Birchwood Care Services is a home care agency situated in an annexe of Birchwood House Residential Home in Speldhurst on the outskirts of Tunbridge Wells. Birchwood Care Services provide care and support to people in their own homes. The service assists people with physical disabilities, people living with dementia and adults over 65 yrs. The service specialising in supporting people in rural areas who have found it difficult to access other care services. There were 57 people using the service at the time of our inspection.

There was a registered manager in post. 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.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good and met all relevant fundamental standards.

Why the service is rated Good

Staff knew how to recognise and respond to the signs of abuse. Risks to individuals’ safety and wellbeing were assessed and minimised. Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced. Medicines were managed safely.

There was a sufficient number of staff deployed to meet people’s needs. Staff received the training and support they needed to meet people’s individual needs. Robust recruitment procedures were followed to ensure staff were of suitable character to carry out their role. We made a recommendation to review the way staff are deployed to take account of user feedback about receiving a specified call time.

Staff knew each person well and understood how to meet their needs. People told us that staff communicated effectively with them and treated them with kindness and respect. People were supported to make their own decisions and remain as independent as possible. Staff supported people in the least restrictive way possible and the policies and systems in the service supported this practice.

People were promptly referred to health care professionals when needed. Staff knew about and provided for people’s dietary preferences and restrictions. Personal records included people’s individual plans of care, life history, likes and dislikes and preferred activities. These records helped staff deliver personalised care.

The registered manager and the provider were open and transparent in their approach. They placed emphasis on continuous improvement of the service. There was a system of monitoring checks and audits to identify any improvements that needed to be made. Action had been taken as a result of these checks to improve the quality of the service and care. Records were maintained accurately to allow the registered manager to monitor care delivery.

Further information is in the detailed findings below.

The inspection was announced and was carried out on 26 and 28 August 2015 and 03 and 04 September 2015 by one inspector and an expert by experience. We gave the registered manager short notice of the inspection because we needed to make sure they and staff would be available to speak with us.

Birchwood Care Services is a home care agency situated in an annexe of Birchwood House Residential Home in Speldhurst on the outskirts of Tunbridge Wells. Birchwood Care Services provide care and support to people in their own homes. The service assists people with physical disabilities, people living with dementia and adults over 65 yrs. The service specialises in supporting people in rural areas who have found it difficult to access other care services.

There was a registered manager in post. 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.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to report any concerns. People told us that they felt safe using the service.

Risk assessments were centred on the needs of the individual. They included clear measures to reduce identified risks and guidance for staff to follow to make sure people were protected from harm. Accidents and incidents were recorded and monitored to identify how risks of recurrence could be reduced.

There were enough qualified, skilled and experienced staff to meet people's needs. Staffing levels were calculated according to people’s changing needs. The registered manager had identified shortfalls in the arrival times for some calls and had taken appropriate action to address this. The registered manager followed safe recruitment practices.

People told us that staff communicated effectively with them, responded to their needs promptly and treated them with kindness and respect. People were satisfied with how their care was delivered. The registered manager had clear person centred values that formed the basis of the service and these were followed by staff in practice.

People were supported to manage their medicines in a safe way. Staff responded quickly to changes in people’s health and worked withhealth care professionals to meet their needs.

The registered manager was proactive in keeping up to date with relevant best practice guidance in person centred care and the care of people living with dementia. They encouraged and enabled staff to improve their knowledge and skills on an ongoing basis. Staff had completed the training they needed to care for people in a safe way. They had the opportunity to receive further training and qualifications specific to the needs of the people they supported. All members of staff received regular one to one supervision sessions and were scheduled for an annual appraisal to ensure they were supporting people based on their needs.

All care staff and management were knowledgeable in the principles of the Mental Capacity Act 2005 (MCA) and the requirements of the legislation. Staff sought and obtained people’s consent before they provided support. When people declined, their wishes were respected and staff reported this to the registered manager so that people’s refusals were recorded and monitored.

Clear information about the service, the management, the facilities, and how to complain was provided to people. Information was available in a format that met people’s needs.

People’s privacy was respected and people were supported in a way that respected their dignity and independence. The staff promoted people’s independence and encouraged them to do as much as possible for themselves.

Staff knew each person well and understood how to meet their needs. People told us, “I’m perfectly happy and very satisfied with the service.” Each person’s needs and personal preferences had been assessed before care was provided and were regularly reviewed. This ensured that the staff could provide care in a way that met people’s particular needs and wishes.

People’s individual assessments and care plans were reviewed regularly with their involvement. People’s support plans were updated when their needs changed to make sure they received the support they needed.

The registered manager took account of people’s comments and suggestions. People’s views were sought and acted upon. The registered manager sent questionnaires regularly to people to obtain their feedback on the quality of the service. The results were analysed and action was taken in response to people’s views.

Staff told us they felt valued under the registered manager’s leadership. The registered manager notified the Care Quality Commission of any significant events that affected people or the service. Quality assurance audits were carried out to identify how the service could improve and the registered manager had an ongoing and effective improvement plan for the service.

We found that people were participating with the writing of their care plans before and after their care and treatment began. The manager told us, "We explain everything, discuss options directly with the people involved and give them as much time as they wish to consider if they want to go ahead or change anything". People who used the service told us, "The staff are wonderful, respectful and mindful: nothing is done before they made sure there was consent every time".

We saw that people's care plans were reviewed regularly and updated when changes were identified. One person who used the service told us, "We discuss any changes together and the workers are simply brilliant, I cannot fault them". Another person said, "My care workers give me excellent on-going care, I simply cannot praise them highly enough". When risks were identified we found clear action plans were in place to minimise the risks. We found that the staff quickly recognised when people who used the service became ill and immediately responded to meet their needs.

The main work of the extension where the agency was accommodated had just been completed. The manager told us, “This is really lovely and such an improvement. We now have more space and the way the offices are designed mean that I can interact more with the team throughout the day”. We found that the premises were suitably designed and laid out to meet people's needs.

We saw that the provider had an effective system of internal audits in place to monitor the quality of the service provided.

Staff records, people's files and other records relevant to the management of the services were accurate and fit for purpose. All records were kept for the appropriate period of time and destroyed securely.

During our inspection we found that people's needs were comprehensively assessed before and during the service. The planning and delivery of care met the people's individual needs. People who used the service commented "The staff are very considerate. They are kind, friendly and thoughtful". One person stated" overall impression is 100% good".

The service had a strong safeguarding policy and clear procedures in place. The staff had received all updated training relevant to their roles and could access additional training. One member of staff told us "I will always look out for them [people] and will act according to the code of practice, they are our primary concern".

The service operated effective recruitment procedures to ensure that staff were suitable for their role, provided appropriate training, supervision and appraisals, and encouraged them to improve their knowledge, skills and qualifications. One care worker said "I have opportunities to develop and improve my practice with working, learning and studying". Another member of staff stated "I feel really supported and listened to".

The service took people who used the service's comments and complaints into account when delivering care, treatment and support. One person commented "Very friendly, patient staff, very obliging, but sometimes overstretched".

We found that the manager was actively involved with monitoring the service to ensure that good standards of care were provided and upheld.