The inspection took place on 2 and 4 May 2018, it was unannounced on the first day and announced on the second day.At the last inspection in May 2017 there were no breaches of regulation. We rated the effective and well-led domains as ‘requires improvement’ which meant the quality rating was 'requires improvement' overall. This is the third consecutive time the service has been rated Requires Improvement. We found quality assurance checks and audits had been improved and staff understood the need to gain consent before care and support was provided. However, the principles of the Mental Capacity Act 2005 were still not followed or implemented in a consistent way.
The service is required to have a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. There was no registered manager at the service, an acting manager had been in place for five days.
The Birches 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. The care home accommodates people across four bungalows and two self-contained flats. Three bungalows (Birchdale, Birchwood and Birchwalk) having eight bedrooms and one bungalow (Birchrise) which has four bedrooms. All bungalows could be accessed via a secure door leading from one to another, but each bungalow was treated as a separate entity. There were two self-contained flats, only one was occupied at the time of the inspection. There were 26 people with learning disabilities or autistic spectrum disorder living at the service.
The care service has been developed in some areas in line with the values that underpin Registering the Right Support. (This guidance clarifies the expectation on providers to ensure care homes are focused on person-centred care and developed in line with national policy). We found the bungalows were separate units, even though they were all based at one location. Registering the Right Support values include choice, promotion of independence and inclusion for people living with learning disabilities and autism to ensure they can live as ordinary a life as any citizen. Further work needs to be undertaken once the breaches of regulation have been addressed to ensure the service complies with Registering the Right Support.
During this inspection we found issues with the environment. During our walk round of each bungalow we found issues with the environment which had to be addressed to help to maintain people’s safety. The acting manager took swift action to address the environmental issues we found. However, we recommend that the provider should monitor the environment to make sure it remains safe for people.
We found the administration and management of people's medicines was not always effective to ensure people's medicines were returned, recorded or stored appropriately. We recommend the provider follows good practice guidance in relation to medicine management.
The principles of the Mental Capacity Act 2005 (MCA) were not followed. Decisions were not made in accordance with the MCA. Associated records lacked detail; they were generic and not person-centred. Best interest decisions were not always completed following capacity assessments, which contravened the MCA. This meant that people who used the service had limited choice and control about their lives and experienced unnecessary restrictions.
We found people’s care records were excessive, not easy to follow and staff had made changes to care records without dating or signing entries. It was unclear from people’s care records what care and support people needed to receive or if their needs were being met. A full review, reassessment of people’s records was required, this was planned to take place.
Auditing and checks to maintain and improve standards were not robust and this had meant corrective action to address issues had not always been acted upon in a timely way.
Staff completed training in a variety of subjects. However, it was not clear if staff had taken on board the information provided to them during training. The provider’s training team were about to commence a full review of the staff’s skills and knowledge. Some staff had not received timely supervision in line with the provider’s policy which meant their skills had not been reviewed.
During the inspection we found there was enough staff available to meet people's needs. Infection control measures were in place. Accidents and incidents were being monitored and corrective action was taken to help to prevent any further re-occurrence.
People were supported to eat and drink, where necessary so people’s dietary needs were met.
We saw staff were caring and kind to people and people’s privacy and dignity was respected.
Information was shared in a format that met people’s needs about what the service could provide and about the complaints procedure. Information about local advocacy services was provided to people.
Staff were caring and kind and respected people’s privacy and dignity.
Activities were provided in line with people’s preferences, social events and outings occurred and people were supported to undertake education or go to work if they wished.
Complaints raised were investigated and this information was used to improve the service.
People, using the service, relatives and staff were asked for their views and feedback received was acted upon to help to maintain or improve the service.
The provider and higher management team supported the acting manager. Action was being taken to improve the service provided to people. The provider and staff were working with the local authority and were assisting in safeguarding investigations, if required. The provider had voluntarily stopped admissions to the service until they were satisfied all concerns and issues had been addressed.
The provider was in breach of four regulations from the Health and Social Care Act 2008 (Regulated Activities) 2014. Regulation 11, Need for Consent, 12, Safe Care and Treatment, 17, Good Governance and 18, Staffing.
You can see what action we told the provider to take at the back of the full version of the report.