Birnbeck House - Care Home Learning Disabilities

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 one quality statement within the Effective key question. The score for this area has been combined with scores based on the rating from the last inspection, which was good. From our observations we were not assured that people were provided with appropriate care and treatment that met their needs and was person centred. This was a breach of the person centred care regulation. Individual care plans provided staff with the information they required to meet people’s need and preferences. However it was not clear if referrals were always being made where people could benefit from external professionals when their support needs changed. Relatives raised some concerns about the effectiveness of the service and whether person centred care was being provided. However, we also heard some positive outcomes for people had been achieved. People told us they had choice, however some would like to do more activities.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Care reviews did not always involve people and their relatives. One relative told us of a positive outcome of a person being supported by an advocate to receive more daily support for activities to stimulate them. However, the relative had concerns this support had not been provided. They told us “It hasn’t been implemented, certainly I haven’t noticed”. We heard one person had been placed on a modified diet, their relative didn’t feel this was working for the person and told us “It’s not person centred at all”. However, we also heard how a relative had shared their views in a meeting around the best way for new staff to get to know their loved one which had a positive impact, they shared [person] “used to be more challenging but is calmer now”. An advocate told us there had been delays in making required referrals to external health service, where these were needed. However, they told us care plans were clear and provided easily accessible information about the person and added “the likes and dislikes of [person] are respected”. We also heard environmental changes had been made for a person to ensure there was enough space to meet their moving and handling support needs, this also meant the person had the opportunity for increased interaction due to their location within the service.

Staff we spoke to could access care plans and information about the support residents want to receive, their likes and preferences. Staff told us they received handovers which covered the information they needed to support people. Staff could explain how they offered choice to people, in their preferred way, for example using objects of reference or pictures. They told us how they supported people to be cared for with dignity and respect. However, one member of staff told us they don’t support anyone with hearing aids while care plans we reviewed detailed some people do have a hearing aid. Not all staff we spoke to were knowledgeable about equality and diversity. The staff training records we reviewed confirmed some staff were due refresher training in this area. The interim manager confirmed the service improvement plan is being reviewed weekly and people’s activities are also in the process of being reviewed. During our assessment it was not easy to gain information on which people are being supported by external professionals and why. The interim manager told us there were quite a few professionals visiting the service, some had become involved due to safeguarding concerns that had been raised. Several people were having physiotherapy reviews and the provider’s positive behaviour support lead was visiting at least one person in the service monthly. The service was also supported by an advanced nurse practitioner. The interim manager told us they received support from senior managers, who undertook quality assurance reviews and audits. The service’s lessons learned log covered incidents and accidents, safeguarding, complaints, hospital admissions and medicine errors, the log was reviewed by senior managers. It wasn’t recorded on this log if information of concern had been shared with CQC or the local authority. The management team were aware some risk assessments were out of date and said they were updating these as they come across them.

People’s care plans were person centred and contained important information such as their likes and dislikes. Some referrals were being made, for example to the dentist, and GP, although it was not always clear other referrals were being made such as when people’s mobility changed or when individual support needs changed. Positive behaviour interventions were not being observed and from reviewing records it was not clear how incidents such as these were being recorded or what training staff had received to support people with this. Risk assessments were not in place but were needed in several areas for example for equipment such as bed and floor sensors, choking risks and showering risks. Where we raised specific risks during our assessment action was taken by the interim manager to put this in place.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Consent to care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.