The inspection took place on 5 December 2016 and was unannounced.

Birchwood Grove provides accommodation for up to 24 older people, some of whom are living with dementia and who may need support with their personal care needs. On the day of our inspection there were 24 people living at the home. The home is a large property, spread over two floors, with two communal lounges, a dining room and a garden. It is situated in Haywards Heath, West Sussex. The providers of Birchwood Grove also own another nursing home within West Sussex.

We carried out an unannounced comprehensive inspection on 19 and 20 October 2015. Areas in need of improvement were found, these included minimal activities and stimulation for people living with dementia, lack of detail in moving and positioning risk assessments, lack of risk assessments for people who were unable to use call bells and the lack of records when applying topical creams or assisting people to move and position frequently. A breach of a legal requirement was also found and following the inspection the provider wrote to us to say what they would do in relation to the concerns found. At the inspection on 5 December 2016 we found that significant improvements had been made in relation to these areas. However, despite this we found an area of practice that was in need of improvement.

There were concerns with regard to the management of medicines. Observations showed that some medicines were left unattended on top of the medicines cabinet. There was a risk that these could have been accessed by people for whom the medicines had not been prescribed. Some people required medicines on an ‘as and when required’ basis. There were insufficient protocols to follow which advised staff of when to administer the medicines, recommended doses and time frames for their use. Records showed that one person had been administered ‘as and when required’ medicines earlier on in the day. This had been recorded, however the person administering the medicines had not recorded the time the medicine was given and therefore there was a risk that the person might have been given more medicines than they should have had or that they had to wait unnecessarily until they received some more medicines.

People were protected from harm and abuse. There were good levels of appropriately skilled and experienced staff who had undertaken the necessary training to enable them to recognise concerns and respond appropriately. People’s freedom was not unnecessarily restricted and they were able to take risks in accordance with risk assessments that had been devised and implemented. People told us that they felt safe. A healthcare professional told us, “The environment appears to be safe when I visit, they have gates on stairs to prevent falls and the front door is coded and locked and closely monitored, I noted a particularly vulnerable person being monitored one to one by staff during a recent visit”.

People were asked their consent before being supported and the registered manager had a good awareness of legislative requirements with regard to making decisions on behalf of people who lacked capacity. Care plans documented people’s needs and wishes in relation to their social, emotional and health needs and these were reviewed and updated regularly to ensure that they were current. One relative told us, “The family have been very involved in the care plan and have had three meetings over the course of time to discuss changes. The nurse keeps us informed about any changes”.

Staff worked in accordance with people’s wishes and people were treated with respect and dignity. It was apparent that staff knew people’s needs and preferences well. Positive relationships had developed amongst people living at the home as well as with staff. One person told us “By nature they are lovely, I think they’re excellent”. Another person told us, “They’re very nice, they’re all different”.

People’s health needs were assessed and met by re

We inspected Birchwood Grove on the 19 and 20 October 2015. Birchwood Grove provides accommodation and nursing care for up to 23 people, who have nursing needs, including poor mobility and diabetes. Most people were living with advanced dementia. There were 22 people living at the home on the days of our inspections. The age range of people varied from 60 – 100 years old.

The provider, Archmore Care Services Ltd had taken over the home in April 2014. Since April 2014, Birchwood Grove had been subject to various renovations, including new flooring, new paintwork and building extensions. Accommodation was provided over two floors with stairs and a passenger lift connecting the floors. Hallways were light and bright and a garden at the back of the home was available for people to use. This was the first inspection of Birchwood Grove under the new provider.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 commented they felt safe living at Birchwood Grove. One person told us, “It’s safe and snug.” However, for people at high risk of skin breakdown, turning charts were not consistently in place. The recording of topical cream was not clear and failed to provide sufficient guidance. Where people’s call bells had been removed, the provider was unable to demonstrate that people were checked upon hourly as per instructions within their risk assessment. We have therefore identified this as an area of practice that needs improvement.

Moving and handling risk assessments did not consistently provide sufficient guidance on the size of the sling required to safely move and transfer a person. We have made a recommendation for improvement in this area.

The requirements of the Mental Capacity Act 2005 (MCA) were not being adhered to. Mental capacity assessments were not completed in line with legal requirements. Decisions were being made in people’s best interests; however, there was no evidence of a mental capacity assessment. Where restrictive practice was taking place, next of kin’s were signing consent forms without appropriate authority. We have therefore identified this as an area of practice that needs improvement.

Staff felt the home was sufficiently staffed. People’s care needs were met and the home presented as calm and relaxing. However, people living with advanced dementia were left for periods of time with little activity and stimulation. We have therefore identified this as an area of practice that needs improvement.

Feedback had been sought from people, relatives and staff. Resident and staff meetings were held on a regular basis which provided a forum for people to raise concerns and discuss ideas. Incidents and accidents were recorded, and consistently investigated.

Staff members had a good understanding of people’s personal history, likes, dislikes and personality traits. It was clear staff had spent time building rapports with people. Staff interacted with people in a kind and friendly manner and people appeared at ease in the company of staff. People and their relatives spoke highly of the caring nature of staff. One person told us, “The carers are all nice.”

Effective recruitment procedures were in place. Each personnel file had a completed application form listing their work history as wells as their skills and qualifications. Nurses employed to work in Birchwood Grove all had registration with the nursing midwifery council (NMC) which was up to date. Training schedules confirmed staff’s training was up to date and nursing staff received clinical training.

Nursing and care staff felt supported by management, said they were well trained and understood what was expected of them. There was sufficient day to day management cover to supervise care staff and care delivery. The current management structure at the service provided consistent leadership and direction for staff.

Everyone we spoke with was happy with the food provided and people were supported to eat and drink enough to meet their nutritional and hydration needs. Any dietary requirements were catered for and people were given regular choice on what they wished to eat and drink. Risk of malnourishment was assessed and acted upon.

The provider and registered manager undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.