Breach House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 67 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

People’s needs were assessed before they moved into the home and were regularly reviewed. Care plans were also reviewed as part of ‘resident of the month’, giving people and their families a chance to share feedback or raise concerns. Additionally, plans were reviewed sooner if a person's needs changed. A relative said, “I feel very involved in [person’s name] care.”

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Where staff identified people as being at risk from choking, referrals were made to the speech and language therapists (SALT) team so their nutritional needs could be assessed. We saw for one person waiting for a SALT assessment, the GP had been contacted and advised the person could have softer foods and level 1 thickened fluids. Staff had received food safety, nutrition and IDDSI training. IDDSI is the International Dysphagia Diet Standardisation Initiative. IDDSI is the classification system used to describe food and drink to help people with swallowing difficulties. We did not receive any concerns relating to people’s nutrition and hydration needs. One person said, “I enjoy my food here. The chefs new. I think they are doing a good job.” We observed a positive mealtime experience for people where interactions between staff and people during the meal were warm and friendly, contributing to a relaxed and sociable atmosphere. People were offered choice and were supported to make decisions about their meals and drinks. Staff were attentive and responsive to individual needs, helping in a discreet, respectful, and unhurried manner where needed. People were given sufficient time to eat at their own pace and were encouraged to keep their independence wherever possible.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

We spoke with 2 healthcare professionals who were visiting the home during our inspection visits. They told us, “Couldn’t fault staff they are on the ball. They know the residents well. Any problems, concerns or worries they will either let us know when we are here which is daily or they will contact us. We have no concerns. Staff act on any advice given. They are kind and caring and attentive to residents.”

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

Since our last inspection, a new activities coordinator had been appointed, and a monthly activity schedule implemented. The variety of activities on offer included balloon tennis, music therapy, movement to music, gardening, and trips to garden centres. These activities promoted physical movement, cognitive engagement, and social well-being.

Care plans provided staff with the necessary information and guidance to manage underlying health conditions safely and effectively. For example, detailed information for diabetes management and control. Furthermore, people were supported to maintain good oral health. Care plans provided guidance on daily hygiene routines, including specific instructions for denture care, ensuring individual healthcare needs were consistently met.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves. However, we found people, and those important to them, were actively involved in care reviews during ‘resident of the month’, which is where staff, the person, and families get together to review the persons support needs, choices and wellbeing and update their care plan accordingly. Furthermore, records on the Person-Centred Software (PCS) system confirmed individual care plans were being reviewed on a regular basis. Accidents and incidents were managed appropriately and reported to the relevant authorities, showing clear evidence of root cause analysis. Nevertheless, these processes could be further strengthened by including more depth in the analysis. We identified these analyses had not been consistently reviewed since the departures of the previous registered manager and deputy manager. The manager had already identified this gap and was actively addressing it.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

One person told us, 'I'm sort of involved in my own decisions.' Another person said, 'I make all of my own decisions.' Despite this, we could not see clear evidence of how people's consent was gathered in their care planning. While procedures under the Mental Capacity Act 2005 (MCA) were followed for certain choices, they were missed for other important decisions which required them. For example, in relation to internal bedroom moves.