Boundary House provides accommodation, personal care and support for up to 16 people with a learning disability or autistic spectrum disorder. At the time of the inspection there were 15 people living in the home. There were 10 single bedrooms and shared facilities in one area which is 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
People were not always receiving safe care and treatment. Allegations of abuse or harm had not always been reported to the local safeguarding team or the Commission. We could not be sure that these allegations had been dealt with appropriately or that action had been taken to prevent a reoccurrence. During the inspection we made safeguarding referrals to the local authority safeguarding team. People had not always received medical attention in a timely manner.
There was no effective oversight or management of incidents which had occurred. As a result, staff were placing themselves and others at risk. Incidents happened regularly and people were harmed. People's care needs, risks and behaviours were not always properly assessed or planned for. Care plans and risk assessments were not being followed by staff consistently. This placed people at risk of not receiving they support they required.
There were not always enough staff on shift to meet people’s assessed needs. People told us that staffing shortages meant they couldn’t always choose what they wanted to do or if they got to go out. Not all staff had training or competency assessments that had been renewed as required by the providers training policy. Staff had not received regular supervisions or annual appraisals and often relied on their colleagues for support and guidance rather than the management team.
Infection, prevention and control measures were not being followed to prevent the spread of infections. Hazardous chemicals were not always securely stored. Testing of the fire equipment such as alarms, emergency lighting and fire doors had not been carried out regularly. This put people’s health and safety at risk.
Some areas of the home had furnishings that were worn and dirty and not fit for purpose. The shared areas of the home were not homely.
People were not supported to have maximum choice and control of their lives and staff did not always 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. We saw records that one person had been physically restrained by up to five members of staff. Deprivation of Liberty Safeguards had expired and had not been renewed when needed for some people.
There was a lack of oversight and governance over a prolonged period. The provider had recognised that there were areas that needed improving and were keen to take action.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
This service was not able to demonstrate how they were meeting some of the underpinning principles of Right Support, Right Care, Right Culture.
• The care and support provided did not always meet the needs of people with learning disabilities. Staff did not receive the training needed on how to meet the needs of people with learning disabilities and autism, so they did not have the skills they needed to provide appropriate support.
• People's care wasn't person centred or planned with people having choice and control over how their health and care needs were met. Care plans were not consistently followed. People were not always cared for in a safe and consistent way.
• The ethos, values, attitudes and behaviours of leaders and care staff did not always ensure people with learning disabilities led confident, inclusive and empowered lives. This was because there was a lack of leadership and oversight. The service was not person centred, open and inclusive nor did it always achieve good outcomes for people. People's human rights were not always respected; people had been harmed and others put at risk of harm.
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 17 July 2019).
Why we inspected
The inspection was prompted in part due to concerns received about staffing levels, the environment, storage of chemicals, training and support of staff. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.
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.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.
The overall rating for this service is ‘Inadequate’ and the service is therefore 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.
You can see what action we have asked the provider to take at the end of this full report.
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 are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to people’s health, safety and welfare, staffing levels, training and support, infection prevention and control and the environment.
We have placed conditions on the provider's registration for Boundary House. We have stopped them from allowing any new people to move into Boundary House. The provider must also improve their quality assurance systems and send a summary to the Commission every month to be reviewed.
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.