This inspection took place on 23 and 29 January 2019 and was unannounced.

At our last inspection in October 2017 the service was rated as required improvement. This was the fourth time in succession that the home had been rated as either inadequate or requires improvement. The last inspection identified breaches of two regulations in relation to safe care and treatment and good governance.

At this inspection we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There were continued breaches of the regulations relating to good governance and safe care and treatment and an additional breach for premises and equipment. You can see what action we told the provider to take at the back of the full version of the report.

We are considering options in relation to enforcement action. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to the end section of reports after any representations and appeals have been concluded.

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

Briarmede Care Home is registered to provide care for up to 32 people, with accommodation in single or shared bedrooms over two floors. It is situated in Middleton, Greater Manchester. At the time of the inspection there were 25 people living in the home.

There were two registered managers 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 made three recommendations. We made a recommendation to support further improvement to help ensure the home is dementia friendly. We have made a recommendation about the Equality and Diversity Act 2010 and a recommendation about data protection.

A new system was introduced during the inspection to manage people’s prescribed creams safely. Records were kept in people’s bedrooms and did not include clear instructions or body maps.

Better oversight was required to ensure that checks were in place to ensure that staff employed continued to be suitable.

Recommendations in a fire risk assessment had not been followed in a timely manner. We made a referral to a fire safety officer because of these concerns. Systems were in place to monitor the safety of other equipment and all other required checks were up to date, including gas and electric safety checks.

There were health and safety shortfalls including unlocked doors to hazardous areas, missing window restrictors, unsecured wardrobes and these issues were not acted upon until we informed the Registered Managers during the inspection.

Systems were in place to ensure sufficient numbers of staff were provided and people reported feeling safe. Staff were aware of their responsibilities to safeguard people from abuse and risks to people's safety were assessed with guidance on how to minimise the risks. The service had a whistleblowing policy and staff reported feeling able to report poor practice if required.

The home was clean and staff had received training and understood their infection control responsibilities. Accidents and incidents were recorded on a regular basis including any responses and outcomes and there was a business continuity plan in place to help staff respond appropriately to any emergencies that could arise.

People’s nutritional and hydration requirements and food preferences were recorded and adhered to. The premises were adapted appropriately for the people who lived there.

People’s needs were assessed before admission and a suppor

We inspected Briarmede Care Home on the 25 and 26 October 2017. The first day of the inspection was unannounced.

Briarmede Care Home is registered to provide accommodation for up to 32 older people who require personal care. There were 30 people using the service at the time of the inspection. Briarmede Care Home is a detached converted building situated on the main road which connects the towns of Middleton and Rochdale. There is a frequent bus service that passes the home and there is a car park to the rear. Bedrooms are provided on the ground and first floor and accessible by a small passenger lift. People have access to a large open plan lounge/ dining room on the ground floor.

We last inspected Briarmede Care Home on 01 March 2017 where we found there were several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to; People’s medicines were not always managed and administered in a safe way, management plans were not in place where risks to people’s health and safety had been identified, there were no effective systems in place to monitor the service and facilities provided, limited activities for people, information in the care plans was not complete and up to date and the recruitment system was not safe. The service was placed into Special Measures following the last inspection which meant it was kept under regular review and inspected within six months of the last inspection. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

During this inspection we found there had been a significant improvement and the provider had met all the previously breached regulations apart from the management of medicines. Due to the improvements seen on this inspection the provider has been taken out of Special Measures.

We found that the management of medicines continued to be unsafe. Although there had been an improvement in the storage, handling and disposal of medicines, there was not always guidance in place for 'when required' or ‘variable dose’ medicines were prescribed. We also saw that several of the medication administration records had handwritten prescriptions that had not been checked and countersigned by another staff member to ensure their accuracy. These had been previous requirements from the last inspection. This was a continued breach of Regulation 12 (2) (g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During this inspection we also found additional breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009. The provider had failed to provide the Commission with information that is required by legislation. This was in respect of the Provider Information Return (PIR).

We also found that not all records, necessary for the management of the home, were in place. Inspection of the fire log book showed that the required weekly or monthly checks on the emergency lighting, fire equipment, escape routes and the activation of the fire alarm, although we were told they had been undertaken, had not been recorded since May 2017. There were no fire drills recorded. There was also no evidence to show that the annual gas safety check had been undertaken since July 2016.

