Archived: Boscobel

Updated 20 March 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place over two days on 9 and 15 February. The first day of the inspection was unannounced.

The inspection was conducted by two adult social care inspectors.

Before the inspection we checked the information that we held about the service and the service provider. This included statutory notifications sent to us by the registered manager about incidents and events that had occurred at the service. A notification is information about important events which the service is required to send to us by law. We contacted professionals connected with the service and asked for their views. We used all of this information to plan how the inspection should be conducted.

We observed care and support and spoke with five people living at the home, a family member, four staff and one of the owners. We also spoke with two visiting healthcare professionals. The registered manager was not available on either of the inspections days. We spent time looking at records, including six care records, four staff files, medication administration record (MAR) sheets and other records relating to the management of the service.

Updated 20 March 2018

This unannounced inspection was conducted on 9 and 13 February 2018.

Boscobel 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.

Boscobel provides accommodation and personal care for up to 20 people with learning disabilities. It is a large Victorian property with accommodation located over three floors. A ramp and steps provide access to the front of the building. The upper floors are accessed via staircases. There is a dining area to the ground floor and a lounge. A garden area is located at the rear of the building and parking at the front. At the time of the inspection 13 people were living at the service.

A registered manager was in post. The registered manager was not available on either day of the inspection. A registered manager 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.

Following the last inspection in May 2017 the provider submitted an application to cancel the registration at Boscobel. At the time of this inspection the application was under consideration by the Commission.

At the last inspection in May 2017 we identified breaches of the regulations in relation to; person-centred care, dignity and respect, safe care and treatment, safeguarding service users from abuse and improper treatment, premises and equipment, good governance, staffing, fit and proper persons employed, requirements as to display of performance assessments and notification of other incidents.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when. As part of this inspection, we checked whether the actions identified in the provider’s action plan had been completed.

There was no evidence that risks had been reviewed in accordance with the provider’s action plan. The failure to review risk meant that the service could not be certain that people were protected from avoidable harm.

Recruitment practices had not been improved as required.

Applications to deprive these people of their liberty had not been submitted in accordance with the Mental Capacity Act 2005. This meant that people were at risk of being unlawfully detained.

There was no record to indicate that their competency had been checked in accordance with the principles of the Care Certificate. This meant that the service could not be certain that they met the required minimum standards and were able to deliver safe, effective care.

We found that health action plans were not consistently completed and one person’s record showed no evidence that a serious health condition had been reviewed.

None of the six plans we checked had been recently reviewed. This meant that the provider could not be sure that people’s care needs were accurately reflected in the records.

We looked care records and saw evidence that person-centred plans had been developed for some people. Where they had been fully completed they contained detailed information for staff about people’s histories, likes, dislikes and goals. However, of the six care records we saw, only four had a completed person-centred plan.

At the last inspection we identified that safety and quality audits had not been effective in identifying issues and driving remedial action. The records that we saw indicated that some progress had been made and that audits were now more extensive. However, there was no structured audit or oversight at provider level.

Improvements had been made to medicines’ management and medicines were safely managed in accordance with best-practice guidance.

At the last inspection the general level of cleanliness in the home was poor. As part of this inspection we checked to see if the necessary improvements had been made and sustained and found that they had been.

Staffing numbers were adequate to meet the needs of people living at the service. A minimum of three care staff were deployed on each daytime shift. This reduced to two waking staff overnight. Additional staff included a cook, a domestic and an administrator.

People spoke positively about the provision of food and drinks and were given a choice of meals.

We spoke with two visiting healthcare professionals about the quality of communication and support provided at Boscobel. Each person spoke positively about the timeliness of communication from staff and the effectiveness of staff support in following treatment plans. We were given examples where people’s health and wellbeing had improved following good partnership working with healthcare services. For example, one person had regained their mobility following a course of treatment.

Staff told us that they received regular training and supervision and felt supported by the registered manager and senior staff. We saw from records that the majority of staff had been given formal supervision since the last inspection.

People spoke positively about the staff and their approach to the provision of care. It was clear from our observations that staff knew people well and were able to respond to their needs in a timely manner.

People had access to a range of activities within their own homes and communities. Staff provided additional support as required. Activities included; watching television, movie nights, singers and crafts.

People’s rooms were personalised with personal items and family photographs. The rooms that we saw were decorated in different styles and colours and furnished to a basic standard.

The overall rating for this provider is 'Inadequate'. This means that it has been placed into 'Special

measures' by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action.

You can see what action we told the provider to take at the back of the full version of the report.