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

Birch Avenue is a one-storey purpose built home and provides nursing care for 40 older people who are living with dementia. The home has four, ten bedded, 'bungalows' with an interlinking corridor surrounding a large garden and patio area. Each unit has a communal lounge and dining room. All 40 bedrooms are single and have en-suite facilities. There is a central kitchen and laundry.

At our last inspection, we rated the service good. At this inspection, we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There was a manager at the service who was 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 and associated Regulations about how the service is run. The registered manager was on annual leave on the day of our inspection. The clinical and deputy managers assisted with the inspection.

People living at Birch Avenue said they felt safe and they liked the staff. Relatives we spoke with felt their family member was in a safe place and did not have any concerns about their family member’s safety. Staff said they had been provided with safeguarding vulnerable adults training so they had an understanding of their responsibilities to protect people from harm.

There was sufficient staff to meet people’s needs safely and effectively. The service used effective recruitment procedures which helped to keep people safe.

There were effective procedures in place for the safe management and administration of medicines. Staff competency to administer medicines was checked regularly to ensure people received their medicines safely.

Staff completed a thorough induction and received regular training to support them in their roles.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People enjoyed the food provided and were supported to receive adequate food and drink to remain healthy.

We found the home was clean, bright and well maintained. There had been recent refurbishment of the home.

People were treated with dignity and respect and their privacy was protected. People, their relatives, visitors and health professionals we spoke with made positive comments about the care provided by staff.

We found people’s care plans and risk assessments were reviewed regularly and in response to any change in needs.

We saw people participated in a range of daily activities both in and outside of the home which were meaningful and promoted independence. Relatives were positive about the increase of activities for people over the last year.

People living at the home and their relatives said they could speak with staff if they had any worries or concerns and they would be listened to.

There were effective systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full and safe procedures were adhered to.

Staff told us they felt they had a very good team. Staff, people and relatives said the registered manager was approachable and communication was good within the service.

The inspection took place on 15 December 2015 and was unannounced. The home was previously inspected in August 2014 and during this inspection we identified a breach of legal requirements relating to the safe use of equipment. Lifting equipment is serviced and tested under the Lifting Operations and Lifting Equipment Regulations 1998 (LOLER) and should be serviced every six months. We identified that equipment had not been serviced within the above timescale. We undertook a focussed inspection of 7 April 2015 identified that the provider had not followed the plan which they had told us would be completed by 31 March 2015. This meant that Birch Avenue continued to be in breach of legal requirements. When we visited on 15 December 2015, we found the provider had addressed these concerns.

We found that all slings and hoists had been checked by LOLER and saw reports to this effect dated 21 April 2015 and 16 May 2015. We also saw a daily audit which contained information about the sling being in good repair, if the label was readable and the sling description and size. This audit was checked on a weekly basis by senior staff and any actions noted and resolved.

Birch Avenue is a one-storey purpose built home and provides nursing care for 40 older people with dementia. The home has four, ten bedded, 'bungalows' with an interlinking corridor surrounding a large garden and patio area. Each unit has a communal lounge and dining room. All 40 bedrooms are single and have en-suite facilities. There is a central kitchen and laundry.

The service had a registered manager in post at the time of our inspection. 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 supported by four senior staff known as clinical educators. Their role was to support each bungalow and ensure day to day effectiveness of the service.

People received their medicines safety and appropriately. However, some medicines were not always recorded correctly. For example, we looked at Medication Administration Records belonging to five people and found there were gaps in two people's records where some medicines had no signature or reason to indicate why they had not been administered. We informed the registered manager and the management team who began to address this.

We looked at care plans and found they contained up to date risk assessments. Any potential risk associated with a person’s care was recorded and actions in place offering guidance for care staff regarding how to minimise the risk.

Through our observations and by speaking with people, we found there were enough staff available throughout the service to meet people’s needs.

The service had a safeguarding policy which identified what they would do if they suspected abuse, what it was and how to report it. We spoke with care workers who told us they had received safeguarding training and could explain the process to us.

We saw records indicating that staff had completed training relevant to their roles. We spoke with staff who confirmed this. Staff felt the training was useful and gave them the skills they required.

The service was meeting the requirements of the Mental Capacity Act 2005.

People were offered a choice of meal at lunch time and drinks and snacks were provided throughout the day.

