Archived: Blackdown House

Blackdown House is a detached bungalow situated in the extensive grounds of Somerset Court which is owned by the provider. The home accommodates 12 people who have autism and complex support needs. At the time of the inspection five people were living at the home.

The service had not originally been developed and designed in line with the Registering the Right Support guidance. This was because there were five other registered care homes set in the grounds of Somerset Court in close proximity to Blackdown House. The Registering the Right Support Guidance was implemented in 2017 after the service had registered with us. The registered manager had since personalised the service to reflect the Registering the Right Support Guidance.

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

People were supported by staff who had a very good understanding of managing risk safely. Records provided staff with clear guidance on how to manage specific risks identified. Staff were kept informed of changes to people’s risk assessments.

Specific risk assessments had been put in place to support people during the Covid 19 lock down, and for managing the return to socialising in the wider community safely.

People were protected by robust infection control policies and procedures. Staff had received training in infection control and the correct use of personal protective equipment [PPE]. Staff had taken into consideration the affect wearing PPE might have on people living in the home.

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.

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 10 September 2018).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about a choking incident. A decision was made for us to inspect and examine those risks. The information CQC received about the incident investigation indicated concerns about the management of choking. This inspection examined those risks and the management of health-related risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe sections of this full report.

The overall rating for the service has not changed following this targeted inspection and remains good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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

When the service was last inspected in June 2017, two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. These related to the agreed conditions of one person's Deprivation of Liberty Safeguards authorisation was not being fully met and the provider’s quality assurance systems were not always effective in ensuring that all areas for improvement were identified or that improvements were made.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions, Effective and Well led to at least good.

The provider wrote to us in August 2017 and told us how they would achieve compliance with the regulations. During this inspection we found the identified improvements had been made.

Blackdown House 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.

Blackdown House is a large detached bungalow situated in the extensive grounds of Somerset Court, along with five of the providers other homes. Somerset Court is described as a ‘campus’ setting. Campuses are a group homes clustered together on the same site and usually sharing staff and some facilities. Staff are available 24 hours a day. The campus model does not meet the underlying principles of the Registering the Right Support guidance. This model of care would be reviewed and scrutinised in line with the principles of Registering the Right Support guidance by CQC, if an application were to be received at this moment in time. Although Blackdown House was situated in a campus setting, we found the service was working in line with the values that underpin the Registering the Right Support 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.

The home accommodates up to 12 people who have autism and complex support needs.

The home comprises of the main building and two self-contained flats attached to the home. During our inspection there were five people living in the main part of the home and one person living in each of the flats.

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 registered manager was not available on the day of the inspection, the deputy manager, a covering manager from one of the provider’s other homes and senior managers were present for the inspection.

Relatives told us they thought their family members were safe living at Blackdown. People were protected from abuse because staff understood the correct procedure to follow if they had any concerns. Staff informed us they were confident concerns would be followed up if they were raised. People appeared happy in the company of the staff.

Risks to people were ¿assessed and managed. People received effective support from staff to help them manage at times when they became anxious. Staff understood their responsibilities to raise concerns and report incidents and accidents.

Medicines were stored and administered safely, where there had been medicines errors in the past, learning from this had been implemented.

Although we received some mixed feedback from relatives relating to the staffing of the home, we found there were suitable staff available.

Staff were recruited safely and received on-going training and support to ensure they had the skills and knowledge required to effectively support people. Staff were aware of the measures in place to reduce the risk of the spread of infection.

Consent to care and treatment was sought in line with legislation and guidance. Where restrictive practices had been identified, such as medicines being locked away, these were reviewed to ensure they were the least restrictive option.

People were involved in planning their menus and supported to be involved in preparing their meals.

Staff monitored people’s health and well-being and made sure they had access to other healthcare professionals according to their individual needs.

People’s diverse needs were supported; staff described how they supported people with their cultural needs.

