Bryony Lodge

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We found two breaches of the legal regulations. During our assessment we found people were not always protected from avoidable harm because risks associated with people’s support needs had not always been assessed, monitored, or mitigated safely. Infection prevention and control practices were not always safe. People were not always monitored effectively to enable staff to take prompt action if their condition deteriorated. The Provider was responsive during our assessment and had made improvements, but these were not yet embedded. There was a safeguarding policy in place, staff had been recruited safely and staff had received safeguarding training. Staff had a good understanding of safeguarding and were confident to raise concerns if needed. Incidents were investigated and lessons were learned. People received their medicines as prescribed.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We received feedback from five people and two relatives. Relatives told us they could raise concerns with staff and with management. However, these concerns were not always dealt with appropriately and concerns were not always resolved. Relatives told us that this has improved since the new manager has been in post. People told us they could raise concerns with staff and knew how to make a complaint.

Staff were not always aware of safety concerns, this meant that there was an increased risk of harm to people. There was not always sufficient management oversight to enable them to effectively identify concerns and rectify them. The service was responsive, and improvements had been made by our final visit. We observed improvements in the staff’s ability to recognise safety concerns and take appropriate action. Staff told us they now felt encouraged to raise safety concerns. The operations manager told us lessons learnt from safety concerns were shared with the provider’s other services.

The provider had systems in place to report accidents and incidents and recorded the actions taken and any lessons learnt. However, initially these processes were not always being used effectively. For example, the manager was not always aware that an incident had happened, incident forms were not always completed, and lessons were not always learnt. The provider was responsive and when we completed our final visit all incidents had been reported. The manager had reviewed the incidents and any lessons learnt were shared with the staff team.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they felt safe, well cared for and listened to. For example, one person said, “I feel safe here, because the staff are kind, they encourage me to complete tasks that are important to my health”. Relatives told us that safeguarding concerns are not always reported and investigated effectively. The provider had not always provided feedback following a safeguarding incident. The provider was responsive to the concerns we raised during the assessment and improvements were being made. The new manager had spoken to people and relatives and encouraged people to raise concerns.

Staff had a clear understanding of signs of abuse and how to raise concerns. Staff told us they would tell the manager. However, initially they told us they were not always able to contact the manager immediately and this increased the potential risk of harm to people. The provider was responsive to our concerns and improvements had been made by our final visit. The new manager was readily available and encouraged staff to speak up.

During our first visits staff were observed to leave a person who needed constant supervision alone for periods of time. The person needed constant supervision due to their health needs. Staff appeared to be very busy and did not have time to engage people in conversation or activities. The provider was responsive to our concerns and took appropriate actions. The provider had increased support hours following our initial feedback and at our final visit staff were observed to be kind and compassionate. They responded quickly and appropriately to people’s needs. People appeared calm and had relaxed body language.

The provider had an effective safeguarding policy in place. The staff were trained to identify safeguarding concerns and report them immediately. However, safeguarding concerns were not always identified by the provider and there were initially not enough staff available to keep people safe. The provider was responsive to our concerns and implemented improvements. At our final visit the staffing had increased, and the provider had implemented strategies to keep people safe. These strategies were being monitored, and both people and staff were being supported.

People and their relatives did not always feel involved in managing their risks. For example, a relative told us that they had requested involvement with the person’s risk assessment and care planning, and they were waiting to review the documentation. The provider was responsive to our concerns and appropriate improvements were in progress but not yet embedded. The new manager had appointed keyworkers to work with people and their relatives to develop people’s risk assessments and mitigation plans.

Staff told us people’s risk assessments did not always provide them with the information they required. This meant staff were not always aware of people’s risks and the actions they needed to take to mitigate any risks. For example, a member of staff told us a person had not had a seizure in years, the member of staff was not able to describe the action they needed to take if the person were to have a seizure. The person’s records showed they had two seizures in the past year. The operations manager told us that he was aware that risk assessments need to be reviewed and improved. This was included within the service’s action plan. The provider was responsive to our concerns and appropriate improvements were in progress but not yet completed. At our final visit new manager was providing effective oversight and was coaching staff to understand and follow people’s risk assessments and support plans.

Staff did not always support people in line with their risk assessments. Staff were rushed at times and this impacted their ability to observe people appropriately or safely move them using equipment. Some staff were completing tasks they had not been trained to complete and had not had their competency assessed. The provider was responsive to our concerns and risk assessments were in the process of being reviewed to include more detail and be personalised. This was not yet complete. We observed improvements at our final visit and staff had the time they needed to provide personalised support. For example, we observed a member of staff recognise a person was having a seizure and they immediately took appropriate action.

