Birnbeck House - Care Home Learning Disabilities

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We assessed 3 quality statement within the Safe key question. We found 3 breaches of the legal regulations in relation to need for consent, staffing and safe care and treatment. The key question has been rated as requires improvement. Systems and processes were not always in place or effective to ensure people were provided with safe care and treatment. Risks to people were not always assessed, monitored and managed to keep them safe. Medicines were not always recorded accurately and monitored safely, and staff were not always trained to support people with specific health conditions. Records evidenced not all staff had completed the necessary training required for their roles. Decisions about people's care were being made without the service demonstrating they had followed the principles of the Mental Capacity Act (MCA). However, staff knew people well and how to support them with their individual needs. Staff had received safeguarding training and knew who to go to if they had any concerns around people’s safety. Safeguarding systems and processes were in place to help ensure people were protected from the risk of abuse and neglect. Staff were supported by the interim manager and people using the service told us they felt safe.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they felt safe living at the service and about participating in activities they enjoyed in the community. Relatives told us when incidents occurred involving their loved ones they were informed. Investigations were completed and actions taken to ensure people’s safety, this included the completion of specific risk and capacity assessments. Relatives said their loved ones were safe now, but they had not always been. They told us, “Only recently yes, but it was not always safe” and “The care is not perfect but it is getting better.” A representative told us people were supported in the least restrictive way to keep them safe and any restrictions in place were “proportionate and needed ”.

Staff we spoke with said they were supported, worked well together and shared information as a team. Staff understood people's support needs and told us they had completed safeguarding training. Staff told us about people’s care needs, their interests and how they interacted. Staff understood what they should do if they had safeguarding concerns and how to ask for the person’s consent before supporting them.

We observed positive interactions between staff and people. People appeared happy and staff knew how to support people in their preferred way.

The service raised and reported safeguarding concerns. They had recently introduced a lessons learned log and this information was discussed during team meetings. The service was working on improving communication between staff. We were told while immediate actions to mitigate risk had been taken for one safeguarding concern, this had not been fully investigated due to changes in the management of the service. The service was not completing mental capacity assessments and best interest decisions. This had been identified as an action in the service improvement plan and marked as in progress. However, we did not see evidence of any Mental Capacity Assessments (MCA) for people during our assessment. The service told us they had mental capacity training booked for staff. Risk assessments were in place for people, but it was unclear if people’s capacity to consent to any restrictions in place had been assessed. For example, a risk assessment detailed a person had restrictions in place for their safety around the use of their kitchen but we did not see evidence of a mental capacity assessment. Some risk assessments also contained conflicting information about people’s capacity. For example, recording people had capacity to make a decision, but then also stating they were unable to understand the decision. This meant people may not be making their own decisions where they had capacity to do so and were at risk of being overly restricted in decisions about their lives. It also created a risk that people were not supported to maximise their independence. We identified a breach of the regulation, need for consent.

One person said they felt safe, and supported and thought their home was a nice place to live. They told us, “So I like this place.”. Relatives told us measures had been put in place to ensure people were supported safely and how they felt assured risks were being managed. One relative told us they are feeling “more confident now”. We also heard some concerns relatives had around the management of laundry and food safety. Relatives said people may be at risk of infection or be given food that is not safe to be consumed. We advised the management team of the concerns raised.

Staff told us how they communicated with people so they can make their own choices. Staff described how they promoted people’s independence in areas including personal care, meaning people are encouraged to do as much as they can for themselves. The interim manager had a good understanding of people’s daily routines and support needs. They also told us care plans were reviewed monthly, we saw a care plan had been reviewed recently and which areas had been reviewed.

We observed staff communicating at a pace suitable for people. Staff were respectful and polite in their interactions.

