Archived: Birchwood Court Residential Care Home

Birchwood Court provides accommodation and personal care for up to 43 older people. At the time of the inspection 43 people were using the service.

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

People and their relatives told us the care was safe and they were happy at the service. Medicines were managed safely. Staff were recruited safely and there were enough staff to meet people’s needs. The registered manager sought to learn from any accidents and incidents involving people.

The registered manager carried out detailed assessments of need to ensure the service could effectively support any new admissions. People were supported to have enough to eat and drink and staff were trained to support people who had different dietary needs. Staff told us they were well trained and supported and supervised by the management team. The service worked well with community healthcare partners such as the local GP practices to ensure people received healthcare support where needed.

People were supported to have maximum choice and control of their lives and staff supported support them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Interactions between people and the staff team were very positive. People were treated with kindness, dignity and respect. Staff were responsive when people needed additional support. People were supported to maintain relationships with those important to them. Relatives we spoke with told us they were always made welcome and the atmosphere at the home was warm and friendly.

People received personalised care that was responsive to their needs and preferences. They were involved in reviews of their care where they were able. People and their relatives knew how to make a complaint. Those people we spoke with said they had opportunity, through regular meetings, to raise any issues they had. The home received regular compliments about the good care people received. Complaints and concerns were dealt with robustly and proactively by the management team.

The registered manager who had been in post for a year had driven improvements and provided stability. People's feedback was sought regularly and acted upon. We received positive feedback from people, relatives and staff about how the service was now managed. There were effective systems in place to monitor the quality of the care provided.

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 good (published 29 April 2017). There was also an inspection on 14 February 2019 however, the report following that inspection was withdrawn as there was an issue with some of the information that we gathered.

Why we inspected

This is a planned re-inspection because of the issue highlighted above.

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.

Birchwood Court provides accommodation with personal care for up to 43 older people. The building is on two levels and is split into three living areas. The home caters for people who have lifelong conditions, those who are recovering from an injury or illness and those who have a dementia type illness. Birchwood Court is set in its own gardens off the main street in a residential area near to public transport routes, shops and local facilities.

There was a registered manager in place who had been appointed since the last inspection in March 2015. 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.

During the inspection the number of staff available at the home to support people’s needs was reviewed by the provider following an incident where staff were not continually present in one part of the home for a period of twenty minutes. The registered manager produced a written report for CQC which gave details of what had happened and the steps they had put in place to ensure this did not happen again.

The registered provider had robust procedures in place to make sure people were protected from abuse. These procedures were subsequently followed where people were found to be without staff to support them in one part of the home. The registered manager made a referral to the Local Safeguarding Authority for further enquiry and followed their requirements.

People who used the service, and family members, were complimentary about the standard of care provided. They told us the staff were friendly and helpful. We saw staff treated people with dignity, compassion and respect and people were encouraged to remain as independent as possible.

The staff team received a good level of training and support that enabled them to meet people’s care needs effectively.

All the care records we looked at showed people’s needs were assessed before they moved into the home and we saw care plans were written in a person centred way. The service supported people to remain as independent as possible whilst taking actions to minimise the risk of harm or injury.

The registered provider had an effective recruitment and selection procedure in place and carried out robust checks when they employed staff to make sure they were suitable to work with vulnerable people.

We saw the home had in place personal emergency evacuation plans displayed close to the main entrance and accessible to emergency rescue services if needed.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported to take medications, encouraged to have regular health checks and were accompanied by staff to hospital appointments and emergencies.

People’s nutritional needs were assessed and plans of care drawn up if they were at risk of malnutrition or choking. The cook demonstrated that she had an extensive knowledge of people’s likes and dislikes and prepared a selection of wholesome and popular meals to cater for people’s tastes.

We found the home was clean and fresh with cleaning schedules in place to prevent the spread of infection.

Information about planned activities for the week had been displayed on a notice board in the main communal area for people to see. During our inspection we found the registered provider had given priority to a variety of interesting activities taking place both inside and away from the home and more were planned.

We saw the registered provider had a complaints policy in place and this was clearly displayed for people to see.

CQC monitors the operation of the Deprivation of Liberty Safeguards [DoLS] which applies to care homes. The Deprivation of Liberty Safeguards are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. We found the registered provider was following legal requirements in the DoLS.

