Agenda item

This report follows on from the one presented to the OSMC in January 2018 in relation to the Care Quality Commission (CQC) rating of Inadequate awarded to Birchwood Care Home following an inspection in September 2017. This report provides a review of the progress achieved since September 2017 and outlines further actions required for scrutiny review.

The Commission considered the report (Agenda Item 9). The report followed on from the one presented in January 2018 in relation to the Care Quality Commission (CQC) rating of Inadequate awarded to Birchwood Care Home following an inspection in September 2017. This update report provided a review of the progress achieved since September and outlined further actions required.

The follow up CQC inspection had taken place between 31^st May and 2^nd June 2018 and Sue Brain reported that it had been hoped that they would have the preliminary report in time for the Commission meeting however, it was not yet available. There would be no indication of the rating until after the report had gone to the CQC review panel. Once the report had gone through the necessary process it would be available for West Berkshire Council to challenge prior to final publication.

The report included as part of the agenda provided detail on work that had taken place since January 2018. It represented a snapshot of work taking place in June 2018. There was now a Registered Manager, Deputy Manager and Clinical Lead in post at Birchwood. There was still a struggle to recruit care workers however, this was a universal issue across the sector.

In November 2017 there had been a ratio of 35% permanent staff to 65% agency staff and this had improved to 52% and 48% respectively. It was hoped that these figures would continue to improve.

Councillor Emma Webster welcomed questions from Members of the Commission and suggested that they went through each page of the Birchwood Improvement Plan.

Councillor Graham Bridgman reported that he had visited the care home with Councillor Marigold Jaques and it had been very positive. The manager had seemed very efficient and much of the refurbishment work to the top floor had been completed. The colour of the walls had been toned down which was a huge improvement.

Councillor Lee Dillon asked what Officers expected the outcome of the inspection to be. Sue Brain explained that the most that could be achieved was to move up one level to ‘Requires Improvement’ and this was the same for any home rated as ‘Inadequate’ at the follow up inspection. Staff would work above and beyond to bring Birchwood up to the same level as all other homes in West Berkshire, which were rated “Good”.

Councillor Webster noted that there were 60 beds at Birchwood and asked how many of these were filled. Sue Brain reported that there was a voluntary embargo in place. Of the 50 beds dedicated to residents with dementia, there were 11 vacancies. The remaining 10 beds were currently used as short term step down beds, where there were fluctuations in bed occupancy. The maximum time someone could stay in the step down unit was six weeks.

It was noted that in light of an increased rating, numbers at the home could increase. Tandra Forster reported that Birchwood had also helped with the West Berkshire Council’s performance levels for Delayed Transfers of Care (DTOC).

Councillor Jaques felt that very positives changes had been made to Birchwood, including the décor. The team at the home were working very closely with families, which was reassuring for Members. It was hoped that a ‘Good’ rating could be achieved in the future.

Councillor Dillon referred back to occupancy rates and queried if the voluntary embargo was not in place, if there would be enough demand to fill beds. Sue Brain confirmed that there would be. When an embargo was lifted it was done so in a phased approach to ensure a care home remained stable and that admissions were safe.

Councillor Webster moved on to look through the Improvement Plan in more detail.

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Councillor Webster referred to the following action:

Storage of medication from delivery, prior to allocation to trolley to be reviewed in respect of temperature of storage facility with options for solution obtained.

It was asked if Officers were satisfied that this had been completed by 30^th June 2018. Sue Brain reported a short term solution had been found and implemented and a long term solution was being sought. It was anticipated that the next step would be to look at an air-conditioning unit and it was likely that this would have costs attached.

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Councillor Webster noted that a Facebook and other social media campaign was in progress to help drive recruitment and asked if there had been a positive response via these methods. Sue Brain reported that there had been a rolling campaign across different types of media and a meeting would be taking place the following week to discuss how successful these had been. It was currently too early to tell how successful media such as Facebook had been in terms of recruitment at Birchwood. Tandra Forster added that these methods had been used elsewhere in Adult Social Care and had proved to be successful.

Councillor Webster noted that the Interim Manager was on a six month contract and asked if this could be extended. Sue Brain reported that the interim deputy manager would be able to apply for the role on a long term basis. She was an internal employee and therefore had a good knowledge of processes within the Local Authority.

