This inspection was unannounced and took place on 18 and 19 June 2018.

Briarscroft 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. A maximum of 66 people can live at Briarscroft and at the time of our visit 62 people were living there. The home is purpose built and is divided into four separate ‘units’ .Two units on the ground floor ‘Fisher’ which is residential care and ‘Spitfire’ Which is dementia care and two on the first floor ‘Dunlop’ which is residential and ‘Digbeth’ which is dementia care.

We previously inspected this service on 27 February 2017. We found that the provider was not always meeting the legal requirements set out by the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014 and were rated as Requires Improvement. The provider was failing to meet regulation 12 of the HSCA which related to the safe management of medicines. After our inspection in February 2017 the provider provided us with an action plan outlining what they would do to meet legal requirements in relation to the breach. We revisited the home and conducted a focussed inspection on 10 May 2017 and found that the provider had adhered to their action plan and improvements had been made in order to meet the legal requirements. Further work was taking place to improve staff skills and monitor the competencies of staff administration of medicines, to prevent reoccurrence of errors.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Prior to this inspection we received whistleblowing concerns about some aspects of the service, including staffing levels and the provision of food. Whistle-blowing is the term used when someone who works in or for an organisation raises a concern about malpractice or wrongdoing; staff should be supported to raise their concerns within the organisation without fear of reprisal. As a result of this information we brought forward our planned comprehensive inspection of this service.

The provider’s quality monitoring systems had not always been robust at identifying where improvements were needed and we found a breach of the regulations. You can see what action we told the provider to take at the back of the full version of the report.

Staffing levels were not always adequate to meet people’s needs. Not all staff were aware of people’s health needs and associated risks.

People were asked for their consent before care was provided. Where people’s rights were restricted this had been done lawfully, however not all staff were aware of who was subject to a Deprivation of Liberty Safeguards DoLS authorisation or the reasons for this. People received sufficient amounts of food to maintain their health.

Most staff were caring however, we saw that at times staff were task focused and there were missed opportunities to engage with people in a meaningful way.

People felt safe living at the home and were protected from the risk of abuse. The provider had systems in place to minimise the risk of abuse and staff had a good knowledge and understanding of the signs of abuse and who to report concerns to.

Arrangements were in place to ensure all staff had received the training they required to meet

people’s needs. Staff told us they had completed an induction programme and had supervision and some meetings had taken place and plans in place to improve the frequency of these.

The home environment was maintained and appropriate for the needs of people living at the home. Plans were

We last carried out a comprehensive inspection at this service on 27 February 2017. The inspection was unannounced and we found that there was a breach of regulations because people were not always getting their medicines as prescribed.

Following that inspection we issued a Warning Notice to the provider on 13 March 2017. The provider sent us an action plan detailing the actions they would take to address the shortfalls. At this inspection, carried out on 10 May 2017, we saw that improvements had been made to the way in which medicines were managed so that people received their medicines as prescribed.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Briarscroft Residential Care Home’ on our website at www.cqc.org.uk’

Briarscroft Residential Care Home can provide personal care to up to 66 people. At the time of our inspection there were 54 people living in the home.

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. At the time of this inspection there was no registered manager in post however, the provider was in the process of recruiting a new manager.

During this inspection we only looked at the management and auditing of medicines. Therefore we have not reassessed the rating of the service.

People spoken with told us that they were happy in the home and that they received their medicines at regular times. We saw that improvements had been made in the management of medicines so that people received their medicines as prescribed but further improvements were needed particularly in the administration of prescribed creams.

The provider was taking actions to improve staff skills and monitor the competencies of staff administering medicines. A variety of audits were being carried out to monitor the administration of medicines so that shortfalls could be identified and actions taken to prevent re-occurrence of errors.

We inspected Briarscroft Residential Care Home on 27 February 2017 and it was unannounced. At our last inspection in October 2016 we found that there was a breach in regulations because the management of medicines did not ensure people received their medicines as prescribed. We found the provider required improvement in all five areas we looked at: safe, effective, caring, responsive and well led. At this inspection we looked at all five areas again and checked whether improvements had been made and sustained in the management of medicines.

Briarscroft Residential Care Home can provide personal care to up to 66 people. At the time of our inspection there were 62 people living in the home.

There was a registered manager in post but not available during our inspection. 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 were not always receiving their medicines as prescribed because sometimes staff signed the medicine administration record to show medicines had been given but they had not always been given. Although staff had received training in giving medicines safely they were not always following the correct procedures and following up with the doctor if people were not taking their medicines. We found that the management of medicines had not improved sufficiently to ensure that people received their medicines as prescribe and we are considering further actions we may take.

We saw that some improvements had been made to the auditing and monitoring of the service but further improvements were needed to ensure that the service improved and improvements were sustained.

