• Care Home
  • Care home

Archived: Boundary House

Haveringland Road, Felthorpe, Norwich, Norfolk, NR10 4BZ (01603) 754715

Provided and run by:
Ms Sandra Bridgwood and Mr Canabady Mauree

All Inspections

28 August 2014

During an inspection looking at part of the service

A single inspector for adult social care services carried out this inspection. This was to follow up concerns identified during our previous inspection of 28 May and 2 June 2014. Two of the key questions we ask ourselves during an inspection are whether the service is safe and whether it is effective. At the last inspection we found that medicines were not being managed properly. This meant that the service people received was not as safe as it should be. We also found that staff were not receiving proper supervision and appraisal to support them in their roles. This meant that the service people received was not as effective as it should be. The provider told us how they were going to make improvements in these areas and this inspection was to check that they had done so.

As part of this inspection we spoke with two people who used the service. We spoke with the manager and two other members of staff. We reviewed records associated with medicines and with staff support and development.

Below is a summary of what we found. If you wish to see the evidence supporting our judgements, please read the full report.

Is it safe?

The last time we inspected Boundary House, we found that the service was not as safe as it should be. This was because people were not protected against the risks associated with medicines and their management.

At this inspection we found that there were improved systems for recording and managing medicines. There were more frequent checks on systems to ensure that any concerns would be identified and could be addressed promptly. Accurate records of medicines administered and those in stock were being kept. We concluded that this aspect of the safety of the service had improved.

Is it effective?

The last time we inspected Boundary House, we found that the service people received was not as effective as it should be. This was because people were being cared for by staff who were not consistently supported to deliver care safely and to an appropriate standard.

At this inspection we found that improvements had been made. The majority of staff had received supervision to discuss their performance, work and development needs. Where this had not happened appointments had been made to ensure the required supervision took place. The provider confirmed that training was funded and arranged for additional key staff so that they could offer effective supervision and support to staff and ensure improvements were sustained.

Arrangements had been made to ensure important training in physical intervention was up to date or scheduled. Staff needed this to ensure they were able to deal with aggression and agitation in a safe manner. The way training was monitored ensured that the manager was able to assess what training was needed and when it should be renewed if this was required.

29 May and 2 June 2014

During a routine inspection

We reviewed our findings at the inspection to help answer the five questions we always ask: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led? Below is a summary of what we found. The summary is based on our observations during inspection, speaking with people who live and work at Boundary House, feedback from other professionals and from looking at records.

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

Is the service safe?

People said that they liked the staff and we observed staff calmly reassuring one person who had become anxious. Visiting professionals felt that the service supported people safely and could meet complex needs. The content of records had been improved to ensure these provided reliable information about care. Assessments of risk had been updated so they reflected people's current needs and how they were to be supported safely.

There were systems in place to learn from events such as whistleblowing concerns and investigations. The new management team had plans to make it easier to review incidents so that action could be taken to reduce risks and to help the service to improve. They were working with the local environmental health team to further improve information, guidance and management of health and safety.

We looked at systems for managing medicines and found that these were not sufficiently robust to ensure people's safety and to minimise the risks associated with medication. We asked the provider to tell us what they are going to do to meet the requirements of the law in relation to managing medicines.

The home had procedures in place in relation to the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) and staff had training in this. We provided information to the manager about a recent Supreme Court decision regarding the DoLS. This was so that further advice could be taken if it was needed.

Is the service effective?

People's health and care needs were assessed with them. Advice from other professionals relating to care and welfare was sought when appropriate and incorporated into plans of care. Staff were able to tell us about people's needs. This meant that staff knew how to support people properly.

Staff had relevant training and staff meetings so that they knew what was expected of them and had underpinning knowledge to support people effectively. However, they were not appropriately supported by means of supervision and appraisal to carry out their work. We have asked the provider to tell us what they are going to do to meet the requirement to support staff in their work.

Is the service caring?

