Briggs Lodge Residential and Nursing Home

Briggs Lodge Residential and Nursing Home is a care home providing accommodation with personal and nursing care for up to 66 people. The service provides support to people over 65 years and people living with dementia. At the time of the inspection there were 52 people using the service.

Accommodation is provided on 3 floors accessed by stairs and a lift. People have their own room with en-suite facilities. There are also communal toilets, bathrooms, lounges and dining areas. There is a cinema room, café, bar and a hairdressing salon. People can access the garden from the ground floor. Some rooms on the ground floor also have access to the garden.

People’s experience of using this service and what we found

Prior to our inspection we received concerns about staffing numbers being too low. During this inspection, we found there were not always enough staff to support people in a timely way. People and relatives told us weekends were times when they noticed lower levels of staff. Whilst there was no impact seen to people’s safety, people noticed their call bells took longer to be answered. Relatives noticed the front door took longer to be answered at a weekend.

The registered manager told us recruitment had been successful, but staffing had been a challenge. They used agency staff to fill gaps in rotas but had not needed to use them as often in the month prior to the inspection. Staff calling in with short notice sickness had been a concern, but the registered manager was addressing this with support from the provider.

Staff had been recruited safely and received training when they started employment. Training covered a range of topics including safeguarding, infection prevention and control and manual handling. Staff we spoke with understood their role in safeguarding and how to report any concerns. The service reported any concerns to local authority safeguarding teams and notified CQC when needed.

People had a personalised care plan which was regularly reviewed. All records were held electronically and only accessed by staff with the required log in passwords. Information about people’s life history and guidance on how they wanted their care delivered was recorded.

Overall risks to people’s safety were assessed with risk management plans in place for staff to follow. We found behaviour support guidance for 2 people was not in place. This was addressed during our inspection. Additional monitoring to mitigate risks had taken place and was recorded. We found conflicting records for 1 person; their notes were not consistent with a record on an accident form. The registered manager took immediate action to address this shortfall.

People’s medicines were safely managed. Staff had training on how to safely administer medicines and their competence was regularly checked. There had been issues with obtaining medicines stock from the pharmacy, but the registered manager was reviewing suppliers to make improvements.

The service was clean throughout, and staff had cleaning schedules in place to cover all areas of the home. Staff wore personal protective equipment (PPE) when needed and there were specific areas identified to store, put on and take off PPE. People had COVID-19 risk assessments in place which helped to identify people more at risk of catching COVID-19.

People were able to have visitors when they wished. We observed family members visiting all times of the day and in the evenings. Activities were taking place which anyone was welcome to join. Special events were planned for national celebratory days such as Easter and the new King’s coronation. Information about activities people enjoyed was recorded in their care plans.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People at the end of their life had their wishes recorded. Staff worked with local healthcare professionals to make sure people had medicines they needed to be comfortable at this time in their lives. Local GPs visited weekly and other healthcare professionals could be called if needed.

There was a registered manager in post. Staff told us they were approachable and visible in the service. Staff told us there was good teamwork amongst staff and good communication. Systems were in place to manage complaints and information about how to complain was available. Quality monitoring was regularly carried out by the management team and the provider. This meant the provider had a good oversight of how the service was performing. Any actions identified were added to an overall service improvement plan.

Meetings were held regularly. People could attend weekly ‘residents meetings’ and staff had opportunity to also meet to discuss changes and ideas. Systems such as keyworker, named nurses and resident of the day were in place. These helped people to discuss their care and make sure their preferences and wishes were known.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 12 August 2021).

Why we inspected

We received concerns in relation to low staffing numbers and the impact on people’s care and the approach of the registered manager. As a result, we undertook a focused inspection to review the key questions of safe, caring, responsive and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We found some evidence that improvement was required for staffing but found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe, caring, responsive and well-led sections of this full report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Briggs Lodge Residential and Nursing Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Briggs Lodge Residential and Nursing Home providers nursing care and accommodation for up to 66 people in Devizes. Accommodation is provided on three floors accessed by lifts and stairs. People have their own rooms and access to communal areas such as lounges, dining rooms, a cinema, café and hair salon. People can access the garden from the ground floor. At the time of our inspection there were 37 people living at the service.

People’s experience of using this service and what we found

This was a targeted inspection that considered improvements carried out in response to a Warning Notice served following the previous inspection. We reviewed what actions the provider had taken in response to the Warning notice.