Staff had built trusting relationships with people. Staff interactions with people were positive and caring.

Staff knew people and understood their care and support needs. People were supported by staff to plan and achieve their goals. Relatives were involved in reviewing their family members care and support.

There was a management structure in the home, which provided clear lines of responsibility and ¿accountability.

The provider had notified the Care Quality Commission (CQC) of significant events in line with current legislation. This meant external agencies were able to monitor the care and safety of people using the service.

The provider had systems in place that were effective in identifying shortfalls in the service and developing action plans to address these.

As a result of the findings of the inspection in June 2016, we served one Warning Notice in relation to safe care and treatment. This was a formal notice which confirmed the provider ¿had to meet one legal requirement by 26 September 2016. We returned to Blackdown House in September 2016 to ensure action had been taken in relation to the Warning Notice served. The service had achieved compliance with this part of the regulation during that inspection.

In addition to the Warning Notices, we set requirement actions in relation to the other three breaches of regulations. Requirement actions are actions the provider must take to ensure they are compliant with the regulations. The provider wrote to us in August 2016 to tell us how they would achieve compliance with these requirements, which we reviewed during this inspection. During this comprehensive inspection whilst we found some improvements had been made there were still areas of the service that needed improving.

Blackdown House is a large detached bungalow situated in the extensive grounds of Somerset Court. The home accommodates up to 12 people who have autism and complex support needs.

The home comprises of the main building and two self-contained flats attached to the home. During our inspection there were five people living in the main part of the home and one person living in each of the flats. People living at Blackdown House can access all other facilities on the Somerset Court site which include various day services.

There was a registered manager responsible for 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.

Whilst we found improvements had been made since our last comprehensive inspection in June 2016, there were still areas of the service that needed to be improved. We found the service had not improved in line with the provider’s action plan. The provider had acknowledged this and put additional management support into the home and had a revised improvement plan for the service.

Staff felt the service had improved a lot in the last year, but they knew they still had improvements to make.

People were supported by a sufficient number of skilled staff to keep them safe and to meet their needs. However, staff did not always follow people’s guidelines when responding to them when they were anxious. The registered manager had addressed this is a staff meeting.

We received mixed feedback about how staff felt about incidents when they occurred. One staff member commented they didn’t feel entirely safe during some incidents, however they went on to say the staff team had supported them to develop their confidence.

Checks to the water system were not being consistently completed to ensure they remained within a safe temperature range. This meant people were at risk of being exposed to hot water.

People’s cultural needs were not being fully met. Staff had plans on how they could support people to explore their religious beliefs.

Relatives told us they thought their family members were safe. Staff had the knowledge and confidence to identify safeguarding concerns. The provider followed safe recruitment procedures to ensure that staff working with people were suitable for their roles.

Risks relating to people’s individual care was assessed and planned for. Medicines were managed safely.

Where people lacked capacity to make decisions for themselves we found most of the decisions made for them had been made in line with the Mental Capacity Act 2005 (MCA). However, some restrictions to certain types of foods had not been assessed as being the least restrictive option for the person. The provider had identified further MCA assessments were required.

Where people had Deprivation of Liberty (DoLS) authorisations in place, we found not all of the conditions in one person’s DoLS were being met. This meant their legal rights were not fully protected.

Staff did not always receive regular supervision with their line manager, however they felt supported and able to request a supervision if they needed one. Staff commented positively about the training they received.

People’s health care was well supported by staff and health professionals. People were involved in planning their menus.

Relatives told us staff were “Well intentioned” and “Caring and willing.” We observed staff interacted with people well and staff had a good knowledge of what was important to people. People were able to make choices about day to day aspects of their care.

People had care plans that identified the support they needed and what they could do for themselves. Some of the care plans included out of date information. The registered manager was in the process of reviewing and updating all of the care plans. Relatives told us they were involved in an annual review of their family member’s care.