The provider had robust policies and procedures. The provider had not always followed their own procedures, some identified risks did not have a risk assessment completed. Where risk assessments had been completed, they lacked detail and were not robust. This meant that actions to reduce risk had not been identified. Mental capacity assessments were generic and lacked relevant information to enable the person to make the decision themselves or for others to decide if they had capacity to make the decision. Best interest decisions that were in place lacked detail to ensure the least restrictive option was chosen. The provider was responsive to our concerns and risk assessments were in the process of being reviewed. The provider was working with relevant professionals to enable them to robustly assess the risks to people.

People we spoke with said they felt safe. Relatives we spoke with said the environment was not always safe, for example, a relative told us they had to replace a person’s sling as a strap was broken and when they spoke to the provider, they were unaware the sling was broken. The provider was responsive to our concerns and took appropriate action. The relative told us that improvements had been made.

The operations manager told us the home was being refurbished, most bedrooms had already been completed and flooring replaced. Damaged furniture and equipment would be replaced as part of the refurbishment. Staff told us that people were not able to access the kitchen and the laundry room, this was due to the size of the room and the space for people’s wheelchairs.

We observed some of the fittings in the home were worn and needed to be repaired or replaced. The service was being refurbished and this had already been identified by the provider. During our first visits, the boiler room was cluttered and contained some cleaning products, increasing the risk of a fire. A fire escape was blocked by a chair and some boxes which would delay evacuation in the case of a fire. People did not have evacuation aids to assist them in case of emergency evacuation when they were in bed. On our final visit, the provider had made improvements. Fire safety had improved, the people that needed evacuation aids had these in place and staff knew how to use them. There were two staff on site at night to aid emergency evacuation. The service was clean, and all damaged furniture and fittings had been replaced.

The Provider had completed audits and were aware of some of the concerns we found during the inspection. The provider had already started to complete a refurbishment of the service. The provider was not consistently prompt to address concerns that they found during their audits. The provider had completed legionella water tests but failed to take appropriate action when these were out of range. During our first visits the provider failed to complete adequate fire evacuation plans and the provider had not completed fire drills to establish if one member of staff was able to safely evacuate people at night. The provider did not have a nighttime evacuation plan in place. At our final visit, the provider had been responsive and had made improvements. The provider had worked with the fire service and had robust evacuation plans in place. The provider had completed fire drills and staff had completed fire marshal training. Health and safety checks were completed regularly, and any shortfalls had remedial work carried out promptly. The manager completed regular audits.

We received mixed feedback from people and their relatives. Overall, the feedback told us people liked the staff and they found them kind and helpful. However, staff did not always support people in a personalised way and there were not enough staff to support people safely and the service was lacking leadership.

Staff told us that they had completed their training and knew people well. Staff were not always able to describe the support people required to manage their health needs. Staff told us, they had two day induction and had completed electronic learning. They had team meetings with the operations manager. The operations manager told us that poor culture in the team had led to a number of staff leaving and new staff being employed. The culture was changing and this was having a positive impact on the service. The service was being led by the operations manager and the director who both visited the service once a week. At our final visit, staff told us they had received additional training. They said that the new manager was supportive. Staff told us that the increase in staffing both during the day and at night had been positive and they were able to spend time with people and were not feeling as rushed. The operations manager told us the manager had completed training and was currently completing further management training. Staffing levels had increased to three staff a day, with two staff working until 10pm and a sleep in and up and awake member of staff at night. Staff had completed fire marshal training and bespoke moving and handling training to be able to meet people’s needs. The manager told us she was supporting staff to develop skills, arranging social events with people and coaching staff to become keyworkers for individuals. The manager told us that staff will be given the opportunity to complete National Vocational Qualifications (NVQ) in care.

Staff were observed interacting with people in a kind, caring way. However, the support staff provided people was not always in line with right support, right care and right culture. We observed staff supporting individuals inappropriately, for example, whilst hoisting someone the staff failed to interact with the person throughout the whole process. During our final visit, staff approach had improved, and staff were taking their time and interacting positively with people. Staff were explaining to people what was happing at the level and pace appropriate to the person. This gave people time to process information before completing the task.

