This comprehensive inspection was carried out on the 28 February 2017. The inspection was unannounced.

Breck Lodge Care Home is a residential home that provides personal care for up to 15 people. The home is situated near the centre of Poulton-le-Fylde and is within easy reach of local shops and facilities. The home is a large detached property with a parking area at the side. There are garden areas at the rear of the home. Communal accommodation consists of three lounges and a dining room. Accommodation is provided in 15 single rooms all of which have en-suite facilities. A chairlift provides access to the first floor.

There was a manager in place who was registered with the Care Quality Commission. 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.

We last inspected Breck Lodge Care Home in October 2016. We identified no breaches in the regulations we looked at.

During this inspection carried out in February 2017 we found the registered provider was working in line with the principles of the Mental Capacity Act 2005. Appropriate applications to deprive people of their liberty were made to the local authorities as required. We observed care and support being provided in a safe way. Documentation recorded the care and support people required to maintain their safety.

Documentation we viewed evidenced people were involved in the planning of their care and people we spoke with confirmed this. People told us they were supported to see health professionals if the need arose and we found this was recorded in care documentation.

We looked at the auditing systems in place to identify shortfalls at the home and drive improvement. We found that when accidents or incidents occurred, the registered manager reviewed these. We spoke with staff that were able to explain the steps taken to minimise the risk of reoccurrence. The registered manager carried out checks of medicines, care records and the environment to identify if improvements were required.

Staff were able to explain the actions to take if they were concerned someone was at risk of harm or abuse. People who lived at the home told us they felt safe. One person told us, “I’m not worried about my safety here.”

We found medicines were managed safely. We observed medicines being administered and saw this was carried out safely. Staff told us they received training to enable them to administer medicines correctly and we saw documentation which evidenced this.

We reviewed staff files and found there were processes that ensured staff were suitably recruited. Staff we spoke with confirmed checks had been carried out prior to starting work at the home.

Staff told us they met with the registered manager on an individual basis to discuss their performance. Staff with were complimentary of the training provided and told us further training was being arranged to ensure their skills remained up to date. Staff spoke positively of the registered manager and registered provider. We found staff meetings took place to enable information to be shared and guidance sought if this was required.

We discussed staffing with people who lived at the home. People told us they considered there were enough staff to support them. Relatives and staff we spoke with raised no concerns regarding the staffing provision at the home.

People who lived at Breck Lodge Care Home told us they considered staff were caring. One person told us, “Staff are kind. They go out of their way to help me.” We observed people being supported with kindness and compassion.

During the inspection we saw an organised activity being provided. We observed people joining in a musical activity. The activity was seen to be enjoyed by peopl

During our inspection we looked at whether people’s privacy and dignity was respected, the way people were cared for and supported, cleanliness and infection control, the management of medication, whether there was a sufficient number of staff on duty to support people properly, and the quality monitoring systems in place. We spoke individually with three people living at the home, the senior person on duty, the housekeeper, and two members of the care staff team. Care practices were also observed during the course of the inspection.

On another day we also spoke with the registered manager who was unavailable at the time the inspection visit took place.

This helped to answer our five 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.

Is the service safe?

People told us that they felt safe and secure living at the home. People we talked with spoke positively of the qualities of staff team. One person told us, “I am very happy here, no complaints about anything. The staff are very kind and this is my home now”.

We saw that people were treated with dignity and respect. One person we spoke with gave a good example of how staff had responded positively and made it possible for her to regularly visit the grave of a relative. This was very important to this person and much appreciated.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people were safeguarded as required.

Medication practices were in the main, robust. Only staff that had received appropriate medication training had responsibility of the administration of medication. A regular medication audit was in place. This helped to ensure that medication practices remained safe, by ensuring that any shortfall was quickly identified and addressed.

The service was safe, clean, and hygienic. Equipment had been maintained and serviced regularly therefore not putting people at unnecessary risk.

The registered manager set the staff rotas. They took into account people’s care needs when making decisions about the numbers, qualifications, skills and experience required. This helps to ensure that people’s needs were always met.

Is the service effective?

There was an advocacy service, soon to be made available by the new homeowners, if people needed it. This meant that when required, people could access additional support.

