Silver Birches is a care home for up to 14people who have learning disabilities, they may also have a physical disability. The home is managed by Fitzroy Support and located in the Richmond area.

At our last inspection of 10 October 2016 the home was rated “Good”. At this inspection the home continued to meet the characteristics of Good in all areas.

People received safe care and support. The provider had systems in place to manage safeguarding concerns and staff were appropriately trained in this area. People were safe from harm because appropriate risk assessments had been carried out with regard to activities people took part in as well as the safety of the premises.

The provider employed sufficient numbers of staff to work in the home so that people’s needs were met. People were safely supported with their medicines and general health and care staff had received training to enable them to carry out their role effectively. Care staff were supported by their management team to do their job.

People had good relationships with care staff who protected their rights to lead as normal a life as possible. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The home had policies and management systems which supported and ensured good care practice.

Relatives told us they felt people were safe and well cared for in the home. Some people were unable to provide detailed verbal feedback but were able to indicate that they felt comfortable and at ease with staff. Other people spoke positively about the support they received.

We found where people lacked capacity that the appropriate authorisations were in place with regard to lasting power of attorney. People accessed health care homes when needed and records were maintained in relation to each person’s health, appointment visits and medicines. People were supported to take part in activities of interest and their preferences, likes and dislikes were known to staff.

The provider had a complaints procedure which relatives were aware of. The home had an open-door policy which welcomed informal discussions and conversations whenever needed.

This inspection was part of our scheduled plan of visiting homes to check the safety and quality of care people received. We will continue to monitor intelligence we receive about the home until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Silver Birches provides accommodation and personal care for up to 14 adults with a learning disability and/ or autistic spectrum disorder. At the time of our inspection 13 people were living in the home. The inspection took place on 10 October 2016 and was unannounced. At the previous inspection, held in October 2013 we found that the service was meeting the required standards.

The home was divided into three flatlets with individual rooms within each flatlet. Communal space within each flatlet consisted of a lounge area, kitchen and dining room. There was a private garden at the rear of the property.

There was a manager in post, who had made application to be registered with the Care Quality Commission (CQC) and they were at the home 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 2008 and associated Regulations about how the service is run.

The home was well decorated and adapted to meet people’s needs. The home had a homely feel and reflected the interests and lives of the people who lived there.

The people living at the home were unable to communicate verbally with us to provide feedback. We therefore used observation of interaction and engagement between people and staff in order to understand how comfortable and at ease people were. People were able to demonstrate their needs through various interactions with staff and enjoyed freedom of movement and activity in and around the home.

There were sufficient numbers of staff to meet the needs and preferences of the people that lived there. Staff understood their duty should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding team or the police. Risks of harm to people had been identified and clear plans and guidelines were in place to minimise these risks, without restricting people’s freedom. Staff ensured that people were involved in these decisions by speaking with people and making sure care plans were personalised and easy to read.

People were offered choices, supported to feel involved and staff knew how to communicate effectively with each individual according to their needs. People were relaxed and comfortable in the company of staff. Staff supported people in a way which was kind, caring, and respectful.

Staff helped people to keep healthy and well, they supported people to attend appointments with GP’s and other healthcare professionals when they needed to. Medicines were stored safely, and people received their medicines as prescribed. People were involved in their food and drink choices and meals were prepared taking account of people’s health, cultural and religious needs.

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 have been 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.

The provider regularly sought people’s and staff’s views about how the care and support they received could be improved. There were systems in place to monitor the safety and quality of the service that people experienced.

We spoke with six people who use the service, three relatives and two placing social workers of people who use the service, seven members of staff and the manager during this unannounced inspection.

The home was divided into three flats, each with a lounge, kitchen/dining area, bathroom and single bedrooms in addition there was a large room for activities, a sensory room and a garden with a summer house which were accessible to people who use the service.

Relatives told us that they were happy with the care and support provided and said "great", "second home", "staff are responsive and caring" and "I am pleased my relative is settled and happy to return when they have visited us at home". Relatives were aware of how to make a complaint and felt that the staff were responsive to their comments. One person said that communication had been an issue and was hopeful that changes to the telephone system would help this improve.

Social workers were "pleased with the improvements made" and said that no issues had been raised at recent reviews.

Staff were happy to be working at the home, had the required checks and the training and support they needed to carry out their role. "People go out a lot", "we get on well as a team", "the families are very involved" and "provide good care" were the things staff said they did well at Silver Birches.

We saw that staff clearly knew people and how best to meet their needs. Staff spoke with people in respectful and caring ways.

During our visit a relative said staff "Are very caring, astonishingly patient and calm". We saw that people were treated with dignity and respect during our visit. They were enabled and encouraged to make their own decisions and choices, including choosing and joining in with activities if they wished. The relative also confirmed they attended care reviews and thought there were appropriate numbers of staff to meet people's needs. They said Silver Birches was "A community with a very vigorous relatives group". They told us they thought it was a good place where people were safe and protected by a competent and professional staff and management team. They told us "The manager has really turned this place around". During our visit staff were very friendly, supportive and met people's needs well.

The conversations we had with people who use the service did not relate to the outcomes we were inspecting, due to communication difficulties. Our findings were based upon the care we observed and peoples' reactions to it. We saw that people felt safe and protected by staff. They were comfortable interacting with staff and people spent most of the time laughing and smiling.

We visited the service to see what improvements they had made in looking after people’s money, managing medicines and keeping the environment clean. On this occasion we met one person who lives at the home but did not talk to them about their experiences.

When we visited in January 2011 we observed that people were well cared for and appeared happy and comfortable. We saw that people were treated with genuine fondness and affection from staff.

Relatives of some of the people who live at the home contacted us as part of the review. They said that they were happy with the care at the home and felt that their relatives were happy there.

The staff told us that they felt well supported and enjoyed their work at the home. They spoke about people in a very caring and knowledgeable way.

Not everyone who lives at the home was able to tell us how they felt about living there. However, when we visited, we observed that people were well cared for and appeared happy and comfortable. Some people told us what they liked doing. We saw that people were treated with genuine fondness and affection from staff.

Relatives of some of the people who live at the home contacted us as part of this review. They said that they were happy with the care at the home and felt that their relatives were happy there.

The staff told us that they felt well supported and enjoyed their work at the home. They spoke about people in a very caring and knowledgeable way.

The manager started working at the home a few months before this planned review. She told us about the plans she had to improve things for the people who live there.