There was inconsistent leadership at the service. Initially, the service did not have a manager or deputy manager in post. There were not enough staff to support people in line with right support, right care, right culture. The member of staff who was responsible for assessing staff competency, was not provided with additional training to enable them to do so effectively. The service had a robust recruitment process in place. Staff were only appointed after they had successfully completed an interview, references were received and enhanced DBS check obtained. Staff were inducted into the service robustly, they completed 16 training courses via eLearning, including autism training and learning disability training, safeguarding, first aid, manual handling, fire and health and safety. Staff completed shadow shifts and completed competency assessments prior to lone working with people. At our final visit a new manager was in post and was completing staff competency assessments, supervising staff and addressing any training needs. Staff had completed face to face fire marshal training and moving and handling training. Staffing levels had increased, and the staff rota demonstrated that this was consistently the case.

We had positive feedback overall. A person’s relative told us the home had recently been refurbished and was much cleaner. However, they said sometimes stained bedding was not changed. People told us the home was clean and tidy. One person told us they liked cleaning.

Staff told us they had access to personal protective equipment (PPE) and cleaning products. Staff told us, some surfaces were hard to clean as they were damaged. They said that the service is being refurbished and these were to be replaced. The operations manager told us that they employed a cleaner and they worked five days a week for a couple of hours each day. The operations manager had written a memo to all staff to remind them to complete thorough cleaning and this has also been discussed in team meetings. The manager and the operations manager confirmed they will complete 1 to 1 staff training to ensure staff PPE practices and hand hygiene is improved.

Staff practices were not always robust. We observed staff complete multiple tasks including administering people’s medicines and then support someone using a hoist. The member of staff did not change their gloves throughout or in between these tasks. Staff did not always practice good hand hygiene. For example, we observed staff administer a person their medicine without first washing their hands. There were some areas of the home that were worn, this included chipped skirting boards and kitchen work surfaces, and some furniture was also chipped. One of the showerheads was visibly dirty, this was replaced immediately. Staff were observed to be using the correct cleaning materials though out our visits. Staff encouraged people to wash their hands before eating. On our final visit we observed increased levels of cleanliness throughout the home. The broken furniture had been repaired or replaced. People’s clean and dirty laundry was kept separately. The provider had increased the cleaner’s hours and given them additional responsibilities in relation to infection control and these measures were starting to have a positive effect on the service.

The provider had a robust infection control policy and procedure and staff had completed infection control training. Infection prevention and control and effective cleaning were discussed at team meetings. However, shortfalls in relation to staff hand hygiene practices and the correct use of PPE were not resolved. The manager told us they would introduce spot checks. The provider was responsive to our concerns and made improvements. The new manager was coaching staff and embedding safe practice.

People’s relatives told us they are not always informed when alterations were made to their family member’s medicines. They also told us they found medicine errors and were not always informed of outcomes of investigations. People told us they were happy with the support they received with their medicine. People said that they were now able to self-administer their own medicines and were being assisted when needed.

Staff told us they completed medicines training and competency assessments before administering medicines. Staff told us that they felt rushed during the evening medicine round. At our earlier visits we observed staff administering medicines, they failed to check the medicines in the blister pack matched the medicines on the medicine administration records, they also failed to complete stock control checks after administering medicines in the evening. Staff were able to explain the process of administering people’s medicines safely and two staff were present when administering medicines to people. At our final visit, staff told us they no longer felt rushed in the evenings, they demonstrated safe and effective medicine administration, they checked the medicines in the blister pack matched those on the person’s medicine administration record. Stock counts were also completed. The manager told us that she had completed additional staff medicine competency assessments. Medicine reviews for people had been completed and the local pharmacy had completed a medicines audit. The operations manager had contacted the GP and had received information on people’s medical histories and medicines. These are being used to develop health profiles and support plans.

Staff had completed medicines training and competency assessments. However, competency assessments were not consistently completed by staff with adequate knowledge and skills. The provider had completed medicine audits. However, these were not consistently robust. The audits had not identified some of the concerns we found during our inspection. Some people didn’t have guidelines in relation to medical conditions such as constipation, this could affect staff ability to know when to administer as required medication. The provider had not kept clear records of people’s health records and medical appointments, outcomes and if follow up appointments were required. The provider was aware of this and had contacted people’s GP to follow this up. The provider had a robust medicines policy and procedure in place, medicine reviews were completed. People’s medicine administration record were completed in full. The provider had processes in place to assess people’s ability to manage their own medicines, this has led to greater independence for some people and they were now able to self-administer their medicines.