The Bungalow

The Bungalow is a residential care home providing respite support and personal care for up to nine people each night with learning disabilities. On the day of our inspection five people were staying at the service and respite support is regularly provided to over 30 people. The service is a detached building with an enclosed garden at the rear of the property.

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

The service’s recruitment practices were safe and there were enough staff on duty to meet people’ support needs. Temporary closures, one weekend each month, had been introduced with the agreement of people and their relatives as a result of low staffing levels. This had ensured the service was consistently safely staffed. Three new staff were in the process of being appointed and once their induction and training was complete the service would be able to open full time.

Staff had received safeguarding training and understood how to protect people from all forms of abuse or discrimination. Risks were well managed, and staff knew how to support people if they became anxious or upset.

Medicines were managed safely and there were robust procedures in place for the receipt and return of people medicines.

Staff had the skills necessary to meet people’s need and their training was regularly refreshed. Staff told us there were well supported and records showed they received regular supervision and annual performance appraisals.

The service had been redecorated since our last inspection and plans had been developed and funding allocated for the installation of a wet room with specialist lifting and bathing equipment.

Staff and managers had a good understanding of the Mental Capacity Act and people’s choices and decisions were respected. People chose which room they stayed in, how to spend their time and which activities they engaged with.

The staff team provided support with kindness, care and compassion. People told us they got on well with their staff and relatives comments included, “I have found the staff team at The Bungalow to be excellent, competent and perfect. They are so helpful and caring.”

People’s care plans were accurate and detailed. They provided staff with enough guidance to enable them to meet people’s needs. People and their relatives were involved in both the development and review of care plans and told us these documents were up to date. The service had systems in place to ensure any complaint received was fully investigated but relatives consistently told us this had never been necessary. Relative’s responses to a recently completed feedback questionnaire and been consistently complimentary.

The service was led effectively by the registered manager and the staff team were well motivated and focused on providing person centred support. Quality assurance systems were effective and designed to drive improvements in the service’s performance.

The service was operating in accordance with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use this respite service are supported to live as full a life as possible and to have as much choice, control and independence as possible. Although the service is larger than most domestic style properties, people received individualised, person-centred support and were encouraged to develop new skills and become more independent.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used very few restrictive intervention practices, as a last resort, in a person-centred way, in line with positive behaviour support principles.

Rating at the last inspection

The last rating for this service was good. (Report published 11 March 2017)

Why we inspected

This was a planned inspection based on the previous rating.

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 service was last inspected on 2 March 2016. At that inspection we found breaches of regulations. This was because some people’s risk assessments had not been updated to reflect a change in a person’s health needs. The environment had not been maintained by not improving paintwork where equipment had damaged walls and doors. Some bathrooms were too small to accommodate equipment for people who required it. Restrictions of movement had not been responded to, to meet the requirements of the Mental Capacity Act 2005. Systems to assess and monitor the quality of the service provided to people were not effective. Risks associated with the environment and equipment had not been assessed, or action taken to mitigate risk. There was a lack of clear leadership within the service. The service did not actively seek the views of people about their experience of using the service. Following the inspection the service provided the commission with an action plan telling us what actions they were taking to meet the regulations. At this inspection we found improvements had been made in these areas and the service was now meeting the relevant requirements.

The Bungalow is a respite service that provides care and support for guests who have learning and/or physical disabilities and other complex needs. The Bungalow can accommodate up to a maximum of 10 guests. The length of stay varied depending on their individual requirements. On the day of our inspection there were two people using the service and following our visit we spoke with a number of relatives about the care provided. The service is owned and operated by Cornwall Council.

Staff referred to people using the service as guests throughout the inspection. This term will be used throughout the report to represent people using the service.

The manager was currently going through the process of registration 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.

The feedback we received from families about the service was very positive and they told us that their relatives looked forward to their stays and staff were very caring. Relatives were confident in the skills, experience and abilities of the staff who supported their family members. They said, I don’t know where we would be without this service. Very good all round” and “Staff very competent.” There were systems in place to protect people from potential harm. Staff were clear about the reporting mechanisms and were confident that concerns would be taken seriously.

The service had reviewed and developed how risks were identified and managed. The records provided guidance for staff in how guests should be supported to reach their individual potential. This included the level of independence and control over their lives while promoting their safety, comfort and wellbeing. For example, supporting someone to cook, bake and use the kitchen appliances with support.

Staff training had been developed since the previous inspection to ensure training which required updates was taking place. Staff were trained in a range of subjects which were relevant to the needs of the people they supported. New employees undertook a structured induction programme which prepared them well for their role.

