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

Silver Birch accommodates seven people in one adapted building.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service was inspected in October 2015 and the service was rated Good. The service was further inspected in February 2017. That was an inspection that focussed on how safe the service was. We rated the service as Requires Improvement for Safe.

At this inspection we found the service remained Good overall and that the Safe rating had improved to Good.

People looked comfortable and at ease around care staff. Relatives we spoke with told us they felt assured their family member was being cared for in a safe way by care staff who understood how to keep them safe. People were supported by staff that understood people’s health needs and the risks to people’s health that people lived with. Staff had access to information on how best to support people and understood the risks to their health that they lived with. People received help to take their medicines and people medicines were safely administered and stored. The registered manager made regular checks to ensure people received the correct support.

People were supported by staff that had access to regular supervision and training. People were supported to have choice and control over their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported to maintain a healthy lifestyle and could access additional medical support when they needed it.

People and their relatives told us, staff were kind and compassionate. Staff worked as a team to ensure people were supported with respect and their dignity maintained. People benefitted from the staff using different approaches and communication equipment to support them to make choices and be involved in their care decisions as much as possible.

People said their needs were met by staff, that were knowledgeable about their rights and preferences. People were supported to raise concerns and where this was done, people’s concerns were investigated and action taken.

People liked and knew the registered manager and staff reported they enjoyed working at the home and felt part of a team. Staff felt empowered to share their ideas to help improve people’s care and worked with other stakeholders to improve people’s experience of care.

Further information is in the detailed findings below.

We carried out an unannounced comprehensive inspection of this service on 20 May 2015. After that inspection we received concerns in relation to some aspects of the safety of the service. In response to this we undertook an unannounced focused inspection of this service on 22 and 25 November 2016 to look into these concerns. This report only covers our findings in relation to this focussed inspection which looked at whether the service was safe. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Silver Birch on our website at www.cqc.org.uk.

Silver Birch provides accommodation without nursing for up to seven people who are living with learning disabilities and have sensory impairments. At the time of the focussed inspection seven people were living at the home.

There is a registered manager at the service who was present throughout the 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 2008 and associated Regulations about how the service is run.

People told us they felt safe living at the home. Staff were knowledgeable about the different types of abuse and told us appropriate action they would take should they have concerns. There were enough staff available to meet people’s requests for support although we noted that the deployment of staff needed reviewing in order to promptly meet people’s specific care needs.

There were systems in place to enable people to receive their medicines safely and to monitor medicine administration.

Staff had a good knowledge of the people they supported however this was not reflected in people’s care plans and risk assessments. We found some records did not reflect people’s current needs. There was a risk that people would not receive consistent, safe support with their care needs.

We received assurance from the registered manager that the issues identified would be addressed.

This unannounced inspection took place on 20 May 2015. Silver Birch can accommodate up to seven people who have learning and physical disabilities and who need support to live in the community. This home specialises in providing support to people with visual impairment.

The service has 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.

The service met all of the Regulations we inspected at our last inspection in September 2013.

People told us that they felt safe. There were good systems for making sure that staff reported any allegation or suspicion of poor practice and staff were aware of the possible signs and symptoms of abuse.

The arrangements for the storage, administration and recording of medication were good so that people were protected from possible errors.

People who lived in this home and people’s relatives, told us that they were happy with the care provided. People were supported to attend social and educational activities of their choice and most people chose to live busy lives with frequent outings. People’s relatives were encouraged to visit and were made welcome.

Throughout our inspection we saw examples of and heard about good care that met people’s needs. People and, where appropriate, their relatives, were consulted about their preferences and people were treated with dignity and respect. People in this home lived active lives and made frequent outings, for example, to places of interest and the theatre.

Staff working in this home understood the needs of the people who lived there. We saw that staff and people living in the home communicated well with each other and that people were enabled to make choices about how they lived their lives.

Staff were appropriately trained and skilled and provided care in a safe environment.

The registered manager and staff we spoke with understood the principles of protecting the legal and civil rights of people using the service. We did not find anyone being deprived of their liberty.

People were supported to have their mental and physical healthcare needs met and were encouraged to maintain a healthy lifestyle. Staff made appropriate use of a range of health professionals and followed their advice when provided.

People were supported to eat meals which met their needs and suited their preferences.

The registered manager assessed and monitored the quality of care consistently. In addition to observing and working alongside members of staff, the registered manager consulted people in the home, their relatives and professional visitors to find out their views on the care provided. The registered manager checked to see if there had been changes to legislation or best practice guidance to make sure that the home continued to comply with the relevant legislation The provider encouraged feedback from people who lived in the home, their family members, advocates and professional visitors, which they used to make improvements to the service.

At the previous inspection we found that the records did not contain appropriate evidence that staff were suitably experienced, or that checks had been made on people’s identity before they started work. This meant that we could not be sure that people were properly protected by the home’s arrangements for employing people. The manager supplied us with details of an action plan for addressing these issues. We found at this inspection that appropriate action had been taken so people were better protected.

At this visit we met four people who lived in the home, two members of staff and a relative of a person who lived in the home. We also looked at a sample of records.

We found that staff followed the instructions in people’s plans to make sure that people were supported to be as independent as possible. The plans showed that people had been consulted about their preferences and staff respected the choices which people had made.

People told us that they liked living in this home. They told us how staff supported them to keep in touch with family and friends. We saw pictures of people taking part in a variety of activities. Two people made hot drinks for us, demonstrating their independence skills.

We found that staff supported people to eat healthy diets. The records showed that people had been helped to reach weights which were considered to be more healthy and this meant that their mobility had increased.

We found good arrangements for the storage, recording and administration of medicines in the home.

The records showed that staff had good opportunities for training. Staff told us that there were checks on people’s understanding of their training to make sure that staff were competent in their roles.

When we visited Silver Birch we met with four people who lived there. We spoke with two staff members, the registered manager and spoke by telephone with two relatives about the care their family member received at Silver Birch.

People who lived at Silver Birch told us they were happy with the way staff supported them with their care. One person told us, “The staff are nice and they listen to me.”

Relatives we spoke with told us they were happy with the care their family member received. They told us, “Staff worked very hard to get to know XX and understand his specific needs” and “XX is settled and I am able to talk with staff about any concern I may have.”

Each person had a care plan. We saw some of the information in it was written in a way that was easy for people to understand with the use of photographs and symbols.

We found that staff knew people as individuals and understood how people communicated their needs. We saw that people were relaxed and at ease with staff supporting them with their care.

We found procedures in place to protect people from harm and staff described what these were and how they would report any suspicion of abuse.

We found systems in place for monitoring the quality and safety of the service.

Information about staff’s suitability to work at Silver Birch was missing in two of the three staff files we looked at. The registered manager advised us that action would be taken to ensure this information was available.

During our visit, we met four of the people living at Silver Birch. They indicated they were content living at the home. One person said they were “happy, just chilling.” They told us “the food is all right” and they were able to have an alternative, if they didn’t like the food being prepared for the meals.

People told us that staff involved them in their care. One person told us “People have talked to me to check I’m getting what I need.” They also said they had not been to meetings that were held with the people living there “but if I wanted to go, I would.”

They said staff supported them to manage their health, because “staff make appointments for me” if they needed to go to the doctors.

People were able to raise any concerns and one person told us that they had made a complaint and “it was sorted out.”