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Reports


Inspection carried out on 14 December 2017

During a routine inspection

Briarcroft Care Home is registered to provide care for up to 20 people. People living at the home were older people, the majority of whom were living with dementia. At the time of the inspection there were 17 people living there.

This inspection was unannounced and took place on 14 and 15 December 2017. The last comprehensive inspection of the service was in August 2016. At this inspection we found breaches of regulations related to person centred care, dignity and respect, the protection of people’s legal rights, safe care and treatment, premises and equipment and quality monitoring. We rated the home as ‘Requires Improvement’ in all five key questions. We took enforcement action in relation to the quality monitoring breach, by serving a warning notice on the provider. This required the provider to improve quality monitoring processes by 7 November 2016, due to the serious and major impact on the safety and quality of services people received. We issued requirements for the other five breaches of regulations. Following the inspection in August 2016 we met with the provider who gave assurances of their commitment to improving the quality and safety of the care and support provided to people.

We carried out an unannounced focused inspection on 13 January 2017 to check that improvements to meet legal requirements planned by the provider after our August 2016 inspection had been made. The team inspected the service against one of the five questions we ask about services, “Is the service well led?” We some found improvements had been made. The provider had developed a service improvement plan, with the support of the local authority’s quality and improvement team, and begun a programme of improvements within the home. However, we found there were other areas that required improvement and some of the decisions made by the manager did not promote safety or protect people’s rights. We identified breaches of regulation related to safe care and treatment and safeguarding service users from abuse. Following this inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question, “Is the service well led?” to at least good.

At this inspection in December 2017 we found significant improvements had been made and the key question, “Is the service well led?” was now rated good. There was a new manager who registered with the Care Quality Commission to manage the service on 11 August 2017. Like registered providers, registered managers 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. People, relatives, staff and external health and social care professionals spoke highly of the registered manager and the positive changes that had been made at Briarcroft in the short time they had been in post.

The registered manager and provider promoted the ethos of honesty and admitted when things had gone wrong. They had acknowledged the areas in which the service needed to develop and improve, and, working closely with the local authority quality and improvement team, had been proactive in making this happen.

There were quality assurance systems in place to help assess the safety and quality of the service, and identify any areas which might require improvement. The findings of the audits informed a service improvement plan, with clearly defined actions, responsibilities and timescales. The views of people, their relatives, and staff were actively sought to ensure the service was run in the way they would like it to be.

People told us they felt safe and there were sufficient numbers of staff deployed to meet their needs. Regular health and safety checks were undertaken at the service. There were effective infection prevention processes in place, the home was now compliant with fire regulations and a programme of refurbishment was in progr

Inspection carried out on 13 January 2017

During an inspection to make sure that the improvements required had been made

Briarcroft is a care home which provides accommodation for up to 20 older people who may be living with dementia.

This focused inspection took place on 13 January 2017 and was unannounced. The inspection was undertaken to review the progress the provider had made with meeting the requirements of the warning notice issued following the comprehensive inspection of the home in August 2016. At that inspection we rated the home as requiring improvement in all five of the key questions. We identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the quality and safety of the services provided.

The home was obliged to have a registered manager in post as this was a condition of the provider’s registration with us. The provider had appointed a new manager following the previous inspection. They confirmed they were in the process of applying to register with us. Following the inspection, the provider confirmed the manager had submitted their application to registered with us. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Following the inspection in August 2016 we met with the provider who gave assurances of their commitment to improving the quality and safety of the care and support provided to people. At this inspection in January 2017 we some found improvements had been made. The provider had taken action to commence a programme of improvements within the home and had been visiting each week. The manager had been working with the local authority’s quality and improvement team and had developed a service improvement plan. However, we found there were other areas that required improvement and some of the decisions made by the manager did not promote safety or protect people’s rights.

Broken and unsuitable furniture had been replaced and equipment had been serviced. A programme of refurbishment and redecoration was underway. The manager confirmed the laundry room would be redecorated as the paint was peeling from the walls which made this room difficult to keep clean. The manager said this room had been identified by the provider as requiring redecoration and this would be undertaken shortly: it had been identified as requiring repainting in the refurbishment plan.

We found equipment in use that placed people’s freedom of movement and their safety at risk. A gate had been placed across part of the hallway on the first floor which restricted access to two people’s bedrooms. This use of the gate had not been properly assessed or authorised and as such its use was an unauthorised restriction of people’s liberty. We also found a portable ramp was being used to bridge the gap between two sets of steps. The use of the ramp had not been assessed as safe to use. The manager removed the gate and the ramp immediately.

At the previous inspection we identified that care planning records were insufficiently detailed to identify people’s care needs and how they should be supported. Since then the home had introduced a computerised care planning system. Each person had a newly competed care plan. However some improvements were still required. For example, people’s preferences in how they wished to be supported were not recorded. In September 2016 the manager had sent questionnaires to people to gain their views about the quality of the care and support in the home: we saw the results of these were favourable about the care being provided. A thank you letter from a relative was received by the home on the day of the inspection.

