Archived: Briar House

The service accommodates up to 62 people in a two-storey building which is served by a main lift to the upper floor. Nursing care is not provided.

At our comprehensive inspection in September 2016 the service was rated as requires improvement. There were not enough staff to ensure that people’s needs were met in a timely way. Staff were not recording people whose nutritional intake was poor. Improvements were needed in the quality monitoring ensure that the service could develop and improve. This unannounced inspection took place on 5 June 2018. Improvements had been made and the service is now rated as good.

There was not a registered manager in post. A registered manager is a person who has registered with the CQC to manage the home. 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 home is run.

A new manager was in post and they had applied to the Commission for registration.

People were kept safe and staff were knowledgeable about reporting any incidents of harm.

People’s individual risk assessments in care records had been developed to minimise the potential risk of harm to people during the delivery of their care. Care records showed they were reviewed and any changes had been recorded.

The environment was clean and a safe place for people to live. We found equipment had been serviced and maintained as required. Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection. We found supplies were available for staff to use when required.

People were helped to take their medicines by staff who were trained and had been assessed to be competent to administer medicines.

People were looked after by enough staff, who were trained and supervised to support them with their individual needs. Pre-employment checks were completed on staff before they were assessed to be suitable to look after people who used the service.

Staff were able to demonstrate their understanding of the principles of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions.

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 supported this practice.

People had access to healthcare professionals and their healthcare needs had been met. Care records seen confirmed visits to and from General Practitioners (GP's) and other healthcare professionals had been recorded.

People were supported to eat and drink sufficient amounts of food and drink.

Staff knew people they supported and provided a personalised service in a caring way. Care plans were organised and had identified care and support people required. We found by conversations with staff they had a good understanding of protecting and respecting people's human rights.

People participated in a range of activities within the service and received the support they needed to help them to do this.

Information available with regards to support from an external advocate should this be required by them.

People were involved in the running of the service. Regular meetings were held for the people and their relatives so that they could discuss any issues or make recommendations for improvements to how the service was run.

There was a process in place so that people’s concerns and complaints were listened to and were acted upon.

Quality monitoring procedures were in place and action was taken where improvements were identified. There were clear management arrangements in place. Staff, people and their relatives were able to make suggestions and actions were taken as a result.

Further information is in the detailed findings below.

There had been a change of manager prior to our visit and the new manager had not yet completed the process to register with us. 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. The home has a new manager, who is in the process of applying to register.

There were not always enough staff available to meet people’s needs and people sometimes had to wait for their care.

You can see what action we told the provider to take at the back of the full version of the report.

Staff knew how to safeguard people from the risk of abuse and how to report concerns to the relevant agencies. Individual risks to people’s safety had been assessed by staff and actions had been taken to reduce or remove these risks. There was adequate servicing and maintenance checks to fire equipment and systems in the home to ensure people’s safety.

People felt safe living at the home and staff supported them in a way that they preferred. Most recruitment checks for new staff members were obtained before new staff members started work, although gaps in employment histories were not always checked.

Medicines were securely and safely stored. Medicines were safely administered, and staff members who administered medicines had been trained to do so. Staff members received other training, which provided them with the skills and knowledge to carry out their roles. Staff received adequate support from the registered manager and senior staff, which they found helpful.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The service was meeting the requirements of DoLS. The registered manager had acted on the requirements of the safeguards to ensure that people were protected. Staff members understood the MCA and presumed people had the capacity to make decisions first. Where someone lacked capacity, best interests decisions had been made.

People enjoyed their meals and were able to choose what they ate and drank. Guidance for staff about how much people should drink each day was not always available and records showed that staff did not always accurately record how much people drank. Staff members worked together with health professionals in the community to ensure suitable health provision was in place for people.

Staff were caring, kind, respectful and courteous. Staff members knew people well, what they liked and how they wanted to be treated. Staff responded well to people’s needs and support was nearly always available. Care plans usually contained enough information to support people with their needs. Staff members knew how to care for people when this information was not recorded.

A complaints procedure was available and people were happy that they did not need to make a complaint. The deputy manager was supportive and approachable, and people or other staff members could speak with them at any time.

The provider monitored care and other records to assess the risks to people, although these did not always identify where care and staffing records were missing information or where systems were incorrect.

We also spoke with the manager and an operations manager who represented the provider. We also reviewed records relating to the management of the service which included three care plans, daily records and quality assurance monitoring records.

Below is a summary of what we found. The summary describes 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 well led?

We looked at the additional checks, audits and actions that the provider had put into place. They showed us that there had been some improvement, although some issues were still not being picked up. Although the home had sufficient plans in place to ensure that the quality of the service provided was assessed and monitored properly, further action was still required to make sure the risks to people were reduced.

As part of this inspection we spoke with a minimum of 15 people who used the service, four of their relatives/visitors, the registered manager, two senior managers who represented the provider, and a minimum of 16 members of staff. We used the Short Observational Framework for Inspection (SOFI). We also reviewed records relating to the management of the service which included 16 care plans, daily records, staff records and quality assurance monitoring records.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

Is the service safe?

