Birchwood

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.

Birchwood is a care home which accommodates up to 15 people with physical disabilities and sensory impairment. At the time of our inspection 14 people used the service.

People’s experience of using this service:

We found breaches of regulations 12, 13 and 19 of the Health and Social Care Act (Regulated Activities) Regulations 2014. We have made recommendations about risk assessments, safeguarding training, infection control. People were not always protected from the risk of potential harm. Actions taken by the provider in response to allegations of abuse were not always robust, timely or effective to protect people from reoccurrences of these incidents. The service’s management of environmental, equipment-related risks and safety checks were inconsistent and did not comply with health and safety requirements. People did not always receive their medicines as prescribed. Medicines were not always stored safely and records were not in line with national guidance. Staff recruitment checks regarding gaps in employment history and disclosure and barring service (DBS) were not always followed-up and risk assessed in accordance with the provider’s policy and procedure. People’s risk assessments met their individual needs.

We found a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. The service did not always report notifiable events to Care Quality Commission (CQC) in line with requirements. We found the service had not notified us of nine medicines administration errors which were reported to the local authority safeguarding team. We have made a recommendation about quality assurance and audit processes. Quality monitoring checks did not always effectively identify or address areas requiring improvement. Staff were committed to people using the service and said they felt supported by the current registered manager and team leaders. The service engaged with people to gain their feedback and worked effectively in partnership with volunteers and health and social care professionals to meet people’s needs.

We have made recommendations about the environment and facilities of the service to meet people’s needs and about equality monitoring for staff. Some equipment was faulty and some people’s furniture was in disrepair. The provider had implemented technology to support people’s independence. 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 supported this practice. People received support from staff who received ongoing training, supervision and support.

Staff treated people with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Relatives, relevant professionals and advocates were involved in people’s care and treatment.

Care planning documentation was up-to-date and met people’s needs. The registered manager and staff demonstrated detailed knowledge of people’s needs and preferences. The service accommodated people’s interests and facilitated a range of activities. Complaints were logged and investigated.

Rating at last inspection: The service was registered by CQC with a new provider on 30 April 2018. This was the first inspection visit to the service under the new provider.

Rating at last inspection:

The last rating for this service was requires improvement (published 16 September 2017). Since this rating was awarded the registered provider of the service has changed. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care.

Enforcement:

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

Follow up:

We will continue to monitor information and intelligence we receive about the service to ensure good quality is provided to people. We will return to re-inspect in line with our inspection timescales for Requires Improvement services.

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