Merle Boddy House

Updated 20 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 was undertaken by one inspector.

Service and service type

Merle Boddy House 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. This means that the provider is 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

The provider was asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We reviewed information we had received about the service since the last inspection. We used all of this information to plan our inspection.

During the inspection

We spoke with two people who used the service, four members of staff and the manager.

We reviewed a range of records. This included three people’s care records, three staff files in relation to recruitment. A variety of records relating to the management of the service, including audits were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and contacted four family members about their experience of the care provided. We contacted the nominated individual requesting audits for Merle Boddy House to see how the service was being monitored since the last inspection and what actions were being taken to ensure the required measures and support were in place to make the required improvements.

Updated 20 November 2019

About the service

Merle Boddy House is a residential care home providing personal and nursing care to people with learning disabilities or autistic spectrum disorder. The service can support up to ten people. At the time of our inspection there were eight people using the service.

The service had not been developed 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. People using the service did not receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. 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 supported to have maximum choice and control of their lives.

Risk assessments were not robust enough to ensure people were kept safe. Not all risks had been identified to ensure people were supported appropriately. Staff did not always keep up to date with changes to people’s risk assessments.

Staffing levels were not managed to ensure that staff could support people to access the community on an individual basis. People were not always supported to develop their interests and take part in their preferred activities. People were not being supported to develop in areas that were important to them.

People were not always supported with maintaining a healthy diet. People were not always involved with their care and support.

Staff received training, however, training in relation to supporting people with learning disabilities could be improved. We have made a recommendation in the report.

The service was not well-led and lacked leadership. Staff did not feel supported. Quality assurance systems did not identify issues which could pose a risk to people’s health and safety. Audits had failed to identify issues. Not all actions from the previous CQC inspection were completed to ensure the required improvements were made and lessons were learnt. Files were not always updated to be kept in line with best practice and to reflect people’s personal care needs.

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

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.

Rating at last inspection and update

The last rating for this service was Requires Improvement (report published 22 September 2018) and there was a breach 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 enough improvement had not been made and the provider was still in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive 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

We have identified breaches at this inspection in relation to person centred care and good governance.

For requirement actions of enforcement which we are able to publish at the time of the report being published:

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

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.