Brown Edge House Residential Home

We found the following examples of good practice:

• Residents were able to see and speak to their loved ones safely and in line with the national guidance. Other means of communication were available such as video and/or telephone calls.

• PPE was available at the front door for visiting professionals and hand sanitisation was seen in various places throughout the home. Most staff were seen wearing their PPE correctly.

• There was a policy in place if people needed to isolate but this had not been necessary to date.

• COVID-19 testing was undertaken weekly for all staff and monthly for residents who were able and willing. Staff and residents had been given appropriate support to access Covid-19 vaccinations.

• The home was clean and hygienic throughout and cleaning staff had enhanced cleaning schedules which were implemented.

Further information is in the detailed findings below.

Brown Edge House Residential Home is registered with the Care Quality Commission to provide accommodation and personal care for up to 20 residents. The home is in the Nutgrove area of St Helens, Merseyside. At the time of the inspection visit 20 people were residing at the home.

Brown Edge House Residential Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

We last carried out a comprehensive inspection at Brown Edge House Residential Home in April 2016. At that inspection the home was rated good.

At this inspection visit carried out in November 2018, we found the registered provider had maintained their good rating but we identified some areas for improvement within the key question safe.

There was a registered manager in place. 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.

At this inspection visit carried out in November 2018, we found environmental risk was not always appropriately identified and responded to in a timely manner. We have made a recommendation about this.

The home had been supported by other professionals to ensure medicines were suitably and safely managed in line with good practice guidance. Although improvements had been made these were not yet firmly embedded. We have made a recommendation about this.

People who lived at the home and relatives told us the home was a good place to live. It was repeatedly described as ‘home from home’ with staff being referred to as extended family. We were told care provision was person centred and delivered in line with people’s choice.

There was ongoing commitment from the registered manager to ensure staff had the appropriate training and skills to carry out their role. Staff told us they had the correct skills to enable them to carry out their role.

Relatives told us the home was good at meeting the needs of people. We saw evidence of multi-agency working to promote effective care. A visiting health professional praised the skills and knowledge of staff who worked at the home.

Staff retention at the home was good. This meant people were supported by staff who knew people well.

People who lived at the home and relatives praised the caring and helpful nature of staff. From observations we saw staff were patient and respectful with people.

Systems were in place to safeguard people from abuse. Staff could identify types of abuse and how to report any concerns.

People, relatives and professionals told us there were enough staff on duty to meet individual needs. We observed responses to call bells and noted they were answered in a timely manner.

People praised the quality and availability of food. The dining area was pleasantly decorated to enhance the dining experience for people. We observed meals being provided and noted there were sufficient quantities of food and flexible choice for people.

People and relatives praised the standard of cleanliness at the home. We found the home was well-maintained to ensure the comfort of people.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service supported this practice. We saw people had freedom to move throughout the building. Consent to care and treatment was routinely sought.

Staff who worked at the home described it as a good place to work. They praised the skills of the new registered manager and said the home was well-led. Staff said they had confidence in the new registered manager and the improvements they had started to make. People and their relatives told us they also considered the service to be well-led.

The registered provider liaised with health professionals when people required end of life care at the home to ensure people received care in line with good practice. We received positive feedback regarding the way in which staff worked with people at the end of their life.

We looked at how complaints were managed and addressed by the registered provider. At the time of the inspection no one had any complaints about how the service was delivered. We were told by relatives the manager was approachable and would take time out to listen to any concerns they may have.

Feedback from relatives about the home and how it was managed was positive.

This was an unannounced inspection carried out by an Adult Social Care inspector. During the inspection we spoke with seven people who lived at the service, five members of staff, two visitors, the registered manager and the registered provider. 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.

We observed care and support in communal areas, spoke with people in private and looked at care and management records.

We saw that medicines were not always managed safely or given in a manner that met people’s individual needs.

Some of the systems used to assess the quality of the service had not identified the issues that we found during the inspection. These were discussed with the registered manager and the registered provider who immediately put new systems into place.

