Bodnant House

Bodnant House is a residential care home registered to provide accommodation and personal care for adults who may be living with a learning disability, autistic spectrum disorders, mental health needs, and sensory impairments. The care home accommodates up to nine people in one adapted building. At the time of the inspection there were six people living at Bodnant House.

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

We expect health and social care providers to guarantee people living with autism 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 the Care Quality Commission (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 some of the underpinning principles of Right support, right care, right culture. People received care that was person-centred and promoted their dignity, privacy and human Rights. People had choice and control about their lifestyles and the support they needed. The values and attitudes of the management and the staff provided a person-centred culture and achieved good outcomes for people.

Systems in place to safeguard people from potential harm had been reviewed and enhanced to ensure people were protected. All staff had completed training about safeguarding and whistle blowing to support people to stay safe.

There were risk management plans in place to keep people safe and we found these had been improved to provide more detail and were reviewed regularly or when people’s needs changed.

The manager had implemented a dependency tool to ensure staffing numbers were sufficient to meet people's needs. We found there were sufficient numbers of staff to meet people's needs safely. The staff rota showed when people needed one to one care and who was going to support them.

The provider had made improvements to the recruitment practices and records showed that all the necessary staff recruitment checks had been followed when new staff had been employed. This was to ensure that staff employed to work at the service were suitable to support vulnerable people.

The systems in place to manage medicines safely had been improved to ensure people received their medicines as prescribed. All staff who were required to administer medicines had their competencies checked and weekly audits of medicines had been completed so any areas of concern were identified and actioned swiftly.

Systems were in place to control and prevent the spread of infection. Staff completed training in relation to the control of infection which included personal protective equipment (PPE), hand hygiene and COVID-19. We observed staff using personal protective clothing and equipment safely.

Improvements had been made to the systems in place to ensure lessons were learned and improvements made when things went wrong. Records showed that lessons learned were discussed during staff meetings every month and during staff supervision. Staff were able to reflect on incidents and learn from them when they did not achieve the desired outcome.

The systems in place to maintain effective oversight of the quality and safety of the service had been reviewed and improved to ensure they were effective. Monthly and weekly quality checks were completed by the manager and the provider also undertook unannounced spot checks at the service.

Records management had improved, and we found systems in place to be organised with detailed records that were fully completed and reviewed on a regular basis.

Accidents and incidents were recorded, and the manager and provider had implemented more effective processes to analyse these to identify any areas that may need improvement.

The provider had improved their systems to ensure they notified the Care Quality Commission of incidents that affect the health, safety and welfare of people who used the service.

The provider and manager had enhanced the way they involved and engaged with people. We saw that meetings with people using the service and staff were held monthly and follow up action had been taken when necessary.

The provider and manager had improved how they worked in partnership with key organisations. We found they had worked closely with the local authority, safeguarding teams and clinical commissioning groups to make significant improvements at the service.

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 22/09/2020) 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 since 22 September 2020. 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

We carried out an unannounced inspection of this service on 13 July 2020. Multiple breaches of legal requirements were found. Already stated above.

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.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this 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 COVIS-19 and other infection outbreaks effectively.

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

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.

Bodnant House is a residential care home registered to provide accommodation and personal care for adults who may be living with a learning disability, autistic spectrum disorders, mental health needs, and sensory impairments. The care home accommodates up to nine people in one adapted building. At the time of the inspection there were eight people living at Bodnant House.

Services for people with learning disabilities and or autism are supported. 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 did not fully reflect the principles and values of Registering the Right Support for the following reasons. People did not always receive person-centred care and treatment that was appropriate to meet their needs and reflected their personal preferences. Their care and support did not always promote enablement, independence, choice and inclusion. The systems in place to prevent and respond to crisis situations, including training in positive behaviour support, safe use of restrictive interventions and learning from incidents was not always used safely and effectively.

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

There was a registered manager for Bodnant House. However, they were not available to support the inspection. A new manager had been in post for a week and they were being supported by the area manager.

People were not always protected from the risk of harm or abuse because the systems and processes in place to safeguard people were not effective. Incidents of abuse were not always identified, reported to safeguarding, the police or notified to the Care Quality Commission.

Care plans and risk assessments did not contain adequate information for staff to know how to support people to manage their behaviours safely. Physical intervention techniques were not always carried out safely and in line with best practice guidance.

People’s care did not support them to learn new skills, become more independent and achieve good outcomes. Care plans did not record people’s goals or celebrate their achievements.

Robust recruitment checks had not been completed to ensure only suitable people were employed to work at the service. Systems in place to audit medicines were not comprehensive and did not include medicines to be given ‘as needed’ (PRN) or controlled medicines.

There were no lessons learnt protocols in place so the provider could learn from incidents and accidents, safeguarding concerns and complaints to improve the quality of the service. Following incidents where physical intervention had been used there was no debrief for staff so that lessons could be learnt.

There was a lack of quality assurance processes in place to monitor the quality and safety of the service. There was a clear lack of provider oversight and they had not ensured effective and competent management was in place.

Feedback from people was not sought on a regular basis. When feedback had been gained the provider had failed to act upon it to drive improvements at the service.

