Archived: Bonhomie House

Updated 18 July 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014. The inspection also checked whether the required improvements identified at our last inspection had been made.

The inspection took place on the 30 and 31 May 2018 and was unannounced. On the first day, the inspection team consisted of three inspectors and two experts by experience. An expert by experience is a person who has personal experience of using or caring for someone who has used a service similar to Bonhomie House. On the second day there was two inspectors.

Before the inspection, we reviewed all the information we held about the service including previous inspection reports and notifications received by the Care Quality Commission. A notification tells us about important issues and events which have happened at the service. We asked the provider to complete a provider information return. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We used this information to help us decide what areas to focus on during our inspection.

During the inspection we spoke with 17 people who used the service and with six relatives. We also spent time observing aspects of the care and support being delivered. We spoke with the general manager, the registered manager, deputy manager, the chef and 15 nursing and care staff, some of whom were permanent staff and some agency workers. We also spoke with 10 health and social care professionals and asked their views about the care provided at Bonhomie House.

We reviewed the care records of eight people in detail. We reviewed the recruitment records of five staff. We also looked at other records relating to the management of the service such as audits, incidents, policies and staff rotas.

The service was last inspected in March 2017. At that inspection, we found three breaches of the legal requirements.

Updated 18 July 2018

This inspection took place on 30 and 31 May 2018 and was unannounced

Bonhomie House is a care home with nursing. 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.

Bonhomie House provides care and support for up to 78 people living with a wide range of complex healthcare needs. These include acquired brain injuries, neurological conditions, physical disabilities and mental health issues. At the time of our inspection there were 59 people living at the service. Bonhomie House provides a range of accommodation. The main house is spread over three floors. The people living in the main house receive a mixture of one to one and shared care provided by a team of nursing and care staff. Also on site are a number of both shared and single dwelling bungalows where people receive either shared care or one to one support. The service has an activity hall with a swimming pool and Jacuzzi which can be used for therapeutic and leisure activities.

This service has been rated as requires improvement since the introduction of ratings in 2014. At the last inspection in March 2017, we rated the service as requires improvement and found breaches of three Regulations. This was because risks to people were not always well managed. There were not always sufficient numbers of suitably skilled staff deployed to meet people’s needs, improvements were needed to the accuracy of care records and to the robustness of the governance arrangements. An action plan was submitted which identified the steps that would be taken to address the breaches of the Regulations. This inspection checked whether the service was now compliant with the Regulations.

Bonhomie House had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Most of the issues identified at the last inspection relating to how risks to people were assessed and managed had been adequately addressed. However, records did not reflect that action had been taken to adequately protect people against the risk of scalding from hot water.

We continued to receive mixed feedback about the number of staff deployed and the continuity of care provided. There continued to be a high use of agency staff to cover staff vacancies. People, however, told us they felt safe and that their needs were generally met.

We found evidence that infection control measures, such as wearing personal protective clothing, were not consistently followed. The systems to manage cross infection needed to be more robust.

Some relatives felt their family members did not consistently receive basic care effectively.

The completion rates for training were variable and action was still needed to help ensure that staff had all of the skills and knowledge needed to consistently meet people’s needs effectively.

Improvements were needed to ensure that the food provided was enjoyed by people and consistently met their needs.

The care plans were more personalised and reflective of people’s individual wishes and preferences.

Improvements had been made to the activities provided, however, some people, and some relatives felt more could still be done to support people to follow their interests and to take part in a range of activities. The registered manager was confident that through embedding an active support approach people would be provided with more regular and meaningful opportunities to engage in activities.

Whilst some improvements had been made, the quality assurance systems in place were still not being consistently effective at identifying areas where the safety of the service might be compromised.

Some staff felt that support from the senior management team was not consistently good. They felt they were not always valued for their hard work or that their concerns about not being able to perform their role effectively were being listened to.

Medicines were managed safely.

Systems were in place to report and review the incidents and accidents that occurred within the service and to ensure lessons were learnt from these events.

Relevant checks had been completed before staff worked unsupervised.

People were protected from the risk of abuse.

Staff received a suitable induction and a system of supervision and appraisal was in place, although we have recommended that the provider review the frequency with which supervision is provided.

There were systems in place to seek and document people’s consent to their care and treatment. Where a person did not possess mental capacity, mental capacity had been assessed in line with legislation.

People’s health care needs were met and there was some evidence that people’s care was planned and delivered in line with current evidence based guidance. Staff worked effectively with other organisations to help ensure that people’s move to and from the service was coordinated and effective.

Overall the design and layout of the premises met people’s individual needs some aspects of the décor and fittings needed repair or replacement. We have recommended that the security measures of the building are reviewed.

People told us staff were kind and caring and overall, staff were observed to be attentive and reassuring to people.

We did observe a small number of interactions where the care could have been provided in a more person-centred manner.

People choices were respected and care was provided in a manner that mindful of people’s need for privacy.

People’s families were welcome to visit at any time and we saw a number of relatives sharing in aspects of their family member’s care.

People's religious and cultural needs were recorded in their care plans an action was taken to meet these.

Complaints policies and procedures were now displayed within the home and accessible to people and complaints had been investigated and a response made to the complainant.

The registered manager had over the last year demonstrated a commitment to driving improvements within the service. They had worked effectively with a range of health and social care professionals to address the areas where concerns had existed about the quality of care provided.

A number of the professionals we spoke with talked of seeing positive changes within the service driven by the leadership team.

Improvements had been made which helped to ensure that people’s views about the quality of the care and support provided were sought and used to drive improvements within the service.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.

This is the third consecutive time the service has been rated Requires Improvement. Whilst this inspection has noted a number of improvements, the service is not yet consistently providing good care. We will meet with the provider to discuss the findings of this report and continue to monitor the service to ensure that improvements are ongoing.