CQC report explained · a nursing home
What the CQC found at Birchwood Care Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Risk assessments did not always give staff clear guidance about seizures and emergency medical help. Medicines were not always managed safely, although staffing, recruitment, safeguarding and infection control were found to be stronger.
- Effective?
- Good
- Staff assessed people's needs, supported good nutrition and hydration, arranged prompt healthcare referrals and had improved training and consent processes.
- Caring?
- Good
- People were treated with kindness, dignity and respect. Staff supported independence and involved people and their representatives in decisions about care.
- Responsive?
- Good
- Care was personalised and adapted when people's needs changed. People were supported with communication, activities, family contact, complaints and end of life wishes.
- Well-led?
- Requires improvement
- The management team had created a caring and open culture, but quality systems had not found or prevented the risks identified in care planning and medicines management.
What inspectors found, March 2023
Birchwood Care Home is Rated Requires Improvement; inspectors found kind, person-centred care but ongoing risks with medicines, care plans and quality checks.
This was an unannounced comprehensive follow-up inspection on 23 and 24 February 2023. Inspectors spoke with people, relatives, staff and health professionals. They observed care, meals, activities and medicine rounds, and checked care records, medicine records, staff files and quality checks.
The home was rated Good for Effective, Caring and Responsive. People were treated with kindness and respect, involved in their care, supported with food and drink, and helped to maintain relationships and take part in activities. Staff training, consent records and recruitment had improved since the previous inspection.
Safe and Well-led were both rated Requires Improvement. Care plans did not always explain how to manage seizures or when to seek emergency help. Medicines were not always managed safely, and the provider's checks had not identified these problems. The overall rating remains Requires Improvement.
Improved staff support
Training, competency checks, supervision and appraisals had improved and helped staff develop the skills needed for their roles.
“Since our last inspection the management team had established and operated an effective system of training, competency assessments, supervision and appraisals.” from the report
Personalised activities and communication
Activities were tailored to people's interests, and staff adapted information and communication for disabilities or impairments.
“There were 3 activities coordinators who delivered a published programme of stimulating activities, tailored to meet people's individual needs.” from the report
Better involvement in care planning
People, relatives and legally appointed representatives were involved in reviewing care plans and discussing preferences.
“Since our last inspection people, relatives and legally appointed representatives had been involved in full reviews of their care and support plans.” from the report
Incomplete seizure risk guidance
seriousSome care plans did not explain clearly how staff should support people during seizures or when emergency medical help should be contacted. This left people at increased risk of harm.
“Information was not always recorded in risk assessments and care plans about how the staff should support people who experienced seizures and when to contact emergency medical services.” from the report
Medicine safety problems
seriousInspectors found several medicine management problems, including missing guidance, insecure thickeners, incomplete records and continuing medicine errors.
“Despite concerted efforts by the management team, supported by external professional health care professionals, including pharmacists, the service still experienced high levels of medicine errors.” from the report
Quality checks had not found risks
seriousThe provider's governance systems had not identified the unsafe care and medicine problems found during the inspection. The provider remained in breach of the good governance regulation.
“The provider had failed to identify the concerns we found in relation to people not always receiving safe care.” from the report
High use of agency staff
needs fixingAgency staff made up 55% of the workforce. Continuity had improved, but some agency staff needed to be shadowed until they knew people and their needs.
“The service used a high level of agency staff (55%).” from the report
- 01What has been done to make sure every person with seizures has clear guidance about what staff should do and when emergency help is needed?
- 02What immediate changes have been made to reduce medicine errors and check medicine records?
- 03How are insulin blood glucose monitors checked, and how are liquid medicines dated when opened?
- 04How will the provider check that its quality systems identify risks in care plans and medicines management?
- 05What steps are being taken to reduce reliance on agency staff and ensure agency staff know each person's needs?
This was an unannounced comprehensive follow-up inspection covering all five key questions and checking progress after six breaches were found at the previous inspection. This explanation was written from the published report of 22 March 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk. The report was longer than we could read in one go; the later sections may not be reflected.
What inspectors found, September 2022
Rated Requires Improvement; inspectors found unsafe medicines processes, incomplete care records and weaknesses in training, dignity and management oversight.
