Boulevard House

Updated 28 November 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 2 inspectors and an Expert by Experience made phone calls to relatives. 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

Boulevard 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. Boulevard 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 a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We looked at the information we held about the service. This included, feedback, notifications and the actions taken by the provider since the last inspection. We requested feedback about the service from Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. The provider was not asked to complete a 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. We used all this information to plan our inspection.

During the inspection

We spoke with 6 people who used the service and 5 relatives on the telephone. We spoke with 6 staff members. These included 3 care staff, 2 senior care staff and the registered manager. We looked at a range of information. This included 6 care records, 8 medicines administration records (MAR) and associated documents. We also checked 2 staff files, training records and information about the operation and management of the service.

Updated 28 November 2023

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.

About the service

Boulevard House is a residential care home providing accommodation and personal care to up to 15 people. The service provides support to people with a learning disability. The accommodation comprises of a bungalow with 3 bedrooms and a main house with 12 bedrooms. At the time of our inspection there were 11 people using the service.

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

Right Support

Risks were not always assessed or managed to ensure staff had the appropriate guidance to keep people safe. The use of restrictive interventions had not been risk assessed so we could not be assured people would be kept safe if restrictive practice was used. Restrictive interventions are interventions that restrict or limit what people can do or where they can go; they can also be used to subdue or control distressed reactions. Restrictive intervention includes physical restraint which is any direct physical contact where the intention is to prevent, restrict, or subdue movement of the body, or part of the body of another person.

Positive behaviour support plans did not give enough information to staff on whether restrictive interventions could be used when people were distressed. Staff told us they had training in prevention and management of violence and aggression but did not need to use it.

Improvements had been made to how incidents were recorded and responded to. Further action was required to ensure documentation and management oversight was consistently completed to ensure it was clear what strategies or interventions had been used when people were distressed.

We could not be assured body maps were effectively used to document and illustrate visible signs of harm and physical injuries. Body maps that had been created, were seen to not be reviewed to track progress and ensure the appropriate treatment was being given.

Further improvements were needed to ensure medicines were managed and administered safely. There had been a reduction in the use of prescribed 'as required' (PRN) medicines, used when people were distressed.

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. However, Deprivation of Liberty Safeguards and the key requirements of the Mental Capacity Act 2005 were not fully understood by the management team.

Right Care

There were sufficient staff to meet people's needs. Most staff had the right skills and competency to meet people’s care and support needs. Staff knew people well and the staff rota provided consistency for people who required this.

People received opportunities to lead active and fulfilling lives, social inclusion and independence was promoted as much as possible.

People had choice and access to sufficient food and drink.

Right Culture

The provider's governance arrangements did not provide assurance the service was well-led. Systems and processes to oversee the safety and quality of the service were effective and had not identified the shortfalls we found during our inspection. Although improvements had been made since the last inspection, these were ongoing and regulatory requirements continued not to be met.

Staff knew and understood people well. There was a clear commitment to minimising the use of restrictive interventions and supporting people to have choice and control over their lives.

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 11 February 2023).

We issued the provider with a warning notice asking them to make improvements in relation to person-centred care, consent, safe care and treatment, safeguarding, good governance and staffing. The provider completed an action plan after the last inspection to show what they would do and by when to improve in relation to requirements. At this inspection we found the provider remained in breach of regulations.

This service has been in Special Measures since 10 February 2023. During this inspection the provider demonstrated that improvements have been made. 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 inspection was prompted by a review of the information we held about this service and to follow up from the previous inspection. 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 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.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, safeguarding and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.