About the service: Birchwood Court Residential Care Home is a residential care home which can provide personal care and support to 43 older people, some of whom are living with dementia. At the time of this inspection there were 35 people living at the service.

People’s experience of using this service: People’s risk assessments were not always regularly reviewed. Emergency plans in the event of a fire did not accurately reflect the people present in the service. People received their medicines safely, however the provider's quality assurance system had not picked up on medicines shortfalls despite having medicines audits in place.

Everyone we spoke with told us the service was a good place to reside and visit, that staff were kind and caring and people were treated with respect. People said staff knew them very well and could anticipate their needs and support was delivered in a timely way.

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 were involved in their day to day lives through being empowered to make their own choices about where they spent their time. Their independence was promoted and staff actively ensured people maintained links with their friends and family. Staff were aware of good practice and guidance in end of life care, and respected people's religious beliefs and preferences.

The environment supported people to have time on their own and time with other people if they chose this. Cleanliness and health and safety were well managed. The environment was safe and people had access to appropriate equipment where needed.

Staff recruitment was safe. There was enough staff on duty. The service had experienced a recent high turnover of staff, including senior managers, and the provider had an active recruitment programme in place. Staff had appropriate skills and knowledge to deliver care and support in a person-centred way. Staff understood how to keep people safe and used information following accidents and incidents to reduce the likelihood of future harm.

People's health was well managed and staff had positive links with professionals which promoted wellbeing for them. In addition, people had opportunity to access a range of activities including access to the local community.

The acting manager worked well to lead the staff team in their roles and ensure people received a good service. People, their relatives and staff all felt confident raising concerns and ideas. Feedback was used to make continuous improvements to the service.

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

Rating at last inspection: Good (report published 2 May 2017).

Why we inspected: This was a comprehensive inspection brought forward in response to information of risk or concern about people’s health and wellbeing. We found the concerns to be unsubstantiated.

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

This inspection took place on 7, 9 and 16 March 2017 and was unannounced. This meant the registered provider was did not know we were inspecting the home at that time.

Birchwood Court provides accommodation with personal care for up to 43 older people. The building is on two levels and is split into three living areas. The home caters for people who have lifelong conditions, those who are recovering from an injury or illness and those who have a dementia type illness. Birchwood Court is set in its own gardens off the main street in a residential area near to public transport routes, shops and local facilities.

There was a registered manager in place who had been appointed since the last inspection in March 2015. 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.

During the inspection the number of staff available at the home to support people’s needs was reviewed by the provider following an incident where staff were not continually present in one part of the home for a period of twenty minutes. The registered manager produced a written report for CQC which gave details of what had happened and the steps they had put in place to ensure this did not happen again.

The registered provider had robust procedures in place to make sure people were protected from abuse. These procedures were subsequently followed where people were found to be without staff to support them in one part of the home. The registered manager made a referral to the Local Safeguarding Authority for further enquiry and followed their requirements.

People who used the service, and family members, were complimentary about the standard of care provided. They told us the staff were friendly and helpful. We saw staff treated people with dignity, compassion and respect and people were encouraged to remain as independent as possible.

The staff team received a good level of training and support that enabled them to meet people’s care needs effectively.

All the care records we looked at showed people’s needs were assessed before they moved into the home and we saw care plans were written in a person centred way. The service supported people to remain as independent as possible whilst taking actions to minimise the risk of harm or injury.

The registered provider had an effective recruitment and selection procedure in place and carried out robust checks when they employed staff to make sure they were suitable to work with vulnerable people.

We saw the home had in place personal emergency evacuation plans displayed close to the main entrance and accessible to emergency rescue services if needed.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported to take medications, encouraged to have regular health checks and were accompanied by staff to hospital appointments and emergencies.

People’s nutritional needs were assessed and plans of care drawn up if they were at risk of malnutrition or choking. The cook demonstrated that she had an extensive knowledge of people’s likes and dislikes and prepared a selection of wholesome and popular meals to cater for people’s tastes.

We found the home was clean and fresh with cleaning schedules in place to prevent the spread of infection.

Information about planned activities for the week had been displayed on a notice board in the main communal area for people to see. During our inspection we found the registered provider had given priority to a variety of interesting activities taking place both inside and away from the home and more were planned.

We saw the registered provider had a complaints policy in place and this was clearly displayed for people to see.