This was an unannounced follow-up inspection on 11 and 12 July 2022. One inspector and an Expert by Experience spoke with three people, 10 relatives, staff and a healthcare professional. They reviewed care records, medicines records, staff files and management records.
The home had enough staff, appropriate infection control measures and good links with health professionals. People were supported with food and fluids, activities, communication and end-of-life care. Staff were often kind and approachable.
However, inspectors found important weaknesses. Medicines errors had occurred, risk assessments lacked clear instructions, many staff training records were incomplete, and records about mental capacity and people's involvement in care were not up to date. All five questions were rated Requires Improvement.
The overall rating remained Requires Improvement, as it was at the previous inspection in April 2022. The home remained in breach of regulations. Effective, Caring and Responsive changed from Good to Requires Improvement, while Well-led improved from Inadequate to Requires Improvement.
Staffing levels
People and relatives said there were enough staff to provide care. A dependency tool was being updated weekly to help calculate staffing needs.
“People and their relatives told us there were enough staff to provide care and meet people's needs.” from the report
Infection control
Inspectors were assured that the home had arrangements to prevent and manage infections, including safe visiting, PPE, testing and hygiene measures.
“We were assured that the provider was making sure infection outbreaks can be effectively prevented or managed.” from the report
Health and nutrition
People were supported with meals, snacks and fluids. Staff made referrals to dieticians and worked with health and social care professionals.
“People were supported to eat and drink enough to maintain a balanced diet.” from the report
Kind relationships
People and relatives described positive relationships with staff. Inspectors observed staff treating people with kindness, compassion and patience.
“We observed people being treated with kindness and compassion.” from the report
Activities and relationships
The home offered group and individual activities and helped people stay in contact with relatives through visits and technology.
“People were supported to engage in activities and to maintain meaningful relationships.” from the report
Medicines safety
seriousThere were significant medicines errors and missing instructions for medicines prescribed when needed. This could leave staff without the guidance needed to give medicines safely.
“This placed people at risk of harm as staff did not have full and complete guidance to support people to take 'when required' medicines safely.” from the report
Risk assessments
seriousRisk assessments did not give staff enough detail about warning signs, prevention or actions to take. Inspectors found examples involving breathing, urine infections, pain and skin damage.
“Risk assessments did not contain sufficiently clear guidance to help staff manage risks to people.” from the report
Consent records
seriousMental capacity assessments and best-interest records were not always clear, complete or regularly reviewed. Some did not show that relatives or lawful representatives had been consulted.
“Assessments of people's capacity to make decisions about their care and support did not contain sufficient information to demonstrate a thorough assessment had been completed.” from the report
Privacy and dignity
seriousInspectors saw a person using the toilet while the bathroom door was open and the person was visible to people passing by.
“The person was clearly visible to people walking past.” from the report
Involvement in care
needs fixingCare records did not show that people or relatives had been involved in planning and reviewing care. Survey results also showed that some people did not feel involved.
“There was a lack of evidence to demonstrate people were involved in making decisions about their care and support.” from the report
- 01What medicines errors have happened since this inspection, and how do you check that 'when required' medicines have complete instructions?
- 02How many staff currently have up-to-date safeguarding and mandatory training, and can you show the training records?
- 03How are risk assessments now written and reviewed so staff have clear instructions about warning signs and actions to take?
- 04How do you involve each person and their relatives or lawful representative in care planning and reviews?
- 05Has a registered manager now been appointed, and how does management check that previous problems have been fixed?
This was an unannounced follow-up inspection covering all five key questions, with infection prevention and control also reviewed under Safe. This explanation was written from the published report of 9 September 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Birchwood Care Home
7 rated inspections over 5 years: the service has improved, from Inadequate to Requires improvement.
- March 2023Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- September 2022Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- April 2022Requires improvementdown from GoodSafe: Requires improvementWell-led: Inadequate
- June 2021Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- November 2019Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- August 2018Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- November 2017InadequateSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: InadequateWell-led: Inadequate
- September 2017
Registered with the Care Quality Commission on 14 September 2017.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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42 live-in carers within about an hour of West Berkshire
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £1,020 to £1,260 a week. 36 can care for a couple. 14 years' experience on average.
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