We carried out a review of the data available to us about Bull Point House & Annex on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Bull Point House & Annex, you can give feedback on this service.
Bull Point House & Annex (hereafter referred to as Bull Point House) is a residential care home providing personal and nursing care to five younger adults at the time of the inspection. The service can support up to five people. Bull Point House is a detached property in its own grounds set over two floors with views over the Tamar river. There is a separate self-contained building called “the annex” that has ground floor accommodation for one person in close proximity to the main building.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.
People’s experience of using this service and what we found
People were supported by exceptionally kind and caring staff. Staff went out of their way to ensure people were happy and could recognise their own goals and start to take steps towards achieving them. People were treated with dignity and respect by staff who were supported to reflect on their practice.
People had choices about what they did in a day, what they ate, and who supported them. People’s living skills were developed, and we saw clear evidence of the service encouraging people to become more independent. People were involved in the day to day running of the service, helping with cooking, shopping, admin tasks and environmental checks.
There were enough staff to meet people’s needs. Staff were recruited safely and given bespoke training, so they could develop the skills to meet people’s unique needs. Medicines were managed safely. Risks were assessed and reviewed regularly by staff who knew people well.
The service linked in with key health professionals to ensure people’s needs were being met. There was a positive behavioural support approach where interactions and behaviours were recorded and observed closely to look for themes and trends.
The service adapted the property around people to meet their individual needs. People’s rooms were highly personalised and comfortable. People enjoyed the food and could choose what they wanted to eat.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff understood consent and asked people how they would like support.
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.
The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent. People went out when they wished to and took part in individual and community activities.
The service was well-led, by a management team that were respected and invested their time effort and resources of the provider into creating a balanced, happy life for the people living in the service. Staff told us they felt supported and the ethos of the service was person-focussed and open.
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 23 June 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.
Some of the people who lived in the home had limited communication and used other methods of communication, for example pictures. We therefore used these and observations to understand people.
At the last inspection, the service was rated Good.
At this inspection we found the service remained Good.
Why the service is rated good:
People remained safe at the service. There were sufficient staff available to meet people's needs and support them with activities and trips out. Risk assessments had been completed to enable people to retain their independence and receive care with minimum risk to themselves or others. This is particularly important for people who may challenge others. People received their medicines safely.
The Provider Information Return (PIR) recorded; “Each individual has a Positive Behaviour Support Plan which is compiled on an individual basis, looking at behaviours specific to that individual, what their triggers are, signs for staff to look out for in advance and what staff can do at each level to either prevent the individual from escalating further, or how to keep the individual and those around them safe.”
People continued to receive care from staff who had the skills and knowledge required to effectively support them. Staff were competent and well trained. People had the support needed to have maximum choice and control of their lives. Staff supported people in the least restrictive way possible; the policies and systems in the service supported this practice. People's healthcare needs were monitored by the staff and people had access to a variety of healthcare professionals according to their individual needs.
The staff were very caring and people had built strong relationships with the staff. We observed staff being patient and kind. People's privacy was respected. People where possible, or their representatives, were involved in decisions about the care and support people received.
The service remained responsive to people's individual needs and provided personalised care and support. People were able to make choices as much as possible in their day to day lives. Complaints were fully investigated and responded to. People were supported to take part in a wide range of activities and trips out according to their individual interests.
The service continued to be well led. Staff told us the registered manager was approachable. The registered manager and provider sought people's views to make sure people were at the heart of any changes within the home. The registered manager and provider had monitoring systems which enabled them to identify good practices and areas of improvement.
Further information is in the detailed findings below
The inspection took place on 27 February 2015 and was unannounced. Bull Point House and Annex provides care and accommodation for up to five people with learning disabilities who each have their own self-contained living accommodation within the home. On the day of our visit four people were living in the service.
The service had a registered manager. 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 visited each person during the inspection. We observed people and staff were relaxed in each other’s company and there was a calm atmosphere. When asked, people said; “yes - staff are kind.” Some of the people who lived in the service were not able to fully verbalise their views so people used other methods of communication, for example signs, symbols and pictures to aid communication and make choices. People told us they liked living in the home. One person was able to say they spoke with to the registered manager and staff and were happy to talk to them about any concerns. Staff had the knowledge of the various communication aids used by people to support them effectively.
