Hellesdon Bungalows

Hellesdon Bungalows is a residential care home providing personal care to up to 8 people with learning disabilities and/or autistic people. At the time of our inspection there were 7 people using the service. Hellesdon Bungalows is a purpose built bungalow with accommodation on one level with some communal areas.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and 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 supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. Although records and staff practice promoted people’s independence with routine tasks, improvements were needed to ensure people’s rights were fully protected.

Right Care: Staff received training, although some further training was needed in some areas. People’s healthcare needs were mostly well managed and staff administered medicines safely. There were enough staff to meet people’s needs.

Right Culture: Staff provided care and support in a person centred way. Relationships between staff and people who used the service were good and people told us they felt comfortable with the staff. People who used the service accessed the local community and were able to follow their own interests and hobbies and maintain relationships

The provider had recognised the staff team and manager required ongoing training and development to help drive the service forward to make the improvements needed. Despite this, some aspects of the service required improvement and better oversight. Audits and systems designed to monitor the culture and performance of the service were not robust. This was the second inspection in a row identifying similar concerns in some areas and repeated breaches of the same regulations. This meant we did not have confidence in the provider to improve.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 11 August 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, although we found some improvements, the provider remained in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last 2 consecutive inspections.

Why we inspected

We carried out an unannounced inspection of this service on 18 May and 6 June 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, safeguarding, governance and staffing.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains Requires Improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Hellesdon Bungalows is a residential care home providing accommodation and personal care to up to eight people with a learning disability or autistic spectrum disorder. The service was located in two adjacent bungalows similar to those in the surrounding residential area. It was registered for the support of up to eight people. At the time of inspection four people were living in one bungalow and three people were living in the other bungalow. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home.

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

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 statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of Safe, Responsive and Well led the service was not always able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. People’s choice was not always maximised due to misunderstanding of government COVID-19 guidance. This had meant that one person had not been allowed to go out unaccompanied when the guidance allowed them to. This had left them feeling frustrated and sad about not being able to be independent and feeling restricted. The staffing numbers on some days (usually weekends) also had meant that people were restricted to staying in the bungalows or all going out together to a place where it would be safe for just one member of staff to accompany them. This limited their choices of what activities or trips out they could experience. The nominated individual stated that they would be increasing the staffing levels to ensure people had more choice.

Some aspects of the service were not always safe. Staff had not always been assessed as competent before administering medication. Improvements were needed to the infection, prevention and control measures to ensure that all staff were following the latest government guidance in relation to COVID-19.

In the absence of a registered manager there had been lack of provider oversight. This had meant that areas for improvement had not always been identified or action taken in a timely manner. The local authority had placed a restriction on placing new people at the home until improvements were made.

Risk assessments were in place so that staff knew what action to take to minimise risks to people. The medication records were audited daily to identify any discrepancies or errors.

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 (report published 24 January 2020.)

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about infection prevention and control and staffing levels. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with people receiving person centred care, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe, responsive and well-led.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the administration of medication, preventing and controlling infection, staffing levels and governance of the service.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Hellesdon Bungalows is a residential care home providing accommodation and personal care to people with a learning disability or autistic spectrum disorder. 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.

The service was located in two adjacent bungalows similar to those in the surrounding residential area. It was registered for the support of up to eight people. At the time of inspection four people were living in each property. 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. This helps people to feel they are living in their own homes.

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

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 felt safe in the service. There were individual risk assessments for people to help staff manage risks while promoting independence. If things went wrong, incidents were recorded, and action taken. There were enough staff to meet people’s needs although there had been some pressures on staffing recently due to staff vacancies and changes in people’s needs.

People’s needs were holistically assessed. People were supported by staff who were competent and well trained. Staff supported people to be maintain a healthy diet. The service worked pro-actively with other professionals to maintain people’s health and wellbeing. 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 had developed strong positive relationships with people and knew them well. People felt comfortable with the staff and told us they were kind and caring. People were involved in making decisions about their care and empowered to be as independent as possible. Staff were mindful of people’s privacy and promoted respect and dignity.

The service was responsive to people’s needs. Care plans promoted the development of independence in stages. Staff adapted their methods of communication according to people’s needs. People were supported to be a part of the local community and to take part activities and hobbies they enjoyed. We have made a recommendation about end of life care.

There was a positive person-centred culture in the service. Managers were approachable, and people and relatives felt they listened and acted on their concerns. People, their relatives and staff were involved in the running of the service through regular meetings and daily conversations. There were robust systems in place for monitoring the quality of care. The service worked constructively with partners to promote positive outcomes for people and enable them to be active in the local community.

