About the service:

The Birches is registered to provide accommodation and personal care for up to seven adults with mental health needs. It is situated in Chesterfield. Six people were living there at the time of our inspection.

People's experience of using this service:

Systems were in place to monitor the quality of the service provision; however, these were not always effective in ensuring issues were identified or improvements were made and sustained.

Improvements were required to the service's governance arrangements to assess and monitor the quality of the service and ensure that action was taken as required.

Whilst people received their medicines safely and as prescribed by their GP, the completion of the medicine administration records needed attention.

People and staff were positive about the care provided at The Birches.

Staff knew people well and had developed meaningful relationships with them. People were given choice and supported to develop daily living skills.

Staff were kind and caring and people were treated with dignity and respect.

People received effective care from staff who understood how to recognise and report issues of concern and potential abuse. Staff were recruited safely, were visible in the service and responded to people quickly.

There was a complaints system in place and people felt able to raise concerns which were addressed.

People could access the community and take part in a range of activities which promoted their wellbeing.

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

People's health was well managed and there were positive links with other professionals to ensure that individual needs were met.

People and staff were positive about the manager and felt they were approachable.

Rating at last inspection: Good (report published 7 October 2016)

Why we inspected: This was a planned inspection based on the previous rating.

Enforcement: Please see the 'action we have told the provider to take' section towards the end of the report.

Follow up: We will continue to monitor all intelligence received about the service to ensure the next planned inspection is scheduled accordingly.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This unannounced inspection took place on 30 June and 1 July 2016. The service was last inspected on 30 September 2015 when we found there was a breach in the legal requirements and regulations associated with the Health and Social Care Act 2008 relating to the care and welfare of people who use services. We asked the provider to take action to make improvements, and this action has been completed.

The Birches is registered to provide accommodation and personal care for up to seven adults with mental health needs. Seven people were living there at the time of our inspection.

The service did not have a registered manager at the time of our inspection visit. 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 provider had appointed a member of staff who was in the process of applying to become the registered manager. The service also had a manager in place who was responsible for the day-to-day running of the service.

People were protected from the risk of abuse and avoidable harm. Risks associated with care were identified and assessed. Staff had clear guidance about how to meet people’s individual needs. Care plans were regularly reviewed with people and updated to meet their changing needs and preferences. People were supported and cared for by sufficient staff who were suitably skilled, experienced and knowledgeable about people’s needs.

The provider took steps to ensure checks were undertaken to ensure that potential staff were suitable to work with people needing care. Staff received one-to-one supervision and had regular checks on their knowledge and skills. They also received training the provider felt necessary to meet the needs of people at the service.

The systems for managing medicines were safe, and staff worked in cooperation with health and social care professionals to ensure that people received appropriate healthcare and treatment in a timely manner.

Arrangements were in place to assess whether people were able to consent to their care. The provider was meeting the legal requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DOLS). This meant people’s rights were being upheld, and any restrictions in their care were lawful and proportionate.

People were supported to be involved in their care planning and delivery by staff who respected and supported their individual choices. The support people received was tailored to meet their individual needs, wishes and aspirations.

Systems were in place to monitor the quality of the service provided and ensure people received safe and effective care. These included seeking and responding to feedback from people in relation to the standard of care. Regular checks were undertaken on all aspects of care provision and actions were taken to improve people’s experience of care.

The provider demonstrated that people, relatives and staff felt confident in the way the service was managed, and that everyone felt confident to raise concerns or suggest improvements.

This inspection was carried out by one inspector in response to concerns reported to the Care Quality Commission. This was not a full inspection. The service was last inspected on 16 September 2013 when it was fully compliant.

The purpose of this inspection was to respond to concerns which had been raised about the service and ensure people using the service were safe from the risk of unsafe care or treatment. There were 7 people living at the home at the time of our visit. We spoke with three people. We were not able to speak with everyone. One person was in hospital. We also looked at care plans and other records. We spoke with the manager and deputy manager working at the service. We used the evidence we collected during our inspection to answer five questions. A summary of what we found is set out below.

Is the service safe?

We spoke with three people who told us they felt safe. One person told us, “It’s much better than anywhere I have been previously.” They said, “I feel safe and can raise concerns with the deputy manager who listens.” Another person told us if they had any concerns they would contact their social worker. Another person said they would contact the police if they had major concerns. One person told us they had raised concerns about how a member of staff spoke with people. They said their concern had been taken seriously and the service had acted to protect people.

Is the service effective?

The service had developed care plans to support people. We saw people had been involved in the development of their care plans and had discussed the content with their link worker. Link workers reviewed people’s care plans regularly to ensure they continued to meet people’s needs.

Is the service responsive?

People we spoke with told us they were sometimes cold. One person told us they had two duvets on their bed. Another person told us they were sometimes so cold they felt physical pain. Care staff said they were not aware feeling cold was related to the person's medical condition. However, the service had not obtained advice from healthcare professionals about the likelihood or how to support the person.

Is the service caring?

Everyone we spoke with told us care staff were kind and supportive. One person told us they enjoyed spending time with care staff and said they wished staff had more time to support them rather than cleaning or carrying out other roles.

Is the service well led?

The provider had systems in place for identifying, assessing and managing risks relating to the health, welfare and safety of people using the service.

Seven people were using the service at the time of this inspection. Three people living at The Birches spoke positively to us about their experiences and life there. One person said "I have only been here for a short time, it is better than where I was before, the staff are all helpful and I feel I can live here with the support I need, I have no complaints".

We saw that people were consulted and gave consent in writing before they received care or treatment. They were involved and in control of these decisions. All people using the service had capacity to consent.

We saw that people's care records contained detailed information about their needs and they had access to a range of health and social care professionals to support them. Care and treatment was planned in a way to ensure each person's personal safety and wellbeing.

We saw from observation, records and speaking to staff that the premises were suitable and safe and were maintained to a high standard. A person using the service said, "Yes, security is good and I do feel safe here".

We found that there were adequate numbers of suitably trained and experienced staff to meet people's needs. Two people using the service said that they felt there had been sufficient staff on duty at all times.

An effective complaints system was available, people using the service were able to tell us how they would make a complaint.

There were three people using the service at the time of this inspection. Two people were living at The Birches. One person was living in their own home and was receiving support as part of the outreach service. We met the two people living at The Birches, but they chose not to speak with us to give us their views of the service. We were able to observe how staff interacted with people using the service.

We found that people were involved in making decisions about their care and support. We saw that people were supported in their chosen lifestyles and relationships.

People were protected from abuse and from the risk of excessive physical restraint by staff awareness and the policies in place.

We found that staff recruitment procedures included making all necessary checks before staff started working with people using the service. We saw that staff had appropriate training to ensure they could meet people’s needs.

We found that people using the service and staff had the opportunity to give their views about the service provided. We saw that changes were made to the service in response to people’s views and in response to incidents and the findings of audits.