This inspection visit took place on 4 December 2018 and was unannounced. The inspection was carried out by two adult social care inspectors.

Brierfields is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. We regulate both the premises and the care provided, and both were looked at during this inspection.

Brierfields is a single storey care home in Failsworth, Oldham It is registered to provide care and support for up to 37 people. At the time of our inspection there were 32 older people living at the home some of whom were living with dementia. All bedrooms are single occupancy and have an en suite toilet and sink. There are two enclosed garden areas, one of which is accessible to wheelchair users. Car parking is available within the grounds.

We last inspected Brierfields in October 2017 and identified two breaches of the of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; Regulation 12 in relation to medicines management and Regulation 17 in relation to good governance.

In October 2017 We also identified a breach of Regulation 18 Registrations Regulations 2009, Notifications of other incidents. This was because the provider had failed to notify the Care Quality Commission of authorised Deprivation of Liberty Safeguards. We rated the service overall as ‘requires improvement’. The service had received an overall rating of ‘requires improvement’ at inspections carried out in February 2017 and October 2017.

At this inspection we found that the service had improved in some areas however, we identified that medicines were not consistently managed safely. This was a continued breach of Regulation 12, Health and Social Care Act 2008 (Regulated Activities) 2014. You can see what action we told the provider to take at the back of this report.

We recommend that the provider carry out a full review of their medicines audit process to ensure systems are robust.

There was a registered manager in place. 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.

Staff knew people's care needs, preferences, personal histories and backgrounds. People said staff protected their privacy and their dignity was respected. People were supported to remain independent.

People said staff treated them with kindness and compassion. Comments included, “I am happy and settled here, the staff are good, we get everything we need" and "[Registered manager] is hands on and knows everyone well.”

People received care from staff who were appropriately trained to effectively carry out their job roles. People were supported to have maximum choice and control of their lives. The service acted in accordance with the Mental Capacity Act (2005).

Appropriate health and safety checks had been carried out on the building and the home was clean and well maintained. We saw that infection control measures were becoming embedded and the manager completed a full health and safety audit every month.

Accidents and incidents had been appropriately recorded and monitored and risk assessments were in place for people who used the service and staff.

People's nutritional needs were met and they were supported to maintain good health and receive ongoing healthcare support.

Staff were aware of their responsibilities to safeguard people from abuse. Safe recruitment practices were in place and the service followed national and local safeguarding guidance.

There were sufficient staff to care for people. Risks to people's safety were assessed.

Care records written in a positive and respectful way we found that plans provided guidance on how to support people.

At our inspection in February 2017 we found the service was in breach of three of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection, although we found some improvements had been made, we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we identified a breach of Regulation 12 in relation to medicines management and Regulation 17 in relation to governance. We also identified a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 (part 4). Notification of other incidents. This was because the provider had failed to notify the Care Quality Commission of authorised Deprivation of Liberty Safeguards. You can see what action we told the provider to take at the back of this report.

We have made three recommendations. These are in relation to improving hand hygiene practices, improving the garden environment and the role of a newly recruited deputy manager.

The service was put in ‘special measures’ following our inspection in September/October 2016. Following our inspection in February 2017 the service remained in ‘special measures’. This was because the well-led key question was rated ‘inadequate’, although the overall rating for the service was ‘requires improvement’. We asked the provider to send us an action plan which stated how the breaches would be addressed. This inspection was to check improvements had been made and to review the ratings.

Brierfields is a single storey care home in Failsworth, Oldham. It is registered to provide care and support for up to 37 people. At the time of our inspection there were 20 people living at the home. All bedrooms are single occupancy and have an en suite toilet and sink. There are two enclosed garden areas, one of which is accessible for people who require wheelchairs. Car parking is available within the grounds.

The home had a registered manager. 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. At our last inspection in February 2017 we found that although the service had a manager who had taken up their position in September 2016 they had not taken steps to register with the CQC. At this inspection we found the manager had registered with the CQC and their registration had taken effect in June 2017.

The home was clean and free from any unpleasant odours. However, some of the communal areas were in need of redecoration. Environmental checks of the home, such as for the gas and electricity supply were up-to-date. However the fire risk assessment was out-of-date. Arrangements have been made for a new fire risk assessment to be carried out.

We saw that some staff did not always follow good infection control practices, including failure to wash their hands or wear protective gloves. We have made a recommendation for the provider to reinforce good hand hygiene practice to all staff.

There were systems in place to help safeguard people from abuse. Staff understood what action they should take to protect vulnerable people in their care. Recruitment checks had been carried out on all staff to ensure they were suitable to work in a care setting with vulnerable people. At the time of our inspection there were sufficient staff to respond to the needs of people promptly.

We identified shortfalls in the management of medicines, including lack of protocols for ‘as required’ medicines.

New staff received an induction and all staff received regular supervision. Staff we spoke to told us they had received training in areas such as moving and handing and safeguarding procedures and we did not observe any poor care practice on our inspec

This inspection was carried out over two days on 7 and 10 February 2017. Our visit on 7 February 2017 was unannounced.