People were supported to follow their interests and take part in various activities and trips out. Relatives were aware of the complaints policy and felt able to raise any concerns with the registered manager.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There was no registered manager for this 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. An experienced member of the provider’s staff was currently managing the home ¿on a temporary basis. ¿

We carried out an unannounced comprehensive inspection of this service on 30 June and 1 and ¿¿5 July 2016. A breach of legal requirements was found as some staff were not skilled, ¿experienced or knowledgeable enough to respond to the complex needs of people. Staff did not ¿always feel supported during incidents. At times, there was not a suitable staff skill mix available ¿to keep people safe. Important information relating to people was not easily available for staff and ¿staff were not all aware of the actions they should take to ensure people remained calm, their ¿guidelines and routines. ¿

After the comprehensive inspection, we used our enforcement powers and served a Warning ¿Notice on the provider on 28 July 2016. This was a formal notice which confirmed the provider ¿had to meet one legal requirement by 26 September 2016.¿

We undertook this focused inspection to check they now met this legal requirement. This report ¿only covers our findings in relation to this requirement. You can read the report from our last ¿comprehensive inspection, by selecting the 'all reports' link for Blackdown House on our website ¿at www.cqc.org.uk

We found action had been taken to improve people’s safety. ¿

People were supported by sufficient staff with the right skills and knowledge to meet ¿their ¿individual needs. Support for and communication throughout the staff team had improved. A new, ¿bespoke induction process had been introduced for all new staff. This induction process ensured ¿staff understood the risks to people and their care needs and staffs’ confidence in providing ¿support to people when they started working on shift.¿

Staff knew about risks to people, their routines, personal and health care needs and causes of ¿anxiety. Staff had a range of documents they could refer to which explained the care and support ¿each person required and how this should be provided. One staff member said “All of our team ¿seem more confident and knowledgeable.”¿

Staff spoken with and records seen confirmed incidents where people had become anxious or ¿upset had reduced. Staff told us people were “Much more settled now; they seem a lot happier.”¿ The provider’s behaviour coordinator and communication coordinator had also been supporting ¿the service to ensure people’s needs were met and to offer ongoing guidance, mentoring and ¿support to staff. ¿

The legal requirement had been met; the provider had therefore complied with our Warning ¿Notice.¿

The home comprises of the main building and two self-contained flats attached to the home. During our inspection there were four people living in the main part of the home and one person living in each of the flats. People living at Blackdown House can access all other facilities on the Somerset Court site which include various day services.

The service was last inspected in July 2014 and was compliant with the standards we inspected. This inspection was unannounced and took place on 30 June and 1 and 5 July 2016.

There was a registered manager responsible for the service, the registered manager had recently resigned. 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 service operations manager was working in the home whilst they were in the process of recruiting a new manager.

Due to their being a predominantly new staff team, some staff were not skilled, experienced or knowledgeable enough to respond to the complex needs of people. Staff did not always feel supported during incidents. At times there was not a suitable staff skill mix available to keep people safe.

Important information relating to people was not easily available for staff and staff were not all aware of the actions they should take to ensure people remains calm, their guidelines and routines.

Where people lacked capacity to make decisions for themselves the principles of the Mental Capacity Act 2005 were not always followed.

There were some gaps in staff training but the acting deputy manager had plans in place to address this. New members of staff received an induction which included shadowing experienced staff, however there were not effective processes in place so support staff to access information about people before working with them.

Staff did not always record information about people in a way that promoted dignity and respect. We observed staff were caring in their interactions with people.

Relatives said the home was a safe place. Systems were in place to protect people from harm and abuse and staff knew how to follow them. Medicines were administered and stored safely.

There were enough staff available to meet peoples needs. A recruitment procedure was in place and staff received pre-employment checks before starting work with the service.

People had access to food and drinks when they wanted them and they were able to make choices about this.

There were systems in place to receive feedback from people who use the service, their relatives and staff. People had access to activities to meet their needs.

