Birchlands is a purpose built care home providing care and accommodation for 52 people. The home is arranged into seven units and all bedrooms are single.

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 inspection took place on 13 June 2017 and was unannounced. At our last inspection in March 2016 we identified one breach in the regulations. This was around the recording of people’s care needs. The registered manager and provider gave us an action plan on how they would address these issues. At this inspection we found that all the areas of concern had been addressed, and people had a positive experience living at Birchlands. There was positive feedback about the home and caring nature of staff from people who live here.

Since our last inspection the registered manager and staff team had made a number of improvements to the home. This included a change in the environment with the introduction of a coffee lounge and game area, new menus, and a greater focus on people being able to follow their individual hobbies and interests. A number of these initiatives had just started, but there was already a positive impact to the lives of the people who live here.

People told us they were happy living there. One person said, “Staff here run around after us all, they [staff] are very good”. A relative said, “The staff are really caring people. They give a relaxed, homelike and welcoming feeling.” Staff were happy and confident in their work and proud of the job they do.

People were safe at Birchlands because there were sufficient numbers of staff who were appropriately trained to meet their needs. Staff understood their duty should they suspect abuse was taking place. Risks of harm to people had been identified and clear plans and guidelines were in place to minimise these risks. 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. People received their medicines when they needed them.

People were cared for by a happy and confident staff team. Staff received comprehensive training, to ensure they could meet and understand the care needs of the people they supported. Staff received regular support in the form of annual appraisals and formal supervision to ensure they gave a good standard of safe care and support.

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 (2005). An appropriate assessment of people’s ability to make decisions for themselves had been completed. Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.

People were supported to maintain good health as they had access to relevant healthcare professionals when they needed them. People had enough to eat and drink, and received support from staff where a need had been identified. People’s individual dietary requirements where met.

The staff were kind and caring and treated people with dignity and respect. People received the care and support as detailed in their care plans. People and relatives were involved in reviews of care to ensure it was of a good standard and meeting the person’s needs.

Feedback was sought from people, and complaints and compliments were reviewed to improve the service. When complaints were received these had been dealt with in accordance with the provider’s complaints policy. A family committee had been formed to work with the regist

Birchlands is a care home that provides residential care for a maximum of 52 older people who may also be living with a dementia type illness. The home is divided into seven units. At the time of our inspection, there were 32 people living in the home. Due to the vacancies in the home, only five units were open, with the other two closed for refurbishment.

We previously carried out an unannounced comprehensive inspection of this service on 06 August 2015. At that inspection a number of breaches of legal requirements were found. As result the service was rated Inadequate overall and the provider was placed into Special Measures by CQC. As part of this decision, we met with the provider to discuss our concerns. We also issued four Warning Notices which required the provider to take immediate action in relation to staffing levels, the management of people’s hydration and nutrition, acting in accordance with the Mental Capacity Act 2005 (MCA) and the effective governance of the home.

Since our last inspection we have continued to engage with the provider. We also required the provider to submit regular action plans that updated us about the steps they had taken to improve the service. This inspection confirmed that the provider had taken the action they told us they had. Significant improvements to the way the home was being managed meant that the provider had complied with the Warning Notices we had issued and we have now taken Birchlands out of Special Measures.

The service did not have a registered manager 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 2008 and associated Regulations about how the service is run. A new manager had been appointed and was in the process of registering with the CQC.

Since our last inspection, the service had experienced a period of considerable change. Whilst it was evident that the new management team had effected improvements to the leadership of the home, these changes now needed to be embedded and sustained.

The recent focus had been on changing the culture at Birchlands. As such other areas of improvement had been identified, but not wholly implemented. For example, like us the management team had highlighted the need to improve the standard of record keeping within the service. For example, whilst we found that people received appropriate care, this was not always reflected in the care plan. Similarly, further improvements to the provision of activities were required. The management team already had plans of ways to provide people with more opportunities to engage in activities and outings that were reflective of their individual interests and hobbies.

The service had a relaxed and friendly atmosphere. Staff were kind and caring towards people and upheld their privacy and dignity at all times. Staff had a good understanding of people’s needs and engaged with and supported them effectively.

People were supported to maintain good health. The service had good links with other health care professionals to ensure people kept healthy and well. Medicines were managed safely and there were processes in place to ensure people received the right medication at the right time.

People were more involved in making decisions about their care and staff understood the importance of respecting people’s choices and giving them control over their personal routines. People were effectively supported to maintain a healthy and balanced diet.

Staffing levels had been increased to ensure people received appropriate support in an unhurried and personalised way. Appropriate systems were in place to ensure only suitable staff were employed and all staff received relevant training and support to enable them to undertake their roles.

