The inspection took place on 15 December 2015 and was unannounced. The home was previously inspected in August 2014 and during this inspection we identified a breach of legal requirements relating to the safe use of equipment. Lifting equipment is serviced and tested under the Lifting Operations and Lifting Equipment Regulations 1998 (LOLER) and should be serviced every six months. We identified that equipment had not been serviced within the above timescale. We undertook a focussed inspection of 7 April 2015 identified that the provider had not followed the plan which they had told us would be completed by 31 March 2015. This meant that Birch Avenue continued to be in breach of legal requirements. When we visited on 15 December 2015, we found the provider had addressed these concerns.We found that all slings and hoists had been checked by LOLER and saw reports to this effect dated 21 April 2015 and 16 May 2015. We also saw a daily audit which contained information about the sling being in good repair, if the label was readable and the sling description and size. This audit was checked on a weekly basis by senior staff and any actions noted and resolved.
Birch Avenue is a one-storey purpose built home and provides nursing care for 40 older people with dementia. The home has four, ten bedded, 'bungalows' with an interlinking corridor surrounding a large garden and patio area. Each unit has a communal lounge and dining room. All 40 bedrooms are single and have en-suite facilities. There is a central kitchen and laundry.
The service had a registered manager in post at the time of our inspection. 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 registered manager was supported by four senior staff known as clinical educators. Their role was to support each bungalow and ensure day to day effectiveness of the service.
People received their medicines safety and appropriately. However, some medicines were not always recorded correctly. For example, we looked at Medication Administration Records belonging to five people and found there were gaps in two people's records where some medicines had no signature or reason to indicate why they had not been administered. We informed the registered manager and the management team who began to address this.
We looked at care plans and found they contained up to date risk assessments. Any potential risk associated with a person’s care was recorded and actions in place offering guidance for care staff regarding how to minimise the risk.
Through our observations and by speaking with people, we found there were enough staff available throughout the service to meet people’s needs.
The service had a safeguarding policy which identified what they would do if they suspected abuse, what it was and how to report it. We spoke with care workers who told us they had received safeguarding training and could explain the process to us.
We saw records indicating that staff had completed training relevant to their roles. We spoke with staff who confirmed this. Staff felt the training was useful and gave them the skills they required.
The service was meeting the requirements of the Mental Capacity Act 2005.
People were offered a choice of meal at lunch time and drinks and snacks were provided throughout the day.
We looked at peoples care plans and found that relevant healthcare professionals were involved in their care when required.
During the inspection we saw staff interacted well with people. They were knowledgeable about maintaining privacy and dignity and respected people.
We looked at records in relation to eating and drinking and found that one person's care plan stated the person had lost quite a lot of weight in a short space of time. We did not see any evidence that this had been followed up. However, other care plans we viewed were in depth and reflected each person’s needs well.
The provider had a complaints procedure and people felt at ease to raise concerns. People felt confident that they would be listened to.
We saw regular audits took place to check the quality of service provision.
People were involved in the service and their views were sought.