Breagha House

Updated 25 December 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by two inspectors.

Service and service type

Breagha 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.

The service had a manager who was in the process of registering with the Care Quality Commission. This means that they (once registered) and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority about the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.

During the inspection

During the inspection we spoke with two people who used the service and observed how care and support was given generally. We spoke with three staff, the manager, the area manager, and the provider’s director of adult services. We looked at a range of records including three people’s care records and how medicines were managed for people. We also looked at staff training, and the provider’s quality auditing system. During the inspection visit we asked the provider to give us additional evidence about how the service was managed, and they provided this.

After the inspection

We continued to seek clarification from the provider regarding the evidence we had. We sought feedback from the local authority safeguarding staff, and quality monitoring team. We also sought feedback from staff from advocacy services who were involved in supporting people.

Updated 25 December 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 eight people. At the time of our inspection, five people were living there.

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

There were not always enough staff to give people the support they were assessed as needing. The management team confirmed recruitment was an issue for the provider, and they were continuously trying to find ways to remedy this. We identified that the record keeping in relation to training and induction for agency staff was not consistently robust.

People were protected from the risk of abuse. People’s needs were assessed, and any risks associated with their health conditions documented. Relatives felt their family members received safe care and support generally. People received their prescribed medicines safely. Risks associated with the service environment were now assessed and mitigated. The service was clean, and risks to people associated with acquired infections were minimised. Accidents and incidents were monitored to identify trends and prevent the risk of them happening again.

People's needs and choices were assessed in line with current legislation and guidance in a way that helped to prevent discrimination. The provider and manager had worked with the staff team to ensure they were up to date with the training and skills needed to support people. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported and encouraged to have a varied diet that gave them enough to eat and drink. People were supported by staff to access healthcare services when required. The provider ensured the environment was suitable for people's needs.

The leadership of the service had improved since our last inspection. Relatives felt confident in the manager’s skills and ability to create a safe environment with good quality care for people. Staff we spoke with clearly understood their roles and responsibilities and felt able to make suggestions to improve people’s daily lives.

The provider and manager had implemented systems that helped them to analyse the causes of incidents or poor care and identify risks to people. This information was then used to improve the quality of care. The provider was working with the local authority and CQC in an open and transparent way to ensure the quality of the service steadily improved. Local authority staff involved in safeguarding processes for people felt the service was much improved since our last inspection.

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 statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of Safe, Effective and Well-led the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

People were able to have choice and control in their day to day decisions. Staff were supported to demonstrate the values the provider felt essential to delivering good quality care that was person-centred. The provider and manager were dedicated to ensuring staff demonstrated values in line with Right support, right care and right culture. The provider was looking at ways to develop staff knowledge and skills which meant people were being supported in the best way possible. This was through reviewing peoples’ care, enhancing staff knowledge and training and listening to people and their relatives.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Inadequate (published 3 August 2021) and there were multiple breaches of regulation. At this inspection we found improvements had been made. The provider was still in breach of Regulation 18 (Staffing) but was no longer in breach of any other regulations.

This service has been in Special Measures since 2 August 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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 COVID-19 and other infection outbreaks effectively.

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 monitor the service.

We have identified a breach in relation to regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.