People told us that they were pleased with the level of care that was being delivered to them and that their assessed needs were being met. From our observations and through speaking with staff it was clear that there was a good understanding of each person’s assessed needs and that personal preferences were accommodated. One person told us, “It is OK living here. I came in for the odd stay but now I live here. I like it here”.

People’s health and care needs had been assessed with them. Although some people spoken with were unsure about their current care plan, they were unconcerned by this. On the care plans we looked at, each had been signed by the person or a close relative, to confirm their understanding and agreement to the content.

Is the service caring?

People were supported by kind and caring staff. We saw that care workers showed humour, patience and gave encouragement when supporting people. People commented, “They listen to you, care for you very well, there are no problems at all”.

People using the service and their relatives and friends had opportunity to complete satisfaction surveys. We looked at the outcome of the most recent survey, responses were mostly very positive.

Is the service responsive?

People’s preferences, interests, and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

People were offered a range of activities inside and outside the service regularly. The people spoken with said they were satisfied with the arrangements in place to support social activities and social interactions. These suited people’s current needs. People also told us that visitors were welcomed and that they were able to see family and friends in private and at a time of their choice.

People knew how to make a complaint if they were unhappy. However nobody expressed any complaints, only positive complements. We looked at the home’s service user/family complaints procedure. This gave sufficient information about how a complaint could be made, the process of investigation, the time scale for a response, however some of the information required updating. The senior person we spoke with told us that no complaint had been made for a considerable period of time.

Is the service well-led?

The service worked well with a range of health professionals to make sure that people received their care in a joined up way.

Staff had a good understanding of the ethos of the home and quality assurance systems that were in place. This helped to ensure that the quality of the service continually improved and that people received a consistent service at all times.

The members of staff spoken with told us that they were clear about their role and responsibility and that they felt well supported by the registered manager. We were also told that the staff team worked well together for the benefit of the people living at the home.

A range of routine audits were in place including medication and fire safety. This helped to ensure that a consistent service was maintained that helped to protect people and keep them safe.

This inspection was carried out on the 20 and 23 October 2015 and the first day was unannounced. We also visited the service on the 29 October to collect some documentation we wished to review.

We last inspected Breck Lodge in July 2014 and identified no breaches in the regulations we looked at.

Breck Lodge is registered to accommodate up to 15 people with personal care needs. At the time of the inspection there were 14 people who lived at the home.

Accommodation is provided over two floors, with a stair lift providing access to the first floor. There are a range of communal rooms, comprising of three lounges, and a dining room. A garden area is sited at the rear of the home, with seating for people to use during the summer months. Car parking is available at the home.

The home has a manager who is registered with the Care Quality Commission. 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.

There were systems in place to protect people at risk of harm and abuse. Staff were able to define abuse and the actions to take if they suspected people were being abused.

We saw appropriate recruitment checks were carried out to ensure suitable people were employed to work at the home.

There were arrangements in place to ensure people received their medicines safely.

Staff knew the likes and dislikes of people who lived at the home and delivered care and support in accordance with people’s expressed wishes.

Processes were in place to ensure people’s freedom was not inappropriately restricted and staff told us they would report any concerns to the registered manager.

During the inspection we saw independence was promoted wherever possible. We saw people were supported to mobilise and engage in an organised activity with patience and understanding.

People were referred to other health professionals for further advice and support when appropriate.

People told us they liked the food provided at Breck Lodge and we saw people were supported to eat and drink adequately to meet their needs and preferences.

There were sufficient staff to meet people’s needs. Staff received regular supervision to ensure training needs were identified and received appropriate training to enable them to meet peoples’ needs.

There was a complaints policy in place, which was understood by staff. People told us they were confident any complaints would be addressed.

The registered manager carried out some quality assurance checks. People who lived at the home were offered the opportunity to participate in an annual survey. We saw checks on the medicines and records were completed. However we found these were not always effective. This has been reflected under the rating, "Is the service well-led?" We have made a recommendation about quality improvement.

Documentation did not always reflect the risk minimisation strategies in place when risks had been identified. This has been reflected under the rating, “Is the service safe?” We have made a recommendation about the management of risk.

The registered manager notified the Care Quality Commission of all notifiable incidents that occurred at the home.