This inspection took place on 5 and 12 March 2015 and was unannounced.
The provider of Bryden House is registered to provide accommodation and nursing care for up to 30 people who have nursing needs. At the time of this inspection 27 people lived at the home.
In November 2014 the ownership of the home changed. This meant there was a new registered provider and the former deputy manager was now the manager of the home. The manager was in the process of applying to become the registered manager. 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.
Staff told us they had received training to support them to understand the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). This law sets out to support the rights of people who do not have the capacity to make their own decisions or whose activities have been restricted in some way in order to keep them safe. We found there was an inconsistent approach in applying the MCA in order to support people’s rights when specific decisions needed to be made so that the right people were involved. This meant the required standards of the law that related to the MCA were not always being met to promote people’s best interests.
The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Where people had been assessed as needing their liberty restricted to keep them safe, referrals had been made to the local authority for their approval. However, practices needed to be strengthened to ensure any urgent DoLS authorisations were reviewed within the required time to do this so that people were not being restricted unlawfully.
All the people we spoke with told us they felt well cared for and felt safe living at the home. People told us staff were respectful and kind towards them and staff were caring to people throughout our inspection. Staff protected people’s privacy and dignity when they provided care to people and staff asked people for their consent, before any care was given.
People had their prescribed medicines available to them and these were administered by staff who had received the training to do this.
Staffing levels promoted people’s needs appropriately. This included staff responding to people’s requests for help and support at times they wanted and needed this.
Arrangements were in place to recruit staff who were suitable to work in the service and to protect people against risks of abuse.
We found people received care and support from staff who had the clinical knowledge and expertise to care for people. However, staff were not aware and did not have all the information they needed about a significant health symptom which could impact upon the person not receiving effective care and treatment when they needed it.
Staff supported people with their meals so that people received nourishing diets and drinks.
People received staff support to follow their individual pastimes and improvements to enhance people’s opportunities of social events were going to be progressed further.
People we spoke with told us they knew how to raise any concerns and who they should report any concerns to. Staff knew how to support people to raise any concerns they had. The provider had a complaints procedure displayed so that people accessed this information.
The manager needed to improve their knowledge regarding their responsibilities around submitting statutory notifications to the Care Quality Commission (CQC). The manager had failed to notify the CQC of an incident which the provider is required to do by law.
The provider and manager were committed to making improvements to the service people received. However, the process for monitoring and checking the quality of the service needed to be strengthened further so that actions to drive through improvements were prioritised for the benefit of people who lived there. This included the arrangements in place for care and medicine documentation to ensure these reflected the care people needed and received.
You can see what action we told the provider to take at the back of the full version of the report.