We looked at peoples care plans and found that relevant healthcare professionals were involved in their care when required.

During the inspection we saw staff interacted well with people. They were knowledgeable about maintaining privacy and dignity and respected people.

We looked at records in relation to eating and drinking and found that one person's care plan stated the person had lost quite a lot

We carried out an unannounced comprehensive inspection of this service on 5 August 2014. During this inspection we identified a breach of legal requirements relating to the safe use of equipment. Lifting equipment is serviced and tested under the Lifting Operations and Lifting Equipment Regulations 1998 (LOLER) and should be serviced every six months. We identified that equipment had not been serviced within the above timescale.

We looked at a number of hoist slings and found that some labels were worn and the information that should be legible was illegible or not easy to read. Slings should be taken out of circulation if this information is not clear. The provider’s moving and handling policy stated that slings are subject to LOLER testing. We could not find any evidence that this had been carried out.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to the breach. We undertook a focussed inspection on 7 April 2015 to check that they had followed their plan and to confirm that they now met legal requirements.

The following report only covers our findings in relation to this topic. You can read the report form our last comprehensive inspection by selecting the ‘all reports’ link for ‘Birch Avenue’ on our website at www.cqc.org.uk.

Birch Avenue provides accommodation and nursing care for up to 40 people living with dementia. There were 34 people living at Birch Avenue at the time of this focussed inspection.

A registered manager was in place. A registered manager is a person who has registered with CQC to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

Our focussed inspection of 7 April 2015 identified that the provider had not followed the plan which they had told us would be completed by 31 March 2015. This meant that Birch Avenue continued to be in breach of legal requirements.

We examined eight hoist slings and found that information which should be legible continued to be illegible or not easy to read on three of the eight slings. Slings had not been tested in accordance with the LOLOER Regulations and the provider’s own moving and handling policy. The lack of this key check placed people at risk of unsafe care and treatment.

The registered manager informed us that sling checks were implemented following the last inspection. We identified that these checks were not undertaken in two of the four bungalows. There were gaps in the sling check sheets of the two bungalows where the form was in place.

The provider’s action plan stated, ‘All care plans will include what size of sling each resident uses and which loop should be used.’ One care plan contained information about the size of sling and hoist required. It did not contain any information about the positioning of hoist loops. Information about the size of sling to be used or the positioning of the sling loops was not present in the three remaining care plans.

We could not review training records to verify that the moving and handling training shortfalls identified during our last inspection had been addressed. This was because the clinical manager who was responsible for this area of practice was on leave at the time of our inspection. The registered manager could not access these records and agreed to forward them on the clinical manager’s return from leave. This information was not provided.

Our inspection identified a continued beach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to pilot a new inspection process being introduced by the Care Quality Commission which looks at the overall quality of the service.

This inspection was unannounced and was undertaken on 5th August 2014.

Birch Avenue was last inspected in October 2013 and was meeting the requirement of the regulations we inspected at that time.

Birch Avenue provides accommodation and nursing care for up to 40 people living with dementia. There were 38 people living at Birch Avenue at the time of this inspection.

A registered manager was in place. A registered manager is a person who has registered with CQC to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

We found that equipment was not always safely maintained and fit for purpose. For example, we found that hoist labels were worn and information that was supposed to be legible was illegible or not easy to read. Slings are supposed to be taken out of circulation if this information is not clear. The care plans of people who required hoisting did not include information about the type of sling and position of loops to ensure they were assisted to move safely.

An equipment check had taken place in January 2014. A further check which was due to tae place in June 2014 had not taken place. Whilst clean and in working order, there was no evidence that the hoist in one of the bathrooms had been serviced.

All staff had received moving and handling training within the past year; however, some staff had not received in-depth moving and handling training for a number of years. This may mean that staff were not aware of up to date techniques and ways to safely support people to move. Staff received a range of other relevant training courses as well as supervision and an annual appraisal.

We found that people were appropriately supported to make decisions in accordance with the Mental Capacity Act, 2005 (MCA). Staff had received training in the MCA and Deprivation of Liberty Safeguards (DoLS) and were able to describe how these pieces of legislation applied to their practice. Birch Avenue had followed the correct procedure in order to ensure that people’s rights were protected. Staff knew how to safeguard adults and we saw that any concerns had been reported and appropriately dealt with.

