Bryn Haven

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 identified 3 breaches of regulations in relation to safe care and treatment under this key question of safe. Medicines were not always managed and administered safely. There was not always enough staff on duty to provide people with safe care and effective support. People’s individual risks were not always managed safely. Staff knew how look out for signs of abuse and report safeguarding concerns. Safety concerns and events were reported and investigated. Staff were recruited safely. People and visitors told us they felt safe.

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.

People and their visitors told us they felt safe at Bryn Haven. One visitor told us their family member had recently had an accident and the staff had let them know and kept them updated.

The registered manager told us any accidents or incidents were reviewed and discussed with staff to ensure learning from incidents. The registered manager told us they worked closely with the local authority when incidents occurred and gave examples of actions taken to prevent future events. Staff told us they were made aware of any accidents and incidents by being told by senior staff or during handover.

We found lessons were not always demonstrably learnt from people’s experiences. A previous safeguarding incident involved a serious altercation between 2 people; however, we observed verbal altercations between people left unattended during the first day of our site visit. Weekly falls meetings took place involving staff from different departments. Audits and accident analysis took place at home level and was reported to head office. An accident log was maintained by the home manager and this log documented the actions taken to prevent further occurrence. Any concerns or learning was passed onto staff through handover and via electronic communications. We spoke with two health professionals who told us they mostly had no concerns about care delivery and documentation. However, they told us had concerns about agency workers not always knowing people and following care plans.

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 and their visitors told us they felt mostly safe and protected from the risk of harm and abuse. People knew who to speak to with any concerns One person told us, “I feel safe when I am transferred from the bed to the chair the staff know what they are doing; I would tell them off if they hurt me.” One visitor told us, “My loved one is well looked after. The GP visits if there are any concerns.” However, we found there was not always enough staff to ensure people were safe and received timely care. People were not always supported in communal areas to reduce risk of incidents.

Staff had received training in safeguarding adults and understood their responsibilities to keep people safe. Staff had access to several ways of raising concerns and they told us they could report any concerning information and felt they would be listened to. However, some staff commented that a lack of staff meant people were not always kept safe and people did not always receive the levels of care they needed. The registered manager told us they had safe systems in place to deal with safeguarding. Local authority and CQC safeguarding reporting processes were followed.

We observed how people were during the two days of site visits. We did not observe any incidents of unsafe practice; however, we observed people were left unattended in communal areas. We also observed incidents where people were placed at the risk of harm from not receiving the correct diet or fluids. Prior to our site visit, 2 people had been involved in a physical altercation leading to 1 person attending hospital. We observed 2 occasions where people were involved in a verbal altercation with one threatening to physically harm the other, there were no staff around to defuse the situation.

A safeguarding policy was in place. The registered manager understood the reporting processes and worked with the local authority to investigate any concerns.

People and their relatives told us they felt safe at the home. We received mixed feedback from people and visitors about how they were involved in their plan of care. One visitor told us “I am fully involved in the care plan and any changes are communicated.” Another visitor told us, “I do not get involved in the care planning, if I had any concerns I could speak freely to a member of staff.”

The registered manager told us people’s risks were reviewed monthly and any changes were documented and passed to staff through handover and communication channels. The registered manager told us people did not always understand discussions around risk management, so risks were discussed at meetings with the family. Staff told us people’s risks were documented in the care plan and they were updated when people’s needs change. We received mixed feedback from staff about their opportunity to read care plans and their knowledge around people’s diets and fluids.

People were not always receiving support in line with their risk assessments. We observed one person being given flapjack when their care plan stated for them to have a ‘soft option’. We intervened when we observed one person was being served a drink that was not thickened in line with their prescribed level. We also observed people being left alone in communal areas without staff presence, this placed people at the risk of harm.

Individual risk assessments were in place for people; however, we had concerns regarding the safe monitoring of people’s risks. These included records of people’s modified diets and thickened fluids, and dietary and fluid intake. We found people had repositioning or fluid monitoring charts that indicated people were not receiving care as per their assessed needs. People’s repositioning charts did not reflect they were being repositioned appropriately, and fluid charts showed people were not reaching their hydration targets. Records did not evidence action had been taken to remedy these risks. People’s risk assessments did not demonstrate they or their representative had been involved in discussions around the management of their risk. For example, we did not see where people or their representative had been consulted on the use of a movement sensor alarm.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

We received mixed feedback from people about staffing levels although people mostly spoke positively about the staff themselves. One person told us, “There are staff around if I need anything.” However, another person told us, “If you press the buzzer, the staff take ages to answer; they take so long sometimes I have soiled myself. They need more staff at busy times.”

