About the service: Birchgrove is a care home for up to three people with a learning disability. It is located in a community setting on the edge of the town of Matlock in Derbyshire. At the time of our inspection three people were using the service.

People’s experience of using this service:

People were not always protected from the risk and spread of infection. People who used the service were safeguarded from the risk of abuse. Risks associated with people’s care had been identified and were managed to keep people safe. There were sufficient staff available to support people to meet their needs.

The design, adaptation and decoration of the premises did not always meet people’s individual needs. People’s needs were assessed and care was provided in line with their preferences. Staff we spoke with felt they were trained and supported to meet the requirements of their job. People were supported to maintain a balanced diet. People had access to healthcare professionals when required.

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.

We observed staff interacting with people and found they were supportive, kind and caring. Staff respected people’s privacy and dignity.

People received person-centred care which was based on their needs and took in to consideration their preferences. People were supported to access the community and be involved in activities of their choice.

The service had a complaints procedure and people were supported to raise concerns.

The registered manager had recently left the service and the team manager was in charge. The team manager completed a range of audits in areas such as, medicine management, health and safety and documentation. However, there were some areas which were not audited such as infection control. Actions raised as part of the audits were recorded but not always actioned by the provider.

More information is in the full report.

Rating at last inspection: Good (report published 24 August 2016)

Why we inspected: This was a planned comprehensive inspection based on the rating at the last inspection.

Follow up: We plan to continue to inspect the service in line with our inspection programme for services rated requires improvement. Until then we will continue to monitor the service to ensure that people receive safe, compassionate, high quality care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This unannounced inspection took place on 24 May 2016. The service was last inspected on 4 November 2013, when no concerns were identified and it was found that all standards inspected were being met.

Birchgrove provides accommodation and support with personal care for up to three people with learning disabilities. At the time of the inspection there were three people using the service. One person had very limited verbal communication and the registered manager explained that the other two people had no verbal communication at all. Therefore, to address this issue, staff had developed and implemented a range of alternative methods and strategies. We saw this included sign language and visual, physical and pictorial prompts, enabling them to communicate more effectively.

The service had a registered manager in place. 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 2008 and associated Regulations about how the service is run.

People’s needs were assessed and their care plans provided staff with clear guidance about how they wanted their individual needs met. Care plans were person centred and contained appropriate risk assessments. They were regularly reviewed and amended as necessary to ensure they reflected people’s changing support needs.

People were happy, comfortable and relaxed with staff. They received care and support from staff who were appropriately trained and confident to meet their individual needs and they were able to access health, social and medical care, as required. There were opportunities for additional staff training specific to the needs of the service. Staff received one-to-one supervision meetings with their manager. Formal personal development plans, such as annual appraisals, were in place.

There were policies and procedures in place to keep people safe and there were sufficient staff on duty to meet people’s needs. Staff told us they had completed training in safe working practices. We saw people were supported with patience, consideration and kindness and their privacy and dignity was respected.

Safe recruitment procedures were followed and appropriate pre-employment checks had been made including evidence of identity and satisfactory written references. Appropriate checks were also undertaken to ensure new staff were safe to work within the care sector.

Medicines were managed safely in accordance with current regulations and guidance by staff who had received appropriate training to help ensure safe practice. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People’s nutritional needs were assessed and records were accurately maintained to ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals, where necessary.

There was a formal complaints process in place. People were encouraged and supported to express their views about their care and staff were responsive to their comments. Satisfaction questionnaires were used to obtain the views of people who lived in the home, their relatives and other stakeholders.

At the time of our inspection there were three people receiving care at the home.

During our visit we spoke with the manager, one staff member and briefly with two people who were receiving care.

People receiving care had limited communication so we were not able to gain much information about their views. However our brief conversations and observations of staff interactions indicated that people were happy living at Birchgrove.

People enjoyed individual and varied lifestyles at Birchgrove. Each person took part in a range of activities of their choosing and their likes and dislikes were well documented.

The care plans we saw indicated that people preferences and care needs were well documented. This ensured their needs would be met.

People received their medicines on a regular basis. There were generally safe systems in place to store and manage medicines.

There were sufficient staff on duty to meet people’s needs. Some people were funded for individual care hours and we saw that there sufficient staff on duty to ensure people received this support.

We spoke with and observed the care of two people living at Birchgrove. One person living at the home told us that they were happy there.

We examined care files and saw that care plans were detailed and personalised. We saw that documents about people's care were compiled using images so that they would more easily understand what they were about.

We found that any risks that could affect people were assessed and managed, and people had positive behaviour support strategies to help them if they felt anxious, angry or upset. We also found that consent was being appropriately obtained for people’s care, including where they could not consent for themselves.

We found that staff were trained to provide appropriate support for people, and that this included specialist training to meet people’s particular needs.

We saw that a range of different ways were used to assess and monitor people's care and safety at Birchgrove, and that people's views were taking into account when assessing quality.

Because of the degree of learning disability exhibited by all of the people living at he home, we did not speak directly to them about their lives there.

The manager and staff told us how the services and support provided at the home had steadily improved with better resources – financial and people – being made available. This is particularly well demonstrated in better care documentation and records that were genuinely aimed at a ’person centred approach’, continuous improvements in the quality of the premises and more individualised decorating and refurbishments, and improved staffing levels. The latter has lead to staff being able to support a greater level of planned individual activities and more opportunities for individual development. Staff said they are encouraged to try new things by ’trial and error’ and to learn about what has been successful and what has not.

Morale of the staff team was positive and a number of staff appointed within the past 12 months have been successfully settled into the team.