The inspection took place on the 16 May 2017 and was unannounced. Birch Grove Nursing Home provides personal care, accommodation and nursing care for up to 50 older people. On the day of our inspection there were 45 people living at the service, some of whom were living with dementia and chronic health conditions. The service is spread over five floors with a passenger lift, communal lounges/dining rooms and a garden.

At the last inspection on 28 April 2015, the service was rated ‘Good’. At this inspection we found some areas of practice that need improvement, however the overall rating for Birch Grove Nursing Home remains as ‘Good’. We will review the overall rating at the next comprehensive inspection, where we will look at all aspects of the service and to ensure the improvements have been made and sustained.

A registered manager was not 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 and associated Regulations about how the service is run. The registered manager had left the service approximately four months previously, and day to day management of the service was carried out by a new manager who had applied to register with the CQC.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. Special dietary requirements were met, and people’s weight was monitored, with their permission. However, improvement was needed to the mealtime experience for people in some parts of the service.

Staff continued to feel fully supported by management to undertake their roles. Staff were given training updates, supervision and development opportunities. One member of staff told us, “If you asked for extra training, they’d be happy to get going on that”. Another member of staff said, “We get supervision quite regularly”. People felt staff were skilled to meet their needs and provide effective care. One person told us, “As far as I’m concerned I think they perform their job well, I’ve no reason to doubt them”. However, we identified some areas of moving and handling practice that needed improvement.

We have made a recommendation in relation to moving and handling practices.

People told us they felt the service was safe. One person told us, “I’d tell any of those in a purple coats [referring to staff in uniforms], actually I’d tell any of them not just those”. Another person told us, “It’s difficult to be anything but safe here”. People remained protected from the risk of potential abuse because staff understood how to identify and report it.

The provider continued to have arrangements in place for the safe ordering, administration, storage and disposal of medicines. People were supported to get their medicines safely when they needed it. Healthcare remained accessible for people and appointments were made for regular check-ups as needed.

Staff considered people’s capacity using the Mental Capacity Act 2005 (MCA) as guidance. People’s capacity to make specific decisions had been assessed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

People remained encouraged to express their views and had completed surveys. Feedback received showed people were satisfied with the overall care, and felt staff were friendly and helpful. People said they felt listened to and any concerns or issues they raised were addressed.

The service had a relaxed and homely feel. Everyone we spoke with spoke highly of the caring and respectful attitude of the

The inspection took place on 28 April 2015. Birch Grove Nursing Home was last inspected on 12 April 2013 and no concerns were identified. Birch Grove Nursing Home is located in Brighton. It is registered to support a maximum of 60 people. The service provides personal care and support to people with nursing needs, some of whom were living with dementia, and many who had complex health needs and required end of life care. The service is set over five floors. On the day of our inspection, there were 40 people living at the service.

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.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. A relative told us, “I wanted somewhere safe for my wife. We’ve never looked back”. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding and what action they should take if they suspected abuse was taking place.

Medicines were managed safely in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately, including the administration of controlled drugs.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, such as wound management, and palliative (end of life) care. Staff had received both one to one and group supervision meetings with their manager, and formal personal development plans, such as annual appraisals were in place.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. People were advised on healthy eating and special dietary requirements were met. People’s weight was monitored, with their permission. Health care was accessible for people and appointments were made for regular check-ups as needed.

People chose how to spend their day and they took part in activities in the service and the community. People and their relatives told us they enjoyed the activities, which included singing, exercises, films, arts and crafts and themed events, such as reminiscence sessions. People were encouraged to stay in touch with their families and receive visitors.

People felt well looked after and supported. We observed friendly and genuine relationships had developed between people and staff. A relative told us, “Such a lovely place. She is well looked after and they are very obliging”. Care plans described people’s needs and preferences and they were encouraged to be as independent as possible.

People were encouraged to express their views and completed surveys, and feedback received showed people were satisfied overall, and felt staff were friendly and helpful. People also said they felt listened to and any concerns or issues they raised were addressed. A relative said, “We raised a formal complaint with the hospital and would do the same here, but we’ve had no need to”.

Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where managers were always available to discuss suggestions and address problems or concerns.

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

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still the registered manager on our register at the time.

During our inspection we spoke with four people who used the service. We also spoke with four staff members; these were the interim manager and three care workers. We also took information from other sources to help us understand the views of people who used the service, which included meeting minutes.

The people we spoke with told us they were happy with the care they had received and with the staff team. One person who used the service told us “I think it’s alright here, it’s always nice and clean”. Another person who used the service told us “It suits me living here”. A care worker we spoke with told us “We try our maximum to give the residents good care”.

We saw that the service had systems in place to gain and review consent to care and treatment from people who used the service. The overall appearance of the service was clean and we saw that they had appropriate systems and policies in place in respect to cleanliness and infection control.

We spoke with three care workers during our inspection and were told that they felt valued and supported and that their training needs had been met. We also saw that the provider had systems in place to monitor, respond and learn from complaints.

We did not speak to people who live at Birch Grove Nursing Home as part of this inspection.

Information shared with us under local safeguarding protocol raised concerns that the people living a Birch Grove had not been protected from abuse.