People told us that staff were busy and they thought that there could be more staff available however; everyone told us that their needs were being met.

People were kept safe because staff were knowledgeable, skilled and able to meet people’s needs in a caring and compassionate way. Staff were supported through training and meetings to meet people’s needs and to have opportunities to raise any concerns they may have. Staff were knowledgeable about the actions they should take in emergency situations.

People were treated with dignity and respect. Staff understood the importance of gaining consent and giving people choices about the care they received. People’s human rights to liberty and making decisions were protected because the appropriate actions were taken. People were supported to remain as independent as possible.

There were group activities for people to be able to take part if they wanted. There were individual activities available for people if they preferred. People told us that they knew who to talk with if they had any concerns but they hadn’t had any as they were happy with the service they received.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The home was visited on the 21 July and 8 August 2016 by an inspector but due to unforeseen circumstances a report of this visit was not completed so another inspection was arranged. Our inspection took place on 3 and 4 October 2016 and was unannounced. At our last inspection of the service on 28 July 2014, the provider was found to be meeting legal requirements in the areas inspected.

Briarscroft Residential Care Home is registered to provide accommodation and personal care to a maximum of 66 older people who may have a diagnosis of Dementia. At the time of our inspection there were 61 people living at the home across four ‘units’; Fisher, Spitfire, Dunlop and Digbeth.

There was a registered manager in post who was present during the inspection. 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.

Medication was not always given in a safe way by staff. Records kept on medication given did not show that medications had been given as prescribed. Where people had medication given with food, there was no evidence that authorisation to do this had been sought from the GP. This is a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. You can see what action we told the provider to take at the end of the full version of the report.

Staff had undergone checks prior to starting work to ensure they were safe to work but there were not always sufficient numbers of staff available to support people Staff did not always manage risks to keep people safe. Staff understood how to safeguard people from abuse.

Staff sought people’s consent prior to providing support in line with Mental Capacity Act 2005 but the provider was not always able to evidence that people were supported in line with this where they lacked capacity to make certain decisions. People’s experience of mealtimes varied and there was a risk that people’s dietary needs would not be met. People were supported to access healthcare services when required but concerns were not always followed up in a timely way. Staff had access to an induction and training to support them in their role.

People were not always supported to make choice or treated with dignity. People were supported to maintain their independence and relationships with family. People had access to advocacy services where required.

People were involved in an initial assessment of their needs. However people were not involved in reviews of their care and records were not always kept up to date. Staff knowledge of people’s care needs varied. There were activities available for people and complaints were investigated by the registered manager.

People knew who the registered manager was and felt able to approach them if needed. Audits were completed to monitor the quality of the service but this was not always effective in identifying areas for improvement. People were able to provide feedback on their experience of the service but we could not evidence that responses given were acted upon.

We visited Briarscroft and carried out a 'follow-up' inspection there. We did

this because the provider was not meeting the requirement of assessing and monitoring the quality of the service provision regulation when we carried out our previous inspection in April 2014.

We looked at information to help us gather evidence about whether improvement had been made. On the day of our inspection, the deputy manager told us that 61 people lived there.

The registered manager was not available on the day of our inspection. We spoke with the deputy manager and with some staff on duty. We also spoke with

eight people that lived there or their relatives.

Below is a summary of what we found.

The detailed evidence supporting our summary can be read in our full report.

The service had a quality assurance system. Records looked at showed that the registered manager and deputy manager identified areas that needed improvement.

We looked at audits of medication, infection prevention and control and care records. We saw that actions to improve were identified but were not always implemented in as timely way as they could be. However, we found that improvement had been made overall.

We visited Briarscroft and carried out an inspection there. We looked at information to help us gather evidence about the quality of the provider’s care and support to people that lived there. On the day of our inspection, the registered manager told us that 60 people lived there.

We spoke with the registered manager and care staff on duty. We also spoke with the chef and activities person. We spoke with 10 people that lived there and observed other people that lived there and later spoke with 13 relatives. Our conversations with people helped us to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? and, Is the service well led?

Below is a summary of what we found. The summary is based on our findings during the inspection, speaking with people and their relatives about the service, staff members supporting people that lived there and from looking at records.

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

All of the people spoken with told us that they felt safe living at the home. One person told us, “I feel safe here.” All of the relatives spoken with confirmed to us that they felt that their family member was safe there. One relative told us, “The staff are very good. I think they care well for my family member and keep them safe.”

There was a system in place to record accidents and incidents. Staff spoken with showed that they were aware of the reporting system. We saw that 45 accidents and incidents were recorded for March 2014. We saw that the provider had taken appropriate action and that a high proportion of these related to one person whose needs had been reassessed.

