Briarfield

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. The service was in breach of legal regulation in relation to people’s safe care and treatment.

This service scored 44 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always promote a proactive and positive culture of safety based on openness, honesty and learning.
Staff did not consistently recognise, record or report incidents, which meant opportunities to identify risks, investigate concerns and learn from events were sometimes missed. Lessons were not always learned to drive improvements in people's care and safety.
Behavioural incidents were not always recognised or recorded appropriately. As a result, opportunities to review incidents for themes, trends and learning were sometimes missed, limiting the service's ability to identify patterns and improve care. Staff did not always understand when incidents should be recorded or where information should be documented. One member of staff told us, "A lot of things don't get documented, and we find out through word of mouth."
Although some incidents were reviewed by the registered manager and members of the multidisciplinary team to identify patterns, trends and opportunities for learning, this approach was not applied consistently across the service.
 

The provider worked effectively with people, healthcare professionals and partner organisations to maintain safe systems of care. Arrangements were in place to support continuity of care and help ensure people experienced safe and coordinated transitions between services.
The provider completed pre-admission assessments to help determine whether people's needs could be met safely and effectively.
The registered manager demonstrated how a person who had recently moved into the service had been assessed prior to admission. Their transition was carefully planned and managed, with effective involvement from external health and social care professionals. The transition took place gradually and at a pace that suited the person's needs and preferences. This helped ensure appropriate care plans, support arrangements and risk management strategies were in place from the outset to support the person's health, safety and wellbeing.
The service had clear procedures and documentation to support transitions, including hospital admissions and discharges. Staff worked with external professionals to plan and manage changes in people's care and support needs. Health action plans and hospital passports were available for people to help ensure important information was shared with other services when required. We found these documents would benefit from regular review to ensure information remained accurate and current.
Professionals spoke positively about the service's approach to partnership working. One professional told us, "[Registered manager] was involved in MDTs [multi-disciplinary teams] to support planning [person's] transition to Briarfield and was actively involved in helping us to create care plans with relevant information for their team in order to make the transition as smooth as possible."
 

The provider did not always ensure staff had a complete understanding of how people's rights should be protected under relevant safeguarding legislation. While processes were in place to protect people from abuse, neglect and avoidable harm, staff knowledge was not always consistent.
People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005. While DoLS applications had been completed where required, staff understanding of what DoLS is, its purpose and who it applies to was not always clear.
However, staff demonstrated an understanding of safeguarding processes and were able to explain how they would report concerns. People were observed to be treated with kindness, dignity and respect. All staff had completed safeguarding training, appropriate statutory notifications had been submitted to us where required, and easy-read information was available to support people to understand how to raise concerns.
 

The provider did not work well with people to understand and manage risks. Risks were not always consistently identified, assessed or managed to keep people safe while promoting their independence.
People's known risks were not always reflected in care plans and risk assessments. In some cases, staff did not have clear guidance about how to support people safely when they became distressed or displayed behaviour that communicated a need.
Only one person using the service had a positive behaviour support plan in place. Daily records showed that when people displayed behaviour that communicated a need, staff responses were not always recorded in sufficient detail and incidents were not always recognised or reported appropriately. Opportunities to understand the causes of people's distress, review incidents for patterns and trends, and implement measures to reduce the likelihood of recurrence were therefore sometimes missed.
Where risks had been identified following incidents or changes in people's circumstances, care plans and risk assessments were not always updated to reflect these risks or the measures introduced to manage them. This meant staff did not always have access to up-to-date guidance to support them to manage risks safely and consistently. However, some areas of risk management were well developed. People with specific health conditions, including epilepsy and diabetes, had detailed, person-centred care plans and risk assessments in place. These provided staff with clear guidance on how to support people safely and respond to changes in their health needs.
 

The provider did not always detect and control potential risks in the care environment. They did not make sure that equipment, facilities and technology supported the delivery of safe care.

