CQC report explained · a residential care home
What the CQC found at Birchwood
Rated Outstanding: inspectors found the home performing exceptionally well.
What inspectors found, May 2023
Rated Inadequate and placed in special measures; inspectors found serious risks in care, staffing, cleanliness and management.
This was an unannounced focused inspection on 14 and 15 March 2023. Inspectors checked whether the home had followed its previous improvement plan, focusing on Safe, Effective and Well-led. They spoke with people, staff and relatives, observed care, and reviewed care plans, medicine records, staff files, training records, audits and the environment.
The home was rated Inadequate overall. Safe and Well-led were rated Inadequate, and Effective was rated Requires Improvement. Inspectors found risks were not properly managed, including risks linked to medicines, choking, nutrition, equipment, night checks and infection control.
Staffing levels had not been properly reviewed, and staff did not always have the training or assessed skills needed for people's care. The home was not suitably clean or maintained. Records and quality checks were not reliable enough to identify and correct these problems.
There were some positive experiences. People were supported with day-to-day choices, relatives described caring staff, and people had access to activities, college, day centres and holidays. However, the overall rating means the home was not providing safe or consistently effective care at the time of this inspection.
Health professional links
The home worked with a range of health professionals, and relatives said they were kept informed about changes in health and wellbeing.
“The service worked closely with other professionals which included the GP, Abbotts nurses, district nurses, dietician and speech and language therapist.” from the report
Activities and community access
People were supported with activities, college, day centres and holidays, including holidays abroad and a cruise.
“People were supported to go to college and day centres and to book holidays, which included holidays abroad and a cruise.” from the report
Recruitment checks
Inspectors found that recruitment systems had improved since the previous inspection. References and background checks were on file.
“Systems were in place to promote safe recruitment practices.” from the report
Unmanaged safety risks
seriousImportant risks were not dealt with promptly. These included a broken bed rail, unsafe PEG guidance, choking risks, missed night checks and missed action on low weight.
“A person's bed rail was not working effectively since 9 March 2023.” from the report
Medicines
seriousSome medicines were not stored, recorded or administered safely. Inspectors found prescribed thickeners used for the wrong person and missing records for patches, creams and medicine stock.
“Safe systems were not in place to promote safe medicine practices.” from the report
Staffing and training
seriousThe home had not shown that staffing levels matched people's needs. Some staff worked very long shifts, and training and competency checks for specialist care were incomplete.
“Sufficient staff were not provided to meet people's needs.” from the report
Cleanliness and repairs
seriousThe home was described as unhygienic and poorly maintained. Inspectors found dirty floors and bathrooms, damaged furniture, damp patches and a damaged fire door.
“The service was not suitably clean and hygienic.” from the report
Consent and restrictions
seriousMental capacity and best-interest decisions were missing for some medicines, care and restrictions. Some restrictions were not included in the Deprivation of Liberty Safeguards applications.
“The service was not working within the principles of the MCA.” from the report
Weak management checks
seriousAudits often showed no problems even though inspectors found serious shortfalls. Records were incomplete, contradictory or difficult for staff to access.
“Good governance was not established to ensure the service was suitably managed, monitored and that records were accurate.” from the report
- 01What has been done to make medicines, thickeners, patches and creams safe and fully recorded?
- 02How do you now calculate staffing levels for each bungalow, including at night and during weekends?
- 03Which staff are currently trained and assessed as competent to provide PEG feeds, stoma care, moving and handling, oxygen therapy and medicines?
- 04What repairs, deep cleaning and equipment replacements have been completed since the inspection?
- 05How have mental capacity assessments, best-interest decisions and Deprivation of Liberty Safeguards applications been reviewed for each person?
This was a focused inspection of Safe, Effective and Well-led; Caring and Responsive were not inspected and their ratings were carried over from the previous inspection. This explanation was written from the published report of 10 May 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.
What inspectors found, June 2019
Rated Requires Improvement; inspectors found kind and personalised care, but serious safety, safeguarding, medicines and management problems.