Relatives told us they were confident they could raise concerns or complaints with the staff and they would be listened to. The provider had a system in place to audit the service and we saw some progress had been made against the actions identified.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are considering the action we are taking and will produce a further report.

Below is a summary of what we found. The summary describes what people using the service, and the staff told us, what we observed and the records we looked at. Due to the nature of people's disabilities we were only able to gather limited comments with the support of staff.

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

This is a summary of what we found:

Is the service safe?

We found the service was safe because medication was stored securely with medicines handled and recorded appropriately. Each of the people living at Blackdown house had personal emergency evacuation plans and there was also a disaster recovery plan in place for dealing with foreseeable emergencies. A member of the Somerset Court management team was available on call in case of emergency.

Staff records demonstrated that the staff employed to work at the home were suitable and had the skills and experience needed to support the people living at the home.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. People were subject to Deprivation of Liberty Safeguard (DoLS). We saw documentation that showed that the staff were following the correct procedure and that policies and procedures were in place.

Is the service effective?

Speaking with staff it was evident that they understood individuals' care and support needs. We saw that support plans were based on people's assessed needs and that risk assessments had been completed and were regularly reviewed. We asked one person if they liked living at the home and they replied 'Yes' with their thumbs up.

Is the service caring?

People living in the home had complex needs and some people were unable to fully express their views. During our visit we observed that staff provided support and engaged with people positively. People appeared relaxed and comfortable in the presence of staff. Staff treated people in a sensitive, respectful and professional manner. In people's support plans we saw that there was detailed information about what they needed help with and how staff should support them. We asked one person if they liked living at the home and they replied 'Yes' with their thumbs up. We saw that one professional commented that 'Staff and SU have an excellent rapport and are very happy; house is well organised and managed'.

Is the service responsive?

People met with staff on a one to one basis every Sunday week to discuss any issues and to plan what they wanted to do the following week. People were also involved in planning their regular person centred planning reviews and were able to invite their relatives or representative. During handover all the people were discussed which ensured that staff were updated about the support people received.

Is the service well-led?

The home had quality assurance systems in place. These included audits undertaken by the provider's representative and quality monitoring audits undertaken by registered managers for other homes ran by the provider. The home undertook regular quality assurance surveys with the people who lived at Blackdown House, their relatives and professional who supported them. Incidents all incidents were recorded and monitored which helped staff monitor patterns in people's behaviour's.

There was a friendly atmosphere in the service that people responded favourably to. We saw that all staff interactions were patient and respectful. We saw that people appeared relaxed with staff. Staff listened to people and showed they respected their opinions.

The service had policies and procedures in place that kept people safe. Staff were knowledgeable and confident about their safeguarding responsibilities and how they would respond to any concerns that may arise. Staff told us the training they received was of a good quality.

People said they felt safe. One person told us they felt "very safe". They added that they would "talk with staff if I was unhappy". Another person gave us the 'thumbs up' sign when we asked if they felt safe.

There were processes in place to monitor the quality of service being provided. We saw that the opinions of people in the service, families and staff were obtained through surveys.

We saw that the manager collated monthly audits and summarised the findings into quality reports. The most recent quality report was positive.

Staff listened to people and respected their views. People discussed any issues they wished to and were helped to plan their week. People chose a wide variety of activities both on the Somerset Court site and in the wider community.

One person said they would talk with staff if they were unhappy or upset. None of the staff we spoke with had any concerns about any person being at risk of abuse. Staff understood the various signs of abuse and knew what action they needed to take to ensure people were safe.

We asked one person if they liked the staff who supported them; they said 'yes thank you.' We saw that staff provided people with appropriate support. People were supported by a consistent staff team who were well trained and well supported.

Systems were in place to monitor the quality of the service provided to people. These included gaining the views of the people who lived in the home and from those close to them. The last quality review showed that people were very happy with the service.