Processes in place regarding the vision of the home were not always clear. The provider did not show evidence of any visions and values they worked to and due to the future plans for the home, the provider did not always share the vision of the staff working at the home. There was an open culture that was promoted in the home where staff were able to speak out and share their concerns.

Staff told us that the registered manager was not accountable for the day to day running of the home. Staff told us there was a high level of delegation to the 5 deputy managers in post and the registered manager did not always take responsibility for the oversight of the service. Staff were given the opportunity to progress through the delegation of responsibilities and tasks. However, they had minimal support to train them to undertake these tasks such as how to undertake audits and competency checks so did not always feel competent. The registered manager told us supervisions were generally delegated, however contingency arrangements weren’t in place to cover supervisions when staff were off which meant they didn’t take place regularly. Staff found the registered manager to be empathetic and compassionate when they shared concerns.

Recruitment processes did not always ensure adequate checks were undertaken to assure the provider that staff recruitment was safe. For example, checks failed to identify where there were gaps in references and employment history. Checks did not always identify where there were gaps in staff training. Processes of delegation were also unclear so it was not always clear who was responsible and accountable for all responsibilities. Where things had gone wrong, apologies to people were limited due to ineffective communication with relatives. For example, relatives had not been informed of the risks regarding fire safety at the home.

Staff told us they were able to speak up. Staff provided mixed feedback regarding whether they were listened to and action taken when they did speak up. One staff member told us, "Suggestions are generally listened to. The registered manager would absolutely feed back to me." Another staff member told us they had raised a suggestion for improving the service and it was implemented and working well. They told us, "I would definitely raise issues if I had any. The office door is always open and we can always go in and say something." However, other staff members did not feel actions were always taken by the registered manager. One staff member told us, "We're able to raise our voice and our concerns but whether the registered manager puts it in place is a totally different matter. The next day its forgotten about." Another staff member told us, "Sometimes the registered manager is approachable to raise issues and suggestions. The financial side of things is limiting things a bit." However, staff we spoke with were confident the registered manager would act immediately on any safeguarding concerns.

A safeguarding policy and a whistleblowing policy was in place that staff understood and encouraged them to speak up. There was an open door policy in place where staff could approach the registered manager with any concerns if they wished. However, there was limited opportunity for staff to share concerns in forums such as team meetings, staff questionnaires or supervisions.

Staff told us they were treated fairly and equally. Staff told us the provider was supportive of flexible working arrangements when needed. One staff member told us, "The manager is fair and approachable, very much so." Another staff member stated, "I'd say the registered manager is definitely fair and does try to help everybody." Staff did not always feel empowered in respect to their ideas resulting in positive change for people living at the home.

Most staff were compliant with equality and diversity training. The provider supported staff to have flexible working arrangements when needed for reasons including childcare. The provider offered flexible working hours and staff were able to work additional hours when they wished.

The registered manager told us they had systems in place to learn from events. They told us where accidents and incidents occurred, staff were required to write statements and complete accident forms. Any learning was then shared with staff to reduce the risk of reoccurrence. The registered manager told us senior staff were delegated audit tasks. Staff confirmed the registered manager delegated a lot of tasks and they did not always feel the registered manager took responsibility for the oversight of the home. Staff did not always feel comfortable with tasks that had been delegated as they did not feel they had received sufficient training to do this. For example, the delegation of audit checks and competencies. Staff were not always clear what the registered manager's role was. There was a lack of responsibility taken by the registered manager and provider in respect to outstanding environmental actions that needed addressing. For example, no-one had taken responsibility to ensure the home was compliant with fire safety regulations despite the actions being clearly identified. This placed people at risk of substantial harm.

A business continuity plan was in place which guided the provider how to respond in the event of emergencies. Systems in place to ensure the provider submitted statutory notifications were not always effective. We found 3 examples where safeguarding referrals had been made but the provider had failed to notify CQC. These were completed retrospectively following the site visit. Audit checks were ineffective. They failed to identify concerns and any actions required to meet people's needs safely and effectively. Quality checks failed to identify where medicines errors had taken place, where equipment was not safely maintained (LOLER checks) and where actions had not been completed in relation to the fire risk assessment. This placed people at significant risk of harm (particularly in relation to fire). Roles and responsibilities were unclear and there was a high level of delegation which meant it was not always clear who was responsible for specific tasks. The registered manager did not always take responsibility or hold themselves to account for the undertaking of tasks.

People we spoke with and observed had received input from partners including speech and language therapists, physiotherapists, occupational therapists and GP's. There was evidence of a range of partners working alongside the provider to improve outcomes for people. However, relatives told us people were not always supported to see professionals in relation to footcare.

Staff told us they worked alongside other professionals. Where people had SALT assessed diets, staff knew what food and fluid consistency they were able to have. Staff told us about referrals they had made to occupational therapists where people had equipment needs and where they had requested GP input when people were not complying with medicines administration. Staff understood the importance of collaborative working with partners. The registered manager gave examples of where they had worked in partnership with the local safeguarding team and other partners including oral health teams and medicines teams to improve care for people living at the home. However, despite these positives, the provider had failed to work in partnership with partners regarding fire risk. Despite actions being identified as essential in order to mitigate risk to people, these actions were not taken by the provider and people were left at risk of substantial harm despite input from partners who were expert in the field of fire safety.

Partners told us the provider worked positively alongside them and did implement suggestions and guidance given. One professional commented on communication could be improved but otherwise, partners found the provider to engage actively in training opportunities and implement advice given. One professional told us, "Overall, the manager and care staff do continue to engage with the programme and implement positive changes for the residents, however communication with them has been my biggest challenge." Other feedback received from professionals included, "The home has always been very open and welcoming to our team and are very keen to attend training events that we deliver and they will ask for advice if needed". Partners told us the provider had implemented changes and had been creative in the way they had done this to improve outcomes for people. However, despite positive feedback from some partners, the fire risk assessment assessor confirmed that actions had not been taken following urgent advice given at the last fire risk assessment, therefore leaving people at risk of substantial harm.

The provider worked closely alongside health partners and was engaging positively with them to improve outcomes for people. Professionals confirmed they were sharing examples of their learning and evidenced improved outcomes for people, for example in relation to oral intake. However, processes in place to ensure the provider took action and followed advice given by fire risk assessors failed to ensure essential maintenance tasks were undertaken which left people at substantial risk of harm. We also found little evidence of any residents meetings or review meetings that were taking place to involve people in their care.

The registered manager acknowledged they needed to work on learning and improvement. The registered manager told us they had asked relatives for feedback in the past but they didn't send out questionnaires or ask for feedback. The registered manager stated that they say to staff, "We all make mistakes, we're only human. Hold your hands up and let's all learn from it and not to be afraid to say if something has gone wrong as we can all learn from it." Staff members told us they were keen to learn and staff gave examples of qualifications they had been encouraged to do such as NVQ Level 5.

Systems were in place for accident and incident analysis. Where it was identified that there was an increased frequency of falls during twilight hours, an additional staff member was put on shift. The provider did not always take on board learning from near misses. For example, where the fire risk assessment identified in 2023 that a significant number of actions required completion, they were not actioned, leaving people at continued risk of harm. The provider had an action plan in place that they were working through but there was not always sufficient emphasis placed on the urgency of completing some tasks and learning where things had gone wrong. Where medicines errors occurred, there was minimal learning taken from this as we saw continued medicines errors and investigations were insufficient to identify learning points. This placed people at continued risk of harm.