The Briars 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.

The Briars is an established care home and is registered to provide care and support for up to five working age adults and older people living with a learning disability and a mental health condition. Accommodation is provided over three floors, with communal areas on the ground floor.

At the last inspection, the service was rated Good. At this unannounced inspection on 15 January 2018 we found the service remained Good.

Staff understood risks to people and followed appropriate guidance. Staff followed safe practices to keep people safe from harm, abuse and discrimination. Systems were in place to ensure all accidents and incidents were recorded and processes were in place to ensure lessons were learned. Health and safety procedures were in place and had been regularly reviewed. Sufficient staff were always on duty. Good procedures were in place for the safe management of medicines.

Staff were supported through regular supervision, appraisal and training. They provided the care and support outlined in people’s care records and in accordance with advice from health professionals. People were supported with their health and well-being and were given choice in all aspects of their lives. Staff supported people with their healthcare appointments. Staff were proactive when people became at risk of malnutrition. People were involved in menu planning and shopping for food. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service supported this practice.

We observed positive relationships between people and staff. Staff understood when people required additional support. This was carried out in a dignified manner. People were treated with kindness and respect. People were involved in their care, their voice was evident in their care records. Choices and preferences had been recorded and people had signed their care plans to show they agreed with them.

Detailed care records were in place which were individual to each person. This meant staff were able to provide the most appropriate care and support to people. Activities were planned daily and reflected people’s choices. Information in standard and easy read formats were on display to inform people how to make a complaint.

The registered manager was visible at the service and had positive relationships with people and staff. All worked together as a team. People were involved in the service through daily living activities and staff sought feedback from them. People were visible within their own community. Quality assurance procedures were in place to ensure the service continued to deliver a good standard of care to people.

Further information is in the detailed findings below.

We inspected The Briars on 18 November 2015. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

The Briars provides care and accommodation to maximum number of five people who have a learning disability. The home is situated in a residential area of Saltburn. Communal facilities consist of a family style lounge, a dining room and a kitchen. Bedrooms are for single occupancy and are on the first and second floor of the home. The home is close to shops, pubs and public transport.

The service had 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.

People told us they felt safe. There were policies and procedures in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. Staff we spoke with told us how they keep people safe and were able to explain the whistleblowing and safeguarding procedures.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety was maintained.

People had risk assessments for bathing/showering, using stairs, going out into the community, medication. One person who was at risk of choking had a detailed care plan but no risk assessment for this. The registered manager told us this would be put in place immediately. This helped staff to have the guidance to manage the risks to people and to keep them safe.

We saw that staff had received supervision and appraisal on a regular basis which was in line with the service’s policy. We observed on the day of inspection there were sufficient staff on duty to meet the needs of the people living there. The service have had two staff hand in their notice recently however they were in the process of recruiting to their posts. Staff had been trained and had the skills and knowledge to provide support to the people they cared for. Staff understood and had received training in the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) which meant they were working within the law to support people who may lack capacity to make their own decisions.

We saw safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

There were appropriate systems in place for the storage, administration and management of medicines so that people received their medicines safely.

We saw positive and caring interactions between people and staff. We saw that staff treated people with dignity and respect. People told us they felt cared for and were looked after. We spoke to staff who demonstrated that they knew the individual needs of people well. We saw staff being responsive to people’s needs.

We saw that people were provided with a good choice of healthy food and drinks which helped to ensure that their nutritional needs were met. Alternatives were offered if people did not like what was on the menu that day.

People were supported to maintain good health and had access to a variety of healthcare professionals and services. People were supported and encouraged to have regular health checks. We saw that people had hospital passports. A hospital passport is a document sent with the person on admission to hospital. The hospital passport is to assist people with a learning disability to provide hospital staff with important information they need to know about them and their health.

We looked at people’s care plans and saw they were very person centred and written in a way that we could see the person had been involved in putting them together. They explained the support and care the person needed and also their likes and dislikes. These were regularly reviewed, evaluated, and updated.

People had varied hobbies and interests which were individual to them. We saw that there were also outings and holidays arranged for people. We saw and were told that where it was needed staff supported people to access activities within the community.

We saw that the service had a policy and proceedure for responding to people’s concerns and complaints. People were regularly asked for feedback verbally, in residents meetings and through questionnaires. People said that they would talk to the registered manager or staff if they were unhappy or had any concerns.

There were systems in place to monitor and improve the quality of the service provided. We saw there were audits carried out by both the registered manager and senior staff within the service. We saw that the views of the people using the service were regularly sought and changes made based on their feedback.

People and staff told us that the registered manager was in the service on a daily basis and that the culture was open and inclusive. People and staff spoke very favourably of the registered manager.

A comprehensive inspection took place at this service on 22 December 2014. At this inspection a breach of legal requirements was found. The registered service did not protect people who used the service against the risks associated with the unsafe use and management of medicines. Staff did not have written guidance for medicines to be given as required. Staff did not have written guidance for those people who were prescribed creams. Staff were not recording the temperature of the room in which medicines were stored.

The registered provider wrote to us telling us what action they would be taking in relation to the breach. As a result we undertook a focussed inspection on 20 July 2015 to follow up on whether action had been taken in relation to the breach.

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 The Briars on our website at www.cqc.org.uk’

The Briars provides care and accommodation to a maximum of five people who have a learning disability. The home is situated in a residential area of Saltburn, close to local amenities.

