We inspected the service on 28 December 2018. The inspection was unannounced. Birkin Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

Birkin Lodge is registered to provide accommodation, nursing and personal care for 50 older people. There were 33 people living in the service at the time of our inspection visit.

The service was run by a company who was the registered provider. The former registered manager had left their post shortly before the inspection. The registered provider had appointed a new manager who was in post and who was in the process of applying to the Care Quality Commission to become the registered manager. 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 carried out an unannounced comprehensive inspection of this service on 20 September 2018 and 24 September 2018. After that inspection we received concerns in relation to the way people were supported to avoid preventable accidents so that they consistently received safe care and treatment. As a result we undertook a focused inspection to look into these concerns. We looked at our domains ‘safe’ and ‘well led’. This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk.

We found that there were two breaches of the regulations. The first breach was because there were shortfalls in the arrangements that had been made to provide people with safe care and treatment. Suitable provision had not been made to prevent avoidable accidents and to learn lessons when things had gone wrong. There were also shortfalls in the management of medicines. Furthermore, there were two oversights that had reduced the level of fire safety protection in the service. In addition to this, robust steps had not been taken to prevent and control infection. The second breach was because the right systems and processes had not been used to monitor and improve the service by addressing the shortfalls described above. You can see what action we have told the registered provider to take at the end of the full version of this report.

We also raised another concern with the manager in relation to which we have made a recommendation. This was because there was a shortfall in the deployment of staff.

Our other findings were as follows: Background checks on two new care staff had not been completed in the right way to ensure that they were suitable to be employed in the service. People were safeguarded from situations in which they may be at risk of experiencing abuse. Nurses and care staff had not been fully supported to ensure that regulatory requirements were met. However, they had been enabled to speak out if they had concerns about the wellbeing of a person living in the service. The registered provider had submitted notifications to the Care Quality Commission about important events that occurred in the service in line with our guidelines. The manager was actively working in partnership with other agencies to support the development of joined-up care. The registered provider had conspicuously displayed the quality rating we gave the service at our last comprehensive inspection both in the service and on their website.

This inspection was carried out on 20 and 24 September 2018. The inspection was unannounced on the first day.

Birkin Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

Birkin Lodge is registered to provide accommodation, nursing and personal care for up to 50 people. It can accommodate older people and people who live with dementia. There were 31 people living at the service at the time of our inspection.

At the last comprehensive inspection on 19 July 2017, the service was rated ‘Requires Improvement’ overall with safe and well-led rated as Requires Improvement. Effective, caring and responsive were rated as Good. We told the registered persons that the improvements they had made following the inspection in December 2016 needed to be used consistently and embedded. At this inspection we found that the improvements had been sustained and the service was now rated ‘Good’ overall.

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 worked at another of the providers locations and had added Birkin Lodge to their registration. The registered manager had split their time between the two services whilst the recruitment of a new manager commenced. The new manager had started in post in the week of the inspection and was completing their induction.

People felt safe and were protected from the potential risk of harm and abuse. Nurses and care staff had been trained to understand the potential signs of abuse and knew the action to take if they had suspicions. Potential risks to people to maintain their safety had been assessed and mitigated. The premises were well maintained and equipment had been regularly serviced to ensure it was in good working order.

People’s safety in the event of an emergency had been assessed, with guidance to inform staff how to keep people safe. Accidents involving people were monitored with action taken to prevent the risk of reoccurrence. People were protected from the risk of infection with cleaning schedules in place to promote the prevention and control of infection.

There were suitable numbers of nurses and care staff deployed to meet people’s needs. Staff were recruited safely following the provider’s policy and procedure. Nurses and care staff received the appropriate training, skills and knowledge to meet people’s needs. Staff received support from the management team to fulfil their role and meet people’s needs.

Medicines were observed to be administered safely by registered nurses. Systems were in place for the ordering, obtaining and returning of people’s medicines. Nurses had received training in the safe administration of medicines and their competency had been assessed by the clinical lead. Medicines requiring additional safe storage were stored safely and securely.

People’s needs were assessed prior to them receiving a service. People received a personalised, person centred service which was responsive to their needs. People were involved in the development and review of their care plan. Guidance was in place to inform staff of how to meet people’s needs whilst encouraging and promoting their independence.

People were supported to maintain contact with people that mattered to them. People’s diversity was recorded with action taken to ensure people’s rights were promoted and maintained. People were encouraged to make their own choices about their lives. People were supported to have maximum choice and control of their l

We inspected Birkin lodge on 19 July 2017. The inspection was unannounced. Birkin lodge provides accommodation, personal care and nursing care for up to 50 older people. There were 18 people using the service at the time of our inspection.

