We carried out a review of the data available to us about Garden House 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 Garden House, you can give feedback on this service.
There were aspects of the service that did not meet the principles and values of Registering the Right Support and other best practice guidance. These help to 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 service had strong community links and supported people to have choice and control in some areas of their lives. However, the premises and how they were organised did not promote the development of independent living skills. People were living in a large group setting, bigger than most domestic style properties, which impacted on their lives.
People’s experience of using this service and what we found
When people were at risk of harm, assessments were in place alongside guidance for staff on how to mitigate the risk. Staff had completed safeguarding training and were confident any concerns would be dealt with. People received their medicines safely in the way prescribed for them.
There were areas of improvement in relation to how people were protected from risks associated with infection control. We have made a recommendation about this in the report.
Staff received an induction when they first started working at the service. Training was updated regularly and staff told us the training was good and equipped them to carry out their roles with confidence. There were sufficient staff to support people according to their needs. Staff told us they were well supported and had regular supervisions with the deputy manager.
People were supported to have choice and control in 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. However, the layout and size of the premises were not in line with best practice guidance. This impacted on people’s autonomy and opportunities to take part in independent living skills. People were living in a large group setting which is different to how most citizens choose to live their lives. Menus were developed by staff with no input from people who lived at the service. We have made a recommendation about developing the service in line with best practice guidelines.
The registered manager told us they had discussed ideas with the providers for developing the service in line with Registering the Right Support guidelines. However, there were no firm plans or timescales for making these improvements.
When we arrived at Garden House the atmosphere was busy and friendly. Staff were supporting people to get ready to go out on various trips. They spent time encouraging people and making sure they were happy with the days arrangements.
People and relatives told us staff were enthusiastic and were kind and helpful. Relatives confirmed they were kept informed of any changes in their family members health needs and were able to speak with a member of the management team at any time.
People spent time taking part in pastimes that reflected their interests. As well as daily events such as shopping and café trips, various celebrations were hosted at Bowden Derra Park. Relatives and residents from the local community were invited to attend these events.
The registered manager and senior management team were highly visible in the service and staff told us they were approachable and would listen to any concerns they had.
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 registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people. The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.
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 good. (Report published 9 May 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.
A registered manager was employed to manage the service. 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 inspection was undertaken in response to concerns raised by the local authority about the services run by Bowden Derra Park Limited.
The issues raised included staff turnover, staff working long hours, lack of staff training, and staff not seeking advice from external professionals or following guidance supplied. There were also concerns whether people were being kept safe, including from the risk of fire or those posed by other people’s behaviour. Concerns were also raised about people living with people that they were not compatible. We were told people were potentially not being supported according to their assessed needs, were having their choices restricted, particularly regarding food, drinks and activities. Also, people were carrying out work they were not paid for and being charged for facilities owned by the provider that should have been included in their fees.
People were supported by a sufficient number of staff. Relatives told us there were enough staff on duty and we observed unhurried interactions between people and staff. This meant people’s needs were met in a timely manner. One staff members told us, “Staffing levels are good.” Staff and relatives told us they felt the staff team was consistent. The registered manager confirmed and rotas showed staffs’ working hours complied with working time regulations. Staff told us they did not work long hours and they had recently been consulted about shift times and patterns to see if any improvements could be made.
A comprehensive training programme was in place which included induction training, mandatory training and training to support people’s individual needs. Staff told us their training was updated regularly and they could request extra training they felt they would benefit from. One staff member told us, “I think the training here is brilliant.”
People, relatives and staff told us people were safe. Staff members commented, “I would definitely say people are safe” and “People are definitely safe. I would not be here if I felt there were any concerns” Risk assessments, guidelines, policies and procedures were all used to help ensure staff supported people’s safety. A fire risk assessment was in place and regular checks were carried out of fire equipment and staff knowledge of evacuation procedures. People had up to date personal emergency evacuation plans (PEEPs) in place.
