What life is like for people using this service:

Service management and leadership was inconsistent and areas for improvements were identified in the quality monitoring of meal time experience, medicines and accurate record keeping. The registered manager provided assurance that people’s views and experiences would be gathered and any improvements made.

Staff knew how to recognise potential abuse and who they should report any concerns to. People had access to equipment that reduced the risk of harm. There were sufficient staff on duty to meet people’s needs.

People had a choice of food and were supported to maintain a healthy diet in line with their needs and preferences. Staff were trained to meet people’s needs and acted promptly to refer people to healthcare professionals when required.

People enjoyed positive and caring relationships with the staff team and were treated with kindness and respect. People’s independence was promoted as staff.

People were supported by staff who knew about their needs and routines and ensured these were met and respected. People and relatives knew how to complain and were confident that their concerns would be listened to.

People and staff were happy with the way the service was led and managed and the provider worked well with partners to ensured people’s needs were met.

We found the service met the characteristics of a “Good” rating in most areas; More information is available in the full report

Rating at last inspection: Good (report published 3 June 2016)

About the service: Bryden House is a residential care home that was providing personal and nursing care up to 30 people aged 65 and over at the time of the inspection.

Why we inspected: This was a planned inspection based on previous rating.

Follow up: There will be ongoing monitoring.

Bryden House is a care home where the provider is registered to provide personal and nursing care for up to 30 people. Care and support is provided to older people with dementia, nursing and personal care needs.

There was a registered manager at 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.

People and their relatives told us that they felt safe and staff treated them well. Staff were seen to be kind and treated them with respect when meeting their needs. People’s privacy was respected and they were supported to maintain their independence.

Staff knew how to identify harm and abuse and how to act to protect people from the risk of harm which included unsafe staff practices. The provider had arrangements in place to review and manage staffing levels which included recruiting staff with the right skills when needed to meet people’s needs with risks to their safety reduced.

Staff told us their training was up to date. All the staff felt their training and supervision supported and enabled them to deliver care safely and to an appropriate standard. Staff understood people’s care and support needs and people were complimentary about the care provided when meeting people’s end of life care needs. People’s medicines were available to them and staff knew how to provide the support people needed to meet their health needs.

People were asked for their permission before staff provided care and support so people were able to consent to their care. Where people were unable to consent to their care because they lacked the mental capacity to do this decisions were made in their best interests. This was an area of improvement the registered manager had sustained following our last inspection.

Staff monitored people’s health and shared information effectively to make sure people received advice from doctors and the community mental health team, according to their needs.

People were satisfied staff cared for and supported them in the way they wanted. People’s care plans described their needs and abilities and were relevant to the risks identified in their individual risk assessments.

Staff enjoyed their work and felt able to share issues and ideas to make improvements for the benefit of people who lived at the home. Staff spoke about people who they supported with respect and showed they knew people well.

The provider had responsive systems in place to monitor and review people’s experiences and complaints to ensure improvements were made when appropriate. This included the improvement work they had in hand in regards to making sure staff were supported in their roles in particular around encouraging people with things of interest and which were fun.

The provider and commissioners visited the home and provided their impressions of the standard of care and management of the home. The management team used this information to enable improvements to be sought. This helped to support continued improvements so people received a good quality service at all times.

We carried out an unannounced comprehensive inspection of this service on 5 and 12 March 2015 at which a breach of a legal requirement was found. We asked the provider to take action to make improvements to how they obtained people’s consent. This was to make sure people’s rights were protected when they could not make their own decisions.

After our comprehensive inspection on, 5 and 12 March 2015, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. They sent us an action plan setting out what they would do to make the improvements and meet the legal requirements and when their actions would be completed by.

We undertook this focused inspection on 26 November 2015 to check the provider had followed their plan and to confirm they now met the legal requirements. This report only covers our findings in relation to those requirements.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Bryden House on our website at www.cqc.org.uk.

Bryden House is a care home where the provider is registered to provide personal and nursing care for up to 30 people. Care and support is provided to older people with dementia, nursing and personal care needs. At the time of our inspection 25 people lived at the home.

There was a registered manager at 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 our focused inspection on the 26 November 2015, we found that the provider had followed their plan which they had told us they would complete by and legal requirements had been met.

People were encouraged and supported to make their own decisions and choices about their care and treatment which were respected by staff. Staff made sure people’s right to consent was upheld as they assisted and supported people. This was achieved by staff checking and making sure people understood what was said to them.

Where people were unable to give their consent and make specific decisions either verbally or in writing about their care and treatment, actions had been taken in people’s best interests. This was with the involvement of people who had the authority to do so and knew people well in order to protect people’s rights as outlined in the Mental Capacity Act 2005.

Staff were knowledgeable about the MCA. This enabled people to receive care and support in the least restrictive way so reducing risks to people’s health and safety.

We will review our rating for this service at our next comprehensive inspection to make sure the improvements made and planned, continue to be implemented by staff in a consistent way.

This inspection took place on 5 and 12 March 2015 and was unannounced.

The provider of Bryden House is registered to provide accommodation and nursing care for up to 30 people who have nursing needs. At the time of this inspection 27 people lived at the home.

In November 2014 the ownership of the home changed. This meant there was a new registered provider and the former deputy manager was now the manager of the home. The manager was in the process of applying to become the registered 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.

Staff told us they had received training to support them to understand the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). This law sets out to support the rights of people who do not have the capacity to make their own decisions or whose activities have been restricted in some way in order to keep them safe. We found there was an inconsistent approach in applying the MCA in order to support people’s rights when specific decisions needed to be made so that the right people were involved. This meant the required standards of the law that related to the MCA were not always being met to promote people’s best interests.

The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Where people had been assessed as needing their liberty restricted to keep them safe, referrals had been made to the local authority for their approval. However, practices needed to be strengthened to ensure any urgent DoLS authorisations were reviewed within the required time to do this so that people were not being restricted unlawfully.

All the people we spoke with told us they felt well cared for and felt safe living at the home. People told us staff were respectful and kind towards them and staff were caring to people throughout our inspection. Staff protected people’s privacy and dignity when they provided care to people and staff asked people for their consent, before any care was given.

People had their prescribed medicines available to them and these were administered by staff who had received the training to do this.

Staffing levels promoted people’s needs appropriately. This included staff responding to people’s requests for help and support at times they wanted and needed this.

Arrangements were in place to recruit staff who were suitable to work in the service and to protect people against risks of abuse.

We found people received care and support from staff who had the clinical knowledge and expertise to care for people. However, staff were not aware and did not have all the information they needed about a significant health symptom which could impact upon the person not receiving effective care and treatment when they needed it.

Staff supported people with their meals so that people received nourishing diets and drinks.

People received staff support to follow their individual pastimes and improvements to enhance people’s opportunities of social events were going to be progressed further.

People we spoke with told us they knew how to raise any concerns and who they should report any concerns to. Staff knew how to support people to raise any concerns they had. The provider had a complaints procedure displayed so that people accessed this information.

The manager needed to improve their knowledge regarding their responsibilities around submitting statutory notifications to the Care Quality Commission (CQC). The manager had failed to notify the CQC of an incident which the provider is required to do by law.

The provider and manager were committed to making improvements to the service people received. However, the process for monitoring and checking the quality of the service needed to be strengthened further so that actions to drive through improvements were prioritised for the benefit of people who lived there. This included the arrangements in place for care and medicine documentation to ensure these reflected the care people needed and received.

You can see what action we told the provider to take at the back of the full version of the report.