St Brelades

Updated 17 February 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was completed by two inspectors, a medicines inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

St Brelades is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. St Brelades is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 4 people and 11 relatives about their experiences of the service. We spoke with 8 staff including the nominated individual, registered manager, operations manager and 3 care staff. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We reviewed a range of records. This included 5 people’s care records, 9 medication records and three staff files in relation to recruitment. A variety of records relating to the management of the service, including checks and audits were reviewed.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

Updated 17 February 2023

About the service

St Brelades is a residential care home providing personal care to up to 37 people. The service provides support to people living with dementia. At the time of our inspection there were 33 people using the service.

People’s experience of using this service and what we found

Improvements had been made at the service since our last inspection. However, further improvements were required to ensure people always received a good quality service.

Medicines management had improved. Further improvement was needed to ensure people were always offer medicines overtly before they were administered covertly. Medicines records were now accurate and medicated patches were applied in line with the manufacturer’s guidance.

Care plans have been improved to provide guidance to staff about how to manage risks. However, information was not always stored in the same place so staff could refer to it quickly in an emergency. Action had been taken when accidents and incidents happened, but systems were not in operation to look for patterns and trends.

Further improvements were required in relation to quality assurance processes, acting on feedback and planning improvements to ensure the quality of the service continued to develop. Relatives continued to tell us laundry was not always well managed and items continued to go missing. New checks and audits were being implemented but time was needed for these to be imbedded to ensure any shortfalls were identified and action taken to address them.

Development plans were in place but did not cover all the plans the registered manager had to improve the service. Detailed plans would support the registered manager and provider to assure themselves the service was continuing to develop.

The culture at the service had improved. People were no longer discriminated against because of their needs and were free to use all areas of the building. The dementia environment had improved, but further work was needed to ensure people are empowered to understand and interact with their environment as much as possible.

People were protected from the risk of infection. A relative told us “It’s always been excellent, clean and tidy. It’s just like walking into somebody’s home”.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. The provider’s quality rating was now clearly displayed. Notifications had been submitted as required.

People were protected from the risk of abuse because all staff had now completed safeguarding training. Staff were confident to raise concerns with the registered manager and were assured she would act.

Staff recruitment had improved. There were enough staff who know people well and have the skills and competence to meet people’s needs. Staff now felt supported, appreciated and motivated. Staff were confident to make suggestions and these were acted on.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 7 July 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 21/6/2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced focused inspection of this service on 10 May 2022. Breaches of legal requirements were found. This inspection was carried out in part to follow up on action we told the provider to take at the last inspection. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, fit and proper persons employed, staffing, good governance, safeguarding service users from abuse and improper treatment, notification of other incidents and requirement as to display of performance assessments.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Brelades on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect. At our next inspection we will check the improvements made have been maintained and the service demonstrates consistently good practice over time.