12 January 2022
During an inspection looking at part of the service
About the service
Silver Birch is a residential care home providing personal and nursing care to six people who are living with a learning disability and/or have a sensory impairment. The service can support up to seven people.
People’s experience of using this service and what we found
People were supported by staff who knew them well and the risks to them, but people’s care records did not consistently provide staff with the most up to date information on how to support them safely and effectively. A number of incidents had not been recognised as safeguarding concerns and had not been reported to the appropriate authorities. Medicines were not always appropriately managed. We were not fully assured regarding some areas of infection control and the provider's infection control policy was not up to date. Accidents and incidents were recorded but there was a lack of analysis to identify any trends learn lessons when things went wrong.
Staff felt supported and valued, but raised concerns regarding the lack of specialist training available to them to enable them to support people effectively.
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.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
Based on our review of safe, effective and well-led key questions the service was able to demonstrate how they were meeting some of the underpinning principles of right support, right care, right culture. The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for the people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People’s support focused on them having the choice and opportunities to gain new skills, where appropriate, and to become more independent.
Quality assurance systems had failed to identify areas for improvement found on inspection. The current systems in place did not provide the registered manager with complete oversight of the service. The service worked alongside other professionals to obtain support for people. Relatives were complimentary of the service, the care staff and the registered manager.
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 7 January 2018).
Why we inspected
We received information in relation to a number of incidents that had not been recognised as potential safeguarding concerns, staff training and a lack of learning from accidents and incidents.
As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.
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.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
The provider responded to the concerns raised during the inspection and action was taken to address these concerns.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Silver Birch on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to safeguarding service users and good governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
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.