Birtley House Nursing Home

Birtley House Nursing Home is a residential care home providing personal and nursing care for up to 47 older people in one adapted building. At the time of our inspection, 33 people were living at the home. The home is also registered to provide personal care for eight independent living flats, however, none of these people were receiving a regulated activity at the time of our inspection.

People’s experience of using this service and what we found

People said they felt safe living at the home. Their risks were identified and assessed, with guidance for staff on mitigating risks. Staff followed this guidance. Staffing levels were enough to meet people’s needs. One person commented, “My feeling is that staff come promptly. I need to ring the bell at night-time because I use a bed pan and staff come quickly”.

Medicines were managed safely. One person said, “Yes, I receive my medicines and staff explain any side effects to me”. The home was clean and smelled fresh. Staff had been trained in infection prevention and control. Lessons were learned if things went wrong.

People were positive about the training and experience of staff who supported them. One person said, “They all treat you as if you are a friend; that’s very important”. Staff had regular supervisions and an annual appraisal. One staff member said, “The whole environment is so lovely to work in, so homely. Everyone is nice and friendly”.

People were supported to have a healthy diet and with their nutrition and hydration needs. The lunchtime meal was a sociable occasion. Special diets were catered for. People had access to a range of healthcare professionals and support. Premises were suitable and comfortable and met people’s needs. A relative said, “She’s comfortable here and gets the attention she needs”.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were looked after by kind and caring staff who knew them well. People were encouraged to be involved in decisions relating to their care and were treated with dignity and respect.

People received personalised care that was responsive to their needs. Activities were organised according to people’s preferences and interests. People were encouraged to go out if they wished and had access to the gardens and grounds of the estate. Many activities involved people from the local community. People spoke highly of the activities on offer. A relative said, “I looked at 21 different places and this was head and shoulders above the rest, down to how Christmas, Easter, theme nights and the seasons are celebrated”.

People could spend the rest of their lives at the home, if their needs could be met and this was their wish.

People considered the home was well-organised and commented on the pleasant working atmosphere amongst staff. People appreciated the community feel at the home. The directors of the provider and the registered manager provided a visible presence at the home. People were encouraged in their involvement and development of the home and their feedback was encouraged.

Staff felt well supported in their roles. Staff meetings provided opportunities to reflect on people’s care and anything that might be done differently.

A system of audits monitored and measured all aspects of the home and were used to drive improvement. There were strong links with the community, for example, people with a learning disability worked in the grounds to produce vegetables and flowers which people enjoyed. The home worked proactively with the NHS and Social Services.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at the last inspection

The last rating for this service was requires improvement (published 2 July 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Birtley House Nursing Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Birtley House Nursing Home is registered to provide accommodation for up to 47 older people who require residential or nursing care. At the time of our inspection there were 39 people living at the home. The home also provides domiciliary care for eight independent living flats, however, none of these people were receiving a regulated activity at the time of our inspection.

The inspection took place on 15 May 2018 and was unannounced.

The last inspection of Birtley House Nursing Home was undertake in January 2016 when it achieved an overall rating of Outstanding.

At the time of inspection there was not a registered manager 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 2008 and associated Regulations about how the service is run.’

The risks to people were documented but not with sufficient detail to provide staff with the guidance they needed in order to provide safe care and staff were not following the guidelines in relation to people’s care.

Staff did not understand how to apply legislation that supported people to consent to treatment and had not followed the principles and codes of conduct associated with the Mental Capacity Act 2005. Where restrictions were in place this was not always in line with appropriate guidelines.

Staff had not received regular supervisions that would enable them to carry out their duties. Appraisals had commenced for staff and would be ongoing.

We have made a recommendation that the environment is adapted to meet the needs of people to find their way to communal areas and their rooms.

People had care plans in place but these were not personalised to their needs. The provider had recognised this and implemented actions to address these.

People had a range of activities that they could choose to be involved in. There was a full activities programme that operated on a 5 day basis. Complaints and concerns were taken seriously and people knew how to make a complaint if they needed to. End of life care was provided sensitively and in line with people’s needs and preferences that help to ensure people had a pain free and dignified death.