The home had 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.

At this focussed inspection on 20 July 2015 we found that the registered provider had followed their plan and legal requirements had been met. This was an unannounced visit which meant the staff and provider did not know we would be visiting.

We could see that improvements to medicines had been made since our last inspection. At this inspection written guidance for medicines to be given as required were in place for people who needed them. This written guidance provided staff with information about why these medicines should be administered and in what dosage. There was information on why such medicines should be given and signs and symptoms to look out for. We could see that this guidance had review dates which meant that they could be regularly reviewed to ensure that the service kept up to date with any changes which might have occurred.

Guidance had also been put in place for people who were prescribed creams. This included a body map which highlighted when and where creams should be applied. We could see that records for prescribed creams had been completed each day and creams had the date of opening recorded on them and the expiry date.

We looked at room temperature records for medicines for June and July 2015. We could see that temperature checks had been carried out twice per day and were within safe limits for storing medicines.

Staff had received training in medicines and had been observed administering medications, although no formal competency checks had been recorded. We could see that medicines were included into staff supervision sessions.

You can find full information about our findings in the detailed findings sections of this report

We inspected The Briars on 22 December 2014. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

The Briars provides care and accommodation to maximum number of five people who have a learning disability. The home is situated in a residential area of Saltburn. Communal facilities consist of a family style lounge, a dining room and a kitchen. Bedrooms are for single occupancy and are on the first and second floor of the home. The home is close to shops, pubs and public transport.

The home had 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.

The registered manager was on annual leave at the time of the inspection; however a senior care assistant who had worked at the home for many years was able to assist us with the inspection process.

There were systems and processes in place to protect people from the risk of harm. Staff were aware of the different types of abuse and staff had received safeguarding training. Staff were aware of the action to take if abuse was suspected.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety, however one bedroom window required restrictors to ensure the safety of people. The senior care assistant locked this window at the time of the inspection to ensure that people did not come to any harm. Some water temperatures of baths and showers were too cool.

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed.

We saw that staff had received supervision on a regular basis and that staff had received their annual appraisal for 2014.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. People told us that there were enough staff on duty to meet people’s needs. Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions, however they had not received formal training in respect of this.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people. We did note that the provider application form and reference request did not ask people to confirm dates of employment. This meant that gaps in employment might not be explored.

At the last inspection of the service in October 2013 we found some concerns in relation to the management of medicines. Staff did not have written guidance for medicines to be given as required. Staff did not have written guidance for those people who were prescribed creams. Staff had not recorded the temperature of the medication room to ensure that medicines were stored at the correct temperature. At this inspection we found that the provider had not taken action to address our concerns.

There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. Staff were attentive, showed understanding, were patient and interacted well with people. When people became anxious staff provided reassurance.

We saw that staff closely monitored people and their nutrition and where necessary made referrals to the dietician, however, staff had not undertaken nutritional screening to identify specific risks to people.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments. We found that people did not have a hospital passport. The aim of a hospital passport is to assist people with a learning disability to provide hospital staff with important information they need to know about them and their health when they were admitted to hospital.

Assessments were undertaken to identify people’s health and support needs as well as any risks to people who used the service and others. Plans were in place to reduce the risks identified. Support plans were developed with people who used the service to identify how they wished to be supported.

People’s independence was encouraged and their hobbies and leisure interests were individually assessed. Staff encouraged and supported people to access activities within the community.

The manager had a system in place for responding to people’s concerns and complaints. People told us they knew how to complain and felt confident that staff would respond and take action to support them. People we spoke with did not raise any complaints or concerns about the service.

There were effective systems in place to monitor and improve the quality of the service provided. Staff told us that the home had an open, inclusive and positive culture.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we took at the back of the full version of this report.

During the inspection we spoke with five people who used the service. We also spoke with the manager, a senior care assistant and a care assistant. People who used the service told us that they were happy with the care and service received. One person who used the service said, “I like it here.” Another person said, “I like doing jigsaws and watching the television.”

We were able to observe the experiences of people who used the service. We saw that staff treated people with dignity and respect. We saw that people had their needs assessed and that care plans were in place.

People were supported to eat and drink sufficient amounts to meet their needs.

People told us that they were involved in meal planning and preparation. One person said, “I like baking.”

We found medicines were safely handled.

Staff monitored the quality of service provided to make sure that people were happy with the care and service provided.

During the inspection we spoke with three people who used the service. Communication was limited because people had complex needs and difficulty with communicating. We also spoke with the manager and a senior care assistant. People told us that they were treated well; staff were good and that they were involved in making choices about their care. People expressed satisfaction with the care and service that they received. One person said, “I like them all. They are all nice.” Another person said, “Very good.”

We were able to observe the experiences of people who used the service. We saw that staff treated people with dignity and respect. Staff were attentive, gave reassurance and interacted well with people. We saw that staff communicated well with people and explained everything in a way that could be easily understood. Staff encouraged and supported people to be independent.

We found the premises that people, staff and visitors used were safe and suitable.

We found that appropriate recruitment procedures were in place.

We found there was an effective complaints system in place at the home.

During the inspection we spoke with two people who used the service. Communication was limited because people had complex needs and difficulty with communicating. One person told us, "I like it here. I can cook omlette and spaghetti on toast. One person said, "We had a nice Christmas with a big tree. I went to Redcar to do my Christmas shopping. I like to go to Morrisons in Redcar."