Staff had undertaken training on safeguarding adults from abuse, they displayed good knowledge on how to report any concerns and described what action they would take to protect people against harm. Staff felt confident any incidents or allegations would be fully investigated.
People’s medicines were managed safely. People received their medicines as prescribed and received them on time. Staff were appropriately trained and understood what the medicines were for. They understood the importance of safe administration and management of medicines. People were supported to maintain good health through regular access to healthcare professionals, such as GPs, consultant psychiatrists and social workers. People were also supported by Modus’s positive behavioural support team.
When people were asked about the care and support they received, they responded positively. People responded with a “yes” or “no” to questions asked or indicated with a smile that they were happy with the staff support. Care records were comprehensive and personalised to meet each person’s needs. Staff understood people’s individual needs and responded quickly when a person required assistance. People were involved as much as possible with their care records to say how they liked to be supported. People were offered choice and their preferences were respected.
People living in the service could be at high risk due to their individual needs and each person had two to one staff support. People’s risks were well managed and they were monitored at all times to help ensure they remained safe. People lived full and active lives and were supported to sample a wide range of activities. Activities were discussed and planned with people’s interests in mind.
People enjoyed the meals and they had access to snacks and drinks at all times. People were involved in planning menus and were able to say if meals were not to their liking.
People did not all have the capacity to make decisions for themselves, therefore staff made sure people had their legal rights protected and worked with others in their best interest. People’s safety and liberty were promoted.
Staff said the registered manager and management of the company were supportive and approachable. Staff talked positively about their roles. Comments included; “They (Modus management and registered manager) always put people first.”
People were protected by safe recruitment procedures. There were sufficient numbers of staff on duty to support people safely and ensure everyone had opportunities to take part in a variety of activities inside and outside of the home. Staff received a comprehensive induction programme. Staff had completed appropriate training and had the right skills and knowledge to meet people’s needs.
People had access to healthcare professionals to make sure they received appropriate care and treatment to meet their health care needs such as Psychiatrists and GPs. Staff acted on the information given to them by professionals to ensure people received the care they needed to remain safe.
There were effective quality assurance systems in place. Any significant events were appropriately recorded and analysed. Evaluations of incidents were used to help make improvements and ensure positive progress was made in the delivery of care and support provided by the home. People met with staff on a one to one base and were able to raise concerns. Feedback was sought from people living in the home, relatives, professionals and staff.
We met most of the people who used the service and were able to speak with two people about the care they received. We checked the provider's records. We spoke to staff about the care given, looked at the care records of two people using the service. We looked at other records and observed staff working with them. We were able to discuss the care provided with two professionals. One professional said, 'Best service I have ever seen for people with complex needs'.
We saw and heard staff speak to people in a way that demonstrated a good understanding of people's choices and preferences. We saw that the staff had a good understanding of people's individual needs and that they were kind and respectful. Staff introduced us and supported people to meet with us.
The staff demonstrated they had a good understanding of what kinds of things might constitute abuse, and knew where they should go to report any suspicions they may have.
During our visit to the home we saw sufficient staff on duty to meet the needs of people living in the home.
We saw that people's care records described their needs and how those needs were met. We saw records that showed that best interest meetings had been held and people's mental capacity to make decisions had been assessed.
All the people living in the home require a high number of staff to meet their needs; some people have two to one staffing at all times. We saw that staff treated people with consideration and respect. For example, we saw that staff responded to people's needs to ensure that they were kept safe and informed about what was happening such as asking people if they wished to speak with us.
Care plans that we saw reflected people's health and social care needs and demonstrated that other health and social care professionals were involved. We spoke with staff about their understanding of what constituted abuse and how to raise concerns. They demonstrated a good understanding of what kinds of things might constitute abuse, and knew where they should go to report any suspicions they may have.
We saw and heard staff speak to people in a way that demonstrated a good understanding of people's choices and preferences. We looked in detail at the care three people received. We spoke to staff about the care given, looked at records related to these three people, met with them, and observed staff working with them.
One person said, 'The best home I have ever stayed in'.