We carried out a review of the data available to us about Birchwood Homecaring Services Limited on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Birchwood Homecaring Services Limited, you can give feedback on this service.
Birchwood Homecaring Services Limited is a domiciliary care agency providing the regulated activity of personal care. At the time of our inspection there were 101 people using the service. The service provides support to adults of all ages, people with a learning disability and people with mental health needs.
Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.
People’s experience of using this service and what we found
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
Right Support:
Staff were recruited safely and received the necessary training to support people safely and meet their needs. People were protected from the risk of abuse and risks to people had been assessed, people’s care plans were regularly reviewed and updated. Staff supported people to maintain their health and wellbeing by accessing healthcare services which positively supported their health.
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.
Right Care:
Staff understood how to promote people's independence and ensured the care they provided treated people with dignity and respect. Staff had received training in equality and diversity and the service supported people to express their views. People's communication needs were considered and met. Medicines were managed safely, and we were assured that the provider had sufficient infection, prevention and control measures in place
Right Culture:
The service promoted a person-centred culture. The registered manager understood their responsibilities and had identified areas to improve the quality of the service through the audit systems in place. People's needs were assessed prior to them receiving care and support from the service. People's needs and preferences were highlighted in their care plans for staff to follow.
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 good (published 16 October 2018).
Why we inspected
The inspection was prompted in part due to concerns received about staffing. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe sections of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Birchwood Homecaring Services Limited on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Not everyone using the service received a regulated activity. CQC only inspects the service being received by people provided with ‘personal care’; such as help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.
At our last inspection in November 2016, the service was rated as ‘Requires Improvement.’ This was because people were not fully protected from risks associated with unsafe, or ineffective care and treatment and complaints handling was not always effective, to ensure care improvements when needed. These were respective breaches of Regulations 12 and 16 of the Health and Social Care Act (Regulated Activities) regulations 2014. Following that inspection, the provider told us what action they were taking to rectify the breaches. At this inspection we found the required action was taken by the provider. Related care and service improvements were made to the standard of ‘Good.’
We carried out this inspection on 4, 12 and 27 July 2018. There were 199 people using the service when we visited the provider’s office on 4 and 12 July; during which we spoke with staff. We spoke with people and relatives on 27 July 2018. The provider was given 2 working days’ notice of our inspection as we wanted to make sure the registered manager was available to support our inspection.
There was a registered manager for the service. 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 personal have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.
People received safe care and support from staff who were safely recruited. The provider’s revised staffing, related management arrangements and risk management strategies for people’s care, helped to fully ensure this. The provider’s emergency and safeguarding contingency measures were revised and followed when required.
Potential risks to people’s safety relating to their health conditions or from unsafe care practice were regularly assessed, monitored and effectively accounted for. Staff understood any related risks and the care steps or reporting procedures they needed to follow for their mitigation. People were consistently and safely supported by staff, including to receive their medicines when required. This helped to ensure people were protected from the risk of harm or abuse.
People received effective care. Revised care planning measures helped to consistently ensure people’s care met with their assessed needs and choices. Staff understood people’s health conditions and followed their related personal care needs to help maintain their health and nutrition. This was done in consultation with relevant external health professionals when required.
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. Staff were trained and supported to help ensure this.
People continued to receive care from staff who were kind and caring. Staff followed the provider’s stated care principles and understood what was important to people for their care. This helped to ensure people’s dignity and rights when they received care.
People were informed and involved to agree and know what to expect from their care, and to access relevant advocacy if they needed to. Measures were implemented by the provider, to ensure people were provided with accessible care and service information, which they could understand.
Overall, people received timely, individualised care, which was agreed and regularly reviewed with them or their representatives when required. Revised management measures were recently introduced, which helped to ensure this. Staff knew how to communicate with people in the way they understood and followed people’s views and wishes for their care; which were shown as agreed with people in their written care plans. This helped to promote people’s inclusion and independence.
Revised complaints handling measures were introduced. People and relatives were informed and confident to raise any concerns or to make a complaint about their care if they needed to. The provider sought, listened and took better account of people’s views and any complaints; to help determine and make care improvements when required.
People received informed personal care, to help ensure they experienced a personalised, comfortable and dignified death in their own home as they chose, when required.
The service was well led. People, relatives, staff and external care professionals were now confident of this. Revised management, communication and staffing measures were introduced, to improve the safety and effectiveness of people’s care and their related care experience.
Staff understood and followed their role and responsibilities, which helped to ensure people received safe and effective care. Records relating to care provision and the management of the service were accurately maintained and securely stored. The provider had sought to improve the service against nationally recognised guidance and practice standards concerned with people’s care. Service improvement planning and management monitoring arrangements, helped to ensure ongoing and continuous service improvement.
