Birdscroft Nursing Home provides accommodation nursing and personal care for up to 28 people, some of whom have dementia. Rooms are arranged over two floors and there is a passenger lift. Communal facilities include a large lounge, a small quiet lounge, a separate dining room and a secluded rear garden which is accessed via a ramp with rails.

Birdscroft is a ‘care home’. 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. Birdscroft is registered to provide accommodation for persons who require nursing or personal care for up to 28 people. There were 26 people living at 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. The registered manager was at the home during the time of our inspection.

We last carried out a comprehensive inspection of Birdscroft in November 2016 where we found the registered provider was in breach of two regulations. These related to the safe management of people’s medicines and the effectiveness of the provider’s quality assurance systems. Following this inspection the registered provider sent us an action plan of how they would address these two issues.

We completed a focussed inspection in June 2017 to check that the provider had taken action to address the concerns we had raised. At that inspection we found that both concerns had been addressed by the provider. At this inspection we found that the care and support people received had continued to improve under the guidance of the registered manager.

The inspection took place on 29 November 2017 and was unannounced.

There was positive feedback about the home and caring nature of staff from people who live here. The registered manager had been in post for over six months, and had made many positive changes to the standard of care people received. Quality assurance processes were now picking up day to day issues, so that corrective action could be taken.

People were safe at Birdscroft Nursing Home. Staff understood their duty should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding team or Care Quality Commission.

Risks of harm to people had been identified and clear plans and guidelines were in place to minimise these risks. The home was clean, and staff practiced good infection control measures, such as hand washing and correct use of personal protective equipment. In the event of an emergency people would be protected because there were clear procedures in place to evacuate the building.

There were sufficient staff deployed to meet the needs and preferences of the people who lived at the home. There had been a recent issue with staffing, but the registered manager had taken action to prevent a reoccurrence. The provider had carried out appropriate recruitment checks to ensure staff were suitable to support people in the home. Staff received a comprehensive induction and ongoing training, tailored to the needs of the people they supported. People’s nursing needs were met by competent staff.

People received their medicines when they needed them. Staff managed the medicines in a safe way and were trained in the safe administration of medicines. Internal audits continually reviewed staff performance around medicines, and appropriate actions were taken where issues were raised.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act

Birdscroft Nursing Home provides accommodation and nursing care for up to 28 people, some of whom have dementia. Rooms are arranged over two floors and there is a passenger lift. Communal facilities include a large lounge, a small quiet lounge, a separate dining room and a secluded rear garden which is accessed via a ramp with rails. There is parking to the front of the property. At the time of our inspection 24 people lived here.

We carried out an unannounced comprehensive inspection of this service on 28 November 2016. At that inspection breaches of legal requirements were found. After that comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to the breaches in medicines management, good governance and provider management oversight by 30 April 2017.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Birdscroft Nursing Home on our website at www.cqc.org.uk.

The provider had taken appropriate action and addressed all of these concerns. The service now required a period of stability for these changes to be embedded and sustained

There was not a registered manager in post. A new manager was in post, and in the process of applying to become registered with the CQC. 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 told us they were happy living here. One person said, “Staff are good, very caring.” Another person said, “The food is really good, my room is warm when it is cold outside, and my bed is comfortable.” Staff told us they were happy in their work.

People were safe at Birdscroft Nursing Home. There were sufficient numbers of staff who were appropriately trained to meet the needs of the people who live here. Staff understood their duty should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding team or the police.

Staff managed the medicines in a safe way and were trained in the safe administration of medicines. People received their medicines when they needed them. The provider’s internal quality assurance processes had identified that some improvements were required in the way some staff managed medicines. They had taken appropriate action to address the issues.

Risks of harm to people had been identified and clear plans and guidelines were in place to minimise these risks. In the event of an emergency people were protected because each person had a plan which detailed the support they needed to get safely out of the building.

Staff recruitment procedures were safe to ensure staff were suitable to support people in the home. The provider had carried out appropriate recruitment checks before staff commenced employment. They had also checked to ensure staff were eligible to work in the UK.

The provider had effective systems in place to monitor the quality of care and support that people received. Quality assurance records were kept up to date to show that the provider had checked on important aspects of the management of the home. The manager had ensured that accurate records relating to the care and treatment of people and the overall management of the service were maintained.

Birdscroft provides accommodation and nursing care for up to 28 people, some of whom have dementia. Rooms are arranged over two floors and there is a passenger lift. Communal facilities include a large lounge and dining area, a small quiet lounge, and a secluded rear garden which is accessed via a ramp with rails. There is parking to the front of the property. At the time of our inspection 24 people lived here.

There was not 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. The current home manager had been in post for two months and had submitted his application to become the registered manager to CQC.

The inspection took place on 28 November 2016 and was unannounced. At our last inspection in February 2015 we identified three breaches in the regulations, and areas of the home that required improvement. The registered manager and provider gave us an action plan on how they would address these issues. At this inspection we found that some, but not all of the areas of concern had been addressed.

