Background to this inspection
Updated
24 March 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 inspection took place on 20 February 2018. The inspection was carried out by two adult social care inspectors and an expert by experience. An expert by experience is a person who has experience of using, or caring for a person who uses this type of service.
Before the inspection we reviewed the information we held about the service. This included past reports and notifications. A notification is information about important events which the service is required to send us by law.
We spoke with five people living at the service. Not everyone we met who was living at St Breock was able to give us their verbal views of the care and support they received due to their health needs. We looked around the premises and observed care practices. We spoke with the registered manager, two representatives for the provider, five staff and a healthcare professional. We spoke with three visitors.
We used the Short Observational Framework for Inspection (SOFI) over the lunch time period. SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.
We looked at care documentation for five people living at St Breock, medicines records for 31 people, three staff files, training records and other records relating to the management of the service.
Updated
24 March 2018
This unannounced comprehensive inspection took place on 20 February 2018. The last inspection took place on 26 January 2017 when the service was not meeting the legal requirements. There were concerns that conditions attached to Deprivation of Liberty Safeguards were not being adhered to, and the service had not notified the Care Quality Commission of the authorisations in place at the service. The service was rated as Requires Improvement at that time.
People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. St Breock is a care home which offers care and support for up to 38 predominantly older people. At the time of this inspection there were 31people living at the service. Some of these people were living with dementia.
There were systems in place for the management and administration of medicines. The service held an appropriate medicines management policy. Staff who administered medicines had undergone training and regular updates. Prescribed liquids and creams were mostly dated when opened to ensure that staff knew when the item should be disposed of. Medicines that required stricter controls were appropriately stored and managed. The stock held at the service tallied with the records. However, the Medicine Administration Records (MAR) contained some gaps where staff had not always signed to evidence that a prescribed medicine had been given. Some handwritten entries on to the MAR had not been signed and witnessed by two staff as directed in the medicines policy. Regular medicines audits were being carried out but were not effectively identifying these issues. The registered manager was aware that this matter needed to be addressed with specific members of staff and planned to address it at supervision. We have made a recommendation about this in the Safe section of this report.
Staff received training on the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty safeguards (DoLS). Staff had a clear understanding of how to ensure people’s rights were protected. One person had an DoLS authorisation in place, there were no conditions attached to this authorisation. The registered manager had notified CQC of this authorisation. This meant the service had met the requirements of the regulation which was breached at the last inspection.
The registered manager held a record of the people who had appointed Powers of Attorney, to act on their behalf when appropriate. However, the information held in some people's care plans was sometimes misleading and could result in a relative being given powers they did not legally hold, such as signing consents on behalf of a family member who could not consent for themselves. The manager assured us this would be addressed immediately.
The service was registered for dementia care. At our last inspection we made a recommendation about the lack of pictorial signage throughout the service to support people who were living with dementia. Pictorial signage helps people to recognise their surroundings more easily and helps them to be as independent as possible. For example, accessing the bathroom when needed. At this inspection there was still very little pictorial signage at the service. However, the registered manager provided evidence that pictorial signage for toilets and bathrooms had been ordered to help address this concern.
The premises were well maintained and were regularly checked and maintained by the provider. There was re-decoration being carried out at the time of this inspection. Equipment and services used at St Breock were regularly checked by competent people to ensure they were safe to use.
We walked around the service which was comfortable and appeared clean with no odours. People’s bedrooms were personalised to reflect their individual tastes. People were treated with kindness, compassion and respect.
Risks in relation to people’s daily lives were identified, assessed and planned to minimise the risk of harm whilst helping people to be as independent as possible.
Staff were supported by a system of induction training, supervision and appraisals. Staff were positive about the support they received from the registered manager.
People were supported by staff who knew how to recognise abuse and how to respond to concerns. The service held appropriate policies to support staff with current guidance. Mandatory training was provided to all staff with regular updates when necessary. The manager had a record which provided them with an overview of staff training needs.
The service had identified the minimum numbers of staff required to meet people’s needs and these were being met. The service had some staff vacancies at the time of this inspection to which they were actively recruiting.
Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy. However, some of these records were not contemporaneous and not always easy to monitor.
Care plans were well organised and contained information relating to all aspects of people’s care and support needs. Care planning was reviewed regularly and people’s changing needs were recorded. Daily notes were completed by staff.
People had access to an organised programme of varied activities seven days a week. There were two activity co-ordinators in post. On the day of this inspection we observed people enjoying the entertainment, spending time with visitors and independently going outside into the grounds to enjoy the nice weather.
The manager was supported by a deputy manager a team of motivated staff and by the provider.