Bedborough House

Bedborough House is a residential care home providing the regulated activity accommodation for persons who require nursing or personal care to up to 8 people. The service provides support to autistic people, younger adults and people with learning disabilities. At the time of our inspection there were 6 people using the service.

Accommodation is laid out over 3 floors. Communal lounge and dining rooms are located on the ground-floor and bedrooms are located on the 1st and 2nd floors. All bedrooms have en-suite facilities and 4 have lockable kitchenettes. People have access to a communal kitchen and a large garden. The registered manager’s office is located on the 3rd floor.

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

Right Support: Areas of the service were visibly unclean and had not been adequately maintained. We observed staff smoking in close proximity to people’s accommodation. There were sufficient numbers of staff to keep people safe. A positive behaviour support coordinator analysed potential triggers of behaviours that may challenge others to help prevent a recurrence.

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.

Right Care: Staff spoke about and treated people in a person-centred way. The provider had introduced equality and human rights care plans to support staff to identify and promote these needs. People were supported to maintain relationships with relatives and friends important to them.

Right Culture: Audits and checks were not always used effectively and consistently to identify shortfalls and drive improvement in the service. Staff spoke positively about the registered manager. The registered manager said activities provision was an area for development and records did not always reflect what activities people were involved with.

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 good (published 19 January 2021).

Why we inspected

We received concerns in relation to the management of medicines and staffing. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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

Enforcement

We have identified breaches in relation to the application of the Mental Capacity Act (MCA), the safety of the premises and the efficacy of checks and audits.

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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Bedborough House is a residential care home providing personal care for up to eight people with Autism and/or other learning disabilities. At the time of the inspection five people were living at the home. The home consists of four en-suite bedrooms and four flats which have en-suite bedrooms and a kitchenette. There is also a communal lounge and kitchen available for people to use.

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

People’s experience of using the service had improved since our last inspection. 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.

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 guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture. People lived in a service that supported them with their independence. One to one and two to one staffing was now available for people to access their choice of activities. Care was person centred and promoted people’s dignity, privacy and human rights. The culture of the service had improved significantly. People’s relatives and staff told us how the leadership and management of the service had improved. The manager and staff team had a good set of values focused on promoting the wellbeing of the people they supported. The ethos of the service was for people using services to lead empowered lives.

Relatives told us their family members were safe. Staff knew how to recognise and report abuse. There was a consistent staff team in place. There were enough staff to meet people’s needs and enable them to engage in their chosen activities. Staff were recruited safely. Risks to people were identified and managed. Medicines were managed safely. Infection control was managed safely. Incidents were recorded and analysed, learning from incidents was shared with the team.

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.

Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills and knowledge required to support people with their needs. Staff received one to one supervision and told us they felt supported.

People’s healthcare needs were identified and met. Staff worked with a range of healthcare professionals and followed professional advice and guidance when needed.

People were supported by caring staff who worked towards promoting their dignity, privacy and independence.

Where relatives and people had raised concerns and complaints, relatives told us they were now listened to and responded to.

Relatives and staff commented positively about the manager and leadership of the service. The provider had a range of governance systems in place to ensure oversight of the service. The provider and manager also had ongoing action plans and sustainability plans in place. They were able to demonstrate how they had embedded systems and improvements into practice since the last inspection in July 2019. Senior managers also regularly visited the home.

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, the inspection was carried out in July 2019, (published 04 May 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures following the last inspection in July 2019. During this inspection the provider demonstrated that improvements have been made and embedded into practice during the time since the last inspection. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

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.

About the service: Bedborough House is a residential care home and was providing personal care to six young adults at the time of the inspection. The service can support up to eight people with Autism and/or other learning disabilities. The home consists of four en-suite bedrooms and four flats which have en-suite bedrooms and a kitchenette. There is also a communal lounge and kitchen available for people to use.

The service had not been developed and designed in line with Registering the Right Support and other best practice guidance. Registering the Right Support 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 had not received planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service and what we found : People were not supported to have maximum choice and control of their lives. Staff had not always supported people in their best interests even though the policies and systems in the service supported this practice. We were not able to converse with all people fully, however two people agreed that staff were caring.

The service didn’t apply the full range of 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.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons; limited independence and limited inclusion e.g. People did not receive the activities of their choice and were not involved in the local community.

There were widespread and systemic failings identified during the inspection. The quality and safety monitoring systems used by the provider were not fully effective in ensuring the quality of service provision and mitigate risks to people. This did not ensure people were treated with kindness, dignity and respect.

The provider had failed to make appropriate statutory notifications; notifications tell us about significant events that happen in the service. We use this information to monitor the service and to check how events have been handled. Safeguarding incidents had not been identified and reported.

The guidance within peoples' risk assessments were not always followed by staff and records used to monitor peoples' health were not always completed. This exposed people to risks of neglect and unsafe or inappropriate care or treatment. People had access to healthcare professionals however we were not assured that staff always identified when referrals were required. People did not always receive their prescribed medicines as required.

The environment was not maintained effectively, and there was an infection control risk to people using the service.

The provider had a complaints procedure however, not all complaints had been recorded as such or investigated following the provider's complaints procedure.

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 (August 2018).

Why we inspected : The inspection was prompted in part due to concerns received about medicines, staffing, people’s safety, access to activities and record keeping. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see all of the sections of this report.

Enforcement: We have identified breaches in relation to medicines, the environment, safeguarding, dignity and respect, infection control, person centred support, staffing, complaints, statutory notifications and governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up: We will request an action plan from 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.

Special Measures: 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.

We are mindful of the impact of 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 regularly monitor the service including requesting an action plan to be submitted to keep

people safe.

[Care home name] is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Describe the care home's premises, for example:

(The care home) accommodates xx people in one adapted building.

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The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.' Registering the Right Support CQC policy

'A registered manager is a person who has registered with the Care Quality Commission 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.'