The environment was not always safe or well maintained. Internally, the property was in a poor decorative state, with some exposed or poorly maintained fixtures and fittings. Some risks had not been adequately managed, including unsecured items of risk such as knives, inappropriate storage of continence products and creams, and unsafe outdoor areas.
Fire safety arrangements required improvement. We identified damaged door fire seals, incomplete records of fire drills and a lack of night-time fire drills. Although the provider had begun to address some of these issues, improvements were still needed to ensure fire safety systems were fully effective.

Additional environmental risks had not always been assessed or managed appropriately. For example, unlocked patio doors provided people with unsupervised access to outdoor areas without documented risk assessments in place. Gardening equipment was not always stored safely, and some maintenance concerns remained unresolved, including faulty equipment, water temperatures that exceeded safe limits and environmental issues that increased the risk of the spread of infection.

Following feedback during the assessment, the provider took action to address some of the concerns identified and demonstrated a willingness to make improvements to the safety of the environment.
 

The provider did not always make sure there were enough qualified, skilled and experienced staff to meet people's needs safely and effectively. Staffing arrangements were not always based on people's assessed needs, and staff did not always feel there were sufficient numbers of staff available to provide the support people required. Leadership capacity was also limited, which affected oversight and support within the service.
Staffing levels were described as operating at minimum levels rather than being determined through a formal dependency assessment. Although rotas generally showed minimum staffing levels were maintained, some staff told us these were not always sufficient to meet people's needs, particularly when supporting people to access the community. One staff member told us, “The rotas have an impact on staff retention.”
Views about night staffing levels were mixed, with some staff reporting staffing was sufficient, while others felt there were not enough staff available.
During an unannounced out-of-hours visit, we observed the registered manager providing direct care due to staffing shortages. Staff comments reflected concerns about staffing levels. One member of staff told us, "Sometimes there just isn't enough people on." Another said, "We just need more staff, and we need a senior on every day."
Staff had training in areas relevant to their job roles such as supporting people living with a learning disability and safeguarding. They told us this training helped prepare them for their job roles and helped them understand how best to support people. Staff were recruited safely in line with legislation.
Observations during the assessment showed staff were occasionally stretched. We also identified that the registered manager lacked sufficient management support. We fed this back to the provider, who responded promptly by appointing a deputy manager from another service within the organisation. Staff received supervision and annual appraisals in line with the provider's policy.

The provider did not assess or manage the risk of infection. Systems to prevent, detect and control the spread of infection were not consistently followed, which increased the risk of people being exposed to avoidable harm.

Standards of cleanliness and infection prevention and control were not always maintained. Areas of the environment appeared visibly unclean, including floors and furniture, dirty freezer seals and dining areas where tables were not always appropriately cleaned between use. Strong odours were present in parts of the home. Cleaning records were not consistently completed which meant the provider could not always demonstrate cleaning tasks had been carried out as required.

Infection prevention and control risks associated with equipment were not always managed safely. For example, mops were stored inappropriately, increasing the risk of contamination and the spread of infection. Some fixtures within the environment also posed infection control risks, including unsealed wood around sinks, which could not be effectively cleaned. Staff practice did not always reflect infection prevention and control guidance.

We observed occasions where staff did not consistently wash their hands or change gloves between tasks, including when administering medicines and applying creams. Following feedback during the assessment, the provider acknowledged the concerns identified and took steps to address some of the issues. We have shared our findings with the local authority infection prevention and control team.
 

The provider did not always make sure medicines were managed and stored safely.
Although medicines were administered appropriately and stock balances were correct on the day of the assessment, some processes were not sufficiently robust to identify and address errors. For example, missing signatures on medicines administration records (MARs) had not always been followed up. An error in the controlled drugs records had not been identified through audit processes, although stock levels remained correct. Some items, including thickener, were not stored appropriately, and the minimum and maximum temperature ranges required for safe medicines storage had not been clearly identified. These issues indicated medicines management systems and oversight were not always effective in ensuring the safe handling and administration of medicines. The provider took immediate action to address these concerns during the inspection.