This unannounced inspection took place on 18 October 2018. We had previously carried out an inspection on 14 March 2016 when we found the service had complied with all the regulations we reviewed.

Birchwood 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. We regulate both the premises and the care provided, and both were looked at during this inspection.

Birchwood Nursing Home is registered to provide accommodation for up to 16 people who require support with nursing or personal care. The service specialises in providing a rehabilitation service for people with enduring mental health conditions. People who use the service have their own en-suite bedrooms and access to the communal areas. At the time of this inspection there were 14 people using the service.

Birchwood Nursing Home is located in Oldham. There are shops and other amenities close by.

At our last inspection in March 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service had a manager who was registered with us. 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 the legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

The registered manager of Birchwood Nursing Home was on annual leave on the day of the inspection. The staff team supported us to collect the information we needed.

People said staff treated them with kindness and compassion. Comments included, "The staff are amazing here, very supportive” and “There are so many good staff who look out for you.”

Staff were aware of their responsibilities to safeguard people from abuse. Safe recruitment practices were in place and the service followed national and local safeguarding guidance.

There were sufficient staff to care for people. Risks to people's safety were assessed and medicines were administered safely.

Staff knew people's care needs, preferences, personal histories and backgrounds. People said staff protected their privacy and their dignity was respected.

People were supported to be independent and develop new skills.

We found that records were written in a positive and respectful way and provided guidance on how to support people.

People received care from staff who were appropriately trained to effectively carry out their job roles.

People were supported to have maximum choice and control of their lives. The service acted in accordance with the Mental Capacity Act (2005).

People's nutritional needs were met and they were supported to maintain good health and receive ongoing healthcare support.

People received personalised care that met their individual needs. People were given appropriate support and encouragement to access meaningful activities and follow their individual interests.

Birchwood Nursing Home had arrangements in place to receive feedback from people that used the service, their relatives, external stakeholders and staff members about the services provided.

We found that records were sufficiently maintained and effective systems were in place to monitor the quality of the service.

This was an announced inspection which took place on 14 March 2016. We had previously carried out an inspection in September 2014. We found the service to be meeting the regulations we reviewed at that time.

Birchwood Nursing Home is registered to provide accommodation for up to 16 people who require support with nursing or personal care. The service specialises in providing a rehabilitation service for people with enduring mental health conditions. People who use the service have their own en-suite bedrooms and access to the communal areas. Two bedsits are also available for people who are assessed as ready to move into a more independent living situation. At the time of this inspection there were 15 people using the service.

The provider had a registered manager in place as required under the conditions of their registration with the Care Quality Commission. 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 registered manager was supported in the day to day running of the service by a clinical lead and an administrator. The implementation and development nurse manager for clinical services was also based at Birchwood.

Staff had received training in safeguarding adults. They were able to tell us of the action they had taken to protect people who used the service from the risk of abuse. They told us they would also be confident to use the whistleblowing procedure in the service report any poor practice they might observe. They told us they were certain any concerns would be taken seriously by the registered manager.

Systems were in place to ensure staff were safely recruited although we noted the provider’s recruitment policy needed to be updated. Staff demonstrated a commitment to providing high quality personalised care for the individuals who accessed the service. People were supported to achieve their rehabilitation goals.

Robust systems were in place to ensure the safe handling of medicines. People were supported to take responsibility for their own medicines whenever possible.

Regular checks took place to ensure the safety and cleanliness of the environment. People who used the service were responsible for cleaning their own bedrooms, with support from staff as necessary.

Staff told us they received the training and supervision they needed to be able to carry out their roles effectively. Staff were able to demonstrate a good understanding of the Mental Capacity Act (MCA) 2005. We saw that arrangements were in place to ensure people who used the service were in agreement with the support provided.

Staff we spoke with told us they enjoyed working in the service and felt valued by both colleagues and the registered manager. Staff felt able to raise any issues of concern or make suggestions to improve the service in supervision and staff meetings.

Care records we reviewed included information about the risks people might experience. Support plans were in place to help ensure staff provided the level of support necessary to manage the identified risks. Support plans were regularly reviewed to address any changes in a person’s needs. People who used the service told us staff provided the right level of support to meet their needs.

People who used the service were able to access meals from the central kitchen or prepare their own meals with staff support as necessary. Staff told us they would try and encourage people to choose healthy ingredients and cooking methods.

People who used the service had opportunities to comment on the support they received. We saw that their views had been taken seriously and acted upon in order to improve their experience in the service.

Quality assurance systems were in place including regular audits

The inspection was carried out by one inspector. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive to people's needs?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and looking at records. We also were given a copy of a report completed by Oldham Clinical Commissioning Quality Monitoring team and the report produced by the pharmacist from the company that supplies Birchwood with medication.

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

Is the service safe?

Birchwood provides support for up to 16 people with mental health needs. The premises are located on the edge of a housing estate in the Lee area of Oldham. The building belongs to Irwell Valley Housing Association (IVHA). The Landlord was responsible for the maintenance of the building and the communal areas within the building. Maintenance of the bedrooms was the responsibility of Turning Point. The premises were generally clean, tidy and well maintained.

