Archived: Briarwood Rest Home Limited

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

During this inspection we spoke with four people using the service and seven visitors. We spoke with four care staff, a cook and the registered provider. We also spoke with the local authority and the police. We viewed records which included, four care plans and daily care records, policies and procedures, recruitment and training records, staff rotas, menus and records of meals served and minutes from meetings.

We considered the evidence we had gathered under the outcomes. This is a summary of what we found:

Is the service safe?

The current arrangements for assessing people's needs, support planning and reviews did not protect people from the potential risk of receiving inappropriate care or treatment. Staff did not always read care plans and did not keep adequate records of the care they provided or sufficiently report on people's changing needs. As a result, changes in people's needs were not always planned for and the delivery of care, treatment and support for people was not necessarily the right care that met with their needs.

People's mental health needs were not adequately assessed and where people presented challenges that staff were required to manage, this was not planned for.

There were policies and procedures, and some staff had received training, in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. This should help them to understand their responsibilities when making decisions for people who were unable to consent to care and treatment. No applications had been submitted since our last inspection.

The safeguarding procedure included incorrect contact information for the local authority and incorrect guidance regarding the role of the Care Quality Commission (CQC). This could cause confusion for staff and a delay in reporting any incidents of abuse or neglect. People's welfare was not always considered and people remained potentially at risk of unsafe care as staff had not reported on unexplained injuries or taken medical advice.

Specialised hoisting/standing equipment was not being used despite this being recorded in people's care plans. This meant people were being moved inappropriately and unsafely. This placed staff and people using the service at risk of harm or injury.

Appropriate employment checks were not always in place prior to staff employment. Concerns noted by previous employers had not been discussed with the applicant and health checks were not conducted to ensure only suitable staff were employed

Staff had undertaken relevant training although practical training in areas such as moving and handling and fire safety had not been given. This meant there was a risk staff did not have the up to date skills and knowledge to meet peoples' needs.

Staffing numbers meant at times there was only one member of staff to attend to all 'residents' in the lounge areas which could place people at risk.

Is the service effective?

People told us they were happy with their care. Comments from people living in the home included, 'I am happy with the care' and 'It's alright here but it's not like home'. Comments from visitors included, 'I am happy with the place' and 'My relative is always dressed nicely; always nice and clean'.

There was little evidence care reviews were accurate or effective. We found people's changing needs were not being adequately monitored or planned for. People's health and well-being was not adequately monitored to make sure people received prompt, co-ordinated and effective care.

People told us they enjoyed the food and we observed staff being attentive and supportive during the lunchtime meal. However, we found there was no information to indicate the action to be taken by staff to ensure people's dietary needs were met. In addition, information regarding people's dietary preferences had not been clearly recorded. This meant people were at risk of not having their dietary needs and preferences met.

Staff were limited in quality time they spent with people using the service and staff routines prevented them from being flexible in their approach to their work. This meant the service was routine led. Staff told us, 'We can't always give people the choices they want; there isn't the time' and 'We have to cover the cleaning hours and also do the laundry; it means we don't have enough time to spend with people or give them the care they need'.

Is the service caring?

People told us staff were very good. Comments made included, 'I have the freedom to do what I want', 'I am very happy here; I have no concerns' and 'I am alright I would say if I wasn't. Staff are nice to me'.

Visitors commented, 'I am happy with the place', 'I know I can leave here and mum will be looked after' and 'We visit at different times and have no concerns about anything; the staff are kind and considerate'.

Is the service responsive?

Referrals to professional people to support care and welfare needs were not routinely made or reported on. This meant people's changing needs might not be effectively monitored as a result of this.

Staff did not have the training to support them to deal with challenging behaviour. This meant staff did not necessarily have an understanding of what could potentially trigger these behaviours, or have the skills and knowledge to respond at an early stage to reduce the likelihood of these behaviours recurring.

Is the service well-led?

People were happy with the staff team. Comments from people living in the home included, "Staff are very nice' and 'Staff are alright; I avoid the person that tells me what to do" and 'The owner is very good; he is a tower of strength and has helped me to manage'. Comments from visitors included, 'Some staff are nicer than others', 'Staff know what they are doing' and 'I have no concerns with staff or management; the owner is very supportive'.

The service had a registered manager responsible for the day to day management of the home. At the time of our visit the registered manager was not in day to day control. Staff were not always clear about their responsibilities and duty of care.

We found the provider had received support from the Care Home Effective Support Service (CHESS) team and had successfully implemented the improvements detailed in the action plan they submitted.

We found the provider had ensured staff were skilled and competent with regard to administration of medicines. Associated records were accurately maintained.

Risk assessments and written pans of care were regularly reviewed and updated in line with changing needs. Referrals were made for specialist support and advice where appropriate.

The records in the home were accurate, fit for purpose, stored appropriately and able to be located promptly.

"I'm really chuffed with how I'm being treated."

"I'm well looked after...There's not much they could improve here."

"The food is always good and the portions are just right."

People told us and we found that the standard of care and welfare being delivered in the home was satisfactory.

Nutritional needs in the home were met and people enjoyed the food that was on offer. The provider ensured that where people were at risk of not getting the nutrition or hydration they required, extra support was given. Referrals were made to the appropriate healthcare professional for advice or guidance where required.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to safely manage them.

There were enough suitably qualified and experienced staff on duty to ensure that people's needs were met in line with written plans of care. The staff told us they felt well supported by each other and the management and that the home was a good place to work.

The provider had systems in place to monitor and assess the quality of care and support provided at the home.

We found that the provider did not accurately maintain records relating to people's care. Regular reviews of peoples assessed risks and needs were not undertaken and recorded as appropriate. This left people at risk of receiving care or support that did not fully meet their needs.

One person confirmed that they knew what medicines they had, and the home 'never ran out'. A second person told us, 'I have (condition) they put my cream on for me when I need it'.

However, we found that medicines handling was not always supported by the clear, auditable record keeping needed in order to evidence medicines use as prescribed. Additionally, although further training was being planned, care workers trained in medicine handing were not always on duty at night.