Breage House

Updated 10 October 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The unannounced inspection took place on 14 September 2018 and was carried out by two adult social care inspectors. Before the inspection we reviewed information, we held about the service. This included previous inspection reports and notifications we had received. A notification is information about important events which the service is required to send us by law. We also reviewed the Provider Information Record (PIR). The PIR is a form that asks the provider to give some key information about the service, what the service does well and the improvements they plan to make.

During the inspection visit we spoke with 2 people who lived at Breage House, the registered manager, deputy manager, and 5 other members of staff. We also spoke with a health and social professionals to get their views of the service. Some people were unable to speak to us due to their health conditions. We therefore spent time in the communal lounge observing care practices so that we could gain an understanding of people's experience in how they received support.

We looked around the premises and observed how staff interacted with people. We looked at four records related to people’s individual care needs. We reviewed four staff recruitment files, training records, staff rotas and records associated with the management of the service including quality audits.

Updated 10 October 2018

We carried out an unannounced comprehensive inspection at Breage House on 14 September 2018. The previous inspection took place on 9 June 2017. At that time, we identified concerns in relation to how some staff approached some of the people they supported, and the staff team dynamics. We also had concerns around staff knowledge and skill in meeting people’s dietary needs. Since that inspection the management team had changed and some staff had left the service. Staff told us they felt more supported by the managers of the service, and with the staff changes this had led to the staff team working more positively together. The catering staff had also changed and staff had all received training in understanding people’s dietary needs. At this inspection we found staff dynamics were no longer impacting on people and that staff had a greater understanding of people’s dietary needs.

At this inspection we found improvements had been made in all the areas identified at the previous inspection. This meant the service had met the breaches of regulation from the last inspection and that the overall rating of the service had changed from Requires Improvement to Good.

We identified some concerns regarding accurate recording of information. For example, some risk assessments were not in place, medicine sheets had gaps, and a lack of formal monitoring regarding accidents and incidents. During the inspection and immediately following the visit the registered manager and Head of Specialist Services put together an action plan and assured us that these would be addressed. Whilst it was acknowledged that this had no direct impact on people’s wellbeing it was an issue in respect of maintaining accurate records. We have made a recommendation regarding this in the Well Led section of the report.

Breage house is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Breage house is one of a number of services in Cornwall which are run by the provider, Keelex 176 Limited. Breage House is a detached home which provides accommodation for up to 14 people who have a learning disability. At the time of the inspection 14 people were living at the service. The registered manager took an active role in the running of the service. They were supported by a core staff team who had worked at the service for some time.

The service had a registered manager in post. 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 care service was established before the introduction of Registering the Right Support and had been developed and designed in line with the values that underpin this and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism, using the service can live as ordinary a life as any citizen.

Some people had limited verbal communication skills so we spent time observing their interactions with staff. The atmosphere at Breage house was calm and friendly. Interactions between staff and people were kind, respectful and supportive. Staff described to us how they worked to support people to make day to day choices and build on their independent living skills. Staff said they were proud to work at Breage house.

The premises were well maintained, pleasant and spacious. People's bedrooms had been decorated and furnished in line with their personal preferences. Risks associated with the environment had been identified and action taken to minimise them.

Care plans reflected people’s needs and preferences and were regularly reviewed to help ensure they were accurate and up to date. They contained information to help guide staff on how best to support people in all areas of their life, including their health, social needs and communication styles.

Staff had received training for safeguarding and this was updated regularly. Recruitment processes protected people from the risk of being supported by staff who were not suitable for the role. There were sufficient numbers of suitably qualified staff on duty and staffing levels were adjusted to meet people’s changing needs and wishes.

Staff were supported to carry out their roles through a system of induction, training and supervision. Training included areas which were specific to the needs of people living at Breage house. Staff felt valued and supported and were happy in their work.

Staff worked according to the principles of the Mental Capacity Act and associated Deprivation of Liberty Safeguards. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff supported people to maintain a balanced diet in line with their dietary needs and preferences. Where people needed assistance with eating and drinking staff provided support appropriate to meet each individual person’s assessed needs.

People were supported to maintain good health, have access to healthcare services and receive on-going healthcare support. The staff had developed positive working relationships with health and social care professionals.

Care records showed that people took part in a range of activities. We saw people undertaking individual activities such as going out for walks with staff, and socialising. People choose where they wanted to go for their holiday with staff support. There were enough staff to support people to take part in individualised activities according to their preferences.

There was a well-established management structure in place with clear lines of accountability and responsibility. Audits were carried out over a range of areas. There were systems in place to gather the views of people who used the service and their families. Staff meetings enabled staff to voice their ideas and suggestions about how the service was organised.