People had detailed support plans in place although some people required a risk assessment around finances, previous relationships, and potential risks to choking. It was not clear how oversight of any needed updates were recorded as the interim manager told us these were not part of the service improvement plan. Risk assessments in place had not been signed by people, the interim manager confirmed during our assessment they would ensure this was completed. Some people might also benefit with being supported to access specific training and guidance on relationships and managing finances. We fed this back to the interim manager for them to take any necessary action required.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Relatives commented staff training was not always effective. One relative told us, “I am not so sure if the training of the staff is all that good. They [staff] seem to learn on the job.” Another relative said, “Staff are trained for residency not independent living.” An advocate told us their observations of staff supporting people had been “gentle, respectful and emotionally reassuring”. People told us they liked the staff supporting them. Relatives told us there had previously been problems with staffing levels when the service first opened. One relative said, “it was chaotic at the beginning” and “they didn’t have enough staff”. However, we were told this had now improved.

Staff told us they were supported and worked well as a team. Staff showed they understood people's needs. One staff member told us a person’s flat had been adapted which enabled them to be independent in some meal preparation. Staff explained how they have encouraged people to make their own decisions, for example choosing daily activities, this included using communication tools such as a now and next board for some people. Staff shared actions they would take to support people when they become upset, they told us “we sit and talk with them or sit outside, give them space for a while”. Staff said they had received training.

We observed people going out for the day with staff. We saw evidence of people’s weekly planners during our assessment which gave information about people’s plans for the week including shared care with other providers. We observed the interim manager and staff completing an afternoon handover, this was informative, and was led by the acting team leader.

Supervisions were held regularly with staff. Supervision occurred more frequently when staff were in their induction period. Appraisals were due to commence for some staff who had been working at the service for a year or more. Recruitment processes were not always robust. The provider carried out some recruitment checks to ensure staff were suitable to work at the service. For example, references from previous employers and Disclosure and Barring Service (DBS) checks. Full employment checks were not always fully recorded. The provider started to address this during the assessment. Not all mandatory training had been completed. Training records we reviewed showed there were gaps in staff’s mandatory training completion, specifically in the areas of choking, manual handling, and fire safety. Training records did not demonstrate people had been trained in epilepsy or administering epilepsy rescue medicines despite people living at the service having epilepsy. The service was not providing learning disabilities training for staff that was specific for their role despite this being a requirement in the Health and Care Act 2022. Providers must ensure that all staff receive training in how to interact appropriately with people with a learning disability and autistic people, at a level appropriate to their role. Training records we viewed did not demonstrate people had been adequately trained to support people with learning disabilities and autism. The service improvement plan had identified some gaps in training but not specifically all the areas we identified as part of our assessment. Staff were not always trained and skilled to meet the needs of the people living at the service. We identified a breach of the regulation, staffing.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

Relatives told us there had been some initial issues with the ordering and management of their loved one’s prescribed medicines. On occasions medicine supplies had run out or were not checked when they arrived at the service. However, these issues have been addressed by the service and relatives said medicine management was “alright now, but it was rocky to start with” and “it wasn’t checked but now they [staff] check it all”.

Staff we spoke to told us they had received training in medicines administration. Staff knew how to report any errors that occurred and were confident to check with the management team if they had any queries. A member of staff told us they had been trained in how to administer an emergency epilepsy medicine, they told us “night staff are trained in how to administer rescue medication”.

We were unable to observe any people being supported with their medicines during our visit to the service. We observed people’s medicines were stored in locked cabinets.

The service was completing medicine audits. We found medicine administration records for one person’s had not been signed for over 3 weeks. It was therefore unclear if the person had been administered the medicine as prescribed. Protocols for as prescribed medicines were detailed and clear for staff to follow. One person had a protocol in place for the use of a device to help prevent seizures, their Medicine administration record gave staff instructions on how seizure rescue medication should be given. However, we found conflicting information in care plans and risk assessments around when medical interventions should occur for a person with epilepsy. While staff were recording specific details of a person’s seizures it was not clear when emergency protocols should be implemented. Training information we reviewed did not show staff were trained in epilepsy, the administration of epilepsy rescue medicine or topical medicines. However we were told night staff had training in rescue medication to support a person who had seizures at night. The interim manager was making a number of changes to the service, including reviewing all staff training. Training and competency checks were listed on the service improvement plan with a planned completion date of August. We were not always assured the service was monitoring people’s medical conditions safely. We identified a breach of the regulation, safe care and treatment.