The Care Quality Commission (CQC) has rated a care home in Buckinghamshire as inadequate and placed it into special measures following an inspection in March.
CQC inspected Birchwood, in Chesham to follow up on the actions inspectors had previously told the service to take regarding managing risk and infection control practices.
Birchwood is a residential care home providing support to people with learning disabilities and physical disabilities. At the time of this inspection there were fourteen people using the service.
The service's overall rating dropped from requires improvement to inadequate following the inspection as did the ratings for safe and well-led. The rating for effective dropped from good to requires improvement. CQC didn’t look at caring and responsive at this inspection.
The service is now in special measures. This means CQC is closely monitoring it, and it will be inspected again to assess whether improvements have been made.
Rebecca Bauers, CQC’s director for people with a learning disability and autistic people, said:
"Inspectors found poor leadership had continued to seriously undermine the culture at the service which resulted in widespread and significant shortfalls in people's care and treatment.
"We found a number of examples where people were at risk of unsafe care because staff didn’t always have the relevant skills or experience.
“Staff didn’t always follow guidance from specialists for example, on one person's care plan for a flexible feeding tube (PEG feeds) into their stomach which hadn’t been carried out correctly.
"Staff didn’t always undertake regular night checks. One person required hourly night checks, but records showed there were often gaps sometimes up to five hours. A person’s bed rail wasn’t working effectively, and it wasn’t repaired at the time of the inspection six days later.
"We also found that the service had completely failed to address the poor standard of cleanliness and state of repair of the service. Staff just accepted the conditions that people had to live in and they had to work in. Ovens and microwaves were caked in burnt food and dirt. There were dirty sinks and shower plugs were filthy and there was an unpleasant odour throughout the service.
“The poor leadership inspectors identified also had a detrimental effect on the staff. The service hadn’t reviewed if staffing levels were appropriate to meet people's needs. Staff worked long days sometimes followed by 'sleep in duties' and then were asked to be on call and to carry out domestic cover such as cleaning and cooking.
"What we found at Birchwood is unacceptable and following the inspection we fed back to the service who are now very aware of what needs to be addressed. We will continue to closely monitor this service and we’ll not hesitate to take further action if we’re not assured people are safe, or if improvements aren’t made.”
Inspectors found:
- One person was at risk of malnutrition because they weren't weighed every two weeks as required, another person was given the wrong prescription thickeners in their drink.
- People's changing needs had not been reviewed to ensure the required staffing levels were provided.
- Up-to-date speech and language therapist guidance was not reflected in two people's care records.
- Some people were prescribed transdermal adhesive patches which are placed on the body to deliver a specific dose of medicine through the skin. Transdermal patch records weren’t in use to show where the patch was applied on the skin and the old patch removed after each administration.
- People's night-time personal emergency evacuation plan (PEEP's) indicated that some people required two staff to evacuate the building. The registered manager hadn’t considered how two staff plus a sleep-in staff member could safely evacuate people at night. This level of staffing had the potential to put people at risk.
However,
- Relatives told us they engaged in their family members care and kept informed of changes in their health and well-being. They told us the service sought timely medical advice.