Archived: Briercliffe Lodge

Briercliffe Lodge is situated in the town of Barnoldswick in Lancashire close to the Yorkshire border.

People's experience of using this service:

• The service met the characteristics of 'Good' in all of the five key questions.

• Staff were recruited safely but we noted in some cases there was a need to improve some pre-recruitment checks.

• The service was following the principles of the Mental Capacity Act 2005 and associated Codes of Practice.

• Risks to people's health and safety were safely managed.

• Care records were up to date and reflected people's health care needs.

• People who used the service and their relatives told us that people were looked after and that they were happy with the care and support that was provided.

• People were protected against abuse, neglect and discrimination through good safeguarding processes.

• Staff we spoke with were positive about their roles and wanted to do the best for people.

• Staff we spoke with knew people well. They had developed good relationships with people.

• People who used the service clearly enjoyed the presence and attention from staff.

• There was a range of appropriate activities for people to participate.

• Management checks and audits were effective but some improvement was required around the checking of employment records to ensure that people were safely recruited.

• More information is contained in the full report.

Rating at last inspection: At our last inspection the service was rated good overall. Our last report was published on 10 May 2016.

Why we inspected: This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Briercliffe Lodge is registered to provide accommodation and personal care for up to 17 people. It is situated in a residential area of Barnoldswick in Lancashire and is a detached building with surrounding accessible garden areas within. Accommodation is provided in 13 single rooms and two shared rooms on the ground and first floor. There is a stair lift for people with limited mobility to access the upper floor.

The service was managed by two registered managers. 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.

People living in the home told us they felt safe and well cared for. They considered there was enough staff to support them when they needed any help. Good recruitment procedures were followed to ensure new staff were suitable to work with vulnerable people. People using the service considered there were enough staff deployed to support and help them when they needed help. They told us they didn’t have to wait long when they rang their buzzer for summoning help.

Staff had been trained in safeguarding vulnerable adults and how to recognise and report any concerns they had if they witnessed or suspected abuse taking place.

Medicines were managed safely and people had their medicines when they needed them. Staff administering medicines had been trained to do this safely.

Risks to people’s health and safety had been identified, assessed and managed safely. The registered managers followed up to date guidance on safety issues such as falls prevention and pressure ulcer prevention.

We found the premises to be clean and hygienic and maintained. Regular health and safety checks were carried out and equipment used was appropriately maintained. The service held a maximum five star rating award for food hygiene from Environmental Health.

People were cared for by staff who were well trained and supervised in their work.

Staff followed the principles of the Mental Capacity Act 2005 to ensure that people’s rights were protected where they were unable to make decisions for themselves. Staff understood the importance of gaining consent from people and the principles of best interest decisions. Routine choices such as preferred daily routines and level of support from staff for personal care was acknowledged and respected.

People told us they had their privacy respected by all staff. Each person had an individual care plan that was sufficiently detailed to ensure people were at the centre of their care. Care files contained a profile of people’s needs that set out what was important to each person, for example how they were dressed, personal care and how they could best be supported.

People’s care and support was kept under review, and people were given additional support when they required this. Referrals had been made to the relevant health and social care professionals for advice and support when people’s needs had changed. This meant people received prompt, co-ordinated and effective care.

We found staff were respectful to people, attentive to their needs and treated people with kindness in their day to day care. Staff had been trained in End of Life care. This meant staff could approach people’s end of life care with confidence and ensure their dignity, comfort and respect was considered.

Activities were varied and people were given opportunities to take part in a wide range of activities that were organised such as keep fit, baking, yoga, and visits to places of interests. Individual activities were arranged such as gardening.

People were provided with a nutritionally balanced diet. All of the people we spoke with said that the food served in the home was very good. They were given choices at meal times.

People told us they were confident to raise any issue of concern with the provider and staff and that it would be taken seriously. They were regularly encouraged to express their views and opinions and also had opportunities to give feedback about the service, the staff and their environment in quality assurance surveys and at their meetings.

All people, their relatives and staff spoken with said the management of the service was very good and they had confidence in the registered managers. There were systems in place to monitor the quality of the service and evidence to show improvements were made as a result of this.

We considered the evidence we had gathered under the outcomes we inspected. We spoke with six people using the service, looked at care records of two people in detail and a selection of other records in relation to other people's care. We also looked at two staff files and other records relating to all staff. We spoke to four staff on duty, one health care professional and we spoke with both the registered managers.

This is a summary of what we found:

Is the service safe?

Before people were admitted to the home they had an assessment of their needs. This helped to make sure they would be safe in the environment and there was enough skilled and qualified staff to meet their needs.

The managers understood their obligation to apply the principles of the Mental Capacity Act and Deprivation of Liberty Safeguards (DOLS). This is a legal framework designed to protect the best interests of people who are unable to make their own decisions.

People’s legal rights were protected. They were given a contract that outlined the terms and conditions of residence and the duties and responsibilities of both parties.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Risk assessments were completed and staff had been made aware of who may be at risk of falling, developing pressure ulcers or may not eat enough. Staff had guidance on how to manage these risks.