There were clear procedures in place to ensure that staff who were recruited had been subject to checks and were suitable for the role. Staffing was organised to meet people’s needs and ensure continuity of care. Due to the nature of the service staffing levels fluctuated in accordance with the numbers and needs of guests using the service.

Staff who had responsibility for the administration of medication had completed appropriate training. Medicines were administered safely by staff and the arrangements for storage and recording were satisfactory.

People were supported to make decisions and their rights were protected in line with relevant legislation and guidance. People were supported to access healthcare services. Records included advice and guidance from healthcare professionals. This was incorporated into care plans to ensure that staff provided effective care and support. People’s nutritional needs were met; their likes, dislikes and special diets were known by staff and were catered for.

The Bungalow had developed systems since the previous inspection to take account of the views of the service. A survey was due to be distributed to family and friends. However, there was no additional format for guests using the service which would support them to understand what the questions meant, in a way which was meaningful for them. We shared this at the time with the manager who agreed to address the issue immediately. The manager showed us a format which they were considering adapting. It would support guests to make their own comments either independently or with staff support. Relatives told us they felt their comments were listened to and acted upon. One relative told us, “They (staff) keep us up to date with what’s going on.”

The environment and equipment used were regularly checked and well maintained to keep people safe.

The Bungalow is a respite service that provides care and support for people who have a learning disabilities and other complex needs. The Bungalow can accommodate up to a maximum of 10 people, although due to the nature of the service this fluctuates on a daily basis. The service is owned and operated by Cornwall Council.

The service is required to have a registered manager and at the time of the inspection visit a registered manager was in post. However, the registered manager was also registered for another service and was not always working at The Bungalow. A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run. In November 2015 a deputy manager had been appointed to manage the day-to-day running of the service with overview from the registered manager.

People using the service had a range of learning, sensory and physical disabilities and there were a range of aids and adaptations in place which met those needs. Rooms and lounge areas incorporated a range of seating and equipment to support people with physical disabilities. However a bath and shower room could not be used for people with specific mobility needs as there was not enough room to accommodate the necessary equipment.

A concern had been raised at a staff meeting in November 2015 about the regulation of water temperature when using showers. Shower heads now had temperature monitors which alerted staff when they rose above a safe level.

All care plans were being reviewed and updated. However, two of the four care plans we looked at contained the previous provider’s information. In those files there was no evidence of reviews taking place from January 2015 to November 2015. Since then where reviews had taken place not all the information had been added to the care plan review section. Staff told us it had been a difficult twelve months when there had been specific staffing problems resulting in agency staff being used to support the core staff team. Comments from staff included, “It has been a really difficult time. We have just got on with the job of supporting guests” and “It has calmed down a lot since Christmas because we have got the staffing right”.

Where staff had been recruited there was limited information to show if they had had the necessary safety checks to work in the service. The deputy manager had requested the information from Cornwall Councils Human Resource department. It was confirmed all checks were in place but evidence of this had not yet been sent to the service.

The general maintenance of the building since registration in January 2015 had been limited. Woodwork was damaged and chipped throughout the service due to the use of equipment to support people. Paintwork was damaged in some of the rooms. Furniture did no match in most rooms.

Where people required specific equipment to support them, for example track hoists and bathing facilities they used the same rooms when using the respite service. A relative said, “(Persons name) likes a certain room and staff try and make sure they get that room when they stay”. People brought their own personal items to make their rooms more familiar to them.

The service complaints procedure had been made available to relatives. One relative told us “I have the information and would know who to speak with. I have never had to make a complaint but think I am confident they would listen. A document called ‘Have Your Say’ was available to support people with learning disabilities to raise a complaint, make a comment or compliment. However, the format was kept in an office file and not made available to people using the service.

There were enough staff working in the service to safely support people at the time of the inspection visit.

People were protected from the risk of abuse because staff had a good understanding of what might constitute abuse and how to report it. Staff told us they were confident that any allegations would be fully investigated and action would be taken to make sure people were safe

There were suitable storage facilities to make sure medicines were stored safely. Medicines were signed in and out for each short stay at the service. Records were accurate and audited following each stay.

On the day of the inspection visit there were no guests using the service during the day. Five people arrived later in the afternoon. Staff were on duty and ready to support people. People engaged in a number of activities with staff who clearly understood people’s individual routines.

Staff were trained in a range of subjects which were relevant to the needs of the people they supported. New employees undertook a structured induction programme which prepared them for their role. The staff team were supported by the deputy manager through daily communication. A formal supervision programme was in place to support staff personally in their learning and personal development.

We identified a breach of the regulations. You can see what action we have told the provider to take at the back of the full version of the report.