CQC report explained · a residential care home
What the CQC found at The Birches - Care Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People felt safe and there were enough staff to meet their needs promptly. Medicines were generally administered safely, but inspectors found one handwritten record error and missing guidance for some as-needed medicines, which the manager addressed.
- Effective?
- Good
- Staff had the skills and training to support people. Consent, capacity and best-interest decisions were handled appropriately, and people received support with food, health needs and access to healthcare.
- Caring?
- Good
- Staff were described as kind and respectful. People were supported to make choices, maintain privacy and dignity, develop independence and stay involved in decisions about their care.
- Responsive?
- Good
- Care plans reflected people's routines, interests and preferences. People had a wide range of activities, could maintain relationships and received information in ways they could understand.
- Well-led?
- Good
- The management team had improved oversight of quality and safety. Audits were used to identify and address shortfalls, and people, staff and professionals were involved in developing the service.
What inspectors found, September 2019
The Birches - Care Home was rated Good; inspectors found kind, person-centred care and improvements since the previous inspection, with minor medicines and equipment issues addressed during the visit.
Inspectors visited unannounced on 10 and 11 July 2019. They spoke with people living at the home, relatives, staff and health and social care professionals. They observed care, toured the home and checked care files, medicines records, staff records, audits, complaints and other documents.
All five areas were rated Good: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough staff, suitable recruitment checks, respectful care, support for independence, personalised activities, good access to healthcare and active management oversight.
The previous inspection had rated the home Requires Improvement, with several breaches of regulation. Inspectors found that improvements had been made and the home was no longer in breach. They did identify one handwritten medicines record error, missing guidance for some as-needed medicines and a damaged pressure-relieving cushion. These were addressed during or immediately after the inspection.
Respectful, person-centred care
People were supported according to their wishes, routines and preferences. Staff promoted choice, privacy, dignity and independence.
“People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.” from the report
Safe staffing and training
Inspectors found enough staff and appropriate recruitment checks. Staff received induction, ongoing training, supervision and competency checks.
“Staff had the skills and knowledge to support people safely.” from the report
Activities and independence
People were supported to build skills, take part in activities and maintain links with family, friends and the local community.
“People took part in a wide range of activities that helped them to lead fulfilling lives.” from the report
Improved management
The home had improved since the previous inspection. Managers used audits and other information to identify problems and make changes.
“Systems identified and addressed quality shortfalls.” from the report
Medicines record error
needs fixingInspectors found one handwritten medicines record error that staff had not identified. The manager acted immediately to correct it.
“We found one error on a hand-written medicine record which had not been identified by staff.” from the report
As-needed medicine guidance
needs fixingProtocols were not always available to guide staff about when to give some as-needed medicines because some guidance had been archived. This was addressed during and after the inspection.
“Though protocols were not always in place to guide staff when to administer 'as and when required' medicines, also known as PRN, as some had been archived.” from the report
Damaged pressure-relieving cushion
minorOne cushion had a torn cover and could not be cleaned properly. The manager removed it from use immediately.
“We found one pressure relieving cushion could not be appropriately cleaned due to a tear in the fabric.” from the report
- 01How do you now check handwritten medicines records for errors?
- 02Are protocols in place for every as-needed medicine, and how are staff told when to give them?
- 03How often is equipment such as pressure-relieving cushions checked, and what happens if it is damaged?
- 04How will you maintain the improvements made since the previous inspection?
- 05How are people's individual activities, routines and independence goals reviewed?
This was an unannounced planned inspection based on the previous rating and covered all five CQC questions, including both the care provided and the premises. This explanation was written from the published report of 6 September 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.
What inspectors found, July 2018
Rated Requires Improvement; inspectors found kind care and enough staff, but serious weaknesses in consent, care records, medicines, training and management.
Inspectors visited on 2 and 4 May 2018. The first visit was unannounced and the second was announced. They spoke with people, relatives, staff and health professionals. They observed care, checked the environment and reviewed care records, medicines, staff files and management checks.
