CQC report explained · a residential care home
What the CQC found at Bryony House
Rated Inadequate: inspectors found the home performing badly and the CQC has taken enforcement action.
What inspectors found, March 2020
Bryony House was rated Requires Improvement; inspectors found kind, responsive care, but weaknesses in medicines, records and management checks.
Inspectors made an unannounced visit on 29 and 30 January 2020. They spoke with people living in the home, relatives, staff and a health professional. They observed care and checked care, medicines, staffing and management records.
People were treated kindly and supported to make choices. Staffing levels were considered safe, moving and handling was carried out safely, and people received help with food, health needs and activities. The responsive rating improved from Requires Improvement to Good.
There were important weaknesses. Medicines records and the management of creams and patches were not always reliable. Checks on accidents, food, fluids and pressure relief were incomplete. Some liberty safeguard applications were delayed, and documents were difficult to retrieve.
The overall rating remained Requires Improvement. Safe and Well-led were both rated Requires Improvement. Effective, Caring and Responsive were rated Good. The home had been rated Requires Improvement at the previous inspection, and the breach in governance continued.
Kind and respectful care
People and relatives said staff were caring and respectful. Inspectors saw people being supported with dignity and encouraged to make their own choices.
“People felt well supported and treated with kindness and compassion.” from the report
Safe staffing and moving
People, relatives and staff reported that staffing levels were safe. Inspectors saw timely responses to call bells and safe moving and handling.
“Call bells were responded to in a timely manner.” from the report
Activities improved
Activities had improved since the previous inspection. People were offered group and individual activities based on their preferences.
“The manager had employed an activity coordinator and they were completing activities as a group and with individual people.” from the report
Good health support
Staff contacted health professionals when needed and followed guidance about people's food, fluids and health needs.
“They [staff team] are very good at contacting us if they are worried about a person.” from the report
Medicines records
seriousCreams and patches were not always managed in line with guidance, and records did not always show that medicines had been given as prescribed. The report says there was no evidence that people had missed their medicines.
“The management and auditing of people's prescribed creams were not effective.” from the report
Weak management checks
seriousAudits did not identify problems with medicines, incidents, care records, liberty safeguard applications or a required notification to CQC. This was a breach of Regulation 17.
“Systems and processes were not robust enough to demonstrate quality and safety were effectively managed.” from the report
Incomplete monitoring records
needs fixingFood, fluid and pressure area checks were not consistently recorded for people known to be at risk. This meant those risks were not being effectively monitored.
“The lack of recording meant peoples known risks were not being effectively monitored.” from the report
Delayed liberty safeguards
seriousSome applications to deprive people of their liberty were delayed. Earlier authorisations could not be located, so inspectors could not verify whether any conditions were being met.
“DoLS had not been applied for in line with legal requirements.” from the report
Poor document storage
needs fixingDocuments were difficult to follow and could not always be retrieved quickly. Care records were not always completed for people's day-to-day needs.
“The storage and retrieval of documents was not effective and did not enable the manager to retrieve documents in a timely way.” from the report
- 01What has changed in the medicines system since the inspection, and how do you check creams, patches and administration records?
- 02How are accidents and incidents now analysed for themes and trends, and what changes have been made as a result?
- 03How do you record food, fluid and pressure relief checks for people at risk?
- 04Have all Deprivation of Liberty Safeguards applications and previous authorisations now been checked and correctly recorded?
- 05How quickly can you retrieve a person's care records and show that their day-to-day needs have been monitored?
This was an unannounced, planned inspection based on the previous rating and covered all five CQC key questions, including the care provided and the home itself. This explanation was written from the published report of 14 March 2020 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, February 2019
Bryony House was rated Requires Improvement; inspectors found kind care and good medicines support, but safety, activities and management checks needed improvement.
This was an unannounced comprehensive inspection on 3 December 2018. Inspectors spoke with people, relatives and staff, observed care, and checked care plans, medicines, recruitment files and management records.
The home was rated Requires Improvement overall. Safe, Responsive and Well-led were rated Requires Improvement. Effective and Caring were rated Good.
Inspectors found delays in answering call bells, unsafe moving and handling practices, and hazards in the building. People were generally treated kindly, involved in choices, supported with food and healthcare, and given their medicines as required.
Activities were limited and complaints were not always recorded. Management checks did not identify important problems, including unsafe moving and handling and risks in the environment. The report found a breach of Regulation 17.
Kind and respectful care
People said staff were friendly, kind and compassionate. People were supported to make choices about their daily routines, food and clothing.
“People felt that staff treated them with kindness and compassion.” from the report
Medicines were managed
Inspectors found that people received their medicines as required. Records matched the medicines available and medicines were stored and disposed of safely.
“We found that people received their medicines as required and that records tallied with medicines available.” from the report
Food and healthcare support
People enjoyed the food and had access to drinks and suitable alternatives. Staff supported people to see healthcare professionals when needed.
“Where people specific dietary needs these were catered for, for example one person was given a food supplement as directed by a health professional.” from the report
Detailed care plans
Care plans covered personal care, health, nutrition, medicines, mobility, preferences and end-of-life wishes. Reviews were completed in a timely way.
“They were detailed and gave information on needs and requirements and how people wanted their care needs met.” from the report
Staffing and call bell delays
seriousStaff were not always available when people needed them. Call bells were sometimes not answered for up to 11 minutes, and there was no tool to show how staffing levels had been decided.
“We saw a delay in staff answering call bells, sometimes this was up to an eleven-minute wait.” from the report
Unsafe moving and handling
seriousStaff did not consistently use the safe techniques they had been trained to use. There were no regular competency checks to identify and correct poor practice.
“We saw staff did not consistently follow their training and the management team had failed to identify this.” from the report
Limited activities
needs fixingInspectors did not see activities taking place and found that many people spent the day sleeping. There was not always an alternative for people unable to join activities.
“We found that although some external providers of activities visited to carry out activities such as bell-ringing, on a day to day basis people were unstimulated.” from the report
Weak management checks
seriousAudits did not identify problems found during the inspection or analyse patterns and trends well enough. This included concerns about moving and handling, environmental risks and repeated falls.
“Audits did not always provide enough information to enable a detailed analysis into patterns and trends.” from the report
Confidentiality and complaints records
needs fixingStaff were heard discussing people's needs openly in front of others. A complaint had been dealt with but was not recorded at the time.
“We heard staff on numerous occasions discussing people's needs openly, using their names in front of other people.” from the report
- 01How are staffing levels now worked out, and how do you monitor and reduce delays in answering call bells?
- 02How do you check that every member of staff uses safe moving and handling techniques?
- 03What activities are currently available, including suitable alternatives for people who cannot take part in group activities?
- 04How are complaints recorded and followed up from the time they are received?
- 05What new audits or checks have been introduced to identify risks, repeated falls and unsafe care?
This was an unannounced comprehensive inspection covering all five CQC questions, with the Safe, Responsive and Well-led ratings falling from Good in 2015 to Requires Improvement. This explanation was written from the published report of 20 February 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Bryony House
3 rated inspections over 4 years: the service has slipped, from Good to Requires improvement.
- March 2020Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- February 2019Requires improvementdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- December 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- November 2013
Report published without a new overall rating.
- August 2013
Report published without a new overall rating.
- December 2012
Report published without a new overall rating.
- January 2012
Report published without a new overall rating.
- November 2010
Registered with the Care Quality Commission on 24 November 2010.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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