Archived: Bryan Wood

Bryan Wood is residential care home providing personal and nursing care to 27 people aged 65 and over at the time of the inspection. The service can support up to 45 people.

People’s experience of using this service and what we found

People received their medicines as prescribed. Systems were in place to maintain people's safety and protect them from abuse. Risks were identified, appropriate control measures were implemented, and the safety and cleanliness of the environment was maintained. Systems were in place to recruit staff safely and there were adequate staffing levels in place to meet people’s needs.

Systems were in place to monitor the quality and safety of the service and drive improvement. However, oversight of staff training had not been effectively managed. We have made a recommendation about this. There was no registered manager. The service was run by a manager and supported by a regional manager. The provider had oversight of the service. Staff morale had not always been positive; steps were taken to improve this.

People’s feedback was used to make decisions about the running of the service. Links were developed with organisations to ensure outcomes were achieved for people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 4 September 2018).

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The inspection was prompted in part due to concerns received about the management of the service. A decision was made for us to inspect and examine those risks.

As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvement. Please see the well-led section of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bryan Wood on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Bryan Wood is registered to provide accommodation and personal care for up to 45 people. There were 36 people living at the home on the day of our inspection. Bryan Wood is a large three-storey building offering accommodation across three floors accessed by a passenger lift. One floor is designated for people living with dementia. Each floor has a communal lounge and bathrooms. Outside there is a courtyard with seating.

Bryan Wood is a ‘care home’. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home had a registered manager who was available throughout our inspection. 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.

People and their relatives told us they felt very safe living at Bryan Wood and their relatives also felt assured their family member was safe. All staff had received safeguarding training and knew how to identify and report suspected abuse and knew the procedure to report any incidents.

Standardised risk assessments were used in care plans so risks to people’s health and safety could be effectively tracked and monitored.

People’s dependency was monitored regularly and staffing levels supported people’s needs. Recruitment processes were thorough ensuring staff were employed who were suitable to work in a care home setting.

Medicines were administered safely and with due consideration to national guidance.

Staff were appropriately trained and knowledgeable about infection control procedures.

The registered manager had robust systems in place for monitoring accidents and incidents and ensuring learning from these was implemented and understood through regular staff meetings and supervisions.

Care plans contained detailed personal histories, and people’s preferences in relation to their physical needs, and social and leisure activities. Appropriate consideration had been given to people’s consent and their capacity to do so for a range of care and support needs. The registered provider was operating within the principles of the Mental Capacity Act 2005 and applications to lawfully deprive people of their liberty (DoLS) had been appropriately submitted to the local authority.

Training completion levels were high. Staff supervisions were planned and taking place regularly. Annual appraisals were up to date. Communication between the registered provider, the registered manager and staff was good.

People were provided with a good choice of freshly prepared food and ‘hydration stations’ and ‘snack stations’ throughout the home were well-used.

People were supported to receive access to healthcare which was demonstrated and recorded in care plans.

People were consulted and involved in refurbishment plans. Dementia-friendly signage was in evidence throughout the home as well as pictorial noticeboards. People’s bedrooms were highly personalised.

Staff were aware of the need to ensure people’s dignity and respect their privacy. Staff were aware to support people’s independence wherever possible.

The registered provider’s monthly quality reports showed effective oversight of the service. The registered manager had systems to monitor quality throughout the home. Accidents and incidents were monitored and trend analysis undertaken. The home had volunteered to be part of a falls reduction pilot, which analysis showed had proved successful. Fire safety and building maintenance was well managed.

Feedback was actively sought to engage people, relatives and staff in the running of the service. Information from this was analysed to develop and improve the service.

Bryan Wood is registered to provide accommodation and personal care for maximum of 45 people. There were 34 people living at the home on the day of our inspection. Accommodation is provided in an extension to the main Victorian house over two floors, with one floor designated for people living with dementia. There are also a small number of bedrooms in the Victorian part of the building accessed by a passenger lift.

There was no registered manager in place but the registered provider had appointed a new manager who was in the process of registering with the Care Quality Commission. 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 registered provider had put in systems to support the new manager to develop into their role.

Since our last inspection there had been instability in the management at the home, as the previous registered manager had left the service and a new manager appointed but left after being in post for a short time. This meant that although significant improvements were found at this inspection, the home had not yet demonstrated improvements had been sustained. This included ensuring all staff received regular supervision and were trained to develop into their roles. This had been planned but had not yet been completed and there had been a gap where staff had not received supervision.