Inspectors visited on four dates in April 2019. They spoke with people, relatives, staff and professionals. They observed care and reviewed care plans, risk assessments, medicines records and management records.
The home was rated Good for Effective, Caring and Responsive care. People were treated kindly, their care plans were detailed, and staff supported their health, choices, communication and activities.
The home was rated Requires Improvement for Safe and Well-led. Inspectors found risks from medicines, equipment, fire safety, water safety and infection control. Safeguarding responses were not always strong or timely, recruitment checks were incomplete, and the home failed to report nine medicines errors to the CQC.
The overall rating means the home was not consistently meeting the required standard. The provider was told to send an action report, and the CQC said it would continue monitoring and return to inspect.
Kind and respectful staff
People and relatives gave consistently positive feedback about staff. Inspectors observed warm, respectful interactions that took account of people's communication needs.
“Staff treated people with compassion and kindness.” from the report
Personalised care
Care plans were up to date and included people's needs, preferences, interests and communication methods. Staff demonstrated detailed knowledge of the people they supported.
“Care planning documentation was up-to-date and met people's needs.” from the report
Health support
The home worked with health professionals and supported people to attend appointments and follow treatment plans. Health action plans and medical records were up to date.
“A healthcare professional told us the service communicated and co-ordinated healthcare needs effectively and escalated concerns appropriately.” from the report
Activities and independence
People were supported with activities, education, religious interests and community access. Adapted technology and equipment helped some people be more independent.
“The provider had recently invested in adapted specialist technology; we saw this improved people's independence and enabled staff to respond to people's needs promptly.” from the report
Safeguarding responses
seriousActions after allegations about staff conduct were not always robust, timely or effective. Inspectors found that another allegation was made before the staff member was suspended from supporting people.
“Actions taken by the provider were not robust, timely or effective to protect people from reoccurrences of these incidents.” from the report
Medicines and safety checks
seriousPeople did not always receive medicines as prescribed. Storage and medicine records did not always follow guidance, and environmental, equipment, water and fire safety checks were inconsistent.
“People did not always receive their medicines as prescribed. Medicines were not always stored safely and records were not in line with national guidance.” from the report
Incomplete recruitment checks
seriousSome employment history and DBS checks were not followed up or risk assessed in line with the provider's policy. This included staff who could have unsupervised access to vulnerable adults.
“Staff recruitment checks regarding gaps in employment history and disclosure and barring service (DBS) were not always followed-up and risk assessed in accordance with the provider's policy and procedure.” from the report
Poor infection control
needs fixingCleaning records were incomplete and some private rooms and bathrooms were not clean. Food safety and supplies such as paper towels were also not consistently managed.
“This meant people were at potential risk of acquiring infections.” from the report
Weak quality monitoring
needs fixingAudits had identified some problems but did not always lead to effective or timely action. Records were sometimes incomplete, difficult to access or not well organised.
“Quality monitoring checks did not always effectively identify or address areas requiring improvement.” from the report
- 01What has been done to ensure medicines are stored safely, given correctly and recorded in line with guidance?
- 02How are allegations of abuse now reported, investigated and managed to prevent repeat incidents?
- 03Have the fire safety, water safety, hoist and other high-priority maintenance problems been completed?
- 04How do managers now check cleaning, infection control, risk assessments and other safety checks?
- 05What changes have been made to recruitment checks, including employment gaps and DBS checks?
This was a planned inspection of the whole home, including the premises and care, with all five CQC questions rated. This explanation was written from the published report of 26 June 2019 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
2 rated inspections over 4 years: the service has slipped, from Requires improvement to Inadequate.
- May 2023Inadequatecurrent ratingdown from Requires improvementSafe: InadequateEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Inadequate
- June 2019Requires improvementSafe: Requires improvementEffective: GoodWell-led: Requires improvement
- April 2018
Registered with the Care Quality Commission on 30 April 2018.
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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89 live-in carers within about an hour of Buckinghamshire
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 £1,300 a week. 79 can care for a couple. 13 years' experience on average.
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“She was v competent and confident and we felt our mum was safe in her care. She supported us through a difficult time.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.