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Inspection carried out on 13 November 2017

During a routine inspection

Bryony Park is a nursing home which is registered to provide 44 places. The home provides care for people who require personal care or nursing care, including people living with dementia. There were 43 people living at the home when we visited.

At the last inspection in July 2015, the service was rated Good. At this inspection we found the service remained Good.

People and relatives gave us consistently positive feedback about the care provided at the home. We observed staff attended to people’s needs with kindness and consideration.

People, relatives and staff described the service as a safe place. They also said there were enough staff on duty to meet people’s needs in a timely manner.

Staff had a good understanding of safeguarding and knew about the provider’s whistle blowing procedure. They also knew how to report concerns.

The provider operated effective recruitment procedures to ensure new staff were suitable to work at the service.

Medicines were managed safely. Staff administering medicines had completed relevant training. We found accurate records to account for the medicines people had been given.

There were regular health and safety checks in place. The provider had up to date procedures to deal with emergency situations.

Staff confirmed they received the support and training they needed.

People were supported to meet their nutritional and healthcare needs.

People’s needs had been assessed and the information used to develop detailed and personalised care plans. These were reviewed regularly to check they were still reflective of people’s needs.

People had opportunities to participate in activities such as trips to the seaside and feeding horses at a local farm.

Complaints had been fully investigated. Although people and relatives gave us positive feedback, they knew how to raise concerns if required.

The service had an established registered manager. People and staff felt the service was well managed and the registered manager was approachable.

A range of quality assurance checks were carried out to help ensure people received good support.

Very positive feedback had been provided during the last consultation with people and relatives.

Further information is in the detailed findings below.

Inspection carried out on 8 July 2015

During a routine inspection

Bryony Park is a nursing home which is registered to provide 44 places. There are 43 single bedrooms. The service provides care for people who require personal care or nursing care, including people living with dementia. There were 43 people living at the home when we visited.

The last inspection of this home was carried out on 22 July 2014. The service met the regulations we inspected against at that time.

This inspection took place on 8 July 2015 and was unannounced which meant the provider and staff did not know we were coming.

The home had a registered manager who had been in this role at Bryony Park for five years. 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.

All the people, relatives and care professionals we spoke with felt the home was a safe place to live. One person told us, “This home is lovely, and the staff are so nice and pleasant.” Healthcare professionals we spoke with told us they had “no concerns” about the safety of the service or the care of people during their visits.

Staff were clear about how to recognise and report any suspicions of abuse. Staff told us they were confident that any concerns would be listened to and investigated to make sure people were protected. The provider carried out checks to make sure only suitable staff were employed. People were assisted with their medicines in the right way.

There were some premises shortfalls which meant the accommodation was not always fully safe. For example, there were items of wooden furniture being stored in stairwells, and which was a fire safety hazard. These were removed but shortly after the inspection, fire safety officers also inspected the home and found additional combustible items in the stairwells so this had not been fully addressed. There was no wash hand basin present in the laundry area. One bathroom that was being used by staff for storage was cluttered and the door had been left open so people might mistakenly walk in this room which was a potential tripping hazard. The provider confirmed these matters would be easily addressed.

People and relatives told us there were enough staff on duty to support them. The staffing levels and skill mix throughout the day and night was suitable to meet people’s needs. Staffing levels had been increased so there was a staff member to support people in lounges and corridors at all times. This had led to reduced number of falls and accidents so it had improved people’s care and safety.

All the people and relatives we spoke with felt staff had the right skills and competencies to provide the right support. Staff had the relevant training and support to care for people. Staff understood the Mental Capacity Act 2005 for people who lacked capacity to make a decision.

Health care professionals said the staff cared for people in a competent, effective way and responded appropriately to any changes in people’s well-being. People were supported to eat and drink enough and they had choices about their meals.

People, relatives and visiting healthcare professionals told us the standard of care and compassion at this home was “brilliant” and “impressive”. Staff spent lots of time talking and listening to people and holding their hands. People were treated with kindness, consideration and dignity. Their individual choices were promoted and their privacy was respected.

One healthcare professional commented, “I have observed evidence of a real culture of care and compassion throughout the home.” Another care professional told us, “I have observed care staff going beyond to help a resident. For example a care staff offered her own apple from her lunch to meet the specific needs of a resident during an assessment.”