The home did not have a registered manager. There had been no registered manager since July 2017. The provider was present during the inspection and told us that a new manager had recently been appointed (two people wanting to undertake a ‘job share’) but they had not started the process of registering with the Commission at the time of the inspection. Failure to have a registered manager is a breach of a condition of the provider's registration and it is an offence.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to rep

This was an unannounced inspection, which took place on the 27 January 2017, 28 February 2017 and 1 March 2017. Our last inspection report was published in October 2016. At that inspection we identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to the notification of incidents which must be reported to the Care Quality Commission (CQC), the lack of dignity and respect in the support provided to people, that prescribed creams were not managed safely and water outlets did not work effectively or at the correct temperature so that people's personal care needs were met safely and effectively. We also issued a warning notice requiring the provider to improve staffing levels within the home so that people were supported in a timely and effective manner.

We asked the provider to send us an action plan telling us what action they had taken to meet the regulations. This was provided. During this inspection we checked to see if the breaches in regulation had now been met. We found the provider had taken the necessary action to meet the regulations. However further breaches were identified during this inspection.

Briarmede Care Home offers accommodation and personal care for up to 32 older people. The home is situated on the main road which connects the towns of Middleton and Rochdale. There is a frequent bus service that passes the home and there is a car park to the rear. At the time of our inspection there were 25 people living at the home.

The service has a registered manager, who is supported in their role by the provider, operations manager and a deputy manager. 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.

During this inspection we identified breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

Systems to demonstrate clear leadership and effective quality monitoring of the service were not in place to help protect people from the risks of unsafe or inappropriate care and support. Better opportunities could be provided for people and their relatives to comment on the service provided.

People’s medicines were not always managed and administered in a way which ensured people received their prescribed medicines safely.

Clear assessments and management plans had not been put in place where risks to people’s health and well-being had been identified.

The provider had not acted in accordance with the principles of the MCA where people were unable to consent to the care and support. Where people were being deprived of their liberty requests for authorisation had been made; these provide legal safeguards for people unable to make their own decisions.

Information in the care records was not complete and up to date to ensure consistent and appropriate care was delivered.

Required information and checks were not always completed when recruiting new staff ensuring their suitability to work at the home. People told us they felt safe and that there were adequate numbers of staff to meet their individual needs.

The lack of social and leisure opportunities did not promote people’s autonomy, independence and community presence and consider their individual needs and preferences.

People told us that staff were polite and caring and responded to their requests for help. Staff spoken with were able to demonstrate a good understanding of the care and support that people required. Specialised training was provided to help ensure that staff were able to care for people who were very ill and needed end of life care.

Suitable arrangements wer

This was an unannounced inspection, which took place on the 13 and 27 July 2016. Our last inspection report was published in June 2015. At that inspection we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to good governance, record keeping, the management of people's prescribed medicines (controlled drugs) and management of risks to people. We asked the provider to send us an action plan telling us what action they had taken to meet the regulations. This was provided. During this inspection we checked to see if the breaches in regulation had now been met. We found the provider and registered manager had taken the necessary action to meet the regulations.

Briarmede Care Home offers accommodation and personal care for up to 32 older people. The home is situated on the main road which connects the towns of Middleton and Rochdale. There is a frequent bus service that passes the home and there is a car park to the rear. At the time of our inspection there were 25 people living at the home.

The service has a registered manager, who is supported in their role by the provider, area manager, operations manager and a deputy manager. 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.

During this inspection we identified five further breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

Work was required to ensure water outlets worked effectively and at the correct temperature so that people’s personal care needs were met safely and effectively

What people told us and what we saw did not demonstrate that the staffing arrangements in place to meet the current and changing needs of people were adequate ensuring people received a good standard of care in a timely manner.

People’s prescribed medicines were kept safe. However the management and administration of prescribed skin creams needed improving to show that people were receiving these safely and effectively.

People’s personal items were not respected and cared for properly. People’s care was not always delivered in a person centred way, which protected their dignity and promoted their well-being.

The registered manager had not notified the CQC of all events, which occurred at the home, as required by legislation.

Systems were in place to support and develop the staff team. A review of staff training needs had been completed and a new training provider source. It was anticipated this would include other areas of training specific to the needs of people who used the service.

Opportunities for people, particularly those living with dementia, to participate in a range of activities offering stimulation and variety to their daily routine were limited. We have made a recommendation about the type of opportunities that could be made available to people to promote their well-being and encourage their independence.

We found the provider was meeting the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions. Where people lacked mental capacity steps were taken to ensure decisions were made in their best interests.

People were offered adequate food and drinks throughout the day ensuring their nutritional needs were met. Where people’s health and well-being were at risk, relevant health care advice had been sought so that people received the treatment and support they needed.

