CQC report explained · a residential care home
What the CQC found at Silver Birches
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- People were protected from harm and staffing levels, medicines and health risks were generally managed safely. However, some bedding and equipment were unclean, and some as-required medicines records did not explain the reason, effect or timing.
- Effective?
- Good
- People's health, nutrition and hydration needs were supported. Staff training was up to date, and legal requirements about capacity and best-interest decisions were being followed.
- Caring?
- Good
- Staff were kind, respectful and familiar with people's needs and preferences. People were supported with privacy, dignity and independence, although not everyone was involved in care plan reviews.
- Responsive?
- Good
- Care plans reflected people's needs and communication requirements were supported. Inspectors found that activities were limited and recommended improving their number and frequency.
- Well-led?
- Requires improvement
- Leadership and oversight had improved, but quality assurance systems were not yet reliable or fully embedded. The home remained in breach because its systems had not identified problems with infection control and some medicines audits.
What inspectors found, October 2023
Rated Requires Improvement; inspectors found major progress since the last inspection, but infection control and quality checks were still not reliable.
Inspectors visited without notice on 22 and 23 August 2023. They spoke with people, relatives, staff and health professionals. They reviewed care plans, medicines records and management documents.
The home had improved in several important areas. Medicines, health risks, staffing, safeguarding and the environment were generally managed safely. Staff were kind, knew people well and supported them respectfully.
Some mattresses, cushions, bedding and equipment were not clean. Quality checks had not found these problems. People and relatives were not always invited to care reviews, and activities were limited.
The overall rating is Requires Improvement. Safe and Well-led were Requires Improvement, while Effective, Caring and Responsive were Good. The home had previously been rated Inadequate and placed in Special Measures, but it is no longer in Special Measures.
Safer staffing
Inspectors found enough staff to meet people's needs, and call bells and requests for help were answered promptly. Recruitment checks had also been completed.
“At this inspection we found there were now sufficient numbers of staff.” from the report
Kind and respectful care
Staff knew people well and supported them in line with their preferences. Inspectors saw warm interactions and support that protected privacy and dignity.
“People were supported by staff who were kind and caring who respected people's individual needs and preferences.” from the report
Better risk management
Records gave staff clearer guidance about people's needs and risks. Diabetes care, pressure care, fire arrangements and environmental safety had improved.
“Information within care plans and risk assessments were now consistent, and guided staff to support people safely in line with their identified needs and risks.” from the report
Good partnership working
The home worked with health professionals and the local authority. Inspectors were told that staff listened and responded to professional advice.
“We can't praise the staff highly enough. They listen and respond to our advice and recommendations.” from the report
Cleaning and infection control
needs fixingSome mattresses, pressure-relieving cushions, bedding and equipment were stained or had not been cleaned effectively. Inspectors were not fully assured that infection control arrangements were embedded.
“There were some stains to mattresses, pressure relieving cushions and bedding, and some equipment had not been cleaned effectively.” from the report
Weak quality checks
seriousThe home's audits and oversight did not consistently identify problems. The lack of arrangements during the care manager's absence contributed to these shortfalls.
“Systems, processes, and oversight of the service were still not fully effective or embedded.” from the report
Care reviews
needs fixingPeople and relatives were not always invited to reviews of care needs. The report recommends that all people and those important to them are consistently invited.
“Not all people and relatives said they were involved in care plan reviews.” from the report
Limited activities
minorSeveral relatives said there were too few activities. The report recommends consulting people and relatives to improve the number and frequency of activities.
“Five out of the 9 relatives we spoke with said the service needed to offer more activities.” from the report
Medicines records
needs fixingRecords for some as-required medicines did not show why they were given, their effect or the timing. The medicines audit also did not cover all relevant checks.
“when these medicines were administered the reason, effect or timing was not recorded.” from the report
- 01How are mattresses, pressure-relieving cushions, bedding and other equipment checked and cleaned, and how do you make sure problems are found promptly?
- 02What changes have been made to quality audits since the care manager's absence, and how will you show that these checks are working?
- 03How will my relative and family be invited to care plan reviews?
