Birtley House Nursing Home is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Birtley House Nursing Home is registered to provide accommodation for up to 47 older people who require residential or nursing care. At the time of our inspection there were 39 people living at the home. The home also provides domiciliary care for eight independent living flats, however, none of these people were receiving a regulated activity at the time of our inspection.

The inspection took place on 15 May 2018 and was unannounced.

The last inspection of Birtley House Nursing Home was undertake in January 2016 when it achieved an overall rating of Outstanding.

At the time of inspection there was not 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 risks to people were documented but not with sufficient detail to provide staff with the guidance they needed in order to provide safe care and staff were not following the guidelines in relation to people’s care.

Staff did not understand how to apply legislation that supported people to consent to treatment and had not followed the principles and codes of conduct associated with the Mental Capacity Act 2005. Where restrictions were in place this was not always in line with appropriate guidelines.

Staff had not received regular supervisions that would enable them to carry out their duties. Appraisals had commenced for staff and would be ongoing.

We have made a recommendation that the environment is adapted to meet the needs of people to find their way to communal areas and their rooms.

People had care plans in place but these were not personalised to their needs. The provider had recognised this and implemented actions to address these.

People had a range of activities that they could choose to be involved in. There was a full activities programme that operated on a 5 day basis. Complaints and concerns were taken seriously and people knew how to make a complaint if they needed to. End of life care was provided sensitively and in line with people’s needs and preferences that help to ensure people had a pain free and dignified death.

People were supported by staff who knew the procedures to follow if they had witnessed or suspected abuse. People were complimentary about staff and said that they felt safe living at Birtley House. There was an up to date fire risk assessment and each person had a personal emergency evacuation plan (PEEPs) in place so staff would know how to safely evacuate them from the home if the need arose. Safe recruitment practice was followed that helped to ensure people were protected from unsuitable staff. The provider had carried out annual analyses of accidents, and incidents were monitored to enable the provider identify any trends and reduce the risk of repeated incidents.

People were treated with kindness and compassion by caring and dedicated staff and there was good interaction between staff and people. People were able to express their views and be involved in making decisions about their care, support and treatment. Staff respected and promoted people’s privacy and dignity and their independence was promoted.

At the time of our inspection there was not a registered manager in post to carry on the regulated activities. Quality assurance systems were in place to monitor the quality of service delivered, however, they were not fully robust. The provider was taking action to address this. People said that the home was well run. People and those impor

Birtley House Nursing Home is a care home that provides long-term, short-term (respite or rehabilitation), end-of life nursing and residential care for up to 47 people. There were 45 people living at the home at the time of inspection. The service also provides domiciliary support for eight independent living flats which are located on the same site as the care home. One person was receiving personal care services at this time.

The service had 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.

People received excellent care in a way that was personalised and responsive to their changing needs. Risks to people were managed in a proactive way which enabled them to live independent and fulfilling lives. Staff worked closely with community health professionals and therapists to maximise people’s well-being. People felt safe at Birtley House Nursing Home and had positive and caring relationships with the staff who supported them.

People had total control over their lives and spent their time as they wished. The service offered a wide range of both group and individual activities that were meaningful to them and which had a positive impact on their lives. Visiting was unrestricted and people’s relatives felt included in the care of their loved ones.

People were provided with a variety of meals and the extensive menu catered for any specialist dietary needs or preferences. Mealtimes were often viewed as a social occasion, but equally any choice to dine alone was also fully respected.

People had confidence in the staff who supported them and felt safe in their care. People benefitted from a high ratio of staff which meant that they never had to wait long for assistance. Staff treated them with kindness and took steps to promote their privacy and dignity at all times.

End of life care was exceptional with the service consistently going the extra mile to meet people’s final wishes and ensuring their final days were lived comfortably surrounded by the people who knew and cared for them. The service had been commended by the National Gold Standard Framework for providing excellent end of life care.

Staff enjoyed working at the service and felt well supported in their roles. They had access to a wide range of training which equipped them to deliver their roles effectively. The registered manager was an excellent role model and there were sound systems in place to develop staff and promote reflective practice. Staff were proud to work at Birtley House Nursing Home and felt valued and empowered to deliver high quality care.

People benefitted from living in a well organised, forward thinking home where their needs were always put first. The culture of the home was open and people felt confident to express their views and opinions. The registered persons provided clear leadership and direction to staff and were committed and passionate about the quality of care provided. The skills of the registered manager had been recognised locally when she was awarded ‘Manager of the Year’. She was also actively involved in research and was a member of various local working parties and partnership groups such as a hydration programme with a local Wellbeing group.

Quality assurance processes were robust and action plans to improve the service were prioritised and completed quickly. Learning was shared from within and outside the organisation and community contacts were well established. National best practice legislation and local policies were referenced to set and measure standards of care.

People expressed their views and were involved in making decisions about their care and support. We spoke with three people who told us they were very happy at Birtley House. They said they had regular meetings with the manager and key staff to discuss and agree their care and support needs. These were subsequently recorded in people's care plans together with information about people's preferences. One person told us "I do have choice about how I spend my day". Another person said "the staff are very kind and they make sure I am comfortable".

We observed staff providing care and support to people in ways that were both friendly and professional. There seemed to be good relationships between people and staff and we saw many interactions when people were smiling and looked relaxed. Staff told us the manner in which care was provided was considered to be very important. We saw references to ensuring people's dignity was respected in their care plans. This meant the provider was taking steps to ensure the staff supported people in appropriate ways.

During our inspection we spoke with three people who used the service. The first person we spoke with said “I think it’s kindly run. I’m very happy”. The second person we spoke with said “It’s very good. They listen to you and they do as much as they can”. The third person we spoke with said “I find it very good. All the staff are alright and care for me well”.

We found evidence people had been involved in their care. We saw their care was planned around their preferences and they were asked questions and given options.

We saw risk assessments had been completed for people and care plans had been regularly reviewed and updated to reflect people’s changing needs.

The home had an up to date safeguarding policy and staff were able to clearly express the process to follow should they need to report any possible abuse.

We found the home had an effective system in place to monitor the storage, distribution and disposing of medicines. We also found the home had an effective recruitment system in place which had been followed when staff had been hired.

We did not inspect the eight independent living flats or the care provided to the people living in these flats.

In this report the name of four registered managers appear who were not in post and not managing the regulatory activities at this location at the time of the inspection. Their names appear because they were still Registered Managers on our register at the time.

Four people using the service told us that were able to visit Birtley House Nursing Home before considering this service as a place to live. Two people told us they can make choices such as their preferred meals and where they have their meals. Five people told us that staff discuss their care and support needs with them.