CQC report explained · a residential care home
What the CQC found at Silver Birch
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Some safeguarding incidents were not recognised or reported to the appropriate authorities. Medicines, risk assessments, infection control arrangements and learning from incidents also had weaknesses.
- Effective?
- Requires improvement
- Staff were supported but wanted more specialist and face-to-face training. Referrals to speech and language teams had not been considered for two people whose care plans said they needed a soft diet.
- Caring?
- Good
- This question was not inspected during this focused inspection. Previous ratings were used for questions that were not inspected.
- Responsive?
- Good
- This question was not inspected during this focused inspection. Previous ratings were used for questions that were not inspected.
- Well-led?
- Requires improvement
- Quality assurance systems did not identify several problems found by inspectors. The registered manager did not have complete oversight of safeguarding, incidents, training, risk assessments, medicines and care records.
What inspectors found, March 2022
Rated Requires Improvement; inspectors found caring, familiar support but gaps in safeguarding, medicines and management oversight.
This was an unannounced focused inspection on 12 and 13 January 2022. One inspector and a medicines inspector spoke with people, staff and relatives, observed care and reviewed care, medicines, staff and management records.
The home supported six people with learning disabilities and/or sensory impairment. Staff knew people well and relatives spoke positively about the care. People were supported with choice, independence and communication in ways that suited them.
However, inspectors found that some safeguarding incidents had not been reported, medicines were not always managed safely and risk assessments and care records were not always up to date. Staff also lacked some specialist training, and quality checks had not found these problems.
The overall rating changed from Good at the previous inspection to Requires Improvement. The inspected areas, Safe, Effective and Well-led, were all rated Requires Improvement. Caring and Responsive were not inspected at this visit.
Staff knew people well
People were supported by a consistent group of staff, including staff who had worked at the home for many years.
“People were supported by a consistent group of staff who knew them well, a number of whom had worked at the service for many years.” from the report
Positive family feedback
Relatives said they felt their loved ones were safe and spoke positively about the care staff and manager.
“Relatives spoke highly of the service, the care staff and the registered manager.” from the report
Support with communication
Staff used different ways to understand people who could not communicate through speech, including facial cues, noises and other communication methods.
“People who used the service who were unable to talk with us used different ways of communicating including using Makaton, symbols, objects and their body language.” from the report
Partnership working
The home worked with health and social care professionals, including GPs, community psychiatric nurses and learning disability teams.
“The service worked in partnership with other professionals and agencies, such a social workers, community psychiatric nurses, learning disability nurses and GPs.” from the report
Safeguarding was not reliable
seriousA number of incidents that may have been safeguarding concerns were not recognised or reported to the appropriate authorities. This increased the risk that people could be harmed.
“There had been a number of safeguarding incidents that had not been reported to the appropriate authorities for further action.” from the report
Medicines management
seriousSome instructions for medicines given when needed were missing, medicines were not always stored safely and the medicines policy was not specific to the home.
“Medicines were not always appropriately managed which meant people were not protected from unnecessary risks and harm.” from the report
Care and risk records
needs fixingSome risk assessments were missing or out of date. Care records did not always give staff the latest information about how to support people safely and effectively.
“Risk assessments relating to some people's needs were not in place or had not been reviewed for some time.” from the report
Insufficient specialist training
needs fixingStaff said they needed more training, including in mental health. The report also found that specialist autism and mental health training was not in place.
“Specialised training in autism and mental health were not in place to provide staff with the additional skills to meet people's needs.” from the report
Weak quality checks
needs fixingThe home's audits and management systems had not identified several problems. Accidents and incidents were recorded but not analysed for patterns or lessons.
“Quality assurance systems in place had failed to identify concerns found on inspection.” from the report
Infection control gaps
minorInspectors were only somewhat assured about some infection control arrangements. There was no hand sanitiser in a communal bathroom, more bins were needed for PPE and some COVID-19 risk assessments were out of date.
“We were somewhat assured that the provider was using PPE effectively and safely.” from the report
- 01Have all safeguarding incidents been reviewed and reported to the local authority and the CQC where required?
- 02How are medicines stored and checked, and are personalised instructions available for every medicine given when needed?
- 03Which staff have received specialist training in autism, mental health and safeguarding, and when will any remaining training be completed?
- 04How often are risk assessments and care records reviewed, and how will you make sure staff always have the latest information?
- 05What changes have been made to quality checks so accidents, incidents, medicines and safeguarding concerns are analysed and acted on?
This was a focused inspection of Safe, Effective and Well-led only; Caring and Responsive were not inspected and previous ratings were used for the overall calculation. This explanation was written from the published report of 3 March 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.
What inspectors found, January 2018
Silver Birch was rated Good overall, with safe, kind and personalised care, although care plans were still being updated.
Inspectors visited the home without warning on 1 and 6 November 2017. They spoke with three people living there, one relative, the manager and three staff. They observed care and checked care, medicine, complaint, accident and quality records.
The home was rated Good overall. Safe, Effective, Caring, Responsive and Well-led were all rated Good. People appeared relaxed and comfortable, and relatives said they felt assured about the care.
The Safe rating had improved from Requires Improvement at the previous focused inspection in February 2017. Inspectors found that medicines were safely handled, staff understood people's health needs, and the manager checked incidents and care. Care plans were being overhauled to make them more person-centred.
Improved safety
The home had improved its Safe rating since the previous focused inspection. Inspectors found that staff understood risks and that medicines were managed safely.
“At this inspection we found the service remained Good overall and that the Safe rating had improved to Good.” from the report
Kind and respectful care
Staff knew people well and supported them gently. People were treated with dignity and encouraged to do things independently.
“We saw staff support people in a gentle and caring way in a calm and relaxing atmosphere.” from the report
Choice and communication
Staff used different communication methods to help people express choices and take part in decisions about their care.
“People were supported to express their opinions in a variety of ways and which reflected their ability to do so.” from the report
Learning from incidents
The manager reviewed accidents and incidents, changed care when needed and shared learning with staff.
“We saw how learning from accident and incidents were monitored to identify trends and where appropriate take action to amend a person's care.” from the report
Care plans still being updated
minorCare plans were being changed to make them more person-centred. This work was ongoing at the time of the inspection, so families should ask how it was completed and kept up to date.
“The registered manager told us about how care plans were in the process of being updated to better reflect the people being supported at the home.” from the report
- 01Have all care plans now been updated to reflect my relative's needs, background, wishes and goals?
- 02How are medicines checked, and what happens if a medicine error or other concern is found?
- 03How will you recognise and respond to changes in my relative's behaviour or health?
- 04How will my relative be supported to communicate choices and stay involved in decisions about their care?
- 05How can my relative and our family raise a concern, and how will we receive a response?
This was a comprehensive, unannounced inspection covering all five questions, following a previous focused inspection of Safe in February 2017. This explanation was written from the published report of 27 January 2018 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 Silver Birch
4 rated inspections over 6 years: the service has slipped, from Good to Requires improvement.
- March 2022Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- January 2018Goodstayed GoodSafe: GoodEffective: GoodWell-led: Good
- February 2017Goodstayed GoodSafe: Requires improvement
- October 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- October 2013
Report published without a new overall rating.
- April 2013
Report published without a new overall rating.
- November 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 18 January 2011.
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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