The lack of good leadership after the departure of the registered manager had an impact across four of the five key areas we looked at. It affected the safety of the home as medicines where not managed safely; how effective the home was at meeting people’s needs; how responsive staff were; and how well the home was led. We have identified three breaches in the regulations. This is the same amount compared to our last inspection showing the lack of leadership was failing the people who live here. You can see what action we have asked the provider to take at the back of the full version of this report.

Staff did not manage the medicines in a safe way. Safe systems of work were not followed so people could not be assured they had the right medicines at the right time. Staff had made decisions to alter the format of medicines by crushing them. This was done without consulting a GP or pharmacist to check if this could affect the effectiveness of the medicine.

The provider did not have effective systems in place to monitor the quality of care and support that people received. Quality assurance records were completed to check on important aspects of the management of the home; however these had not identified the issues found during this inspection. The home manager had not ensured that accurate records relating to the care and treatment of people and the overall management of the service were maintained. This was an area of improvement we had highlighted at our previous inspection.

People were not always supported to have access to healthcare professionals to maintain good health. The management of pressure wound care was variable, with concerns being raised about the accuracy of, and lack of records to manage peoples nursing needs. These concerns were also identified a week after the inspection by a visiting tissue viability nurse, showing the management had not acted quickly to improve the support people received.

People received the care and support they needed, however the care plans did not always reflect peoples current needs. Care plans were based around the individual preferences of people as well as their medical needs. People and relatives were involved in reviews of care, but these reviews did not always result in a change of the support plan to reflect current needs. People were at risk of not getting care they really needed as staff who may not be familiar with people (such as agency staff) would not have access to correct information.

The staff were kind and caring and treated people with dignity and respect. However the failures across the home demonstrated there was a lack of care and attention to following

We spoke with five residents and relatives in some detail during this visit, and with five other residents more briefly. People told us staff were respectful towards them and they received the care they needed. Positive comments included "Can't fault the staff" and "They are always respectful to families and make us feel welcome." Comments on the food ranged from "Not bad" to "Quite good", with several people mentioning that this had improved recently.

People told us they felt safe in the hands of staff at Birdscroft, and when asked if the home was kept clean and fresh, all those we spoke to said it was. One added "No unpleasant odours."

We asked people if they received the help they needed in a timely way and we were told they did, though additional comments included "Mostly. On the odd occasion you have to wait if several people want help at the same time." When we asked people's opinions on the overall quality of the service comments ranged from "Eight out of ten and moving in the right direction" to "Fairly good."

All those we spoke to said they would know how to make a complaint and we were told the manager "Is on the ball" and would deal with any concerns personally.

This inspection took place on 26 February 02 March 2015 and was unannounced on both days.

Birdscroft provides accommodation and nursing care for up to 28 people, some of whom may be living with dementia. Rooms are arranged over two floors and there is a passenger lift. Communal facilities include a large lounge, a small quiet lounge, and a secluded rear garden which is accessed via a ramp with rails. There is parking to the front of the property.

At the time of our visit there was no 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. The newly appointed manager was in the process of applying to the CQC to become the registered manager.

Not all of the risk of harm to people had been identified or effective controls put into place to manage them. Areas such as falls from windows had not been managed effectively.

The provider did not have a robust recruitment process and there were gaps in information in relation to staff employment files. People and relatives thought there were enough staff to meet their needs. We saw that there were sufficient staff to keep people safe.

The provider had not assessed and monitored the quality of service people received at the home in the absence of a manager. Important areas such as medicines management, staff training and introduction of new policies such as prevention and management of choking had not been put into place until the manager had started. This the new manager had to develop a clear plan that detailed where the service needed to improve. The plan was reviewed and updated as tasks were completed with a senior manager. The quality assurance systems were still in the process of being introduced so were not yet effective at showing how the home was performing against management targets.

People were generally positive about the permanent staff saying they were kind and caring, but they felt the agency staff could be better trained.

People said they were happy with the medicines they received and had it when they needed it. Apart from a few minor issues with recording when they had been given medicines were managed well in the home. People also received appropriate treatment to keep them healthy, or if their health needs changed.

Documentation to enable staff to support people and record the care and support given were not complete. The management was switching to a new system to try to improve the service. Care plan information was available to staff by use of hand written notes at the front of care files, or in people’s rooms so staff could access it.

People told us the activities available to them had improved, but those that chose to stay in their bedrooms wanted more to do to keep them entertained throughout the day.

Food and drink was readily available throughout the day. The food was freshly prepared and looked appetising. Those people on specialist diets received the food in the form they needed it.

The home was well maintained and had been adapted to make it more suitable for the people who live here. Floors were smooth and clear of obstructions to reduce the risk of trips and falls, and there was clear signage around the home including words and pictures to denote the use of the room.

Some good interactions were seen between the staff and the people who live here. Staff were friendly, caring and supportive to people and clearly knew them well.

We have identified three of breaches in the regulations. You can see what action we told the provider to take at the back of the full version of this report.