Breach House

Breach House is a residential care home providing regulated activity of accommodation and personal care to up to 34 people. The service provides support to older people some of which have dementia. At the time of our inspection there were 5 people using the service.

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

Improvements had been made to the assessment and management of risks however further improvements were needed. Improvements had been made to the administration of medicine though further improvements were required to ensure the safe storage of medicines. Staff were recruited safely, and a sufficient number of staff were employed to meet people’s needs. Staff understood and followed infection control measures, and when things went wrong, the provider had learned lessons and developed improved systems.

The provider had introduced audit systems to monitor the safety and quality of the service, but these required further development and time to embed. A positive person-centred culture was promoted, and the manager promoted learning and development.

Staff gained the skills and knowledge necessary to meet people’s care and nutritional needs through regular training. People were supported to access healthcare as needed; through positive links the manager had established with external professionals.

We found an improved culture in the home. The manager and staff were caring and respectful of people which ensured a person-centred approach to the people living in the home. People’s views were sought with equality, privacy and dignity promoted.

Staff were responsive to the needs of each individual. The provider had introduced a new complaints procedure to manage and respond to any complaints they received.

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.

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 inadequate (published 21 July 2022). At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 21 July 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Breach House is a residential care home providing personal and nursing care for up to 34 older people. At the time of our inspection visit there were 18 people living at the home.

Breach House accommodates people in one building over two floors. Thirty two people at the home had en-suite facilities in their bedrooms. Other people shared bathroom and shower facilities.

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

People’s risks were not managed. Some people had damage to their skin and wounds from poorly managed pressure area care. Staff were unclear about what to look for in relation to monitoring people’s skin health. One person needed thickened fluids due to a risk of choking. This was not in their care plan or risk assessment. Staff did not always provide the person with drinks that were thickened.

People’s care plans and risk assessments did not contain the information staff needed to provide safe and effective care. Important information regarding people’s known risks was missing. For example, details regarding a change to a person’s swallowing capability following an admission to hospital were not in the person’s records, and staff were unaware of the steps needed to keep the person safe.

People did not always have access to health services in a timely way. One person had raised with staff that they did not have good vision through their glasses. The person told us that they had told staff, however we could not find evidence that action had been taken.

Peoples’ medicines were not managed safely. Medicines were not always administered in line with their prescriptions. People’s medicines were missed due to time constraints without the medical advice or authorisation to do so safely. effectively to ensure staff were recruited safely and the risk of the spread of infection was not well managed.

People were not always treated with dignity and respect. Some people told us they were not always spoken with in a manner that was respectful. During the inspection we witnessed staff were not always respectful in how they spoke with people. Staff did not always take actions to ensure people’s dignity was protected.

People’s care plans were brief and task orientated. They did not contain person centred information and were not always updated or reviewed when people’s needs changed. There was limited support for people to avoid social isolation, follow interests or take part in any activities.

There were no systems or processes in place to ensure the service was well led. The service had failed to identify and act on risk. The provider did not provide a service that met people’s individual needs and preferences. There were no systems in place to audit medicines, incidents, accidents, care plans or complaints to identify risks, themes or lessons learnt.

People and their families were not involved in their care planning and there were no systems in place to seek feedback from people using the service. People did not always feel they could raise concerns with the staff supporting them.

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 requires improvement (published 11 May 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about staffing, management of risks and lack of management oversight. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring, Responsive and Well Led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, person-centred care, staffing and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Breach House is a residential care home providing personal and nursing care for up to 34 older people. At the time of our inspection visit there were 23 people living at the home.

Breach House accommodates people in one building over two floors. Around half of the people at the home had en-suite facilities in their bedrooms. Other people shared bathroom and shower facilities.

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

The provider did not always manage risks to people’s health and wellbeing. Procedures to maintain a high standard of cleanliness, and to ensure infection control risks were always managed were only somewhat effective.

The provider's systems and processes were not always used effectively to review and maintain oversight of the quality of the care people received. Governance procedures required improvement to ensure people always had accurate and up to date care records, that reflected their care needs.

Staff understood their responsibility to protect people from abuse and avoidable harm. People, staff and relatives told us there were enough staff to meet the needs of people using the service. Medicines were managed safely.

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.

The provider took some action immediately when we identified improvements at our inspection.

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

Rating at the last inspection

The last rating for this service was requires improvement (published 15 January 2020). The service remains rated requires improvement with a breach in Regulation 12 safe care and treatment, and a breach in Regulation 17 good governance.

