Bryony House

Bryony House is a residential care home providing personal and accommodation for up to 35 people aged 65 and over. At the time of the inspection 30 people were living at the home.

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

The day to day monitoring of the home was not effective. Incident and accidents weren’t analysed for themes and trends. Systems were not effective for monitoring medicines. The wrong applications had been submitted to deprive people of their liberty, this had not been identified. Records relating to people’s day to day needs were not always completed. The storage and retrieval of documents was not effective.

The registered manager had left in 2017 and CQC had not been notified of this.

Prescribed cream and patched were not always managed in line with best practice (NICE) guidelines. Staff did not always record people had received their medicines as prescribed. Lessons were not always learnt following incidents and accidents.

Moving and handling was carried out safely. People felt safe. There were safe staffing levels. Staff knew how to protect people from abuse.

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 treated with kindness and compassion. People felt well supported. People were encouraged to be independent.

People’s and their relatives were involved in the review process. People’s personal preferences were identified in their care plans. People were involved in decisions about their care.

People received person centred care. People, relatives and staff expressed confidence in the manager. People, relatives and staff were given the opportunity to provide feedback.

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 20 February 2019) and there was a breach in relation to the governance of the service. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had not been made and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to governance at this inspection.

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

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. 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.

Bryony House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. Bryony House is a care home without nursing, which can accommodate up to 35 people. At the time of our inspection 30 people were using the service and included older people.

The acting manager had been in place for the last six months and was looking to make an application to become registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were not assisted to mobilise safely through the consistent use of safe moving and handling practices by staff.

Staff were not always available to support people and there were concerns around the number of staff on each shift. Hazards were found around the home which could impact on people’s wellbeing. Risk assessments were in place and safeguarding processes were followed.

Safe recruitment of staff was carried out and people received medicines as required.

People felt that staff treated them with kindness and compassion. People were supported to be involved as much as possible in making decisions. Staff supported people to have choices and independence, wherever possible.

People told us that they did not always have the opportunity to be stimulated by activities and we did not see any take place, with many people spending the day sleeping. The audit trail for complaints was completed retrospectively. Care plans contained information about the person, their needs and choices. People were able to speak openly with staff and understood how to make a complaint. End of life wishes were considered.

Audits did not provide enough information to be effective in identifying ongoing patterns and trends. Inappropriate practice had not been identified through any audits or checks. Staff did not always acknowledge confidentiality in the way in which they spoke of people and their needs within the home. People and staff were positive about the leadership skills of the registered manager. We were provided with information we expected to receive.

Staff were knowledgeable on people’s needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People were assisted to access appropriate healthcare support and received an adequate diet and hydration.

We found a breach of regulation 17. You can see what action we told the provider to take at the back of the report.

Everybody we spoke with told us that they were happy living at the home and felt that the provider understood their specific care needs. People spoken with told us, 'I like living here, I have no complaints' and 'Its fine here, just as good as it always was.'

At our last visit we were concerned that people's care plans did not contain enough information to support people's individual care and welfare needs. At this inspection we saw that things had improved. The provider had reviewed the care records of each person who used the service. They had developed individual risk assessments to manage any risks associated with each person's specific conditions. All the staff we spoke to could explain people's care plans to us and therefore knew how to deliver care which met people's needs and could keep them safe from the risk of harm.

The provider had a system in place to deal with comments and complaints. People who used the service could be confident that their comments and complaints were listened to.

People who used the service were involved in planning their care. They were supported to make choices about the care they received.

People received care which met their needs but the provider did not always have care plans in place to manage the individual health and support needs of some of the people who used the service.

People had a choice of food and drinks which met their nutritional needs. There was a choice of drinks, snacks and fresh fruit available all day.

Staff felt supported to meet the care and welfare needs of the people who used the service. One member of staff told us, 'I like working here, it feels like a team'.

The provider was able to protect people against the risk of unsafe care and treatment by regularly assessing and monitoring the quality of the service provided and introducing changes when required.

We saw that all of the staff treated people with warmth and kindness and people who used the service told us that the staff caring for them had a good manner and respected their dignity.

We saw that the provider carried out assessments of their individual needs so the care was planned and delivered appropriately. A relative told us they were confident their spouse's care was planned and delivered in the way that was promised.

We saw that the provider had made suitable arrangements to ensure that service users were safeguarded against the risk of abuse.

We found that care workers were skilled, qualified and competent to provide people with the care required to meet their needs. A district nurse told us,' I trust the staff to carry out my instructions". One person told us that staff responded promptly to requests for assistance,' Staff will always answer the bell, even if they are busy they will still come".

We found that the provider protected people who use the service from unsafe care and treatment by regularly assessing and monitoring the quality of the service provided.