This inspection took place on 10 and 14 January 2019. The first day of the inspection was unannounced which means the provider and staff did not know we were coming.

Briardene Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

Briardene Care Home accommodates 31 people across two purpose built sites. The service provides care for people with complex needs associated with dementia.

There was a registered manager in post. 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 previously inspected the service in December 2015 and rated the service as good overall. At this inspection we found that the service had improved further and was outstanding overall.

Without exception staff and management worked in a way that put the needs of people living at Briardene first. Care plans were written in an extremely sensitive and thoughtful way. Staff knew every person they cared for in depth, what was important to them and the best way to provide care to them.

We observed care being delivered in a way that truly reflected the provider’s values of respect, integrity, responsibility, passion and empowerment. The ethos of putting the person at the centre of everything was driven from the top. The registered manager and deputy led by example and there was a pride and passion for the home that was reflected in everything the management team did. This in turn inspired staff to do their best to deliver the extremely high standard of care that was observed throughout the inspection.

Relatives told us the service provided safe care to their loved ones and peace of mind for them. Falls, accidents or incidents were closely monitored to ensure lessons were learned and future risks minimised.

Throughout the inspection we found there to be plenty of staff, not only to meet people’s basic care needs but to spend time with them on a one to one basis, engaging in a meaningful and caring way. Relatives we spoke to told us about the positive impact this level of interaction with staff had on their loved ones. They described how people had become more engaged after moving to the service, dancing, laughing and talking more.

The service was very forward thinking and proactive in their approach to people’s health and wellbeing. A full time holistic therapist was employed at the service and worked closely with other health professionals to achieve exceptionally positive outcomes for people. There was a team of four dedicated therapy and activity staff who were each focused on caring for and supporting people to live a meaningful life best to their ability.

A very in-depth assessment of a person’s needs was done prior to them moving to the service. These assessments looked at all aspects of a person’s care needs and formed the basis of the initial care planning. Respecting diversity and challenging inequality was part of the provider's values and working practices incorporated this ethos. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The service adopted an inclusive approach to planning end of life care and ensured people’s wishes were explored and recorded.

Feedback from people and their relatives was all extremely positive. People were cared for by a dedicated staff team who were proud of the work they did. Staff were very responsive to people, reading body language and responding accordingly to minimise any distress. Relatives were made to feel very welcome when

We carried out this inspection on the 21 December 2015. The inspection was unannounced which meant the staff and registered provider did not know we would be visiting.

Briardene is a 16 bedded purpose built care home providing nursing care to people with complex needs associated with dementia. It is located on the outskirts of Billingham. Public transport, shops and public houses are in close proximity.

The service had a registered manager in place and they have been registered with the Care Quality Commission since February 2011. 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 and all the staff were extremely passionate about providing a service that placed people and their families at the very heart of the service.

The ethos of the service was to provide a homely environment and support people to be as independent or as comfortable as possible.

Risks to people were being identified and assessed. Staff managed the risks related to people’s care well. Accidents and incidents were monitored and a system was in place to identify trends and patterns.

There were more than sufficient numbers of staff on duty to keep people safe. The registered manager followed safe recruitment processes. Staff were extremely positive about the support they received from their managers. They were encouraged to strive to improve. Staff were very motivated and proud of the service. Staff received comprehensive training that was up to date and a robust induction was in place.

People, relatives and visiting professionals could not speak highly enough about the support and care that was provided.

People were calm, settled, happy and contented. Staff treated people as individuals and treated them at all times with dignity and respect. People were never hurried or distracted from what they wanted to do. Staff were familiar with peoples life stories and were very knowledgeable about people’s likes, dislikes, preferences and care needs. They approached people using a calm, friendly manner which people responded to positively.

People had varied communication needs and abilities. Staff knew people very well and knew how to respond and talk to each person to give them the support and care that they needed and wanted. Staff listened to what people had to say and they gave them time to express themselves.

Staff understood the requirements of the Mental Capacity Act (MCA) 2005 and associated legislation under the Deprivation of Liberty Safeguards (DoLS) and put this into practice. Safeguarding procedures were in place to keep people safe from harm.

People felt safe living at the home and their risks had been identified and assessed so that staff were well informed on how to look after them safely. Accidents and incidents were reported and dealt with satisfactorily. Staff spent quality time with people to give them emotional support and comfort.

People’s medicines were managed, stored and administered safely

We saw safety checks and certificates that were all within the last twelve months for items that had been serviced and checked such as fire equipment and electrical safety.

