Bourne Hill Care Home

Bourne Hill Care Home is a residential care home providing accommodation and personal care for people living with autism and learning disabilities.

Bourne Hill accommodates up to five people in one adapted building. At the time of the inspection there was four people living at the service.

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 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 positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.

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

We observed throughout the inspection that people were supported by staff who were kind, caring and respectful in their approach.

People knew the staff team that supported them and were observed to be at ease and reassured in their presence.

Care staff knew people well. We saw staff communicate and respond to people using ways and methods which people understood, especially where some people were non-verbal or presented with behaviours that challenged.

Relatives complimented the ways in which their relative was supported by the service and were re-assured that their relative was safe whilst in the care of Bourne Hill Care Home.

People were supported and encouraged to access the community, participate in activities as well as be involved with daily living tasks where possible. However, we found that the service did not always focus or take a creative approach on activities that took into consideration people’s hobbies and interests.

Risk assessments in place were comprehensive and person centred. Assessments provided clear guidance and information to care staff on how to minimise identified risks and keep people safe.

People received their medicines safely and as prescribed. Policies in place supported this.

All staff recruited to work at Bourne Hill Care Home had been assessed as safe to work with vulnerable people. Staffing levels were enough to ensure that people’s needs were met.

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.

Care plans were person centred and gave comprehensive information about the person, their needs and how they wished to be supported.

People were appropriately supported with their meals. Identified, specific dietary requirements had been recorded in people’s care plans. Care staff knew about people’s specialist needs and supported them accordingly.

Care staff told us that they were supported well in their roles. Records confirmed that they received regular training, supervision and annual appraisals.

Complaints were investigated and responded to according to the providers policy.

Management oversight process in place monitored the quality of care people received. Issues and concerns were identified and addressed to further support improvements and learning.

We have made a recommendation about the provision of activities for people.

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 20 September 2018) and there were multiple breaches of regulation. We found areas of concern around risk management, staff support and ineffective management oversight processes. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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.

Bourne Hill Care Home 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. Bourne Hill Care Home provides care and support for up to five people with learning disabilities. At the time of our inspection there were four people using the service. The care service has 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.

There was a registered manager at the service 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 and associated Regulations about how the service is run.

We found there was a procedure to identify and manage risks however assessments were not always updated regularly or when people’s needs changed. Staff told us they felt supported however they did not always receive their on-going professional development. Staff were not receiving annual appraisals. Staff did not always receive formal supervision.

People and a relative told us they felt safe with staff and there were enough staff to meet their needs. Staff were trained in safeguarding and knew how to safeguard people against harm and abuse. Staff kept detailed records of people’s accidents and incidents. Staff wore appropriate protection equipment to prevent the risk of spread of infection. Medicines were stored and administered safely. People’s finances were handled safely. The home environment was clean.

Staff undertook regular training to help support them to provide effective care. The registered manager had a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). However, staff did not have a good understanding of MCA and DoLS. MCA and DoLS is legislation protecting people who are unable to make decisions for themselves or whom the state has decided need to be deprived of their liberty in their best interest. We have made a recommendation about staff training on the subject of MCA and DoLS.

We saw people had choices about their life. The service was well decorated and adapted to meet the needs of people using the service.

People told us that they were well treated and the staff were caring. We found that care records were in place which included information about how to meet a person’s individual and assessed needs. People’s cultural and religious needs were respected when planning and delivering care. Discussions with staff members showed that they respected people’s sexual orientation so that lesbian, gay, bisexual, and transgender people could feel accepted and welcomed in the service. People had access to a variety of activities. People’s end of life wishes was explored. The service had a complaints procedure in place and relatives knew how to make a complaint.

Staff told us the registered manager was supportive. The service had various quality assurance and monitoring mechanisms in place however had failed to identify or address the concerns found during the inspection.

We identified breaches of three regulations. 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.

Bourne Hill Care is a home for five adults with a learning disability or are on the autistic spectrum. On the day of the inspection visit there were four people using the service.

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. A newly recruited manager was in post and applying for registration with the CQC.

Statutory notifications to CQC had not been made in respect to outcomes of Deprivation of Liberty Safeguards for people who used the service.

Staff had received training on the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS) and staff understood what to do if they had concerns as regards people's mental capacity. DoLS had been appropriately applied for where people’s liberty was restricted. However, we found that the service did not complete best interests decisions or mental capacity assessments for people where there were concerns regarding their mental capacity.

People and relatives told us that they felt safe with the staff that supported them. Staff understood how to keep people safe and protect them from abuse.

Safe recruitment practises were noted which ensured that all staff employed by the service were assessed as being safe to work with vulnerable people.

People’s individual risk associated with their health and care needs had been identified and appropriate guidance had been provided so that staff were able to support people in order to reduce or mitigate risks.

Medicines were managed, handled and stored securely. Appropriate systems and processes were in place to ensure medicines were administered to people safely and appropriately.

Care plans reflected how people were supported to receive care and treatment in accordance with their current needs and preferences.

Staff received an induction as well as relevant training which supported them to carry out their role effectively. Staff were appropriately supported through various ways which included regular supervision and annual appraisals.

People were supported to access a variety of health care services such as GPs, dentists chiropodists and psychiatrists.

We observed care staff and management approach and speak with people in a way that was caring and positive. People and relatives spoke positively of the management team.

