Two adult social care inspectors carried out this inspection over two days, 07 July 2014 and 10 July 2014. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?As part of this inspection we spoke with a minimum of 15 people who used the service, four of their relatives/visitors, the registered manager, two senior managers who represented the provider, and a minimum of 16 members of staff. We used the Short Observational Framework for Inspection (SOFI). We also reviewed records relating to the management of the service which included 16 care plans, daily records, staff records and quality assurance monitoring records.
Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.
Is the service safe?
When people’s health and safety risk assessments had been carried out, these were not always done with accuracy. This meant that people were placed at risk of receiving inappropriate care due to the inaccuracy of these assessments. This meant there had been a breach of the relevant legal Regulation (Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010) and the action we have asked the provider to take can be found at the back of this report.
CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care services. While no applications had needed to be submitted, arrangements had been made for relevant staff to be trained to understand when an application should be made, and how to submit one. Briar House looks after people living with dementia. However, we found insufficient evidence to demonstrate that people were provided with support and care and this was done in their best interest.
People were safe because they were supported to manage their prescribed medication. People were satisfied with how they were supported with their prescribed medication and described this as, “Perfect.”
Some, but not all, pieces of equipment were safe for people to use. Although remedial action had been taken to improve the levels of safety risks, this action was ineffective. This meant that people remained unsafe as a result. This meant there had been a breach of the relevant legal Regulation (Regulation 16 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010) and the action we have asked the provider to take can be found at the back of this report.
There was an insufficient numbers of staff employed to provide people with consistent, safe and appropriate support and care. This meant there had been a breach of the relevant legal Regulation (Regulation 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010) and the action we have asked the provider to take can be found at the back of this report.
Is the service effective?
People’s choices and decisions about their support and care were not always assessed. It was unclear, therefore, what people wanted and chose to do. In addition, members of staff were not always able to meet people’s complex communication needs. There was also insufficient evidence to demonstrate how people living with dementia had their individual communication and mental health needs effectively met. This meant there had been a breach of the relevant legal Regulation (Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010) and the action we have asked the provider to take can be found at the back of this report.
The standard of support and care had often failed to provide people with the respect and dignity that they had the right to. This was due to the way they were looked after. This meant there had been a breach of the relevant legal Regulation (Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010) and the action we have asked the provider to take can be found at the back of this report.
Is the service caring?
People who we spoke with, including some relatives and visitors of people who used the service, said that they liked the members of staff and how they were being looked after. However, we found examples where people were looked after without warmth and compassion.
People were not always protected from the mental ill-health risks of feelings of being isolated. This was because members of staff failed consistently to effectively engage with individual people. There was also a lack of appropriate stimulation to promote people’s sense of wellbeing. This meant there had been a breach of the relevant legal Regulation (Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010) and the action we have asked the provider to take can be found at the back of this report.
Is the service responsive?
People’s needs, choices and personal preferences had not always been assessed and therefore it was unclear how these could be acted on. Furthermore, people’s individual social and health care needs were not always responded to. This meant there had been a breach of the relevant legal Regulation (Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010) and the action we have asked the provider to take can be found at the back of this report.
Is the service well-led?
There were ineffective and a lack of monitoring and reviewing systems in place in relation to care records, complaints and accidents and incidents. This meant that people were placed at risk of unsafe and inappropriate care. It also meant that the provider failed to learn from incidents and subsequently failed to improve the safety and quality of people’s support and care. This meant there had been a breach of the relevant legal Regulation (Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010) and the action we have asked the provider to take can be found at the back of this report.
People who used the service and staff members were provided with opportunities to make suggestions and comments to improve the quality of their support and care. Surveys were carried out for people to complete.
Members of staff were enabled to make suggestions and take actions to improve the standard and quality of people’s support and care.