Breckside Park Residential Home

Breckside Park Residential Home (“Breckside Park”) provided personal care to 29 people aged 65 and over at the time of the inspection. The service can support up to 33 people in one adapted, three-storey building within a residential area of Anfield in Liverpool.

People’s experience of using this service and what we found

Although we received some mixed feedback, overall people told us they were happy living at Breckside Park. People told us about individual circumstances that had led to their admission to the service and one told us, “I had to move in [after events at home] and I am happy I came here – I am happy here.” However, we found that at times the safety and quality of people’s care needed to be underpinned and ensured by more robust processes.

The cleanliness and infection control of the service, as well as the planning and deployment of staff to support a safe quality service, needed to be improved. We made recommendations regarding these areas. The robustness of governance, such as meeting regulatory requirements, ensuring effective quality assurance, development of safety related plans and best practice learning, at times needed to be improved.

However, we also observed a warm, homely atmosphere and interactions that showed people and staff knew and respected each other. This was supported by personalised care plans that were continuously being developed. The service worked effectively with other professionals to achieve positive outcomes for people and this had been complimented by health visitors.

The service involved people, relatives and staff in the design and delivery of people’s care. Questionnaires and meetings sought everyone’s opinions and implemented changes to make improvements when needed. The provider has extended the building, to provide updated accommodation for people. This had also added a brighter, more spacious dining room, as well as an accessible patio and garden for people to enjoy.

There were different activities for people to get involved in and we saw they enjoyed this. The service continuously developed trips out for people and supported people to retain or develop their independence. A Christmas dinner had been arranged for everyone to attend at a restaurant in the community, staff not on shift had come into work to support this. There was an ethos of a service led by people, which staff described as, “The staff do not run this house - the residents run this house. It is their home.”

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice and had been improved since our last inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 19 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

There was a manager in post who was in the process of completing their registration with CQC. 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.

Breckside Park is a care home providing personal care for up to 26 older people. The home is situated in a residential area of Anfield in Liverpool. It is close to local shops and public transport links. Accommodation is provided over three floors and a passenger lift is available for people to access all floors.

The home was last inspected in April 2016. During this inspection we found the service was in breach of regulations relating to the safe care and treatment, staffing and governance. The overall rating for this service was ‘requires improvement’. The provider sent us an action plan detailing how they would meet these breaches and we reviewed the action plan as part of this inspection. We found that the provider had taken action and improved in these areas. The service was no longer in breach of these regulations.

During our last inspection in April 2016, the service was in breach of regulations relating to the safe management of medications and the safety of the environment. This was because there was not adequate procedures in place to manage people’s medication needs during the night. Also, there were fire doors wedged open, and razors left in communal bathrooms which could have caused people harm. We checked to see what improvements had been made. There were now staff trained to be able to support people with medication needs during the night. Medication procedures were well managed, however we did see one person not supported adequately with medication, which was addressed at the time of inspection. We found that the service was no longer in breach of this regulation.

During our last inspection in April 2016, the service was in breach of regulations relating to staffing. This was because there was not enough staff employed by the service to support people with activities or complete other tasks, such as the laundry. We checked what improvements had been made at this inspection. Additional members of staff had been employed since the last inspection, such as an activities coordinator and a laundry assistant. The service was no longer in breach of this regulation.

During our last inspection in April 2016, the service was in breach of regulations relating to the governance of the home. This was because records relating to people’s safety were not always kept accurate and up to date. In addition, we found that quality assurance procedures were not robust and did not identify the shortfalls we found during our inspection. We checked what improvements had been made. We found that all records were accurate and completed, and quality assurances systems had improved and was no longer in breach of this regulation.

We looked and the Mental Capacity Act and associated principles and found some inconsistences. Consent was not documented for people, and at least two people who lacked capacity had signed their own care plan without a best interest process being considered. We have made a recommendation regarding this.

Everyone we spoke with told us that they felt safe living at the home. Staff has all been trained in safeguarding and were able to describe the course of action they would take if they felt someone was being harmed. This included whistleblowing.

Staff were being recruited and selected safely, and only started working at the home once all references and checks had taken place.

We had received information prior to our inspection concerning the fire safety of the building. The provider had been set a list of actions from the fire service following a visit to the home. We saw that these actions had all been completed along with refresher training for staff. Emergency evacuation plans were in place, and these were also routinely checked. Other checks on the building and the equipment within it were regularly being completed. Some of the décor required updating, however there was an ongoing plan to address this, and since our last inspection some redecoration had taken place.

All staff training was completed. Staff told us they regularly engaged in formal supervision and had had an annual appraisal.

We received mostly positive comments concerning the food although one or two people were not overlay satisfied. We ate lunch with the people who lived at the home and felt the food could do with some improvement. We highlighted this at the time of our inspection.

People were regularly supported to access healthcare appointments and medical intervention and referrals were made on people’s behalf when needed. One medical professional we spoke with complimented the responsiveness of the staff.

There was some positive examples of person centred information in peoples care plans, we saw this was a work in progress, as the manager had not long introduced new documentation. The new documentation was more in depth with regards to finding out more information about people, their likes, dislikes and how they wanted their support to be delivered. We saw an example of one that had been implemented.

There was a procedure in place to document and address complaints. Everyone we spoke with said they knew how to complain. The complaints procedure was displayed in the communal areas of the home.

Feedback was regularly gathered from people who lived at the home and their relatives and used to improve their experience of living at Breckside Park.

Everyone told us they liked the manager and there had been clear improvement in the service since they had been in post. A Health and Social Care professional we spoke with also said they had noticed the service had improved.