We made a recommendation for improvement and identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Inspection carried out on 1 August 2016

During a routine inspection

This inspection was unannounced and took place on 1 August 2016. The inspection started at 06:20 am to allow us to meet with the night staff and observe activity at the home first thing in the morning.

Briarcroft Care Home was registered to provide care for up to 20 people. People living at the home were older people, the majority of whom were living with dementia.

The home did not have a registered manager. Although there was a manager in post, they had not yet completed their registration with the Care Quality Commission, and are therefore referred to as the manager throughout this report. 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.

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Briarcroft Care Home was last inspected on 8, 10, and 13 July 2015. The home was rated as good across all key questions at that time. This inspection on 1 August 2016 was bought forward because we had received information of concern about the home since the last inspection, including about cleanliness, people being got up early, general care of people and a recent safeguarding concern about a person with a pressure ulcer.

On this inspection of 1 August 2016 we identified a number of concerns about the home, including issues around cleanliness and infection control, management and leadership, care planning, systems for managing quality and risk and a lack of action with regard to protecting people’s rights under the Mental Capacity Act 2005.

Risk assessments were not always in place or did not contain enough information to help keep people and others safe from risks associated with their care. This included concerns about the monitoring of people’s food and fluid intake where they had been assessed as being at risk, and support to help people with distressed or risky behaviours.

The environment was not always safe for people. We identified risks from the furnishings, equipment, poor cleanliness, and poor infection control. Some areas of the home were not being cleaned regularly or thoroughly, and stained or torn cushions and chairs were evident both in communal areas and in people’s rooms. Some areas were visibly dirty, and care and attention was not always being paid to quality issues such as making beds properly to help provide a comfortable environment for people to live in.

People’s rights under the Mental Capacity Act 2005 were not always being respected and applications had not been made for Deprivation of Liberty Safeguards where needed. Best interest decisions had not always been recorded. However staff had a good understanding of capacity and consent issues in day to day practice. Staff understood how to report concerns about people’s well being and welfare. Systems were in place for the management of complaints.

People were not always being protected from the risks associated with medicines, for example we found some prescriptions creams had been left out in people’s bedrooms. Other areas of medicines practice was well managed, and people received the medicines they were prescribed appropriately. People had access to the community healthcare services they needed, including medical specialists and community nurses.

There were enough staff on duty to meet people’s physical care needs on the day of the inspection, although staff told us that at times this was ‘tight’ dependent on people’s changing behaviour or needs. Staff were able to respond to people’s planned needs and care tasks, but people were left alone in the lounge and unobserved for periods, and there was a lack of dedicated time to support people socialise or engage with activities. The manager did not have a system to identify the number of staff needed based on the dependency level of the people at the home. We have made a r

Inspection carried out on 8, 10 and 13 July 2015

During a routine inspection

Briarcroft is a care home which provides accommodation for up to 20 older people who may be living with dementia. This inspection was unannounced and took place on 8, 10 and 13 July 2015. One adult social care inspector conducted this inspection. At the time of the inspection there were 19 people living in the service and 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were protected from the risks associated with medicines. Each person had a detailed care plan which identified risks to the person’s welfare and safety. Clear steps were taken to minimise risks where these had been identified. Care plans and risk assessments had been regularly reviewed and updated when needs had changed. Appropriate checks had been undertaken in relation to staff and their ability to work with vulnerable people.

Staff received appropriate training to enable them to deliver good quality care to people which was based on best practice. People were supported to eat and drink sufficient amounts to avoid possible dehydration and malnutrition. The food provided to people was of good quality and ensured people received a balanced diet tailored to their preferences. People were appropriately referred to outside services and healthcare professionals and their advice was used to update people’s care planning and risk assessments. People were supported to make decisions and choices and appropriate steps were taken in relation to the Mental Capacity Act (2005).

People were cared for by friendly, caring and patient staff who worked hard to improve the quality of life of people who lived in the home. Staff were encouraged to spend time with people and get to know their histories and their preferences. People expressed fondness towards the staff and spoke very highly of them. People were treated with dignity and respect.

Each person had a personalised care plan which had been created with them and their relatives. Care plans contained detailed information about their preferences, likes, dislikes and routines. Personalised risk assessments had been created with a view of supporting people to make the choices that mattered to them. People were asked for their opinions and encouraged to give feedback. Steps were taken to involve people and avoid them becoming isolated.

The service promoted an open and person centred culture. Staff were supported to provide feedback and take part in further training and qualifications. People were encouraged to visit the home unannounced in order to gain an accurate view of the care provided throughout the day. Appropriate quality monitoring and safety assessments were carried out.