CQC report explained · a residential care home
What the CQC found at Breage House
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found suitable staffing, safeguarding training, safe recruitment, maintained equipment and secure medicines. Some risks were understood by staff but had not all been formally recorded.
- Effective?
- Good
- People received suitable food and support with eating and drinking, and their weights were monitored. Staff had relevant training and supported people with healthcare and legal decision-making.
- Caring?
- Good
- Staff were kind, patient and respectful. They supported people's communication, choices, independence and preferred routines.
- Responsive?
- Good
- Care plans were personalised and regularly reviewed. People were supported with activities, relationships, communication and complaints.
- Well-led?
- Requires improvement
- Management and staff relationships had improved, and there were several quality checks. However, records about risks, medicines and accidents and incidents were not consistently accurate or complete.
What inspectors found, October 2018
Rated Good overall; inspectors found kind, effective care, but the well-led rating was Requires Improvement because records were not always accurate.
Inspectors made an unannounced, comprehensive visit on 14 September 2018. They spoke with people living at the home, managers, staff and a health and social care professional. They also observed care, checked the building and reviewed care, staff and management records.
The home had improved since the previous inspection. Earlier concerns about staff teamwork and meeting people's dietary needs had been addressed. Inspectors found safe staffing, suitable training, personalised care plans, kind support, good access to healthcare and activities that reflected people's choices.
The overall rating was Good. Safe, Effective, Caring and Responsive were all rated Good. Well-led was rated Requires Improvement because some risk assessments were missing, medicine records had gaps and accidents and incidents were not formally monitored well enough.
Kind relationships
Inspectors saw a calm and friendly atmosphere. Staff were patient, respectful and gave people time to make choices.
“Interactions between staff and people were kind, respectful and supportive.” from the report
Staff understood people
Staff knew people's needs, preferences and ways of communicating. Care plans gave guidance on how to support people in daily life.
“Staff knew people's care and support needs very well.” from the report
Improved food and nutrition
The home had acted on earlier concerns about food and dietary needs. Staff received training and people could request alternatives to the menu.
“Staff were aware of people's dietary needs and preferences.” from the report
Enough trained staff
Inspectors found staffing levels met people's needs. Staff received induction, training, supervision and appraisal.
“There were sufficient numbers of suitably qualified staff on duty and staffing levels were adjusted to meet people's changing needs and wishes.” from the report
Incomplete records
needs fixingSome risk information was not formally recorded, medicine administration sheets had unsigned entries and accidents and incidents were not formally monitored in enough detail. Inspectors said this had limited direct impact on people's wellbeing, but recommended further support, advice and training for the home's governance systems.
“It was not always clear from the MARs whether people had received their medicine as some entries had not been signed by staff as required.” from the report
Risk information not recorded
needs fixingStaff understood some risks, including dietary risks, but the information was not always written in people's care records. The management team added risk assessments during the inspection.
“However, these were not all formally recorded on people's care records, for example risks in association with people's diet.” from the report
- 01How do you now check that every medicine administration record is signed correctly and followed up when there is a gap?
- 02Are risk assessments now in place for every person, including risks linked to diet and eating or drinking?
- 03How are accidents and incidents recorded, reviewed and used to identify patterns or required changes?
- 04What evidence can you show that the action plan from the 2018 inspection has been completed and is being checked regularly?
- 05How do you make sure staff continue to use each person's preferred communication method and support their choices?
This was an unannounced comprehensive inspection covering all five key questions and the overall service rating. This explanation was written from the published report of 10 October 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, September 2017
Overall rating Requires Improvement; inspectors found safe, kind and responsive care but weaknesses in food, kitchen cleaning and management.
The inspection was unannounced and took place on 9 June 2017. It was brought forward after four anonymous concerns about how some staff approached people and about tensions among staff.
Inspectors spoke with people, relatives, the manager, deputy manager, nine care staff and the cook. They observed care and checked care records, staff records, medicines and quality checks.
The home was rated Good for Safe, Caring and Responsive. It was rated Requires Improvement for Effective and Well-led. The overall rating changed from Good at the September 2016 inspection because inspectors found two breaches of regulations.
The main problems were poor food quality and presentation, limited understanding of specific dietary needs, gaps in kitchen cleaning records, no weighing scales available to monitor people's weight, and staff lacking confidence to raise concerns with managers.
Safe staffing and medicines
Staffing levels were adjusted to people's needs. Recruitment checks were completed, and medicines were administered, stored and audited safely.
“Medicines had been checked on receipt into the service, given as prescribed and stored and disposed of correctly.” from the report
Kind and respectful care
Inspectors saw calm and friendly interactions. Staff respected people's privacy, dignity, communication styles and choices.
“We observed people had good relationships with staff and staff interacted with people in a kind and respectful manner.” from the report
Personalised support
Care records reflected people's needs and preferences. Staff knew people well and supported individual activities and contact with family.
“Written care records were up to date, had been regularly reviewed and accurately reflected people's care and support needs.” from the report
Support for health and rights
People were supported to access healthcare. Inspectors found that staff applied the Mental Capacity Act and Deprivation of Liberty Safeguards appropriately.
“Staff applied the principles of the MCA in the way they cared for people and told us they always assumed people had mental capacity to make their own decisions.” from the report
Food quality and special diets
seriousFood was sometimes unappetising, and the cook did not have a good understanding of how to prepare meals for people's specific dietary needs. Inspectors said the quality of food was unacceptable.
“The cook did not have a good understanding of how to prepare meals for people with specific dietary needs.” from the report
Kitchen cleaning
seriousThe kitchen was observed to be clean, but records did not show that it had been cleaned weekly. Inspectors said this created risks of food contamination and infection.
“The kitchen premises were not cleaned at regular intervals to ensure that the standards of cleanliness were in place to prevent cross containment of foods and infection risks.” from the report
Weight monitoring
needs fixingThe home's weighing scales had been moved elsewhere. Staff therefore could not monitor people's weight for possible changes in health and wellbeing.
“People's weight was not able to be monitored as the weighing scales had been moved to another care service.” from the report
Staff confidence in management
seriousMost staff spoken with described divisions and said they did not feel confident raising concerns with managers. This could reduce the home's ability to identify and improve problems.
“We concluded there was a lack of confidence in the management of the service.” from the report
Quality checks missed problems
needs fixingThe home had quality checks, but some were not strong enough to identify the food and kitchen cleaning problems found during the inspection.
“However some auditing processes were not robust, as they had failed to identify the significant issues identified during the inspection in relation to food quality and the cleaning of the kitchen.” from the report
- 01What has changed about the preparation and presentation of blended and other special-diet meals since the inspection?
- 02How do you now check that the kitchen is cleaned regularly and that the records are complete?
- 03How are people's weights monitored, and what happens if there is a change?
- 04How can staff raise concerns confidentially, and what has been done to address the reported divisions in the staff team?
- 05What action was taken in response to the two breached regulations, and how was this checked?
This was an unannounced comprehensive inspection covering all five key questions, with observations, discussions and checks of selected records and management systems. This explanation was written from the published report of 14 September 2017 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Breage House
4 rated inspections over 3 years: the service has improved, from Requires improvement to Good.
- October 2018Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- September 2017Requires improvementdown from GoodSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- November 2016Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- February 2016Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Good
- September 2013
Report published without a new overall rating.
- January 2013
Report published without a new overall rating.
- December 2011
Registered with the Care Quality Commission on 29 December 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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