People’s monitoring records were completed in full documenting what care and support staff had provided. Where people were at risk of developing pressure ulcers there were re-positioning charts in place which recorded care provided and at what time. Where people were at risk of dehydration or malnutrition, they had food and fluid charts in place. Records seen were completed in full with all fluids consumed added up at the end of the day. Nursing staff kept regular monitoring of all charts to make sure they were completed in a timely way.

Incidents had been recorded and investigated by the registered manager. Any referrals needed to the local authority had been made and CQC notified where appropriate. The registered manager recorded all investigations on the provider’s electronic reporting system. This enabled the provider to have oversight of actions taken and to help the service close records where possible.

The registered manager had been supported by the provider to make improvements needed. Quality compliance teams and regional management support had helped to complete the action plan in place following our last inspection. There was new management at the service who were working with the provider to make all improvements needed.

The home was clean, and staff had cleaning schedules to help them make sure all areas were regularly cleaned. Staff had personal protective equipment (PPE) and were seen to use it safely. Staff had training on working safely during COVID-19 and were provided with updates as needed.

All staff were testing regularly for COVID-19 and had all been vaccinated. People were also testing regularly for COVID-19 with support from staff. People were able to receive visitors in their rooms following some screening actions. For example, all visitors had to complete a Lateral Flow Test prior to entering the home and have their temperatures checked. The registered manager knew who to contact for advice and guidance with regards to any positive COVID-19 cases.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 19 October 2021) and there was one breach of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Briggs Lodge Residential and Nursing Home provides care and accommodation for up to 66 older people over 3 floors. At the time of our inspection there were 41 people living at the service.

People had their own rooms and access to communal rooms such as lounges, dining rooms and a hairdressing salon. There was also a cinema, café and gardens which people could use. The home had a room accessed from the garden to support socially distanced visits .

People’s experience of using this service and what we found

Records of care provided were incomplete which put people at an increased risk of dehydration and developing pressure ulceration.

Staff knew how to recognise and report safeguarding concerns to line managers, however meaningful investigation had not been completed and any lessons learnt not shared with staff. Safeguarding concerns had not always been reported to the local authority in a timely manner. This put people at an increased risk of recurring harm and delayed interventions to reduce ongoing risks.

Staffing levels met assessed dependency needs, however people and staff commented the care provided was sometimes impacted when short staffed. People and relatives mainly spoke positively about the care provided.

Medicines were administered safely, however needed improvements in how they were managed. Infection prevention and control measures were appropriate.

The registered manager left on the day of the inspection. A new manager had been recruited and started that week. Governance was undertaken using an electronic system, however, checks and audits had not identified the issues identified during our inspection.

Staff said they weren’t confident in raising concerns and that action would be taken by the registered manager, however staff were more positive and confident with the recent change in management.

Relatives said the pandemic had impacted their involvement in the running of the service, however, knew how to raise any concerns.

Statutory notifications which the service is required to notify CQC were either delayed or had not been submitted. There was evidence of partnership working with professionals to support people's healthcare needs.

The new management team demonstrated an understanding on what improvements were required in the service with the support of the provider. An action plan had been developed with the involvement of people and staff.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 1 December 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We received concerns in relation to the management of the service and staffing. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The overall rating for the service has remained requires improvement. This is based on the findings at this inspection .

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Briggs Lodge on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified a breach of regulation in relation to good governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Briggs Lodge Residential and Nursing Home provides care and accommodation for up to 66 older people. At the time of our inspection there were 30 people living on the ground and first floor. The second floor of the home had been registered to be used by another of the provider’s services as a separate location. This arrangement was coming to an end and the registered manager told us they hoped to have the second floor in use for this service by the end of 2020. The second floor was not inspected as part of this inspection.

People had their own rooms and access to communal rooms such as lounges, dining rooms and a hairdressing salon. There was also a cinema, café and gardens which people could use. The home also had a room accessed from the garden, which was temporarily being used for visiting due to the COVID-19 pandemic.

People’s experience of using this service and what we found

People told us they were being supported by enough staff but at times they were very busy. Staff had been recruited into vacant posts, but some had left within short periods of time. This put pressures on existing staff which they were concerned about. Staff were recruited safely following necessary checks.

People had their medicines as prescribed and people were supported to manage their own medicines where possible. Risks had been identified and measures in place to support people safely. Not all risk management plans were up to date and completed consistently. This was also seen in care plans and other supporting documents. The registered manager was aware of this shortfall and had taken steps to make the required improvement.