Further information is in the detailed findings below.
There is a registered manager at the service. 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 told us they felt safe with the staff team from Birchwood Homecaring Services Limited. Staff had a good understanding of the various types of abuse and knew how to report any concerns.
People were not supported by a staff team that was consistent. People told us staff did not always arrive when they were expecting them and they were regularly not informed their calls were going to be late. Some people experienced missed calls. Some people were supported by regular staff who respected their privacy and dignity. However, some people told us they did not feel they were always treated with dignity by some staff.
People were supported to take their medicines safely. Staff had received the necessary and appropriate training to assist them to meet people’s needs.
The registered manager understood the principles of the Mental Capacity Act 2005 (MCA) and their responsibilities around this. People using the service told us staff always obtained their consent before they provided care and support. Staff we spoke with confirmed this.
Staff had a good understanding of people’s dietary needs. They were aware that different medical conditions meant people had to eat at regular intervals. This information was recorded in care plans. Staff ensured people’s physical well-being was supported and maintained and contacted health and social care providers when this was necessary.
People contributed to an assessment of their needs and received care that met their needs.
People felt able to raise concerns with the service. People were satisfied with the services response to their concerns. However, some people expressed the view that when they tried to contact the office their messages were not always returned. Information about how to make a complaint was included in the information sent to new service users.
The staff team had a good understanding of their roles and responsibilities.
At the last inspection there was a breach of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 systems and processes around Complaints. This relates to a breach of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulation 16 Receiving and Acting on Complaints. At this inspection we found there were adequate systems and processes in place to meet this requirement.
At this inspection there was a breach of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulation 12 Safe Care and Treatment. You can see what action we told the provider to take at the end of this report.
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.
The initial inspection visit was announced and this meant the provider and staff knew we would be visiting the agency’s office 48 hours before we arrived. Our second visit was unannounced and we returned to follow up comments made by some people and to speak to more care workers. Our previous inspection was carried out in November 2013 and no breaches of regulations were found at that time.
Birchwood Homecaring Services provide personal care to people in their own homes in Amber Valley. At the time we visited the office there were 285 people using the service.
There was a registered manager for the service. 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 and associated Regulations about how the service is run.
People who used the service told us they felt safe and care workers were trained to look after people safely. Care workers knew what to do if they had any concerns about a person’s well-being. There were systems in place to protect people from risks to their health and safety and to ensure safe staff recruitment. Some people expressed concerns about the recent high turnover of staff at the agency and the effect it had on their care being provided late sometimes. We found there had not been any missed calls. Recruitment was on-going to ensure sufficient care workers were employed to meet needs.
Care workers were caring and knowledgeable about the people they supported. They treated them with dignity and respected their privacy. People’s specific care needs were assessed and care workers were made aware of these in plans of care. They alerted health care professionals if they had any concerns.
There was a clear staffing structure for the service. Systems were in place to supervise and manage staff. There were also arrangements in place to assess and monitor the quality of the service and this was being developed further by the registered manager.
Complaints were not fully investigated and resolved to people’s satisfaction. This was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.
People who used the service provided us with very positive feedback about the provider. All of the people spoken with said the care workers provided the support and assistance required. One person told us "I'm glad I moved to Birchwood. I had been with other providers before and they never quite did what I needed. Birchwood are meeting my needs now".
The provider was reporting potential safeguarding incidents correctly and responding appropriately. Staff were aware of types of abuse and what to do if they suspected abuse had taken place.
Staff were receiving appropriate supervision from the provider which supported them in their role. Staff also received comprehensive training which enabled them to carry out their role effectively.
The provider had a system in place to deal with comments and complaints. We saw that the provider responded to and investigated complaints received appropriately.
People using the service experienced effective, safe and appropriate personal care that met their needs. People we spoke with were highly complimentary about the provider. One person said the care they received was excellent and the care workers went "above and beyond" what was expected.
People who use the service were not protected from the risk of abuse. The provider was not following local reporting procedures when safeguarding concerns were raised. This would ensure proper safeguarding investigations could be carried out where necessary. The provider was also not acting on concerns raised about a staff member working with vulnerable people.
The provider had clear recruitment procedures in place ensuring that people employed to provide care had appropriate background checks carried out.
The provider had sufficient staff to meet the needs of people using the service. One person said "I've used Birchwood for over six years and I can only recall one occasion when a call was cancelled because of no staff available and that was a long time ago".
People who use the service can be confident that their personal records are accurate, fit for purpose, held securely and remain confidential.
Several of the service users have been with the agency for a while and have said' they would not wish to be with any other, they help me and I would not be able to get out with out them.'
We were told 'they keep good contact with people and the staff and have a good relationship with their carers.'