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The Briars Requires improvement

Reports


Inspection carried out on 30 April 2019

During a routine inspection

About the service: The Briars is a residential care home providing care and support for up to 7 adults with a learning disability. There were 6 people at the time inspection.

The care service has been developed and designed in line with the values that underpin Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. The aim is that people with learning disabilities and autism using the service can live as ordinary a life as any citizen.

People’s experience of using this service:

At this inspection we found people lived in an environment that was both homely and met their support needs. However, we found that shower hot water exceeded safe temperatures and presented a scalding risk to people.

There were enough care staff to be able to support people safely. However, we found that required staff checks such as employment references, and work history records, were not complete. This meant there was a risk of unsuitable staff being employed to provide care to people.

The care home ownership had changed from a Partnership to a Limited Company. The provider had not notified CQC about that change in the status of the care home, something that it is required to do by law.

People received kind and caring support from staff who knew how to meet their needs. We observed staff talking kindly to people and treating them with respect.

People were supported to have maximum choice and control of their lives and care staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice

People were supported to take their prescribed medicines and care staff followed systems and procedures to ensure medicines were administered safely.

People were supported with their dietary needs and to get medical attention when they needed it. People had personalised plans of care which gave staff the knowledge and information to support them in a way that people preferred.

The registered manager worked in partnership with others to ensure people received safe care and support. People had the choice to engage with a variety of activities including adult education and local community social groups.

People, and their relatives, told us that the registered manager was approachable, and that any concerns they raised had been dealt with effectively.

The registered manager had a quality assurance system in place to monitor the safety and quality of the service.

More information can be found in the detailed findings below.

Rating at last inspection: Requires Improvement: 21 May 2018

At the previous inspection we found that the service was in breach of Regulation 18; Registration Regulations 2009: Notifications of other incidents.

The provider had failed to notify a number of safeguarding incidents to CQC as is required by law.

Additionally, the provider was not monitoring incidents sufficiently and people's risk assessments had not been regularly reviewed and updated and did not always accurately record the current risks.

We had also not been assured that there were always sufficient care staff on duty to meet people’s needs.

The provider had made the required improvements in all these areas.

Why we inspected: This was a planned inspection based on the previous rating.

Enforcement: Action we told provider to take (refer to end of full report)

Follow up: We will continue to monitor the service through the information we receive.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Inspection carried out on 17 April 2018

During a routine inspection

We inspected the service on 17 April 2018. We contacted the provider 24 hours prior to our inspection to ensure someone would be at the service when we visited. 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 Briars accommodates up to seven people and is designed to meet the needs of people with a learning disability. On the day of our inspection seven people were using the service.

The care service has been developed and designed in line with the values that underpin Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. The aim is that people with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service had a registered manager in place at the time of our inspection. 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. The registered manager was also the provider and worked across two services who were in close proximity to each other.

The last inspection of this service was carried out in October 2015. At this time we rated the service as 'Good'.

At this inspection we found that the service was not always monitoring incidents robustly and that the service wasn't notifying the relevant authorities in relation to some of the potential safeguarding incidents which had taken place at the service.

We found that although care and support plans contained relevant and up-to-date information, people's risk assessments had not been regularly reviewed and updated and so did not always accurately record the current risks associated with the delivery of people's care and support.

There were enough staff at the service to safely meet people's needs, although we were not assured that this was always the case and raised our concerns with the provider. Staff were safely recruited and supported in their roles and appropriate and relevant training was delivered to staff and regularly reviewed and updated.

People felt safe at the service with the staff who supported them and were protected against the risk of infection as we found the service to be clean and hygienic. People received their medicines safely and there were plans in place for any potential emergency situations.

We found that people received care and support to meet their individual needs and that there was a culture of inclusion which was promoted by the provider. People's views were listened to and respected and people were involved in the day to day running of the service. People could spend their time as they chose and were part of the wider community. We found that people took part in activities both within the home and outside it and that this was actively encouraged by the service to ensure people lived meaningful lives and maintained their independence.

People's consent was sought by the service and the principles of the Mental Capacity Act 2005 had been followed.

People's nutritional risks were assessed and planned for and people had a choice in what they had to eat and drink. People had access to various healthcare professionals to maintain their health and well-being.

There was strong leadership from the provider at the service and people and their relatives felt they could approach the management of the service should they need to raise any issues. Staff felt supported and were generally happy in their roles.

The provider was displaying their inspection rating at the service as required by law.

Inspection carried out on 7 October 2015

During a routine inspection

This inspection took place on 7 October 2015. The provider was given 48 hours’ notice because the location is a small care home for people who are often out during the day and we needed to be sure that someone would be in. At our previous inspection on 30 August 2013 the service was meeting the essential standards.

The Briars is a residential care home providing care and support for up to seven adults with a learning disability. It is situated in a residential area of Hinckley. Accommodation is on the ground and first floor which is accessed by stairs. The Briars has a communal dining area, lounge and conservatory.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

The service provided a homely setting for people using the service. This was evident from outside the home by the absence of any sign that it was a residential care home. It looked like every other residential property in the area.

People using the service were protected from harm because staff understood and practised their responsibilities under the providers safeguarding procedures. People spent a lot of time outside The Briars during the day when they attended various activity venues in the community. They were taught how to stay safe and report any concerns they had about their safety and welfare whilst out.

