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We are carrying out a review of quality at Breagha House. We will publish a report when our review is complete. Find out more about our inspection reports.

Inspection Summary


Overall summary & rating

Inadequate

Updated 3 August 2021

About the service

Breagha House is a residential care home which provides accommodation and personal care for young adults whom are living with a learning disability and/or autism. The service can support up to ten people. At the time of our inspection, ten people were living there.

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

People were not kept safe from the risk of abuse. Staff did not always feel confident to raise concerns or did not feel their concerns would be taken seriously. People were at risk from neglectful and abusive care practices.

Risks to people's health, safety and welfare had not been adequately assessed and mitigated. The provider had not ensured people lived in a safe environment. There were not enough staff to keep people safe. People’s medicines were not managed safely.

We were not assured that the provider had good infection control practices. The provider did not learn lessons when things went wrong.

People's needs and choices were not assessed in line with current legislation and guidance, or in ways that helped to prevent discrimination. People were not supported to communicate in ways which were meaningful to them.

People were at risk of receiving support from staff who were not trained to meet their needs. People were at risk of being offered unhealthy and unsuitable food choices, and at risk of not being able to participate in their own meal planning.

People were not always supported to access external health appointments in a timely way. Consent to care was not sought in line with legal requirements.

The service was not well-led. People were put at risk because the provider and registered manager failed to ensure suitable quality assurance checks were in place. The provider did not ensure staff followed policies and procedures for the delivery of safe care.

The provider had not consistently notified CQC of significant events as they are legally required to do. Systems and processes to assess risk and monitor quality were insufficient and ineffective in driving improvements.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People’s care was not person-centred and did not promote their dignity and rights. Due to the range of safeguarding concerns being investigated by the local authority and police, we felt there was a risk some staff did not demonstrate attitudes and values that promoted compassionate and inclusive care.

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 (published 14 September 2019).

Why we inspected

We received concerns in relation to staffing levels, medicines management, safeguarding issues, restrictive care practices, and poor management practices. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well-led only.

The inspection was also prompted in part by notification of a specific incident, following which a person using the service sustained a serious injury. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

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.

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 coronavirus and other infection outbreaks effectively.

The overall rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection. 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 Breagha House on our website at www.cqc.org.uk.

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 regulations 9, 11, 12, 13, 14, 15, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also identified a breach of regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

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 have already met 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.

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.

Inspection areas

Safe

Inadequate

Updated 3 August 2021

The service was not safe.

Details are in our safe findings below.

Effective

Inadequate

Updated 3 August 2021

The service was not effective.

Details are in our effective findings below.

Caring

Good

Updated 3 August 2021

Responsive

Good

Updated 3 August 2021

Well-led

Inadequate

Updated 3 August 2021

The service was not well-led.

Details are in our well-Led findings below.