People were protected from the r

We carried out an unannounced comprehensive inspection of this service on 12 May 2015. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the cleanliness and infection control, the management of people’s medicines, safeguarding people from abuse, staffing levels, the need for consent, treating people with dignity and respect, care and treatment, assessing and monitoring the quality of the service, the accuracy of their records, how people were cared for and respected and requirements that related to the recruitment of staff.

We undertook this inspection to check that the provider had followed their plan and to confirm that they had now met legal requirements. This report covers our findings in relation to those requirements and any other additional areas that we looked at on the day of the inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Birchlands on our website at www.cqc.org.uk.

Birchlands is a purpose-built care home providing accommodation and personal care for up to 52 older people, some of whom are living with dementia. There were 46 people living at the home at the time of our inspection. Accommodation is arranged in seven units over two storeys.

There was no 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 and associated Regulations about how the service is run. The manager had been in post for several weeks at the time of our visit and have submitted their applicationfor registered manager with the CQC.

The provider had not followed their plan of action and continued to breach legal requirements.

Sufficient improvements to how medicines were administered had not been made. Topical creams for people had not been given to people as prescribed. There were no gaps or discrepancies in the medicine charts for people. All medicine was stored and disposed of safely.

People were still at risk of harm. People were still at risk of falling as there were not enough staff to meet people’s needs safely. People were being left on their own for long periods of time. Since the inspection in May 2015 there had been more falls. Risk assessments in people’s care plans had not all been reviewed since the inspection in May 2015. One health care professional told us “They (the service) lack people on the ground, the busiest time is in the morning.”

Staff practice led to some people being inappropriately restrained. One person was unable to get up from their chair as it was pushed in too much at the table.

There was no evidence that Mental Capacity Act 2005 (MCA) assessments had taken place in relation to whether people were able to consent to decisions being made. No additional Deprivation of Liberties Safeguards (DoLs) applications had been made to the local authority where needed. Additional training had not been provided to staff to increase their knowledge of MCA or DoLS since the last inspection.

Staff did not always provide the most effective care. Staff were not always provided with the most up to date information about the needs of the people they were caring for. They were not always provided with training around the conditions that people were living with.

Staff told us that before they started to work at the service they needed to complete the service’s mandatory training including moving and handling and infection control and the records confirmed this.

People were not always supported to eat and drink sufficient amounts to maintain their health. People were positive about the quality of the food. One person said “It (the meal) was very nice.”

We saw that the unit’s design of the environment of the service did not help people with dementia to be as independent as they could be.

People had access to a range of health care professionals, such as the community nursing team, and the GP.

People said that staff were caring. One person said “I like it here, the staff are very kind” and another said “They (staff) are very caring and very helpful

We found that staff were not always as kind as caring as they could be. Staff did not always offer support or give people choices about what they wanted to do. People were left on their own for long periods of time without any interactions with staff.

We did see some examples of laughter and chatting between staff and people and we saw that people enjoyed that.

People’s family and friends were able to visit at any time and we saw this happening throughout the visit.

People had their privacy and independence respected by staff. We saw people choose to sit in their rooms if they wished and heard staff knock on their doors before they entered.

There were not enough meaningful or individualised things for people to do on each unit. We did not always see staff encourage people to access any activities on the unit other than the radio being played or the television being on.

There were some activities taking place in one of the large lounges on the ground floor that four people attended. We saw people enjoyed these and were happy to take part.

Care was not provided in response to people’s needs. One person was at risk of pressure sores and steps had not been taken to reduce the risk of these developing whilst the person was sat in their chair.

Staff did not always have information about people’s backgrounds. There was not always information in care plans around people’s life histories and their preferences.

Comments from people about how caring the staff were varied.Comments included “I feel that I am being a nuisance if I want anything” and “I don’t feel wanted (here)“. One person said “I like it here, the staff are very kind.”

One health care professional told us that the television was not always showing age appropriate programmes and felt that no one was asked what they wanted to watch. We also found this during our inspection. We did see that some people’s care plans had been reviewed since the last inspection and that these reflected the person’s up to date needs.

There were still gaps in the records around the care that had been provided. Where people had undertaken activities or taken baths these had not always been recorded in their daily notes. Where people had had baths this was not always being recorded.

Not all of the audits we saw at the previous inspection were used to improve the quality of the service. The manager told us “We are aware of the areas that still need looking at; there is a long way to go.”

Improvements had been made to the cleanliness and infection control around the service. There were still areas around the service that required improvement including how people’s laundry was cleaned.

We recommend that all areas of the service are maintained and cleaned to a suitable standard.

Staff had regular supervision and staff meetings and said that they felt supported.

We found during this inspection that sufficient improvements had been made to ensure that all recruitment checks were undertaken for staff. This gave assurances that only suitable staff were recruited.

In the event of an emergency such as a fire, each person had a personal evacuation plan and at each handover staff discussed these.