The overall rating for this service is ‘Requires improvement’. However, the service remains in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. At the last inspection and at this inspection the ‘Well Led’ section has been rated as ‘Inadequate’.

Brierfields is a single storey care home in the Failsworth area of Oldham, registered to provide care and support for up to 37 people. At the time of our inspection there were 19 people residing at Brierfields. All bedrooms have single occupancy and ensuite toilet and sinks. There are two enclosed quadrants providing a garden area accessible to people who used the service with a ramp for wheelchairs. Car parking is available within the grounds.

At the last inspection carried out on 29 and 30 September and 3 October 2016, we rated the service as ‘Inadequate’, which meant the service was in ‘special measures.’ At that inspection we identified seven regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014, relating to person centred care, consent to treatment, safeguarding people from abuse, maintaining safe premises, dealing with complaints, staffing and good governance. We also identified two breaches of the Care Quality Commission (Registration) Regulations 2009, as the service had not notified us of incidents affecting the delivery of the service. We issued warning notices in respect of the breaches relating to person centred care; safeguarding people from abuse and good governance

Following the last inspection the provider sent us an action plan which stated the breaches would be addressed. This inspection was to check improvements had been made and to review the ratings.

When we visited the service there was a manager who had been appointed and began working as manager of Brierfields in September 2016. However this person had not 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. At our last inspection we asked that this person seek registration but when we returned they had still not applied. This was in breach of regulation 7 of the Health and Social Care Act 2008 (Regulated Activities) 2014

During this inspection we found that action had been taken to make improvements and the provider was meeting the requirements of seven of the regulations. However, we found that the improvements made in relation to good governance and person centred care were still not sufficient and the service remains in breach of both regulations. You can see what action we have told the service to take at the back of this report.

There was insufficient detail in care plans to inform or guide staff when considering risk. We found that where risks had been identified the corresponding care plans did not contain enough information to consider how to overcome or mitigate the risk. We also found that care plans were task oriented, information was inconsistent or inaccurate, and did not provide a reliable way to meet assessed needs.

We saw that there was a consistent staff team who know the people who used the service well. They demonstrated a good understanding of how to protect people from harm. Where allegations of abuse had been made the service responded appropriately to ensure the allegations were followed up and investigated. We saw that the service had reviewed its recruitment procedures and

Brierfields is a single story care home in the Failsworth area of Oldham, registered to provide care and support for up to 37 people. At the time of our inspection there were 25 people residing at Brierfields and one person who was receiving day care.

All bedrooms have single occupancy and ensuite toilet and sinks. There are two enclosed quadrants providing a garden area accessible to people who used the service with a ramp for wheelchairs .Car parking is available within the grounds.

When we visited the service there was no registered manager in place. 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 identified nine breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and two breaches of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report. We found that the home had not been managed well, and that this had led to a number of concerns. One care worker we spoke to told us, “All checks had gone, there was no accountability; we just had to get got on with it.”

We found that staff understood the needs of people who used the service but this was not reflected in care plans, which were drawn up without consultation with people who used the service and their relatives. Risks were not always identified and when they were, they did not lead to a corresponding change in the care plan.

The service did not have systems in place to ensure that safeguarding concerns relating to people who used the service were appropriately followed up, or that protective measures were put in place to ensure the safety of people who used the service.

There were no systems in place to store or file documents. For example, staff files were incomplete, there was no admission and discharge register to document who was admitted to the home and when, and you was discharged and to where, and no central record of Deprivation of Liberty Safeguarding authorisations or requests. We were unable to locate maintenance checks for essential equipment or building requirements.

When we checked staff personnel files we saw that one person did not have proof of checks relating to their character and fitness to work with vulnerable adults.

People who used the service told us that they had never been asked their views on the delivery of service or completed any questionnaires that might influence the way their care was provided.

They told us that if they raised a concern this was dealt with effectively but there was no central file to monitor or record any complaints received by the service or how the service responded, or learnt from the complaint.

Staff were unclear about any training they had received, and there was no central system to determine if staff had attended courses or if they required any training in specific areas. There was no evidence that new staff had undergone a full induction, and staff told us that their supervision had been sporadic and that they had never had an appraisal. The new manager had prioritised staff supervision and had begun a timetable of three monthly supervision for all staff.

The service did not tell the Care Quality Commission about incidents where we should have been informed, for example, any accidents or emergencies or if a person who uses the service dies. This lack of notification means we cannot be assured that the right action has been taken. It also shows a culture that is not open and transparent with the Regulator.

We found that there were sufficient staff and that people who used the service were treated with respect and kindness by staff who knew them well.

People told us they liked

Brierfields is a purpose built care home offering accommodation and support for up to 37 people, all in single rooms. At the time of our visit there were 30 people living at the home.

The inspection was undertaken by one inspector. This summary addresses five key questions: is the service safe; is the service effective; is the service caring; is the service responsive and is the service well led?

This summary is based on a visit to the home where we spoke to the manager and observed staff interactions with people using the service. We looked at records and talked in private with three visiting relatives, three people using the service and four members of staff.

