Care home resident consistently given wrong dose of medication

Briarwood Care Home, on Normanby Road in Eston, faced a two-day inspection in March from the Care Quality Commission. The regulator found medicines were not always managed safely, it was not identified that a person was losing weight for five months and there was an odour in the home.

The last inspection in July 2022 also saw a ‘requires improvement’ rating. However, this was better than the damning report it received after a visit in January 2022 that found the provider was inadequate and it was put in special measures.

Overall, the service was rated as ‘requires improvement’, with three of the five areas in need of changes. However, two areas, whether the service was caring and if it was effective, were ranked as good.

The care home remains in breach of regulations after medicines were not always managed safely. According to the CQC report, one person’s medication record showed they were “consistently given the wrong dose”. Records relating to medicines were not always accurate and records for creams that were no longer prescribed were found.

The report states: “We found no evidence that people had been harmed. However, systems were either not in place or robust enough to demonstrate medicines were always effectively managed.”

While assessments were completed regarding the risks people might face, they were not always monitored. The report states: “One person was at risk with their nutrition. They were weighed monthly for monitoring, but this did not identify the person had been losing weight since October 2023. This was reported to the regional manager for their action.”

However, inspectors did find that people were safe from the risk of emergencies in the home.

Though they did find that the facility wasn’t smelling as fresh as it should be. The CQC report states: “We did notice an odour during our inspection which was reported to the regional manager who confirmed they would take action to address it.”

The report has also revealed that care plans did not always contain information on people’s likes, dislikes and personal history and they also did not “consistently and accurately reflect people’s needs and preferences”.

The care plans were reviewed but inconsistencies were not always spotted. The regional manager and new home manager confirmed they would take action to tackle the issues raised.

While improvements had been made, inspectors also found the facility failed to have effective systems to assess, monitor and improve the quality and safety of the service.

However, residents and relatives did speak positively to inspectors about the care received. One person said: “[Staff] help me to the toilet if I have an accident, they clean me up and they change my clothes.”

While the report adds: “We observed staff treating people with kindness, informing them what was happening and asking permission to support them. We observed people smiling and joking with staff, appearing comfortable in their presence.”

At the last inspection, there were not enough suitably trained staff to meet people’s needs and the care home was in breach of regulations but enough have improvements have been made so that is no longer the case. The regional manager told the CQC that people had been recruited to permanent posts which had reduced reliance on agency staff.

One staff member said: “Things are improving. We get regular supervision and [regional manager] door is always open. We have lots of support and we are good team.”

A spokesperson for Briarwood Care Home said: “We are disappointed with the findings in our latest CQC inspection report, despite inspectors noting the improvements that have been made.

“We were pleased to receive ‘good’ ratings for the care we provide our residents and the effectiveness of our services, but we are aware further action is needed in other areas and steps are being taken to address these.

“An action plan of ongoing improvements has been submitted to the CQC and we want to reassure our residents and their loved ones of our commitment to providing the quality of service both they and we expect. Our highest priority is and always has been providing a safe, comfortable, and caring environment for those who reside with us.”