Briar Close House Care Home

Briar Close House Care Home is a residential care home providing personal care for up to 40 people in total, across four wings. However, at the time of our inspection the home was undergoing refurbishment so one wing was not in use whilst building work was ongoing. There were 22 people using the service on the day of our inspection. People had a variety of support needs such as those living with dementia or other mental health conditions, those with a physical or sensory impairment, older people and those who may be living with a learning disability or autism.

People’s experience of using this service and what we found

People felt safe living in the home, they were protected from abuse and had their risks assessed, planned for and mitigated. There were enough safely recruited staff to meet people’s needs. Lessons were learned when things had gone wrong. Medicines were safely managed and stored. Infection control measures were in place to keep people protected.

Effective quality assurance systems were in place to monitor the quality and safety of care. There was an open and inclusive culture in the home. People, relatives and staff felt positive about the registered manager and the management of the home. People and staff were asked for their feedback. People were supported with their protected characteristics. The registered manager was aware of their duty of candour. Audits were in place to check people’s care and an action plan was in place to continue to improve the service. The home worked in partnership with other organisations.

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

Rating at last inspection

The last rating for this service was good (published 17 July 2018).

Why we inspected

We received concerns in relation to how people were supported in relation to their risks and how staff worked together. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We found no evidence during this inspection that people were at risk of harm from this concern.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained the same; good. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Briar Close House Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

¿There was a planned approach to visitors, which involved a booking in process, temperature checks, risk questionnaire and face coverings. Those unable to visit had the option of video calls, email or telephone calls.

¿ Some relatives had written their loved one letters. These were placed in a plastic booklet, this meant the person could read them as often as they wished, and they could be cleaned to reduce the risk of infection.

¿ Activities had increased as the service was supported by day centre staff, due to these currently being closed. This had enabled reminiscence booklets to be completed and more one to one time.

¿ Personal protective equipment was used in accordance with the latest guidance. Clear faced masks were being sourced to support staff who used lip reading to support their communication. Measures were in place until these had been obtained to ensured they received all the required information in written format.

¿ The home was divided into four units. One unit was designated to support anyone who was isolating or had a positive Covid test. The other units were supported by consistent staffing to make best use of working in ‘bubbles’.. This reduced the risk of cross infection from each unit.

¿ The units had been provided with hot buffet servers and other items to make them as self-sufficient as possible.

¿ The cleaning of the home had increased to cover touch surfaces. The provider had also purchased a steam cleaning for furniture with a fabric covering.

¿ Staff had continued to complete training through a workbook approach, this involved completed information on worksheets which were then reviewed and marked by trainers. Any new training was reviewed through competencies to check staff understanding.

¿The provider continued to have oversight, with regular audits and video links. to share good practice and any new or developing guidance and changes.

¿ Relationships with health care staff had been enhanced, through shared tasks to support one another.

¿ The registered manager was proud of their staff team and the way they had adapted and worked together to ensure everyone’s safety.

Further information is in the detailed findings below.

Briar Close House Care Home provides accommodation and personal care for up to 40 older people who maybe living with dementia. There were 30 people living at the home on the day of our inspection. The home is situated in a residential area of Borrowash and has good access to local shops and public amenities.

We inspected this service on 26 June 2018. The inspection was unannounced. At our previous inspection on 11 May 2017 we rated the service as requires improvement. This was because we identified concerns with how people were supported to manage risks; how accidents were monitored, how staff received training and how systems were used to monitor and improve the service. The provider sent us an action plan which stated how and when they would make improvements to meet the legal requirements. On this inspection visit we saw improvements had been made.

There was a registered manager in post. 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.

Staff understood their responsibilities to protect people from harm and knew how to raise concerns. Risks to people’s health and welfare were assessed and staff knew how to minimise the identified risks. Where people needed additional support because they had complex needs, there were plans in place to guide staff how to respond to keep them and others safe. There were sufficient, suitably recruited staff to meet the support needs of people and staff understood their role.

Medication systems were managed safely to ensure that people received their medicines as prescribed. Medicine audits were completed and could easily identify if there were any errors so suitable action could be taken as required.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People could decide how they wanted to be supported and where they lacked capacity, restrictions were only in place where this was in their best interests. Staff received training and support to ensure they had the necessary skills and knowledge to support people. The staff had opportunities to identify areas for personal development and to raise any concerns they had.

People enjoyed the food and drink that was available and had a choice of what to eat. People received support from health care professionals to ensure their well-being was maintained. Health concerns were monitored to ensure people received specialist health care intervention when this was needed. The environment met people’s needs.

People were involved in planning and agreeing how they were cared for when they moved into the home. The support was reviewed to ensure it continued to meet their needs and expectations. People enjoyed the opportunities they had to be involved in activities that interested them.

People felt well looked after and had developed good relationships with staff. People were cared for by respectful and compassionate staff who knew their preferences for care and their likes and dislikes.

The provider’s quality monitoring system included consulting with people and their relatives to ensure planned improvements were focussed on people’s experience. Quality audits included reviews of people’s care plans and checks on medicines management and staff’s practice. Accidents, incidents and falls were investigated and actions taken to minimise the risks of a re-occurrence.

There is a requirement for Briar Close House Care Home to have a registered manager and a registered manager was 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.

The service is registered to provide residential care for up to 40 older people, some who are living with dementia. At the time of our inspection 35 people were using the service.

