Birchwood Care Services improved from Inadequate to Requires Improvement following a focused inspection against Warning Notices for Regulations 12, 13, 17 and 18, with breaches resolved but improvements still needing to be embedded. Ongoing concerns remain around cancelled care calls due to staff sickness and recently introduced governance checks that have not yet been fully embedded into day-to-day practice.
Concerns (5)
moderateMissed or late visits: “Some care calls had continued to be cancelled at short notice, relying on relative to provide support, and this was an area for improvement.”
moderateStaffing levels: “The service was reliant on agency carers to cover staff sickness and was actively recruiting to increase their staff levels.”
moderate
Governance
: “Some of these had been introduced in March, were now being completed and needed time to be embedded in day-to-day practice.”
moderateComplaints handling: “One person told us they had raised a complaint at the end of 2022, and it had not been investigated.”
moderateLeadership: “At the time of our inspection there was not a registered manager in post. An application had been received by CQC for a manager to register.”
Strengths
· Risks to people's health and safety had been assessed and risk assessments implemented with guidance for staff.
· People received their medicines safely and staff competencies were checked regularly to ensure best practice.
· Staff were recruited safely with DBS checks and references obtained before induction.
· Staff had regular one-to-one supervision meetings and kept training up to date.
· Incidents and accidents were recorded, monitored and reviewed with action taken on identified trends.
Birchwood Care Services was rated Inadequate overall following an inspection in November 2022, with Warning Notices issued for breaches of Regulations 12, 17 and 18, and a further breach of Regulation 13 for safeguarding, arising from chronic understaffing that caused widespread late and cancelled care calls. The service was placed in Special Measures due to systemic failures in risk assessment, medicines management, governance and leadership, including the absence of a registered manager since September 2021.
Concerns (11)
criticalStaffing levels: “The provider failed to ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons were deployed to meet people's needs.”
criticalMissed or late visits: “People's calls were late or had been cancelled at short notice, relying on people's families to support their loved ones.”
criticalSafeguarding: “The provider's failure to provide sufficient numbers of staff, to ensure people received their support in a safe and timely way, represented neglect, a form of abuse.”
criticalMedication management: “There was a risk people may not be supported to have their medicines as prescribed as many care calls were late or cancelled.”
criticalGovernance: “The provider failed to ensure systems and processes were established and operated effectively to assess, monitor and improve the quality and safety of the services provided.”
criticalLeadership: “The service had not had a registered manager leading the service since September 2021. There had been several changes in manager.”
moderateCare planning: “Care plans lacked important information about people's health conditions. Care plans varied in the level of person-centred detail.”
moderateStaff competency: “Staff completed medicines administration training. However, staff competency had not been assessed to ensure they followed best practice.”
moderateIncident learning: “The manager had not completed any analysis of the missed or cancelled calls. People had raised concerns with the office about their calls being late.”
moderateSupervision / appraisal: “The manager had not completed any staff competency assessments or audits of care plans or medicines management since they started at the service.”
minorRecord keeping: “When people had prescribed creams to help keep their skin healthy, there were no topical body maps to guide staff to where the creams should be applied.”
Strengths
· People were supported by staff who had been safely recruited, with DBS checks, employment gap checks and at least two references obtained before induction.
· Staff completed training to keep their knowledge up to date, including moving and handling, first aid and catheter care.
· Staff understood infection prevention and control measures and had adequate PPE supplies.
· Staff worked with healthcare professionals such as occupational therapists and community nurses.
· People told us staff supported them in the least restrictive way possible and gained consent before providing care.
Quality-Statement breakdown (9)
safe: Staffing and recruitment; Learning lessons when things go wrongInadequate
safe: Assessing risk, safety monitoring and managementInadequate
safe: Using medicines safelyInadequate
safe: Systems and processes to safeguard people from the risk of abuseInadequate
safe: Preventing and controlling infectionGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsInadequate
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringInadequate
well-led: How the provider understands and acts on the duty of candour