When people’s health and safety risk assessments had been carried out, these were not always done with accuracy. This meant that people were placed at risk of receiving inappropriate care due to the inaccuracy of these assessments. This meant there had been a breach of the relevant legal Regulation (Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010) and the action we have asked the provider to take can be found at the back of this report.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care services. While no applications had needed to be submitted, arrangements had been made for relevant staff to be trained to understand when an application should be made, and how to submit one. Briar House looks after people living with dementia. However, we found insufficient evidence to demonstrate that people were provided with support and care and this was done in their best interest.

People were safe because they were supported to manage their prescribed medication. People were satisfied with how they were supported with their prescribed medication and described this as, “Perfect.”

Some, but not all, pieces of equipment were safe for people to use. Although remedial action had been taken to improve the levels of safety risks, this action was ineffective. This meant that people remained unsafe as a result. This meant there had been a breach of the relevant legal Regulation (Regulation 16 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010) and the action we have asked the provider to take can be found at the back of this report.

There was an insufficient numbers of staff employed to provide people with consistent, safe and appropriate support and care. This meant there had been a breach of the relevant legal Regulation (Regulation 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010) and the action we have asked the provider to take can be found at the back of this report.

Is the service effective?

People’s choices and decisions about their support and care were not always assessed. It was unclear, therefore, what people wanted and chose to do. In addition, members of staff were not always able to meet people’s complex communication needs. There was also insufficient evidence to demonstrate how people living with dementia had their individual communication and mental health needs effectively met. This meant there had been a breach of the relevant legal Regulation (Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010) and the action we have asked the provider to take can be found at the back of this report.

The standard of support and care had often failed to provide people with the respect and dignity that they had the right to. This was due to the way they were looked after. This meant there had been a breach of the relevant legal Regulation (Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010) and the action we have asked the provider to take can be found at the back of this report.

Is the service caring?

People who we spoke with, including some relatives and visitors of people who used the service, said that they liked the members of staff and how they were being looked after. However, we found examples where people were looked after without warmth and compassion.

People were not always protected from the mental ill-health risks of feelings of being isolated. This was because members of staff failed consistently to effectively engage with individual people. There was also a lack of appropriate stimulation to promote people’s sense of wellbeing. This meant there had been a breach of the relevant legal Regulation (Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010) and the action we have asked the provider to take can be found at the back of this report.

Is the service responsive?

People’s needs, choices and personal preferences had not always been assessed and therefore it was unclear how these could be acted on. Furthermore, people’s individual social and health care needs were not always responded to. This meant there had been a breach of the relevant legal Regulation (Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010) and the action we have asked the provider to take can be found at the back of this report.

Is the service well-led?

There were ineffective and a lack of monitoring and reviewing systems in place in relation to care records, complaints and accidents and incidents. This meant that people were placed at risk of unsafe and inappropriate care. It also meant that the provider failed to learn from incidents and subsequently failed to improve the safety and quality of people’s support and care. This meant there had been a breach of the relevant legal Regulation (Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010) and the action we have asked the provider to take can be found at the back of this report.

People who used the service and staff members were provided with opportunities to make suggestions and comments to improve the quality of their support and care. Surveys were carried out for people to complete.

Members of staff were enabled to make suggestions and take actions to improve the standard and quality of people’s support and care.

After this inspection the provider wrote to us and said that it had completed all of the necessary improvements.

At our inspection of 3 October 2013 people who used the service said that they were receiving all of the care they needed. They told us that the service provided a comfortable setting in which to live. They also said that staff were kind, caring and trustworthy. One of them said, "The staff are very kind to us and are caring. I get all of the help I need."

At this inspection we found that staff had received training and were confident about how to protect the interests of people whose liberty needed to be restricted. Also, we found that the accommodation provided a safe and comfortable environment.

We saw that staff had consulted with people who used the service (and their representatives) about what assistance was to be provided.

People said that they received all of the health and personal care they needed. Records confirmed that assistance had been provided in a safe, reliable and responsive way.

Records showed that there was a varied menu of meals. We saw that meals were presented in an attractive way and that when necessary people were given individual assistance to dine.

We found that the provider had measures in place to help safeguard people from abuse. However, more robust arrangements needed to be made to support people who might need to have their liberty restricted in order to keep them safe.

The provider had not fully ensured that people who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises. One area of the accommodation had a stale atmosphere. Some parts of the fire safety regime were not robust. Some of the arrangements used to ensure the security of the building were not fully developed.

We spoke with relatives of people who use services at Briar House who told us they had been involved in the planning of care for the person and continued to be consulted when the plan of care changed. We observed staff speaking to people, asking them how they felt and what they (staff) could do for them. One person we spoke with told us, "I am told what is going on and know I am being cared for here".

Care plans we examined were appropriate to the needs of the person concerned and were easily understood. Risk assessments were also completed for each person and these were seen to be regularly reviewed and updated.

Medication records were recorded accurately with a regular management audit policy seen to be in place. Special instructions from people's doctors were also seen with an associated plan of care in relation to those instructions being kept in people's care plans. This was to ensure people using the service were protected against the risks associated with the unsafe use and management of medicines.