The home was caring, and people were treated with kindness, dignity and respect. There were enough staff during the inspection. People received help with food and drinks, took part in activities and were supported to go out, work or attend education if they wished.
However, the home was not consistently safe, effective, responsive or well-led. Inspectors found problems with medicines, environmental safety, mental capacity decisions, staff supervision and training, care records and quality checks. Four regulations were breached.
This was the third consecutive Requires Improvement rating. The provider had stopped new admissions voluntarily while it worked on the problems. An acting manager had been in place for only five days, and there was no registered manager.
Kind and respectful staff
Inspectors saw staff offering reassurance and treating people with kindness. Privacy, dignity, diversity and independence were respected.
“We saw staff were caring and kind to people and people's privacy and dignity was respected.” from the report
Enough staff on duty
Inspectors saw enough staff to meet people's needs promptly. Night staffing had increased after concerns were raised.
“During our visit we observed there was enough staff to meet people's needs in a timely way.” from the report
Activities and community life
People were supported with activities, outings, family contact, work and education according to their wishes.
“People had opportunities to be involved in social activities that interested them, both in the service and the community.” from the report
Complaints were investigated
The home gave people information about complaints in an accessible format. Complaints were investigated and used to help improve the service.
“Complaints received were investigated and responded to.” from the report
Unsafe medicines processes
seriousSome medicines were not stored securely, records had gaps and returned tablets were not identified. This created a risk that medicines might not be managed safely.
“It was unclear if these items had been administered, been taken or declined.” from the report
Mental capacity and consent
seriousCapacity assessments were generic and some best-interest decisions were made without the required assessments. This restricted people's choice and control.
“Some best interest decisions were made without capacity assessments being completed, which was a contravention of the MCA.” from the report
Care records did not reflect current needs
seriousPeople often had several confusing files. Changes were not always dated or signed, and records did not always explain the support people needed or the action to take when health risks arose.
“People's care records were not person-centred and they did not provide evidence that people were involved in creating or reviewing their care needs, where this was possible.” from the report
Staff skills and supervision
seriousNot all staff had received supervision in line with the provider's policy. The provider was concerned that staff might not have understood all their training.
“12 out of 37 staff had one supervision since December 2017.” from the report
Weak quality checks
seriousAudits had identified some issues but action was not always timely or effective. Important checks, including water temperatures and staff medicine competence, had gaps.
“The provider had failed to assess, monitor and improve the quality and safety of the service.” from the report
- 01What has been done to correct the Regulation 11 breach, and how are capacity assessments and best-interest decisions now checked?
- 02How are medicines stored, recorded and returned, and how has every staff member been assessed as competent to manage them?
- 03Has every person's care record now been reviewed, simplified, dated and signed to reflect their current needs?
- 04How often are staff receiving supervision, and how does the home test whether training has been understood in practice?
- 05Who is managing the home now, and has a registered manager been appointed?
This was a comprehensive inspection covering all five areas, after safeguarding notifications increased and the local authority raised concerns. This explanation was written from the published report of 11 July 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 The Birches - Care Home
6 rated inspections over 5 years: the service has held its Good rating throughout.
- September 2019Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- June 2017Requires improvementstayed Requires improvementSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- March 2017Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Inadequate
- May 2016Goodstayed GoodSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- December 2014GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2014
Report published without a new overall rating.
- March 2013
Report published without a new overall rating.
- October 2011
Report published without a new overall rating.
- November 2010
Registered with the Care Quality Commission on 29 November 2010.
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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32 live-in carers within about an hour of North Lincolnshire
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 £980 to £1,300 a week. 29 can care for a couple. 11 years' experience on average.
“What truly stands out is how mindful and attentive she is to all of my medical needs, always going above and beyond to ensure I’m comfortable and well cared for.”
“Martin was more than a carer, he managed the home and became my uncle's best friend, enriching his life during his last few years.”
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.