Birchwood

Updated 10 May 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 2 inspectors and an Expert by Experience, who made calls to relatives after the inspection.

An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Birchwood is a ‘care home.’ People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Birchwood is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 2 people who used the service to get their feedback on care. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We spoke with 10 staff which included the registered manager, deputy manager, team leader, senior support worker and 5 support workers. The Group Head of Quality Assurance and Inspection was present on behalf of the provider. They helped facilitate the inspection.

We reviewed the environment and records relating to people’s care, which included 11 care plans, 8 medicine records, meeting minutes, 3 staff recruitment files, health and safety, infection control, multiple staff training and supervision records.

After the inspection we continued to review information sent to us, which included audits, policies, training records. We spoke with 7 relatives by telephone after the inspection and requested feedback from 3 professionals involved with the service.

Updated 10 May 2023

Birchwood is a residential care home providing the regulated activity accommodation for persons who require nursing or personal care to up to 15 people. The service provides support to people with a learning disability and or physical disability. At the time of our inspection there were 14 people using the service.

Birchwood accommodates people across 3 bungalows, each of which has separate adapted facilities. All of the bedrooms have ensuite facilities of a bath or shower. There is a self-contained flat in 1 of the bungalows.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right Support:

Whilst people were supported, enabled, and encouraged to make day to day choices and their independence was protected. We found people were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Risks to people were not mitigated, including infection control risks. Safe medicine practices were not promoted.

Right Care:

People’s changing needs had not been reviewed to ensure the required staffing levels were provided. Staff worked long days followed by sleep in duties and on call. Training had not been completed in line with people's assessed needs. As a result, staff did not always have the relevant skills or experience to ensure people received the appropriate care. Therefore, staff did not consistently understand how to ensure people got the right care.

Right Culture:

People were not always supported by a management team and staff who promoted a culture of inclusivity to empower people. The service was not effectively managed and monitored to promote positive outcomes for people. This resulted in people living in a service that was not suitably clean, hygienic, and maintained, with equipment not replaced when damaged.

A person told us they felt safe and described staff as “very good.” Relatives were happy with the care provided. They felt confident their family member got safe care. They described staff as “Friendly, welcoming, caring” and gave examples where they felt staff had gone above and beyond what is expected of them by arranging home visits, celebrating birthdays, supporting their family members with an activity and planning holidays. Relatives gave us mixed feedback on the staffing levels and cleanliness of the service.

People’s health needs were met, and relatives felt involved in their family member’s care. We observed positive relationships between a staff member and the people they supported, which demonstrated mutual respect.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 26 June 2019). 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 the provider remained in breach of regulations.

At our last inspection we recommended the provider works to best practice in relation to infection control, improving the environment, managing risk in line with national guidance, and implement robust and effective quality assurance and auditing systems. At this inspection we found the provider had not acted on the recommendations and had not made the required improvements.

Why we inspected

We carried out an unannounced comprehensive inspection of this service in April 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, safeguarding service users from abuse and improper care, recruitment of staff and making the required notifications to us.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, and well-led sections of this full report. The overall rating for the service has changed from requires improvement to inadequate. 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 Birchwood on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, staffing levels, staff training, infection prevention and control, cleanliness levels, maintenance, and upkeep of the service, consent, management, and monitoring of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures.’ This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.