We undertook an unannounced inspection of this service on 17 and 18 March 2015. This service provides accommodation, personal and nursing care for up to 45 older people, some of whom have limited mobility, are very frail or receiving end of life care. There were 37 people living at the home at the time of our inspection. Accommodation is arranged over three floors and each person had their own bedroom. Access to the each floor is gained by the main staircase or two lifts, making all areas of the home accessible to people.
This service had a registered manager in post. A registered manager is a person who is 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.
We last inspected the home in June 2014. We found the provider was in breach of regulations about the care and welfare of people, how some of this information was recorded, aspects of the safety and suitability of the home as well as how they assessed the quality of the service they provided. The provider sent us an action plan telling us what they intended to do make the improvements needed. During this inspection we checked to see if the relevant regulations were now met. We found our previous concerns had been addressed; however, we identified other areas that breached regulations. Some of these breaches were of a similar theme to those identified at our last inspection.
People commented very positively about the care and support received and their experience at Bryher Court. However, the inspection highlighted shortfalls in the following areas that could compromise the safety of people in the service.
Recruitment processes did not ensure that thorough checks took place. These are required to establish why previous employment ended and to inform decisions about the suitability of applicants for their role. Incomplete checks did not promote the principles of a robust recruitment policy or protect the interests of people living at the home.
Staffing levels occasionally did not meet the numbers the home had assessed it needed and processes, intended to safeguard against insufficient staff, were not always effectively implemented. When this occurred, staff told us their shifts felt difficult and hectic to ensure that people’s needs could be met.
Arrangements for the supervision and appraisal of staff were not effective. Although staff supervision took place about concerns, regular supervision and appraisals, intended to monitor the training, on going development and the competence of staff, had lapsed.
Although resolved quickly, checks to ensure the safety of equipment such as the lifts, gas boiler and other gas appliances were out of date. The home could not evidence that they were safe to use and did not present a risk to people living and working at the home.
We made a recommendation that the home review its medication policy to reflect current guidance and amend practices.
The record of complaints and how these were progressed was incomplete and the wording used in the displayed complaints process could be viewed as off-putting. It did not give people confidence that all complaints would be viewed with the same seriousness with which they were made.
Care plans were reviewed regularly, but did not always reflect people’s involvement or the support they may require to ensure they understood and were involved in making and reviewing decisions about their care.
Although care plans recorded changes in people’s condition and support required, they did not always contain sufficient information to enable all staff to understand what had caused the change or if action was required to address the cause. We have identified this as an area for improvement.
A quality monitoring system was in place but was not effective to enable the service to highlight the kind of issues raised within this inspection.
There were also the following areas that did work well. The manager had an understanding of the mental capacity Act 2005, and Deprivation of Liberty safeguards, they understood in what circumstances a person may need to be referred, and when there was a need for best interest meetings to take place. We found the service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and that people’s rights were respected and upheld.
The service records showed that there were low levels of incidents and accidents and these were managed appropriately by staff who sought appropriate action or intervention as needed to keep people safe. Risks were identified and strategies implemented to minimise the level of risk.
People were able to choose their food at each meal time, snacks and drinks were always available. The food was home-cooked, including some home-made biscuits and cakes. People told us they enjoyed their meals, describing them as ‘excellent’ and ‘first class’.
Two activities co-ordinators oversaw the management of activities programmes and entertainment. All staff had a holistic approach and saw it as their responsibility to spend time with people, talk with people, and carry out small acts of kindness such as getting drinks or showing people where to go.
Staff understood how to protect people from the risk of abuse and the action they needed to take to alert managers or other stakeholders if necessary if they suspected abuse to ensure people were safe.
New staff underwent an induction programme and shadowing experienced staff, until they were competent to work on their own. There was a continuous staff training programme, which included courses relevant to the needs of people supported by the home. Most care staff had completed formal qualifications in health and social care or were in the process of studying for these.
The home was led by a registered manager who worked closely with the deputy manager and the staff team. Staff were fully informed about the ethos of the home and its vision and values. They recognised their own roles as important in the whole staff team and there was good team work throughout the inspection. Staff showed respect and valued one another as well as people living at the home.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. Which now correspond to 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.