Breton Court

Breton Court is a residential care home for older people. They provide the regulated activity of accommodation for people who require personal care to up to 28 people. The home provides support to older people in an adapted building. At the time of our inspection there were 26 people using the service.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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. A relative told us, “There are no problems turning up ad hoc. They (the staff) are always happy”. We observed people had a choice about their living environment and were able to personalise their rooms. People told us, “I love it here. I have all my bits and pieces. I even love my curtains.” Staff told us, “We have a family atmosphere.”

Right Care: People received kind and compassionate care. We received positive feedback from people about the care they received. People told us they were looked after well, and the staff were kind. Staff were responsive to people’s needs and there was evidence of partnership working with health care professionals. Staff understood people’s individual communication needs.

Right Culture: Systems and processes designed to provide management oversight of risks were not consistently employed. However, the provider and registered manager were responsive to feedback and committed to making improvements. People’s quality of life was enhanced by the service’s culture of improvement and inclusiveness. Relatives told us, staff were warm, helpful and their kindness overwhelming. We observed staff speaking warmly and affectionately with people and they reciprocated. People received consistent care and support from staff who knew them well.

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

Rating at last inspection and update

The last rating for this service was good (published 31 July 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Breton Court on our website at www.cqc.org.uk.

Follow up

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

Breton Court Care Home is registered to provide accommodation and personal care for 28 older people. There were 18 people living in the service at the time of our inspection visit.

The service was run by a company who was the registered provider. The company was formed of two directors both of whom were present during our inspection visit. Although there was a manager who had applied to be registered with the Care Quality Commission, we had not finished our consideration of their application. 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. In this report when we speak about both the company’s directors and the registered manager we refer to them as being, ‘the registered persons’.

At the last comprehensive inspection on 30 and 31 March 2017 the overall rating of the service was, ‘Requires Improvement’. We found that there were five breaches of the regulations. The first breach was because there were shortfalls in the arrangements that had been made to provide people with safe care and treatment. This included concerns that could have reduced the level of fire safety protection provided in the service and oversights in the arrangements made to safely assist people who lived with reduced mobility. There were also shortfalls in the arrangements that had been made to support a person who lived with a particular healthcare condition.

The second breach was because people had not been fully safeguarded from the risk of abuse and the third referred to shortfalls in the way care staff were given training and guidance. The fourth breach was because suitable provision had not always been made to fully enable care staff to provide people with care that promoted their dignity. This included shortfalls in the arrangements made to support people at the end of their life and in the management of complaints. The fifth breach referred to shortfalls in the systems and processes used to ensure that people received high quality care that had led to the occurrence of the other breaches of regulations we found.

We told the registered persons to send us an action plan stating what improvements they intended to make to address our concerns. After the inspection the registered persons told us that they had made the necessary improvements.

At the present inspection we found that sufficient progress had been achieved to meet all of the breaches of regulations. Suitable provision had been made to provide safe care and treatment and people were safeguarded from situations in which they may be at risk of experiencing abuse. Care staff had received all of the training and guidance they needed and suitable arrangements had been made to provide people with care that promoted their dignity. The systems and processes used to assess and monitor the operation of the service had been strengthened, although further improvements were needed to ensure that progress in the service was sustained.

Our other findings were as follows. Medicines were managed safely and pre-employment checks on new care staff had been completed in the right way. Most of the necessary provision had been made to promote good standards of hygiene in order to prevent and control the risk of infection. Lessons had been learned when things had gone wrong so that there was less chance of accidents happening again.

Appropriate arrangements were in place to assess people’s needs and choices so that care was provided to achieve effective outcomes. This included providing people with the reassurance they needed if they became distressed. People were helped to eat and drink enough to maintain a balanced diet. Suitable provision had been made to help people receive coordinated care when they moved between different services. People had been supported to access all of the healthcare services they needed. Suitable arrangements had been made to obtain consent to care and treatment in line with legislation and guidance. Some parts of the exterior of the building were poorly maintained. However, the registered persons had an action plan to address these defects in the near future.

People were given emotional support when it was needed. They had also been supported to express their views and be actively involved in making decisions about their care as far as possible. This included them having access to lay advocates if necessary. Confidential information was kept private.

People received responsive care that met their needs for assistance. This included care staff supporting them to have access to written information that was relevant to them. Suitable arrangements had been made to promote equality and diversity.

There was an open and inclusive culture in the service. Suitable arrangements had been made to ensure that regulatory requirements were met. The registered persons were actively working in partnership with other agencies to support the development of joined-up care.

Breton Court provides accommodation and personal care for up to 28 older people and is suitable for those with poor mobility. At the time of the inspection there were five vacancies and the provider accommodates people for respite care when rooms are available. The service is a detached building with only offices and staff accommodation on the first floor. There are 26 bedrooms (two are doubles/shared occupancy). All bedrooms are on the ground floor and have a wash hand basin and some also have an ensuite wash hand basin and toilet. In addition there is an assisted bathroom, wet room and four additional toilets. People have access to a lounge and dining room overlooking the rear garden. The rear garden is accessible to people and has a paved area for seating, lawn and pond, which is fenced. There is parking available to the front of the service. It is approximately 10 minutes’ walk to St Michaels village with shops, a pub, church and other local amenities.

The service is run by a registered manager. 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.

Risks associated with people’s care and support had been assessed, but there was not always sufficient information recorded in assessments to show how staff kept people safe and promoted their independence. People were not always fully protected from harm as proper procedures had not been established and staff lacked an understanding and knowledge of reporting and recording.

People were protected by safe recruitment practices. However people did not receive care and support from staff that had effective support, supervision and appraisals. Staff had shortfalls in some areas of training to enable them to provide effective care and support.

Medicines were on the whole were handled, stored and recorded safely. However all medicines including topical medicines were not always recorded when administered.

People and/or relatives had been involved in the assessment and the initial planning of care and support. However the level of detail in people’s care plans needed to be improved to ensure people received care and support consistently and according to their wishes. Promoting people’s independence was not supported by the care planning.

There were some audits and checks in place to help ensure the service was effective. However systems had not been established or were not robust enough to identify shortfalls highlighted during this inspection as requiring improvement.

People, relatives and other visitors all spoke positively about the service received and were happy with the quality of care and support provided.

People’s health was monitored and they had access to appropriate health professionals to help maintain good health. People liked the food and had a varied and healthy diet.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Where people were restricted DoLS authorisations were in place or had been applied for and the registered manager was in discussions with the DoLS office about others. People were supported to make their own decisions and choices and these were respected by staff. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant. The registered manager demonstrated they understood this process.

People were relaxed in staff’s company and staff listened and acted on what they said. People were treated with dignity and respect and their privacy was respected. Staff were kind and caring in their approach.

People had opportunities for a range of activities, which they enjoyed. There were good links with the local community. People did not have any concerns, but felt comfortable in raising issues. Complaints had been taken seriously and were used to improve the service. There were opportunities for people to give feedback about the service provided.

The registered manager was very accessible to people and they took action to address any issues straightaway to help ensure the service ran smoothly. The provider visited frequently and was known to people.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.

People told us they were treated with dignity and respect by staff. One person told us "I would not be here if it was otherwise". Another person told us they were "Very happy with the way they treat me, staff are very caring".

People said they were involved in their care planning and that their care plans had regular monthly reviews.

People told us they felt safe at the service and that care was given considerately. People said they could talk to the manager and the staff about any problems they had.

Staff told us they had regular training which meant they were able to provide care and treatment which ensured the well-being and safety of the people at the service.

People and their relatives were invited to express their views and opinions on their visits to the service and through "Resident and relative meetings".