Archived: Boniville House

Boniville House is a care home providing personal care to up to five people who live with mental health conditions. At the time of our inspection five people were living in the home.

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

Quality assurance systems were not always effective. Audits of routine checks and other areas of the service to assess, monitor and improve the service were not completed by management staff.

It was not clear how the provider determined that staffing during weekends was suitable and effective in meeting people’s individual needs and ensuring that people and staff were safe.

We saw positive engagement between staff and people. Systems were in place to ensure people were protected from abuse and treated with respect and dignity. Policies and procedures were in place to protect people from abuse and staff were confident that allegations of abuse would be dealt with appropriately

Suitable infection prevention and control measures and practices were in place to keep people safe and prevent people, staff and visitors catching and spreading infection.

Care staff told us that management were approachable and provided the training, guidance and support they needed to carry out their role and responsibilities effectively.

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 (published 8 June 2018).

Why we inspected

The inspection was prompted in part due to us having received anonymous information about concerns in relation to the management of the care home, medicines, confidentiality, and staffing. A decision was made for us to undertake a focused inspection to examine those risks by reviewing the key questions of Safe, Effective, and Well-led.

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 these. 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 Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, and Well-led sections of this full report.

You can see what action we have asked the provider to take at the end 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.

Enforcement

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 one breach in relation to quality assurance monitoring. Please see the action we have told the provider to take at the end of this report.

Follow up

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.

We carried out an unannounced inspection of Boniville House on the 17 April 2018. At our previous inspection on the 4 April 2017 we rated the service 'requires improvement' and identified three breaches of legal requirements relating to safe care and treatment, staffing and good governance. At this inspection we found the provider had taken sufficient action to address the breaches of regulation identified at our previous inspection and we rated the service as good overall and for the key questions safe, effective caring, responsive and well-led.

The service has a registered manager. 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.

All the people using the service told us that they were happy living in the home and satisfied with the care and support that they received from staff.

People told us that they felt safe at the service. Risk assessment and management processes had been improved and staff knew about the risks to people’s safety and how these were minimised by the service. Action had been taken to address the deficiencies in fire safety, and an emergency plan had been put in place.

Staff training and supervision arrangements had been improved. The provider had introduced a new training programme to ensure staff had the knowledge and skills to undertake their roles in providing people with individualised care. Staff now received effective supervision that supported them to carry out their roles.

The provider had improved and developed the arrangements in place to regularly monitor health and safety and the quality of the care and support provided for people who used the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff gained people's consent before providing them with assistance with personal care.

People's care plans included details about people’s individual preferences and information staff required to provide people with the care and support they needed in the way that they wanted. Care plans were reviewed regularly with people using the service and were updated when people's needs changed.

People told us that staff were kind to them. Staff knew people well and had a caring approach to their work and understood the importance of treating people with dignity, protecting people's privacy and respecting their differences.

People had the opportunity to take part in a range of activities of their choice. Appropriate recruitment procedures were in place so that only suitable staff were employed to provide people with the care and support that they needed. Staffing levels and skill mix provided people with the assistance and care that they needed.

People knew how to make a complaint and/or raise concerns about the service. They were confident that they would be listened to and their concerns addressed appropriately by management.

People’s healthcare needs were assessed and met by the service. Management liaised with healthcare and social care agencies to ensure people’s needs and preferences were met.

People enjoyed the meals provided by the service and confirmed that their dietary needs and preferences were understood and supported by staff.

Boniville House is registered to provide accommodation and personal care for five people. The home provides care and support for people who live with mental health needs. Some people had plans to move into more independent living and were being supported to do so. On the day of our visit there were four people living in the home. Public transport and a range of shops are located within walking distance.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission [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.

People said that they felt safe and were treated with respect. Staff engaged with people in a friendly and courteous manner. Throughout our visit we observed caring and supportive relationships between staff and people using the service. People told us staff were kind to them and respected their privacy and dignity.

There were procedures for safeguarding people. Staff knew how to safeguard the people they supported and cared for. Arrangements were in place to make sure sufficient numbers of skilled staff were deployed at all times. People’s individual needs and risks were identified and managed as part of their plan of care and support to minimise the likelihood of harm. However there were some other areas where risk to safety had not been identified.

Staff knew people well and understood people’s needs. However, although staff had received appropriate training, staff did not have an individual training plan, and refresher training in some areas to ensure they were skilled and competent to carry out their roles and responsibilities, had not been received by staff. Staff told us they received the support they needed to provide people with individualised care and support. However, records did not show staff were receiving organised and regular supervision and appraisal to receive support, guidance and to promote their personal and professional development in their role

There were systems in place to check certain aspects of the home however we found some deficiencies to do with assessment of people’s risks, staff training and supervision had not been identified and effectively addressed

Care plans reflected people’s current needs. They contained the information staff needed to provide people with the care and support they wanted and required. People were supported to choose and take part in activities of their choice. People’s dietary preferences and needs were understood by the service. People chose what they wanted to eat.

People were encouraged and supported to make decisions for themselves whenever possible and their independence was upheld and promoted. People were provided with the support they needed to maintain links with their family, friends and others important to them.

People were supported to maintain good health. They had access to appropriate healthcare services that monitored their health and provided people with appropriate support, treatment and specialist advice when needed. Systems were in place to make sure people received their medicines safely.

Staff understood the legal requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). They knew about the systems in place for making decisions in people’s best interest when they were unable to make one or more decisions about their care and/or other aspects of their lives.

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

Each person who used the service had a plan of care that had been regularly reviewed, and included information about the individual support and care that people who used the service needed.

People made choices about their lives. People told us that they were asked for their consent about matters to do with their care and treatment.

Staff knew about their roles and responsibilities in meeting the needs of the people they supported. There were enough skilled and experienced staff to meet people's needs.

The home was clean. People's health, safety and welfare were protected as they received the advice and treatment that they needed from a range of healthcare and social care professionals.

Records were accurate and up to date.

During this follow-up inspection we spoke to two people who used the service, a care worker and the manager. We also checked the premises and looked at records. We did this to make a judgement as to whether the provider was meeting the compliance actions Regulation 15 (Health and Social Care Act 2008 Regulated Activities) Regulations 2010 (Outcome 10 -Safety and suitability of premises), and Regulation 22 (Health and Social Care Act 2008 Regulated Activities) Regulations 2010 (Outcome 13 -Staffing).

At this inspection we found that the provider had taken action to ensure that people who used the service,staff and visitors were protected against the risks associated with unsafe or unsuitable premises and there were sufficient qualified, skilled and experienced staff to meet people's needs. The provider was compliant with the compliance actions that had been made during our previous inspection.

People informed us that care staff were attentive and responsive to their care needs. They had access to healthcare services and had their medication administered to them by care staff.

People's needs had been fully assessed. Appropriate care plans had been prepared and they were reviewed regularly. Most of the staff had worked in the home for many years and were knowledgeable regarding the care needs of people.

People said they were happy with their accommodation. The premises were clean and tidy. Bedrooms of people appeared comfortable and had been personalised by them. Safety inspections had been carried out on the gas and portable electrical appliances. Fire safety arrangements were in place. Improvements are however, needed in the staffing levels and in the maintenance of the premises.