We previously inspected this service on 14 December 2016 when we found breaches of the Health and Social Care Act 2008 (regulated activities) Regulations 2014 and the overall rating for the service was Inadequate. The breaches of regulation related to person centred care, dignity and respect, consent, governance and staffing. We took enforcement action to impose a condition on the registered provider’s registration to ensure they reviewed and updated people’s care plans and informed us about the action they had taken to improve care. We issued a warning notice in respect of staffing. The service was placed in special measures with an expectation that the necessary improvements would be made within six months. We found that the provider and manager had taken action to meet all breaches at this inspection.

There was not a registered manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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. The registered manager had left the service since our last inspection and a new manager had been appointed. They had not yet applied to be registered, but told us they intended to do so.

At this inspection we found that the provider had ensured there were sufficient numbers of staff working in the service to meet people’s needs and respond to their requests. The registered provider ensured effective recruitment procedures to ensure that staff were safe to work with vulnerable adults.

The provider had systems in place to identify and minimise risks to the safety and welfare of people using the service and for the staff. There were regular safety checks on equipment that was being used. The provider had ensured that the environment was safe for people by carrying out safety checks on water, gas and electrical appliances. The provider had an infection control policy in place that was implemented in practice. People living at the service and their visitors told us that the premises were kept clean and tidy. However, relevant risk assessments had not been completed for bed rail safety. We have made a recommendation about this in our report.

People were protected from abuse by trained staff who understood how to recognise the signs of abuse and how they should report it. Staff received training that gave them the confidence and knowledge to provide effective care.

Medicines were being managed safely by trained staff. Medicines were being stored securely and there were appropriate auditing and checking tools used to quickly identify any shortfalls.

There were sufficient numbers of staff on duty at all times to meet people’s needs in a safe way. The registered provider had systems in place to ensure that staff were recruited safely. Staff received training that gave them the necessary skills to provide effective care. All staff received regular supervisions and yearly appraisals.

Staff sought and obtained people's consent before they helped them. People's mental capacity was assessed when necessary about particular decisions. Meetings were held, when needed, to make decisions in people's best interests, following the requirements of the Mental Capacity Act 2005.

Care records showed that people’s dietary needs were being documented and known by kitchen staff. There was an option of two choices of meal per day and alternatives were available if someone did not like or want one of the main options. People had the equipment they needed so they could eat independently. If someone

We inspected Birkin lodge on 14 and 15 December 2016 and the inspection was unannounced. Birkin lodge provides accommodation, personal care and nursing care for up to 50 older people. There were 27 people using the service at the time of our inspection. Whilst the registered provider was registered for 50 people they told us that, following refurbishment works, they only accommodated a maximum of 41 people.

This was the first inspection of Birkin lodge since it was registered on 2 August 2016. The service is registered under the provider Alliance Care (Dale Homes) Limited. This is part of the Brighterkind group of care homes. However, whilst the service was previously registered under a different provider, Brighterkind had been managing the service on a day to day basis during 2016.

There was a manager in post who had been in post since the service was registered. The manager was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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.

There were insufficient numbers of staff to meet people’s personal care needs within a reasonable timeframe and in a personalised way. People and their relatives told us that the staff were not always responsive to their needs within a reasonable timeframe. One person told us, “There are not enough staff, they don’t come and see me and we have to wait ages for our wash.” People had not been consulted about the time they would like to be supported to get washed and dressed in the morning. During our inspection we saw that some people waited an unreasonable length of time for their care which did not promote their dignity. Where people refused care, staff did not always ensure that care was offered again within a reasonable timeframe. Some people waited a long time for their meals to be served.

Staff had not completed all the training they required to enable them to carry out their roles effectively and training had not always been updated when training certificates had expired. Staff were not supervised regularly in line with the registered provider’s policy.

Staff did not understand and correctly apply the principles of the Mental Capacity Act 2005 (MCA). This meant that people’s right to make their own decisions was not always respected.

People told us that there had been a recent decrease in the frequency and quality of social activities provided in the service. People were enabled to spend their time how they wished, but there were not sufficient social activities provided to ensure people were occupied in a meaningful way. Staff had worked with people, during the assessment process, to gather information about their life history, but this information had not always been used to develop a personalised plan for meeting people’s social needs.

The most recent customer survey showed that people were generally satisfied with the service they received. The areas where improvements were required had been collated into an action plan. However, we found that the required improvements had not been successfully implemented.

Records about the care provided to people and their wellbeing were not consistently completed. Records were not always completed accurately to enable the registered provider to monitor the quality and safety of the service.

People told us they felt safe using the service. One person told us, “The staff make me feel safe.” Staff understood how to recognise and respond to the signs of abuse. The registered manager had not used learning from a safeguarding investigation to make improvements across the service. We have made a recommendation about this.

Risks to people’s safety and welfare were managed appropriately to ensure they were minimised. However, the fluid