People said they liked the staff who delivered their care. We observed that staff spoke with people in a kindly manner and gave encouragement when supporting people. Where people refused care and support, staff approached them at a later time to offer any assistance that was required. Visiting professionals felt that standards of care were good.

Is the service responsive?

People had opportunities to engage in activities inside and outside the service. The management team recognised that further flexibility could be built into this and were reviewing one to one support for one person to reflect their needs and preferences. A survey for relatives and professionals providing support to people had been compiled and was being issued by the provider's head office so that improvements could be made if necessary.

Is the service well-led?

We acknowledged that all members of the management team were newly in post. The new manager was not registered with the Care Quality Commission but had started the registration process. The management team had already identified where improvements could be made and had looked at how these could be prioritised. There was a quality assurance system showing that the quality and safety of care was checked. The management team had displayed a checklist of notifications that needed to be made to the Care Quality Commission so that they were aware of their legal obligations. This represented an improvement from our last inspection.

Staff were clear about their roles and responsibilities and aware of forthcoming changes to the staff structure. These were aimed at strengthening leadership within the service to ensure people received good quality care.

30 September 2013

During a routine inspection

We found that people were asked about their care and welfare and efforts were made to support people with decisions about it.

People had their needs assessed but the information was not always personal to them and did not always promote their safety. We found that an identified risk to do with use of a car had not been assessed and planned for to see how it could be managed safely while the home waited for professional advice.

We found that staff supported people with their personal care and to do activities they liked such as trips out, shopping, walking and fishing. One person told us that staff "... help with my food and cutting it up for me." Another said that staff had helped them with saving for and going on a holiday. We observed that one person was assisted to be as independent as they could when they wanted to make a telephone call. We also found that staff supported people to see others who could help keep them well, like the doctor and dentist.

However, people's care was not always delivered in line with their plan. For example, people needing assistance to keep their weight at a healthy level were not consistently offered this as their care plans said they should be, so that items such as crisps, chips or biscuits were an occasional treat. We also found that advice had not been sought regarding people's safety where they were being singled out and hit by another person.

Staff were able to tell us about the needs of individuals and how they were met. Staff were also able to confirm that they had access to training to help them meet people's needs. There was training planned to address a shortfall in staff skills when they were dealing with people who could be aggressive and we observed that staff were available to respond to people's needs promptly.

We found that records were not always maintained as accurate and up to date. We also noted that events had taken place in the home that the Care Quality Commission should have been told about by law.

19 December 2012

During a routine inspection

Two people we spoke with told us that they could do the things they wanted. One person told us that they had been shopping earlier that day and had bought some new clothes and a present for a friend. Another person we spoke with said they sometimes enjoyed doing 'horti', which they explained was what everyone called the horticulture centre, which was located in the grounds of the home.

People we spoke with told us that they were treated well and that staff respected them. One person told us that they liked most of the staff but had their differences with one or two. They also said, "They look after us well here, it's a good place to live". Another person said, of the staff, "They're nice and I like living here too".

Two people told us they were happy with their private rooms and one person said, "It's my own space and I like to have it as I want it".

From the training records we looked at, we saw that there was a balanced complement and skill mix of staff in sufficient numbers to oversee the care provision in Boundary House.

During our inspection it was evident, particularly by the actions of people living in the home, that the staff and management team were very approachable and had an 'open door policy'.

Two people we spoke with told us that they felt safe living in the home and could talk to staff or the manager if they had any concerns.

15 December 2011

During a routine inspection

People told us that they liked living at this home. They said they had their own rooms with their own things in them. People said they had made friends at the home and one person told us about their special friend they had made at the home and how they were able to spend time together if they wished.

People living at the home told us about the weekly meeting they had with staff, when they chose what activities they would like during the week and also what food they would like to have on the menu. They also spoke about the recent Christmas party that had been held at the home and had been attended by some of their families. They said the party had been very good and they had enjoyed it. People were looking forward to Christmas at the home and some of them were busy making decorations to hang up in the lounge.