- 04What activities are now available, and how are people's interests and wishes used to plan them?
- 05How are as-required medicines recorded, including why they were given, their effect and the time they were administered?
This was an unannounced follow-up inspection focused on action from the previous inspection and infection prevention and control; Caring and Responsive had not been inspected at the previous three inspections and their Good ratings remained at this inspection. This explanation was written from the published report of 5 October 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 2023
Rated Inadequate and placed in special measures; inspectors found serious risks involving staffing, medicines, infection control and management.
This was an unannounced focused inspection. Inspectors visited the home on 7 February 2023, then used remote technology, records and phone calls until 3 March 2023. They spoke with people, relatives, staff, managers and healthcare professionals.
Inspectors found that the home was not always safe or clean. Risks linked to pressure damage, diabetes, fire evacuation, medicines and staffing were not managed reliably. Some records were out of date or inconsistent, and there were not always enough staff to respond safely.
The home was rated Inadequate overall. Safe and well-led were rated Inadequate, while effective was rated Requires Improvement. The rating worsened from Requires Improvement at the previous inspection. The home was placed in special measures.
Food and drink
People could choose food and drink and had enough available. The home had also acted on feedback about food quality.
“People could exercise choice and could access enough food and drink.” from the report
Healthcare referrals
Healthcare professionals said referrals for support were made promptly.
“Healthcare professionals told us referrals for people from Silver Birches for support were sought promptly.” from the report
Visits
People could have visitors when they wanted, in line with government guidance.
“Visiting aligned to government guidance and people were able to have visitors when they wanted.” from the report
Unsafe care and infection risks
seriousThe home was not always clean or safe. Inspectors found stained equipment, damaged surfaces, poorly managed waste and unsafe medicines practices.
“Medicines and infection control risks were not always managed safely. This placed people at risk of harm.” from the report
Not enough staff
seriousThere were times when staffing levels meant people could not receive safe and timely support, including urgent help after motion sensors were triggered.
“There were not always enough staff to meet people's needs and ensure their safety.” from the report
Risks and records
seriousPressure care, diabetes care and fire evacuation information were not managed consistently. Some records contained outdated or conflicting information.
“Systems had not been established to assess, monitor and mitigate risks to the health, safety and welfare of people using the service.” from the report
Consent and best interests
seriousSome Deprivation of Liberty Safeguards conditions were not met. Best interest decisions did not always involve the right representatives or record the outcome fully.
“The principles of the MCA were not always followed. This was a breach of regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014” from the report
Weak management checks
seriousThe provider's audits had not found or dealt with problems that inspectors identified, including medicines records, cleanliness and care records.
“The provider had failed to have effective systems to assess, monitor and improve the quality of the service.” from the report
- 01How many care staff will be on duty on each shift, and how will two-person repositioning be covered alongside urgent falls support?
- 02What has been done to make sure pressure-relieving mattresses, diabetes checks and insulin instructions are correct and up to date?
- 03How are refused medicines now disposed of, and how is this checked?
- 04How have the home’s cleaning, damaged surfaces, stained equipment and clinical waste arrangements been put right?
- 05What action has been taken to complete staff training and meet all Mental Capacity Act and Deprivation of Liberty Safeguards conditions?
This was a focused inspection of Safe and Well-led, widened to include Effective; Caring and Responsive were not inspected and their previous ratings carried over. This explanation was written from the published report of 10 June 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.
Every inspection of Silver Birches
6 rated inspections over 8 years: the service has slipped, from Good to Requires improvement.
- October 2023Requires improvementcurrent ratingup from InadequateSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- June 2023Inadequatedown from Requires improvementSafe: InadequateEffective: Requires improvementWell-led: Inadequate
- August 2022Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementWell-led: Requires improvement
- September 2021Goodstayed GoodSafe: GoodWell-led: Good
- October 2018Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- February 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- June 2014
Report published without a new overall rating.
- August 2013
Report published without a new overall rating.
- January 2013
Report published without a new overall rating.
- August 2012
Report published without a new overall rating.
- May 2012
Report published without a new overall rating.
- September 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 20 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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