Boston House

Boston House is a care home providing support for people with complex needs following a brain injury. The service is based in Oldham and can support up to 17 people. The building is divided into three units. At the time of our inspection the service was supporting 14 people; 3 more independent people were living on Rose unit, 6 people on Lavender unit, each with their own studio apartment and ensuite facilities, and 5 people on Sunflower unit, with a higher level of dependency.

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

At the last inspection there were concerns in relation to the safe management of medication. At this inspection we found managers had addressed the issues from the last inspection, however, some medicines remained unsafely managed. The provider responded immediately during and after the inspection and put an action plan in place to immediately address the issues we found with the safe management of medicines.

Systems in place helped safeguard people from the risk of abuse. Assessments of risk and safety and supporting measures in place helped minimise risks. Staff followed infection prevention and control guidance to minimise risks related to the spread of infection. Staffing levels were sufficient to meet people’s needs and managers recruited staff safely. Staff followed an induction programme, and training was on-going throughout employment.

Care plans included information about support required in areas such as nutrition, mobility and personal care to help inform care provision. Staff made appropriate referrals to other agencies and professionals when required.

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.

People told us they were well treated and their equality and diversity respected. People felt staff respected their privacy and dignity and took into account their views when agreeing on the support required. Staff identified people’s communication needs and addressed these with appropriate actions.

The registered manager responded to complaints appropriately and used these to inform improvement to care provision. The provider was open and honest, in dealing with concerns raised. The registered manager was available for people to contact and undertook regular quality checks, to help ensure continued good standards of care.

The provider and registered manager followed governance systems which provided oversight and monitoring of the service. Some improvements had been made to governance systems and were embedded into practice, but more improvements were necessary.

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 requires improvement (published 02 September 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last 3 consecutive inspections.

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 the provider remained in breach of regulations.

At our last inspection we recommended that the provider reviews their quality assurance process to ensure internal oversight. At this inspection we found the provider had acted on this recommendation and had made some improvements to their governance arrangements, however further improvements were needed.

Why we inspected

We carried out an announced comprehensive inspection of this service on 16 June 2021. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe 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.

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.

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

Enforcement

We have identified breaches in relation to safe care and treatment at this inspection. Please see the action we have told the provider to take at the end of this report. The provider responded immediately during and after the inspection and put an action plan in place to immediately address the issues we found with the safe management of medicines.

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

Boston House is a care home providing support for people with complex needs following a brain injury. The service is based in Oldham and can support up to 17 people. The building is divided into three units; a residential unit, a nursing unit and six studio apartments. At the time of our inspection the nursing unit was closed and the service was supporting ten people.

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

At the last inspection we found there were concerns in relation to the safe management of medication. At this inspection we found the management team had addressed some of the issues from the last inspection. However, medicines remained unsafely managed. We observed some staff not wearing personal protective equipment (PPE) appropriately. We discussed this with the management, who took immediate action to address this. The registered manager advised action would be taken against staff who were not compliant with wearing PPE appropriately.

People and relatives said care was provided in a safe way. Risks to people’s health and wellbeing were assessed and clear guidance was provided to staff on how to support people. Staff demonstrated a good understanding of how to safeguard people from the risk of harm and abuse. Some staff said they did not feel confident they would know what to do in the event of a fire. The registered manager scheduled fire drills and stated that people’s evacuation plans would be reviewed as a priority. We have recommended the provider follows guidance relating to fire safety.

People living at the service were able to provide limited feedback. However, we observed care being provided in accordance with the information recorded in people’s care plans. Relatives reported that they were involved in decisions made about people’s care and in the development of care plans, risk assessments and activity plans. Communication plans had detailed information recorded in them and were personalised.

Staff had received a robust induction programme and subsequent training relevant to their role. Systems were in place for the management, supervision and support of staff. Staffing levels had been impacted by several staff leaving the service in a short space of time. However, new staff were going through the recruitment process and were expected to start imminently. Staff reported the management team were implementing new systems to improve the service, such as recording systems and drop-in sessions for staff to share their views, concerns and suggestions for improvement.

Person centred care was evident in people’s records, such as risk assessments and care plans; it was also evident in the providers policies and in the interactions between people and staff. Relatives praised the services flexibility in how they supported people and felt staff were warm and caring in their approach.

Relatives reported they had been kept up to date with any changes in people’s lives and when things had gone wrong. They also felt the provider consulted them to gather important information, so they knew how to best support people. The provider had good links with local health and social care partners.

The providers oversight was completed using audits that could be transferred onto an electronic recording system. This helped the provider highlight any trends, learning or good practice. The provider used independent auditors to ensure they were identifying any areas for improvement or where things had gone wrong without bias. However, the medicines audit had not identified the same issues we found at this inspection. We have recommended the provider reviews their quality assurance process to ensure internal oversight.

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.

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)

At our last inspection the service was inspected but not given an overall rating. However, the service was rated as requires improvement in the safe and well-led sections of the report (published 18 November 2020).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about staff support of a person with complex needs and associated risks. 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 the safe 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

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 Boston House on our website at www.cqc.org.uk

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.

Since the last inspection we recognised that the provider had failed to manage medicines safely. This was a breach of regulation. Full information about CQC’s regulatory response to this is added to reports after any representations and appeals have been concluded.

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.

Boston House provides support for people with complex needs following a brain injury. It is a new service which opened in January 2020 in Oldham, and can support up to 17 people. The building is divided into three units: a residential unit, a nursing unit and six studio apartments. At the time of our inspection the nursing unit was closed. The service was supporting seven people.

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

Medicines were not always managed safely.

Correct infection control procedures were followed and the service had taken additional infection control measures to minimise the risk posed by COVID-19.

Relatives told us they were happy with the care and support provided by staff.

Staff demonstrated a good understanding about how to safeguard people from the risk of abuse. Recruitment procedures were robust and there were enough staff to care for people safely. Staff had completed appropriate training and received regular supervision to help develop their skills.

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.

There was a new management team at the service. We received positive feedback about their management and leadership from everybody we spoke with. Staff told us there was a positive culture at the service and that staff morale had improved over recent weeks.

The service used a range of audits and monitoring tools to assess the quality and safety of the environment and care provided. However, the medicines audits had not identified all the concerns we found during our inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

Boston House was registered with us on 17 January 2020. This is the first inspection of the service.

Why we inspected

The inspection was prompted in part due to concerns received about the management of medicines. As a result, we undertook a focused inspection to review the key questions of safe and well-led. We have not provided an overall rating for the service, as we have only inspected two key questions.

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 coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

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 have identified a breach of regulations in relation to the management of medicines. Please see the action we have asked 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.