The full report contains the evidence to support this summary.

Is the service safe?

Overall the people we spoke with at the inspection visit were positive about the care provided by the home. Visitors told us they thought their relatives were safe. One said “I don’t think for one minute staff would hurt [my relative]”. Another visitor told us they thought the staff were “wonderful”. People living at the home also told us they felt safe. Their comments included “if I saw anything I would put a stop to it” and, when asked if they felt safe, replied, “absolutely”.

Staff who we spoke with told us they believed people using the service were protected from abuse or exploitation. Comments from staff about the service included “very safe, without a doubt” and “we [staff] all care and work together very well”.

There was documentary evidence that staff had received training in the safeguarding of vulnerable adults. This was confirmed by staff who we asked. Staff also told us they understood the need to be vigilant and, to whistle blow if necessary.

We had a quick tour of the building. This included communal areas and a small selection of people’s bedrooms. No obvious hazards to people’s health and safety were seen. Staff were provided with disposable gloves and aprons to help minimise the risk of cross infection.

People were provided with ample food and drink.

Medication was stored securely and administered by staff who were competent to do so.

Is the service effective?

Each individual’s care needs were assessed and reviewed. A care plan was developed on the basis of the assessment. Staff who we asked described good communication within the staff team. One member of staff, when asked what they thought the best thing about the home was, said “we are a good team, all work well together”.

People’s changing care needs were well communicated within the staff team. Staff told us they were updated at the start of each shift and were confident they understood the needs of each person who was using the service. Daily records were made in respect of each person using the service to further assist staff’s understanding of the person’s circumstances.

People using the service told us they were involved in discussion and decision making about their care. They told us that they felt listened to. Visitors who we spoke with during the visit also told us they felt involved. One visitor told us they were particularly grateful for the support that had been provided which had ensured an effective transition for their relative from hospital.

Is the service caring?

People we spoke with during the inspection visit were complimentary about the approach and attitude of the staff. Comments included “most are brilliant”, ”the girls [staff] are lovely, very helpful”, “very family like”, “it’s a comfortable safe place for my Mum to be”, “staff are wonderful” and “I can sleep at night knowing my mother is being looked after”.

Staff who we asked talked about good teamwork and confidence in their colleagues. When we asked staff what they thought was the best thing about the home, replies included “a good atmosphere and a good bond with the residents”, “the residents, I love them” and “a good team, we all work well together”.

Observation of interactions between staff and people using the service indicated a calm and friendly approach.

Is the service responsive?

We did not look specifically at the service’s complaints procedure. However, people using the service and visitors who we asked during our visit said they believed they would be listened to if they had a complaint.

People told us that they were involved in decision making about how their care was provided. Staff also told us that people using the service could influence the way their care was provided.

One person told us they had wanted to visit the local shops by themselves. Their first trip was with a member of staff, but following that and an assessment of their risk, there was no restriction on their independent trips out.

One person using the service also told us about an occasion when they had requested something to eat which was not on the menu, but in response to their request had been provided straight away.

Is the service well led?

There were clear lines of accountability between the manager and the care staff, including the seniors. We were told that a representative of the provider regularly visited the home. There were also regular meetings with the managers of the four homes owned and managed by the provider.

Staff who we asked told us that the manager was approachable and supportive. One person said “Nicole [the manager] is a good leader and approachable”. Another said the manager was “fair” and staff had “a clear sense of what Nicole expects”.

During this inspection we spoke in private with five people who used the service, three visiting relatives and three members of staff. Everyone spoke positively about the standard of care and support provided. Comments included "[staff] treat me very well, nothing is too much trouble for them"; very nice staff, very very decent" and "staff respect what I want".

Peoples care needs were assessed and there were written plans of care to help ensure that staff were aware of the individual needs of each person living at the home.

In the main medication was dealt with appropriately. However, the way in which the receipt and administration of a controlled drug was recorded did not guarantee that a safe system was being provided.

Sufficient staffing levels were provided to help ensure peoples’ needs were met in a timely manner. Staff were described as "friendly" by several people we spoke with.

The home had a complaints procedure. Everyone we spoke with was confident that they could complain if necessary and any complaint would be appropriately dealt with.

During our visit to the home we spoke with four people who used the service and two visiting relatives.

Everyone who we spoke to was positive about the care provided at Brierfields. People said staff treated them with respect and maintained their dignity and that they were involved in discussion about the best way to meet their care needs. One person mentioned that they had needed to raise an issue with the manager before it was resolved, but then it was quickly and satisfactorily dealt with. Staff were variously described as "down-to-earth and very helpful in every way", "it's like one big family, we have such a laugh", "staff are smashing", and "no need to influence care because staff just do it and it is fine".

Everyone who we asked told us they felt safe living at Brierfields. One person, when asked what was the best thing about living there replied "being looked after and having nothing to worry about."

People told us that they believed the staff team to be competent, with staff undertaking their work in a warm and friendly manner. One person who lived at the home when asked what was the best thing about it replied "the friendliness of staff and they make you feel comfortable."

People told us that they were confident that any complaints would be listened to.