CQC

In this report the name of a registered manager appears who was not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time. We were told a new manager had been appointed and was due to commence employment at the end of June.

This inspection was carried out by one inspector. We met with 15 people who used the service and observed their experiences of care to support our inspection. Not every person we met was able to talk with us due to living with dementia or other health conditions. We spoke with the regional manager, a registered manager from another service operated by the same organisation who was supporting the deputy manager, ten staff and eight relatives and friends.

We considered our inspection findings to answer questions we always ask:-

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

Below is a summary of what we found. If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

There were concerns with the management of medication, including administration and recording. We found the arrangements in place for the management of medication left people at risk of not getting the treatment they needed.

We found care records were not kept securely.

We saw information was missing from people care records; for example, support plans, risk assessments and photographs.

We found there was an assessment completed of the needs of people who were living at the home.

We saw people were cared for in an environment that was clean and hygienic.

We found call bells were not being responded to in a timely manner and where people could not access call bells, hourly checks were not maintained.

At the time of the inspection, there was no one at the home subject to an authorisation made under the Deprivation of Liberty Safeguards.

There were quality checks and audits completed to ensure procedures were maintained. However, we found that they were not robust.

Is the service effective?

We found the personal needs of people who lived at the service were not met and we found actions required to ensure the welfare of people at the service were not always completed. One person told us they rarely received support with showering and said, “I used to have a shower every day.”

We had a mixed response from people we spoke with. Some told us they were happy with the care being delivered and their needs were met, while others were less positive.

We saw people walking around the home freely and making their own decisions about where they wanted to go, including some people going out to the local shops with a staff member.

Staff had received appropriate training to meet the needs of the people who lived at the home.

We saw people had a choice of where they ate meals and what they had, although one person was not aware that a dining room existed until the day of the inspection. Meals were found to be nutritious and in adequate quantities. Refreshments were available throughout the day.

Is the service caring?

During the day and we saw some positive interactions taking place and staff responding in a kind manner to people who lived at the home. Two people we spoke with said the staff were lovely and caring. One said, "They (staff) would do anything for you."

Is the service responsive?

We found that the provider had not responded to the requests of relatives when they were concerned about the welfare of their family member.

We saw limited activities taking place for the majority of people who lived at the home on some days. Although we saw a range of activities that were available on other days.

We found that complaints were listened to. We saw evidence of this from the regional manager during the inspection.

Reviews were carried out to make sure the people’s care and treatment needs had not changed. This helped ensure staff supplied the correct amount of care and treatment. However, we found that this had not always occurred.

Meetings had not taken place with staff to discuss the running of the service and to ensure the service was responsive in meeting the changing needs of people who used the service since November 2013, although one staff member said one meeting had taken place to update all of the staff on recent changes.

Is the service well-led?

There was no registered manager in post at the home, although we were told that a new manager had been appointed. The deputy manager was overseeing the service with support from another local manager and also the regional manager.

Bed rails were put into place without the agreement of people, their representatives or professionals.

We found that staff had received appropriate training.

People and relatives we spoke with knew who to contact if they wanted to complain.

On the day of our inspection visit we found 43 people were living at Birchwood Court. We saw the building was on two levels. The ground floor had 19 rooms for residential care. The upper floor had 24 rooms and was for people with nursing care needs.

We found people who used the service understood the care and treatment choices available to them. People’s needs were assessed, and the planning and delivery of care and treatment met their needs and protected their rights. We spoke with four people who lived at Birchwood Court. Everyone said they liked living there. One person said, "Very nice; comfortable." Another said, "The staff are very helpful."

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

Three people who we spoke with were happy with the support they received with their medicines. People told us “I get my medicines morning, lunchtime and teatime, I can’t grumble” and “if I needed a doctor the girls would fetch him”.

Overall, we found that medicines were managed in a safe way.

We saw the manager and regional manager undertook regular audits of the services provided. There were arrangements in place to gain additional feedback about the services provided through the use of surveys of people who lived at Birchwood Court, their relatives and visiting professionals.

We watched one nurse and one carer giving people their medicines. They followed safe practices and treated people respectfully. People were given the time that they needed to take their medicines.

We were told that one person managed their own prescribed creams; however the appropriate risk assessment had not been completed to ensure that they could do this safely.

