Archived: Brierfield House

Brierfield House is purpose built residential care home, providing accommodation and personal care for up to 42 older people and people living with dementia. The home is close to the centre of Brierfield. Accommodation is provided over two floors; all bedrooms were single occupancy. At the time of the inspection 31 people were using the service.

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

Improvements were needed to how people's medicines were managed to ensure they were safe. People told us they felt safe at the service. We observed people were relaxed and content in the company of staff and managers. However, there had been a number of safeguarding incidents, we found action had been taken and was ongoing to make improvements. We made a recommendation about ensuring safe care and treatment. Some risks to people’s well-being and safety were not properly managed. The registered manager acted immediately to rectify matters and clear plans were in place to make improvements.

Although there were enough qualified staff available to provide safe care and support, there had been shortfalls with staffing arrangements. We were assured this matter had been resolved. The provider followed safe processes when recruiting staff. Staff were aware of the signs and indicators of abuse and they knew what to do if they had any concerns. The premises were clean and systems were in place to promote good hygiene.

The provider had not given proper attention to overseeing the service and checking people were receiving safe and effective care. We found positive steps were being taken to make improvements, but the shortfalls could have been minimised with earlier interventions. There had been changes in management and leadership which had an influenced on the day to day running of the service. Some staff were positive about the management and ongoing changes at the service, others were discontent. None of the people living at the service expressed any concerns about the management and leadership arrangements.

People’s needs and preferences were assessed before they moved to the service. But we found some matters had not been fully considered. We made a recommendation about assessing and reviewing people’s needs. Improvements had been made with supporting people with their healthcare needs. People said they were satisfied with the variety and quality of the meals provided at the service.

Some parts of the accommodation and outside areas needed improvement. However, the provider had plans in place to develop the service for people's comfort and wellbeing. 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 care plans to support their needs and preferences. However, some lacked information or needed updating to reflect people's current needs. We made a recommendation about planning for people’s needs. There were opportunities for people to engage in a range of group and individual activities. Visiting arrangements were flexible, relatives and friends were made welcome at the service. Processes were in place to support people with making complaints.

People made positive comments about the caring attitude of staff. They said their privacy and dignity was respected. We observed staff interacting with people in a kind, pleasant and friendly manner. Staff were respectful of people's choices and opinions.

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 25 September 2018).

Why we inspected

The inspection was prompted in part due to concerns received about medicines, staffing and general management. A decision was made for us to inspect and examine those risks.

Enforcement

We have identified breaches in relation to medicines management and monitoring and oversight of the service.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Brierfield House is a 'care home' which is registered to provide care and accommodation for up to 42 older people including people living with a dementia. People in care homes receive accommodation and nursing care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and both were looked at during this inspection. Nursing care is not provided at Brierfield House. At the time of our inspection 38 people were using the service.

There was a registered manager at the service. A registered manager is a person who has registered with the 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.

At the last inspection on 28 and 29 June 2016 the service was rated Good overall. However, we found the provider was in breach of one regulation of the Health and Social Care Act (Regulated Activities) Regulations 2014. This related to the registered provider not ensuring the premises and equipment were suitable and safe for their intended purpose. The provider sent us an action plan outlining the progress to be made. We found sufficient action had been completed to make improvements.

At this inspection, we found the evidence continued to support the overall rating of Good. Some sustained progress was needed with ensuring the safety of the premises, however, there was no evidence or information from our inspection and ongoing monitoring that showed serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

We found there were management and leadership arrangements in place to support the effective day to day running of the service.

People told us they felt safe at the service. Processes were in place to make sure all appropriate checks were carried out before staff started working at the service.

Staff were aware of the signs and indicators of abuse and they knew what to do if they had any concerns. Staff had received training on safeguarding and protection matters.

There were enough staff available to provide care and support; we found staffing arrangements were kept under review.

People’s needs were being assessed and planned for before they moved into the service. People were supported with their healthcare needs and received appropriate medical attention. Changes in people’s health and well-being were monitored and responded to.

