Briarwood

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At the last inspection we rated this key question good. At this inspection the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 72 (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 had a strong proactive and positive culture of safety, based on openness and complete honesty. Staff actively listened to concerns about safety and thoroughly investigated and reported safety events. Lessons were always learnt; staff continually reflected on their practice to identify how they could improve. We found the quality and safety team, clinical leadership teams and management team within the service constantly reviewed the operation of the service and actively made changes as and when needed. The way they monitored services meant they could readily identify even minor changes in practice and use the information to complete deep dives into the service. Staff told us they felt able to speak up and that their ideas were listened to and acted on. This culture encouraged openness, reflection and a “no blame” approach that supported staff confidence.

Systems were in place to ensure safe care pathways and transitions. Risk assessments were comprehensive and regularly reviewed, enabling staff to manage presenting risks effectively. Staff worked closely with healthcare professionals to respond promptly to changes in people’s conditions. The service provided a 12-week assessment period and staff worked collaboratively with either other care services or the families to ensure people safely transitioned to new environments or back home. When people moved to their new environment, staff worked with those individuals who would be providing the ongoing support, visit them and provide follow-up.

Staff worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately. When incidents occurred, staff completed a full investigation and took a proportionate, balanced approach when dealing with them. Staff had training and a good understanding of what to do to make sure people were protected from harm or abuse. Records showed safeguarding incidents were investigated and lessons learned were shared with the team. Staff understood when Deprivation of Liberty Safeguards (DoLS) authorisations would need to be sought and what to do if there were conditions imposed. Some people were subject to the powers of Mental Health Act 1983 (amended 2007) and staff had a good understanding of how to ensure these requirements were met.

Staff worked with people to understand and manage risks by thinking holistically. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Risk assessments were in place and assisted staff to identify how to mitigate risks. This was a dynamic assessment service, with short turnaround times for staff to assess and implement new strategies designed to support people live with the challenges of their mental health conditions or dementia. Staff were very skilled at quickly understanding any risks and determining ways to mitigate them. A staff member said, “We aim to really get to know people well so we can make a formulation plan that will help others successfully work with people.” However, the electronic care record system did not assist staff to produce reports about the impact of any approaches they had tried. The provider was addressing this and aimed to pilot the new parts of the system.

The provider detected and controlled potential risks in the care environment. The provider had a rolling programme of refurbishment. People were supported to be as independent as possible within the environment. Environmental risks were assessed and addressed. The provider made sure equipment, facilities and technology supported the delivery of safe care and worked with external professionals to review people’s aids. The staff team knew who to contact when people might benefit from additional aids or equipment. Staff were trained to use any equipment people needed.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. Staff worked together well to provide safe care that met people’s individual needs, but people frequently highlighted the current constraints of staff time. Currently there was no kitchen assistant and care staff needed to prepare the meals. Also since the change to external cleaning contractors no housekeeping support was provided and care staff completed all the laundry tasks. Albeit there is a marked period of overlap of staff from 11.30am to 4pm this meant key task such as dealing with the laundry would be problematic if left to this condensed time-period. A staff member said, “We work well as a team, but it is difficult at times fitting everything in.” The provider was reviewing the cleaning contract and staff deployment and were in the process of employing a new kitchen assistant.

Recruitment practices were meeting requirements. The people’s team had developed robust training programme, which was effectively delivered, and they routinely evaluated its effectiveness. The team considered the impact this training had on how staff delivered the service and whether this was embedded into their practices. They checked it assisted staff to effectively support people and supported the organisation to embed the overriding culture of ‘Here so no one struggles alone.’ The provider offered access to additional training including nurse training, apprenticeships, preceptorship and mentoring programmes. A staff member said, “We complete lots of training and find it interesting. Normally we can do it during work times but currently it is difficult to find time on shift to do it but once the kitchen is covered it should be easier.”

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Staff followed the required infection control guidelines. Audits confirmed high compliance with hand hygiene and personal protective equipment (PPE) protocols. However, there was a strong and persistent malodour evident throughout the home. Under the new contract the domestic staff would not attend to bodily fluid spillages and left them for care staff. This meant in-between attending to people’s personal care, completing 1:1 tasks, activities, completing care records, the laundry and kitchen tasks the staff needed to find time to clean areas where people had been incontinent. This led to delays in spillages being cleaned. These issues indicated that infection prevention systems were not always implemented effectively and that oversight required strengthening to ensure a consistently hygienic environment. The provider was aware of these issues and was actively resolving them with the cleaning company contract.

Staff made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff who administered medicines had the appropriate training and competency checks. Storage areas were secure, and temperature checks were recorded. Medication Administration Records were accurate, and controlled drugs were handled in line with regulations. If audits identified any gaps, such too much stock, action plans were implemented to address them, and staff were reminded of best practice. These practices ensured staff managed medicines safely.