Archived: Birch Court Care Home

Birch Court is a ‘care home’ providing accommodation, nursing and / or personal care for up to 150 older adults; some of whom lived with dementia. At the time of the inspection 71 people were living at the home across three separate units.

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

Recruitment processes were safely in place, but staffing levels were not safely or effectively managed. Observations during the inspection and feedback we received, confirmed that inadequate staffing levels was impacting the provision of care people received. One relative expressed that the home was "grossly understaffed."

People were not receiving a safe level of care, areas of risk were not robustly reviewed or safely managed. Care records contained information and guidance that staff needed to follow as a measure of managing risk and keeping people safe, but this was not always followed.

Infection prevention and control (IPC) measures and arrangements were not embedded and we were not assured that people were protected from risk. Both internal and external premises were unkempt, shortfalls were not identified or responded to in a timely manner.

Poor quality assurance and governance measures meant that the quality and safety of care people received was compromised. The provider did not ensure that quality performance measures were robustly in place, that areas of risk were safely managed, or regulatory requirements were complied with. Ineffective audits, tools and governance checks meant that the provision of care was not suitably assessed, monitored or improved upon.

Medication procedures had improved. People received their medicines by trained and competent members of staff, people received support with their medicines in line with administration guidance and ‘as and when’ (PRN) protocols were in place. However, we identified some areas that need strengthening. We have made a recommendation regarding this.

Staff were passionate about providing care and support that people needed but they told us they didn’t feel valued or supported in their roles. Staff expressed that they were under a lot of pressure, weren’t listened to when raising concerns about staffing levels and their well-being was impacted upon.

Rating at last inspection and update

The last rating for this service was ‘requires improvement’ (published 17 December 2019). We found breaches of regulation in relation to safe care and treatment and staffing. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made. We found the provider was still in breach of multiple regulations.

Why we inspected

We carried out an unannounced inspection to follow up on concerns we had received from the Local Authority in relation to staffing levels and the impact this was having on the quality of care people were receiving. The information The Care Quality Commission (CQC) received indicated that there were concerns around staffing as well as safe care and treatment.

Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

We looked at IPC 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 coronavirus and other infection outbreaks effectively.

Our report is only based on the findings in those areas at this inspection. The ratings from the previous comprehensive inspection for the effective, caring and responsive key questions were not looked at during this visit. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used to calculate the overall rating at this inspection.

The overall rating for the service has remained ‘requires improvement’. This is based on the findings at this inspection. We found evidence that the provider still needs to make improvements.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified breaches in relation to safe care and treatment, staffing, premises and equipment and good governance. Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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. We will request that the provider submits further action plans to determine if they have addressed the breaches of regulation we identified.

We will meet with the provider following the publication of this report to discuss how they will continue to make changes to ensure they improve their rating to at least ‘Good’. We will work with the local authority to also monitor progress.

Birch Court Nursing and Residential Home is split into five separate single -storey houses: Brook House; Moss House; Fern House; Bank House and Waterside House, each with the capacity to accommodate 30 people who need nursing, dementia, palliative, respite or residential care. The service is provided by HC-One Oval Limited. At the time of our visit Bank House was not in use and there were 112 people living at the service.

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

People living at Birch Court and their relatives shared mixed views, but the majority were positive about the staff being caring and kind. We received mixed comments regarding staffing levels, use of agency staff and activities.

We noted several concerns regarding how staff were recording and administering medications using the current electronic system. We identified a breach of regulation regarding safe care, treatment and management of medications.

We have made a recommendation about the clarification of some job roles with regards to medication.

People living at the service and visiting relatives were unsure how many staff they could expect to see on duty each day. The registered manager advised they were recruiting and advertising posts and were also recruiting more activities organisers. We identified a breach of regulations relating to staffing.

Quality assurance processes were regularly carried out to show actions and improvements to the service in the last 10 months. However, concerns regarding the management of medications and of the deployment of safe staffing needs further review by the provider.

The home was clean and staff used appropriate techniques to prevent the spread of infection. Two corridors had an unpleasant smell and staff took action to improve these areas.

People told us they enjoyed the food and drink provided. We observed mealtimes and saw that people had a choice of meals. Mealtimes were noisy at times with staff busy in various departments. Staff could be heard

carrying out their work, while dining room and small galley kitchen doors were left open.

