Briarcroft Care Home

Updated 6 May 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by one inspector.

Service and service type

Briarcroft Care Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Briarcroft Care Home is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

During the inspection we spoke with people living at the service and spent time making observations in the communal lounge and in the dining room at lunch time. We spoke with 1 health professional, 1 relative and 4 members of staff including the registered manager. We reviewed a range of records including 2 people’s care plans, medicines records, 3 staff files and records relating to safety and governance.

Following our site visit we spoke with 6 people’s relatives, 5 health professionals and 3 members of staff on the telephone. We also met with the provider via videocall.

Updated 6 May 2023

About the service

Briarcroft Care Home is a residential care home providing care and accommodation to up to 21 people. The service provides support to older people living with dementia. At the time of our inspection there were 20 people using the service.

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

Environmental risks were not always identified or well managed. Some risks relating to fire safety had not been identified, the premises and equipment were not well maintained and in parts the premises was in poor repair, and visibly dirty. Governance systems had failed to identify the concerns identified at this inspection.

Following our site visit, we contacted the fire service with our concerns. They inspected the premises and made 7 recommendations the provider should address to ensure compliance with fire safety requirements. The provider assured us they would take action to address fire safety concerns and the maintenance issues identified.

Whilst there was no evidence people had been harmed, people were at potential risk of harm. This was because records didn’t always evidence care being provided in line with individual care plans, risk assessments had not always been completed, and staff had not completed training specific to people’s needs.

There were a range of risk assessments in place, and they were regularly reviewed. Some individual risks were very well managed. For example, staff were skilled at managing risks around people’s behaviours, particularly when people were experiencing significant distress and agitation. One visiting health professional told us they were supporting a person who had 3 previous placements terminated due to their behaviours. They said, “Briarcroft have worked so hard, with the support of the [health professionals] Team, on finding strategies that work for [person’s name]. Systems and processes to protect people from abuse were in place and being operated effectively. Staff and people’s relatives told us they felt comfortable raising concerns. Staff were recruited safely, and there were enough staff to meet people’s needs. People received their medicines safely and there were good medicines management systems in place. Incidents and accidents were analysed on a regular basis and any themes or patterns identified.

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.

The culture of the service was open and inclusive, and staff worked with other professionals to ensure people achieved good outcomes. All the relatives we spoke to gave positive feedback about the staff team. Comments included, “From the first time I stepped into Briarcroft, it felt like a blanket of love”. “I don’t have enough good words to say. They are brilliant. It’s like a real home”. And, “They’re wonderful, been fantastic, like a family to me. [Relative] is so happy”. Staff supported several people who had failed placements elsewhere. They were non-judgmental about how people expressed their emotions and worked with people and professionals to develop positive strategies to support people.

Staff were keen to continuously learn and improve care and sought opportunities to engage with external professionals to do so. Two senior staff had volunteered to take part in a hydration pilot project with a view to improving hydration and reducing urinary tract infections and falls. In December 2021 they were awarded a silver award in recognition of their work. The service had also engaged in a research project with Plymouth University looking at what constituted good quality care across a range of services. Health care professionals highlighted how open the service was and how keen they were to improve. One said, “They genuinely have people’s best interests at heart”. The registered manager sought feedback from people’s relatives both informally and via an annual survey. The provider collated the responses and we saw people’s relatives openly shared both positive and constructive feedback.

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 (22/02/2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service and the length of time since we last rated the service.

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 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.

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

The provider has taken action to address the concerns identified at this inspection, including engaging an external fire safety company to complete a professional fire risk assessment.

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

Enforcement

We have identified breaches in relation to premises and equipment, safe care and treatment and good 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 continue to monitor information we receive about the service, which will help inform when we next inspect.