Relevant information and checks were completed when recruiting new staff. This h

Briarmede Care Home offers accommodation and personal care for up to 32 older people. The home is situated on the main road which connects the towns of Middleton and Rochdale. There is a frequent bus service that passes the home and there is a car park to the rear.

This was an unannounced inspection carried out on the 28 April 2015. At the time of our inspection there were 23 people living at the service.

The home had a manager who was registered with the Care Quality Commission. 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 last inspected the home in July 2014. We found the provider was meeting all of the regulations we assessed at that time.

During this inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

People were supported by sufficient numbers of staff to meet their needs. However we found opportunities for staff training could be enhanced so that staff were able to develop their knowledge and understanding in relation to the specific needs of people.

The manager was aware of their responsibilities with regards to the deprivation of liberty safeguards. Suitable arrangements were made where people lacked the capacity to make decisions for themselves so that they were protected.

We found systems to monitor, review and assess the quality of the service were not in place to help ensure that people were protected from the risks of unsafe or inappropriate care. Whilst people and their visitors said they felt able to raise any issues or concerns, we found that records were not maintained to show that information received had been acted upon.

Checks were made to the premises and servicing of equipment. However suitable arrangements were not in place in the event of an emergency to help ensure that people were kept safe.

We found the management and administration of people’s medicines was not safe.

People and their relatives were involved and consulted about the development of their care so their wishes were considered and planned for. People were happy with the care and support they received and told us that staff were caring and friendly.

We talked to staff about how people were protected from harm. Staff were confident in describing the different kinds of abuse and signs which may suggest a person might be at risk of abuse. They knew what action to take to safeguard people from harm.

People were offered adequate food and drinks throughout the day ensuring their nutritional needs were met.

Routines were relaxed, with people spending their time as they chose. Activity staff were exploring a range of activities so that people’s social and emotional needs were considered.

During our visit we saw examples of staff treating people with respect and dignity. People living at the home and their visitors were complimentary about the care and support provided. Sensitivity and compassion had been shown to people at the end of their life. 

We spoke generally with several people who used the service and three people specifically about this inspection, the registered manager, area manager and three staff members. We also looked at the quality assurance systems and records. This helped answer our five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found.

Was the service safe?

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. People who used the service said, "I have friends I can talk to or one of the staff if I had any worries. The deputy manager is wonderful and she would listen to me", "I would talk to my daughter or staff if I had any worries. I have no complaints about my care here" and "I would tell staff if I had any worries. You don’t get anywhere if you don’t speak your mind but I don’t have any complaints". This reduced the risks to people and helped the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made and how to submit one.

The home was clean, warm and free of any offensive odours. There were dedicated domestic staff to clean the home. Three people who used the service told us, "The home is always clean and tidy", "My room and clothes are kept clean" and "It is so clean and tidy. They change the bedding every day". We saw that improvements had been made to infection control procedures to help stop the spread of infection.

We saw that the electrical, fire and gas equipment had been maintained. Staff were aware of the system for having items repaired and replaced. The home and equipment was maintained and repaired to help keep staff and people who used the service free from possible harm.

Was the service effective?

People's health and care needs were assessed with them if possible, and they were involved in writing their plans of care. The three care plans we looked at showed there had been regular reviews and any changes to people's care and condition had been recorded. However, more information around a person's end of life care would ensure their wishes were taken into account at this difficult time. People who used the service told us, "I get the care I need and what I want. I am treated like the Queen. They close the curtains and door and care for me privately", "I get the care I need and staff are careful to treat me with privacy" and "They help me with my care. I asked for a shower late on last night and had the best night’s sleep in ages".

Specialist dietary, mobility, skin care and community support needs had been identified in care plans where required. Specialist equipment was provided such as pressure relieving devices or mobility aids.

The manager and other key staff audited the effectiveness of the systems they used. This included medication, the environment, infection control and plans of care. The information was used to improve the service.

The meals served at the home were nutritious and people were given sufficient fluids to help keep them hydrated. We sat in the dining room for most of the inspection. We saw that people had a choice of meal. The meal was held as a social occasion for those who wanted to eat in the dining room. All the people we spoke to around lunch time said the food was good. Three people also told us, "The food is reasonable. I am a picky eater and for me there is not a lot of variety. What we do get is hot and nice. I have a small appetite. I like my sandwiches and they will always make them for me", "I like the food and you can ask for something else" and "The food is very good. We get good choice and plenty of it".

