28 February 2023
During an inspection looking at part of the service
Bryher Court Nursing Home is a residential care home providing regulated activities personal and nursing care to up to 45 people. The service provides support to people who were living with a range of health care needs associated with their age and physical health conditions. At the time of our inspection there were 34 people using the service.
People’s experience of using this service and what we found
Improvements were needed to some aspects of risk management. Systems were not robust enough to demonstrate safety was always managed effectively. Improvements were needed to recruitment procedures to ensure there was a full employment history for each staff member.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
Care plans and records did not always contain all the information staff needed to support people. An audit system was in place but this had not identified all the shortfalls we found. The manager and provider had oversight of the service and had implemented improvements which needed further time to be embedded into everyday practice. This included training, quality assurance feedback and accident and incident monitoring.
The home was clean and tidy throughout. Systems were in place to help ensure people were protected from the risk of infection. Staff understood safeguarding risks and procedures and knew what to do if concerns were raised. People were supported to receive their medicines when they needed them. There were enough staff working in the service to meet people’s needs.
People told us they were happy living at the home and we observed an open and friendly relationship between staff and people. Staff knew people well; they understood peoples care and support needs and were committed to providing good care. One staff member said, “We always try to do our best for people.” We identified areas that suggested care and support was not always person-centred. The provider and manager addressed this immediately. People, relatives and staff told us there was a positive culture at the home. They said the manager was approachable and they could speak with them at any time.
People were supported to maintain and improve their health with support from health care professionals. People were supported to have enough to eat and drink throughout the day to meet their nutritional and health needs, individual choices and preferences.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic. The service provided care and support to 2 people with learning disabilities and autism. The manager was aware of the principles of RSRCRC. At the time of the inspection these people’s needs required care from nurses due to their health needs .
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
We undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
Rating at last inspection
The last rating for this service was Good (published 17 November 2017).
Why we inspected
This inspection was prompted by a review of the information we held about this service.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
The overall rating for the service has changed from Good to Requires Improvement based on the findings of this inspection.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bryher Court Nursing Home on our website at www.cqc.org.uk.
Enforcement
We have identified breaches in relation to Safe care and treatment, Need for consent and Good governance.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.