The registered provider had a robust quality assurance system in place and gathered information about the quality of their service from a variety of sources including people who used the service and their family and friends. The registered provider’s organisation collected this information and provided additional oversight and monitoring of the home. The staff and registered manager reflected on the work they had done to meet peoples’ needs so they could see if there was any better ways of working.

This inspection was carried out by one inspector. We met with 15 people who used the service and observed their experiences of care to support our inspection. Not every person we met was able to talk with us due to living with dementia or other health conditions. We spoke with the regional manager, a registered manager from another service operated by the same organisation who was supporting the deputy manager, ten staff and eight relatives and friends.

We considered our inspection findings to answer questions we always ask:-

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Below is a summary of what we found. If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

There were concerns with the management of medication, including administration and recording. We found the arrangements in place for the management of medication left people at risk of not getting the treatment they needed.

We found care records were not kept securely.

We saw information was missing from people care records; for example, support plans, risk assessments and photographs.

We found there was an assessment completed of the needs of people who were living at the home.

We saw people were cared for in an environment that was clean and hygienic.

We found call bells were not being responded to in a timely manner and where people could not access call bells, hourly checks were not maintained.

At the time of the inspection, there was no one at the home subject to an authorisation made under the Deprivation of Liberty Safeguards.

There were quality checks and audits completed to ensure procedures were maintained. However, we found that they were not robust.

Is the service effective?

We found the personal needs of people who lived at the service were not met and we found actions required to ensure the welfare of people at the service were not always completed. One person told us they rarely received support with showering and said, 'I used to have a shower every day.'

We had a mixed response from people we spoke with. Some told us they were happy with the care being delivered and their needs were met, while others were less positive.

We saw people walking around the home freely and making their own decisions about where they wanted to go, including some people going out to the local shops with a staff member.

Staff had received appropriate training to meet the needs of the people who lived at the home.

We saw people had a choice of where they ate meals and what they had, although one person was not aware that a dining room existed until the day of the inspection. Meals were found to be nutritious and in adequate quantities. Refreshments were available throughout the day.

Is the service caring?

During the day and we saw some positive interactions taking place and staff responding in a kind manner to people who lived at the home. Two people we spoke with said the staff were lovely and caring. One said, "They (staff) would do anything for you."

Is the service responsive?

We found that the provider had not responded to the requests of relatives when they were concerned about the welfare of their family member.

We saw limited activities taking place for the majority of people who lived at the home on some days. Although we saw a range of activities that were available on other days.

We found that complaints were listened to. We saw evidence of this from the regional manager during the inspection.

Reviews were carried out to make sure the people's care and treatment needs had not changed. This helped ensure staff supplied the correct amount of care and treatment. However, we found that this had not always occurred.

Meetings had not taken place with staff to discuss the running of the service and to ensure the service was responsive in meeting the changing needs of people who used the service since November 2013, although one staff member said one meeting had taken place to update all of the staff on recent changes.

Is the service well-led?

There was no registered manager in post at the home, although we were told that a new manager had been appointed. The deputy manager was overseeing the service with support from another local manager and also the regional manager.

Bed rails were put into place without the agreement of people, their representatives or professionals.

We found that staff had received appropriate training.

People and relatives we spoke with knew who to contact if they wanted to complain.

We found people who used the service understood the care and treatment choices available to them. People's needs were assessed, and the planning and delivery of care and treatment met their needs and protected their rights. We spoke with four people who lived at Birchwood Court. Everyone said they liked living there. One person said, "Very nice; comfortable." Another said, "The staff are very helpful."

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

Three people who we spoke with were happy with the support they received with their medicines. People told us 'I get my medicines morning, lunchtime and teatime, I can't grumble' and 'if I needed a doctor the girls would fetch him'.

Overall, we found that medicines were managed in a safe way.

We saw the manager and regional manager undertook regular audits of the services provided. There were arrangements in place to gain additional feedback about the services provided through the use of surveys of people who lived at Birchwood Court, their relatives and visiting professionals.

We were told that one person managed their own prescribed creams; however the appropriate risk assessment had not been completed to ensure that they could do this safely.

On the day of our visit we found 41 people were living at Birchwood Court, eight of which required nursing care.

We found people's needs were assessed and the planning and delivery of care and treatment met their needs and protected their rights.

We found appropriate staffing arrangements were in place in order to safeguard the health, safety and welfare of people using the service.