The environment was not dementia friendly. There was a lack of appropriate signs and aids to orientate and support people living with dementia to find their way around the home.

People’s nutritional needs were met. Our observations of mealtimes and our review of nutritional records evidenced that people received a choice of suitable food and drink. People’s physical health needs were monitored and referrals were made when needed to health professionals.

We found that there were enough staff to meet people’s needs. Our conversations with the registered manager, staff and our review of records evidenced that the home had an effective process to ensure that employees were of good character and held the necessary checks and qualifications to work at the home.

Conversations and interactions with people tended to be task focussed and we noted that there was often a lack of engagement and interaction from staff outside of these direct care tasks. Staff had a good understanding of people’s individual needs and preferences and people told us that they were treated with kindness. Staff knew how to respect people’s privacy and dignity.

Some people told us that they were bored during the day. The registered manager told us about the action being taken to increase activities and showed us a range of equipment which had recently been bought to support this.

Regular audits were undertaken to monitor the quality of the service. People and relatives did not raise any complaints about the home. There were no complaints at the time of our inspection.

During our inspection we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

In order to capture people’s experiences of Birch Avenue we undertook both formal and informal observations throughout the home. This was because some people were not able to tell us about their experience due to dementia. The formal assessment we used is called the, ‘Short Observational Framework for Inspection’ (SOFI). These observations enabled us to see how staff interacted with people and see how care was provided. We also spoke with two people, one relative and with ten members of staff and reviewed a range of records.

People were positive about the care and treatment they received at Birch Avenue. One person described Birch Avenue as a, “home from home.” Another person stated, “the carers are kind to me.” We saw that the direct care provided was safe, appropriate and took people’s individual needs into account.

Our observations and conversations with a range of staff evidenced that people’s nutritional needs were met. People were also positive about the food at Birch Avenue. One person said, “I can’t complain about the food here, I eat everything that’s put in front of me”.

We saw that people benefited from equipment that was used safely and met their needs.

We found that people were cared for by suitably qualified, skilled and experienced staff who had been subject to an effective recruitment and selection process. We found that staff records and records about people’s health and social care needs were generally up to date and were stored securely.

We looked at five care plans and found that people and /or their relatives and representatives had consented and been involved in decisions about their care and treatment. The clinical manager had a clear understanding and practical experience of the processes they would follow to assess capacity and ensure any decisions made for people who lacked capacity were made in their best interest.

People and their relatives were positive about the care and treatment at Birch Avenue. One person described Birch Avenue as, “brilliant” and stated, “I couldn’t be in a better place than this.” One relative stated that they had, “always been happy” with the care their family member received. During our inspection we saw that the care provided at Birch Avenue was safe, appropriate and took people’s individual needs into account.

We found that medication was administered safely and that staff reassured and remained with people until they had taken it.

Whilst staff were supervised and received training, we found that the records kept documenting these key requirements were not always up to date. We found that a number of staff had not received appraisal within the providers identified timescales.

We saw that there was a system in place to investigate complaints. We reviewed a complaint and found that it had been investigated appropriately. We found that the home had learnt from this and had taken action to reduce the risk of similar concerns arising in the future.

Some people who live at Birch Avenue have some conditions that mean we had difficulty talking with them. Other people were able to express their views clearly, others we were not able to verbally communicate with. Due to people’s communication needs we used informal methods of observation during the site visit. We sat with people in the bungalows, observed care practices ,and saw how staff and people interacted with each other.

Throughout our observations on all the bungalows we saw staff treat people with respect and courtesy.

We saw that there were sufficient staff numbers on duty, to meet people’s assessed needs.

The atmosphere on all the bungalows was generally relaxed. There felt to be a real warmth between staff, relatives and people at Birch Avenue.

People that were able told us that overall they were happy living at Birch Avenue and satisfied with the care and support they were receiving. People said:

“The staff are brilliant here.”

“It’s out of this world here.”

“You couldn’t wish for a better place.”

Relatives said that they were very happy with the support provided to their loved ones and were always made to feel welcome at the home when they visited. Relatives said:

“The staff are absolutely wonderful.”

“Nothing is too much trouble for the staff.”

Health and social care providers said they were satisfied with the care at Birch Avenue.

Comments included:

“We are always impressed with the cleanliness of the home ,the friendliness of staff and the good level of care people receive at Birch Avenue.”