Archived: Birch Holt Retirement Home

We carried out an unannounced comprehensive inspection at Birch Holt Retirement Home on 10 and 12 October 2016. Breaches of Regulation were found and the service continued to remain in special measures following a previous rating of Inadequate in November 2015. As a result we undertook this inspection on 27 and 28 March 2017 to follow up on whether the required actions had been taken to address the previous breaches identified. We found some improvements however risks still remained.

A manager was in post, however due to ongoing Registration applications neither the provider nor manager was registered with the Care Quality Commission (CQC) and this is currently an unregistered service. The CQC are taking action to address this matter. A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

The ratio of care staff to people on each shift had improved since our last inspection. However there were examples of where the poor management of short notice unavailability of staff and their deployment impacted on responsiveness and the smooth running of the service.

The provider had not undertaken all appropriate checks on staff to ensure their suitability for employment.

We saw examples of poor staff practice in regard to infection control whist they undertook routine care tasks around the home.

Risks related to people’s safety had not always been mitigated effectively. For example with regards to specialist care equipment.

The provider had not taken steps to ensure they were fulling their legal responsibilities in regard to the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS).

The systems the provider used to track staff training requirements had improved however we found examples where some staff had not completed training in a timely manner. Staff supervision and probationary meetings provided limited feedback that was designed to develop staff’s performance and capability.

We found examples within the service where the culture and staff approach did not consistently promote people’s dignity.

The provider had not made adequate provision to ensure people with the highest care support needs had their social needs met.

Although with support from an external consultant the provider’s quality assurance systems had improved these had not been effectively used by senior staff to provide them with clear oversight of the service.

Despite the concerns we identified during our inspection people wanted to communicate with inspectors that they enjoyed living at Birch Holt Retirement Home and had many positive comments about the service provided.

The management of medicines had improved and people were receiving safe and appropriate support with their medicines. Senior staff had worked collaboratively with the pharmacy service the provider used to establish safe effective systems.

People told us staff were kind and we observed positive interactions between people and staff. We observed various meals, people told us they enjoyed the food and looked forward to coming to the dining room to spend time with others.

At the last comprehensive inspection this provider was placed into special measures by CQC. At this inspection there was not enough improvement to take the provider out of special measures. There were a number of breaches of the regulations. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after all legal requirements have been fulfilled.

We carried out an announced comprehensive inspection at Birch Holt Retirement Home on the 3 and 5 November 2015. Breaches of Regulation were found and the service was placed in special measures. As a result we undertook an inspection on 10 and 12 October 2016 to follow up on whether the required actions had been taken to address the previous breaches identified. Although we found some improvements in areas where we had previously identified concerns at this inspection we found significant risks still remained.

A registered manager was in post. 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 and associated Regulations about how the service is run. However at the time of our inspection the registered manager was absent from work and the provider’s deputy manager had the day to day responsibility for the service.

There were not always sufficient numbers of staff on duty to keep people safe and support their individual needs.

The provider had not protected people’s safety by ensuring effective management of medicines. There were multiple concerns related to the administration of people’s medicines, for example appropriate guidance was not always available for staff when supporting people with their ‘as required’ PRN medicines.

Risks related to people’s safety had not always been mitigated effectively. For example with regards to accidents and incidents and the setting of specialist care equipment.

The provider had not taken adequate steps to ensure the service was appropriated cleaned. Areas of the service were seen to be grubby and required cleaning.

The provider had not undertaken all appropriate checks on staff to ensure their suitability for employment or specific tasks such as driving people to appointments.

The provider had not taken steps to ensure they were fulling their legal responsibilities in regard to the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS).

The provider had not sought timely health care intervention for a person whose body weight had fallen.

The systems the provider used to identify staff training requirements had not been effective in ensuring all staff had received the training in a timely manner. Staff supervision minutes provided limited feedback that was designed to develop staff’s performance and capability.

The design of some areas within the service were not suitable for their use, for example narrow corridors which were used to move mechanical lifting equipment.

There were several examples within the service of culture, staff approach and physical environment which did not consistently promote people’s privacy or dignity.

The provider had not made adequate provision to ensure people’s social needs were met. People told us the routines of staff were task orientated and fixed to predefined times.

The provider had made limited improvements to their quality assurance systems since our last inspection. This meant that they did not have clear oversight of the service and the areas which required improvements.

People told us staff were kind and we observed positive interactions between people and staff.

We observed various meals, people told us they enjoyed the food and looked forward to coming to the dining room to spend time with others.

The overall rating for this provider is ‘Inadequate’. At the last comprehensive inspection this provider was placed into special measures by CQC. At this inspection there was not enough improvement to take the provider out of special measures. CQC is now considering the appropriate regulatory response to resolve the problems we found.

Full information about CQC's regulatory response to any concerns found during inspections is added to reports after all legal requirements have been fulfilled.

Relatives we spoke with complimented the home on its caring relaxed atmosphere. One relative described the situation for their relative before coming to the home and described the change as 'giving them their life back'.

We saw that there was a detailed policy in place regarding safeguarding vulnerable adults and whistle blowing. These include a checklist for the action to take if anyone suspected abuse was occurring. Staff were able to tell us about the potential form of abuse and were able to apply this to the people who use the service. They showed genuine concern for the people who use the service.

People told us they were very comfortable living in Birch Holt. One person said, 'I can do what I like when I like, and the food is very good.' We found evidence that people were encouraged to make choices and observed people being treated with respect and dignity. A visitor said, 'There is a lovely family atmosphere.'

We examined four care plans, and found that people living in the home and their relatives were involved in making decisions about the care provided. We spoke with one of the care workers and they were able to demonstrate a good understanding of people's needs and how these were met.

We looked at staff files and the training and supervision records. Staff told us they received training and supervision to help them provide the care and support people needed and wanted. We looked at the records for staff we spoke with and found they had attended relevant training.

There were a number of systems in place to review the quality of service being provided at Birch Holt. Questionnaires were used to capture how people felt about living in the home. There were six monthly meetings with people, which ensured their needs were met, and we saw there were day to day discussions about the care provided.