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Inspection Summary


Overall summary & rating

Good

Updated 10 October 2018

We carried out an unannounced comprehensive inspection at Breage House on 14 September 2018. The previous inspection took place on 9 June 2017. At that time, we identified concerns in relation to how some staff approached some of the people they supported, and the staff team dynamics. We also had concerns around staff knowledge and skill in meeting people’s dietary needs. Since that inspection the management team had changed and some staff had left the service. Staff told us they felt more supported by the managers of the service, and with the staff changes this had led to the staff team working more positively together. The catering staff had also changed and staff had all received training in understanding people’s dietary needs. At this inspection we found staff dynamics were no longer impacting on people and that staff had a greater understanding of people’s dietary needs.

At this inspection we found improvements had been made in all the areas identified at the previous inspection. This meant the service had met the breaches of regulation from the last inspection and that the overall rating of the service had changed from Requires Improvement to Good.

We identified some concerns regarding accurate recording of information. For example, some risk assessments were not in place, medicine sheets had gaps, and a lack of formal monitoring regarding accidents and incidents. During the inspection and immediately following the visit the registered manager and Head of Specialist Services put together an action plan and assured us that these would be addressed. Whilst it was acknowledged that this had no direct impact on people’s wellbeing it was an issue in respect of maintaining accurate records. We have made a recommendation regarding this in the Well Led section of the report.

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

Breage house is one of a number of services in Cornwall which are run by the provider, Keelex 176 Limited. Breage House is a detached home which provides accommodation for up to 14 people who have a learning disability. At the time of the inspection 14 people were living at the service. The registered manager took an active role in the running of the service. They were supported by a core staff team who had worked at the service for some time.

The service had 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.

The care service was established before the introduction of Registering the Right Support and had been developed and designed in line with the values that underpin this and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism, using the service can live as ordinary a life as any citizen.

Some people had limited verbal communication skills so we spent time observing their interactions with staff. The atmosphere at Breage house was calm and friendly. Interactions between staff and people were kind, respectful and supportive. Staff described to us how they worked to support people to make day to day choices and build on their independent living skills. Staff said they were proud to work at Breage house.

The premises were well maintained, pleasant and spacious. People's bedrooms had been decorated and furnished in line with their personal preferences. Risks associated with the environment had been identified and action taken to minimise them.

Care plans reflected people’s needs and pr

Inspection areas

Safe

Good

Updated 10 October 2018

The service remains safe.

Effective

Good

Updated 10 October 2018

The service had improved from Requires Improvement to Good.

Staff supported people to maintain a balanced diet appropriate to their dietary needs and preferences.

The service met the requirements of Mental Capacity Act and Deprivation of Liberty Safeguards. This helped to ensure people�s rights were respected

People were supported to access a range of health services as necessary which meant their day to day health needs were met.

Staff were supported by a system of induction, training and supervision.

Caring

Good

Updated 10 October 2018

The service remains Caring.

Responsive

Good

Updated 10 October 2018

The service remains Good.

Well-led

Requires improvement

Updated 10 October 2018

There were some concerns regarding the maintaining of accurate records. We have made a recommendation regarding this.

The provider/registered manager provided staff with appropriate leadership and support and staff were well motivated.

People, their relatives and staff were asked for their views of the standard of service provided.