Archived: Brierfield Residential Home

Brierfield Residential Home is a residential care home providing personal care to up to 26 people. The service provides support to older people in one adapted building. At the time of our inspection there were 19 people using the service, some people were living with dementia.

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

Risks were not always being identified and measures put in place to reduce these risks. This included the safety of the stairs in the building and routine checks on the water system to reduce the risks of legionella bacteria. This had not been identified in the provider’s own governance systems.

Risks in people’s daily lives were being assessed, however the risk assessments in their care plans did not always provide detailed guidance for staff in how the risks were mitigated. There were some inconsistencies in people’s care plans, we were assured this was being addressed by the registered manager.

Prior to our inspection, we had received concerns regarding the quality and safety of care provided in the service. The service was working on an action plan with support from the local authority to implement improvements. Although some improvements had been made, for example in the staffing levels, progress had not always been made in a timely way. We were also concerned that all of the shortfalls had not been independently identified by the provider and actions taken prior to them being pointed out.

Improvements were needed in the provision of training for staff, not all staff had received training in safeguarding and there was only one staff member who had received training in supporting people with behaviours others may find challenging.

Medicines were being monitored and checked. The management team had identified shortfalls in the recording of the administration of medicines, such as creams, and medicines to be administered where required. We were assured actions were being taken to improve this.

Improvements were needed in the general cleaning of the service, such as cobwebs in the communal lounge and a build-up of dust on the stairs. Staff wore appropriate personal protective equipment (PPE) such as masks. However, where staff were wearing gloves and aprons to support people with their personal care needs, they were seen to be walking around the service in these prior to and following supporting people, which is not recommended infection control practice.

During our inspection we found that improvements were being made in areas such as how much people had to drink, how staff were deployed to reduce risks in the communal areas, governance systems and the overall monitoring of the service provision to people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Deprivation of Liberty Safeguard referrals were made where required and people’s capacity was identified in their care records.

People using the service told us they were happy, and the staff treated them with kindness. During our visit several people went out for a meal in a local restaurant.

The management team were working to improve the service and had developed a shared a commitment to ensure people were receiving good and safe quality care moving forward.

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 February 2020).

Why we inspected

We received concerns in relation to governance, the safety of the service provision and care provided and staffing levels. 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 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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We have identified breaches in relation to safe care and treatment and governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

People were being supported to receive visits from their relatives. Visits were being completed in line with current government guidance.

The service was visibly clean and ventilated.

Staff and people using the service received regular COVID-19 testing in line with current government guidelines.

Vaccination records were monitored and stored by the manager for people, staff and regular visitors. Where visiting professionals attended the service, their vaccination status was checked.

Brierfield Residential Home is a residential care home providing personal care to up to 26 older people, in one adapted building. At the time of our inspection there were 18 people using the service, the majority were living with dementia.

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

Systems were in place to reduce the risks of people experiencing avoidable harm and abuse. Risks to people were assessed and systems were in place to reduce them. Medicines were managed safely, and people received their medicines when they needed them. There were enough staff to meet people’s needs and recruitment of staff was done safely.

The service was visibly clean, and systems reduced the risks of cross infection. The environment was suitable for the people who lived there.

Staff were trained to meet the needs of the people they supported. People’s needs relating to their health and diet were assessed and met. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People received care and support from a kind and compassionate staff team. People’s rights to privacy, dignity and independence were promoted and respected.

People’s needs were assessed, planned for and met. People’s decisions and choices relating to their care preferences were valued and documented, including people’s end of life decisions. People had access to meaningful activities to reduce the risks of boredom and isolation.

There was a complaints procedure in place and people’s concerns and complaints were addressed and used to drive improvement. There were systems to monitor the service provided to people and address any identified shortfalls promptly to provide people with good quality care.

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 10 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Our last inspection of 9 February 2015 this service was rated as Good. During this inspection we found that the service had continued to maintain a Good service and was Outstanding in Responsive.

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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service was extremely responsive to people's individual needs. People were provided with exceptionally personalised care and support which was planned to meet their individual needs. Care and support was planned proactively and in partnership with people.

The provision of activities was innovative and met people's needs and preferences. Activities and social inclusion were designed to enhance their wellbeing and enable them to live a full life as possible. People were encouraged to share their hopes and aspirations and the service used creative ways of meeting them to ensure they were valued.

People were actively encouraged to give their views about the service. A complaints procedure was in place. People's concerns and complaints were listened to, addressed in a timely manner and used to drive improvements in the service.

The service continued to provide a safe service to people. This included systems in place intended to minimise the risks to people, including from abuse and with their medicines. Staff were available when people needed assistance and the recruitment of staff was done safely.

People continued to be supported by staff who were trained and supported to meet their needs. 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. Systems were in place to assess and meet people’s dietary and health needs.

People who used the service continued to have good relationships with staff. People continued to be involved in making decisions about their care and support.

The service continued to have a quality assurance system and shortfalls were identified and addressed. As a result the quality of the service continued to improve.

Further information is in the detailed findings below.

People were protected from the risks of inadequate nutrition and dehydration. Their dietary needs and preferences were catered for and they told us that they enjoyed the food. One person said, 'The food is good ' always nice and hot'. A visiting family member commented that people's food preferences were respected.

People's health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others.

Effective recruitment and selection processes ensured that people were cared for by suitably qualified, skilled and experienced staff.

During our inspection we observed that the staff were attentive to people's needs. Staff interacted with people using the service in a friendly, respectful and professional manner. We saw that staff sought their agreement before providing any support or assistance.

Most of the people we saw were relaxed, engaged with their surroundings and interacted well with each other. If people became distressed or worried, staff attended to them quickly and acted to distract them or to offer them comfort.