Birkdale Residential Home

Birkdale Residential Home provides accommodation and personal care to up to 29 people. At the time of this inspection there were 26 people using the service. Some of whom were living with dementia.

People’s experience of using this service and what we found

People were at the risk of harm from preventable injury as the provider failed to ensure risks had been identified and mitigated.

People were at risk of exposure to infectious illness as the provider failed to ensure appropriate infection prevention and control practices were being followed.

The physical environment within which people lived did not support effective cleaning as equipment, fixtures and fittings were damaged, rusted or unprotected. Food items were not safely stored.

People did not always receive their medicines as prescribed.

The provider did not have effective systems in place to review incidents, accidents, or significant events to see if something could be done differently to keep people safe.

The provider did not have effective systems in place to identify improvements and drive good care. The management team and provider failed to keep themselves up to date with best practice in health and social care.

People were protected from the risks of ill-treatment and abuse as staff had been trained to recognise potential signs of abuse and understood what to do if they suspected harm or abuse.

People were supported to have maximum choice and control of their lives and the provider supported them in the least restrictive way possible and in their best interests; the application of the policies and systems supported good practice.

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

Rating at last inspection.

The last rating for the service was good, published on 11 July 2019.

Why we inspected

The inspection was prompted in part due to concerns received about the management of risk within the building. A decision was made for us to inspect and examine those risks.

This report only covers our findings in relation to the key questions safe and well led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Birkdale Residential Home on our website at www.cqc.org.uk

Enforcement and Recommendations

We have identified breaches in relation to keeping people safe and with the overall management of the care provision at this inspection.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures.’ This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect

We found the following examples of good practice.

Visitors were checked on arrival for proof of vaccination where it was applicable. On the day of the inspection a visiting professional was not allowed entry as they could not provide evidence, they had the vaccine. This showed the provider was following the correct government guidance.

We saw there was a plentiful supply of PPE throughout the building and staff were observed to be wearing it at all times.

The manager kept relatives up to date with any changes and people were receiving visits from their relatives in line with the current guidance.

Risk assessments were in place for people and staff regarding individual risk factors of COVID-19. Staff and people were regularly tested and had received COVID-19 vaccinations.

Birkdale is a residential care home providing personal care to 25 people, aged 65 and over at the time of the inspection. The service can support up to 27 people. The home accommodates people in one building and has a day care facility on site called the Daisy Club.

People’s experience of using this service and what we found

Governance systems were in place however, some reviews had not been scheduled and care audits needed to be more in-depth. People were positive about the home and staff said they enjoyed coming to work. People told us the management were open and honest and relatives were told when things went wrong. Feedback was gathered from various sources as part of helping the home progress. The management team worked in partnership with others.

People were protected from harm by staff who had been trained in safeguarding procedures. People were supported by sufficient numbers of staff. Risks to people’s safety were assessed and people received their medicine by staff trained to administer. Infection control measures were in place and lessons were learnt when things went wrong.

People’s needs were assessed, and care plans were person centred. Staff received the necessary training to meet people’s needs. People were supported to maintain a balanced diet and had regular access to drinks and snacks. People were supported to access health care and the building was adapted to meet their needs.

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

People were treated with dignity and respect and they were encouraged to express their views. People’s privacy was maintained.

People were supported to maintain relationships and received information in an accessible format. Complaints were investigated, and feedback provided. People received end of life care in line with local multi-disciplinary guidance.

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

Rating at last inspection

The last rating for this service was requires improvement (published 7 June 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Following the last inspection, we asked the provider to provide us with an action plan of how they were going to make improvements. We checked the provider had taken the actions required at this inspection.

At this inspection we found improvements had been made and the provider was meeting the regulations for safe care and treatment, person centred care, dignity and respect, consent, responding to complaints and governance arrangements, however further improvements were needed.

Birkdale residential home 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.

Birkdale residential home accommodates up to 27 people on one adapted building. At the time of the inspection there were 22 people using the service.

There was a registered manager in post 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.

People were supported to manage risks to their safety however improvements were needed to the assessments and plans as they sometimes lacked detail.

Staff had received training, however further work was required to ensure this was kept up to date.

Improvements were needed to the environment to ensure it was suitable for people living with dementia. People did not always receive consistent care. People received support from staff that were caring, however improvements were needed to make this consistent.

People’s preferences were understood by staff. However this did not always inform people’s care planning. People were not consistently supported to follow their interests. Improvements were needed to how people were supported in a way that met their wishes and effectively at the end of their life.

The governance arrangements required further improvement to ensure they were driving improvements and that the changes made were sustainable.

People were safeguarded from potential abuse. People were supported by sufficient numbers of staff that had been safely recruited. People were supported to take their prescribed medicines. People were protected from the risk of cross infection.

