Birch House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We assessed all the quality statements within the key question of safe. People’s holistic needs were assessed including the best ways to communicate with people. Staff supported people to access health professionals when needed to make sure people received the most appropriate care and support. There was effective monitoring of people’s health care needs. An area for improvement was identified in relation to ensuring people received the best outcomes through setting goals based on their dreams and aspirations. Decision making had not consistently followed best practice. Some decisions had been recorded without evidencing that people had been assessed to check if they could understand, retain and weigh up the information and communicate their decision about the matter concerned.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives said they were involved in their family members care and kept up to date with any changes in their well-being.

Staff said they knew people well and so were able to recognise any changes in their usual presentation. Staff described people’s preferred routines, the support people needed with their physical and emotional well-being and the best ways to communicate with them.

Assessments included all aspects of people’s physical, social and emotional well-being. There was guidance for staff about how to support people who had anxieties. This included how to recognise the early warning signs that people were getting distressed and what actions staff should take to maintain their well-being and safety. Assessments included communication passports and tools to guide staff about how people with limited or no verbal communication presented when they were happy, sad or in pain. However, some of this information was not readily accessible to staff. This was addressed during the inspection.

Relatives told us they were involved in reviews of their family members care which took place with a care manager from the local authority. These meetings were to review how people’s assessed needs were being met.

Staff understood people’s current needs and we observed they communicated with people using specific words or phrases that people could understand. Staff understood the importance of ensuring people had regular drinks and a healthy diet to maintain their health.

The provider had systems and processes in place to meet people's oral, continence, nutrition and hydration needs. However, we found that for people who used blood glucose monitoring machines these were not calibrated in line with the manufacturer’s recommendations. This was to ensure the equipment gave accurate readings.

People said staff supported them to attend the doctor. Relatives said staff supported people to attend all the health care appointments and checks they needed. This included keeping their vaccinations up to date and follow up appointments at the doctors. One relative told us, “Staff would know if he was unwell or unhappy as they know him well”.

Staff told us that when it had been identified that people were to transfer to or from the service, they shared important information about the person. Staff described how they were working with another provider to help a person make choices about the type of accommodation they would move to.

Care records were held using an electronic system with some documents in paper format which could be uploaded to the system for staff to access. This meant the service was able to share information if people moved between services. Hospital passports were available in paper format and could be easily handed to hospital staff if needed.

Relatives were very positive about how staff supported people with their health and to live healthy lives. Relatives told us that staff were particularly skilled in relation to people’s nutrition and diet. Comments included, “Staff are very conscious about people’s fluids and getting her to drink. There is always fruit available”; “Staff look after her diet whilst ensuring she has a treat. She was under the dietician and has lost weight”; and “She was told by the doctor she was prediabetic. Staff consulted with family and she has a balanced diet. She has not been diagnosed as diabetic”. Prediabetes means that a person’s blood sugars are higher than usual, but not high enough to be diagnosed with diabetes.

Staff told us some people found it difficult to make informed decisions about how to live a healthy life. This was because some people had limited understanding of the consequences of their actions on their health. Staff described how they supported people to make healthy choices with regards to what they ate and in encouraging people to go for walks. Staff told us that each person’s keyworker was responsible for ensuring people attended health care appointments.

Staff made a record of any health care appointments and their outcomes. This included visits with the doctor, consultants and by the chiropodist. Maintaining scheduled health care appointments helps to monitor any deterioration in people’s health.

Relatives gave mixed views about how the service improved outcomes for people. Some relatives said that people had opportunities to do all the things that mattered to them and other relatives that this approach was not consistent. These comments included, “The manager is trying to improve things for people, but often staff are sitting around and talking to one another. When things have improved it has been a bit of a battle”; and “There is a lack of opportunities and stimulation for people. People’s worlds are getting smaller and smaller”.

Staff said they knew people well and what things were important to them and this information was recorded in people’s care records. This knowledge helped staff to monitor people’s wellbeing. However, staff told us people did not have any goals set to specifically promote improved outcomes for people.

It could not be assured the provider’s person-centred planning system was always effective in ensuring people received the outcomes they wanted to achieve. This was because people had not been supported to identify their dreams, wishes or goals and what support and actions were required to help make them possible. This is an area identified as needing further improvement.

People were supported to make informed choices and encouraged to make decisions as much as they could for themselves. We observed staff checked with people before providing care and support to gain their consent. One person did not agree to the support being offered by staff. Staff respected this decision and returned later with the same request. This time the person agreed to the support staff offered.

Staff described situations when people had been assessed as not having the capacity to consent to a specific decision. In these circumstances staff explained that people’s representatives were involved, such as family members or health professionals, so the decision could be made in their best interests.

The provider’s action plan had identified that mental capacity assessments had not consistently taken place when decisions had been made with regards to people who may not be able to give informed consent. We found this to be the case at our inspection visit. There were some detailed assessments about people’s understanding of money which included if people could understand, retain and weigh up the information to communicate their decision. However, one person had an audible monitoring devise in their bedroom to keep them safe. However, there was no information about whether this person had the capacity to agree to this monitor being place in their room nor if the decision had been made in their best interest. The manager gave assurances that completing mental capacity assessment would be prioritised.