Councillor Dillon queried the implementation of the bespoke training programme. Sue Brain confirmed that Public Health were delivering dementia training. Various training initiatives were back on track. Tandra Forster added that the Dementia Bus would be returning on 19th September 2018 and 13th March 2019.

Councillor Webster asked for further information on training in safeguarding and medication that would be delivered in-house. Sue Brain reported that there were three levels of safeguarding training and not all three levels were appropriate for all employees. There were various ways of delivering training including e-learning however, in her opinion safeguarding training was best delivered face to face and this was what had been done. Individuals requiring further levels of training were picked up.

Councillor Webster asked if Adult Social Care were satisfied with the way information had been handed over by Care UK and Sue Brain confirmed that she had not been part of the hand over processes.

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Councillor Dillon noted that the number of safeguarding incidents, CQ1 and complaints had declined since November 2017 for Birchwood. Sue Brain reported that complaints had dropped to a level that she would expect for a Care Home of that size.

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Councillor Webster referred to the following point under action taken:

Paperwork and charts introduced to monitor nutrition and hydration. Other appropriate documentation relevant to a person’s health and wellbeing introduced.

Councillor Webster asked if Adult Social Care was satisfied with the information provided by Care UK. Tandra Forster reported that Care UK had used an IT system that the Local Authority had been unable to use, which had caused gaps in information that had needed to be filled. Councillor Webster stated that in the private sector a deep dive approach would have been used. Tandra Forster confirmed that the IT system had provided sufficient information however, technically the Local Authority was unable to adopt it.

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Councillor Somner queried if there was a struggle in providing these services and Sue Brain confirmed that there were struggles in accessing these services. Councillor Webster queried if a solution to the problem had been found and Sue Brain reported that the Local Authority had good relationships with partners in health. Having clinical staff at Birchwood was helpful as they could pick up issues requiring attention

Councillor Webster referred to the following point and asked if it had been implemented over the last six months:

Clinical lead and RGN/RCO’s to ensure supervisions are structured sufficiently to delivery support to improve performance and quality and tackle poor performance through the capability process.

Sue Brain reported that this point had been implemented. The capability process was robust however because the home had moved away from a high number of agency staff, many members of staff were still new in post and therefore the performance structure was still bedding in.

Tandra Forster added that regarding gross misconduct, action was always taken immediately and could end in dismissal. In the event that a member of staff did not hold the values required, they would go through a disciplinary process and would be dismissed if appropriate.

Councillor Bridgman stated that a shift from agency staff had made a huge difference to the way Birchwood operated. Councillor Bridgman however stated that they must not lose sight of the support that agency staff had provided over the years.

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Councillor Webster referred to the following point and asked if any lessons had been learnt from the thoughts and feelings experienced by staff at Birchwood:

Staff Surveys undertaken since January 2018 and outcomes to be shared at June 2018 staff meeting.

Sue Brain stated that the Registered Manager would be best positioned to answer the question as she did not have access to all of the responses. Staff surveys were something Adult Social Care liked to carry out on a regular basis to see how staff were feeling. Staff were now much more engaged at Birchwood and had recently held a party at the home with families. Engagement was at a much higher level than it had been seven to eight months ago. Councillor Bridgman commended the efforts of the Registered Manager in increasing the level of engagement amongst staff.

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Councillor Webster asked if the Disclosure and Barring Service Checks (DBS) had been updated accordingly and Sue Brain reported that the recruitment policy had been changed to reflect changes and this had been through the Human Resources Department.

Councillor Webster thanked Sue Brain for her report. Sue Brain added that Birchwood was work in progress and was constantly changing. The refurbishment had been a positive step and had provided a feeling of calm. The refurbishment to the top floor was almost complete. Sue Brain was unsure what the report would reveal however, the team would deal with it accordingly.

Councillor Bridgman highlighted a piece of work taking place across the piece regarding the use of agency workers. Employees on temporary contracts could now be sought via a staff bank rather than approaching agencies and the Commissioning Team and Human Resources were conducting this piece of work.

 Councillor Webster concluded that subject to the findings of the CQC report, it would be helpful for Sue Brain and Tandra Forster to return to the Commission meeting in October 2018 so that progress could be tracked. Councillor Webster requested that the team that had helped with the transition of Birchwood Care Home be thanked on behalf of the Commission.

RESOLVED that:

1)    the update be noted.          

2)    An item on Birchwood Care Home be added to the OSMC Work Programme for October 2018.