Breadalbane Residential Home is a care home for up to 15 older people. It is a converted house which has been adapted and extended to provide accommodation over three floors.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated Good

People received support which was individual to their needs. Risks were minimised, wherever possible, whilst maintaining people’s independence. Staff received good training and support which helped them be effective in their roles. People had choice and control of their own lives. The service provider’s policies and systems were up to date and effective. We observed a relaxed atmosphere throughout the home during our inspection. The registered manager ensured the quality of the service was monitored, and improvements were made when required. 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 support this practice.

Further information is in the detailed findings below

We inspected the service on 5 October 2015. The visit was unannounced. Our last inspection took place on 9 February 2015 in which there were four breaches of legal requirements identified. These were in relation to the need for consent, person centred care, safe care and treatment and staffing. We saw that the service had taken all required measures to improve and that they had met all relevant requirements.

Breadalbane Residential Home is a care home for up to 15 older people. It is a converted house, which has been adapted and extended to provide accommodation over two floors. There is a passenger lift operating between the floors. The home has one double bedroom, this is currently being used by one person and the rest of the rooms are single occupancy. On the day of our inspection there were 14 people living at the home.

The home had 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.

During our visit we saw that people appeared happy and relaxed. We saw that all staff had positive relationships with people and their families. We saw that the provider knew the people well and made time to go and speak to them on their arrival at the service. The provider made time throughout the day to speak to people and share common interests and humour with residents and visitors.

People we spoke with told us that they felt very safe living at the service and they had no concerns about any aspect of their care. People felt that they had good relationships with staff and that staff knew them well and were able to give good care as a result of their knowledge. People told us they were always treated with dignity and respect and that the staff were very caring towards them.

We found that the registered manager had addressed all issues relating to the legal requirements relating to Deprivation of Liberty Safeguards (DoLS). The manager had identified all service users who were at risk of being deprived of their liberty due to reduced capacity to make their own decisions, had carried out an assessment of their mental capacity in relation to making specific decisions and had applied for the necessary safeguards to be put into place. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act (MCA) 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom.

We found that the provider had taken action to improve the management of medicines in the service. We found no concerns about the way in which medicines were stored, recorded or administered.

We carried out an environmental check of the service, we found no evidence of excessive water temperatures in any of the bathrooms, or people’s rooms.

We saw that the manager had put in place robust auditing processes which meant that they were aware of any issues within the service and we saw that there were processes for these issues to be resolved in a timely manner and evidence that these processes were being used effectively.

We saw that the provider had a schedule of improvements for the service. At the time of our visit there were plans in progress to redecorate the main lounge. This was particularly in relation to removal of the patterned carpet which was not suitable for some of the people who were partially sighted as it made it difficult for them to judge their footing when walking in the lounge.

We saw that the manager had made improvements to the signage in the service. They had implemented signs which were pictorial to help the service users who were living with dementia, they had also maintained the original signs as some of the service users felt that they preferred them.

On the day of our visit we saw that people were given choices about how they wanted to spend their time. A member of staff was playing table top games with some people in the morning. After lunch some people decided that they wanted to watch a film in the main lounge. We saw that they chose the film and were actively watching it. A member of staff asked if anyone wanted to do any other activity, the offer was declined.

We saw that the home was very clean, there were no malodours anywhere in the service. We saw that there was a domestic member of staff cleaning throughout the day, this included door frames and skirting boards. We saw that all staff were washing their hands and using personal protective equipment appropriately.

We saw that all people had been assisted to get up, get washed and dressed and have had their breakfast by 10:30; when we asked people if they got up at their preferred times they told us they did. People told us they enjoyed the food they were served and we saw that staff offered drinks to people throughout the day.

We saw that there were sufficient numbers of suitably trained and skilled staff available throughout our visit to meet people’s needs safely.

Breadalbane Residential Home is a care home for up to 15 older people. It is a converted house which has been adapted and extended to provide accommodation over three floors.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated Good

People received support which was individual to their needs. Risks were minimised, wherever possible, whilst maintaining people’s independence. Staff received good training and support which helped them be effective in their roles. People had choice and control of their own lives. The service provider’s policies and systems were up to date and effective. We observed a relaxed atmosphere throughout the home during our inspection. The registered manager ensured the quality of the service was monitored, and improvements were made when required. 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 support this practice.

Further information is in the detailed findings below

This inspection considered our five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them as well as from looking at records.

Is the service safe?

People told us they felt safe. Staff told us they understood safeguarding policies and would report any concerns they had about people's care and treatment.

Whilst staff demonstrated they knew the people they supported, people’s care records did not reflect it. Care plans need to be specific to the person and describe how they wish to be supported.

When people display aggressive behaviour staff knew how to respond but there were no clear record of the actual risk and how to calm or support people. Which meant care records did not give enough guidance to staff.

Is the service effective?

People's health and care needs were assessed with them or their relatives. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

Where people required additional support from health professionals referrals had been made and any instructions had been followed.

Is the service caring?

We observed staff were kind and attentive to people in the home. They supported people at their own pace. Some of the comments from the people living in the home were, “The staff are good they always knock on your door. It’s a good place”

“The staff are kind, they get on well. They always answer you when you ask them anything”

Although people's preferences, interests, aspirations and diverse needs had not always been recorded their care and support had been provided in accordance with people's wishes.

Staff engaged well with people when they were offering support and changed their approach to meet the needs of the individuals they were supporting.

Is the service responsive?

People received support in accordance with their known preferences and only where they had given consent.

People told us they were confident they could raise any concerns and these would be addressed.

Is the service well-led?

At the time of our visit the manager was in the process of registering with the Care Quality Commission.

People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on.

The owner was supporting the manager and team to develop the service and drive improvement.

There was a quality assurance system in place that involved people who lived in the home and their relatives.

We used a number of different methods to help us understand the experiences of people using the service, because the majority of people using the service had various stages of dementia, which meant they were not all able to tell us their experiences.

We case tracked three of the people who lived in the home which means we spoke with them, reviewed their care plans and records and spoke with the staff who support them. We also spoke with another person who lived in the home and two relatives to gain their views of the home.

The people we spoke with were complimentary about the care and support they receive at Breadalbane. Everyone said they enjoyed the food. They told us there was plenty to eat and it was well presented. Their comments included:

“The food is great and you can always get more if you want. It’s cooked and is dished up beautifully”

“It’s lovely here. The staff are ever so helpful they notice everything. I haven’t heard a bad word said here”

Relatives said “We are very happy with the care our relative gets. The staff are very good and patient”

We observed staff relating kindly with the people who lived in the home and were supporting them in a manner that upheld their dignity.

We visited Breadalbane on 11 September 2012 as we had received information of concern about people not being involved in their care, the lack of social stimulation and how people were not always protected from the risk of poor pressure area care. We found there was a need to further develop people’s involvement in their care and ensure people are receiving social stimulation on a daily basis. However, we also found that although there had been concerns about the management of pressure area care this had been acted upon. Records showed changes in people’s condition in relation to pressure area care had been reported immediately and appropriate action taken.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs, which meant they were not able to tell us their experiences.

We spoke to three relatives who told us that the staff were always kind and helpful and they kept in touch." I have no complaints” one relative said, “My relative is quite settled and happy" They also said and their relatives were always well dressed and clean. That the home was well kept, fresh and clean.

One relative said, “I have not tasted the food but it looks good and my relative always eats well. I couldn't think of a better place, my relative always wanted to go to this home"