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 28 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hellesdon Bungalows 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.

There was a registered manager in post. 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 Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and report on what we find. Staff and the management team understood the MCA and DoLS and its impact on the support they provided. The service was not fully ensuring they were acting in accordance with the MCA as people’s capacity and best interest decisions were not being formally assessed. We have made a recommendation that the provider reviews this legislation and associated guidance to ensure they are acting in full accordance with the MCA. Staff had a good understanding of the MCA and how to support people to make decisions.

People were safe living in the home. The service took a positive approach to risks and risks to people were identified and managed. Staff demonstrated an awareness of adult safeguarding and knew how to report concerns. Incidents and accidents were reported and the registered manager analysed these in order to identify any patterns and ensure actions had been taken in response.

There was enough staff to meet people’s needs. Some staff raised concerns about the use of agency staff in the service however the provider had taken action to minimise the impact of using agency staff as much as possible.

Medicines were managed and stored safely. There was guidance in place so staff knew how to administer medicines. Regular audits were taken on medicines to check and ensure they were managed safely.

People were supported to maintain their health, this included supporting people to eat healthily and address nutritional risks. Staff ensured people received the health care they required.

Staff were supported to provide effective care through training, good team work, and supportive management.

People were supported by staff who cared for them and treated them respectfully. Staff supported people to discuss their views on the support provided. Some people using the service had complex communication needs. Staff understood people’s individual gestures and how they communicated so people were able to express themselves. People were supported to be as independent as possible.

Staff ensured they knew people’s individual preferences and needs. Support was provided in a way that met these. People were supported to access activities and maintain their personal interests and hobbies.

Care plans contained sufficient guidance for staff. They were accurate and up-to-date.

Relatives felt able to raise concerns. They felt confident that action would be taken to resolve any concerns they raised.

There was an inclusive culture in the home. Staff were positive about working in the service and felt supported. Relatives and staff were positive about the management team and the way the service was managed. There were quality monitoring processes in place to help monitor and identity issues that might affect the quality of the service provided.

Hellesdon Bungalows provides accommodation and support with personal care for up to eight adults with a learning disability who may also have autism. At the time of our visits there were five people living in the home.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run.

The service people received was not consistently safe. Action to minimise risk was not always taken and so compromised people's safety. Medicines were generally given as the prescriber intended. However, there were minor shortfalls that audit systems for checking for omissions had not always picked up.

People were supported by enough staff to meet people’s needs safely. They were properly recruited to make sure they were suitable to work in care services. Staff understood the importance of reporting concerns about people's safety and welfare. They had access to training to enable them to support people competently and effectively but there were gaps in this. However, pending formal training, staff were supported by more experienced colleagues to gain the skills they needed. More staff had been recruited and were undergoing induction so that people would be able to receive support from a consistent, permanent staff team.

Staff and the management team were aware of the importance of supporting people to make their own decisions. The management team had sought professional advice in determining whether people understood the implications of decisions. They were aware of the need to ensure that people's best interests were taken into account and, where appropriate, had involved an advocate to support the person.

There had been some difficulties in ensuring the staff team always and consistently implemented professional advice to promote people's health. However, where complex health needs warranted it, staff implemented additional checks on people’s wellbeing. This contributed to them being aware at an early stage of any changes in health requiring intervention or professional advice.

Staff understood people's needs and preferences and delivered support which took these into account. They had developed good relationships with people using the service and promoted their dignity and respect. Where there were concerns about staff conduct, the provider had systems in place to ensure they were addressed and monitored if necessary.

The registered manager for Hellesdon Bungalows was also registered in respect of another of the provider's services as well as fulfilling the role of operations director. This meant that they were overseeing quality and safety issues, management performance and staff practice within nine services in total. During 2015 a replacement manager had been appointed at this service but had subsequently left. The registered manager's ability to oversee the service on a day-to-day basis was compromised due to the additional responsibilities. Significant difficulties with performance, teamwork and attitude had developed, adversely affecting staff morale. Quality assurance systems were not being implemented consistently to ensure that improvements were made promptly.

The provider was aware of the issues and had appointed an acting manager who was able to spend more time within the service and help to promote improvements. It was that person's intention to apply to CQC for registration in due course. Staff saw more regular management presence within the home as supportive. It also contributed to addressing concerns about lack of management 'on the ground' that were raised with us in feedback from professionals. However, arrangements had not had time to stabilise and ensure that the range of improvements needed were made and sustained.