All the staff we spoke with demonstrated a good understanding of how to ensure people were safeguarded against abuse and they knew the procedure to follow to report any incidents.

Standardised risk assessments had been undertaken for those people at risk of malnutrition and pressure sores. Other risk assessments such as choking risk assessments were in place and we observed practice which confirmed risks were reduced. There had been an improvement in moving and handling risk assessment and care planning since our last inspection and the number of falls at the home had significantly reduced over the past two months.

We found the necessary recruitment checks had been made to ensure staff suitability to work in the home and staff received an induction to ensure they developed into their role and were able to shadow shifts with more experienced staff to ensure they felt confident to take on the caring role.

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.

Food was freshly prepared and choice was offered at mealtimes. We observed staff supporting people with their meals and senior staff monitored people at risk of malnutrition to ensure they had adequate nutrition and hydration.

We found staff to be compassionate and caring when dealing with the people who lived at Bryan Wood. We observed staff protecting people’s privacy and dignity and ensuring their needs in relation to equality and diversity were appropriately met.

People were provided with care which met their choices and preferences such as what time they got up, went to bed, what they ate and they were encouraged to share their views on how they wanted the service to be run. Staff we spoke with demonstrated they were aware of the needs of the people they were supporting and their individual personalities and preferences.

The activities coordinator engaged with people to ensure activities were meaningful to the people who lived there and there were plans in place to ensure activities were appropriate for people living with dementia.

We found an inconsistent standard and quality of recording but this had been recognised and care plans had been audited to give staff clear direction where improvements were required.

Staff spoke highly of the new manager who was being supported into the role by a peripatetic manager and a regional manager. The new manager was passionate about raising the profile of Bryan Wood to be a homely location where people would consider they were at home.

Both day to day and the quality improvement audits had improved since our last inspection and actions were completed where issues had been identified. The registered provider completed detailed audits of the home and identified actions to raise the quality of the service. They transferred these actions into a home improvement plan and outcomes were monitored by the regional manager. People were involved in developing the service and one person who used the service was actively involved in chairing the 'residents and relatives’ meeting.

We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five key questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

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

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People were cared for in an environment that was clean and hygienic. However, we found parts of the premises were in need of updating. We were told the person employed for the purpose of maintaining the home had recently had their working hours reduced. The manager told us this had impacted on the maintenance of the home.

There were enough staff on duty to meet the needs of the people who lived at the home.

One visitor, who was a relative told us; 'They seem to have plenty of staff around and they're always friendly.'

Is the service effective?

We looked at three people's care records we saw their individual needs were assessed thoroughly and care and support was developed from an assessment of their needs.

People were provided with a healthy, nutritionally balanced diet to support their health. This protected people from the risks of inadequate nutrition and dehydration.

Is the service caring?

People were supported by kind and attentive staff who obviously knew people well. We saw that care assistants were patient and encouraging when supporting people.

The three people we spoke with all told us they were very happy with the care they received at the home. One person told us, 'The staff are so good to me. Nothing is too much trouble for them. I feel very well cared for. The food is lovely too, and there are always snacks available. I've put two stone on since I came here.'

The care assistants we spoke with told us they felt confident the service provided to people who lived at the home was good and they had a good staff team.

When we looked around the home we saw people's bedrooms had been personalised and contained personal items such as family photographs.

Is the service responsive?

We saw from the care records that people's needs had been assessed before they moved into the home. Records confirmed people's preferences, interests and life histories had been recorded. The care, treatment and support provided at the home met people's individual needs.

People were supported to maintain relationships with their friends and relatives.

Is the service well-led?

Staff we spoke with told us they felt well-supported by the manager. One of them said, 'The manager is really nice; very approachable and encouraging.'

(During our inspection) we reviewed how peoples' care and treatment needs were assessed, planned, and delivered in order to ensure their safety and welfare. We also spent time talking with people who lived at the home. All of the people we spoke with told us they were, 'Comfortable' living at the home and the majority also told us, "The staff are very nice and look after us well." One visitor told us their relative was "Really well looked after."

In the main reception area there was a range of information on display for people who lived at the home, their relatives and visitors. This included previous CQC inspections, the homes brochure of services, healthy eating information, planned activities, photos, posters and items of memorabilia which related to the past and present day.

The main entrance and internal doors were all secured and controlled by electronic key codes to keep people safe. We saw staff answering the main entrance door. If staff were not able to recognise people they enquired as to whom they were and asked them to sign the visitor's book in the main entrance.