Each person had a care plan, describing their individual needs, preferences and routines. This provided guidance for staff on how to provide support. People’s needs and choices were kept under review.

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 at the service supported this practice.

People made positive comments about the caring attitude of staff. They said their privacy and dignity was respected. Throughout the inspection we observed staff interacting with people in a kind, pleasant and friendly manner. They were respectful of people's choices and opinions.

We found visiting arrangements were flexible. People were keeping in contact with families and friends. There were opportunities for people to engage in a range of group and individual activities.

Most people said they were satisfied with the variety and quality of the meals provided. We found various choices were available. People were involved with devising menus.

People spoken with had an awareness of the service’s complaints procedure and processes. They indicated they would be confident in raising concerns.

There were adaptations and equipment to assist people with mobility and orientation. We found there was a good standard of décor and furnishings to provide for people’s comfort and wellbeing.

A variety of audits on quality and safety were completed regularly. Arrangements were in place to encourage people to express their views and be consulted about Brierfield House, they had opportunities to give feedback on their experience of the service.

Further information is in the detailed findings below.

Brierfield House is a purpose built care home located in a residential area on the outskirts of Brierfield, near Nelson. The home is registered to provide care and accommodation for up to 42 older people including people with a dementia. The accommodation is provided over two floors and is divided into two separate areas. A passenger lift is available for access between the floors. On the first floor there is a lounge, a dining area with kitchen facilities and a ‘sensory room’. On the ground floor there is a reception area with seating, a lounge/dining room and a conservatory. There are bedrooms located on both floors. All bedrooms are single and have en-suite toilets. There is an enclosed garden to the rear of the premises with raised flower beds, garden furniture and a shelter for people who smoke. There are several car parking spaces to the front of the building. When we visited there were 37 people accommodated at the service.

At the time of the inspection the registered manager had left the service. 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. There was a new manager in post who had applied for registration with the commission. Following the inspection visit we noted the manager’s registration had been completed on 12 July 2016.

At our last inspection on 15 May 2014, the provider was compliant will all of the standards that were reviewed at the time. At this inspection we found the provider was in breach of one regulation of the Health and Social Care Act (Regulated Activities) Regulations 2014. This related to the provider not having ensured the premises and equipment were suitable and safe for people who used the service. You can see what action we told the provider to take at the back of the full version of the report.

There were some good processes in place to manage and store people’s medicines safely. However, we found some improvements were needed in certain areas; therefore we have made a recommendation about the management of medicines.

There was an open and friendly atmosphere at the service. We found there were some good systems and arrangements in place to promote an efficient day to day running of the service.

People told us they felt safe at the service and they made positive comments about the care and support they experienced. They said “It’s lovely here the staff look after you” and “My relative has improved since coming to Brierfield House.” We observed people being supported and cared for by staff with kindness and compassion.

Recruitment practices made sure appropriate checks were carried out before staff started working at the service. Staff were aware of the signs and indicators of abuse and they knew what to do if they had any concerns. Staff confirmed they had received training on safeguarding and protection.

People’s needs were being assessed and planned for before they moved into the service. Everyone had a care plan, which had been reviewed and updated on a monthly basis. Information was included regarding people’s likes, dislikes and preferences, routines, how people communicated and any risks to their well-being.

People were supported with their healthcare needs and medical appointments. Changes in people’s health and well-being were monitored and responded to.

People spoken with indicated they were treated with kindness and compassion. Throughout the inspection we observed staff interacting with people in a kind, pleasant and friendly manner and being respectful of people's choices and opinions. People said their privacy and dignity was respected.

The service was working within the principles of the MCA (Mental Capacity Act 2005). During the inspection we observed staff involving people in routine decisions and consulting with them on their individual needs and preferences.

People were happy with the variety and quality of the meals provided at the service. Support was provided with dietary requirements in response to individual needs. We found various choices were on offer. Drinks were readily accessible and regularly offered.

