The Bungalow

The Bungalow is a small residential care home providing personal care to four people with learning disabilities at the time of the inspection. The service can support four people maximum.

The accommodation is mainly all on the ground floor, with one bedroom and a small lounge area upstairs. People have access to a garden and the home is close to local amenities.

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

People were protected from harm by staff who had been trained in recognising and reporting abuse. Restrictive practices were currently being reviewed by the provider alongside staff confidence to speak up. Staff did not always feel they were listened to but this had improved following some recent changes.

Risks to people’s safety were assessed but improvements were needed in regard to fire safety documentation. Infection and prevention controls were in place. However, some of the identified risks needed further attention. For example, individual staff risk assessments had not been completed.

Systems were in place to ensure lessons were learnt when things went wrong. The processes in place were being reviewed and investigations were underway to establish why some issues had not been highlighted sooner.

People were supported by a sufficient number of staff, although staff felt tired due to having to cover shortfalls in the team. People received their medicine from staff who had received the necessary training.

Plans were in place to increase staff engagement following a noted reduction in staff supervision. The provider was working in partnership with others to make necessary improvements.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. A closed culture in the home had begun to develop. A closed culture can be described as poor culture where the risk of harm is increased due to a range of different factors such as poor leadership and restrictive practice.

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

Rating at last inspection

The last rating for this service was good (published 1 August 2019).

Why we inspected

We received concerns in relation to the management of the service and the potential for people to be at risk of harm. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We found no evidence during this inspection that people were at risk of harm. However, we have found evidence that the provider needs to make improvement.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Bungalow is a ‘care home’ registered to accommodate up to four people. At the time of this inspection the service was providing accommodation and personal care to four people with learning disabilities and other complex needs.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

People were supported to have maximum choice and control of their lives and staff supported people in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice.

People's experience of using this service:

People were safe and well supported by a staff team who knew them well. Staff could recognise, and report suspected abuse or poor practice and managers were aware of the process to follow should an allegation be made. People received appropriate support to receive their medicines as and when they needed them. Risks to people were assessed and procedures were in place to help keep people safe.

People were protected from the risks associated with the control and spread of infection and the accommodation was suitable to provide a homely environment.

Staff understood, and protected people's rights and people were treated as individuals. Support was very personalised to meet individual needs. People were encouraged to be as independent as they were able with a culture of promoting independence underpinning all care and support. Staff worked effectively with health and social care professionals to ensure people’s needs were met.

People had opportunities to engage in activities that gave them a sense of self-worth and achievement.

There were enough staff to meet people’s needs flexibly. Staff were well supported and well trained. People told us that staff were kind and people were supported with respect and understanding.

There was a complaints procedure in place however people who used the service expressed dis satisfaction through body language and behaviours. Staff knew people well, meaning they could tell when someone was unhappy or uncomfortable.

Reviews and audits of the service showed people received good outcomes and a safe and well managed service. The management team were approachable and proactive to ensure the service met the needs of the people they supported. The service had good community links that promoted inclusion.

Rating at last inspection:

The service was rated Good at the last inspection in October 2016 (published November 2016).

Why we inspected:

This was a scheduled inspection based on the previous rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

The Bungalow provides accommodation and personal care for up to 4 adults with a learning disability. At the time of our inspection 3 people lived there.

There was not a registered manager in post 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. However the provider had appointed a manager to oversee the management of the location and this person would be applying for the registered managers status.

Systems to monitor the quality and consistency of the care provided were not always being completed and, where they were, they were not always effective at identifying improvements required. However, the manager was aware of the improvements required and there was an action plan in place to address these issues.

People felt safe living at the home. People were supported by staff who knew how to recognise and report potential abuse and staff had a good understanding of how care and support should be provided in order to keep people safe. Risks to the health, safety and well-being of people were identified and managed. People received their medicines as prescribed.

People were supported by sufficient numbers of staff to respond to people’s needs and support people safely. People were supported by staff who had been recruited safely and had the skills and knowledge to meet people’s care and support needs.

The principles and applications of the Mental Capacity Act 2005 were understood and followed.

People had enough to eat and drink and were involved in the planning of meals and were given choices. People had good access to a range of healthcare professionals when required.

People were supported by staff who were kind and caring. Staff supported people in a way which maintained their privacy and dignity and encouraged people’s independence.

Staff had a good understanding of people’s individual needs and interests and had people had choice and control over how they lived their lives. People and their relatives knew how to raise concerns or complaints.

People and staff were encouraged to be involved in the development of the service. People and relatives knew who the manager was and felt they were approachable. Staff felt supported and felt they could approach the manager with concerns or suggestions.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

On the day of our inspection there were two people present at the Bungalow. Because of their complex health needs we were unable to communicate verbally in any great detail. However, when we asked them if they were happy, felt safe and whether the staff treated them well both were able to show their agreement. One person we spoke with was able to communicate by giving us the 'thumbs up' sign when we asked questions.

People were looked after by staff who had received training in how to recognise possible harm or abuse and understood their responsibilities in acting on and reporting this.

Risks to the environment and people had been identified and managed in a way that ensured people's safety. This included risks associated with medicines and activities people took part in.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no application had needed to be submitted procedures were in place and staff had received training in these safeguards.

Is the service effective?

People's needs had been assessed before care was provided and their plan of care was individual to them. People were involved in keeping their own care records up to date and encouraged to contribute to their plan of care. Staff showed a good understanding of how to respond to people's support needs.

Staff were supported in their roles through regular meetings with the registered manager. Training was appropriate to their roles and kept updated. This ensured they could meet people's needs.

We saw evidence that the provider worked closely with other health professionals to ensure there was a joined up approach to meeting people's care.

Is the service caring?

We observed staff treated people with respect, dignity and kindness. Staff told us, 'It's more like a family environment' and 'It's not like being at work, everyone's great'.

Care records reflected how people wanted to be supported and described what was important to them.

People using the service were comfortable interacting with staff. This meant staff were familiar with how people wanted to be supported and had developed positive relationships with them.

Is the service responsive?

Activities were provided for people which were individual and relevant to them. One person was excited about going to 'Soccer Aid' in the near future. We saw staff engaged with a person playing table football. Another person was happy to listen to music in their room and staff respected this.

Incidents and accidents were acted on and monitored by the provider. Changes in people's needs were responded to and care records updated to reflect these changes.

Is the service well led?

Staff told us they found the registered manager, 'Approachable and supportive'. They told us that they were able to speak about any concerns or issues with them and felt they were listened to.

The quality of care provided was monitored by the registered manager and the provider on a regular basis. Regular 'resident' and staff meetings were held where people and staff could raise any concerns and make comments. This helped to ensure that people received a good quality service at all times.

We found that people were supported to make decisions and that their choices were respected. We saw evidence that people's best interests were considered when decisions were taken on their behalf.

We saw that care plans were comprehensive and person centred. We saw that people's personal goals, choices, likes and dislikes were recorded in their care plans. The care plans also contained details of how each person expressed their dissatisfaction or disagreement. We saw staff treating people with respect and kindness throughout our visit.

We found that medicines were safely stored. However we found that medicines administration records were not always accurate.

The provider had a suitable complaints procedure in place. It had been made available to people's relatives and representatives and was available in an easy to read format for those who needed it.