Birch Hill Care Centre

We last visited the service in December 2015 where we rated the service as good. At this inspection we found the provider continued to meet all of the regulations we inspected against and had introduced a number of changes and improvements. We have rated the effective and well led key questions as outstanding so the overall rating for the service is outstanding.

Birch Hill is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection. Birch Hill accommodates up to 24 people, most of whom are living with dementia. There were 23 people living in the home at the time of the inspection.

There was an experienced registered manager in place. 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 service was extremely effective. Bespoke and innovative training was provided to staff to help them to understand the experiences of people living with dementia. Relatives were also supported to gain a greater understanding of how people might be affected by their dementia related condition. They learned about the person centred model staff followed to minimise behavioural disturbance and distress and maximise potential, quality of life and wellbeing.

Changes in practice and the environment showed staff had taken training and advice regarding dementia care best practice on board. Steps had been taken to minimise noise and improve lighting and there was great attention to detail in order to maximise the comfort of people living in the home.

Staff received regular supervision and appraisals and were well supported to carry out their roles effectively.

The nutritional needs of people were extremely well supported through personalised ordering of meals and flexibility in the provision of food and drinks. Snack shacks and hydration stations ensured people had access to food and drinks throughout the day, and food was available at all times of the day and night.

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

In addition to routine audits and quality assurance systems, the registered manager and deputy continuously looked at ways to develop the service and enhance the experience of people living in Birch Hill. The outcome of this was an extremely well-led service. They accessed various forums and networks to help them find new ways of working with the aim of improving care. There were numerous examples of new ideas being put into practice seen during our inspection. Staff felt extremely well supported and morale was good in the home. There was an ever present shared sense of purpose with all staff demonstrating that the needs and wishes of people living in Birch Hill were paramount.

People told us they felt safe at Birch Hill and systems were in place to monitor the safety of the premises and equipment. Medicines continued to be managed safely and there were suitable numbers of staff on duty.

Staff were caring and courteous. We observed numerous examples of compassionate care during the inspection and observed the privacy and dignity of people was maintained.

A range of activities were available and people were involved and included in decisions about the home wherever possible. The individual needs and preferences were taken into account when planning activities including the provision of early bird activities for early risers and evening activities for “night owls.” Staffing was planned around the needs of people using the service to ensure they could be supported at times convenient to them. Person centred care plans were in place which were up to date and regularly reviewed. A complaints procedure was also in place.

The inspection took place on 29 December 2015 and was unannounced.

The service was inspected in October 2013. At the time we found that people were not protected against the risk of unsafe or inappropriate care because accurate and appropriate records were not kept. At a follow up inspection in March 2014 we found that this regulation had been met.

There was 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 and associated Regulations about how the service is run.

People told us they felt safe. There were safeguarding policies and procedures in place and staff knew what action to take if abuse was suspected. They had received training relating to the protection of vulnerable adults. There were no ongoing safeguarding concerns and this was confirmed by the local authority safeguarding adults officer.

Risk assessments were carried out to ensure that people were protected whilst supporting them to remain as independent as possible. These included risks relating to their physical and psychological health, and assessments were reviewed regularly. Accidents and incidents were recorded and acted upon appropriately.

We saw that the building was well maintained and clean. Staff were aware of infection control procedures and had received regular training. Environmental risk assessments were carried out and safety checks of the building and equipment were completed on a regular basis. Emergency contingency plans were in place in the event of damage to the building or due to inclement weather.

People, staff and relatives told us there were enough staff to meet people’s needs. This was confirmed by our own observations. There was a training programme in place. Staff were trained in safe working practices and to meet the specific needs of people who lived at Birch Hill. This included additional training in dementia care and supporting people experiencing behavioural disturbance or distress.

Safe recruitment procedures were followed which meant that people were protected from harm. New staff completed induction and mandatory training prior to commencing work and then shadowed experienced staff. It was an expectation that all would complete their Care Certificate. New staff said they felt well supported and a staff handbook was provided.

Medicines were managed safely. Procedures for the safe administration of medicines were in place and regular audits were carried out. Staff had received training in medicines management and their competency had been assessed regularly by a registered nurse to ensure they were able to administer medicines safely.

People and visitors told us, and our observations confirmed that people were well cared for. Staff spoke kindly with people and privacy and dignity was respected. We saw that staff had received the necessary training to deliver care competently. A consent policy was in place and staff told us that the consent of people was always sought prior to any care being delivered.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure that people are looked after in a way that does not inappropriately restrict their freedom. The registered manager had submitted DoLS applications to the local authority for authorisation. Assessments of mental capacity had been carried out but the outcome was not always clear.

People told us that they were happy with the meals provided at the home. Menus were reviewed and rotated regularly. People were consulted about their food likes and dislikes. We observed a mealtime and saw that people were supported sensitively with eating and drinking, and that their dignity was maintained. Nutritional risk assessments were carried out and regularly reviewed.

We found that people were able to access a range of healthcare services and health concerns were acted upon promptly, with appropriate advice sought. Visiting professionals spoke highly of the service and staff.

The premises were adapted to meet the needs of people using the service. A new stair lift had been installed, in addition to the passenger lift. A safe internal courtyard garden was available to allow freedom of movement and to maximise independence while reducing risks to safety. We saw that some attention had been paid to dementia friendly design but found that there could be some improvements.

We observed that staff were caring. We saw that staff spoke kindly to people and were respectful and courteous. People and relatives told us that staff were caring. The provider had developed a booklet about how to support people with dementia. This was an example of best practice.

We read care four care plans and spoke with staff about the care available to people. Care plans were personalised, detailed and were reviewed monthly. The service had signed up to a dementia pledge run by the provider organisation. A booklet had been developed by the provider about how to support people with dementia. This was available to relatives and friends and was an example of best practice.

A varied programme of activities was in place and regular trips were planned using the service’s mini bus.

End of life care was good and we received positive feedback from a relative and district nursing services regarding the care provided.

There was a complaints procedure in place which was prominently displayed. The registered manager told us that no complaints had been received. There were a number of feedback mechanisms to obtain the views from people, relatives and staff. These included meetings and surveys.

The registered manager carried out a number of audits and checks to monitor the quality of the service. The provider also arranged regular quality monitoring checks by a senior manager employed by the organisation to ensure high standards of care were maintained.

People's personal records were updated to reflect their changing needs. Other records, such as audits were fit for purpose and all records were held securely.

People told us the food was good and they enjoyed their meals. One person said, 'I really enjoy my meals and we get a choice.' We saw people were supported to be able to eat and drink sufficient amounts to meet their needs.

The home was clean and staff had received training in infection control. People told us the home was always clean.

At the time of this visit there were enough qualified, skilled and experienced staff available to meet people's needs. Staff responded promptly to requests for assistance.

People's personal records were not always updated to reflect people's changing needs. Other records were fit for purpose and all records were held securely. Staff records were kept in an appropriate format.

We saw that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. People said they received medical and specialist attention when they needed it. They said there was a programme of activities and outings available.

People said staff were kind and caring and confirmed they were given the opportunity to comment on the service, change routine or raise complaints.

We saw relationships between staff and people were good and there was a relaxed atmosphere. We saw good interactions between staff and people during our visit.

Staff recruitment procedures were followed and appropriate checks were undertaken before staff began work.

There was an effective complaint procedure in place and people were aware of how to make a complaint. People were satisfied staff listened to their views.