Why we inspected

This was a focussed inspection. We inspected the service following anonymous concerns that had been raised with us. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well-led only.

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.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has not changed from Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the Safe, Effective and Well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to Regulation 12 safe care and treatment, as risks to people’s health were not effectively managed. We have also identified a breach in Regulation 17 good governance, as the provider’s systems and procedures were ineffective in identifying and driving forward improvements.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Breach House is a residential care home providing personal care and accommodation to 26 people aged 65 and over at the time of the inspection. The service can support up to 34 people, some of whom may be living with dementia.

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

We identified some concerns with the way the service assessed and managed risks. Actions identified during a fire risk assessment completed in April 2019 had not been addressed and the way in which staff monitored those people at risk of dehydration did not ensure the risk was well-managed to ensure people were protected. The provider began to address these concerns immediately after we brought them to their attention.

Since our last inspection the previous registered manager had changed their role with the provider. A new manager was in place but had not yet completed their registration with us. The staff felt supported by the manager and told us their views were sought and acted upon. Staff were recruited safely and understood their safeguarding responsibilities. Quality assurance checks were completed but these were not always effective. They had not identified areas for improvement we found during our inspection.

Staff received training to administer medicines and had their competency to do this regularly checked. Overall, people received their medicines safely as prescribed. However, we identified that improvements could be made to how the use of medicine patches were recorded. The manager addressed this when we brought it to their attention.

Staff had a good understanding of consent, however we identified that applications for Deprivation of Liberty Safeguards (DoLS) had not been made for everyone who needed them. The manager acknowledged this and immediately submitted the applications. People were supported to have maximum choice and control of their lives. Staff practice supported people in the least restrictive way possible and in their best interests. The policies in the service supported this practice .

There were enough staff available to support people at the times they needed them. People were treated with respect and supported to be as independent as they wanted to be. Staff knew people well and supported them to take part in activities they enjoyed.

People had access to healthcare and staff made appropriate and prompt referrals to healthcare professionals if a person’s needs changed. People enjoyed the food and the manager regularly sought feedback on the dining experience.

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 (28 April 2017).

Why we inspected

This was a planned inspection based on the previous rating. During the planning of this inspection we received concerns about falls, unsafe medicines management and infection control. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the Safe section of this full report.

Enforcement

We have identified a breach in relation to the governance of the service at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This inspection took place on 23 March 2017 and was unannounced.

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.

At the last comprehensive inspection on 17 March 2016, we found improvements were required in recreational opportunities for people and that the manager and staff were not consistently following the Mental Capacity Act 2005(MCA). We also received mixed views from people about their mealtime experiences, and the opportunities for staff to develop their skills and knowledge needed to care for people. At this inspection, we found improvements had been made.

People were positive about the ways staff met their safety needs. Staff understood people’s individual risks and cared for them in ways which promoted their safety. Staff knew what action to take to protect people from the risk of potential abuse. There were enough staff employed to care for people so they received care promptly and the risk of people feeling isolated was reduced. Where people needed assistance to take their medicines this was given by staff who knew how to do this safely.

People benefited from receiving care from staff with the knowledge and skills to care for them and staff recognised people’s rights. People enjoyed their mealtime experiences, and had enough to eat and drink to remain well. Staff took action to support people if they required medical assistance, and advice provided by health professionals was followed. As a result, people were supported to maintain their physical health.

Positive and caring relationships had been built between people and staff. People and their relatives were complimentary about the staff that supported them. Staff knew people well and took action so people felt included and at home. Staff took time to chat to people and reassured them when this was needed. People were encouraged to make their own day to day decisions about their care, with support from staff where this was required. People’s right to privacy and dignity was taken into account in the way staff cared for them and they were encouraged to maintain their independence.

People and their relatives were involved in deciding how care should be planned 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. Relatives and staff gave us examples of how staff adapted the care provided as people’s needs changed. People and their relatives understood how to raise any concerns or complaints about the service and were confident these would be addressed. Systems for managing complaints were in place, so any lessons would be learnt.

Positive comments were received about the improvements introduced by the registered manager, so people had more interesting things to do. People, relatives and staff found communication with the registered manager to be open and were encouraged to make suggestions to developing care further. Staff knew how they were expected to care for people and were encouraged to reflect and improve on the care provided.

