The inspection took place on 30 August 2018 and the visit was unannounced.

Silver Birches is a residential care home providing accommodation and support for up to 19 people.

Silver Birches had 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.

Silver Birches 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. Silver Birches accommodates a maximum of 16 people in one building, with bedrooms on the ground floor and first floor. At the time of our inspection there were 15 people who lived at the home.

At the last inspection on January 2016 the service was rated as Good. At this inspection we found the service remained Good.

People had their support needs assessed and were involved in the development of their care plan. Staff had access to people’s care plans and received regular updates where people’s needs had changed. Care plans were updated and included changes to peoples’ support needs. People were supported to attended routine and specialist health checks.

People felt staff were kind and caring, and their privacy and dignity was respected in the delivery of care and their choice of lifestyle. People were aware of their care plans and they were involved in care plan reviews. Staff prompted people’s choices and respected their decisions.

People were provided with a choice of meals that matched their dietary and cultural needs and choices. Staff ensured people were able to maintain contact with their family and friends and visitors were welcome without undue restrictions. There was sufficient person centred and culturally appropriate activities provided on a regular basis.

Staff were subject to a thorough recruitment procedure that ensured staff were qualified and suitable to work with people. All the staff received a training induction and then on-going training for their specific job role. Staff were informed about and were able to explain how they kept people safe from abuse. Staff were aware of whistleblowing and what assistance was available from external bodies to report suspected abuse on to and follow up alleged incidents.

Staff told us they had access to information about people’s care and support needs and what was important to people. People who used the service and staff felt they could make comments or raise concerns with the management team about the way the service was run and were confident these would be acted on.

There was a clear supportive management structure within the service, which meant the staff were aware of who to contact out of hours. The provider undertook quality monitoring in the service and was supported by the compliance manager and staff. Staff were aware of the reporting procedure for faults and repairs and had access to maintenance services and resolve emergency repairs.

The provider had developed opportunities for people to express their views about the service. These included the views and suggestions from people using the service, their relatives and health and social care professionals. We received positive feedback from a health professional about the support offered to people.

This inspection took place on 8 December 2015 and was unannounced.

Silver Birches is a care home that provides residential care for up to 16 people. The home specialises in caring for older people. At the time of our inspection there were 13 people in residence. The provider has commissioned an extension to the building, when completed will provide and extra three bedrooms and further office facilities. On completion the home's capacity will rise to provide accommodation for 19 people.

A registered manager was 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.

At the last inspection of the May 8 2014 we asked the provider to take action. We asked them to make improvements in the storage of people’s medicines, infection control and improvements in the safety of the building. We received an action plan from the provider which outlined the action they were going to take and be compliant by July 2014. We found that the provider had taken the appropriate action in all three areas.

People were happy and told us that they felt safe. Staff were able to explain how they kept people safe from abuse, and knew what external assistance there was to follow up and report suspected abuse. Staff were knowledgeable about their responsibilities and trained to look after people and protect them from harm and abuse.

Staff were recruited in accordance with the provider’s recruitment procedures that ensured staff were qualified and suitable to work at the home. We observed there were sufficient staff available to meet people’s needs and worked in a co-ordinated manner. Staff received an appropriate induction and on-going training for their job role, had access to people’s care records and were knowledgeable about people which was important to meet their needs.

Staff communicated people’s dietary needs appropriately, which protected them from the risk of losing weight. People’s care and support needs had been assessed and people were involved in the development of their plan of care. People told us they were satisfied with the care provided.

People were provided with a choice of meals that met their dietary needs. Alternatives were provided for people that did not like the meal offered. We noted that the food came out of the kitchen plated, and gravy was brought out separately. There were drinks and snacks available throughout the day. The catering staff were provided with up to date information about people’s dietary needs. Medicines were ordered, stored and administered to people safely.

People felt staff were kind and caring, and their privacy and dignity was respected in the delivery of care and their choice of lifestyle. Relatives we spoke with were also complimentary about the staff and the care offered to their relatives.

We observed staff speak to, and assist people in a kind, caring and compassionate way, and people told us that care workers were polite, respectful and protected their privacy. We saw that people’s dignity and privacy was respected which promoted their wellbeing.

Staff had a good understanding of people’s care needs, though some documents within the care plan and risk assessments lacked depth of information and explanation.

People told us that they had developed good relationships with staff.

People were involved in the review of their care plan, and when appropriate were happy for their relatives to be involved. We observed staff regularly offered people choices and respected their decisions.

People told us that they were able to pursue their hobbies and interests that was important to them. These included the opportunity to maintain contact with family and friends as visitors were welcome without undue restrictions.

Staff told us they had access to information about people’s care and support needs and what was important to people. Care staff were supported and trained to ensure their knowledge, skills and practice in the delivery of care was updated, though some of the courses had not been undertaken recently. Staff knew they could make comments or raise concerns with the management team about the way the service was run and knew it would be acted on.

The provider had developed opportunities for people to express their views about the service. These included the views and suggestions from people using the service, their relatives and health and social care professionals.

Staff sought appropriate medical advice and support from health care professionals. Care plans included the changes to peoples care and treatment. People were confident to raise any issues, concerns or to make complaints.

People who used the service and their visiting relatives spoke positively about the open culture and communication with the staff. We noted that the provider interacted politely with people and they responded well to him. When we spoke with the provider, it was clear he knew people and their relatives.

The provider had a clear management structure within the home, which meant that the staff were aware who to contact out of hours. Care staff understood their roles and responsibilities and knew how to get support. Staff had access to people’s care plans and received regular updates about people’s care needs.

