Birkdale Residential Home

On this page

• 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 identified two breaches of the legal regulations. People were not safe. The provider had failed to comply with fire safety regulations which meant people were at risk of substantial harm in the event of a fire. The provider has given assurances this will be addressed as a matter of urgency. Equipment was not always maintained at the frequency required to ensure people were safe. People did not always have risk assessments in place to guide staff how to mitigate risk related to their clinical needs such as diabetes. Staff did not always complete daily records such as for fluid monitoring which meant people were placed at risk of harm. People were supported by a sufficient number of staff to meet their needs. However, the fire risk assessment indicated there were insufficient staff at night in the event an evacuation was required. Accidents and incidents were investigated and action taken when needed to reduce the risk of further reoccurrence. Staff understood when to raise safeguarding concerns and were confident these would be addressed. Safeguarding referrals were submitted to the local authority when required. Processes in place regarding assessing people’s mental capacity were insufficient which meant the provider could not be assured people were not being unlawfully restricted. People were supported to access health and social care professionals when needed such as SALT, physiotherapists and GP’s. However, relatives told us people did not always receive foot and nail care when required. People’s medicines were not always administered as prescribed which placed people at risk of harm. The home was generally clean although we saw some soiled bedding and furnishings. Despite people not being safe at the home due to risks relating to fire, people told us they felt safe living in the home with the staff who supported them and their relatives felt the care provided was safe.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they could raise concerns openly with staff. One person said, “I would be able to complain, I wouldn’t be blocked. The staff would help me, they would listen.” Relatives told us they felt confident speaking to staff if they had any concerns and felt these would be addressed. One relative said, “I would be happy to speak to staff or the manager if I was not happy. I know they would listen to me.” One relative told us about an incident that had occurred at the home which the provider had responded positively to. However, one relative told us they needed reassurances regarding fire safety concerns at the home that they had not received since the last inspection.

Staff were confident the registered manager would ensure concerns around people's safety were investigated and reported. Staff told us incidents and accidents were discussed during handovers. Staff told us the registered manager responded when there had been a pattern of incidents between 5pm and 11pm by putting an extra member of staff on which had made a difference to people’s care needs being met safely.

Accidents and incidents were reviewed and action taken to reduce the risk of reoccurrence. For example, when the provider had identified a high number of falls in the evening, an additional member of staff was employed between these hours. Where concerns had been identified following the last legionella risk assessment, action had been taken to address this. However, where actions had been identified in the fire risk assessment in 2023, the provider had failed to take action which had placed people at continued risk of substantial harm. These actions remained outstanding when the fire risk assessment was completed in 2024.

People told us they felt involved in their care and support and were supported to access health professionals when needed. People’s care records showed evidence of referrals being made to physiotherapists, occupational therapists, GP's and Speech and Language Therapists (SALT). However, relative feedback indicated concerns around foot and nail care were not always escalated.

Staff knew people well and were aware of their aspirations. One staff member told us about one person’s goals to return home. People’s needs were shared when they were transitioning to new homes. One staff member told us they had shared concerns regarding the capacity of one person with the social worker prior to their move to another placement to help to promote a safe transition. The registered manager gave us examples of where people had been supported to move to other placements where they were unable to meet their needs any longer.

Professionals told us the provider made appropriate referrals into them when needed and worked alongside them positively. Commissioners told us the provider had engaged with them and made improvements to the care provided at the home. Partners told us staff had positively engaged in training set up by them and had transferred their training into supporting people at the home.

The provider worked in partnership with other professionals, such as district nurses and SALT teams. Preadmission records evidenced the provider carried out assessments of people's needs prior to moving into the home. Where one person had just arrived from hospital, the provider had liaised with the hospital regarding the discharge and took immediate steps to request input from other health professionals following admission to the home. Where the provider did not feel they could meet people's needs safely any longer, they made referrals to relevant health and social care professionals to request reassessment and supported them to move on safely and effectively. However, there were some gaps in clinical records which meant the provider could not always be assured that referrals to other health professionals were made when needed. For example, where fluid recordings were required, they were not being monitored effectively which meant the provider would not know when there were concerns around someone's fluid intake and when to refer.

People told us they felt safe living in the home. One person said, “Oh yes I feel safe.” Another person told us “I feel safe here, my friends come and visit me, the staff are so lovely to me, nothing is too much trouble.” Relatives told us they felt people were safe living in the home. One relative told us, “The staff are very good, I know [my family member] is safe.” However, despite people feeling safe, evidence indicated they weren’t safe due to concerns around fire risk. However, one person who was residing at the home at the time of the site visit had not consented to be there at the time of admission and was not being listened to. Whilst staff were supporting them with empathy and compassion, consideration was not given to inconsistencies in their mental capacity assessment records which meant they were at risk of being unlawfully restricted. This person was no longer at the home by the second day of the site visit.

