Birkin Lodge

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This is the first assessment for this newly registered service. This key question has been rated good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. Before people moved into the service their needs were assessed. These assessments were used to develop the person’s care plans and make the decisions about the staffing hours and skills needed to support the person. The assessment included making sure that support was planned for people’s diversity needs, such as their religion, gender, marital status, culture and their abilities. Each person’s care plan and assessments were also reassessed once a month as part of the ‘resident of the day’ process. This ensures that every person’s care plan and risk assessment is updated at least monthly. People were reassessed as their needs changed to ensure the care they received met their needs. Some assessments included information about what people could do for themselves. People told us they were involved in their assessments and care planning processes. Some relatives told us they had been involved in the assessment and care planning process when their family member first moved to the service. A relative said, “The manager came to visit us in the hospital to discuss the care package.” Changes to people’s care needs were passed on at handover meetings and documented in handover notes. A staff member said, “We have handovers and handover information is shared in [online care planning program].”

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. The provider had systems and processes in place to meet people’s nutrition and hydration needs. However, it was not always evident that drinks were offered in a timely manner, we viewed many overdue fluid reminders on the online care planning program. A person had been calling out asking for their water bottle to be refilled. They said they felt dehydrated. Records showed that people were not having enough fluids to keep well. We discussed this with the registered manager, they felt this was a recording issue and added this to the staff meeting agenda and action plan for improvements. Care plans and risk assessments clearly described what modified diet people were prescribed and the care plans followed The International Dysphagia Diet Standardisation Initiative (IDDSI) framework. The guidance was also available in the kitchen to staff responsible for preparing, cooking and serving meals. Kitchen staff and those responsible for supporting people with their food had a good understanding of people’s assessed needs in relation to type and texture of food as well as any allergies and food intolerances. Staff told us they helped people to make their meal choices if they needed it. We observed kitchen staff asking people what food choices they would like. We received positive feedback about the food. Comments included, “Food is excellent”; “Lunch was quite good, and I appreciate that it is difficult to cater for a lot of people” and “It is alright, sometimes there is a bit much (in terms of volume).” We observed that people received nutrition which met their assessed needs. People had their meals in the dining room, lounge and in their bedrooms.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services. The provider had a clear process in place to escalate health concerns within a timely manner. They had reviewed and amended the process to learn lessons from where things had not worked quite as well. People’s care plans included hospital passports. Staff worked with health professionals to ensure people got the care and support they needed. A healthcare professional told us, “The team are usually good at referring and following up on patients where progression isn’t as expected.” The registered manager team told us, “We work with the Hospice in the Weald when people are at end of life, we log with them and link in with them regarding pain relief. They are quite supportive.” Nursing staff and other staff told us there were good links with other health professionals such as SaLT (Speech and Language Therapy), the GP, TVN (Tissue Viability nurse). Trained nurses within the service reviewed and updated people’s clinical records daily. People told us staff worked with GP’s and health professionals to meet their health needs.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support. People told us they were supported with their healthcare. People said, “I had appointments for a check for my eyes and ears since I have been here, I have got new glasses” and “The doctor comes on a special day each week, but she will come if she is needed on another day.” A relative told us, “On a couple of occasions when mum had Covid-19, they rang me to say mum was going to the hospital. I thought that was good.” We observed the GP carried out their weekly visit when we assessed the service, a visiting dentist also visited the service to provide dental check-ups. People living at the service had access to onsite nurses employed by the provider and other health care professionals, for example, the community mental health team, chiropody, dietician, dentists and SALT (Speech and language therapists). Visiting was encouraged and people were supported to attend medical appointments. Staff had a good understanding of meeting people’s changing needs. A staff member told us, “If there are urgent concerns that cannot wait until the (GP) ward round then we call the Home Treatment Team. We have good links with them as well as the Tissue Viability Nurses (TVN).”

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves. Staff worked together as a team to support people and to ensure people received their care and support in the way they chose. A relative told us, “I feel happy mum is in an environment where a GP that comes around once a week. If we have concerns, we can put her on the list to be seen.”

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment. We checked whether the service was working within the principles of the Mental Capacity Act (MCA), whether appropriate legal authorisations were in place when needed to deprive a person of their liberty. The service worked within the principles of the MCA and if needed, appropriate legal authorisations were in place to deprive a person of their liberty. When people were assessed as lacking capacity to make decisions appropriate procedures were followed to ensure principles within the MCA were followed. Decisions made were appropriately documented to demonstrate who had been involved in the decision. However, a relative told us they had not been involved with a decision about prescribing medicine to support their loved one to sleep better. They explained they were the lasting power of attorney for health and welfare and had not been involved. People had signed consent forms within their care records. Deprivation of Liberty Safeguards (DoLS) applications and authorisations were in place for people around any restrictions within their lives that they did not have capacity to consent to. Systems to review these were also in place. People's ability to consent to care and support had been assessed. Care was person centred, people were offered choices throughout the day and most people told us they felt listened to and their views and opinions were important to staff.