This is a summary of what we found:-

Is the service safe?

People told us they liked the staff. We saw that people had no reluctance in approaching staff to ask questions or just to chat. This indicated that they did not feel anxious or uncomfortable in the presence of staff.

The home had information for staff about where to seek guidance in case someone's freedom was being restricted to keep them safe. This included how to contact and seek advice from the 'supervisory body' in case any applications under the Deprivation of Liberty Safeguards should be considered.

Systems were in place to make sure that the safety of the service was checked regularly. This included checks on how medicines were managed. There was guidance for staff about cleaning and infection control and checks made that tasks were completed properly. This reduced the risks to people and helped the service to improve.

Is the service effective?

People living in the home had regular residents' meetings where they could raise concerns or suggestions with staff support. Staff meetings reflected how people could be supported to do as much as they could for themselves and join in the running of their home. People joined in getting their meal ready, setting the table, clearing away or washing up for example.

Staff knew how to communicate with people and people could make themselves understood.

People’s health and care needs were assessed and, as far as practicable, they were involved in developing their plans of care. Information was presented in pictures and simple language to help with this.

We were able to see that people were supported in the way their plans said was necessary. Staff were able to tell us about people's preferences, support needs and health.

Is the service caring?

Staff spoke respectfully to people and there was a lot of laughter between staff and people living in the home. People who had other difficulties in addition to a learning disability were treated inclusively and encouraged to take part in activities and routines inside and outside the home.

People using the service and their relatives had the opportunity to complete a survey so that the manager could see if anything needed to improve.

Is the service responsive?

People joined in activities inside and outside their home regularly if they wanted to. One person had been shopping for clothes and showed staff what they had bought. Two people had bought books during the morning, which reflected their interests. People had planned holidays and were looking forward to these. One said, “I’m going to Blackpool.” They were hoping to go up the tower. Another told us, “We’re going to a big cottage in Bury St Edmunds.”

A group of people were intending to visit the pub during the evening of our visit. One person showed us around the garden, which they enjoyed helping to keep tidy with staff support.

A staff member was able to tell us how someone's needs had changed and how they fluctuated. Staff took this into account when they were supporting the person or planning any activities with them. Where people's health changed, staff sought appropriate advice promptly.

Is the service well-led?

The service had regular checks to make sure things were happening as they should and that the service was safe. Where necessary, improvements were identified and prioritised for following up.

Staff had a clear understanding of the needs of people living in the home. This helped to ensure that people received a good quality service at all times. They had opportunities for training, for staff meetings and for supervision and appraisal. This helped ensure staff were competent and worked consistently to meet people’s needs.

If you wish to see the evidence supporting our summary please read the full report.

People had their needs assessed and plans of care were drawn up showing how their needs were to be met. Staff spoken with understood how people's needs were to be met, as well as being aware of their social and recreational interests, contact with family and likes and dislikes. We saw that people were asked about the sorts of activities they would like to do during the forthcoming week so that these could be accommodated where possible. However, in one case we found that a person's care plan was out of date and if relied upon by new, inexperienced or agency staff as guidance for delivering care, the person would not be safe. We also saw that one person did not receive the required level of supervision to ensure their safety when they were eating and drinking.

People had a choice of what they ate and drank and their suggestions were incorporated into menu plans. They told us that the staff were good cooks and everyone had enjoyed their evening meal.

Staff supported people with their medicines. They had access to training to ensure they knew how to do this safely. However, systems for recording medicines were insufficiently robust to make sure records were always completed when medicines were given and to show who had given them. Medicines in use were appropriately stored but the home had not made any arrangements for controlled drugs should these be prescribed at any point.

We found that people were given regular opportunities to express any concerns or complaints they had about the service, so that these could be followed up if necessary.

One person we spoke with told us that they enjoyed gardening and feeding the birds. During our visit we saw this person setting up a new bird feeding station in the garden. This person also told us that they could talk to the staff if they had any problems or were bothered about anything.

Two people showed us their individual rooms, which they said they were happy with. A third person, who was spending time singing along to music in their room, told us they were happy and that they had everything they needed.

When asked if there was anything they would like to change to further improve people's lives in the home, staff responded that they would like to develop the garden, with raised flower beds and have the kitchen work surfaces adapted to better accommodate people who used wheelchairs.

A member of staff told us that people were regularly asked if there were any improvements or changes that they would like. They also explained that support was given to help people make informed choices, such as using colour charts or carpet samples when considering any redecoration of the home.