We inspected Breagha House on 8 August 2017. The inspection was unannounced. Breagha House is a large, modern detached property in the village of Hayton, near Retford in Nottinghamshire. It is owned by Kisimul Group Limited. It is registered to provide care for up to ten younger adults with a learning disability. On the day of our inspection ten people were using the service.

The service had a registered manager in place at the time of our inspection. The registered manager registered with the Care Quality Commission on 6 June 2017. 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 our last inspection on 14 and 20 February 2017 we identified significant failings and multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to safe care and treatment, safeguarding people from abuse and improper treatment, staffing, dignity and respect, person-centred care, good governance and not notifying the Care Quality Commission for incidents the provider was legally obliged to do. The provider sent us an action plan to tell us what action they would take to meet these breaches in regulation.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Staff had received safeguarding refresher training and additional training to support them to manage safeguarding incidents more effectively. New processes and systems had been introduced as additional measures to monitor safety.

Risks associated to people’s individual needs including the environment, had been reassessed and care records updated to provide staff with the required information to protect people’s safety. These were regularly reviewed and amended to reflect people’s needs. Action had been taken to improve some aspects of the environment to ensure people’s safety.

Significant improvements had been made to the staffing levels; these were appropriate and supported people’s needs. Consideration had been given to the staff skill mix, ensuring a balance of skills, competencies and experience. New staff had completed all required recruitment checks before they commenced their employment.

Medicines were managed, stored and administered safely. Staff had the required information and had completed appropriate training. Monitoring checks were in place that assured the provider people received their prescribed medicines safely.

Improvements had been made to staff training and ongoing support. Staff received regular opportunities to refresh their skills and knowledge and to review their training and development needs.

Staff understood how to apply the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Mental capacity assessments and best interest decisions had been reviewed to ensure least restrictive options had been considered and applied. Staff had received specific training around managing behaviours that could be challenging. This had a positive impact on people and incident of physical intervention had significantly reduced.

People’s nutritional and health needs had been reviewed and staff had the required information to support people with these needs. Staff had worked with external healthcare professionals and had supported people to attend heath appointments as required. People’s health needs were monitored and recorded. Peopl

We inspected the service on 14 and 20 February 2017. The inspection was unannounced. Breagha House is a large, modern detached property in the village of Hayton, near Retford in Nottinghamshire. It is owned by Kisimul Group Limited. It is registered to provide care for up to ten younger adults with a learning disability. On the day of our inspection eight people were using the service.

We were informed prior to our visit that the registered manager was no longer in post. 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.

Action was not always taken to reduce the risk of people being placed at risk of abuse. Risks in relation to people’s daily lives were not always assessed and planned for to protect them from harm and people were being placed at risk of harm.

People did not always receive appropriate care and support as there were not enough staff deployed in the service. Medicines were not always managed safely.

People were not protected from avoidable restraint and were supported by staff who did not have all of the knowledge and skills they needed to provide safe and appropriate care and support.

People were supported to make some decisions and staff knew how to act if people did not have the capacity to make decisions. However staff did not always act in people’s best interests.

People were not fully supported to maintain their nutrition. People were supported to attend health appointments.

People were supported by staff who knew them well and sometimes cared for them with compassion but staff were not empowered to support them in a way they would prefer. People were not always given the opportunity to live their life to their full potential or enjoy an active social life.

The systems in place to monitor the service had been ineffective in maintaining the quality of the service people received. This had led to deterioration in the quality of the service and people being placed at risk of harm. The lack of appropriate governance and risk management framework had resulted in us finding multiple breaches in regulation and this had led to people being placed at risk of harm and receiving care and support that was not safe.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer

We inspected the service on 23 and 30 March 2016. The inspection was unannounced. Breagha House is a large, modern detached property in the village of Hayton, near Retford in Nottinghamshire. It is owned by Kisimul Group Limited and is registered to provide care for up to ten younger adults with a learning disability. On the day of our inspection eight people were using the service.

The service had a registered manager in place 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.

People were supported by staff who knew how to recognise abuse and how to respond to concerns. Risks in relation to people’s daily life were assessed and planned for to protect them from harm.

People were supported by enough staff to ensure they received care and support when they needed it. Medicines were managed safely and people received their medicines as prescribed.

People were supported by staff who had the knowledge and skills to provide safe and appropriate care and support. People were supported to make decisions and staff knew how to act if people did not have the capacity to make decisions.

People were supported to maintain their nutrition and staff were monitoring and responding to people’s health conditions.

People lived in a service where staff listened to them. People’s needs were recognised and responded to by a staff team who cared about the individual they were supporting. People were supported to enjoy a social life.

There were systems in place to monitor and improve the quality of the service but these were not always effective in making improvements to record keeping. People lived in an open and inclusive environment and were involved in giving their views on how the service was run.

Due to the complex needs of the people using the service we used a number of different methods to help us understand their experiences when we undertook our visit.

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with two people who lived at the service, three relatives, two care workers and the registered manager. We also looked at some of the records held in the service including the care files for two people. We observed the support people who used the service received from staff and carried out a brief tour of the building.

We found people gave consent to their care where possible and the provider acted in people’s best interests when needed. The care and support people received met their needs.

Staff were provided with the leadership they required to protect the rights of people who did not have the capacity to consent. There were sufficient numbers of suitably trained and experienced staff to meet people's needs and the provider maintained records that were accurate and fit for purpose.

We found the staff team were supported through training, and the records in use protected people from the risk of unsafe or inappropriate care and support.