Briardene Care Home

We found the following examples of good practice.

Systems were in place to prevent people, staff and visitors from catching and spreading infections. Checks were made on visitors to the service including temperature, COVID-19 test results and vaccination status.

The home had an infection prevention and control lead who was responsible for sharing best practice with other staff.

The environment was clean and additional cleaning was taking place for surfaces that were touched frequently, such as handrails.

Staff wore PPE correctly throughout the home. There was clear signage on the correct use of PPE and handwashing techniques, and staff had received training in infection prevention and control.

Briardene Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

Briardene Care Home accommodates 31 people across two purpose built sites. The service provides care for people with complex needs associated with dementia.

There was a registered manager in post. 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 previously inspected the service in December 2015 and rated the service as good overall. At this inspection we found that the service had improved further and was outstanding overall.

Without exception staff and management worked in a way that put the needs of people living at Briardene first. Care plans were written in an extremely sensitive and thoughtful way. Staff knew every person they cared for in depth, what was important to them and the best way to provide care to them.

We observed care being delivered in a way that truly reflected the provider’s values of respect, integrity, responsibility, passion and empowerment. The ethos of putting the person at the centre of everything was driven from the top. The registered manager and deputy led by example and there was a pride and passion for the home that was reflected in everything the management team did. This in turn inspired staff to do their best to deliver the extremely high standard of care that was observed throughout the inspection.

Relatives told us the service provided safe care to their loved ones and peace of mind for them. Falls, accidents or incidents were closely monitored to ensure lessons were learned and future risks minimised.

Throughout the inspection we found there to be plenty of staff, not only to meet people’s basic care needs but to spend time with them on a one to one basis, engaging in a meaningful and caring way. Relatives we spoke to told us about the positive impact this level of interaction with staff had on their loved ones. They described how people had become more engaged after moving to the service, dancing, laughing and talking more.

The service was very forward thinking and proactive in their approach to people’s health and wellbeing. A full time holistic therapist was employed at the service and worked closely with other health professionals to achieve exceptionally positive outcomes for people. There was a team of four dedicated therapy and activity staff who were each focused on caring for and supporting people to live a meaningful life best to their ability.

A very in-depth assessment of a person’s needs was done prior to them moving to the service. These assessments looked at all aspects of a person’s care needs and formed the basis of the initial care planning. Respecting diversity and challenging inequality was part of the provider's values and working practices incorporated this ethos. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The service adopted an inclusive approach to planning end of life care and ensured people’s wishes were explored and recorded.

Feedback from people and their relatives was all extremely positive. People were cared for by a dedicated staff team who were proud of the work they did. Staff were very responsive to people, reading body language and responding accordingly to minimise any distress. Relatives were made to feel very welcome when visiting and told us how staff also did their very best to support the whole family not just this individual. Relatives all felt very involved in their loved ones’ care and spoke very highly of the management of the service.

There was an excellent level of management oversight. The registered manager and deputy were able to answer any questions about the service with confidence and ease. Records were well organised, up to date and extremely comprehensive. A comprehensive system of audits was in place that ensured the standards within the home were regularly monitored to maintain the existing high standards. The service had not received any complaints since our last inspection.

People received their medicines as prescribed and records were correctly completed. Medicines were stored in line with best practice guidelines and stock levels were appropriately managed. Health and social care professionals gave very positive feedback about the service and staff team.

There was a plan in place for dealing with emergency situations so people would continue to receive the appropriate support. All necessary maintenance checks were done and maintenance records were extremely well maintained.

Staff training was monitored closely and staff were up to date with essential courses. Staff were supported by a system of supervision meetings and annual appraisals. Staff meetings were also held regularly and feedback was sought from staff via annual surveys.

There were good links with the local community. For example, the ‘Safe in Tees Valley’ police cadet programme provided senior cadets who were dementia champions, to train care staff how to use some new technology that had been introduced into the home. People from the service accessed local pubs, shops and cafes and were therefore encouraged to be an active part of the local community.

Briardene is a 16 bedded purpose built care home providing nursing care to people with complex needs associated with dementia. It is located on the outskirts of Billingham. Public transport, shops and public houses are in close proximity.

The service had a registered manager in place and they have been registered with the Care Quality Commission since February 2011. 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.

The registered manager and all the staff were extremely passionate about providing a service that placed people and their families at the very heart of the service.