The home maintained adequate staffing levels to support people both in the home and the community.

A complaints procedure in place which was displayed for people and relatives. There was an incident and accident procedure in place which staff knew and understood.

Quality assurance systems were in place to monitor quality of care provided.

We identified one breach of regulation relating to submitting statutory notifications to CQC. You can see what action we have asked the provider to take at the back of the full version of this report.

Below is a summary of what we found. We used a number of different methods to help us understand the experiences of people using the service, because people using the service had complex needs which meant they were not able to tell us their experiences. We observed how staff interacted with people who used the service and spoke with two relatives of people who used the service. We looked at care records that showed how people's needs were being met and a recent survey that the service had completed which reflected the views of people's relatives and professionals of the service.

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

Is the service safe?

Care plans clearly identified people's needs resulting from their diverse cultural backgrounds. One relative said, "they treat everyone fairly." There were risk assessments in place to ensure that people's safety and well-being were maintained when receiving care and support. Risk assessments provided guidance for staff on how to minimise risks to people. This meant that people's needs were identified and met in a manner that promoted their independence and safety.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Staff demonstrated they were aware of the Deprivation of Liberty Safeguards (DoLS) and the appropriate process to apply. Policies and procedures were in place to ensure staff had appropriate guidance when considering an application for DoLS.

The two relatives we spoke with said that if they had any concerns about people using the service they could talk to staff. One relative told us, 'you can talk to them if anything is wrong.' Staff knew how to respond to safeguarding concerns to keep people safe and promote their rights. They were able to explain how they would recognise the signs of abuse and report their concerns. Training records confirmed that staff had received training on safeguarding. Safeguarding and whistle blowing policies were in place.

There were effective recruitment and selection processes in place. Staff told us that they had been through a detailed recruitment process that included completing an application form, interviews and references being taken up from their former employers.

Is the service effective?

We observed that people were treated well by staff. We saw that staff understood their needs. People were spoken to in an appropriate manner. Guidance was available in people's care plans regarding their need for one-to-one support and where they had particular behavioural needs we saw that these were monitored regularly. We observed that people's changing behaviour was responded to sensitively in a manner that enhanced the individual's well-being. Where necessary the appropriate professionals had been consulted for advice regarding people's behaviour.

Is the service caring?

We observed that staff were friendly and attentive towards people. Relatives and people who used the service had been involved in the care planning process and taken part in reviews. One relative said, "yes, I am fully involved in decisions about the care." People and their relatives were involved and consulted about decisions affecting their care and treatment. For example, staff asked a person if they wanted to go to the park. One relative said, "the staff involved me in decisions about my son's care."

Is the service responsive?

Staff we spoke with were aware that all people should be treated with respect regardless of their background. One relative said, 'it's alright there.' People's needs were assessed and support was delivered to meet their individual needs. We looked at two care plans. These provided information about people's needs and gave guidance for staff about how they should be met. Care plans clearly identified people's needs resulting from their diverse cultural backgrounds. One relative said, "they treat everyone fairly."

We observed staff responding to people's behaviours sensitively and in a manner that enhanced their well-being. Where necessary the appropriate professionals had been consulted for advice regarding people's behaviours. Staff had been trained in techniques to support people.

Is the service well-led?

An annual quality survey had carried out. The manager explained that a report had been produced, and any suggestions to improve the service were addressed. Peoples' suggestions were used as the basis to improve the care provided by the home. Staff told us they were able to make suggestions to improve the home. They felt that staff meetings provided them with a way to raise issues. Staff meeting minutes showed that staff had a regular opportunity to discuss improvements to the home. Staff played an active role in improving the care of people. There had been a recent audit of care records to make sure that they were up-to-date and provided consistent information regarding people's needs.

At this inspection we found improvements had been made. A formal system of clinical waste management had been implemented. The service's overall risk assessments included recent updates on infection control and clinical waste management.

We spoke with one of the two people using the service. They raised no concerns about standards of cleanliness. We saw that personal protective equipment including gloves and aprons were available for use. This all helped to protect people from the risk of infection.

We also checked on the safety and suitability of the premises because the local fire authority found minor concerns when they visited the service in November 2013. We were shown evidence that the concerns were addressed. For example, mains-linked smoke detectors had now been fitted in the new rooms built during a recent refurbishment.

We found that people were protected against the risks of unsafe or unsuitable premises. The premises was well-maintained overall. We noted a few matters that would benefit from improvement, for example, the sink-unit around one person's fitted wash-basin had evidence of water damage. The provider contacted us after the inspection to supply evidence that they were addressing these matters.

One person's relative said "The staff are not bad" and "I like the home."

We found that the provider was working with various agencies in delivering care and treatment. These include speech and language therapists, GPs, occupational therapists and the district nurses. We saw people were regularly visited by other agencies and staff followed through directions given by them.

Arrangements to ensure that the cleaning of the home was done regularly were not in place. We also found the provider did not have proper arrangements in place to manage infection control.

There were suitable arrangements in place for the recruitment of staff with relevant experience and skills.

The service had systems in place to help protect people from abuse.

Environmental improvements had been completed which meant the service was more homely.

Staff were supported to develop their skills and received training relevant to their role. Staff received supervision to enable them to deliver care and treatment to people safety and to an appropriate standard.