People told us they enjoyed the food overall and were able to share their views on what menus should be in place. People were able to see a GP if needed. Health needs were recorded, and additional monitoring took place for areas such as food and fluid monitoring. Staff had daily handover to share information with each other.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were living in a home that was clean and smelt fresh. Staff had been trained on infection prevention and control and followed the providers’ policies and procedures. Personal protective equipment was available in the service and staff had been shown how to use it safely. People could have visitors but there were systems in place to reduce risks of infection. People and staff were engaging in the government COVID-19 testing programme.

People were supported by staff to maintain contact with friends and family. The staff used electronic devices, letter writing and phone calls to help people keep in touch.

People and staff told us the leadership had improved. There was a registered manager in post who was supported by the provider. The registered manager completed weekly meetings with people to hear their views and share updated information. Staff were also able to attend meetings to get updates on working safely during the pandemic.

Quality monitoring was carried out by staff, the registered and regional managers. Actions required were added to the service improvement plan. The provider monitored the actions regularly to make sure they were completed in a timely way.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires improvement (report published 7 April 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations. This is the second consecutive time the service has been rated requires improvement.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 19 February 2020. We identified four breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve need for consent, safe care and treatment, good governance and staffing.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, effective, responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Briggs Lodge Residential and Nursing Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Briggs Lodge Residential and Nursing Home is a purpose-built nursing home in Devizes providing personal care for up to 66 older people. At the time of our inspection the service was only providing residential care. At the time of our inspection there were 24 older people living at the service on the ground and first floors. The second floor of the home had been registered to be used by another of the provider’s services as a separate location. This arrangement was in place until June 2020 whilst refurbishment works were being carried out. After this time the people living on the second floor planned to move back to their home. The second floor was not inspected as part of this inspection.

People had their own rooms with en suite shower rooms. Each floor had its own lounge and dining area. There were also communal rooms such as a cinema, garden room, café and hairdressing salon. There was a garden accessible from the ground floor.

People’s experience of using this service and what we found

People were not always supported by sufficient numbers of trained staff. The manager had not made attempts to obtain agency staff to cover the shortfall. People and staff told us the service was regularly short of staff which meant people had to at times wait for their care.

Whilst the provider’s quality monitoring of the service was identifying some improvements needed to improve safety, the concerns about staffing were not being addressed.

People and staff were not confident with the management approach at the service. Staff did not always feel able to approach the manager or feel they were valued. People were worried the service was not being well-led.

Staff had not been trained or supported effectively. There was a delay in providing moving and handling training for new staff. The provider told us they were organising a moving and handling trainer to be based at the home.

Risks to people were not always managed safely, and guidance had not been updated when needed. This meant staff were not sure about consistent approaches to use when supporting people. Care plans contained conflicting information and lacked details in some areas. Where additional monitoring was needed there were gaps in the recording, or no records of the care provided. People’s records were not always stored securely.

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.

People’s medicines were not always managed safely. People did not always have their medicines in stock which meant there were times they could not have their medicines. People’s records for their prescribed topical creams were not always completed in full. This meant the provider could not be sure people had their creams applied as prescribed.

People’s views about the food were mixed, some people did not like the food, however, some people did enjoy their meals. People had not been involved in planning the menus. There was a choice of two options daily and people could order alternatives if they wanted. People could eat where they wished.

People told us they had not seen a care plan and not been involved in planning their care. Pre-admission assessments had been carried out, but the forms used were tick box based. This meant the information gathered was limited. People’s life histories had not always been sought which helps staff to work with people with dementia effectively.

We found activities for people with dementia were limited and the environment was not engaging. Staff had not always had dementia training and struggled to support people effectively.

People could have visitors when they wanted without any restrictions. People and relatives told us staff were kind and caring though rushed and had too much to do. Two relatives told us the care their family member received was good and they thought their relative was safe living at the home.

The home was clean throughout and staff followed good infection prevention and control practice. The kitchen had been inspected by the local authority and achieved a rating of ‘5’ which meant it had very good hygiene standards.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection - This service was registered with us on 12/04/2019 and this is the first inspection.

Enforcement

We have identified breaches in relation to the regulations for safe care, good governance, need for consent and staffing at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider to discuss how they will make changes to ensure they improve their rating to at least good. We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.