The ethos of the service was to provide a homely environment and support people to be as independent or as comfortable as possible.

Risks to people were being identified and assessed. Staff managed the risks related to people’s care well. Accidents and incidents were monitored and a system was in place to identify trends and patterns.

There were more than sufficient numbers of staff on duty to keep people safe. The registered manager followed safe recruitment processes. Staff were extremely positive about the support they received from their managers. They were encouraged to strive to improve. Staff were very motivated and proud of the service. Staff received comprehensive training that was up to date and a robust induction was in place.

People, relatives and visiting professionals could not speak highly enough about the support and care that was provided.

People were calm, settled, happy and contented. Staff treated people as individuals and treated them at all times with dignity and respect. People were never hurried or distracted from what they wanted to do. Staff were familiar with peoples life stories and were very knowledgeable about people’s likes, dislikes, preferences and care needs. They approached people using a calm, friendly manner which people responded to positively.

People had varied communication needs and abilities. Staff knew people very well and knew how to respond and talk to each person to give them the support and care that they needed and wanted. Staff listened to what people had to say and they gave them time to express themselves.

Staff understood the requirements of the Mental Capacity Act (MCA) 2005 and associated legislation under the Deprivation of Liberty Safeguards (DoLS) and put this into practice. Safeguarding procedures were in place to keep people safe from harm.

People felt safe living at the home and their risks had been identified and assessed so that staff were well informed on how to look after them safely. Accidents and incidents were reported and dealt with satisfactorily. Staff spent quality time with people to give them emotional support and comfort.

People’s medicines were managed, stored and administered safely

We saw safety checks and certificates that were all within the last twelve months for items that had been serviced and checked such as fire equipment and electrical safety.

The service had a complaints file and policy, however they had not received any complaints.

The service employed a therapy coordinator and they provided activities and occupation for people’s waking moments from leisure to personal activities. For example pamper sessions and music sessions.

People told us the cook provided good quality food and catered for their individual preferences. This included people’s specific health and dietary requirements. Food and drink was available to people throughout a 24 hour period. Staff gave excellent and discreet support to those who required extra help in eating and drinking.

The registered manager and registered provider carried out regular checks to monitor and improve the quality of the service.

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

If you want to see the evidence supporting our summary please read the full report.

Is the service safe? - People were treated with respect and dignity by the staff. Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards and appropriate applications had been submitted and records held accordingly. Policies and procedures were in place to make sure that unsafe practice is identified and people are protected. Staff we spoke with knew how to report any concerns they had to management.

Is the service effective? - People's health and care needs had been assessed and were written with support from families and described how people would like their care to be delivered. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

Is the service caring? - People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. One visitor told us that she felt staff were very caring in their interactions with people. People using the service, their relatives, friends and other professionals involved with the service were asked for their views through meetings. interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. We saw letters from family members describing the 'excellent' level of care their family members had received whilst at Briardene.

Is the service responsive? 'The service regularly sought views of people using the service and visitors via meetings. The home had a complaints policy and procedure that was accessible and people and visitors to the home told us they could raise any issue with the managers or staff.

Is the service well-led? - The manager and clinical nurse lead had clear roles along with care staff and a therapy team. Together they met regularly to plan how the service should be managed. The service has a quality assurance system; records we saw showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving. Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

We observed people who lived at the service as their dementia meant communication was difficult and we spoke with one relative and three members of staff as well as the clinical nurse lead. One visitor told us; "I can speak to any of the staff or the nurse in charge if I have any issues, I feel my relative is safe here and well cared for, I'm glad I chose this place".

We spoke with three members of staff. They told us; 'The staffing levels are really good, if you need time out you can just ask' and 'You are never in a situation where you don't feel supported'. Another said; 'There is support if you are worried about anything' and 'The training is great'.

A relative we spoke with said, "They are very good here, their care plan has been discussed with me and I am invited to attend review meetings.' Another said, 'I am very satisfied with how my relative is looked after. I believe they are well cared for and have confidence in the staff to meet their needs.'

We found that people had person centred care plans that were up to date and reflected their care needs. We also found that staff worked in collaboration with other health and social care professionals.

We found that people lived in an environment that was homely, clean, well maintained and safe.

We found that people needs were met by sufficient staff with appropriate skill, knowledge and training.

We saw that there were systems in place should people want to raise concerns or complaints about the service.