Background to this inspection
Updated
22 May 2021
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.
As part of CQC’s response to the COVID-19 pandemic we are looking at the preparedness of care homes in relation to infection prevention and control. This was a targeted inspection looking at the infection control and prevention measures the provider has in place.
This inspection took place on 12 March 2021 and was announced.
Updated
22 May 2021
This unannounced comprehensive inspection took place on 16 and 19 July 2018.
Birchley Hall 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 (CQC) regulates both the premises and the care provided and we reviewed both areas during this inspection.
This is the first time this service has been inspected under the new registered provider.
Birchley Hall is located in Billinge, Wigan. It provides accommodation for up to 31 people over two floors. Bedrooms located on the first floor can be accessed via passenger lift. At the time of our inspection there were 28 people using the service.
A manager was in place and they were applying to be registered with us 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.
Individual risks to people living in the home were assessed and reviewed regularly with measures in place to manage the risks identified and keep people safe from harm.
Staff were aware of different types of abuse and how to report safeguarding incidents. Those that were reported had been done so appropriately. Staff had received appropriate training in safeguarding and were able to explain how to keep people safe from abuse - Staff were also aware of the whistleblowing policy.
Staff had received training in areas such as infection control, health and safety and manual handling. Appropriate infection control measures were in place and the safety of the environment was checked on a regular basis.
Staff had received other training appropriate to their roles and were supported through regular supervision.
Accidents and incidents were reported and recorded appropriately. They showed evidence of analysis, review and action taken where needed.
Medicines were managed and stored safely and staff had received appropriate training in order to safely administered medication. Those responsible for administering medication had their competency levels assessed regularly.
Sufficient staff were deployed to meet the needs of the people living in Birchley Hall.
Consent for care was obtained in accordance with the Mental Capacity Act 2005; staff showed a good awareness of the need to obtain consent when providing care and support.
People’s nutritional needs were assessed and met to ensure they maintained a health balanced diet; care plans clearly identified people with specific dietary requirements and provided guidance for staff to manage this.
People were supported with access to other health and social care professionals such as GP, podiatrist, opticians and wound specialists.
Staff were observed to be kind and caring towards people and treated them with respect. People spoke positively about the staff and the care they received.
People received care and support specific to their needs; care plans were person centred and provided detailed information for staff to know the people they were supporting.
Whilst people were provided with a range of activities, the registered provider told us they had plans to improve on the quality of activities offered to people in the home.
People knew how to make a complaint if they needed to and any recorded had been dealt with appropriately by the manager.
The quality and safety of the service was regularly monitored with the use of effective audits and checks completed by the manager and registered provider.
The manager had notified CQC of important incidents and events that occurred within the home.
People spoke positively about the management team and how the home was being managed.