Bryony House

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to inadequate. Although we saw caring interactions between people and staff, systems in place were not adequate to ensure people were always treated with compassion and respect.

The service was in breach of legal regulation in relation to seeking consent from people and assessing their ability to make decisions.

This service scored 30 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always treat people with kindness, empathy and compassion. We saw no evidence of deliberate intention to treat people unkindly. However, the failure of some of the provider’s systems resulted in some people receiving delayed care and medical attention.

Some people were hoisted or helped up from the floor following a fall, when guidance for staff stated they should remain in the position of the fall whilst medical professionals reviewed their situation. Some of these people had been later found to have sustained significant injuries from their fall. Some people who had signs of a possible head injury did not receive timely care and treatment. Systems did not support and facilitate kind and compassionate care. We received mainly positive views from people about the staff who supported them. Most people told us staff were kind and caring, as did their relatives. One person told us, “The staff are all nice.” Another described them as “kind and caring”. However, one person told us staff’s approach and attitude to their work was variable. They said some were nice and some were not very kind. They did not give details of which staff they were unhappy with. Relatives spoke positively about the care team. One described them as, “attentive’, ‘kind’ and ‘very respectful’.

Staff told us how they treated people with dignity and respect, and we saw examples of this. They told us about the steps they would take during personal care to help protect people’s privacy. We saw staff knocking on people’s doors and waiting before entering.

The provider did not always treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences. They did not always take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Staff were provided with lists each shift of people that needed to be taken to bed after they had eaten tea, and people who needed to be woken and dressed before the end of the night shift at 7.30am.

Prior to our assessment, we received an anonymous concern from a person saying they were a staff member at the service. They stated night staff were made to get people up very early in the morning and people were told, once they were up and dressed, they could sleep in their chair if they wanted to. We arrived on site at 5.30 am on the first day of our unannounced inspection and found 5 people were up and fully dressed in the lounge at that time. There was a list of 9 people night staff were asked to get out of bed, washed and dressed by the end of their shift at 7.30am. Of these 9, only 1 person had the mental capacity to confirm their wish to be assisted to rise early each day. We could not determine from discussions with the 5 people up at 5.30, or checks on their care records, whether this had been their wish on that day. People who had mental capacity to make decisions about when they wanted to get up and go to bed told us they were supported to do so. People who did not have this capacity were more at risk of having decisions made upon their behalf which may not reflect their wishes. One staff member told us they believed the lists of who to take to bed and who to wake were in place to manage the fairness of workload between the day and night shifts. All the staff and managers we spoke with assured us people would never be expected to get up or go to bed if they did not want to. However, the management team were unable to explain why staff needed such lists and there was no record of any associated best interest’s decision-making. The management team told us, they would either remove the lists or consider the wording of the instruction, so it was clearer that it was only based on people’s wishes and preferences.

The provider did not always promote people’s independence, so people did not always know their rights and have choice and control over their own care, treatment and wellbeing.

Where people may not have mental capacity to make decisions about their care, decision-specific mental capacity assessments and, where appropriate, best interests decision-making had not always been completed. This meant the provider could not evidence that consent was always sought, and any restriction to a person’s liberty or daily activity was in their best interests. Staff were guided by lists to determine when to get some people up and out of bed in the morning and when to support them to bed at night, without any clear rationale for these lists or reference to the person’s wishes. This did not demonstrate how people’s choice and control over these aspects of their care were being promoted.

People and their loved ones told us they were supported to see each other whenever they wanted to. There was no restriction on visiting.

People were offered various activities to engage them and offer entertainment. We saw people participating in arts and crafts, singing and doing physical exercise. Some people visibly enjoyed what was on offer and some people chose not to participate. Their wishes were respected by staff.

Staff did not always respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

People who were at risk of having sustained a head injury during unwitnessed falls had not always had care provided to mitigate the risk. Staff did not always recognise the signs of a possible head injury and were not following the provider’s policy and procedure guidance in place.

People who had sustained injuries as a result of falls did not always receive the medical care they needed in a timely way. This left people at risk of pain and distress, as well as risking worsening injury by trying to carry on day to day care activities.

People who were able to use them had call bells in their rooms to call for assistance if needed. Two of the people living at the home told us they sometimes had to wait quite a long time for staff to respond. They told us sometimes staff were just very busy. We reviewed one week of call bell response data. We saw examples of records showing call bells were not deactivated for over 20 minutes and in 1 case, 55 minutes in that week. There was no evidence of a risk assessment to determine whether a target response time of within 10 minutes was an adequate time to meet people’s needs effectively. We saw no evidence people had been spoken with about their experience and the impact upon them when they had had to wait for extended periods of time for carers to respond. We saw no evidence that the target time of 10 minutes for staff to respond to calls had been discussed or reviewed with people to determine if they thought it was reasonable.

Following our feedback the provider changed the policies and procedures in relation to responding to falls and managing falls risks. They also updated staff training to ensure they understood how to respond to falls appropriately. The provider also advised that they would be updating the care call system. The provider also told us they were investing in a new call bell monitoring system which they hoped would improve staff response times.

Staff told us overall they felt well supported by the management team. Staff received supervisions and training. They told us about times when they received support with personal circumstances. However, the provider did not always support or enable staff to deliver safe and effective care. We found staff were not always provided with the training and tools they needed to give them clear guidance. For example, management and staff did not fully understand their responsibilities under DoLS and the need for decision-specific and time-specific mental capacity assessments.