We inspected the service on 9 February 2015. The visit was unannounced. Our last inspection took place on 6 July 2014 and there were no identified breaches of legal 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 three floors. There is a passenger lift operating between the floors. The home has one double bedroom; the remainder are for single occupancy. There were 14 people living at the home on the day of our inspection.
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 people looked well cared for. We observed staff speaking in a caring and respectful manner to people who lived in the home. Staff demonstrated that they knew people’s individual characters, likes and dislikes.
People we spoke with told us they felt safe living at the home. They told us they trusted the staff and felt the staff knew them well and how they liked support to be provided for them.
The home provided care for people living with dementia. There was little evidence of national guidance or best practice on which the home based the care they provided for people living with dementia. This meant the provider could not assure themselves they were meeting the required standards regarding dementia care.
We found the service was not meeting the legal requirements relating to Deprivation of Liberty Safeguards (DoLS). The manager of the home had not considered if people were at risk of being deprived of their liberty. Staff demonstrated a lack of understanding of the Mental Capacity Act 2005. Where assessments of people’s mental capacity had been carried out we saw people had not been supported to make decisions about their care, or consent to the care, they received at the home.
We found there were issues with regard to the management of medicines within the home. This was in relation to the administration, storage and lack of guidance in place for staff to follow when administering ‘as required’ medicines to people.
Staff we spoke with told us they were aware of their responsibilities with regard to safeguarding people who lived at the home. They were able to tell us about the symptoms of possible abuse taking place and how they would report this. However, we found staff had not acted within the policy and procedures available to them to report incidents of possible abuse. The manager, however, had failed to report all incidents of abuse and alleged abuse appropriately to the CQC.
We were told by the manager the provider carried out checks on the environment of the home however; there were no records of these checks. We found the temperature of the hot water in three people’s hand basins and two of the communal bathrooms was 50 degrees centigrade and meant people were at risk of being scalded.
We saw staff had completed ‘in house’ training on medicines. However, we found the training consisted of a ‘competency’ check only. We also saw the home did not provide training in dementia care for staff. The provider responded to our concerns and ensured proper training in medicines and dementia awareness was arranged for staff.
We saw the provider did not have a system in place for the purpose of assessing and monitoring the quality of the service.
People told us the food at the home was good and that they had enough to eat and drink. We observed lunch being served to people and saw that people were left unsupervised for periods of time during their meal. This meant staff were not available to respond to people’s needs, to offer direct supervision or to maintain people’s safety.
People who used the service said they did not have enough to do to make sure their social needs were met. Comments included; “I play records, I like the music. There's nowt else to do. I'd like to go for a long walk. You know, feel the grass under my feet.” Another person told us “I just sit in my chair, that's what we do in the afternoon. Just sit in the chair.”
We looked at four staff personnel files and saw the recruitment process in place ensured that staff were suitable to work in the home. Staff we spoke with told us they received supervision every three months and had annual appraisals carried out by the manager. We saw minutes from staff meetings which showed they had taken place on a three monthly basis and were well attended by staff.
The home was clean and had personal protective equipment was in place for staff to use however, in two people’s bedrooms we noted malodours. The manager told us there were plans in place to change the carpeting.
We found there were not at all times, enough staff to ensure people’s needs were met safely and that people were properly supervised to ensure their safety.
We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, now replaced by the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.