The registered manager and provider checked people’s experience of living at the home. People and their relatives were encouraged to give feedback on the care they received, so improvements would be driven through and people would continue to consider Breach House as their home.

The provider of Breach House is registered to provide care for up to 26 older people, including people with dementia. There were 25 people living at the home at the time of our inspection.

At the time of our inspection there was a manager in post who had applied to become 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.

The manager and staff were not consistently following the Mental Capacity Act 2005 (MCA) which is intended to ensure people are supported to make decisions for themselves. When this is not possible the MCA requires that decisions are taken in people’s best interests by people who have the authority to do this and there is documentary evidence to reflect this.

There was a lack of a structured approach in the provision of recreational activities in the home so at times there was limited stimulation and occupation for some people. The manager was aware and had plans to improve and enhance people’s opportunities to do fun and interesting things. However, we could not measure the effectiveness of these improvement plans as they needed to be fully implemented.

We have made a recommendation about the adaptation of the home environment to support people with dementia.

Staff knew how to protect people against the risk of abuse or harm and how to report concerns they may have. Risks to people’s health and wellbeing were assessed and measures put in place to meet people’s needs with safety in mind. There was evidence of learning from incidents and accidents and changes were put in place to reduce the risk of these happening in the future.

Checks had been completed on new staff to make sure they were suitable to work at the home. People told us there were enough staff to meet their needs although at times staff could be busy but they did not have to wait for assistance for too long. The manager had recently increased staffs’ opportunities to gain support through more practical training to effectively carry out their caring roles.

We saw staff applied their knowledge gained from training in an effective way when responding to the individual care and support needs of all people who lived at the home. This included their communication skills so people’s mental health and emotional needs were consistently supported and met. The manager put into practice their skills and knowledge to reassure some people who lived at the home when they needed this on the day of our inspection. They viewed this as one positive method of guiding and supporting staff to provide good care.

People had their prescribed medicines available to them and these were administered by staff who had received the training to do this. People told us they were supported to access health and social care services to maintain and promote their health and well-being. A doctor visited people on the day of our inspection and spoke with staff about people’s changing health needs. The monitoring and recording of what people ate and drank had improved so risks to people from not eating and drinking sufficient amounts to stay well.

People told us they felt their privacy was respected and they felt safe. We saw conversations between staff and people who lived at the home were positive in that staff were kind and polite to people. Staff had a high degree of knowledge about people’s individual choices and preferences. People knew how to make a complaint and felt able to speak with the staff or the manager about any issues they wanted to raise.

People knew the manager and they felt they were approachable and visitors to the home felt they were welcomed. The manager had introduced more opportunities for people and staff to make suggestions about the services people received which included the introduction of a ‘friends of Breach House’ committee. Staff understood their roles and responsibilities and believed the manager was trying to make things better for people who lived at the home and people. The manager showed they had an accountable and responsive approach to the issues we identified and was committed to make sure people received good quality care.

Since the manager had been in post they had and were continuing to make improvements and introduce a range of checks to make sure the quality of the services people received were of a good standard. From carrying out these checks the manager was working towards making key improvements. The manager showed the improvements which they had made so far had been effective such as the retraining of staff in medicine administration following medicine errors so these were reduced.

During this inspection we spoke with the registered manager and three care workers. We reviewed the care records of three people who had different mobility assistance needs. Most of the inspection time was spent observing staff practices and how they interacted with people who used the service.

We found that improvements had been made in care records as they clearly identified people's care needs in respect of their mobility. We saw that staff practices promoted people's safety and welfare. The staff we spoke with demonstrated good knowledge of people's individual needs. The provider had put systems in place that supported and protected people from risks of injuries.

Throughout our inspection we observed positive interactions between people who lived at the home and staff. People were supported to be involved in all aspects of their life and, as much as possible, in decisions about their care or treatment. One person who lived at the home told us: 'It is very nice here and I am always made aware of what is going on'. Another person said: 'They (staff) do show me respect; they don't treat me like a bit of nothing'.

We observed that staff moved two people between chairs and wheelchairs with inappropriate techniques. This practice can put people at risk of harm.

We watched staff supporting several people who lived at the home to take their medicines at breakfast time. This was done with patience and consideration for each person's needs. We saw that people received their medicines in the right way and at the right time.

Staff also told us that the training and support provided ensured that they were able to look after and meet the needs of people who lived at the home.

There were arrangements in place to assess and monitor the safety and quality of care. The views of people and families were used to improve the quality of services delivered.