We have made a recommendation regarding the environment and activities.

We saw that people were supported with various activities including occasional trips out, visiting entertainers and the forming of a Birch Court choir. Whilst some people enjoyed the activities others felt they didn't see much going on as they didn't have an activities organiser on their unit.

Care plans and risk assessments were in place and generally contained the correct level of information in relation to the support people needed. Some areas of recording needed updating for one plan.

People could express their views in a variety of ways. Regular meetings were held, annual surveys were carried out and there was a complaints procedure in place. We saw that complaints had been recorded and responded to in line with this policy. We received four complaints from residents and relatives which we passed to the registered manager to review in line with their complaints policy. Some concerns were around the use of agency staff.

Staff and visitors noted improvements to the service since the registered manager commenced in post.

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. Policies and systems in the service supported this practice.

Staff had received training and were knowledgeable about how to protect people from abuse. Staff felt supported and listened to. Staff received the training, support and supervision they needed to carry out the roles they were asked to do.

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

Rating at last inspection

The last rating for this service was ‘good’ (published 6 April 2017.)

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to 'staffing' and 'medications' at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

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

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress.

This was the first inspection of Birch Court since it had been re-registered with The Care Quality Commission in January 2017. The re-registration had taken place as a business entity to reflect changes to the providers named responsible people. This did not create any changes to the overall registration of the home.

Birch Court Nursing and Residential Home is split into five separate single -storey houses: Brook House; Moss House; Fern House; Bank House and Waterside House, each with the capacity to accommodate 30 people who need nursing, dementia, palliative, respite or residential care. The home is situated in the Warrington suburb of Howley, within a quiet residential setting. At the time of our visit Bank House was not in use and there were 20 people living in Moss House, 20 people living in Waterside House, 25 people living in Fern House and 26 people living in Brook House.

There was a 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.

People were well cared for at Birch Court. People told us they were happy with the care and support provided and that staff were kind and caring. Staff maintained people's privacy and dignity ensuring that any care or discussions about people’s care were carried out in private. We saw that interactions both verbal and none verbal between staff and people who used the service were caring and respectful with staff showing patience, kindness and compassion. External health and social care professionals told us that the standards of care appeared to be very high.

Arrangements were in place to protect people from the risk of abuse. We spoke to staff about their understanding of safeguarding and they knew what to do if they suspected that someone was at risk of abuse or they saw signs of abuse. People who lived in the home and their relatives told us that they felt that staff provided safe and supportive care.

Relatives told us they were made to feel welcome and staff and managers were considerate to them and ensured they felt looked after and valued. They were kept informed of any changes and had open dialogue with staff about concerns or changing needs.

Staff were recruited through a rigorous procedure and attend mandatory training as part of their induction and continuous personal development. The registered manager ensured that staff had a full understanding of people's care and support needs and had the skills and knowledge to meet them.

Staffing provision was responsive to the numbers of people living in each house and their changing needs. We saw that staff on duty in one house were quite rushed around the lunchtime as a meeting had been arranged for one staff member to attend and they were therefore unable to assist with the care and support provision. However we noted that an extra staff member quickly joined the staff team to ensure that there were sufficient staff around to provide needs led care.

People’s nutritional needs were met and they had access to a range of professionals in the community for advice, treatment and support.

People received their medicines as prescribed by their GP. The home had a medication policy in place and a range of associated procedures which included arrangements for the administration of homely medicines. Medicines were managed safely to ensure people received them in accordance with their health needs and the prescriber’s instructions.

The service had a complaints policy details of which were provided to all of the people who used the service and their relatives. One person told us they had raised a concern and it was quickly dealt with. Other people told us they had not had reason to complain but would know what to do if they did.

We observed a positive culture within the home with all staff having clear visions and values and being proud of the services provided. Staff told us that the registered manager and regional director led by example and they were constantly seeking ways to improve and enhance the lives of the people living at Birch Court.

Systems to continually monitor and review the quality of the service were effective and there were on going plans to further improve the environment and services provided.

We saw a range of risk assessments were in place which were reviewed on a monthly basis. We saw that actions were in place to minimise risk in order to support people and those around them to live more fulfilling lives.