Cary Brook

Cary Brook is a residential home providing personal care and accommodation to 45 people. The service specialises in support for older people living with dementia. At the time of our inspection, 36 people were using the service.

The home is purpose built, set across two floors. There are communal areas such as dining rooms and lounges. There is level access to secure outside area.

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

The provider's systems for sharing learning had not ensured information was acted upon promptly following an incident in another service to make sure people were protected from the risks associated with hot pipes, in line with the provider’s policy. The systems in place to monitor the quality and safety of the service were not always effective in ensuring shortfalls were identified and addressed in relation to environmental risks and medicines.

People were happy living at the home. Relatives spoke positively about the care and activities provided by staff. Staff worked as a team. There was a friendly and welcoming atmosphere.

The home was clean, tidy, and well maintained. There were infection prevention control measures in place. People could move freely around the premises. Positive feedback was received about recent refurbishment work.

Staff were recruited safely. The service was working to recruit to vacant positions. Equipment and fire safety systems were regularly checked.

The home was part of the local community. Meetings and events took place to engage and gain feedback from people, staff and relatives. Systems to communicate with staff and relevant others were in place.

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

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 13 September 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cary Brook on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified a breach in relation to Regulation 17 (Good governance) at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor the information we receive about the service, which will help inform us when we next inspect.

At the last inspection in March 2015, the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated Good

People remained safe at the home. People were supported by adequate numbers of staff who had the skills and knowledge to meet their needs. Staff knew how to protect people from the risk of harm and abuse.

Risks to people were reduced because there were systems in place to identify and manage risks such as reducing the risk of falls, assisting people to mobilise and reducing risks to people who were at high risk of malnutrition and pressure damage to their skin.

People received effective care. 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 support this practice. People’s health care needs were monitored and met. Staff had been trained to care for people who were living with dementia.

The home continued to provide a caring service to people. One person told us “Staff are good, really good actually. Very kind.” Another person said, “They are kind and look after you.” One person who was at the home for respite care told us, “I like coming here because everyone is friendly. You can have a bit of fun. I like to pull their legs.” Staff treated people with respect and worked hard to make sure people’s wishes during their final days and following death were respected.

The home provided a responsive service. People received care and support which was tailored to their needs and preferences. For example one care plan said the person liked to cuddle a large soft dog toy. When we met this person they had the soft toy with them. It also said they liked milkshake and we saw this was regularly offered to them. Staff were kept up to date with each person’s health and well-being. They attended a handover meeting at the start of every shift. One member of staff said “Handover tells you everything you need to know. Like if someone is not themselves and you need to keep an extra eye on them.”

The service continued to be well led. The registered manager had managed the home for several years. Staff morale was good and staff felt well supported. One member of staff said “There is good teamwork which creates a good atmosphere. The more relaxed we are the more relaxed people are.” The views of people who lived at the home were valued and responded to. The registered manager and provider continually monitored the quality of the service and made improvements where needed.

Further information is in the detailed findings below

Below is a summary of what we found. The summary describes what relatives of people using the service and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report. This is a summary of what we found:

Is the service safe?

We saw that there were procedures in place in the event of a fire and emergency hospitalization.

The provider had taken steps to ensure that the premises were appropriately risk assessed and maintained. This meant that people were protected from the risks of an unsuitable environment.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. People at the home were at risk of being unlawfully deprived of their liberty. There were no records of mental capacity assessments taking place before decisions were made about people's care by others on their behalf.

Is the service effective?

People living at the home had care assessments and plans to identify their needs. One relative said that there was, 'Good care.' They described how staff had supported a person living at the home to visit the GP, dentist, and to attend a hearing appointment. Another relative said, 'Medication is given ok.'

People were supported to eat enough food and drink to meet their needs. One relative said, 'There is enough food and drink and an ok choice.' Another relative said, 'There is a drinks trolley between meals, breakfast, snack, lunch, and dinner.'

Is the service caring?

We observed that interactions between staff and people living at the home were supportive and friendly. One relative said, 'All staff are friendly and considerate.' Another relative said of staff, 'They are so nice and speak gently.'

Is the service responsive?

We saw that systems were in place to enable managers to learn from complaints, concerns, accidents, incidents, and audits and improve care due to this information. One relative said, 'I've not made a complaint. I would phone and speak to the manager. The policy was in the pack we were given.' Another relative said, "I would find it difficult to fault. They listen to anything asked and resolve it."

Is the service well led?

There was a system to assess and monitor the quality of service that people receive. The views of people living at the home and their relatives were sought and action plans were developed to improve the service if appropriate. This meant that the provider had taken some steps to reduce the risk of inappropriate care and treatment through monitoring the quality of the service.

We saw that staff maintained people's dignity and treated them respectfully. We saw that people were offered choice throughout the day, from where to sit, what to eat and what to do.

We saw that people's care was planned and reviewed regularly and that it was based on the individual's needs. One person told us "I have my own room, self-contained" and "the staff are very nice, polite and treat you like a person".

We saw evidence that there were procedures in place and staff training was provided in order to protect people from the risk of abuse.

We saw that staff were well trained and supported to perform their role. One staff member told us "I feel like I'm an important part of someone's life here" and another told us "I like making sure that people are well cared for and safe".

We saw evidence that the provider continually monitored the quality of the service provided at Cary Brook and that they invited input from staff, people and relatives.

We found that peoples health and welfare needs were being met and that support given was individualised and person centred.

Evidence informed us that systems were in place to protect people from possible abuse and that staff had an awareness of safeguarding issues.

We found that staff were available in enough numbers and had experience to meet the needs of the people living in the home.

We found the quality of the service was being regularly monitored and evidence indicated that concerns were promptly acted upon.