People were supported to maintain their health and well-being. People had their rights protected by staff that understood and could apply the principles of the Mental Capacity Act 2005. People were supported to meet their dietary needs.

People were involved in decisions and had their choices respected by staff. People were respected and their dignity was maintained. People understood how to make a complaint and these were responded to and used to make improvements.

Notifications were submitted as required and the registered manager understood their responsibilities. We found people; their relatives and staff felt supported by the registered manager and were able to be involved in their care.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Birkdale Residential Home provides accommodation and personal care for up to 27 people. At the time of the inspection 25 people were using the service including some people who were living with dementia.

We were supported throughout the inspection by the 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.

Risks of harm to people were not being assessed, managed or reduced to prevent further incidents which had resulted in harm. Lessons were not being learned to ensure incidents and accidents were minimised.

People were not protected from the spread of infection as prevention measures were not being followed effectively.

People's medicines were not always administered safely.

There were sufficient numbers of staff however they were not always deployed safely. New staff had been employed through safe recruitment procedures.

People's needs were not assessed holistically to achieve effective outcomes. People were not cared for by staff who were trained and supported to fulfil their roles effectively.

People's nutritional needs were not always met and when people became unwell or their health care needs changed the appropriate health care advice was not always sought in a timely manner.

The principles of the Mental Capacity Act 2005 (MCA) were not always followed to ensure that people who lacked the mental capacity to agree to their care and support were supported to do so in their best interests.

The building and environment required further adaption to meet the needs of people who used the service.

People were not always treated with dignity and respect and people's choices and preferences were not always respected.

People's needs were not assessed effectively and their preferences were not always gained.

Complaints and concerns were not dealt with appropriately and some people did not feel their complaints were taken seriously.

The governance systems the provider had in place to monitor and improve the service were not effective in ensuring improvements were made.

People were safeguarded from the risk of abuse as the staff and management knew what to do if they suspected abuse.

There were a range of hobbies and activities to support people to maintain active and promote their well being.

Birkdale residential home is registered to provide diagnostic and treatment procedures, at the time of our inspection this was not being provided by the service so was not inspected.

There was a registered manager in post 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 registered manager received support from a staff team, which included an assistant manager, senior care staff and care staff.

At our last inspection carried out 15 October 2015 we asked the provider to take action to make improvements to the checks required by law to ensure only suitable people were employed at the service, and the provider has taken appropriate action.

People received care and support in a way that kept them safe. Staff protected people from the risk of harm and understood how to report concerns. Staff understood how to identify and minimise risks to help keep people safe. People were supported by safely recruited staff and there were enough staff to support people when they needed it. People received their medicines as prescribed and staff administered them safely.

The service had systems in place to assess people’s mental capacity. The registered manager understood when an application to the authorising agencies for a DoLS was required. Staff understood the principles of the MCA and DoLS and could apply these when delivering care and support.

People received support from trained staff who understood how to meet their needs. People had support to maintain a healthy diet and could access a choice of food and drinks as and when they wanted. People had access to health care professionals when they needed them, which helped people maintain their health and wellbeing.

People had positive relationships with staff that were respectful and caring whilst delivering people’s care and support. People were involved in making decisions about their care and support and were encouraged by staff to remain independent. People had their dignity and privacy respected by the staff who provided their care and support.

People did not always receive care that reflected their needs and preferences. People had access to a range of different activities and could do things they enjoyed. People’s complaints were investigated and responded to appropriately.

People were not supported by a management team who had effective systems and governance in place, which enabled them to recognise areas of improvement required within the service and take steps to make improvements. The registered manager had developed quality assurance systems, however not all of these were effective in making sure improvements were made. People and staff told us they felt confident to raise concerns with the registered manager.

There were two breaches of the regulations, you can see what action we told the provider to take at the back of the full version of the report.

We spoke with over half of the twenty two people living at the home, six relatives and eight members of staff including the manager and provider. Some people had health needs which meant they could not share their experiences with us. We spent time in both lounges to observe their care and support. Everyone we met was relaxed and confident and many said they liked living at Birkdale. One person told us, 'They are doing a grand job looking after us here."

People were involved in their health, care and treatment in ways they could understand. We saw they were encouraged to choose how to spend their time and were offered the opportunity to take part in variety of activities if they wished to. This was reflected in care records we looked at.

Systems were in place to protect people from the risk of abuse. Staff we spoke with felt the training they had received helped them to be confident to recognise and report abuse.

There were satisfactory recruitment procedures which reduced the risk of unsuitable

people being employed to work at the home. Staff told us they had received all of the necessary support and training they required to help them do their job well.

The management had effective systems to monitor and review the quality of their service. People were regularly reminded about the different ways they could have their say to improve living at Birkdale. We saw these actions had continued to improve the provision of care for people living at home.

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