Was the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. There was a friendly atmosphere within the home and we observed that staff interacted and chatted to people who used the service throughout the day. Three people who used the service told us, "The staff are nice and you can have a laugh and joke about things. The staff know what they are doing and I keep them in check and if you need help the staff come right away", "I find it all right here. One of the things I did not like they have fixed for me. The staff are pleasant and polite. Staff are hard working and know what they are doing" and "The staff are very nice. The manager and new deputy are lovely".

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. People who used the service were encouraged to provide as much information about their past lives and what they liked or did not. This information gave staff the knowledge to treat people as individuals.

People lived in a comfortable environment and were able to personalise their rooms to make them feel more at home. Three people told us, "I am doing fine here. I like to stay in my room. I get my meals here because I want to. I like this room. I have a good view and as you can see I have lots of family photographs and Manchester City football club memorabilia", "I have a lovely room. Quiet and peaceful" and "I am very happy here in my nice room. I have lots of my own things to make it like home".

Was the service responsive?

People completed a range of activities in and outside the service regularly. Each person had their known hobbies and interests recorded. One person told us, "Because I stay in my room I do my own thing. I rarely join in activities but they do ask me. I like to watch television, read my Kindle, do word searches and knitting". Only one of the three people we spoke with wanted to join in activities. There were activities on offer and some people attended. However, the registered manager was in the process of employing a person to provide activities and entertainment to try to help stimulate the people at the home. Activities were suitable for the people accommodated at the home.

The registered manager held regular meetings with people who used the service and staff. Each day staff attended a 'handover' meeting to ensure they were up to date with people's needs. Staff were able to voice their opinions at meetings and supervision sessions.

Was the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. There was a system for providing information to other providers in an emergency.

Records we looked at were up to date and policies and procedures had been reviewed by the registered manager. The records were stored securely and easily available for inspection.

The service had good quality assurance systems. The registered manager undertook regular audits of the service. Records seen by us showed that identified shortfalls were addressed promptly and as a result the quality of the service was continually improving. Two staff members we spoke with told us of their involvement with care plans which was suitable for their roles. They said they had been well trained and the home was clean and tidy. They told us, "I like working here most of the time. It can be stressful, especially the management side. I like caring for people the most. I have had good support when I need it. I think the care staff do their very best to deliver good care." and "I like working here. I like interaction with the residents and the banter is very good. We get good support from management. The new manager is very approachable. There is a good staff team and we get loads of training – enough to do the job".

We found there were systems in place to assess people’s needs and risks to their well-being. We saw staff assisted people in a warm, friendly and unhurried manner. People generally made positive comments about the care people received, which included “It’s very good on the whole”.

We saw that the home worked effectively with other professionals involved in people’s care. We saw that professional visits and advice was recorded in people’s care records.

Following our inspection in June 2013 we had asked the Provider to make some improvements to the way they managed risks of cross infection. We found improvements had been made by the systems put in place by the Provider. However we found that the processes were not always followed by staff. This meant that people were not always protected from the risk of cross infection.

We found that there were effective systems in place to manage people’s medication.

Following our inspection in February 2013 we had asked the Provider to make improvements to the standard of people’s care records. We found some improvements had been made, however quality checks were not carried out on all records and we found some records were not always complete. We also found records were not kept securely.

The purpose of our inspection visit was to follow up on information of concern we had received. We were told that staffing levels were not sufficient to meet the needs of the people at the home and that infection control procedures were unsafe and potentially placing people at risk.

We found that arrangements to minimise the control of infection were not adequate to prevent the risk of infection to people living and working at the home.

We found that staffing levels were sufficient to meet the number and dependency of people living at the home. Staff spoken with told us that this was kept under review and increased staffing was put in place if necessary.

During our visit we spent some time speaking with people at the home and their visitors. Overall people spoke positively about the care and support provided. One visitor told us, “they [the care staff] appear to care and look after people well” and “my relative seems to be well looked after”.

Individual care records were in place to guide staff about how people wished to be cared for. Some of the information needed updating so that information was accurate and reflected the current and changing needs of people.

Activities offering people variety to their day were being improved. A new activity worker had been appointed and ideas were being developed offering people a choice of things to do.

People living at Briarmede were provided with comfortable accommodation that was well maintained.

No issues were identified with regards to the safety and protection of people. The manager and staff were aware of their responsibilities in keeping people safe.

Suitable arrangements were in place with regards to the recruitment of new staff. On-going training and support was available so that staff had the knowledge and skills needed to support people living at Briarmede. Staff spoken with said they were happy working at the home, they felt supported and had confidence in the management team.

Systems were in place to monitor and review the service provided ensuring people received a good standard of care.