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 18 March 2018)

Why we inspected:

We received concerns in relation to the safe use of restrictive interventions and safeguarding people from abuse. In addition, we received concerns about a lack of consultation with people about changes to their care, a lack of notifications in relation to incidents and insufficient staffing. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 them. 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 Inadequate. This is based on the findings at 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 Bodnant 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.

We have identified breaches in relation to safe care and treatment, safeguarding service users from abuse and improper treatment, poor recruitment processes, good governance and a failure to send legally required notifications to the CQC.

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

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

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.

• People said they felt safe at the home. Risks to people’s health, safety and welfare had been identified and were known by staff. Risk assessments relating to the environment were in place to keep people safe. Staffing levels were appropriate to meet the needs of the people using the service. People told us they thought the home was well-staffed. The registered manager put extra staff on duty where necessary, for example if people were unwell. Medicines were safely managed. The home was clean, tidy and fresh. There were systems in place to monitor incidents and accidents and learn from these.

• People’s care, health and cultural needs were identified so staff could meet these. The staff were skilled and competent and knew the people they supported well. People said they liked the food served and had a choice of English and Indian dishes. People were supported to maintain good health and referred to health professionals when required. The design and decoration of the home suited people’s needs. Staff worked within the principles of the Mental Capacity Act (MCA) 2005 and ensured people consented to their care.

• The staff were caring and kind. They talked with people in a supportive way and reassured them when necessary. People told us they liked living at the home and had good relationships with the managers and staff. People and their relatives were regularly asked for their views on the care provided. Staff respected people and treated them with dignity and respect.

• People received good quality care and support. Care plans were written from the perspective of the person using the service and set out how staff should meet their needs. The multicultural, multilingual staff team were knowledgeable about people’s cultural needs. Managers and staff ensured information was provided to people in an accessible format. People took part in a range of group and one-to-one activities depending on their preferences. People said they knew how to make a complaint if needed.

• People told us the home was well managed and had an open and friendly culture. The managers and staff were approachable and helpful. Staff said the home had a family atmosphere and they felt well-supported by the managers. The home’s audit system covered all aspects of the service and helped to ensure the care people received was safe and the environment fit for purpose and well-maintained. People were involved in how the home was run on a one-to-one level, at meetings, and through quality assurance questionnaires. Managers and staff worked in partnership with other agencies to ensure people got the care and support they needed.

For more information please see the Detailed Findings below.

Our last inspection report for this service was published on 18 May 2016 and the rating was ‘Good’.

Bodnant House is a residential care service providing personal care and support for up to 10 younger and older adults living with learning disabilities, autistic spectrum disorders, mental health needs, and sensory impairments. At the time of our inspection there were nine people using the service.

This was a scheduled inspection based on the service’s previous rating.

Bodnant House is a residential care service providing personal care and support for up to 10 younger and older adults living with learning disabilities, autistic spectrum disorders, mental health needs, and sensory impairments.

The premises are on three floors, all bedrooms are single, and there is a lounge and a separate dining room on the ground floor. There is a secluded garden at the rear of the home. At the time of our inspection there were seven people using the service.

The service did not have a registered manager. This 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. At the time of our inspection the manager had applied to become registered with CQC and their application was being processed.

Bodnant House had a lively, friendly atmosphere. The people who lived there came in and out of the premises with staff on various errands. We observed plenty of interaction between the people using the service, relatives, staff, the managers, and the provider. Everyone seemed to get on well and was sociable. Bodnant House was to be a homely place where group living was working well and people were happy and settled.

All the people using the service and relatives we spoke with said the staff were caring and kind.

Staff took an interest in the people they supported and encouraged them to develop their hobbies and interests. They talked, ate, and did activities with them. People were also encouraged to be independent and to get involved in the day to day running of the home. One relative told us this had given their family member a sense of responsibility which was positive for them as it improved their self-esteem.

People told us they felt safe at the service and relatives also said they thought their family members were safe. One relative said their family member had been at risk of harm prior to coming to the service but was now safe. Staff were trained in safeguarding and knew what to do if they had concerns about any of the people using the service. Risks were safely managed because staff enabled people to do what they wanted to do with measures in place to help ensure they remained safe.

There were enough staff on duty to keep people safe and meet their needs. The staff employed had the right skills and experience to work with the people using the service. People had their medicines safely and at the right time. We observed that staff knew the people they supported well and worked confidently with them. They were knowledgeable about people’s day to day needs and knew their likes, dislikes, and how they preferred to be supported.

People using the service and relatives said the food was good and included both English and Indian dishes. People chose what they ate and helped in the kitchen if they wanted to. Staff were aware of people’s likes and dislikes and any cultural requirements they might have with regards to their diets.

Staff supported people them to maintain good health and access healthcare services if they needed to. They understood where people might be at risk of poor health and what they needed to do to address this. They accompanied people to the doctor or to other healthcare appointments when necessary. Staff encouraged people to lead a healthy lifestyle by encouraging them to eat well, exercise, and take care of themselves.

People using the service were involved in how it was run. They were asked for their views and suggestions at regular house meetings held every one to two months, and during reviews and meetings with staff. The manager also spoke with them on a daily basis, as did the provider when he visited, to check they were satisfied with the service. Annual surveys gave people using the service, relatives, and visiting professionals the opportunity to comment on the service.