Archived: Briardene Care Home

Briardene is a care home which provides nursing and residential care for older people, including people living with dementia. There were 49 people living at the home at the time of this inspection.

The service had a registered manager however they had resigned in the week prior to our inspection. The regional manager and a rapid response manager were supporting the deputy manager to run the home following the registered manager’s resignation. A registered manager is a person who had registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons.’ Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People living in the home were kept safe from harm. Staff had received safeguarding training and were aware of the different types of abuse people may suffer and their responsibility for reporting any potential signs of abuse.

Systems were in place to identify and minimise possible risks to the health and safety of people using the service.

Robust recruitment systems were in place to ensure staff employed by the service were suitable to work with vulnerable people.

Topical medication records for people using the service were incomplete. We found these did not contain body maps or specific instructions for staff about the application of these medications. We were unable to establish from the records we reviewed whether people using the service had received their topical medication as prescribed. We found records held of oral medication administration were completed. We observed part of a medication round during the inspection and observed good practice throughout.

Feedback received from people and their relatives indicated that staffing levels were not sufficient to meet their needs. Staff members confirmed staffing levels were not always consistently maintained at the appropriate level. Our observations during the inspection were that call bells were not always answered promptly.

Staff were provided with an induction when they first commenced their employment. They were then provided with support through the provision of on-going training relevant to their roles.

Staff had not been provided with the support they required in terms of regular supervisions and appraisals to enable them to perform their roles effectively.

Care plans we viewed were evaluated on a regular basis. However there was limited evidence of people and their family members being involved in care planning. People and their relatives had also not been provided with the opportunity to be involved in regular reviews of their care and treatment to ensure it continued to meet their needs. Despite this people told us they were happy with the care they were receiving and should they have any concerns or problems they would feel confident speaking to a member of staff.

The home had a stable staff team, many of whom had worked at the home for a number of years. This meant people had been able to develop strong relationships with the staff who cared for them. People and their relatives spoke highly of the caring nature of staff.

People and their relatives were provided with the opportunity to be involved in the running of the home through regular resident and relatives meetings.

Complaints records we reviewed were incomplete. Copies of outcome letters were retained but details of internal investigations were missing. It was not possible to tell from the records available whether complaints had been resolved to the complainant’s satisfaction. In addition to this, some of the relatives we spoke with told us their complaints had not been responded to.

The service had an activities programme in place to help prevent people from becoming socially isolated. People and relatives we spoke with felt the programme had declined recently. We found the service’s activities co-ordinators had been off work for a few months and that a member of staff had just been appointed to undertake this work in their absence.

The provider had a range of systems in place for monitoring and reviewing the effectiveness of the service. However, we found in the months prior to the inspection these had not been used. The homes overall action plan which recorded all areas where improvement was required was also incomplete and had not been updated on a regular basis. This meant it was not possible to determine whether or not action was being taken to improve the service.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to staffing; complaints; and governance. You can see what action we told the provider to take at the back of the full version of the report.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements. These related to the breaches of regulation regarding good governance, safe care and treatment and the arrangements for ensuring staff were suitably supported by means of training, supervision and appraisal.

We undertook a focused inspection on 17 May 2016 to check they had followed their plan and to confirm that they now meet the legal requirements. During the course of the inspection we also followed up on some concerns that had been raised with us. This report only covers our findings in relation to those requirements and the concerns. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Briardene Care Home on our website at www.cqc.org.uk.

Briardene is a care home for older people, some of whom have a dementia-related condition. Nursing care is provided there. At the time of the inspection 49 people were living at the home.

The registered manager had left in the period since our last inspection. A new manager was in post at the time of this inspection and was in the process of registering. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found the provider had met the assurances they had given in their action plan and were no longer in breach of the regulations.

The provider had completed assessments of general risks to people, staff and visitors and there was evidence action was being taken to minimise these risks.

The provider was in the process of refurbishing the home. Newly appointed medicine storage rooms had been created on both the ground floor and first floor. Temperature checks were completed on a daily basis and showed temperatures in both of these rooms was appropriate for the safe storage of medicines.

The support given to workers in the service had improved. The provider had reviewed the provision of staff training and staff had been provided with the opportunity to undertake the necessary training required to support them. The provider had taken action to ensure all staff were scheduled to receive three supervision sessions and an annual appraisal in line with their policy and procedure for supporting staff.

The provider had made improvements to the process for acting on areas for improvement identified during audits. An overall home action plan had been introduced to capture all areas for improvement identified and track progress. Although at the time of the inspection this had not been updated, the manager did this following the inspection and sent us a copy which confirmed action was being taken to address areas for improvement.

We saw that the home was in the process of assessing its current response to the care needs of people with dementia and taking appropriate specialist advice to improve its practice. It had implemented a programme of training all its staff for working with dementia. It had yet to clearly define its strategy for meeting the latest NICE standards in dementia care.

We looked at the care records of people living in the home. We found people’s needs were properly assessed and met, using personalised care plans.

We talked to people about their care. Those able to express an opinion told us they were well cared for, and that staff listened to them. Comments included, “They look after me well. I get anything I ask for.” Another person said, “If I ask to go to the toilet, they come straight away.” .”

Feedback from the relatives of people with dementia living in the home was very positive. They told us they felt the home was responsive to the changing needs of people with dementia living in the home. They told us they were involved in decisions about their family member’s care. One relative commented, “I couldn’t fault the care my relative had here – and the manager and staff were wonderful with me, too, very supportive.” Another said, “Everybody’s brilliant, here, and the care is fantastic.” They told us they had never seen or heard anyone shouted at in the home, said the staff were “lovely with people with dementia.”

Staff on the unit for people with dementia were well-trained, well-motivated and took pride in the quality of the care they gave. They demonstrated good values and skills in their work.

We observed the care of people with dementia. We saw no inappropriate interventions from any staff, and nearly all the staff interactions we saw with people were positive. Staff demonstrated genuine care and compassion, and were sensitive and appropriate in their approaches to people with dementia.

The home was participating in a project with the local NHS hospital trust aimed at preventing unnecessary admissions to hospital. This had been in progress for six months, and had resulted in a significant reduction in admissions to hospital.

We examined some of the systems in place for maintaining the appropriate standards of care, and found they were working well. The manager told account of all feedback about the service, and took any complaints or concerns seriously. Staff and relatives confirmed they could speak to the manager whenever they had a problem.

People's care needs had been fully assessed and detailed care plans were in place to help staff meet those needs. People told us that staff were kind, patient and attentive, and that staff gave them their care in the way they wanted it given. Visiting relatives confirmed that the care was of a good standard, and said that the home kept in contact with them about any issues.

Appropriate arrangements were in place for the management of people's prescribed medicines. Medicines were safely stored and appropriately administered by trained staff.

The home was appropriately staffed with skilled and experienced nurses and care workers. Staff were able to meet people's needs within a reasonable time, and in a personalised way. Arrangements were in place to make sure the home was always fully staffed.

People were given clear information about how to make complaints to the home, and detailed records were kept of complaints received. The manager responded positively to complaints, investigated them fully and took appropriate actions were they were upheld.