You are here

Merle Boddy House Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 22 September 2018

The inspection took place on 23 July 2018 and was unannounced. The last inspection to this service was 21 July 2017. The service was rated ‘requires improvement’ in three key questions we inspect against: Safe, Effective and Well led. There were two breaches of regulation; one for clinical oversight and governance and the other regarding the recruitment of new staff. Following this inspection, the provider sent us an action plan stating how they had addressed our concerns. At the inspection on the 23 July 2018 we found the service had significantly improved but there was still a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014. We found concerns about the premises and unassessed risk. Care records were poorly organised in terms of accessibility to help ensure people received consistently safe care. This meant we had concerns about the oversight and clinical governance as these concerns had not been identified by the service.

Merle Boddy House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service can accommodate up to ten people who have a learning disability. Accommodation was spacious and provided easy access to Norwich. Everyone had their own bedroom and generous communal space.

The care service had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy

There was a registered manager in place 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.

In summary we found, since the last inspection to this service the manager had become registered having only been in post a couple of weeks at the last inspection.

They had made efforts to change the environment and this was generally suited to people’s assessed needs. However, we identified several potential risks posed both by the environment but also from the lack of assessment and planning around individual risks.

We found records were not sufficiently robust in illustrating changes to people’s needs or how these were being addressed. Staff were familiar with people’s needs so this lessoned the risk of people not getting their needs met. However, there was still a risk in staff not being fully aware of changes to the persons plan of care or treatment because this was not accurately reflected in the records.

The above gave us concerns about the oversight of the service and how robust the quality assurance systems were in identifying concerns.

We found them to be open, friendly and knowledgeable. They told us the ethos of the service had been poor and people did not have sufficient opportunity to develop their skills and confidence through increased participation in the community. They had worked hard to change the culture of the service and help each person develop and grow. This had meant changing the staffing culture through regular support, challenge and providing the necessary training to develop staff. In addition, they had asked for support from the trustees to change the way they worked and to have a more hands on approach.

There were systems in place to help ensure the environment and equipment on the premises was in good order and staff were trained to act in an emergency, including fire evacuation.

Staff understood

Inspection areas

Safe

Requires improvement

Updated 22 September 2018

The service was mostly safe.

The service had several risks identified on the day both in relation to the immediate environment and risks associated with people’s care. These had not been identified by the service.

There were sufficient staff to meet the needs of people using the service.

Risks were mostly assessed and mitigated. The environment was mostly fit for purpose and clean.

Medicines were administered as intended by staff qualified to do so.

Staff understood what constituted abuse and how to protect people from it.

Effective

Good

Updated 22 September 2018

The service was effective.

Staff kept their knowledge and practices up to date. They received a good induction and regular training and support for their role.

People were supported to eat and drink sufficient for their needs and this was monitored by staff. People were supported to have their needs met in regard to their health care needs and long-term conditions like epilepsy. This was not always adequately supported by care records.

The environment was spacious, well maintained and mostly fit for purpose.

People had choices and decided about their care and treatment. Whilst staff recognised the importance of choice they also understood people might need support to make more complex decisions and understood how to support people lawfully.

Caring

Good

Updated 22 September 2018

The service was caring.

Staff knew people’s needs well and responded to them in a timely way.

Staffs interactions were appropriate and they supported people’s emotional well -being and upheld their dignity and privacy.

Staff encouraged people to retain their independence and do what they could for themselves.

People were involved in their day to day care and wider decisions about their environment and how they wished to spend their time

Responsive

Requires improvement

Updated 22 September 2018

The service was not fully responsive.

We found staff had sufficient knowledge of people’s needs and their likes, dislikes and routines. Care records did not always give a complete picture of the persons assessed needs and gaps in records exposed people to unnecessary risk of receiving the wrong care or treatment.

People had opportunities to go out and pursue things that interested them.

The service supported people for as long as it was appropriate to do so and this included end of life. Care records did not reflect people’s preferences regarding end of life care.

Well-led

Requires improvement

Updated 22 September 2018

The service was not always well led. A lot had been achieved by the current registered manager and the service was moving in the right direction.

There were systems in place to identify the quality of the service and to identify any improvements necessary in terms of health and safety, the environment and the care. We identified some gaps in this process so could not be assured the systems in place to measure the quality and safety of the service were fully effective.

The service was run in the interest of people using it and care and support was provided by motivated, cheerful staff.