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Inspection carried out on 8 May 2017

During a routine inspection

This inspection took place on 8 May 2017 and was unannounced. The Briars is part of a charitable trust that provides care and accommodation for older people. The home provides accommodation for up to 38 people. The home provides specialist care to people living with varying degrees of cognitive impairment and some people had complex needs.

There was a registered manager in place. 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 received exceptionally personalised care from staff who knew people well. Every staff member demonstrated a shared commitment to putting people at the heart of the service and enhancing their quality of life in any way they could. People, families and professionals praised the person-centred approach taken by staff and described how it had improved the physical and emotional well-being of people living at The Briars.

People were supported by staff who were highly caring and compassionate. Staff knew people and their backgrounds well and used this knowledge to communicate effectively with people and reassure them when they became anxious. Staff worked tirelessly to meet people’s holistic needs, including supporting people in their own time with particular activities that were important to them.

People were treated with the utmost respect at all times. Staff protected their privacy, involved them in decisions about their care and promoted their independence. They also supported people to build and maintain relationships with one another and with those important to them.

There were enough staff deployed at all times. Recruitment procedures helped ensure only suitable staff were employed. Staff protected people from the risk of harm and supported them to receive their medicines safely. Care was provided in a safe and dementia friendly environment.

Staff were highly skilled. They received appropriate support and training to equip them in their roles. They supported people to make choices and decisions and followed legislation designed to protect people’s rights.

People praised the quality of the meals, which formed an important part of the day for people. Staff supported people to eat and drink enough and to access healthcare services when needed.

People and their families felt the home was well-led. There was a clear management structure in place. All staff understood their roles, were highly motivated and worked well as a team. There was a robust quality assurance process in place to continually improve the service, including effective oversight by the provider.

There was an open and transparent culture in the home. Relatives could visit at any time and were made welcome. Positive links had been developed with external organisations which benefitted people.

Inspection carried out on 23 and 27 April 2015

During a routine inspection

This inspection took place on 23 and 27 April 2015 and was unannounced. The Briars is part of a charitable trust that provides care and accommodation for older people. The home provides accommodation for up to 38 people, all of whom were living with dementia. There were 37 people living at the home when we visited.

At our previous inspection on 7 and 8 August 2014, we identified breaches of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. Incidents of conflict between people were not recorded appropriately and insufficient information was recorded in people’s care plans. We set compliance actions and the provider sent us an action plan stating they would be meeting the requirements of the regulations by 28 February 2015.

At this inspection we found effective action had been taken and the provider was meeting the requirements of all regulations.

People felt safe and staff had received training in safeguarding adults and knew how to identify, prevent and report abuse. Incidents of potential conflict between people were dealt with effectively and recorded appropriately. Risks to people were regularly reviewed and managed effectively.

People were supported to receive their medicines safely from suitably trained and competent staff. There were enough staff to meet people’s needs. They were organised and attended to people quickly. Relevant checks were conducted before staff started working at The Briars to make sure staff they were of good character and had the necessary skills.

Staff sought consent from people before providing care or support. The ability of people to make decisions was assessed in line with legal requirements to ensure their liberty was not restricted unlawfully. Decisions were taken in the best interests of people.

People praised the quality and variety of food. Meals formed an important part of people’s day and was reflected in the flexible catering arrangements. A choice of fresh and nutritious meals was available each day, staff encouraged people to drink regularly and provided appropriate support. People had prompt access to healthcare services and the home were able to seek advice directly from some specialists.

Staff were motivated to work to a high standard and were supported through one-to-one sessions of supervision and yearly appraisals. Each staff member had a learning and development plan and were up to date with all essential training.

Best practice guidance had been followed to create an environment suitable for people living with dementia. This included good lighting levels, bright colour schemes and pictures placed at appropriate heights. Additional work was planned to further enhance some areas of the home.

People were cared for with kindness, compassion and sensitivity. We observed numerous positive interactions between people and staff, who went out of their way to do things for people in their own time. Staff knew about the people’s lives and backgrounds. They used this knowledge to communicate effectively in a way that met the communication needs of people living with dementia.

People (and their families where appropriate) were involved in assessing, planning and agreeing the care and support they received. They were encouraged to remain as independent as possible. Their privacy was protected, including by the use of symbols on bedroom doors which provided discreet information about their individual needs.

Care plans provided comprehensive information about how people wished to receive care and support. These helped ensure people received personalised care in a way that met their individual needs. Staff recognised that people’s mobility, health and mood could change on a daily basis and took this into account.

People were supported and encouraged to make choices and had access to a wide range of activities tailored to their specific interests. Residents meetings and surveys allowed people to provide feedback and influence the way the home was run.

People liked living at the home and felt it was well-led. There was an open and transparent culture with strong links to the community. A robust and effective quality assurance system in place and action was taken when improvements were identified. The ethos of the provider and staff was one of continuous improvement. Staff at The Briars were supported appropriately by the provider who monitored and shared best practice between all their homes.

Inspection carried out on 7 and 8 August 2014

During a routine inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This was an unannounced inspection. The Briars is part of a charitable trust that provides care and accommodation for older people. The service had a registered manager in place. 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. At the time of our inspection, 32 people were living at the service.

