Archived: St Breock Residential 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. St Breock is a care home which offers care and support for up to 38 predominantly older people. At the time of this inspection there were 31people living at the service. Some of these people were living with dementia.

There were systems in place for the management and administration of medicines. The service held an appropriate medicines management policy. Staff who administered medicines had undergone training and regular updates. Prescribed liquids and creams were mostly dated when opened to ensure that staff knew when the item should be disposed of. Medicines that required stricter controls were appropriately stored and managed. The stock held at the service tallied with the records. However, the Medicine Administration Records (MAR) contained some gaps where staff had not always signed to evidence that a prescribed medicine had been given. Some handwritten entries on to the MAR had not been signed and witnessed by two staff as directed in the medicines policy. Regular medicines audits were being carried out but were not effectively identifying these issues. The registered manager was aware that this matter needed to be addressed with specific members of staff and planned to address it at supervision. We have made a recommendation about this in the Safe section of this report.

Staff received training on the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty safeguards (DoLS). Staff had a clear understanding of how to ensure people’s rights were protected. One person had an DoLS authorisation in place, there were no conditions attached to this authorisation. The registered manager had notified CQC of this authorisation. This meant the service had met the requirements of the regulation which was breached at the last inspection.

The registered manager held a record of the people who had appointed Powers of Attorney, to act on their behalf when appropriate. However, the information held in some people's care plans was sometimes misleading and could result in a relative being given powers they did not legally hold, such as signing consents on behalf of a family member who could not consent for themselves. The manager assured us this would be addressed immediately.

The service was registered for dementia care. At our last inspection we made a recommendation about the lack of pictorial signage throughout the service to support people who were living with dementia. Pictorial signage helps people to recognise their surroundings more easily and helps them to be as independent as possible. For example, accessing the bathroom when needed. At this inspection there was still very little pictorial signage at the service. However, the registered manager provided evidence that pictorial signage for toilets and bathrooms had been ordered to help address this concern.

The premises were well maintained and were regularly checked and maintained by the provider. There was re-decoration being carried out at the time of this inspection. Equipment and services used at St Breock were regularly checked by competent people to ensure they were safe to use.

We walked around the service which was comfortable and appeared clean with no odours. People’s bedrooms were personalised to reflect their individual tastes. People were treated with kindness, compassion and respect.

Risks in relation to people’s daily lives were identified, assessed and planned to minimise the risk of harm whilst helping people to be as independent as possible.

Staff were supported by a system of induction training, supervision and appraisals. Staff were positive about the support they received from the registered manager.

People were supported by staff who knew how to recognise abuse and how to respond to concerns. The service held appropriate policies to support staff with current guidance. Mandatory training was provided to all staff with regular updates when necessary. The manager had a record which provided them with an overview of staff training needs.

The service had identified the minimum numbers of staff required to meet people’s needs and these were being met. The service had some staff vacancies at the time of this inspection to which they were actively recruiting.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy. However, some of these records were not contemporaneous and not always easy to monitor.

Care plans were well organised and contained information relating to all aspects of people’s care and support needs. Care planning was reviewed regularly and people’s changing needs were recorded. Daily notes were completed by staff.

People had access to an organised programme of varied activities seven days a week. There were two activity co-ordinators in post. On the day of this inspection we observed people enjoying the entertainment, spending time with visitors and independently going outside into the grounds to enjoy the nice weather.

The manager was supported by a deputy manager a team of motivated staff and by the provider.

The service is required to have a registered manager and at the time of our inspection a registered manager was not 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 and associated Regulations about how the service is run. The service was being overseen by a registered manager from another Cornwall Care home. They were sharing their time between the two homes. The position was being advertised and we were told this was expected to be filled in the near future.

People and relatives told us they were happy with the care they received and believed it was a safe environment. Comments included; “I’ve never had concerns about people’s safety.” Some people were unable to tell us about their experiences and we observed they were at ease with staff. Staff sat with people when they had the time and spoke with them kindly, demonstrating an interest in their conversations.

There were sufficient numbers of suitably qualified staff on duty to meet people’s needs in a timely manner. Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge. Staff knew how to recognise and report the signs of abuse.

People received their medicines on time. Medicines administration records were kept appropriately and medicines were stored and managed to a good standard. Staff supported people to access to healthcare services such as occupational therapists, GPs, chiropodists and dieticians.

Applications to deprive people of their liberty in order to keep them safe had been made for most people living at the service. Conditions attached to DoLS authorisations were not being adhered to.