People told us how they were keeping in contact with families and friends. Visiting arrangements were flexible. There were opportunities for people to engage in a range of suitable activities both inside and outside the home.

Systems were in place to ensure all staff received regular training, supervision and support. Staff spoken with understood their role in providing people with effective care and support.

People spoken with had an awareness of the service’s complaints procedure and processes. They said they would be confident in raising concerns. We found records were kept of the complaints and the action taken.

Arrangements were in place to encouraged people to express their views and be consulted, they had opportunities to give feedback about the service. There were systems in place to monitor the quality of the service and evidence to show improvements were made as a result of this.

• 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:

Is the service safe?

People told us they felt safe at the service. One person said,“I have no worries, I feel safe here”. We found arrangements were in place to protect people from abuse and the risks of abuse.

People said they were satisfied with the clean, comfortable and well maintained accommodation provided at Brierfield House. We found action was being taken to improve the bathing facilities for people’s well-being and safety.

We found the staffing arrangements were sufficient in ensuring people received effective care and support. There were enough staff on duty to respond to the needs of people who used the service. Arrangements were in place to provide suitable staff training and management support.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, appropriate policies and procedures were in place. Relevant staff had been trained to understand their responsibilities in supporting this process.

Is the service effective?

People told us they were happy with the support they experienced at Brierfield House. We found people were involved with decisions which affected them on a daily basis and in residents meetings. One person said, “We talk about things in general, they try to follow up our suggestions, I think it’s a good thing”.

Processes were in place for staff to attain nationally recognised qualifications. Staff spoken with, told us of the training they had received. They were aware of people’s needs and gave examples of how they delivered support.

People said they were satisfied with the catering arrangements at the service. One person said, “They ask us what we want and we can choose; we get plenty”.

Is the service caring?

People who used the service told us they were happy with the care and support they experienced at Brierfield House. They said: “The care is fine, they are nice people”, “It’s nice here, we can do what we want” and “They are good with us, we are looked after very well”.

We observed staff treating people in a kind, friendly and respectful way. People told us they were happy with the staff team they said, “They are nice people” and “The staff are very good”.

We found arrangements were in place to assess people's needs and abilities prior to admission. This meant individual needs and choices would be considered and planned for before they moved into the home.

Records and discussion showed people were getting attention as appropriate, from healthcare professionals. Staff confirmed people had access to a range of healthcare resources.

Arrangements were in place to offer a range of individual and group activities. People spoken with were mostly satisfied with various activities, events and visiting entertainers.

Is the service well-led?

The service had a registered manager responsible for the day to day running of the home. There was a management team to provide ongoing direction and supervision of the service. Support and expertise was also provided by external management within the organisation.

There were systems in place to assess and monitor how the home was managed and to evaluate the quality of the service. People using the service and their relatives had completed satisfaction surveys. We were given examples of the manager and owners making changes and improvements, following discussions and requests from people using the service.

We saw that members of staff were courteous and attentive to people's needs. One person said, 'I'm quite content.' One visitor said, 'I'm pleased with the home, it's very good. The staff are friendly and helpful.'

We found that a sufficient number of staff was employed at the home in order to meet the health and social care needs of people using the service.

We noted that systems were in place to monitor the quality of the service provided. There was evidence to demonstrate that people were regularly consulted about the care and facilities provided at the home.

We saw that appropriate and accurate records were kept for people using the service and the overall effective management of the home.

We saw that people were treated with respect and a variety of leisure activities including ones suitable for people with a dementia were organised everyday.

We found that members of staff had a good understanding of safeguarding procedures and told us they would report any concerns immediately.

Members of staff told us they received the training they needed in order to provide safe and appropriate care for people using the service.

We noted that systems were in place to effectively monitor the quality of the service provided. There was evidence to demonstrate that people were regularly consulted about all aspects of the care and facilities provided at the home.