This inspection was completed on 31st May and 4th June 2018, and was unannounced on the first day. Birchwood is a 60 bed service that provides facilities over three floors to older adults with varying needs. The ground floor provides a respite service for up to ten people undergoing an assessment period when transitioning from hospital or home and prior to an appropriate care package being sought. The first floor provides residential services to a maximum of 25 people. The second floor provides nursing care to a maximum of 25 people. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. People’s needs varied depending on their diagnosis. We found some people required extensive support whilst others were able to complete some tasks independently.

This inspection was carried out to establish if improvements to meet legal requirements planned by the provider after our October 2017 inspection had been completed. The team inspected the service against all five key areas. This is because the service was not meeting legal requirements and was rated overall as inadequate and placed in special measures. At our last inspection, we found the provider was in breach of nine regulations. Following that inspection, on 22 August 2017, the provider sent an action plan which identified improvements to ensure the service was no longer in breach of the regulations.

At the inspection of October 2017, the provider was rated overall inadequate, with three ratings of inadequate in ‘Safe, ‘Responsive and ‘Well-led. ‘Effective’ and ‘Caring’ were all rated as requiring improvement. At this inspection we found the provider’s had made improvements in all inadequate domains. As a result the overall rating of the service has now been changed to requires improvement. The changes to the key lines of enquiry have meant that additional information is sought in some of the domains.

The service had appointed and registered a new manager in January 2018. However, due to unforeseen circumstances the registered manager had been absent from the service for a period of two months, but had returned to work prior to the inspection. The service was managed by an interim deputy manager, with the additional support of the local authority services manager. However, the management overview remained inconsistent during the period of the registered manager’s absence. 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 not always kept safe. Whilst risk assessments were in place for people, these did not provide information to staff on how to minimise the possibility of a risk. This meant that staff did not always know how to manage a risk should one arise . The provider did not have robust systems in place to ensure sufficient suitably qualified or safe staff were employed to work with people. A criminal records check and photographic identification was missing from staff files and there were gaps in people’s recorded employment history. Of the nine files reviewed all had information missing.

Medicines were not always managed safely, putting people at risk. Covert medicines did not have appropriate directions in place, or evidence of best interest decisions to illustrate how this decision had been reached.

People received care and support from staff who had completed the provider’s identified mandatory training, skills and knowledge to care for them. . The provider had a comprehensive induction process in place that involved both the corporate and location induction.

Staff were appropriately supervised in t

This inspection was completed on 29th September and 1st October 2017, and was responsive in relation to a number of concerns and safeguarding issues received by the CQC.

The service was taken over by West Berkshire County Council on 1st June 2017, prior to which the care was provided by a corporate service provider. Some of the staff were transferred as part of the acquisition; however senior management within the service was lost.

Birchwood is a 60 bed service that provides facilities over three floors to older adults with varying needs. The ground floor provides a respite service for up to ten people undergoing an assessment period when transitioning from hospital or home and prior to an appropriate care package being sought. The first floor provides residential services to a maximum of 25 people. The second floor provides nursing care to a maximum of 25 people. People’s needs varied depending on their diagnosis. We found some people required extensive support whilst others were able to complete some tasks independently.

A registered manager had been in post since the service was taken over by the local authority. 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.

Notifications had not been made to the CQC for all incidents that were considered safeguarding alerts or reportable as a serious injury. This is a requirement of the registration regulations.

People were not kept safe. Risk assessments and comprehensive documentation was not in place to ensure people were offered responsive safe care and treatment. Care plans contained minimal information, often leaving out crucial information. For example, one care plan did not document how frequently a person required assistance with personal care. This meant they were at risk of their basic needs not being met and increased the potential of the person’s skin being damaged.

Medicines were not managed safely. During a medicine round we observed the medicine trolley was left unlocked and unattended for a brief period of time. A person was witnessed approaching the trolley. MAR charts were completed and errors were noted. However guidelines had not been written for all people who were prescribed medicines to be taken ‘as required’.

Fire safety checks were being completed and recorded. However people were not being kept safe at all times due to a failure in appropriate monitoring and recording of other health and safety checks. Not everyone living or staying at Birchwood had a current personal evacuation plan in place, although staff did have access to one page colour coded list that them who was independent and who needed assistance. Water temperatures checks were not being carried out as required, leading to concerns that staff would be unaware if a thermostatic valve stopped working, putting people at risk of scalding.

Staff did not appropriately record information. Incidents were not reported, and information was not accurately updated in daily records. We noted that one person had sores on both legs, without any dressings. Staff told us that dressings had been removed by the person. No alternative dressing had been applied. Records did not note that the person had sores on legs, what dressing should be applied or how the sores were to be managed.

Staff had not received supervision, or had a team meeting that allowed them to gain an understanding of the provider’s values and vision since taking over.

Neither the provider nor the registered manager had effective systems in place to assess, monitor and improve the quality of the service. There was also no system to assess, monitor and mitigate risks to people using the service, their visitors and staff.

Staff generally were polite and re