Background to this inspection
Updated
7 November 2019
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 Care Act 2014.
Inspection team
The inspection team consisted of two inspectors.
Service and service type
87 Bouncers Lane 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.
The service did not have a manager registered with the Care Quality Commission. A registered manager and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We looked at the notifications we had received for this service. Notifications are information about important events the service is required to send us by law. We reviewed information received from local authority commissioners and other professionals who visited the service. We used all of this information to plan our inspection.
During the inspection
We were not able to speak with people living in the service as they did not verbalise, but we observed interactions. We spoke with two family members and representatives to gather their views about the care their relative received. We spoke with six members of staff including the locality manager, the team leader and support workers.
We reviewed a range of records. This included three people’s care records and medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We requested and received feedback from four health and social care professionals who regularly visit the service.
Updated
7 November 2019
About the service
87 Bouncers Lane is a care home providing accommodation and personal care for up to three people with learning disabilities and autism. At the time of the inspection three people were living in the home.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This 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. However, people using the service did not always consistently receive planned and coordinated person-centred support that was appropriate and inclusive for them.
There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.
People’s experience of using this service and what we found
People were not always safe and were at risk of avoidable harm. Risks to people’s safety had not been regularly reviewed. Behaviours that challenged were not always managed well and the systems in place were not effective enough to mitigate these known risks. Medicines were not always managed safely.
There had been a significant turnover of support staff, managers and senior management. Relatives expressed great concern over this and told us people’s needs may not have been met. Professionals were concerned over the impact of many staff changes. Peoples anxiety resulting in challenging behaviours may have increased due to a disruptive staff team. Some staff were not trained in specialist behavioural management techniques.
The kitchen, shower room and some communal areas were not clean, outside the house appeared to be shabby. Inside, the house was bland and lacked homely comforts.
Although care plans were person-centred they had not been regularly reviewed. This meant that information on how to support the person was out of date and staff may not have followed appropriate guidance or practice.
The service did not consistently apply 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 using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. However, people's support did not always focus on them having as many opportunities as possible for them to gain new skills and become more independent.
The staff were caring and had positive relationships with the people they supported. People had their own private space and access to the communal areas and garden.
The provider had recruited a new home manager. There was confidence from the locality manager and support staff that this would mean improvements within the service.
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
The last rating for this service was good (published 07 February 2017).
Why we inspected
This was a planned inspection based on the previous rating.
You can see what action we have asked the provider to take at the end of this full 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.