Archived: Boundary House

Updated 20 October 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors, a medicines inspector, and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Boundary House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Boundary House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. This included recent submissions in relation to the imposed conditions following the previous inspection. We sought feedback from the local authority and professionals who work with the service. Due to technical problems we were not able to review the provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We visited the service twice. We spoke with 2 people who used the service and 4 relatives. We spoke with 10 staff, these included 7 care staff, the manager, the area manager and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We observed the care and support provided to people. We reviewed care records relating to the care of 5 people. We reviewed medicine administration and associated records for 9 people and spoke with 2 members of staff about medicines. We reviewed a range of records relating to the management of the service.

Updated 20 October 2023

About the service

Boundary House is a residential care home providing accommodation, personal care and support for up to 16 people with a learning disability or autistic people. At the time of the inspection there were 10 people living in the home. There were 10 single bedrooms and shared facilities in one area known as Horizon House and six self-contained flats in the area of the home known as Boundary House. The home is in a rural location with a day centre and offices on the same site.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

People were not supported to manage risks to themselves and from the environment. This placed people at risk of harm. We were not assured that people received the correct level of 1-1 staff support. People were not always supported by the correct staff and this caused them distress.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The systems in place limited the ability of staff to provide support that enhanced people’s choices and control. Information about people’s changing care needs and the support they required was not always shared with staff.

People’s health needs were not always met, and staff did not always support people to access health care services. We have made a recommendation that the provider review how they support people with healthy eating and improve their mealtime experience.

Right Care:

People were not supported to stay safe and their human rights were not always protected. Safeguarding incidents were not always identified and reported.

Incidents were not used to support staff learning and ensure people were receiving the right care. Staff were not well supported because they had not received the training they needed to carry out their roles. This meant people did not always get the support they needed.

People did not always receive person centred care because their needs were not always met.

Right Culture:

Best practice guidance in a range of areas such as communication, distressed behaviours, and bowel management were not followed. The provider had not effectively engaged in external support. This meant people did not receive a high-quality service that supported them to achieve good outcomes.

Staff morale was low. There had been multiple changes of managers and staff lacked direction and support. This impacted on their ability to provide a person-centred culture. Governance systems were inadequate and did not contribute to the delivery of a safe high quality service.

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 inadequate (published 21 December 2021). The service remains inadequate. This service has been rated inadequate for the last two consecutive inspections. This means the service has remained in special measures.

We imposed positive conditions on the providers registration after the last inspection. They must not admit any new people to Boundary House without the permission of the CQC. The provider must submit governance documents and assurances on the first Monday of each month to the CQC.

At this inspection we found the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service on 8 and 14 September 2021. Breaches of legal requirements were found. We undertook this focused inspection to check the provider had made improvements and to confirm they now met legal requirements. This report only covers our findings in relation to the Safe, Effective and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Boundary House on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, staffing, safeguarding, person-centred care, consent, and governance. We have made a recommendation regarding healthy eating and mealtimes.

Following this inspection we took action to cancel the provider's registration.

Follow up

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.