Prior to our visit, we received some information of concern which indicated some people may have been put at risk because the planning and delivery of their care was not always appropriate to their needs. In response, we carried out an unannounced inspection.

On the day of our visit we found 41 people were living at Birchwood Court, eight of which required nursing care.

We found people’s needs were assessed and the planning and delivery of care and treatment met their needs and protected their rights.

We found appropriate staffing arrangements were in place in order to safeguard the health, safety and welfare of people using the service.

We spoke with a number of people who used the service within the home. People told us they were happy with the staff at Birchwood Court and the care they provided. One person said she had been fully involved with decisions about her care and treatment. She said "I can make all my own decisions and they ask my opinion about everything” and another told us "If I was in any bother or needed anything, they’re there for me”.

Comments from people included, “I have no complaints. All the staff, the cleaners, the laundry, the carers, are all very pleasant”.

“They all do their best for me”, “My son got me in here; it’s the best thing he ever did. There’s one thing, we’re safe in here”

One person referring to the nurse providing her medication said, “I wouldn’t be able to remember all my tablets, so it’s a good job"

One person told us "I think it’s very good here. The care is first class.” Another person said "You can be on your own as much as you want to. There are activities; the Activities Coordinator always asks but I’m not much of a joiner, but she always asks”.

People said they knew they could approach the staff at any time if they wanted something. One person said, “I’ve been out for a walk this morning with one of the girls (Carers). It was lovely. We went to the Post Office and the shop”.

People told us they were happy with the care and attention they received at Birchwood Court. They confirmed they were given choices in life and staff supported them to take some risks and be independent.

People we spoke with said, "I really like it here", "our mam is so happy since she came to live here" and "the staff are lovely, it is a lovely place to live".

People said they received enough to eat and drink. They said "the food is always good", "I enjoy my food", "the cook came to see mam to see what she liked" and "always got plenty to drink".

People confirmed they could receive medical and specialist attention when they

needed it and were helped to fulfil their social needs within the home and community.

People we spoke with said, "the staff are very aware and will always get the doctor before we ask", "there is enough to do", "we can visit any time and we are here everyday and are very happy with the care our mam gets" and "I can join in or spend time in my room".

People told us their home was clean, comfortable and warm. They said "I have a lovely

room and enjoy my view", "everything is always so clean" and "they look after my clothes really well".

People confirmed they were given the opportunity to comment on the service, change routine or raise complaints. They said their visitors were made to feel welcome and information sharing was good.

Birchwood Court is a purpose built home on two floors which provides accommodation for up to 43 older people who need residential or nursing care. At the time of inspection there were 37 people living in the home. We noted some people in the home were diagnosed with dementia type conditions.

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.

We undertook an unannounced inspection took place on 2, 3, 4, 9, December 2014.

At our last inspection in June 2014 we found the provider was not meeting the regulatory standards in relation to the care and welfare of people, the management of medicines, assessing and monitoring the quality of the service provision and record keeping. The provider was asked to send us an action plan to state how they intended making improvements. During our inspection we checked the action plan and found the provider had made the improvements they told us about.

Risks to people who lived at Birchwood Court were minimised because the home had arrangements in place to make sure people were protected from abuse and avoidable harm. We found people were cared for, or supported by, sufficient numbers of suitably qualified, skilled and experienced staff. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

The registered manager had knowledge of the Deprivation of Liberty Safeguards (DoLS). Theyunderstood DoLS and had made applications to apply it in practice. All applications were made lawfully and with the person’s best interests at the heart of decision making. Deprivation of Liberty safeguards is where a person can be deprived of their liberties where it is deemed to be in their best interests or their own safety.

We saw the provider had in place care planning and risk assessments. We found people’s care plans were person centred and the risk assessments gave instructions to staff how the risks to people should minimised.

Suitable mealtime arrangements were in place and people were provided with a choice of healthy food and drink ensuring their nutritional needs were met.

There was a calm and relaxed atmosphere in the home and we saw that staff interacted with people in a friendly and respectful manner.

There were effective systems in place to monitor and improve the quality of the service provided. We saw copies of audit reports produced by the registered manager and the company’s regional manager which included action planning.

Staff we spoke with said they had received training in how to recognise and report abuse. All were clear about how to report any concerns.

The registered manager was approachable and effective. The registered manager carried out relatives and resident meetings to engage people in improving the service.