Birch House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We assessed all the quality statements within the key question of safe. Staff and leaders were able to identify situations that amounted to safeguarding. There were some shortfalls in the assessment of risks to people, which were immediately addressed during the assessment process. Staff had ongoing training but some staff were more skilled than others in supporting people. Medicines were administered, stored and recorded safely. Staff were recruited safely and there were enough staff to support people. Accidents and incidents were reviewed and actioned. The environment was clean and regular checks were made to ensure it remained a safe environment for people.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their relatives told us they felt safe to raise concerns with the service. One person said, “There are a number of staff who I can talk to”. A relative said, “Staff are always chatty. I can talk to them but I’ve not had any issues”.

Staff told us the registered manager was approachable and therefore they felt comfortable raising any concerns about people’s safety with them. Staff were confident action would be taken by the registered manager as a result.

There were systems to record, investigate and respond to accidents, incidents and events. For example, when a resident tripped on decking but came to no harm, staff were reminded to place a wet floor sign to advise people and staff of the potential hazards. The provider was responsible for other care homes for adults with learning disabilities. Any lessons learned were shared between the providers services.

Relatives told us when people had moved to Birch House they had settled well and more quickly than they had anticipated.

Staff told us that before people moved to the service, they had the opportunity to visit and meet the other residents and staff. This was to help people decide if Birch House was the right place for them to live. People were referred to healthcare professionals when appropriate. Staff were knowledgeable about people’s needs. This included people’s health care needs and how these impacted on the person’s daily life.

People were supported to access the health care support they needed. Guidance given by health care professionals was available to staff so they could act on it. People had hospital passports which contained important information about the person and their health to share with health professionals. The provider had identified that some of the information in people’s hospital passports was overdue for review and therefore did not contain up to date details about the person.

People told us they could talk to staff they knew well if anything was upsetting them. One person told us that sometimes they got upset and angry and shouted at staff. This person said staff never shouted back at them in response. Relatives said their family members were kept safe and from avoidable harm. Comments included, “I can trust the staff. I always feel comfortable at Birch House” and “They are absolutely safe and secure at Birch House”.

Staff had received training on how to recognise different forms of abuse. They understood their responsibilities to challenge a staff members poor practice and report their safeguarding concerns to a senior member of staff or the registered manager. Also, to make a record of their concerns so they could be investigated. Staff felt confident if they raised concerns they would be acted on by the registered manager. The registered manager told us they had a positive working relationship with the local authority and were confident to contact them for advice and to report concerns.

We observed people were familiar with staff which helped them to relax and feel safe. Staff supported people with safe practice whilst allowing them to maintain their routines and freely move around their home. Staff responded appropriately to people in a way they could understand which helped people to feel safe and reassured. The contact details of external agencies that staff could report their concerns to were on display in the office.

There were processes to monitor, report and escalate concerns about people’s safety. Staff’s understanding of safeguarding was checked at monitoring visits. Applications had been made under the Mental Capacity Act to ensure that any deprivations of a person’s liberty (DoLs) to receive care was in their best interests and legally authorised. However, information contained in one person’s DoLs had not been accurately transferred to their care notes. This meant staff did not have the right information about this person. This was rectified by the registered manager during the inspection.

People were able to pursue some of their interests, maintain important relationships and to go out on trips through positive risk taking. Relatives told us staff understood the potential risks in their family member’s care. This included any health conditions or anxieties the person may have. Comments included, “Staff know what to do if my family member has an epileptic seizure”; “Their keyworker has worked hard to understand them. They know what makes them stressed and how to calm them”; and “Staff know what to do if they have a ‘melt-down’. There is no restraint”.

Staff understood potential risks to people in their daily lives and how to act on them. There was a mix of staff available each day. Some of these staff had supported people for many years and knew people well and any changes in their presentation that may be of concern.

We observed staff being vigilant when people who were unsteady on their feet moved around their home. Staff kept a discreet eye on people who liked to spend time outside to ensure their on-going safety.

Although the majority of risk assessments contained information to guide staff about how to minimise identified risks to people, there was some inconsistency in this practice. One person’s risk assessment with regards to seizures was not comprehensive. Assessments of risk were not detailed about the support people may need during the night. Staff were not easily able to access some risk assessments as they had not been uploaded to the electronic system staff used to guide them about people’s care needs. These shortfalls were immediately addressed by the registered manager.

People and relatives did not raise any concerns with the safety of the building. A relative told us, “She has everything in her bedroom she needs”.

Staff told us a maintenance person was available when needed and came promptly when called.

We did not see any hazards in the environment and people were able to access all areas of their home safely.

The provider had processes in place to make sure the premises were safely maintained. There were regular visual checks of the premises to ensure it was safe and clean. The boiler and electrics were regularly serviced together with fire equipment. There was a programme of fire drills to ensure staff knew what actions to take in the event of a fire. A fire risk assessment had been undertaken by an external provider in 2024 and recommendations actioned.

Relatives told us there were enough staff to support people including on a one to one or two to one basis. However, there were mixed views about the effectiveness and skills of the staff team. Comments included, “Staff have the right skills”; “Staff spend a lot of time sitting around the table or sofa talking to each other”; and “Some staff are more skilled at supporting people than other staff”.

Staff said there were sufficient staffing levels during the day and at nighttime. Staff who were new to the service told us they had shadowed existing staff to get to know the people who lived there. They said they had regular training and were well supported by one another and the registered manager.

We saw there were the right number of staff available according to people’s assessed needs and agreed support hours on both days we visited the service. However, we observed there were differences between staff in how skilled and effective staff were in engaging people in communication and things they enjoyed doing.

Appropriate checks were carried out to ensure that staff recruited to the service were suitable for their role. This included obtaining a person’s work references, a full employment history, right to work in the UK and a Disclosure and Barring Service (DBS) check. The DBS helps employers make safe recruitment decisions and helps prevent unsuitable people from working with people who use care and support services. Staff had undertaken training in the wide range of strengths and impairments people with a learning disability and or autistic people may have. Staff training was monitored by the registered manager and provider to ensure staff were kept up to date with current practice.

People and relatives said the service was clean. Comments from relatives included that the service was, “Happy, warm and clean”. People told us they did their own laundry.

Staff told us they had enough personal protective equipment (PPE) such as gloves and aprons, to make sure they and people they provided personal care to were kept safe from the risk of infection.

We observed that the home was clean throughout. PPE was available to staff such as in bathrooms and the laundry room and we saw staff were using it correctly. There were hand washing facilities and peddle bins in the laundry room which help to promote hand hygiene.

The provider had systems and processes in place to assess and manage the risk of infection. Cleaning was undertaken daily and infection control audits undertaken regularly so any concerns could be addressed.

People and relatives told us staff gave support to people to make sure they took their medicines as prescribed.

Staff who gave people their medicines told us they felt confident to do so as they had received medicines training. This included training in specialist medicines that were prescribed to be taken as and when needed (PRN). Staff knew the protocol of when to give PRN medicines, how they should be given and when to call for additional medical assistance. Staff said people’s medicines were regularly reviewed with their doctor to evaluate the efficacy of medicines being taken. As a result, staff said the medicine for one person was being gradually reduced. This action is in line with STOMP (stopping over medication of people with learning disability and autistic people).

Medicines were stored, administered and disposed of safely. Medicines were kept securely, and clear records kept of medicines administered. People received their medicines from senior care staff who were trained and assessed to ensure they followed the providers' medicines policy and procedure. There were checks of medicines and audits to identify any concerns and address any shortfalls.