Agenda item

To consider the improvement plan in place in order to address the recent Care Quality Commission (CQC) judgement of “inadequate” at the Council’s recently acquired Care Home – Birchwood.

Councillor Emma Webster introduced the topic to the Commission who were reminded that the discussion would take place in two parts. Members were asked to consider the nature of their enquiry for the suitability of Part I discussion. The Part II discussion would follow.

Tandra Forster introduced the report to Members which detailed the outcome from the Care Quality Commission (CQC) inspection, completed in September 2017, which rated the Birchwood Care Home as ‘inadequate’. The report set out the background to the inspection and the actions required to improve the current position.

Tandra Forster advised that, subsequent to the CQC rating, the service developed an action plan to direct focus and make changes within Birchwood Care Home; in particular around leadership and systems.

Sue Brain explained that she was appointed the task of overseeing and managing the action plan from October 2017. The action plan was an organic document which they reviewed and updated on a regular basis to monitor progress. This plan was reactive to the inspection taking place.

A key element of the action plan was leadership. In her experience, strong leadership was crucial. The new Care Home Manager was from an existing West Berkshire Council care home rated “good” and this provided a seamless transfer when they came into post (in January 2018). Furthermore, the new manager was familiar with the Council’s policies and procedures, which reduced the period of time they required to settle into the role. It was expected that the new manager would take a proactive approach towards managing the action plan and the running of the care home.

Sue Brain advised that the Council was in regular conversations with the CQC, in particular the safeguarding team, which helped ensure the action plan was focusing on the right areas.

Members heard that a significant issue the Council encountered was the inability to access Care Plans. Sue Brain explained that, due to ICT restrictions, West Berkshire Council could not inherit the existing systems used to hold and manage client’s Care Plans.

Other areas for improvement which had been identified were those such as the building’s environment, layout and interior. These recommendations contained some quick wins and others which required investment or further investigation; these would be picked up with the new manager.

Sue Brain expected the self-imposed embargo to be reviewed and monitored. When lifted, this would be done in a phased approach. 

The action plan included the delivery of training to all staff at Birchwood Care Home and this was positively moving forward.

Furthermore, it was felt that cultural change was necessary and that the Council had not yet succeeded in embedding its ethos regarding the management of the care home. Sue Brain reassured Members that this was a priority but that cultural change would take time.

Councillor Marigold Jaques asked whether the service had the resources they required to undertake the actions as detailed in the action plan.  Sue Brain advised that they had inherited a large number of agency staff, which was not unique to Birchwood Care Home, as recruitment within the care industry was notoriously challenging. The team was working hard to change this situation but it could be difficult to encourage agency staff to transfer into permanent employment for various reasons.

Councillor Dillon asked when the service became aware of the staff skillset deficit and how the service monitored performance at the care home before it was acquired by the Council. Rachael Wardell advised that the Council’s Care Quality
Commissioning Team visited care homes and inspected their performance for residents funded by the Council but it was impossible for them to identify every issue within a care home, particularly those that would be visible only to those managing the home. An independent regulator, the Care Quality Commission was in place for all registered care providers. Sue Brain informed the Commission that often it was necessary to have a holistic view towards the operation of a care home through the information provided by the CQC and sight of the complaints systems to highlight independent concerns. It could be difficult to identify an issue with any one of these in isolation but when the Care Team had overall visibility of these information sources then it could be possible to take a view on care quality.

Councillor Tim Metcalfe asked whether the Council felt it had the appropriate skillset and experience to develop a robust improvement plan. Sue Brain stated that the Council had ample experience and she was confident that the plan was sufficient to drive / deliver improvement. All other Adult Social Care services were rated by the Care Quality Commission (CQC) as at least ‘Good’ or better by Ofsted

In response to questions asked by the Commission, Tandra Forster reassured Members that they were already seeing improvements at Birchwood Care Home and this was echoed by the feedback from family/ friends of those receiving care.

Councillor Dillon asked how the same situation could be avoided in the future and what powers the Council could exercise to manage concerns regarding providers’ care quality. Rachael Wardell advised that the service worked with care providers where possible to highlight concerns and secure improvements. Where necessary the Council had the option to discontinue placements with a provider if those concerns were significant and/or had not been resolved. However, such decisions would always be taken with care due to the sensitivities around moving someone from their home; noting that the family would often be happy with the care in place and want their family members to remain. For these reasons it was important to consider the bigger picture before simply suggesting a change of care provider.

The Commission heard that West Berkshire, generally, had access to good care providers which was not common place in comparison to the rest of the South East.

In response to concerns raised by the Commission, Tandra Forster advised that the Council spoke with each family impacted by the CQC assessment prior to the report’s publication. The Service encouraged the involvement and input from families to shape the improvement plan because it was recognised that their contribution was key.

Members heard that the service was clear about the steps required in order that sufficient changes were made within Birchwood Care Home and it was not anticipated that the care home would be in the same position again.

In summarising the Part I debate, Councillor Webster highlighted the primary concerns as being the level of care for Birchwood Care Home residents and to ensure residents were safe, as well as learning lessons for other homes across West Berkshire. The CQC inspection found that Birchwood Care Home did not provide a sufficiently safe or caring service and Councillor Webster stated the importance of reassuring care home residents and their families. Sue Brain assured the Commission that the service moved swiftly to respond to the CQC’s findings. Initial meetings and follow up meetings were held with residents and their families to explain concerns highlighted from the inspection. As explained, a clear action plan was in place and was being implemented to put things right both within the Council and with key health partners as well as the CQC.

Councillor Webster thanked Officers for the information provided and proposed that the meeting proceeded under Part II for reasons associated with Paragraph 3 – information relating to financial/business affairs of particular person. The proposal was accepted by the Commission.

Resolved that:

(1)       The report was noted.