Bole Aller House

Updated 5 November 2022

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 Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two adult social care inspectors, a member of the CQC medicines team and two Experts by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Bole Aller is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Bole Aller is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make.

We used information gathered as part of monitoring activity that took place on 26 July 2022 to help plan the inspection and inform our judgements.

We used all this information to plan our inspection.

During the inspection

Two inspectors visited Bole Aller House on 29 September 2022. One inspector visited with an expert by experience on 3 October 2022. We spoke with 11 people who used the service. We spoke with seven members of staff including the registered manager. We also spoke with a representative from the provider.

We observed people’s experience in the communal areas of the Stables, Angel House, and the main house. We also visited two people’s individual bungalows and saw three people’s bedrooms.

We reviewed a range of records. This included eight people’s care records and a variety of records relating to the management of the service such as policies and procedures, training records, audits and health and safety records.

We checked seven people’s medicines records and looked at arrangements for administering, storing and managing medicines.

Following our visits an Expert by Experience spoke with two relatives about their experience of the care provided and we sought feedback from health professionals involved in the service.

We discussed the oversight of the service with the registered manager and deputy manager on 10 October 2022.

Updated 5 November 2022

About the service

Bole Aller House (hereafter referred to as Bole Aller in the report) is a residential care home providing accommodation and personal care. The home is registered to provide care to up to 23 people. The home specialises in the care of people who have mental health needs and/or a learning disability. At the time of our inspection there were 19 people living at the home. The home is made up of different living areas known as The Main House, The Stable Block, Angel House and The Bungalows.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Where people lacked capacity to make decisions, the provider had failed to put in place documents to support decision making. Restrictions in people’s lives had not been considered to ensure the least restrictive options for individual people were identified.

The senior team in the home were responsive to our questions about restrictive practices and started to implement a program of review and change.

People did not all have up to date outcome focused support plans. People were not always supported to contribute to and agree support plans in ways that were meaningful to them.

Risk management was inconsistent. A lack of support plans and assessments in place meant the staff approach to risk varied. People were mostly not put at risk of harm due to this inconsistency however, it did lead to people being required to accept varying levels of restrictions in their lives.

A failure to record and monitor incidents consistently meant there were missed opportunities to avoid and reduce risks in ways that respected people’s views.

People lived in an isolated physical setting that meant most people needed staff support to go into town. Staff were alert to the potential risks associated with this, and most people went into town on a minimum of a weekly basis. The physical environment also had an impact on people’s access to the internet which put people at risk of reduced access to information and online activity. The provider was seeking to redress this issue.

People accessed specialist health and social care support where appropriate. People’s medicines were managed safely, and they received them in the way prescribed

Right Care:

People’s care plans did not show how restrictions had been agreed upon with them. There was little evidence that historical restrictions were reviewed to enable people more responsibility and freedom. In some instances, restrictions were imposed on people because of the assessed needs of other people living at the home.

Staff spoke with genuine warmth and affection for people and this care and warmth was felt by the majority of people living in the home. However, this care was not always designed to promote people's human rights.

There was a core team of staff who knew people's needs and were kind and caring.

Right Culture:

There was a failure to identify and mitigate institutionalised practices. A number of restrictive practices were found, and the routines within the home were not always personalised to individual people. The service had not been supported by the provider to ensure they were aware of and implementing current best practice and guidelines.

Internal quality assurance systems and governance processes were in place to audit or review service performance and the safety and quality of care. This oversight had not always identified or prevented issues occurring or continuing at the service. People’s rights were not embedded in these oversight tools.

There was a caring culture evident in the service. The senior team were available to the people and staff team.

The senior team in the home were committed to ensuring the best possible care and support for people.

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 22 February 2019)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bole Aller 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 monitor the service and will take further action if needed.

We have identified breaches in relation to risk management, consent and governance at this inspection.

Please see the action we have told the provider to take at the end of this 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 continue to monitor information we receive about the service, which will help inform when we next inspect.