Breach House

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect.

At our last inspection we rated this key question good. At this inspection the rating has changed to requires improvement. This meant people did not always feel well-supported, cared for or treated with dignity and respect.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always treat people with kindness, empathy and compassion. We observed that members of staff were individually very kind and caring when they interacted with people, however, they were mostly task focussed.

When we spoke to people about whether members of staff were kind and caring, there was a mixed response. Comments included, “In the main they [staff] are nice, they have off days sometimes though”, “Mixed bunch, got to know them [staff] very well, most are very kind” and “All of them are very pleasant, helpful, and when I ask for anything they get it for me”.

People’s care records did not always contain information about people’s personal history, backgrounds and goals. This information helps people to have their needs met by staff who understand the context of their experiences. The manager had not been effective in identifying the areas of improvement around how people received their care. They told us they carried out general observations, however, did not record these interactions.

The provider did not always treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences. The provider did not take account of people’s strengths, abilities, and aspirations.

Care plans lacked sufficient detail to guide staff on people’s specific needs, wishes and preferences. This limited staff’s ability to deliver person-centred care.

People told us "I used to go to church. The church doesn't visit me here" and “I would like to see someone that I could talk to confidentially". Another person said, “I’m not so fussed about the activities, they aren’t really my taste”. We saw that activities were not always tailored to people living with dementia. People had limited access to dementia friendly items or tactile objects to keep them engaged and stimulated. There was no information on the benefits and outcomes of the activity for individuals which would help staff to identify what makes a difference for people so they can continue to provide individualised activities. The manager and provider had not collected people’s or their representative’s feedback about their care and had therefore not identified people's important individual aspects and preferences. However, towards the end of our visits, we noted the deputy manager, and staff were working on engaging with people to design and tailor activities to their personal preferences.

People’s care records lacked information about their individual likes, dislikes, interests, abilities and wishes and did not contain detailed information to guide staff on how they liked to receive care and support. Care plans did not always contain sufficient guidance for staff to manage specific conditions and enable them to provide consistent and effective support to people. For example, people living with dementia had limited information in their care plans to support staff to understand how their dementia impacted them as a person and how to support them through their dementia journey.

We could not be assured people’s choices and wishes were respected or that they were supported to be independent. This was because people’s care records did not contain personalised and up to date information, lacked detail about their likes and dislikes and did not include personalised information of what was important to them.  

Care records did not always make clear what decisions people could make for themselves. For example, decisions about meals or drinks, or what to wear, and therefore records did not place focus on encouraging independent decision making. This impeded people’s independence as staff had become task orientated.

The provider did not always listen to and understand people’s needs, views and wishes.

We observed staff who were responsive to people, some had built effective relationships and understood people’s needs. People shared mixed feedback with us in relation to how responsive the service was to their needs. One person told us, “They [staff] always call you by own name, say your coffee not tea”. Another person said, “Staff are usually about when I need them, not used a call button, but there are less about at weekends”. A third person told us, “I’ve got to ask for everything I need, it’s got worse and worse, most of the time staff are about, but some of the night staff not comfortable with”.

The provider did not always care about and promote the wellbeing of their staff. They did not always support or enable staff to deliver person-centred care. Due to the limited information within some care records in relation to people’s specific needs, and the gaps in training provided to staff, we could not be assured staff were supported or enabled to deliver person-centred care.

Feedback from staff was mixed. Some staff told us they loved working at Breach House and felt supported by the manager and provider. Other staff told us they did not feel valued at work and that their concerns or suggestions were not taken forward by the manager and provider. Additionally, we also received anonymous feedback via our website from staff that were unhappy in their roles, they found the manager inaccessible at times as the manager was often not on site and when they were, the manager spent the majority of their time in the office.

Staff had not always been given the opportunity to discuss any development needs or other issues as part of a supervision or appraisal meetings, as these had not been held regularly. Some staff did not feel supervisions were helpful as the manager and provider did not always follow up on their concerns.

Team meetings were infrequent and there was limited action documented. Staff felt meetings were not effective as they did not support improvements raised by staff. Staff were not updated on action taken from the manager following the previous meetings and did not always receive minutes from these meetings.