Archived: Botchill House

Botchill House is a residential care home providing personal and without nursing for up to 15 people with learning disabilities.

The service is in a rural setting and accommodation is provided in one adapted building with bedrooms on the ground and first floor.

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 a large home, bigger than most domestic style properties. It was registered for the support of up to 15 people. Ten people were using the service with no plans to increase these numbers. All ten had previously lived together in a ward in a large hospital and moved together to this service. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. 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.

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

People could not directly tell us about their experience of living at Botchill due to their complex needs and communication difficulties. We observed people moving freely around the house, enjoying each other’s and staff company. People were relaxed and enjoying the warm weather. There were lots of different seating areas set up outside, some with shade. The garden provided people with lots of safe space to wander.

People’s relatives were positive about the care and support people received. One said “We are very happy (name of person) is here. She is settled and happy.”

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.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These 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. Although the service was in a rural location, people were supported throughout the day to enjoy trips out to the local town. A small group also went on a trip to a local zoo on the day we inspected.

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 were encouraged to take part in activities of daily living such as helping with meal preparation.

Staff were skilled at understanding people’s communication needs and this helped people to make their views known by various ways.

Staff were knowledgeable about people’s needs, preferences and wishes. They ensured a person-centred approach through detailed and collaborative care planning. People’s privacy and dignity was respected.

The service used individualised communication tools to assist people to make choices and make their needs known. The provider ensured best practice guidance was followed. They were signed up and contributors to a range of national organisations who promoted best practice for people with learning disabilities.

People were supported to enjoy a wide variety of meals, snacks and drinks. Staff were observant to ensure people had good hydration. Where people may be at risk of choking, staff closely monitored them when eating and drinking.

People’s healthcare needs were well met. Staff used a variety of national tools to ensure people’s particular health issues were closely monitored. Each person had a hospital passport which had important information about how best to communicate and care for the person.

People were protected because risks had been assessed and any measures needed to mitigate these were fully documented. New staff were only recruited once they had all their checks to ensure they were suitable to work with vulnerable people. People’s medicines were safely managed.

There were quality assurance systems in place to assess, monitor and improve the quality and safety of the service provided.

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 December 2016)

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.

There was a registered manager in post. A registered manager is a person who has registered with the 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 registered manager was also a registered manager at another Havencare service. They were supported at Botchill House by a service manager who had daily oversight of the service.

The house, whilst only 1.5 miles from Dawlish, is in a very rural setting and is set in extensive grounds. There is a large orchard next to the property, areas for growing vegetables and a chicken coop. On our arrival we were greeted by some of the people who lived at Botchill House and the registered manager. A social story had been created about our arrival and this was displayed on several walls in shared areas of the building. Social stories are short descriptions of particular events. They are used to support people with a learning disability or autism to understand what to expect in a specific situation.

There was a sense of activity as we arrived and some people were getting ready to go out. We were directed to the office and for some time the door was kept open which enabled people and staff to come in and out and meet us when they were ready to do so. Later the door was closed to enable some of the more sensitive discussions to happen but we were told that this was different to usual and people were used the office door being open. It was clear the door being closed was not people’s preference and it was good to experience their expectation that the office was open to all.

People’s medicines were managed safely. Medicines were stored, given to people as prescribed and disposed of safely. Staff received appropriate training and understood the importance of safe administration and management of medicines. People were supported to maintain good health through regular access to health and social care professionals, such as GP's, dentists and speech and language therapists.

People’s care records were detailed and personalised to meet individual needs. Staff understood people’s needs and responded when needed. People were not able to be fully involved with their care plans, and plans were underway to develop a more user friendly version of support plans to give people greater ownership of them. People’s preferences were sought and respected.

Risks were documented, monitored and managed well to ensure they remained safe. One person had recently been identified at being at increased risk to choking. The risk assessment had not been fully updated to reflect the change. Evidence to show staff had read new information contained in the communication book had not been signed as seen by all staff. Staff we spoke with were clear as to how to support the person safely and arrangements for input from other healthcare professionals were in place.

People lived full and active lives and were supported to access local areas and activities. Activities reflected people’s interests and individual hobbies. People were given the choice of meals, snacks and drinks they enjoyed whilst maintaining a healthy diet. People, when possible were encouraged to help prepare meals and drinks.

People’s needs in relation to their behaviour were clearly understood by the staff team and met in a positive way. Staff had a good understanding of people’s communication styles and were able to support our conversations with people.

Staff had completed safeguarding training and had a good knowledge of what constituted abuse and how to report any concerns. Staff described what action they would take to protect people against harm and were confident any incidents or allegations of abuse would be fully investigated.