During the inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this report is ‘Inadequate’. This means that it has been placed into ‘Special measures by CQC. The purpose of special measures is to;

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement power in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such as there remains a rating of inadequate for any key questions overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the providers registration.

Birchlands is a purpose-built care home providing accommodation and personal care for up to 52 older people, some of whom are living with dementia. There were 46 people living at the home at the time of our inspection. Accommodation is arranged in seven units over two storeys.

The inspection took place on 12 May 2015 and was unannounced.

There was no 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 and associated Regulations about how the service is run. The manager had been in post for several weeks at the time of our visit and had begun the process of registering as registered manager with the CQC.

People were not protected from potential risk of harm by staff. For example, one person felt scared in the home because of the actions of others, but staff had not addressed this.

Staff did not follow correct and appropriate procedures in relation to medicines to ensure people received their medicines safely. There was no guidance to staff for people who may request ‘as required’ medicines.

There were insufficient numbers of staff to meet the needs of the people living at Birchlands. We observed numerous occasions when there were no staff around.

Staff did not understand their roles and responsibilities in relation to infection control which meant people may be at risk of infections.

The provider had not ensured safe recruitment practices were followed, which meant they may employ staff who were not suitable to work in the home.

Care was provided to people by staff who were trained, although we found staff had not received regular supervisions so the provider could not ensure they put this training into practice or identify what other support they may require.

Staff did not understand their responsibilities in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). Best interest decisions were not made in line with legislation.

Staff supported people to access health care professionals, such as the GP or district nurse, however we did not always find staff referred people to them in a timely manner.

Although we observed some good examples of kind care from staff, we found people were not made to feel as though they mattered by staff. Staff did not take the time to interact with people and we saw people sitting for long periods of time with nothing to do. We also heard some staff speak to people in an inappropriate manner.

Care plans were not person centred and did not always contain information to guide staff on how someone wished to be cared for. People were not involved in developing a care plan which was responsive to their needs. Information was missing in care plans. For example, in relation to personal care, medicines and risk assessments.

Activities occurred in the home, however they were not specific to the needs of all the people living there. For example, there were no reminiscence items for people who were living with dementia. Staff supported people to take part in various activities but individualised activities had not been considered by staff.

Complaint procedures were available to people. Some complaints had been received by the provider however, we did not find these were always addressed.

We saw evidence of quality assurance checks carried out by staff to help ensure the home was a safe place for people to live and people were provided with a good quality of care. However staff had not acted on the recommendations from some of these checks. For example, ensuring care plans were up to date.

Relatives were made to feel welcome when they visited and they and their relatives met together for meetings to discuss the running of the home. People and relatives were happy with the care provided which included a range of healthy meals and drinks each day.

Staff felt supported by the new manager and felt they could approach them if they had any concerns. Staff knew the procedures to follow should they have any concerns about abuse taking place in the home.

During the inspection we found some breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We visited Birchlands to look at the care and welfare of people who used the service. We spoke with six people who used the service. This was not in depth due to people living with the experience of dementia. We observed people interacting with staff and how they communicated together.

All the people that we spoke with told us they were happy at the home. They told us they felt safe and liked the staff that looked after them.

We saw that staff consulted with people who used the service. This was to ensure they gained consent prior to personal care or treatments being carried out.

Care plans and risk assessments had been updated regularly and reflected the care needs identified. We saw that the care plans and risk assessments had been signed by the people who used the service and their family member. We also saw that information held contained details that related to those people who held a lasting power of attorney for their relative.

Safeguarding training had taken place for staff and they had good knowledge of the procedures to be followed.

We saw that the person in charge had carried out appropriate checks when employing new staff. This ensured staff were of good character and had the necessary skills and experience to do the job.

We saw the complaints policy was displayed on the notice board. We were told all new admissions to the home are given a copy of this policy.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had a diagnosis of dementia which meant that not all of the people were able to tell us their experiences. We spoke to one person who told us

“The staff makes a fuss of me and are very good.” One person told us that they had concerns regarding two members of staff and their attitude towards them. This had been reported to the care manager and the registered manager told us this had been investigated and the problem resolved.

Another person told us they were not sure if they had had a bath regularly. We talked to staff and checked the care records and found this not to be the case.

The home was very busy with good attendance at the morning and afternoon activity sessions.

The day before our visit the home had an inspection from the CQC pharmacy inspector who found that the home had good systems in place to ensure the safety of the people using the service when receiving their medicines.

People who use the service told us that staff consulted with them about their personal care needs and the types of activities they could do that day. People confirmed that they felt safe at Birchlands and that the staff were always very kind to them.

People who use the service could not remember being involved in the care plans but confirmed that staff knew about them including their likes and dislikes.