Staff were trained in emergency procedures such as fire and first aid. All staff had been trained in safe moving and handling people. This was kept up to date.

People told us they felt safe and never had any cause for concern. One person said, “I’ve no problems here at all. If I had I would say. It‘s nice here and the staff are kind and thoughtful.” People also told us there were no rules to follow and no rigid routines. Staff spoke to them properly and they were respectful.

Staff had been trained in safeguarding vulnerable adults. Care had been taken to make sure people were kept safe by good recruitment procedures being followed. Staff contractual arrangements prevented them from gaining financially from people they cared for.

We found appropriate arrangements were in place in relation to the safe storage, receipt, administration and disposal of medicines. People told us they received their medicines when they needed them.

Systems were in place to make sure the provider continually checked the service was safe. Guidance was being followed such as health and safety in the work place, infection control, fire regulations and control of hazardous substances. This reduced the risks to people and helped the service to continually improve.

Is the service caring?

People told us they were happy with the care they received and the staff team. They said staff were, “kind”, “very nice”, and “I like them all”. “If I need any help I just ring my bell and they will come and help me. I get help to have a bath.”

We observed staff were considerate, respectful of people's wishes, and delivered care and support in a way that maintained people’s dignity and promoted their independence. Staff engaged well with people and involved them in activities. Activities were wide ranging.

Staff worked to care plans that were person centred, well written and sufficiently detailed on how best to meet individual needs. Daily records maintained, showed staff responded to people's needs as required day and night. Staff had received training to meet the needs of people living in the home.

Surveys carried out showed people considered the service they received was very good. Comments noted had included, ‘A very good care home. If you have a relative that is a resident there, you are very privileged because it is an excellent home’. ‘I feel very fortunate to have found such a caring home. Thank you’.

Is the service responsive?

A continuing assessment of need was on-going for people, including a mental capacity assessment to support continuing care needs being addressed appropriately. The service had good links with other health care professionals to make sure people received prompt, co-ordinated and effective care.

Care plans were being regularly reviewed. Where instructions were written to observe conditions people presented with, these were followed through. Risk management was regularly reviewed to make sure any change in people’s circumstances was not overlooked.

Where people required medicines to be taken when required (PRN), such as pain killers, this was managed well. People told us they got their medication when they needed it, such as when they got up, after breakfast and on demand for medicines prescribed for symptom relief such as pain killers.

Staff were provided with current information and kept up to date with any changes in legislation and good practice guidelines.

A system was in place for receiving comments, compliments and complaints. Meetings were held and we saw where people gave their views this was received well with action taken to improve the service. People told us that they would know how to make a complaint, should they need to do so.

People told us they were happy with their care. They had their own preferred routines, likes and dislikes. There were no unnecessary rules to follow and no rigid routines. People told us they were consulted with and listened to. They had opportunities to express their views in resident meetings and in satisfaction questionnaires.

Staff told us they were given opportunities and time to attend training. Topics they were trained in were varied and relevant to their work such as end of life care. This meant people were being cared for by a staff team with the relevant knowledge to meet their needs.

Is the service well led?

The service had two registered managers responsible for the day to day management of the home. Meetings were held for staff and residents and these showed people were kept up to date with all aspects of the running of the home including best practice issues, quality monitoring and of planned improvements.

People told us the management of the service was good. One person said, “They (the managers) work here and always have time to chat with us. They help us when we need help and I know if I had any problem I could tell them. Either of them would sort it out.” Written comments from relatives included, ‘Briercliffe Lodge, it’s management and staff give the sort of care that is very rare these days, care at its best’.

Staff enjoyed their work and considered the service was managed well and they had very good support from the managers. They were clear about their responsibilities and duty of care and were encouraged to develop their skills and knowledge. Training was provided for them and they were supervised. Staff were kept up to date with any changes in legislation and good practice guidelines.

There were systems in place to regularly assess and monitor how the home was managed and to monitor the quality of the service. We saw evidence the service knew when to consult with health and social care professionals when required. This meant any decision about people’s care and support was made by the appropriate staff at the appropriate level.

We found there were processes in place to ensure, where people may not have had the capacity to make particular decisions, staff had the necessary information, training and policies and procedures to be able to act in their best interest.

People told us they were consulted about the care they received and were all very positive. One person told us, "I have no issue about the quality of care and attention I receive here”, another person said “The staff are very thoughtful and I have no complaints whatsoever “. The care plans we reviewed highlighted people's needs and any risks had been reviewed by the home.

We found people were supported to have adequate nutrition and hydration and systems were in place to monitor this. People were provided with a choice of food and drink to meet their dietary and nutritional needs.

All the people we spoke with made complimentary comments about the staff team. One person said, “The staff are very good, they all speak to us very nicely and I couldn’t complain about anyone”. Another person told us, “You couldn’t wish for any better staff, you couldn’t question the care we receive”. Other comments included, “The staff are very good, excellent and they spoil us and some staff put in that little bit extra”.

We found there was an adequate complaints process in place to ensure that any comments and complaints were listened to and acted upon.