Archived: Boldshaves Oast

We observed how people spent their time and their interactions with staff. We also spoke with the Chief Executive Officer, the registered manager, three staff and one person during our inspection. We reviewed care plans and other records relating to the management of the service.

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

Is the service safe?

People felt they were safe living at Boldshaves Oast. Staff had received training and understood how to recognise abuse. Staff were aware of how to report abuse if they suspected it had taken place. There was evidence that staff had been given detailed information about external agencies, such as the local authority, which could provide further guidance and information.

We reviewed five care plans and found that they all contained risk assessments, which provided detailed information on how to minimise risks and hazards to the person. For example, how to safely care for a person who was epileptic, if the person had a seizure whilst in a car.

There was an effective system to manage accident and incidents and learn from them, so they were less likely to happen again. This reduced the risks to people and helped the service to continually improve.

We found a policy covering the arrangements for the management of people's medicines, although there were some areas which needed more clarification for staff.

Is the service effective?

We observed care being given to people, and found that interactions between staff and people at the home were positive. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well.

People's needs were assessed by the service. Care plans were in place for each person, which detailed people's wishes and preferences. We noted that care plans included information on the person's cognition and ability to make decisions. We found that each person had an annual review, and this included information on the person's ability to make decisions independently.

People had access to a variety of health care professionals to help make sure their health care needs were met.

There were no Deprivation of Liberty Safeguards authorisations in place, and no applications had been made. Staff understood the importance of supporting people to make their own decisions, and also demonstrated an awareness of when a formal assessment of a person's mental capacity might be required.

Is the service caring?

We saw that staff were kind and patient with people at the service. For example, we observed one staff member supporting a person at lunchtime, and noted that the staff member waited until the person was ready before offering the next mouthful, and explained what the food was. We saw that staff knocked on people's doors and waited for a response before entering.

We saw good interactions between staff and people who lived at Boldshaves Oast. People were treated with dignity and had their privacy respected. Staff demonstrated a caring approach when discussing people that used the service during the inspection.

Is the service responsive?

Staff were responsive to people's needs. We saw and heard during the inspection that some people were able to make their views known about what they wanted in relation to their day to day care and support. We saw that staff respected these wishes. People had annual review meetings with staff, their relatives and their care manager to discuss their future. The complaints procedure was written in easy read format, and clearly displayed.

Is the service well-led?

There was a clear management structure in place, although this had gone through several changes over the last few months, which had been unsettling for people that used the service.

Staff knew their roles and responsibilities. Staff had an understanding of the ethos of the service and quality assurance processes were in place. The registered manager was approachable and was present in the service during the inspection. Staff told us that the registered manager was easy to talk to.

Where investigations had been required, for example, in response to accidents and incidents, the service had completed an investigation. This included what actions needed to be taken so that risks to people of future occurrences were minimised.

At the time of this inspection there were 14 people accommodated at Boldshaves Oast. We spoke with five people who used the service. We observed how people spent their time and their interactions with staff. We also spoke with the Chief Executive Officer, the manager, six staff and a visiting therapist during our inspection. We reviewed care plans and other records relating to the management of the service. We later telephoned three relatives to gain their feedback about the service provided.

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

Is the service safe?

People and their relatives all felt people were safe living at Boldshaves Oast.

Staff had received training and understood how to recognise abuse. However guidance about reporting such incidents was lacking and a recent incident had not been reported in a timely manner to outside agencies, such as the local authority.

Some risks assessments did not contain sufficient guidance to ensure staff took a consistent approach and people remained safe. For example, when a person had a seizure.

There was an effective system to manage accident and incidents and learn from them, so they were less likely to happen again. This reduced the risks to people and helped the service to continually improve.

We found shortfalls in the management of people's medicines.

Is the service effective?

People and relatives told us they were happy with the care and support people received. People said they liked living at Boldshaves Oast. People felt their needs were met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well.

People's needs were assessed by the service. Care plans were in place for each person, which detailed people's wishes and preferences. However care plans lacked detail about some areas of people's care and support. For example, the Makaton signs (sign language) that people understood, so that staff could communicate effectively with people.