We received negative feedback from all care and ancillary staff about the staffing levels at the home. We spoke with several staff over the two days of site visits and found concerns about safe staffing levels. Staff told us there was a high turnover of staff and many staff had left recently. Staff gave us examples of when providing care was difficult due to low staffing levels, one staff member told us, “Morning is worse when people are still in bed and there is no staff. There are quite a few people that need the support of 2 staff.” Another member of staff said, “It is horrible as I don’t have time to sit down and talk to people due to staffing issues.” Ancillary staff often had to leave their role and help provide care. They gave us examples of where people or their visitors needed support and were unable to find staff in the building. Staff told us they received enough training but did not always feel supported in their role. One staff member told us it was difficult to get support as the registered manager was just as busy as they were. We spoke with the registered manager about our staffing level concerns and they told us they used a dependency calculator to ensure staffing levels were sufficient and told us they actually overstaffed the home. On day 2 of the inspection, we found there was one less care assistant and one less senior on duty than rostered. The deputy manager stepped into the senior role to provide cover. The registered manager told us that if they need to use agency, then they use regular staff and have a folder of their pen portraits.

We observed people did not always receive timely care and attention. Assessed night staffing levels were 2 staff on duty on each floor. On our early arrival on day 1, we found only 1 night shift staff member present on the ground floor. The staff member went up to the first floor to report our arrival and this left the floor completely unstaffed. We observed several people in lounge areas with no staff presence and we saw people did not get timely assistance with their meals in one lounge. We reported our concerns to the registered manager to enable them to address our concerns. On day 2 we observed some improvements; however, we found staffing levels were insufficient to ensure people's needs were met in a timely way.

The service had employment checks in place to ensure suitable staff were employed to care for people at the service. A training matrix was in place that demonstrated most staff had completed their training. The home told us they provide end of life care; however, the staff training rates for end of life care were low. The registered manager told us staff had a programme of supervision and appraisal. However, staff did not confirm this happened regularly.

People and their visitors felt the home was clean and tidy. Relatives mostly fed back that their relative was clean. However, one visitor told us, “Sometimes when we visit their (person) nails are not clean.” People were not always getting regular baths and showers, or oral care based on the records and our observations.

Staff commented that people did not always have regular personal care and there was limited evidence of how people were monitored to ensure high standards of personal care were maintained.

The home was clean and free from odours. Staff wore personal protective equipment (PPE) as required. We observed staff cleaning the home throughout the day. The laundry was clean and well managed. We observed that people’s hygiene needs were not always met. People did not always have clean nails and were not always supported to change their clothes in a timely manner when required.

Staff had completed infection prevention and control (IPC) training and training in the use of personal PPE. The home conducted internal monthly IPC and sling audits and received an annual IPC audit by the local authority. A suitable policy was in place.

Care plans did not always have up to date information about people’s medicines and associated risks. Records for adding thickening powder to drinks, for people who have difficulty swallowing, were inconsistent and not always completed. Therefore, we could not be assured people were safe from the risk of choking. Information to support staff to safely give ‘when required’ medicines was not always in place. This meant there was a risk people might not have received their medicines when they needed them.

Staff had dedicated time to manage medicines processes such as ordering and receiving. Managers told us that staff had completed medicines training and had been assessed to ensure that they gave medicines safely. We were shown evidence of training records to confirm this. Medicines audits were not always effective in identifying medicines related issues occurring in the service. Following the inspection, the service sent an action plan detailing improvements made.

Medicines were not always stored securely. On 2 occasions we found creams stored in people’s rooms that had not been risk assessed to prevent inappropriate access. A tub of thickening powder was also found in an unlocked cupboard in a communal area. However, controlled drugs were stored securely according to legislation and policy. We found the site of the application of topical patches was not always recorded. Therefore, we were not assured the patch site was rotated in accordance with the manufacturer’s instructions. This meant people were at risk of skin irritation. Medicines with a variable dose did not always have the supporting information available detailing when a higher dose may need to be given.