Breach House

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last inspection we rated this key question good. At this inspection the rating has changed to requires improvement. This meant people’s needs were not always met.

This service scored 46 (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 make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

The information staff had access to in care records lacked information about people’s specific needs, wishes, interests and goals. There was a lack of information including childhood and early life history, work history and significant places and life events to encourage reminiscence, which could help people living with dementia retrieve past memories. By understanding people’s life story, staff could better connect with them, address distressed behaviours, and create a more person-centred approach to care. Care plans did not fully explore people’s ability to make day to day decisions. People did not always feel in control of their care, and several people were not aware of having a care plan.

We spoke with the management team about the lack of person-centred care and clear guidance for staff on how to support people in a person-centred way. The management team stated they were completing immediate reviews and would include people and their families where appropriate.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

Staff did not always have training to meet the needs of the service user group, such as specialist training and skills needed for the people they supported.

Systems and processes in place did not always ensure continuity of care and support. People did not always experience consistent or positive care. Whilst some people were able to advocate for themselves, others were not, we were not assured of how people’s care was provided. Where people were not able to advocate for themselves, the service had not ensured advocacy services were in place to support people.

The provider did not always supply appropriate, accurate and up-to-date information. Some people were not aware of having a care plan and had therefore not been given an opportunity to access their care records and contribute to the content.

People’s care records contained limited information on how to effectively communicate with them, and didn’t fully explore the impact sensory losses, such as reduced hearing, may have on a person.

The provider and manager failed to demonstrate consideration had been given to allow people to move freely and independently around the home. For example, clear signage was not always in place to support people to find their bedrooms or bathrooms. Information about activities in the service was displayed on a wall in the hallway. However, this information would have been too small for some people to read.

People’s records were stored securely on an electronic system. Most staff had received GDPR (General Data Protection Regulation) training that describes how organisations should handle the personal data of individuals. The manager told us that people were able to have large print formats of relevant information if needed.

The provider did not make it easy for people to share feedback and ideas, or raise complaints about their care, treatment, and support. The manager did not involve people in decisions about their care or tell them what had changed as a result.

People told us complaints in the past had been resolved; however, some people were not always clear on who they would report concerns to or were not asked about their care. People were not able to identify who the manager was.

People were not always encouraged to feedback any areas for improvements. Relatives told us staff regularly communicated with them when needed. However, review meetings to enable people and their relatives to discuss their care and support needs had not always been completed. The manager told us this was an area they were addressing, and meetings were being planned.

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.

Systems and processes in place were not always effective in ensuring people were supported to experience equality in the care and support they received. For example, further improvements were needed to ensure people’s care was person-centred.

The manager and provider had not been effective in identifying the areas of improvement in the home environment to reduce the risk of people injuring themselves. Information around accidents and incidents documented were not clear, there was no evidence these were reviewed in order for people to access the care support and treatment they needed.

The manager did not meet with people to review their needs and find out if further support was needed. Care plans did not show involvement of people or their representatives in these processes.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

Care records for people contained limited information on their equality and diversity needs. Most people living at the home were elderly, many of whom were living with dementia. However, information within people’s care plans were limited and there was no information on how to involve people in communicating or expressing their needs or wishes. For example, processes were not in place to gather information from people, there were no meetings in place for residents or their relatives to collect feedback, however there was a newsletter in place to keep people up to date on changes in the home.

People were at risk of not receiving person centred care.

The environment was not always tailored to meet people’s various needs. Aspects of the building were not in line with guidance on dementia friendly environments. Signage was not in place to guide people around the building and people’s names were not always displayed on bedroom doors to help them identify their bedroom. Whilst some bedrooms were personalised with people’s belongings, others felt bare, with limited personalisation.

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life. People’s end of life care plans did not always include or fully detail information in relation to people’s spiritual and cultural needs, involvement of family and friends, reassurance about pain management and rapid support to medicines that may be required.