Staff and relatives were positive about the management of the service. There was a robust system of audits in place to help ensure the safe running of the service. These were carried out internally and by a representative from the Havencare senior management team.

The 12 people we met at Botchcill House had lived together for over 20 years, with one of the current staff having supported them throughout this time.

People had difficulty giving their views in detail about living at the home and the care they received because of communication needs due to their learning difficulties. We therefore spent some time with most of the people living at the home to enable us to see how they spent their time, if the environment was suitable for them and observing some of the support they received from staff. We spoke with one person's visitors, the Registered Manager, deputy manager, cook and three care workers. We also looked at records relating to people's care and the running of the home, as well as having a look around the building and its grounds.

Below is a summary of what we found. The summary is based on what people using the service, visitors and the staff told us, what we observed and the records we looked at. 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?

Care was planned and delivered in a way that was intended to ensure people's safety and welfare. Risk assessments covered the support individuals needed as well as the environment, both inside and outdoors, with people able to visit garden areas as they wished and having regular outings in the local community.

People were cared for in an environment that was safe, clean and hygienic. A system of checklists, audits, maintenance, and regular involvement of specialist companies meant that the environment, including hygiene aspects, was monitored and maintained. Action was taken to address any issues identified through the monitoring systems.

Adaptations were in place or provided so that individuals' needs could be met safely, even when their needs changed. This included a wet room to meet new mobility needs and bedroom door locks suited to individuals' needs so they could use them as independently as possible.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. No applications had needed to be submitted, by the service, under the safeguards. However, a policy and guidance was in place, with relevant staff trained to understand when an application should be made.

Is the service effective?

People looked content and at ease with the care and ancillary staff, approaching them freely. They appeared happily active, using the different areas at the home as they wished. We saw people enjoying activities such as puzzles and outings, with their care records showing they undertook them regularly in line with their care plan. Staff we spoke with evidenced that they understood people's care and support needs, and that they knew their individual routines, likes and dislikes.

Is the service caring?

We observed that staff took time to listen to people and to engage in meaningful conversations with them. They did not appear to be in a rush when with people, ensuring information given and reassurances were sufficient for the person concerned. We saw that staff respected people's personal space, including their bedrooms, and supported their independence as much as possible, which upheld their dignity.

Is the service responsive?

People's needs had been assessed and reviewed. People were consulted about their care in care planning, and involved in reviews of their care plans. These were carried out regularly and if concerns were raised about a person's care, such as when their needs changed. There was evidence of action to provide a highly person-centred service for individuals which met their various ongoing and changing needs

Is the service well-led?

A variety of quality assurance processes were in place. Effective systems were also in place to identify and manage risks to the health and welfare of people living at the home and others. These included risk assessments and audits, which were either carried out by the provider or were monitored and responded to by the provider. Staff told us they had a safe working environment in their opinion.

We saw that people had opportunities to give their views of the service through surveys and care reviews. Records and conversations with staff showed that people's views were acted on to improve their service. Visitors we spoke with had not had to make a complaint, reporting that staff were very responsive to their comments or queries. Staff also told us that changes were made as a result of their views or suggestions. There was evidence of ongoing action to improve the service on the basis of quality assurance findings and risk assessments.

We spoke with the manager, deputy manager, cook and three care workers. We observed that all of the staff treated people with respect and protected their dignity.

People we spoke with told us they were happy at the home and enjoyed living together, which most had done for many years. We saw evidence that people ate a balanced diet. We saw that people made choices in relation to what they ate.

We saw that care workers respected people's wishes and people told us they felt respected. We observed friendly conversations between people and care workers at the home.

We toured the home with the manager and looked at all areas of the home including bathrooms, toilets, bedrooms and communal areas. People told us that they had made choices about the personal effects and furniture in their rooms.

The provider had completed all required pre-employment checks on staff including references and Disclosure Barring Service (DBS) checks.

We saw that a monthly quality assurance audit was undertaken by a senior manager from the provider's head office. We saw that systems were in place to effectively monitor the quality of care and that feedback had been acted upon appropriately.

We observed eight of the twelve people who lived at Botchill House. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We saw that people were supported to carry out activities in the house, and to go out with the support of staff.

People had clear assessments of their needs and plans and strategies were in place to meet them. Information was communicated well within the staff team and people's care plans were reviewed regularly. The home had staff with a range of experience, skills and training to meet people's needs.

We saw staff interacting with people in a relaxed, friendly and respectful manner. Staff worked at the pace of each individual and encouraged independence. People had made friendships within the home and had access to social activities such as music, crafts and quizzes.

Staff had received training in safeguarding vulnerable adults and recognising abuse. The home had procedures in place for reporting and responding to any concerns.

The home had systems for quality assurance. We saw evidence that when improvements had been identified at Botchill House they were acted upon.