There was a system in place to handle concerns and complaints. The registered manager told us that three complaints had been received by the provider from people that lived there or their relatives since our last inspection in November 2013.

The registered manager told us that several new staff had commenced employment at the home since our last inspection. We saw that staff files looked at contained the required pre-employment checks. This meant that the provider ensured that people employed were suitable to work with vulnerable adults.

As part of our inspection we asked the registered manager about how they implemented the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DOLS). They told us that they would make the appropriate referrals for people if needed. We saw that a recent audit had identified that some updates were needed in a few people’s care plans that included the provider’s general mental capacity assessment which meant updates were planned for and the registered manager was aware of their responsibilities under the Mental Capacity Act.

We looked to see if the service was safe, clean and hygienic. We saw that all communal areas were visibly clean, and were free from any strong odours. Of the 13 relatives spoken with, two told us that they felt their family member’s bedroom was not always visibly clean. All of the other relatives spoken with told us that they felt that the level of cleanliness throughout the home was good.

We also looked at the main kitchen and saw that this was visibly clean. This meant that there was a reduced risk of cross infection.

We looked at the management of medicines and found that actions needed to improve systems were not always implemented or sustained.

Is the service effective?

We saw that the provider's information guide was displayed in the home and gave people information about the service.

The registered manager told us and gave us an example of when an advocacy would be used for people.

We saw that information was displayed about activities that were planned for. We also saw that a newsletter was available that provided details of what was planned. Some people told us that they enjoyed the activities that took place. One person told us, “I enjoy watching a film.” This meant that activities were planned for and took place.

Is the service caring?

People we spoke with told us that they thought staff were kind and caring. One person told us, "The staff are good.” One relative told us, “I am happy with my family member’s care at the home and the activities that they provide there.” Another relative told us, “My family member is always well-presented. I am happy with the care they receive.”

Is the service responsive?

Most relatives spoken with told us they had no concerns or complaints. One relative told us, “I find the manager approachable. If I had any concerns I would speak with them.”

Is the service well led?

We saw documented evidence that showed that the provider worked with other health care professionals and made referrals for advice and guidance when needed.

People that lived there and their relatives were asked for feedback about the service. Resident and relative meetings took place so that feedback could be gathered. However, a few relatives told us that they did not know if actions were implemented.

The service had a quality assurance system. Records looked at showed that audits took place. However, we looked at a recent medication audit and saw that actions needed to improve were identified but were not effective. We have set a compliance action.

Since the time of our last inspection in May 2012, there had been a change of provider.

There were fifty seven people living at the home at the time of our visit. We spoke with ten of these people and the staff that were supporting them. We spoke with some relatives and a health professional that was visiting the home.

We observed the care and support being provided. Staff supported people in a respectful manner and offered choices of how and where they wanted to spend their time.

People told us that staff supported them in a respectful and sensitive manner. However, some people said that staff were not always available at the times they needed them.

People told us that they were happy with the choice and quality of food provided.

People told us that they felt safe living at the home and that they would speak to the staff if they had any concerns. However from training records reviewed it was evident that not all staff had undertaken refresher training in this area since their induction.

During our inspection, we asked local authority staff involved in monitoring the home about the quality of service provided. They did not have any information to share with us about the quality aspects of the service. We were informed at the time of our inspection that the registered manager was leaving and new manager was due to commence working in the home.

During our inspection of this service in July 2013 we found non-compliance with six outcome areas; care and welfare of people, meeting nutritional needs, management of medicines, records and the assessing and monitoring the quality of service provision. We also found that there was inadequate overall scrutiny from the registered person to give assurance that the service was being run as it should have been. We carried out this inspection to find out if improvements had been made. We found that improvement had been made in some areas but further improvement was still needed.

No one knew we would be inspecting and we carried out our inspection over two days. We were told that fifty people used the service at the time of our inspection. During our inspection we spoke with twenty people who lived there, seven relatives of people, ten care staff and two other staff members. We also spoke with the new manager that started working there during the summer of 2013, the area manager and the area catering manager.

One person told us, “Staff are kind and help with my needs.” The care and welfare of people who used the service was protected and people’s identified needs were met.

One relative told us, “I think that the food has improved.” We saw that choices of suitable and nutritious food and drinks were offered to people.

We asked people who lived there whether they felt safe. All the people that we asked told us that they felt safe. One person told us, “Yes, I feel safe.” One relative told us, “I feel my relative is safe living here.” We saw that processes were in place to protect people from the risk of harm or abuse.

We saw that the system for ordering people’s medication was not robust. We found improvement was required to ensure that people were not placed at risk of ill health due to the unsafe medication practices.

We found that systems of audit of the quality of the service being provided were more robust than we found at our previous inspection. This meant that the service was being run in the best interests of the people who lived there.