Staff we spoke with understood what Deprivation of Liberty Safeguards (DoLS) were. However, they did not apply this understanding where a person did not have a DoLS in place and wished to return home. The registered manager told us they did not think that the person who wished to return home had capacity to make that decision but acknowledged their documentation indicated they had capacity to decide upon where they lived. Staff had undertaken safeguarding training and were knowledgeable about how to protect people from abuse. One staff member told us all concerns needed to be reported to a member of the management team straight away. Another staff member gave us an example of where they had shared safeguarding concerns and told us, "I have had safeguarding training. The types of abuse are verbal, financial, neglect, physical." Staff were confident that any safeguarding concerns raised would be dealt with appropriately. The registered manager told us they took advice from the local safeguarding team if they weren't sure if something constituted a safeguarding or not to ensure they were making appropriate referrals.

People were supported by staff who interacted with them positively and with compassion. We observed staff sharing their concerns with the registered manager to keep people safe. For example, one staff member fed back concerns about a person refusing medicines with the registered manager so GP input could be requested. However, we also observed one person's medicines being left with them in a drink to take without a staff member being present which may have placed them or other people at risk of harm.

There was a safeguarding policy in place. However, there was no reference to any underpinning legislation and was not always sufficiently thorough. Statutory notifications were not always submitted when required. We found 3 examples where safeguarding referrals had been made but there was no statutory notification submitted to CQC. This was addressed retrospectively following the site visit. Where accidents and incidents occurred, safeguarding referrals had been made when needed. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests, the policies and systems in the service did not support this practice. Whilst people were supported to make day to day decisions themselves, systems in place to assess people’s mental capacity were insufficient which meant people were not always supported in the least restrictive way. The provider did not always undertake their own mental capacity assessments which meant they relied on outdated mental capacity assessments which may not have always been an accurate assessment of people’s capacity on that date and placed them at risk of being unlawfully deprived of their liberty.

Relatives raised some concerns regarding the temperature of the building and whether people were always provided with sufficient fluids to meet their needs. People told us they had choices and had autonomy over how they spent their day. One person told us “They will support you how you want to, they have a nice attitude, they respect your opinion. We are not cajoled into activities; you can say no if you want.” People’s health risks were escalated when needed. One relative told us, "If there are any issues, they always let me know. My relative has a few infections and can go down quite quickly but they are always on to it and get people in." People were supported to mobilise safely. One relative told us, “They usually hold their hand to support my relative and the staff support them carefully. The door has always been locked at the top of the stairs. They haven't had any falls since they've been there."

Staff generally knew people well and understood how to manage risks to them and support them safely. However, there were some gaps in knowledge in respect to managing people's risks due to a gap in effective clinical care plans. For example, diabetes. Staff understood how to manage people's mobility needs. Staff were also knowledgeable about people's SALT assessed diets and what food people were able to eat safely. Where people had clinical needs, staff were not always aware they should regularly complete clinical monitoring records such as fluid charts which meant risk was not always monitored safely. The registered manager told us they delegated risk assessments to a deputy manager to complete but people and relatives were not always involved in the process. The registered manager acknowledged risk assessments had not always been completed for clinical risks and indicated they would look at their processes as the online assessment was not always effective in ensuring all risks were assessed and managed safely.

We saw people being informed about risks such as one person being advised to wear a coat before going outside when it was raining. People were observed being supported to eat in line with their SALT assessed diets. People were observed being supported to mobilise safely in line with their care plans. Some labels on hoist/sling equipment we saw had not been maintained in accordance with regulations which placed people at risk of harm.

Risk assessments were not always completed when needed for clinical risks such as diabetes and epilepsy. This meant the provider could not be assured staff understood how to manage risk to people safely. Where risk assessments identified people’s health needed regular monitoring, there were gaps in the documentation. Fluids and oral healthcare were not being monitored safely and effectively. Fire risks were not being mitigated effectively which left people at risk of substantial harm. Actions had not been taken to address where the home was not compliant with fire regulations. Personal Emergency Evacuation Plans (PEEPs) were in place but lacked some detail. People were being repositioned in accordance with their care plans. Accidents and incidents were investigated and analysed to identify patterns in order to mitigate risk.

Staff supported people to use their mobility equipment safely. One person we observed being supported to walk with a walking frame told us, “The staff are very patient with me, the staff help me to walk safely.” People’s rooms were not always maintained at a suitable temperature. We raised concerns regarding the temperature of one person’s room during the site visit and this was addressed. A relative of another person also raised concerns regarding the temperature in the home. They told us, "It's really boiling in my relative's room. I had to open the windows. They don't put fans in the rooms. They will open the windows sometimes, but I do it if I'm there. The heating was on on a red-hot day." People were not always involved in regular fire alarm tests which placed them at risk of harm in the event of a fire.

Staff told us they had received moving and handling training and were confident in using mobility equipment. Staff told us emergency equipment was available to support people if they experienced a fall. The registered manager told us that following the last inspection they had temporarily covered hot pipe work and taps in foam and they were addressing this as they went round. All aspects had not yet been completed. The registered manager told us extractor fans had been cleaned since the last inspection. Whilst the registered manager initially indicated that actions from the 2023 fire risk assessment had been addressed, they confirmed there were a number of outstanding actions and acknowledged this placed people at risk of harm within the home environment.