The registered manager and staff told us before people moved into Garden House, their needs were assessed to help ensure the service could meet their needs and that other people already living in the service would not be adversely affected. If the person’s needs changed or they were not compatible with other people living there, the registered manager told us they contacted the local authority for support to find an alternative place for them to live.
People had personalised care plans in place. Staff and relatives confirmed people and their relatives were involved in ensuring records reflected people’s needs and wishes. Staff and relatives confirmed support was provided in line with people’s care plans. Comments from staff members included, “The care plans are good and are in the process of being updated” and, “The care plans are good, they are quite concise and informative.” People’s private information was not always locked away. This meant it was possible for other people to have access to it. We have made a recommendation about this in the report.
People’s care plans and risk assessments showed advice had been sought from external professionals regarding people’s health or social care needs. Staff and relatives confirmed this guidance was followed.
When people experienced behaviour that could challenge others, advice from professionals was sought and any related incidents were recorded and monitored. Guidelines were put in place for staff to understand the best way to support people at these times. Staff were due to receive training to give them a deeper understanding of how to support people effectively. Any change or increase in incidents prompted a referral to external agencies for further advice and support.
People told us they enjoyed the food and confirmed they could choose what and where they wanted to eat. Mealtimes were a positive experience, which people looked forward to. People told us meals were of sufficient quality and quantity and there were always alternatives on offer for them to choose from. Residents’ meetings were used to gain people’s opinions and suggestions regarding meals offered; a relative confirmed comments they had made had been acted upon.
We observed people taking part in different activities and records showed people regularly took part in internal and external activities. However, when people had not taken part in activities, records did not show whether this was the person’s choice, if alternatives were offered or if any further action was taken to help ensure their needs and wishes were being met. We have made a recommendation about this in the report.
The registered manager, staff and relatives confirmed no-one paid for using the onsite facilities owned by the provider. The registered manager confirmed no-one currently living in Garden House worked paid or unpaid at any Bowden Derra services or facilities. We found no information to suggest people living at Garden House were undertaking paid or unpaid work at Bowden Derra Park.
People received support from staff who knew them well and had the knowledge and skills to meet their needs. People and their relatives spoke highly of the staff and the support provided. Comments included, “Staff are caring and cheery. They have a bit of a spark and are creative.”
There was a positive culture within the service. The registered manager had clear values about how they wished the service to be provided and these values were shared by the whole staff team. Staff talked about ‘personalised care’ and ‘respecting people’s choices’ and had a clear aim about improving people’s lives and opportunities.
Staff were recruited safely. Checks were carried out prior to staff commencing their employment to ensure they had the correct characteristics to work with vulnerable people. Staff had received training in how to recognise and report abuse and were confident any allegations would be taken seriously and investigated to help ensure people were protected. Staff were supported in their role by an ongoing programme of supervision, appraisal and competency checks.
The registered manager and staff had attended training on the Mental Capacity Act 2005 (MCA).
Staff were knowledgeable about the Mental Capacity Act and how this applied to their role. Where people lacked the capacity to make decisions for themselves, processes ensured that their rights were protected. Where people’s liberty was restricted in their best interests, the correct legal procedures had been followed.
Learning from events, feedback received about the service and outcomes from audits were used to aid change and drive improvement across the service. The manager and staff monitored the quality of the service regularly by undertaking a range of regular audits and speaking with people to ensure they were happy with the service they received. People and their relatives where appropriate, told us the management team were approachable and included them in discussions about their care and the running of the service.
The inspection took place on 19 and 21 October 2015 and was unannounced.Garden House provides accommodation and care to a maximum of 14 adults, who may have mental health needs, learning or physical disabilities. Garden House is part of a complex of residential accommodation.
On the day of the inspection 14 people were using the service.The service had 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 registered manager was also responsible for the other services on the same complex. Garden House had a team leader who oversaw the day to day running of the service. People and staff were relaxed throughout our inspection. There was a calm, friendly and homely atmosphere. People told us they enjoyed living in the home. Comments included, “The staff are all lovely, they look after me," and "I think it is lovely here."People’s records were personalised and gave people control over all aspects of their lives.