Care plans and risk assessments for people with behaviour that challenged did not identify current risks and control measures to sufficiently reduce risks of harm to people and staff. Staff practice when caring for people with behaviour that challenged was not always consistent as care plans did not reflect current care needs and risks. Care plans and risk assessments for other areas of people’s care and treatment reflected people’s current needs.

Incident reporting and behaviour monitoring records were not always completed to enable the quality and safety of services to be assessed, monitored and improved, and in addition reduce risks relating to health, safety and welfare of people and staff. Other systems and processes to ensure good practice were in place, for example kitchen standards and fire prevention checks.

Procedures designed to uphold people’s rights, in line with the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) had not always been considered when people, who lacked the mental capacity to consent to their care, were resistant to their care and treatment.

Not all staff had completed training to the timescales identified as required by the provider for them to complete their role.

Medicines administration records did not always show people had been offered creams as prescribed. Medicines were stored securely, administered and records kept in line with the provider’s policy. Other risks to people’s health, for example from falls, were identified and actions taken to reduce those risks.

People told us most staff were caring, however they commented some staff were better with people than others. Some people experienced loneliness and not all staff took opportunities to reduce this.

People told us they felt safe and were able to raise any worries or concerns. Staff had been trained and had an understanding of safeguarding and how to keep people safe from potential abuse. Staff were recruited in line with the provider’s policy and procedures, and checks were completed to ensure staff employed were suitable to work at the service. Staffing levels were based on meeting people’s needs and enough staff were deployed to do so.

People were happy with the meals they received. We saw people’s special dietary requirements were catered for and people had access to snacks and drinks throughout the day.

Other healthcare professionals were involved in supporting people’s health care needs when needed. For example, people had access to district nurses and doctors when needed.

Most, but not all staff felt supported by their managers and found meetings with their managers useful.

Families were welcomed when they visited. Care plans were developed to include people and their relatives’ views. Staff provided care that respected people’s privacy and dignity.

Staff supported people with personalised and responsive care. People were supported to enjoy activities and events. People who needed help to orientate around the building, or needed help with communication received this personalised support.

At this inspection we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

There is a requirement for Briar Close House Care Home to have a registered manager and a registered manager was not in place in place at the time of this 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 service is registered to provide residential care for up to 40 older people. At the time of our inspection 36 people were using the service.

The service could not demonstrate that the numbers of staff deployed were specifically planned in relation to people’s needs. In addition the service could not produce recruitment records to assure us that all staff had been recruited using pre-employment checks designed to ensure staff working with people using the service were suitable to do so.

Practices to prevent and control infection had not always been implemented, however the manager provided assurances that these issues would be addressed.

Incidents were recorded and actions had been taken to reduce risks to people. However consideration had not always been given to whether a referral to the local safeguarding authority needed to be made. Risks to people’s health were identified and care plans were in place to ensure that these were reduced. We found medicines were being managed and administered safely to protect people from the risks associated with the management of medicines.

People were asked for their consent to their care and support. For people who lacked capacity to consent to their care and support the provider had followed the principles of the Mental Capacity Act (MCA) 2005. The provider had also applied for assessment and approval of any restraint on a person’s freedom in line with the Deprivation of Liberty Safeguards (DoLS). Staff knowledge on the MCA and DoLS was variable and staff had not received up to date training, however staff training in other areas relevant to people’s care needs was up to date.

Staff received supervision and demonstrated knowledge of people’s needs. People were supported to access other health care services as required. In addition, people were supported to enjoy mealtimes and received sufficient food and drink that met their nutritional needs.

People were supported by staff who were kind and caring. People enjoyed the conversations that staff shared with them and people shared fun and laughter with the staff that supported them. People’s choices and decisions were respected by staff. Staff were mindful of respecting people’s dignity and supporting their privacy.

People did not always receive responsive and personalised care. People, and where appropriate families, were involved in planning people’s care and support. People could share their views in a variety of ways, including meetings with staff. People were able to maintain relationships with those who were important to them. People received support to engage in interests and activities, although some people had aspirations for more activities to take place.

Some records regarding the employment of staff were kept at a different location and could not be retrieved. Other records and audits were available to check on the quality and safety of services provided to people using the service.

The manager was viewed as being supportive. The manager had involved people and staff in the development of the service and they were supported in their leadership by a motivated and supportive staff team.

People had been asked for their views and the manager told us new surveys to gather people’s views had been planned. We saw information had been made available advising people and their families how to make a complaint or offer feedback. People knew how to raise concerns or make suggestions.

We identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Both families we spoke with told us that staff involved the GP and other professionals with their relatives care when necessary. One person said, 'My relative saw the optician last week and they also see the chiropodist.'

We saw training records that showed staff had received training within the last year on safeguarding people from abuse. Staff we spoke with on the day of the inspection could explain the procedure for reporting a safeguarding concern and also the procedure for whistleblowing.

Records we looked at of three care staff's employment interviews showed that the questions asked were relevant to the job role and allowed the provider to judge people's competencies and suitability for the post effectively.

We found evidence that health and safety risks had been identified and action taken to remove risks. This included removing moss from outside paths to reduce the risk of slips, trips and falls. We read an action plan to improve the prevention and control of infection in the service. This had identified actions to be taken and included the installation of additional soap and paper towel dispensers at all hand washing sinks.