Breckside Park is a care home providing personal care for up to 26 older people. The home is situated in a residential area of Anfield in Liverpool. It is close to local shops and public transport links. Accommodation is provided over three floors and a passenger lift is available for people to access all floors. During the inspection, there were 22 people living in the home.

A registered manager was 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 looked at the systems in place for managing medicines in the home and found that systems were not in place to ensure people could receive their medicines when they needed them as night staff were not trained to administer medicines.

The care files we looked at showed staff had completed risk assessments to assess and monitor people’s health and safety. We found however, that not all risks had been assessed appropriately, such as whether people could self-administer medicines safely. Other risk assessments had not been reviewed as people’s needs changed.

We found that the environment was not maintained sufficiently to ensure people’s safety and wellbeing. Broken window restrictors, fire doors being wedged open and faulty equipment all posed risks to people living in the home. We observed some areas of the home and equipment that required cleaning.

Most people we spoke with told us they felt safe living in Breckside Park. Staff we spoke with had a good understanding of safeguarding and told us they would not hesitate to raise any concerns.

We found that there was a system in place to ensure staff were recruited safely. We looked at how the home was staffed and received mixed feedback. Relatives we spoke with did not have any concerns regarding the number of staff on duty, but people living in the home and staff, told us they did not feel there were sufficient numbers of staff on duty at all times.

Deprivation of liberty safeguards (DoLS) were applied for appropriately and we found that consent was sought in line with the principles of the mental capacity act 2005.

Staff were supported in their role through induction, training, supervision and appraisal and staff told us they felt well supported by the registered manager. This helped to ensure that staff had the knowledge and skills to meet people’s needs and help ensure their safety and wellbeing.

People told us they had a choice of meals and we found that dietary needs were catered for within the home.

People told us staff were kind and caring and treated them with respect. One person told us, “They are very good; I get on very well with the staff.” People we spoke with agreed their dignity was maintained by staff and that staff always knocked on their doors and ensured bathroom doors remained closed.

Most care plans we viewed showed that people and their families had been involved in the creation of care plans. Care plans were written in a way to promote independence and staff we spoke with told us they encouraged people to do as much for themselves as possible.

We observed care plans to be in place, providing information and preferences regarding people’s health and social care needs. We found that not all care plans contained current information regarding people's needs, though staff were aware of the support people required.

People told us entertainers came to the home every few weeks, but we found there was a lack of activities available. One person told us, “I get bored.”

Processes were in place to gather feedback from people, such as quality assurance surveys and resident meetings. People told us they felt able to raise any concerns they had with the staff and registered manager. People had access to a complaints procedure and this was displayed on a notice board within the home.

The audit systems in place did not identify the issues we highlighted during the inspection, such as those relating to care plans, risk management and environmental concerns. This meant that systems in place to monitor the quality and safety of the service were not effective.

The registered manager had notified CQC of events and incidents that occurred in the home in accordance with our statutory notifications.

We asked people their views of how the home was managed and feedback was positive.

Staff were aware of the home’s whistle blowing policy and told us they would not hesitate to raise any issue they had.

Is the service safe?

People had been cared for in an environment that was safe and hygienic .Senior care staff and the registered manager were on duty throughout the day. There were enough staff on duty to meet the needs of the people living at the home.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to residential services and care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Records we reviewed confirmed that staff had been trained to understand the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

Is the service effective?

People told us that they were happy living at the home and felt their needs were being met. It was clear from what we saw and from speaking with staff, that the staff understood people's individual support needs. One person told us; "I'm alright here." Records confirmed that staff had received training to meet the needs of the people living at the service.

Is the service caring?

People were supported by kind and attentive staff. We saw staff were patient and gave encouragement when supporting people. People told us they were able to do things at their own pace and in their own way. Our observations confirmed this.

Is the service responsive?

People's needs had been assessed before they moved into Breckside Park. Records confirmed that people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes. People had access to activities and had been supported to maintain and develop relationships outside of the service.

Is the service well-led?

Systems were in place for assessing and monitoring the quality of the service. These included regular checks on aspects of the service and seeking the views of people who lived at the home and their relatives. The service was managed in a way that ensured people's health, safety and welfare were protected and the interests of the people who lived at the home was at the centre of how the service was run and managed.

At our last inspection we had concerns about the environment at Breckside Park. This was because the d'cor was dated and certain furniture and fittings were in a state of disrepair. We saw improvements in this area and it was evident areas of the home had been modernised since our last inspection. This work was ongoing. We noted a smell of cigarette smoke in part of the home. This was become some people who used the service smoked inside the building next to the back door despite being reminded not to do so by staff. We addressed this with the manager during our inspection.

We looked at staff files to ensure staff were recruited appropriately. We found references had been sought from previous employers and CRB (Criminal Records Bureau) checks undertaken.

We spoke with staff to see if they received enough support and training to undertake their work. One member of staff said to us; 'The training is good. We did an infection control course recently. The manager is approachable and support is pretty much ongoing'.

We found that people living at Breckside Park had been asked their views and opinions of the service they had received and staff had acted on these.

People told us that they had received the help and support they had needed from staff. Their comments included, 'They are nice to you, they help' and'I get on with them all'. We found that people had received the support they had needed with their health care. We also found that although people had received support with their personal care this had not always been provided in a timely manner.

People told us that they had felt safe living at Breckside Park and we found that staff were aware of how to identify and report potential safeguarding adults occurrences. However we found that records and risk assessments for protecting people were not sufficiently robust.

People told us that they liked the environment at Breckside Park and appreciated recent improvements. Their comments included, 'I like it' and 'Great, I'm satisfied'. We found that although some improvements had been made to the environment other areas remained shabby.