Birkdale Court

“We found care planning, risk management and governance systems placed people at risk of harm, resulting in breaches of the legal regulations relating to safe care and treatment and good governance. We found incomplete and inconsistent care planning across several people's records, with important information about health conditions, associated risks and required support either missing or poorly documented. Healthcare plans were not always in place and identified risks were not consistently managed in practice, increasing the risk of avoidable harm. These concerns contributed to the breach of the regulation relating to safe care and treatment.”

“Medicines and recruitment processes were not always managed safely. We found staff recruitment practices did not consistently follow the providers own policy, and medicines management systems did not always provide assurance that people received their medicines safely.”

“Despite these concerns, people received care from a consistent staff team who knew them well and treated them with kindness, dignity, and respect. Staff demonstrated a good understanding of people's needs, preferences, and protected characteristics. People were offered choice and supported in a person-centred way. During our assessment, we observed positive interactions between staff and people using the service, with staff providing support in a compassionate and respectful manner.”

“Governance and oversight arrangements were not sufficiently robust to identify and address concerns effectively. Quality assurance systems and audits had not consistently identified the shortfalls found during our assessment, resulting in a breach of the regulation relating to good governance. Although some people lacked documented mental capacity assessments and best interest decisions where required, the provider had taken action to address these issues following our feedback. However, the registered manager responded promptly to our feedback, demonstrated openness to learning and improvement, and took immediate action to address the concerns identified.”