People had access to a variety of health care professionals to help make sure their health care needs were met.

There were no Deprivation of Liberty Safeguards authorisations in place, and no applications had been made. Staff understood the importance of supporting people to make their own decisions, but lacked the knowledge to link practice to the legislation, such as identifying when a formal assessment of a person's mental capacity might be required. For example, when restrictions, such as monitors and door alarms were in place.

People and relatives said the food was 'good' and people had an adequate, varied and wholesome diet. We saw that healthcare professionals had been involved in nutritional assessments and clear guidance about how to meet people's nutritional needs were recorded in their care plan.

Is the service caring?

People told us 'the staff are nice and kind'. One relative said, 'The staff are brilliant'. Another said, 'It is very good and very caring'. People and relatives felt people's privacy and dignity was always respected.

During the inspection we saw that staff adopted a kind and patient approach when dealing with people. Staff were patient when supporting a people. We saw good interactions between staff and people who lived at Boldshaves Oast.

People were treated with dignity and had their privacy respected. Staff demonstrated a kind and caring approach when discussing people that used the service during the inspection.

Is the service responsive?

Staff were responsive to people's needs. People told us who they would speak to if they had any worries. We saw and heard during the inspection that some people were able to make their views known about what they wanted in relation to their day to day care and support. We saw that staff respected these wishes. People had annual review meetings with staff, their relatives and their care manager to discuss their future.

People told us that there were opportunities to offer their views and feedback, such as the regular Sunday meetings. People and relatives told us they felt comfortable complaining and if they did have any concerns, these would be sorted out. The complaints procedure was in need of review and was not in a format that people who used the service would find easy to understand.

People were happy with the range of activities that were available. We saw that people were busy with a wide range of activities within the service, but they were also very involved in the local community.

Is the service well-led?

Relatives felt the service was well-led. There was a clear management structure in place, although this had gone through several changes over the last few months, which had been unsettling for people that used the service.

Staff knew their roles and responsibilities. Staff had an understanding of the ethos of the service and quality assurance processes were in place. Staff received supervision although this had not been in line with timescales within the services policy. People felt that communication and accessibility of the manager was good. The manager had recently submitted an application to the Commission to become the registered manager.

Where investigations had been required, for example, in response to accidents and incidents, the service had completed an investigation. This included what actions needed to be taken so that risks to people of future occurrences were minimised.

We saw that staff were able to demonstrate what action they would take in response to a potential safeguarding concern and there was written information available for staff to be able to reference about safeguarding matters.

There were effective systems in place to obtain consent from people around matters relating to their care. Where people were unable to provide consent, procedures were followed to ensure their welfare and uphold their rights.

People had their care and welfare needs met. People participated in activities they enjoyed, had their health needs met and their care was reviewed regularly.

We saw there were enough staff on duty to meet the needs of people at the service and there were systems in place to support staff to be able to undertake their role safely and effectively. One staff member told us the staff all work 'collectively as a team'.

There were systems in place to monitor and review service delivery and to regularly maintain the safety of the premises.

We saw that people's independence was promoted, there were two married couples living in log cabins in the grounds of the service. They were supported by staff.

A relative told us 'it is such a magical and special place, the staff are dedicated and compassionate and simply love it there.' They added that the staff 'go the extra mile'. Another relative told us that a staff member was coming in early on Christmas day to share Christmas with the people who lived at the service. 'It is like the Walton's, they all care about each other and there are different generations living under one roof'. They added that the service 'has a fantastic ethos which hasn't waned'. Another relative told us their relative was 'loved' by staff at the service, it was 'home from home', 'it is fantastic'. A staff member told us 'it is an amazing place'.

A professional who provided support to people living at the service told us the staff they had spoken with had been enthusiastic about the guidance they were adopting. They noted that people also attended the training they delivered to staff about sign language and how integrated the people and staff were.

We saw there were systems in place to monitor service delivery, to monitor staff development and provide support to staff.