People’s safety was being compromised in some areas. Incidents of physical conflict between people and people’s capacity to make decisions were not always recorded appropriately. Techniques needed to support a person who could display behaviour that challenged others were not shown in their care plan. Risks associated with a person using the stairs had not been assessed and doors giving access to the garden put people at risk of falling as they could not be secured in the open position.

Staff were up to date with current guidance to support people to make decisions.  Any restrictions placed on them were done in their best interest using appropriate safeguards, although these were not always recorded.

For people who would not be able to tell staff when they were in pain, there was no information for staff about the signs and body language they may display. One person had an injury which staff were not aware of. Another person had not been referred to a specialist after having multiple falls and, having broken their hip, was being supported to weight-bear without having had an assessment by a specialist. People were supported appropriately to drink enough, but the recording of people’s fluids was not effective.

Care plans initially contained a lot of detail about action staff should take to meet people’s needs. However, as plans were reviewed, this level of information reduced, which meant people may not have received consistent care and support. Staff knew how to support people with their continence, but this was not recorded in people’s care plans. A wide range of activities was available, but people’s participation activities was not recorded effectively.

People and their family members praised the standard of care people received and told us staff had the skills and knowledge to meet their needs. A doctor who had regular contact with the service said, “If I am asked would the home pass the friends and family test, the answer is absolutely. I have total confidence in this home and its staff”.

A relative told us “This home must be one of the best, if not the best on the island, the staff are brilliant, nothing is too much trouble, it is clean, the food is fantastic and people get real care and attention to detail”.

The building had been extended and redecorated recently and guidance had been followed to make the environment suitable for people living with dementia. The garden could be accessed by people who used wheelchairs and had won a national award for its suitability for older people.

There were sufficient staff to meet people’s needs and recruitment practices were safe. Staff were suitably trained and supported. They received regular one-to-one sessions of supervision and annual appraisals where objectives were set for the coming year. Staff knew what action to take if the fire alarm sounded and a fire officer described the service’s procedures as “faultless”.

People were offered a choice of varied and nutritious meals, food was available throughout the day and staff made mealtimes a pleasant and social experience. Catering staff were well informed about people’s conditions or medication that affected their ability to eat and drink.

People told us they were happy at the service and talked about it warmly. One person said, “It’s beautiful here and [the staff] are very kind”. Another described it as “very homely”. Staff knew people well and were skilled in providing effective support in a caring and compassionate way. The service was part of an initiative to promote caring relationships, which its policies and staff training supported.

People were able to receive care and support at times that suited them. They were involved in decisions about their care during review meetings and were asked for their views of the service in residents’ meetings and through survey questionnaires. Where changes were needed, we saw these were made. Relatives told us if they had any concerns the manager and staff would respond promptly and people knew how to make a complaint.

Feedback from people, relatives and staff showed the service had a positive, open culture. Staff engaged well with external professionals, welcomed visitors and had strong links with the community. These included charitable groups and a local school, whose children worked on joint projects with people, such as the building of a first world war commemorative garden.   

People were cared for by staff who were well motivated and led by an established management team. The service had achieved Investors in People accreditation, which is a government initiative to support individuals and teams to “be the very best they can be”.

Senior representatives of the provider visited The Briars each month and were actively involved in monitoring and supporting the performance of the service. A range of audits was conducted to monitor the quality of service provided. A recent audit of care plans had identified some were not up to date and staff were working to update these.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 14 May 2013

During a routine inspection

Before people received any care or treatment they were asked for their consent. We looked at five care plans. We saw these were signed by the person concerned or a relative, indicating their agreement.

People experienced care and support that met their needs. We spoke with 11 people using the service and four family members. They told us their (or their relative’s) needs were met consistently. One person said, “We’re happy here, they do look after us”. We spoke with three external health care professionals who made positive comments about the service. One said, “The care is excellent”.

People who use the service were protected from the risk of abuse. We spoke with the manager and five members of staff who had received training and showed a good understanding of safeguarding principles.

Medicines were prescribed appropriately. We spoke with the doctor responsible for prescribing medicines. They told us each person’s medication was reviewed on admission. Medicines were kept securely and administered safely.

The environment that was suitably designed and adequately maintained. The home was in a good state of repair and necessary safety checks and maintenance had been completed.

There were enough qualified, skilled and experienced staff to meet people’s needs. We saw there was a programme of auditing in place to monitor the quality of service provided. People were asked for their views and the provider took account of comments to improve the service.

Inspection carried out on 4 February 2013

During a routine inspection

We spoke with eight people who lived at the service and looked at four care plans. We observed people being supported by staff and saw that people's privacy, dignity and independence were respected. People's views and experiences were taken into account.

People experienced care, treatment and support that met their needs and protected their rights. One person told us “it’s lovely here and the food is lovely”.

We spoke with five visitors. The friend of a person using the service told us the Briars was a service “par excellence”. Two visitors told us that the home was “wonderful. They do their best to make it special”. One relative said “Nothing is too much trouble”.

Through looking at safeguarding referrals that had been made, reviewing arrangements for staff training, talking to staff and reviewing care plans we found that people were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

Looking at staff records and talking with staff demonstrated that people were safe and their needs were met by competent staff.

The provider had in place systems that sought people's views, took account of complaints and comments and learnt from investigations into accidents and incidents. This meant the provider had an effective system to assess and monitor the quality of service.

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