People were supported to be as independent as they wanted to be. Risks associated with their care and support and activities they participated in were assessed and managed. This meant that restrictions about what they couldn’t do were kept to a minimum.

The provider deployed enough suitably skilled and experienced staff to meet the needs of people using the service.

People received their medicines on time and understood what they were for. Only staff who were trained in medicines management handled medicines. A medicines administration error was made in August 2015, but the provider took action to prevent a similar error being repeated.

Staff had the right knowledge and skills to be able to support people using the service. Staff were supported through effective supervision, training and appraisal. They were supported to acquire further qualifications and develop their career in adult social care.

Staff had practical working knowledge of the Mental Capacity Act 2005. They provided people with information to enable them to make informed choices. Staff were aware of the Deprivation of Liberty Safeguards (DoLS) even though no person using the service was under a DoLS authorisation.

People were able to choose what foods they had. Staff advised people about healthyeating options and respected people’s choices. Staff supported people who had made their own decisions to lose weight by monitoring and supporting their progress towards their objective.

Staff understood and were attentive to people’s health needs. They supported people using the service to access health services when they needed them.

People using the service and staff developed caring relationships because staff had a very good understanding of people’s needs. People were involved in decisions about their care and support and they had access to independent advocacy services when they needed them.

Staff treated people using the service with dignity and respect. They respected choices people made. People’s views were listened to and acted upon. People’s privacy was respected. They were able to spend time alone when they wanted.

People received care and support that was centred on their needs. People’s care plans were individualised and contained information about things that were important to them. Staff used that information to provide and arrange activities people enjoyed..

The provider had procedures for the reporting on incidents and accidents. Reports were investigated and when necessary action was taken to prevent similar events happening again.

People using the service, their relatives and staff were involved in developing the service. Their suggestions were listened and, where practical, acted upon to the benefit of people using the service and staff.

The service was well led. People using the service, relatives and staff all felt well supported by the registered manager.

The provider had procedures for monitoring and assessing the quality of service. Regular checks were carried out by the registered manager and they were well supported in this area by an administrative person. A key element of the quality assurance was providing people using the service and relatives the opportunity? to express their views about the service. Their views were acted upon.

Inspection carried out on 30 August 2013

During a routine inspection

People using the service lived in an environment that is suitably designed to meet their needs. Individual bedrooms were personalised and staff supported people with daily living tasks such as cleaning. Arrangements were in place to adequately maintain the premises to ensure people’s wellbeing is promoted and their health and safety is protected.

Inspection carried out on 15, 16 July 2013

During a routine inspection

People using The Briars told us they were well supported by the staff. People said they made decisions about the care needed and supported to maintain their choice of lifestyle. People were offered a choice of meals that met their dietary needs and preferences. One person enjoyed cooking and were supported to prepared dishes from the recipe books. Another person said: “I have to stay healthy. Because it’s hot we have to make sure we drink enough.” Records viewed reflected the choices and decisions made by people, which were reviewed regularly.

Effective recruitment processes were followed when new staff were appointed and appropriate checks carried out before they commenced their new roles. All new staff completed a period of induction training for their job role.

The Briars is a traditional Victorian house. People had personalised their bedrooms and there were adequate bathroom facilities and a new wet room. However, improvements were needed to a bedroom and bathroom in order to maintain the health and safety of the person who used the bedroom and better monitoring to ensure checks and repairs were carried out in a timely manner.

Information about the people who live at The Briars were kept in their individual care files and stored securely. Staff were aware of their responsibilities to maintain accurate records. Other records relating to the staff and the management of the service were accurate, kept secure and could be easily accessed when required.

Inspection carried out on 23 January 2013

During an inspection to make sure that the improvements required had been made

People told us staff helped them with their medicines, which they received at the correct times. People knew what medicines they took and why. One person said: “They (the staff) always make sure we get our tablets on time.” Medication records were completed accurately and consistent with the medicines remaining in the blister packs.

People were supported by staff trained to look after them and promote their health, safety and welfare. Staff received their annual appraisal to review their work performance and identified training and developmental needs. Staff received support and supervision through team meetings and one to one meetings, which were scheduled for the year.

Inspection carried out on 4 October 2012

During a routine inspection

People who live at The Briars told us about their views and experiences of living at the home and the activities they took part in. People attended the day centre and took part in social and leisure activities within the community. One person said “I do voluntary work at Age Concern and today’s my day off.” People had social events which they all took part in such as day trips and celebrations. One person said “We went to Southport yesterday” and “we’ve got a party to go to tonight, it’s ….birthday.”

People’s care needs and the support they required were recorded within their care plans. Care plans were written with the person’s involvement and in a format that could be understood by them. People were supported to maintain contact with family members and where appropriate they were involved the review of people’s care and support needs. Records showed people had access to a range of health care professionals who work with staff to promote people’s health. Measures were in place to manage unforeseeable emergencies.

People’s health was monitored and they received their medicines on time. However, improvements were needed in the recording of when medicines were taken to prevent any potential risk to people’s health.

People were supported by staff trained to provide the care and support they needed. However, staff supervision was not in place to ensure staff received the appropriate support they needed and to identify training and developmental needs.

Reports under our old system of regulation (including those from before CQC was created)