There were effective systems in place for monitoring of the building and equipment which meant people lived in an environment which was regularly maintained. However the internal audits and monitoring of person centred planning did not reveal areas that were not fully detailed.

Staff were aware of the reporting procedure for faults and repairs and had access to external contractors for maintenance to manage any emergency repairs.

We saw eight people that lived in the home and three staff. Some of the people we saw in the home had memory problems or difficulty with communicating their needs. We spoke directly with three people living in the home, but they did not pass comment on the home.

The one person that did speak with us said, “I am happy here, I wouldn’t stay if I wasn’t,” they also stated “she’s a good girl, (pointed to a member of staff) she looks after us.”

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

At our inspection of 7 August 2013 we found that care plans and risk assessments were undated, and there were inconsistencies in the way people’s care and treatment was planned and delivered.

At this inspection we found care plans reflected people’s needs and staff understood how to support people individual needs in line with their care plans. Care plans were written in an individual way ensuring people received personalised care from staff. There were arrangements in place to deal with foreseeable emergencies such as individual evacuation plans in case of a serious event such as a fire.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit an application.

However we found medicines were not stored securely, and the record system used for controlled medicines could be made more secure. We also that the storage of care plans and medication details could be made secure and so increase confidentiality. We also found there were instances where repairs had not been quality checked to ensure the area was in full working order.

Staff told us they were provided with personal protective equipment (PPE). We also saw plentiful supplies of PPE placed around the home. We also noted that the cleaning schedules did not cover all the areas we would expect in the home, and a number of bins waste bins did not have disposable liners, which would have reduced the occurrence of cross contamination and cross infection in the home.

Is the service effective?

People’s health and care needs were assessed, and they and their representatives were involved in the agreement of their plans of care. However the storage of confidential information could be made more secure.

Is the service caring?

The service worked well with other agencies and services to make sure people received care appropriate to their needs. We saw where people were supported by visiting doctors, specialists and district nurses on a regular basis.

Is the service responsive?

The staff took action to ensure a person had not suffered any ill effects from being given a prescribed medicine that may have been stored incorrectly. They called for more specialised advice only after we highlighted the issue during our visit.

Is the service well-led?

Quality assurance systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. People using the service and their relatives, were invited to complete an annual satisfaction survey.

We spoke with four people using the service and five relatives visiting their family members. We also spoke to three members of staff.

We found people were able to make informed decisions about their care and support. One person told us “I like it here. The staff look after me well, they are always respectful and polite. I make my own personal choices.” One relative told us Silver Birches is “brilliant. I cannot fault it at all. I have never had a problem. My [family member] is looked after well.”

We found that care and support may not always be delivered in a way that met people’s needs. Whilst we found people’s care needs had been assessed, these assessments were not dated. We did not know whether the assessments related to the person’s current needs.

People were protected from the risk of abuse and staff knew how to raise any concerns. We found the provider had policies in place relating to the safeguarding of vulnerable adults, and whistle blowing.

We found that there were enough appropriately trained, skilled and experienced staff to meet people's needs.

We found systems were in place to regularly obtain people's views about the care and service they receive. We found the provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service.

We spoke with three people who lived at Silver Birches and asked them for their views about the home. One person who had recently moved into the home told us: “The staff are nice and they look after me well.” A second person told us “I like living here and I’m looking forward to Christmas.”

We observed staff supporting people with their daily care and noted staff gave clear verbal direction and guidance and provided reassurance to people who were confused. We noted a friendly rapport between people using the service and staff.

We looked at the care plans and records of two people and found that the information they contained provided clear guidance to staff to follow, which supported staff in delivering care which was consistent and reflected the individual needs of people.

We spoke with four people who use the service and asked them for their views about Silver Birches and the care and support they received. People told us they had visited the service prior to moving in and the reasons for choosing the service were because of the services small size and friendly atmosphere. People told us they were happy with the care they received and found the staff to be supportive and friendly. People’s comments included: - “The staff here are lovely, I like living here.” “I get the help I need and the staff are very friendly.”

We spoke with a visitor who was visiting a relative. They told us members of the family had visited the service and the reason for there choosing Silver Birches. They told us: - “when we visited it seemed friendly and intimate.” We asked the visitor for their views about the care their relative received. They said: - - “The care is very good, we’re very pleased and the care staff are friendly.” When asked whether they were kept in formed about their relative they told us: - “They’re on the case with any medical issues; we’re aware that they’ve been seen by doctor about a recent health issue, we were kept informed.”

We found by reading the care plans and records of three people that the service people receive could be improved by an individualised approach to care planning. The outcome and experiences of people with dementia could be improved if the development of care plans provided greater information as to people’s needs and acknowledged the impact of dementia on people’s daily lives.

We spoke with three people who used the service and asked them for their comments. People’s comments included: - “I decide what I want, staff listen to me.”

“I like it here, I am looked after well.” “It’s friendly here, and I like the meals.” “The staff are great, they’re very friendly.”

People told us they were happy with the way staff treated them. One said “it’s lovely here”. Another said “I’m quite happy”. They told us they were looked after well. They said “the doctor will come if you need”; “the nurses are very good, they help you the best they can” and “I’m satisfied with the care”. Their care records did not always fully support this.

People told us they were satisfied with the level of activities provided but there was poor evidence that people's social needs had been considered in their plans of care. Trips out to integrate people within their community were not being routinely arranged.

People told us they felt safe living at the home. One said there were no staff at the home that they would not want to care for them. We saw that there were gaps in the management of safeguarding, recruiting staff and infection control that could impact negatively on people's care.