People had been individually assessed and their care was planned to make sure they got the right support to meet their specific needs. There was a warm, sociable atmosphere in the home and there were friendly interactions between people and staff. People had opportunities to join in activities every day and to go out on trips with staff.

People had information about how to make a complaint or comment and their views were actively sought by the registered manager. People, relatives and staff felt they could approach the registered manager at any time. One relative commented, “The manager always speaks when she sees you and tells you what is happening.”

People, relatives, staff and healthcare professional felt the home was well-managed. Staff felt there was a supportive culture amongst the staff team. They said they “loved” working at the home. They felt appreciated and supported by the registered manager and provider.

The provider had a quality assurance system and people and relatives felt their views were sought and listened to. The registered manager and provider constantly strived to improve the quality of the service and there were plans to build a conservatory room for people to enjoy the garden views.

Inspection carried out on 22 July 2014

During an inspection in response to concerns

We carried out this responsive inspection because we received concerning information about how people’s palliative care needs were being managed at this home. We carried out a joint visit with a safeguarding officer of the local authority and a clinical quality officer of the Clinical Commissioning Group.

We looked at the care records for four people who received support with their care needs during the end of their life. We saw there were clear, detailed records of people’s palliative care needs. These included planned care to support people to remain comfortable and pain free.

During this unannounced visit we spoke with a visiting health care professional who had been recently involved in people’s palliative care. They told us, “The home put all the things in place that the person required at that time. The nurses here understood their role in relation to the person’s end of life care.”

We also spoke with three visiting relatives of people who lived at the home. They told us they were satisfied with the care provided.

Inspection carried out on 12 September 2013

During a routine inspection

During this inspection we spent time talking to people and observing how they were cared for to help us understand the experiences of people using the service. This was because some of the people using the service were poorly or had dementia care needs which meant they were not always able to tell us their views.

We saw people were treated with consideration and dignity, and their individual choices were respected. People had been individually assessed and their care was planned to make sure they received the right support to meet their needs.

We spoke with four of the 43 people who used the service and 10 visitors to get their views. They told us they felt the care was “excellent” and that people were “looked after very well.” One visitor told us, “The nursing care is exceptional, they keep her as well as she can be.”

The home was clean and hygienic. Relatives comments included, “It’s kept spotlessly clean”, “they keep it immaculate” and “there are never any smells”.

People and relatives told us there were enough staff on duty to support their care needs. One visitor told us, “There are always plenty of staff around, and they take the time to talk with relatives.”

The provider had a quality assurance system and people felt their views were sought. One person told us, “The manager is always asking us if anything could be better. They are all very approachable and I would have no qualms about making any suggestions.”

Inspection carried out on 17 January 2013

During a routine inspection

Some people were not able to tell us directly what they thought about the service. However, during our visit we spent time observing how care staff supported people and this was positive and respectful.

Care plans were written in a clear and easy to understand way and people's personal preferences were clearly recorded. There were sufficient staff on duty to support people for their care needs.

We looked at how the service recruited staff by checking five staff files. These showed that the appropriate checks and procedures were being followed.

We spoke to four visitors of people who live at Bryony Park who felt that their relatives received good care and were looked after well. One relative told us, "I know I have made the right choice. My relative is well cared for and I visit everyday. The staff are lovely towards him."

Another relative told us, "It was a hard decision to let my relative move into Bryony Park. I visit twice a day and she is in the best place and I am happy now." Another relative told us, "I looked around quite a few homes. I visited Bryony Park and this was the best one. I have had no regrets."

Inspection carried out on 1 December 2011

During a routine inspection

This was the first inspection of the home since it was registered to provide nursing care in December 2010. People who lived in the home and their visitors told us that they felt staff could not do any more. They felt overall that the care was very good and staff worked well with people. The activities co-ordinator was singled out by all the people spoken with as an excellent member of staff because he was so warm and friendly. The people we spoke with could all remember their name, which was significant as some people had marked memory loss. One person described the staff team as a whole as “first rate,” and another that people working in the home were “absolutely brilliant. They look after me well.”