People told us that they had been included in planning and agreeing to the care and support provided. We saw that people had an individual plan, which outlined some of the ways staff were to support individuals. Risks were not always addressed in order to fully maintain the safety of people.

People told us that they were treated with kindness, compassion and respect. Visiting professionals were complimentary about the support given by the service and the warm welcome they themselves received. We saw many positive interactions and people enjoyed talking to the staff in the service.

Staff we spoke with recognised the importance of knowing people’s routines, so that, people received personalised support.

Staff took the time to get to know people and supported them in undertaking activities according to their hobbies and interests.

People told us they were able to see their friends and families as they wanted. We saw that there were arrangements in place to support people living in the service to access the community and maintain relationships with their families.

The staff told us they were aware of their responsibility to protect people from harm or abuse. They knew the action to take if they were concerned about the safety or welfare of an individual. They told us they would be confident in reporting any concerns to management.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the staff supporting them and from looking at records.

Is the service safe?

We carried out a tour of the premises and saw that it was safe. We observed that up to date fire extinguishers and portable appliance checks had been carried out and were found to be suitable and safe to use. We saw people being treated with dignity and respect by the staff.

We saw members of staff positively interacting with people who lived in the home. Two people, who lived in the home, told us they felt safe living at Brown Edge House. In discussion and in observation, we saw that people were relaxed and at ease, with people telling us they were happy.

We found satisfactory safeguarding procedures in place, with staff having had up to date safeguarding training.

Staff recruitment records contained all the information required by the Health and Social Care Act 2008. This meant the provider could demonstrate that the staff employed to work for the service were suitable and had the skills and experience needed to support people living in Brown Edge House.

Is the service effective?

The people we spoke with in the home were complimentary about the service that had been provided. Some of the comments were, 'The staff are really good' and 'The girls will do anything for me, they are marvellous'. We spoke with four members of staff and they demonstrated that they had a clear understanding of people's needs and how to meet them.

We saw that staff training and staff supervision was consistent and up to date. This helped to demonstrate that the staff employed to work for the service had received the correct training and support to meet people's needs.

We found that people's health and care needs had been assessed by the service before they went to live at Brown Edge House. We found that people receiving a service and/or their relatives had been involved in drawing up care plans.

Is the service caring?

During our inspection we observed that staff were attentive, caring and enthusiastic about meeting the needs of people who received a service. People positively responded to members of staff, which showed that a good rapport existed between them. We saw people were treated with dignity and respect by the staff.

One of the comments from a person living in the home was, 'I am treated with respect by the girls (Care staff)' and a relative said, 'The family feel that all of the staff genuinely care for the residents'.

Is the service responsive?

Brown Edge House had quality assurance monitoring processes in place. We saw that the provider sought the opinions and views of people living in the home and also sought the views of their relatives. There was written evidence that highlighted, when any issues had been identified, the service had responded and addressed them.

We saw documented evidence that 'service user' and relatives meetings had taken place, with actions from meetings being implemented. Staff team meetings had also been taking place. Members of staff informed us they felt supported and included in the service provision.

Is the service well-led?

Brown Edge House had a manager who was registered with the Care Quality Commission (CQC) to carry out their role. The service always informed us when there were significant incidents. We were informed and observed that the provider was involved with the home on a daily basis.

In discussion with some members of staff, they said the management were very supportive and understanding. One staff member said, 'The manager is both encouraging and supportive'.

We found as a result of learning from this the provider had made a number of improvements within the home. The recording system used for incidents had been revised and we could see that incidents were now being correctly recorded and acted upon. Staff understood how to identify whether an incident constituted a safeguarding concern and we noted that an incident from the previous week had been appropriately referred.

During our inspection, we spoke with one person who was using the service and their friend who was visiting them. They told us they were satisfied with the care and support provided to them. We were able to spend time sitting with people in the lounge area and to observe the care and support people received. The atmosphere was cheerful and we saw a number of positive interactions between people using the service and staff members.