The service had a complaints file and policy, however they had not received any complaints.

The service employed a therapy coordinator and they provided activities and occupation for people’s waking moments from leisure to personal activities. For example pamper sessions and music sessions.

People told us the cook provided good quality food and catered for their individual preferences. This included people’s specific health and dietary requirements. Food and drink was available to people throughout a 24 hour period. Staff gave excellent and discreet support to th

Our inspection team was made up of an inspector and this helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe? - People were treated with respect and dignity by the staff. Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards and appropriate applications had been submitted and records held accordingly. Policies and procedures were in place to make sure that unsafe practice is identified and people are protected. Staff we spoke with knew how to report any concerns they had to management.

Is the service effective? - People’s health and care needs had been assessed and were written with support from families and described how people would like their care to be delivered. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

Is the service caring? - People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. One visitor told us that she felt staff were very caring in their interactions with people. People using the service, their relatives, friends and other professionals involved with the service were asked for their views through meetings. interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. We saw letters from family members describing the “excellent” level of care their family members had received whilst at Briardene.

Is the service responsive? –The service regularly sought views of people using the service and visitors via meetings. The home had a complaints policy and procedure that was accessible and people and visitors to the home told us they could raise any issue with the managers or staff.

Is the service well-led? - The manager and clinical nurse lead had clear roles along with care staff and a therapy team. Together they met regularly to plan how the service should be managed. The service has a quality assurance system; records we saw showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving. Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

We observed people who lived at the service as their dementia meant communication was difficult and we spoke with one relative and three members of staff as well as the clinical nurse lead. One visitor told us; "I can speak to any of the staff or the nurse in charge if I have any issues, I feel my relative is safe here and well cared for, I'm glad I chose this place".

We spoke with three members of staff. They told us; “The staffing levels are really good, if you need time out you can just ask” and “You are never in a situation where you don’t feel supported”. Another said; “There is support if you are worried about anything” and “The training is great”.

During the inspection we sat in the dining room so that we could see both staff and people who used the service. We used a number of different methods to help us understand the experiences of the people who used the service, because some individuals had complex needs which meant they were not able to tell us their experiences. We also spoke with the deputy manager, four staff and four relatives of people who used the service.

A relative we spoke with said, "They are very good here, their care plan has been discussed with me and I am invited to attend review meetings.” Another said, “I am very satisfied with how my relative is looked after. I believe they are well cared for and have confidence in the staff to meet their needs.”

We found that people had person centred care plans that were up to date and reflected their care needs. We also found that staff worked in collaboration with other health and social care professionals.

We found that people lived in an environment that was homely, clean, well maintained and safe.

We found that people needs were met by sufficient staff with appropriate skill, knowledge and training.

We saw that there were systems in place should people want to raise concerns or complaints about the service.

The visit took place because we were following up issues raised at the last inspection about ensuring care records were evaluated and staff training. We also looked at how people were supported to make choices and how the manager checked that the home continuously delivered an effective service. The people who used the service had complex needs and experienced great difficulty when discussing their experiences and views. Therefore time was spent observing how staff worked with people. From our observation, staff were seen to constantly work in ways that fully supported people. We found people were treated as individuals; were encouraged to participate in activities; and staff were very sensitive when working with individuals. Staff were observed to have regular physical contact with people, holding hands or giving reassuring touches. When speaking with people staff constantly made sure the person could follow what was being said, included people in conversations and approached people in a gentle and caring manner. If people were experiencing distress, staff quickly went to the person and offered comfort.

People living at the home had complex needs and were not able to verbally communicate their views and experiences to us. Due to this, we have used a formal way to observe people in this review to help us understand how their needs were supported. We call this the ‘Short Observational Framework for Inspection (SOFI).

Throughout this observation we saw people being treated very much as individuals, being encouraged to participate in activities and being spoken to very kindly by staff. Staff were observed to have regular physical contact with people, holding hands or giving reassuring touches.

However, one person was leaning forward in their chair for some time before staff intervened. When they did they were extremely reassuring and provided the person with the care and support they needed in a kind, respectful way, explaining what they were doing and including the person in the decision making.

We spoke to one relative who could not praise the service highly enough. They said, "I would give them 10 out of 10, they are attentive, caring staff, they give reassurance, cuddles and hugs and as a relative they make me very welcome".

A relative said, "I am kept informed of changes to his/her health, life for them is as good as I could hope for, they are well looked after".