Regular checks of the premises were made to help ensure the environment was clean and safe. There was limited signage around the building to help people maintain their independence. We have made a recommendation about this in the report.

Care plans were up to date and relevant. Staff told us they were a useful tool and helped ensure they were aware of any changes in people’s needs. Any risks in relation to people’s care and support were identified and appropriately documented. Staff supported people in line with the guidance in care plans.

There was a management structure in the service which provided clear lines of responsibility and accountability. Staff received regular training in areas identified as necessary for the service. Staff told us they were well supported and able to raise any concerns with the management team.

People and their families were given information about how to complain. There were quality assurance systems in place to make sure that any areas for improvement were identified and addressed.

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

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

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

Is the service safe?

During our inspection of St Breock we saw evidence to support a judgement that this service was safe.

People were treated with dignity and respect by the staff. Some of the comments received from people who lived at St Breock included 'The staff are patient and caring, they have been very kind to me', 'It is as good as it can get, but you can't please everyone all the time' and 'I meet with a member of staff every six weeks to discuss any changes in my care needs'.

People were safe because staff knew what to do when complaints were raised and where concerns had been raised we found the home had taken appropriate action to ensure people were safe from harm. People told us they would feel able to 'speak their minds'.

We saw St Breock understood the legal requirements of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards.

We found there was enough qualified, skilled and experienced staff to meet people's needs. We were told the service regularly monitored people's needs and adjusted staffing levels to meet people's needs if they changed.

Is the service effective?

During our inspection of St Breock we saw evidence to support a judgement that this service was effective.

People's health and care needs were assessed and mobility and equipment needs had been identified in care plans where required. Staff we spoke with and observed showed they had good knowledge of the people they supported.

The home worked with other services to ensure people's health needs were met. This included professionals such as GPs, dieticians, tissue viability nurses and district nurses.

People were asked for their consent for any care or treatment and the home acted in accordance with their wishes. Where the home assessed people did not have the capacity to consent, they acted in accordance with legal requirements.

We spoke with one visitor and they confirmed they were able to visit the home whenever they wished.

Is the service caring?

During our inspection of St Breock we saw evidence to support a judgement that this service was caring.

We saw and heard staff ask permission and then explain what was going to happen when they provided care. For example, 'Is that okay?', 'May I?' and 'Please can you?' We saw staff paid attention to the choices we all make in daily lives, such as 'would you like salt and pepper?' or 'would you like some sugar in your tea?' We observed staff responded to people in a kind and sensitive manner.

People's individual care plans recorded their choices and preferred routines for assistance with their personal care and daily living. Where people were unable to be communicate their choices the home had worked with people's families to write details of their known daily routines on their behalf. We saw staff provided support in accordance with people's wishes.

Is the service responsive?

During our inspection of St Breock we saw evidence to support a judgement that this service was responsive.

People confirmed they could have what they wanted at meals if they did not like what was offered. People were able to take part in a range of group and individual activities such as dancing, scrabble games and craft work.

People who used the service and their representatives were asked for their views about their care and treatment.

Is the service well-led?

During our inspection of St Breock we saw evidence to support a judgement that this service was well-led.

We were able to talk with staff and they were all positive in their attitude on how the home was organised and run and we were told by one staff member who had worked there for 25 years that it was the best run home they had experienced.

We saw people who used the service were spoken with in an adult, attentive, respectful, and caring way. People talked with staff during personal care and when being assisted. We observed the lunch time meal and saw staff respected peoples' dignity when assisting them to eat.

During our inspection, we found people's privacy, dignity and independence were respected. Where people were able to express their views and experiences, these were taken into account in the way the service was provided and delivered in relation to their care.

People were protected from abuse and staff were trained and supported to carry out their roles.

Staff told us training was provided and also confirmed they had received supervision.

Care plans and associated documentation provided sufficient detail to direct and guide staff as to the actions necessary to take in order to meet people's assessed care needs. People's records were personalised and provided clear information about the person's wishes and abilities.

During the observations we saw staff help people to move around the home. We saw staff assist people to the bathroom. We saw people talking to each other in the lounges.

We witnessed staff interaction with people which was generally positive.

We heard care workers ask people what they would like to do and gave them ideas if they could not make a choice.

People experienced care, treatment and support that met their needs and protected their rights.

People we spoke with said that they enjoyed the food they received. We were told the food was of a good standard, and we saw the food provided at lunch was hot, well presented and in sufficient quantities. We saw people were offered choices at meals.

People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.