Archived: The Briars

Updated 4 July 2019

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

One inspector carried out this inspection.

Service and service type

The Briars is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The provider was the manager who was registered with the Care Quality Commission. This means that they are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make.

We reviewed information we had received about the service since the last inspection. We sought feedback from Redcar and Cleveland local authority and professionals who work with the service such as South Tees infection control team and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used all of this information to plan our inspection.

During the inspection

During the inspection we spoke with four people using the service. We spoke with a social worker and relevant person's representative (RPR) involved in the same two people’s care. In this case, the RPR was a paid professional who was trained and experienced to act as the representative. We also spoke with the registered manager, deputy manager and three members of care staff.

We reviewed three care records, recruitment and induction records for two staff and supervision, appraisal and training records for four staff. We also reviewed a variety of records relating to the day to day running of the service. People using the service had limited communication skills; we used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

After the inspection

We continued to seek clarification from the provider to corroborate evidence found. We looked at information the provider sent to us after inspection, such as updated records for window restrictors and electrical safety.

Updated 4 July 2019

About the service

The Briars is a residential care home for up to five people living with a learning disability. The service was providing personal care to four young adults at the time of the inspection.

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

Health and safety standards had not been maintained and records to manage risk were not effective. Lessons had not been learned and analysis of incidents had not taken place. Recruitment procedures were not robust. People received their medicines, however medicine records needed to be improved. Staff followed safeguarding procedures. There were sufficient staff on duty.

People were not always supported to have maximum choice and control of their lives and staff did not robustly 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.

Improvements to the environment were needed. Staff received supervision but not an appraisal. Some training was not up to date. We have made a recommendation about these. The service supported people with their healthcare and dietary needs. Guidance from professionals had been followed.

People were supported with their independence. However, where risks were identified, their independence could be limited. We made a recommendation about this. Privacy and dignity were maintained. Staff understood people’s needs, however staff had not recognised how the wider risks identified during inspection increased the risk of potential harm to people.

Care records were not accurate or up to date. Reviews did not determine if the care provided was relevant. People were not supported with information in appropriate formats. People were supported with activities. No complaints had been received, however systems were in place to manage these.

The provider lacked oversight of the service. Quality assurance systems were ineffective. Feedback was sought, but not used to drive improvement. Staff were supported by the registered manager. The service worked well with professionals and had good links with their community.

The principles and values of Registering the Right Support and other best practice guidance ensure people with a learning disability and or autism who use a service can live as full a life as possible and achieve the best outcomes that include control, choice and independence. At this inspection the provider had not always or consistently applied them.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons – People could not access the garden area independently. Where risks were identified, people’s independence could be limited. Care records did not assist staff to support people to lead fulfilled lives.

The size of service meets current best practice guidance. This promotes people living in a small domestic style property to enable them to have the opportunity of living a full life.

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 overall rating was Good (Published 15 February 2018).

Why we inspected

The inspection was prompted in part due to concerns received about practices of staff when supporting people using the service. A decision was made for us to inspect and examine those risks.

We found no evidence to show that people were at risk of harm by the practices of staff. However, we have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

Following feedback during inspection, the provider had started to take action to mitigate the risks identified.

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