People were supported by staff who knew the procedures to follow if they had witnessed or suspected abuse. People were complimentary about staff and said that they felt safe living at Birtley House. There was an up to date fire risk assessment and each person had a personal emergency evacuation plan (PEEPs) in place so staff would know how to safely evacuate them from the home if the need arose. Safe recruitment practice was followed that helped to ensure people were protected from unsuitable staff. The provider had carried out annual analyses of accidents, and incidents were monitored to enable the provider identify any trends and reduce the risk of repeated incidents.

People were treated with kindness and compassion by caring and dedicated staff and there was good interaction between staff and people. People were able to express their views and be involved in making decisions about their care, support and treatment. Staff respected and promoted people’s privacy and dignity and their independence was promoted.

At the time of our inspection there was not a registered manager in post to carry on the regulated activities. Quality assurance systems were in place to monitor the quality of service delivered, however, they were not fully robust. The provider was taking action to address this. People said that the home was well run. People and those important to them had opportunities to feedback their views about the home. People told us that they had regular resident meetings where they could put make suggestions about the home. Staff at the home worked with other related agencies to ensure that people received joined up care, treatment and support. The provider was aware of their responsibilities with regard to reporting significant events to the Care Quality Commission and other outside agencies.

During this inspection we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we asked the provider to take at the end of this report.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run.

People received excellent care in a way that was personalised and responsive to their changing needs. Risks to people were managed in a proactive way which enabled them to live independent and fulfilling lives. Staff worked closely with community health professionals and therapists to maximise people’s well-being. People felt safe at Birtley House Nursing Home and had positive and caring relationships with the staff who supported them.

People had total control over their lives and spent their time as they wished. The service offered a wide range of both group and individual activities that were meaningful to them and which had a positive impact on their lives. Visiting was unrestricted and people’s relatives felt included in the care of their loved ones.

People were provided with a variety of meals and the extensive menu catered for any specialist dietary needs or preferences. Mealtimes were often viewed as a social occasion, but equally any choice to dine alone was also fully respected.

People had confidence in the staff who supported them and felt safe in their care. People benefitted from a high ratio of staff which meant that they never had to wait long for assistance. Staff treated them with kindness and took steps to promote their privacy and dignity at all times.

End of life care was exceptional with the service consistently going the extra mile to meet people’s final wishes and ensuring their final days were lived comfortably surrounded by the people who knew and cared for them. The service had been commended by the National Gold Standard Framework for providing excellent end of life care.

Staff enjoyed working at the service and felt well supported in their roles. They had access to a wide range of training which equipped them to deliver their roles effectively. The registered manager was an excellent role model and there were sound systems in place to develop staff and promote reflective practice. Staff were proud to work at Birtley House Nursing Home and felt valued and empowered to deliver high quality care.

People benefitted from living in a well organised, forward thinking home where their needs were always put first. The culture of the home was open and people felt confident to express their views and opinions. The registered persons provided clear leadership and direction to staff and were committed and passionate about the quality of care provided. The skills of the registered manager had been recognised locally when she was awarded ‘Manager of the Year’. She was also actively involved in research and was a member of various local working parties and partnership groups such as a hydration programme with a local Wellbeing group.

Quality assurance processes were robust and action plans to improve the service were prioritised and completed quickly. Learning was shared from within and outside the organisation and community contacts were well established. National best practice legislation and local policies were referenced to set and measure standards of care.

We observed staff providing care and support to people in ways that were both friendly and professional. There seemed to be good relationships between people and staff and we saw many interactions when people were smiling and looked relaxed. Staff told us the manner in which care was provided was considered to be very important. We saw references to ensuring people's dignity was respected in their care plans. This meant the provider was taking steps to ensure the staff supported people in appropriate ways.

We found evidence people had been involved in their care. We saw their care was planned around their preferences and they were asked questions and given options.

We saw risk assessments had been completed for people and care plans had been regularly reviewed and updated to reflect people's changing needs.

The home had an up to date safeguarding policy and staff were able to clearly express the process to follow should they need to report any possible abuse.

We found the home had an effective system in place to monitor the storage, distribution and disposing of medicines. We also found the home had an effective recruitment system in place which had been followed when staff had been hired.

We did not inspect the eight independent living flats or the care provided to the people living in these flats.

In this report the name of four registered managers appear who were not in post and not managing the regulatory activities at this location at the time of the inspection. Their names appear because they were still Registered Managers on our register at the time.