Breach House is registered to provide accommodation for up to 26 older people. There were 24 people living at the home at the time of our inspection. This included one person who was staying at the home for a short period of time.

This inspection took place on 23 March 2017 and was unannounced.

A registered manager was in post at the time of our inspection. 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.

At the last comprehensive inspection on 17 March 2016, we found improvements were required in recreational opportunities for people and that the manager and staff were not consistently following the Mental Capacity Act 2005(MCA). We also received mixed views from people about their mealtime experiences, and the opportunities for staff to develop their skills and knowledge needed to care for people. At this inspection, we found improvements had been made.

People were positive about the ways staff met their safety needs. Staff understood people’s individual risks and cared for them in ways which promoted their safety. Staff knew what action to take to protect people from the risk of potential abuse. There were enough staff employed to care for people so they received care promptly and the risk of people feeling isolated was reduced. Where people needed assistance to take their medicines this was given by staff who knew how to do this safely.

People benefited from receiving care from staff with the knowledge and skills to care for them and staff recognised people’s rights. People enjoyed their mealtime experiences, and had enough to eat and drink to remain well. Staff took action to support people if they required medical assistance, and advice provided by health professionals was followed. As a result, people were supported to maintain their physical health.

Positive and caring relationships had been built between people and staff. People and their relatives were complimentary about the staff that supported them. Staff knew people well and took action so people felt included and at home. Staff took time to chat to people and reassured them when this was needed. People were encouraged to make their own day to day decisions about their care, with support from staff where this was required. People’s right to privacy and dignity was taken into account in the way staff cared for them and they were encouraged to maintain their independence.

People and their relatives were involved in deciding how care should be planned and risks to their well-being responded to. Where people were not able to make all of their own decisions their representatives and relatives were consulted. Relatives and staff gave us examples of how staff adapted the care provided as people’s needs changed. People and their relatives understood how to raise any concerns or complaints about the service and were confident these would be addressed. Systems for managing complaints were in place, so any lessons would be learnt.

Positive comments were received about the improvements introduced by the registered manager, so people had more interesting things to do. People, relatives and staff found communication with the registered manager to be open and were encouraged to make suggestions to developing care further. Staff knew how they were expected to care for people and were encouraged to reflect and improve on the care provided.

The registered manager and provider checked people’s experience of living at the home. People and their relatives were encouraged to give feedback on the care they received, so improvements would be driven through and people would continue to consider Breach House as their home.

This inspection took place on 17 March 2016 and was unannounced.

The provider of Breach House is registered to provide care for up to 26 older people, including people with dementia. There were 25 people living at the home at the time of our inspection.

At the time of our inspection there was a manager in post who had applied to become a registered manager. 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 manager and staff were not consistently following the Mental Capacity Act 2005 (MCA) which is intended to ensure people are supported to make decisions for themselves. When this is not possible the MCA requires that decisions are taken in people’s best interests by people who have the authority to do this and there is documentary evidence to reflect this.

There was a lack of a structured approach in the provision of recreational activities in the home so at times there was limited stimulation and occupation for some people. The manager was aware and had plans to improve and enhance people’s opportunities to do fun and interesting things. However, we could not measure the effectiveness of these improvement plans as they needed to be fully implemented.

We have made a recommendation about the adaptation of the home environment to support people with dementia.

Staff knew how to protect people against the risk of abuse or harm and how to report concerns they may have. Risks to people’s health and wellbeing were assessed and measures put in place to meet people’s needs with safety in mind. There was evidence of learning from incidents and accidents and changes were put in place to reduce the risk of these happening in the future.

Checks had been completed on new staff to make sure they were suitable to work at the home. People told us there were enough staff to meet their needs although at times staff could be busy but they did not have to wait for assistance for too long. The manager had recently increased staffs’ opportunities to gain support through more practical training to effectively carry out their caring roles.

We saw staff applied their knowledge gained from training in an effective way when responding to the individual care and support needs of all people who lived at the home. This included their communication skills so people’s mental health and emotional needs were consistently supported and met. The manager put into practice their skills and knowledge to reassure some people who lived at the home when they needed this on the day of our inspection. They viewed this as one positive method of guiding and supporting staff to provide good care.

People had their prescribed medicines available to them and these were administered by staff who had received the training to do this. People told us they were supported to access health and social care services to maintain and promote their health and well-being. A doctor visited people on the day of our inspection and spoke with staff about people’s changing health needs. The monitoring and recording of what people ate and drank had improved so risks to people from not eating and drinking sufficient amounts to stay well.

People told us they felt their privacy was respected and they felt safe. We saw conversations between staff and people who lived at the home were positive in that staff were kind and polite to people. Staff had a high degree of knowledge about people’s individual choices and preferences. People knew how to make a complaint and felt able to speak with the staff or the manager about any issues they wanted to raise.

People knew the manager and they felt they were approachable and visitors to the home felt they were welcomed. The manager had introduced more opportuniti

During the inspection of 3 June 2013 we found that the provider was in breach of Regulation 9 of the Health and Social Care Act 2008. Care plans did not fully reflect a person's mobility needs and we observed staff used inappropriate moving and handling practices for the same person who used the service.

During this inspection we spoke with the registered manager and three care workers. We reviewed the care records of three people who had different mobility assistance needs. Most of the inspection time was spent observing staff practices and how they interacted with people who used the service.

We found that improvements had been made in care records as they clearly identified people's care needs in respect of their mobility. We saw that staff practices promoted people's safety and welfare. The staff we spoke with demonstrated good knowledge of people's individual needs. The provider had put systems in place that supported and protected people from risks of injuries.

We spent time at the home watching to see how staff supported people, and talking with people about life at Breach House. We spoke with two people living at the home and two relatives. We also looked at records, and spoke with two staff and the manager.

Throughout our inspection we observed positive interactions between people who lived at the home and staff. People were supported to be involved in all aspects of their life and, as much as possible, in decisions about their care or treatment. One person who lived at the home told us: “It is very nice here and I am always made aware of what is going on”. Another person said: “They (staff) do show me respect; they don’t treat me like a bit of nothing”.

We observed that staff moved two people between chairs and wheelchairs with inappropriate techniques. This practice can put people at risk of harm.

We watched staff supporting several people who lived at the home to take their medicines at breakfast time. This was done with patience and consideration for each person’s needs. We saw that people received their medicines in the right way and at the right time.

Staff also told us that the training and support provided ensured that they were able to look after and meet the needs of people who lived at the home.

There were arrangements in place to assess and monitor the safety and quality of care. The views of people and families were used to improve the quality of services delivered.