Although no one at Birchwood had been assessed as not having mental capacity; training in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) took place. This ensured that should people who were not able to make decisions or choices in the future were protected and kept safe. However a small number of people were subject to a Community Treatment Order (CTO). We saw that these were reviewed and that if someone required an Independent Mental Health Advocate (IMHA) they could be accessed through the local MIND facility.

We saw people had received an assessment of their care needs and that these had been discussed with the person concerned.

There were a sufficient number of people in the staff team to ensure that people were supported with their care needs.

Is the service effective?

Training was in place that ensured services were provided at Birchwood by a qualified staff team with up to date skills to provide support. We saw that people had training which included safeguarding adults, safe handling of medication, drug and alcohol awareness and positive behaviour management.

We saw from looking at the care files that people had received an assessment and that there were comprehensive personal support plans in place. We also saw that the medication file contained a support plan with each medication administration record. This ensured that everyone was aware of up to date information regarding medication for that person.

Everyone had their own room which they were able to personalise. There was also a kitchen on the ground floor which had recently been refurbished where people could make drinks and meals for themselves. There was also another kitchen on the lower ground floor which was also used.

Is the service caring?

All of the people we spoke with were happy with the service and the care provided.

We spoke with three people who used the service. They had no complaints about the staff team. One person told us; “If it was not for the staff I wouldn’t have got this far, they do a very good job.” Another said they (staff) are brilliant.

We saw during our inspection that people were treated with respect; staff knocked on doors before entering and conversations were relaxed and friendly. People's preferences were recorded in the care file and they were able to express their views and opinions through talking to members of the staff team, taking part in reviews and service user meetings.

Is the service responsive to people's needs?

We saw that people's needs were assessed using the Manchester Care Assessment Schedule (MCAS) which formed the basis of the personal support plan. The MCAS assessment was completed before people were offered a place at Birchwood.

The support to be provided and the rehabilitation programme were agreed with the person and documented on the care plan. People were encouraged to go out and manage their own shopping and cook their own meals with a view to people eventually taking responsibility for their day to day needs.

We saw that people were encouraged to administer their own medication and that systems were in place to support people in this and keep them safe.

Is the service well led?

Birchwood is part of the national organisation Turning Point which is a registered charity. The charity produces an annual report which can be found on their website.

Surveys and meetings were conducted regularly with people and staff who lived and worked at Birchwood in order to improve the service provided.

The area operations manager visited the home alternate days. A quality monitoring tool was completed quarterly and was sent to the regional manager. The report covered such areas as; care and welfare of people who use the service and consent to care and treatment.

The organisation had the Investors in People (IIP) Accreditation Gold Standard which was awarded in 2012. IIP assess and accredit organisations on the management and quality of the service they provide to both people who use the service and those who work for the service.

During this inspection we spoke in private with the manager, four members of staff and four people who used the service. Everyone who we spoke with was positive about the service provided. One person described it as “excellent”.

People were treated with respect, had their dignity maintained and were involved in discussion about the way in which their care and support was provided.

Care and support planning was based on a comprehensive set of assessments and was centred around the individual needs of the person using the service. People were involved in discussions and decisions about their own care.

The provision of food was good, providing choice, ample portions and nutritional balance. One member of staff said they particularly liked the Sunday roasts.

The building was clean, tidy and well maintained.

There were numerous quality assessment and monitoring processes. A good overview of these was maintained by the service provider. Action was required by the provider if any aspect of the service fell below their required standard.

During this unannounced inspection we spoke with three people who used the service and three members of staff.

All the people who used the service were very positive about the care and support they received at Birchwood. Comments included "I love it, it's brilliant, staff are lovely" and "they do everything they can for us".

People were involved in discussion and decisions about the way in which their care and support needs were met.

Each person had a written support plan which was regularly reviewed. People had access to their files and were encouraged to contribute to the planning process.

People told us they felt safe at Birchwood. Staff had received training in connection with safeguarding vulnerable adults, and were aware of their responsibility to protect people using the service.

The home ensured that rigorous recruitment and vetting procedures were followed. This helped to ensure that only appropriate staff were recruited.

The home had a complaints procedure. Staff and people using the service believed that any complaint would be listened to and dealt with.

We spoke to a small number of people who used the service. Other people were offered the opportunity to talk to us but did not wish to.

The people who we did speak with were very positive about the support they received. Staff were described as accessible, "very nice", and "not rude". One person, when asked what the best thing about the service was told us "everything! If you need help or want to try something you know they will listen and help. [This is an] easy place to be in." Another person told us that the best thing about the home was that "the people are nice … A really good atmosphere with the staff".

People who used the service told us that they were involved in decisions around their support, care and planning for the future. The staff enabled good relationships to be maintained with other healthcare professionals who were also involved with individuals using the service.

People told us that they felt safe in the home and that they were confident any complaint they did have would be dealt with appropriately. They also told us that they believed other people living at the home were treated with equal competence and a positive attitude from the staff team.

People who used the service also told us that the accommodation provided was clean and tidy, medication was managed to their satisfaction and that the provision of food and cooking facilities was good.