Staff responded quickly to people’s changing needs. People or where appropriate those who mattered to them, were involved in reviewing their needs and how they would like to be supported.
People’s preferences were identified and respected.Staff put people at the heart of their work; they exhibited a kind and compassionate attitude towards people. Strong relationships had been developed and staff focused on people rather than on tasks.Staff were highly knowledgeable about the people they were supporting and had an in-depth appreciation of how to respect people’s individual needs around their privacy and dignity.
People’s risks were managed well and monitored. People were promoted to live full and active lives and were supported to be as independent as possible. Activities were meaningful and reflected people’s interests and individual hobbies.People’s medicines were managed safely. People received their medicines as prescribed, received them on time and were told what they were for. People were supported to maintain good health through regular access to healthcare professionals, such as GPs, social workers, community psychiatric nurses and speech and language therapists.
People told us they felt safe and relatives confirmed this. Comments included, “I feel safe here. There are people here looking after me.” All staff had undertaken training on safeguarding vulnerable adults from abuse and demonstrated a good knowledge of how to identify and report any concerns. Staff described what action they would take to protect people from harm. Staff felt confident any incidents or allegations would be fully investigated.People were protected by safe recruitment practices. Staff underwent the necessary checks which determined they were suitable to work with vulnerable adults, before they started their employment.
Relatives and friends were made to feel welcome and people were supported to maintain relationships with those who mattered to them. People and those who mattered to them knew how to raise concerns and make complaints. Complaints had been recorded, investigated and the outcome fed back to the complainant.
Staff described the management as supportive and approachable. Staff talked passionately about their role. Comments included, “You make a difference to people" and "I really enjoy working with the guys, ensuring they have a nice day."
Staff received a comprehensive induction programme and there were sufficient staff to meet people’s needs. Staff were appropriately trained and had the correct skills to carry out their roles effectively.
Staff understood their role with regards to the Mental Capacity Act (2005) and the associated Deprivation of Liberty Safeguards. Applications were made and advice was sought to help safeguard people and respect their human rights.
There were effective quality assurance systems in place. The registered manager followed a monthly and annual cycle of quality assurance activities.
Before people received any care or treatment they were asked for their consent and staff acted in accordance with their wishes.
We spent time talking to people who lived at Garden House and observing the interactions between them and staff. Comments included: 'I like living here' and 'The staff are nice and I feel happy here.' During our visit, we saw that people appeared relaxed and content.
Care plans that we saw reflected people's health and social care needs and demonstrated that other health and social care professionals were involved.
Medicines were safely administered. We saw the medication recording records which were appropriately signed by staff when administering a person's medication.
Staff confirmed that people's needs were met in a timely manner and felt that there were sufficient staffing numbers.
People were made aware of the complaints system. This was provided in a format that met their needs.
We looked closely at the care of two people who used the service. This involved meeting them, talking to staff about their needs and reading records about their care. We also talked to three health care professionals who were visiting the home and a training instructor working with staff on the day. The registered manager was available and involved in the visit.
People told us, "I like it here"; "There is nothing I would change" and "I like to do my own cleaning of my room and staff help me if I ask". They said that if they were unhappy with anything they would tell the staff. A person's family said, "He likes it here so much" and that he had changed in a positive way since living at Garden House.
We saw that people were relaxed in staff company and talked to them without hesitation, indicating that the staff were kind to people and people felt safe with them.
We observed staff giving people information, asking their opinion and promoting their dignity and independence. One of several examples was staff explaining what we were doing. People's care records were detailed and provided staff with clear information on how the person's needs should be met.
We found that staff understood the complex needs of people using the service. For example, they knew how to respond to a person's anxieties or behaviour that might challenge others. Staff were fully trained and supported in their work.
People's health care needs were being met and community health care professionals were fully involved as necessary for people's welfare. The health care professionals told us that the home always followed their advice and worked in the person's best interest.
The home and organisation had good systems in place to monitor the service provided and ensure people's health, safety and well being.