The inspection was unannounced and took place on 17 February 2017. At our previous inspection on 15 November 2015, the service was rated Good. It met all legal requirements with the exception of keeping up to date care plans. We asked the provider to take action to make improvements to care plans and this action has been completed. During this inspection, the service remains Good with one recommendation.

Birchwood provides care to a maximum of 44 people. The service is split into five separate communities. Hollywood and Woodland are residential communities located on the ground floor whilst Rosewood and Mayfair are located on the first floor. Penthouse is also on the first floor and accommodates people living with dementia. On the day of our visit there were 38 people using the service.

At the time of our inspection, there was a registered manager in place. 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 told us they felt safe at Birchwood and that they were treated with dignity and respect by polite and caring staff. They felt if they raised any concerns they were promptly rectified. They were aware of the complaints process which was displayed in several communal areas within the service. They were able to feedback at monthly ’resident’’ meetings, through the comments and suggestions box at any time they felt the need to talk with the registered manager.

Staff were aware of the safeguarding processes in place and had attended training on safeguarding adults. They were aware of how to recognise and report abuse and where to locate the safeguarding policy.

Incidents and accidents were investigated and managed appropriately. Staff were aware of recent incidents and any identified learning was shared during handovers and team meetings.

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

Risk assessments were completed to ensure any identified risks were mitigated. Risks identified included falls, choking, and reduced mobility.

Medicines were managed safely by staff who received appropriate support and training.

Staff completed a comprehensive induction and received regular supervisions and yearly appraisals. This ensured their skills and competence were up to date and enabled them to support people safely.

People were supported to eat and drink a balanced diet that met the cultural, religious and personal preference. Where people were identified as at risk of malnutrition, appropriate referrals were made to enable them to maintain a healthy lifestyle.

Care plans were individual and reflected people’s current likes and dislikes. People were encouraged to participate in activities as they wished and had a lot of choice or communal or individual activities.

There was an open and honest culture where people, their relatives and staff felt they could approach management and discuss any issues and concerns.

There were effective quality assurance in place including seeking and acting on people’s feedback in order to improve the service.

The inspection was unannounced and took place on 3 November 2015. There were no breaches of any legal requirements at our last inspection in December 2013.

Birchwood Home provides accommodation and support with personal care for up to 44 older people some of which may have a physical disability or may be living with dementia. On the day of our visit there were 41 people living at the service.

The service had a manager in place who had started on 19 October 2015 and was in the process of completing the relevant steps to become a 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.

People told us they felt safe and that staff were kind and compassionate. We observed people were treated with dignity and respect and their privacy was respected.

Staff were aware of the procedures to follow in response to allegations of abuse, reporting incidents, medical emergencies, fire and had attended appropriate training. Staff were supported by means of regular supervision, annual appraisals and regular meetings. In addition continuing professional development by means of gaining vocational qualifications was also supported.

People told us that there were enough staff to meet their needs most times although they told us over the summer where there had been shortages. Staff and management confirmed that there had been shortages in July and August. However, there had been a big recruitment drive and all vacancies had now been filled. We checked staff files and found appropriate recruitment checks had been completed.

People were supported to maintain a balanced diet and given choice. Staff were aware of the Mental Capacity Act 2005 (MCA) and the need follow appropriate procedures to ensure that people who lacked capacity to make certain decisions were only deprived of their liberty when it was in their best interests to do so.

People told us that staff were considerate and kind. We observed compassionate interactions between staff, people and relatives. Staff had attended equality and diversity training and were able to demonstrate how to apply this in practice.

Although care plans had an element of describing people’s individual needs, they were not always updated to reflect the current needs of people.

People thought the management were approachable and visible. There were clear management and reporting structures in place and staff were aware of the vision and values of the service.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the back of the report.

People told us that they were happy in the home and felt that their wishes were respected. They told us that staff listened to them and were caring. One person told us "I would not be here if the staff were not good". People told us that there were plenty of activities for them to do and they took part if they wished.

We found that care was planned and delivered by experienced staff who understood the needs of the people. There was a choice of menus and people were supported during mealtimes. We found that the staff interacted well with the people. "We are happy here; very very wonderful staff", said one person who spoke to us.

The service had a complaints procedure and it was kept in a folder in the entrance hall. People told us that they were able to raise their concerns with the manager who would deal with the issue satisfactorily. People felt safe in the home and we found that the staff had regular training, including on safeguarding and manual handling. Clinical staff such as the general practitioner, the district nurse and the dentist visited the home as required to provide care and treatment.

The residents and their relatives were surveyed during the year and they responded that they were happy with the home.

People told us they were satisfied with the care and support they received, and that staff knew how to meet their needs. When asked if staff knew how to support them, one person replied "they know very well. If I need help they stay with me when I have a bath." People told us that the service supported them to meet their health care needs. One person said "I got a terrible cough and cold and they got the doctor." We saw that care plans and risk assessments were in place for people. Records showed that people had access to health care professionals, including GP's chiropodists and district nurses.

People told us they liked the food, and that they were offered choices. People also told us they were given enough food and drink. One person said "the food is all right, they don’t keep you short or anything." We observed the lunchtime period to be relaxed and unhurried, and people appeared to enjoy their meal. Kitchen staff had a good understanding of people's individual dietary needs.

We found that medications were stored securely, and administered in line with prescribing instructions. The service had a complaints procedure in place. People told us they had not had to make a complaint, but that they knew who to complain to if they did want to. We found that checks were carried out on staff before they began working at the service including Criminal Records Bureau checks and employment references.

People told us that Birchwood is a welcoming and pleasant home to live in. We observed in the comments book that “ The staff are very friendly and helpful. The home itself looks to be very comfortable and bright”, and another comment stated “Beautiful home, X is very happy and well cared for. I could recommend this home to anyone looking for good care”. A person living at the care home and their family told us that “Everyone is lovely here”.