People moved freely around their home and the corridors were clear of obstruction. Doors that should be locked were locked and stair gates were secure. COSHH items were stored in locked cupboards. However, we saw slings that had not been adequately maintained according to their label placing people at risk of harm when in use.

The provider acted on some concerns raised from the previous inspection. However, some equipment had not been maintained in accordance with health and safety legislation. Room temperature recordings were being taken daily; however the provider was not proactive in taking action when temperature rose to unsafe levels. The fire risk assessment identified that equipment was not being maintained safely and placed people at substantial risk of harm. Window restrictors were in place on windows to keep people safe from harm.

People and relatives told us there were enough staff available to support them safely. One person told us, “Staff come quickly if I press the buzzer.” Another person said, “There are plenty of staff, the staff help me when I ask them.” One relative told us, “The staff are very good, there are enough of them.” People and relatives told us staff were well trained and knew them well.

The registered manager told us they were not currently using agency staff other than where temporary 1:1 support was required. The registered manager told us upon recruitment, they undertake DBS checks and request references as well as looking at what qualifications staff have. They told us staff are then supported by a mentor until they are competent. The registered manager acknowledged staff supervisions and competency checks had been delegated and they had not always been carried out as frequently as they should have. The registered manager told us they did not use a dependency tool to calculate staff numbers but they adapted and increased staffing numbers when needed. The registered manager told us they had sufficient staff and that an additional member of staff had been put on during the twilight hours due to them identifying an increase in falls. Staff told us they didn't always think there were enough staff as they were so busy but they told us this did not impact on meeting people's needs and keeping them safe. Staff told us they had received training and felt competent in supporting people safely. Staff told us they had not had regular supervision.

We observed staff responding promptly to people and taking time to sit and talk to people. People did not wait long for their care and staff were present in communal areas. We observed staff treat people with kindness and respect and staff knew them well.

Whilst there were enough staff on duty to keep people safe, staff were not always recruited safely. There were gaps in employment history, a lack of health questionnaires and we did not find evidence of all references received prior to the start of employment. Staff files and the training matrix indicated staff were not always up to date with their training.

People told us staff kept their rooms clean and tidy. One person told us, “The staff help me when I ask them, they come in and clean my room all the time, I'm happy.” A relative told us, "The home is always clean, that's improved now they've had it all redecorated". Another relative told us, "It's always nice and fresh and clean. When my relative first went in, it wasn’t the most modern but the care and cleanliness were above and beyond so I'm really happy." People were supported by staff who wore Personal Protective Equipment (PPE) in line with current guidance.

Staff had access to PPE. Staff told us they were aware of their responsibilities in relation to infection prevention and control. One staff member told us there were 3 cleaners that were split across different areas of the home so they all had their own responsibilities. They told us night staff generally mopped communal areas for health and safety reasons but cleaning was undertaken regularly every day of rooms.

The home appeared tired in places and some bedding was stained. We observed soiled curtains and miscoloured tiles. However, this was isolated and the home was generally clean. We saw evidence of cleaning being undertaken throughout the site visit days. Staff were observed wearing PPE in line with current guidance.

Cleaning schedules were in place and complied with. IPC audits had been completed regularly since March 2024 on a monthly basis. Actions were identified from audits and addressed. An action plan was in place to address IPC actions identified at the last inspection and actions had been taken to comply.

Relatives told us they were aware of some medicines errors that had occurred. Relatives gave examples where people had received medicines they were not prescribed and where they did not always have medicines that were prescribed to them. This placed people at risk of harm of medicine misadministration.

Staff who administered medicines told us they were trained to do so but they had not all had regular medicines competency checks. Where medicines competency checks were undertaken, staff did not always feel confident in doing so as they had not received specific training for this and were sometimes expected to audit their own medicines administration. The registered manager told us they would be training more staff to do this and no staff members would be expected to audit their own medicines administration going forward. Where there were gaps in the Medicine Administration Record (MAR) charts, staff told us they had not yet been identified but may have been picked up at the end of month audit. Staff acknowledged these gaps had not been identified or reported at the time of the site visit so no action had been taken to address this placing people at risk of harm. The registered manager told us medicines errors were investigated and missed signatures were checked and recounts were undertaken. The registered manager told us they had made some changes to medicines storage to make it safer. They told us thickeners were now stored in a locked cupboard that can be accessed when needed.

People's medicines were not always administered safely. There were some gaps on people's MAR's which could not be accounted for as medicines counts were correct. One person's topical creams were also not administered as prescribed. Protocols were in place for when required medicines but were not always sufficiently detailed to guide staff when to specifically administer them. Where medicines errors had been made, these had not been identified so had not been investigated in a timely manner. Medicine's names were spelt wrong on the MAR which increased the risk of medicines errors and placed people at risk of harm. Medicines were stored safely in a locked cabinet in a locked room. However, we found one medicine was past its expiry date and had not been disposed of. There was no evidence this had been administered to anyone but this may have placed people at risk of harm.