Breme Residential Care Home

Breme Residential Care Home is a residential care home providing personal to up to 60 people. The service provides support to older and younger adults, people living with dementia or a physical or learning disability, sensory impairment or autistic people. At the time of our inspection there were 35 people living in the home.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

Right Support:

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. Medicines were managed safely. Staff were recruited in line with the providers policy and procedures. The provider had plans in place to update the environment where needed.

Right Care:

Staff knew people well and understood how to provide care in a person-centred way. Staff ensured their rights and dignity were promoted and protected. Infection, prevention and control was managed well. People said they felt safe and their relatives agreed with this. Staff received training in how to keep people safe.

Right Culture:

The provider had good oversight of the home. The new manager was experienced and committed to improving the culture of the home through speaking to people, relatives and staff about how they felt things needed to improve. Staff said they felt supported by the management team. Staff liaised with a range of professionals to ensure that people’s health and wellbeing needs were being met.

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 23 October 2019).

Why we inspected

The inspection was prompted in part due to concerns received about staffing and the culture in the home. A decision was made to complete a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Breme Residential Care Home is a residential care home, providing personal care to 60 people aged 65 and over. At the time of our inspection, 58 people were living at the home. The home was a purpose built home over three floors, and separated into four named units.

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

Staff knew how to recognise potential abuse and who they should report any concerns to. People had access to equipment that reduced the risk of harm. There were sufficient staff on duty to meet people’s needs. Staff supported people to take their medication as prescribed.

People had a choice of food and were supported to maintain a healthy diet in line with their needs and preferences. Staff were trained to meet people’s needs and acted promptly to refer people to healthcare professionals when required. 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.

People enjoyed positive and caring relationships with the staff team and were treated with kindness and respect. People’s independence was promoted as staff were careful not to do things for people they could do for themselves.

People were supported by staff who knew about their needs and routines and ensured these were met and respected. People and relatives knew how to complain and were confident that their concerns would be listened to.

People and staff were happy with the way the service was led and managed and the provider worked well with partners to ensure people’s needs were met.

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 12 April 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.

The inspection was unannounced and took place 21 February 2017. We arranged with the registered manager to return on the 22 February 2017 to finish our inspection.

A registered manager was in post at the time of our inspection. 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 supported by a manager, who was responsible for the day to day management of the home.

At the last comprehensive inspection on 16 and 17 October 2014, we found improvements were required in the way people’s medicines were managed and in staffing levels to support people. At this inspection we found the improvements required had been made. There were enough staff to care for people and to respond to their needs so they received the individualised care they needed. Improvements had been made in the way people’s medicinal creams were administered.

People told us they received the support they needed from staff to feel as safe as possible and told us they were confident staff would take action to make sure they were safe and well. Staff knew what action to take to protect people from the risk of potential abuse and understood how to balance the risks to people’s individual safety with their desire for independence.

People benefited from receiving care from staff with the knowledge and skills support them and recognise their rights. Staff took action to provide the care people agreed to. Where people needed support to make some key decisions about their lives staff took action to do this in ways which took people’s best interests into account. People were encouraged to have enough to eat and drink to remain well and people enjoyed their mealtime experiences. Staff took action to support people if they required medical assistance, and the advice provided by health professionals was followed, so people enjoyed the best health outcomes possible.

Caring relationships had been built between people and staff and people and their relatives were positive about the staff that supported them. Staff took action to make people feel valued and included. Staff used their knowledge of people’s interests and histories and took time to chat to people so they did not feel isolated. People were offered reassurance from staff in the ways they preferred when they were anxious. People were encouraged to make their own day to day decisions about their care. Where people needed support to do this this was given by staff. People’s rights to dignity and privacy were understood by staff.

People and their relatives were comfortable to make suggestions about the care people received, so their preferences would be met and risks to their well-being responded to. Where people were not able to make all of their own decisions their representatives and relatives were consulted. Staff recognised when people’s needs changed and adjusted the way they cared for people so their needs would continue to be met and their well-being enhanced. Systems for managing complaints were in place, so any lessons would be learnt.

Positive comments were made about the way the home was managed and the culture of the home. People were encouraged to see Breme Residential Care Home as their home and felt included in the way it was run. People, their relatives and staff were encouraged to make suggestions for developing care further and were listened to by the registered manager, manager and senior staff. Staff understood what was expected of them and how they were required to care for people. The provider, registered manager and manager regularly checked the quality and safety of the care so they could be assured people received the care they needed. Changes had been introduced to the care provided to people in line with best practice standards, so people would be as safe as possible and so they would continue to enjoy living at the home.

During our inspection we found that many of the people were not able to tell us about their experiences of living at Breme Care Home. We were able to speak with six people who used the service, five family members and we received five comment cards where people gave their views about the care and treatment that people received. We observed the care of some of the people who were unable to speak with us because their dementia affected their ability to recall or communicate.

We looked at some of these people's care records. We also spoke with seven members of staff who were working on these units, the deputy manager and the registered manager.

We saw that before people came to live at the home their health and social care needs were identified. This included information about people's dementia care needs and what their daily routine preferences were. This was completed with people themselves as far as possible and with people's representatives to ensure that they felt part of the person's care.

Throughout the day of our inspection we observed staff worked hard to ensure the personal care and health needs of people were met. The interaction between staff and people who used the service were generally good. We did however observed two members of staff who supported two people who lived at the home use inappropriate techniques when they moved or repositioned these people. This practice can put people at risk of harm or injury as they were inappropriate and unsafe.

We saw that health and social care professionals were consulted with and staff worked with other providers. This made sure that people received the right care at the right time to meet their individual needs.

We found that the registered manager had systems in place to enable the quality of care to be assessed, monitored and improved.

We observed that staff treated people as individuals. There were positive interactions between staff and people with lots of laughter and smiling and clear friendships were established. It was clear from what we saw that staff knew people's needs and provided care and support in a gentle way when people's behaviour needed to be supported.

One person who lived at the home told us: 'I like it here, the staff are very caring'. 'I get up when I want, they give me lots of drinks, I go to bed when I like which is very nice'.

People's family members told us positive things about the care and support people received whilst they lived at the home. They told us that they felt involved in any decisions that needed to be made and these were done with their relation's best interests at heart. One family member told us: 'They (staff) are always there for you' and another said: 'We are involved in discussion on their care; I also make amendments to their care when needed'.

We saw there were enough staff to meet people's care needs and promote their social opportunities. One family member told us: 'They don't just plonk them in front of a TV, the girls talk to them in a lovely way, they don't talk at them. 'The staff are very caring, they all know my name'.