The inspection took place on 20 February 2017 and was unannounced. Garden House provides accommodation and care to a maximum of 14 adults who may have complex mental health needs. On the day of the inspection 14 people lived in the home. Garden House is owned by Bowden Derra Park Limited. Bowden Derra Park Limited also provides care in five other residential homes and one nursing home across the same site and in Polyphant village, near Launceston.A registered manager was employed to manage the service. 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.
The inspection was undertaken in response to concerns raised by the local authority about the services run by Bowden Derra Park Limited.
The issues raised included staff turnover, staff working long hours, lack of staff training, and staff not seeking advice from external professionals or following guidance supplied. There were also concerns whether people were being kept safe, including from the risk of fire or those posed by other people’s behaviour. Concerns were also raised about people living with people that they were not compatible. We were told people were potentially not being supported according to their assessed needs, were having their choices restricted, particularly regarding food, drinks and activities. Also, people were carrying out work they were not paid for and being charged for facilities owned by the provider that should have been included in their fees.
People were supported by a sufficient number of staff. Relatives told us there were enough staff on duty and we observed unhurried interactions between people and staff. This meant people’s needs were met in a timely manner. One staff members told us, “Staffing levels are good.” Staff and relatives told us they felt the staff team was consistent. The registered manager confirmed and rotas showed staffs’ working hours complied with working time regulations. Staff told us they did not work long hours and they had recently been consulted about shift times and patterns to see if any improvements could be made.
A comprehensive training programme was in place which included induction training, mandatory training and training to support people’s individual needs. Staff told us their training was updated regularly and they could request extra training they felt they would benefit from. One staff member told us, “I think the training here is brilliant.”
People, relatives and staff told us people were safe. Staff members commented, “I would definitely say people are safe” and “People are definitely safe. I would not be here if I felt there were any concerns” Risk assessments, guidelines, policies and procedures were all used to help ensure staff supported people’s safety. A fire risk assessment was in place and regular checks were carried out of fire equipment and staff knowledge of evacuation procedures. People had up to date personal emergency evacuation plans (PEEPs) in place.
The registered manager and staff told us before people moved into Garden House, their needs were assessed to help ensure the service could meet their needs and that other people already living in the service would not be adversely affected. If the person’s needs changed or they were not compatible with other people living there, the registered manager told us they contacted the local authority for support to find an alternative place for them to live.
People had personalised care plans in place. Staff and relatives confirmed people and their relatives were involved in ensuring records reflected people’s needs and wishes. Staff and relatives confirmed support was provided in line with people’s care plans. Comments from staff members included, “The care plans are good and are in the process of being updated” and, “The care plans are good, they are quite concise and informative.” People’s private information was not always locked away. This meant it was possible for other people to have access to it. We have made a recommendation about this in the report.
People’s care plans and risk assessments showed advice had been sought from external professionals regarding people’s health or social care needs. Staff and relatives confirmed this guidance was followed.
When people experienced behaviour that could challenge others, advice from professionals was sought and any related incidents were recorded and monitored. Guidelines were put in place for staff to understand the best way to support people at these times. Staff were due to receive training to give them a deeper understanding of how to support people effectively. Any change or increase in incidents prompted a referral to external agencies for further advice and support.
People told us they enjoyed the food and confirmed they could choose what and where they wanted to eat. Mealtimes were a positive experience, which people looked forward to. People told us meals were of sufficient quality and quantity and there were always alternatives on offer for them to choose from. Residents’ meetings were used to gain people’s opinions and suggestions regarding meals offered; a relative confirmed comments they had made had been acted upon.
We observed people taking part in different activities and records showed people regularly took part in internal and external activities. However, when people had not taken part in activities, records did not show whether this was the person’s choice, if alternatives were offered or if any further action was taken to help ensure their needs and wishes were being met. We have made a recommendation about this in the report.
The registered manager, staff and relatives confirmed no-one paid for using the onsite facilities owned by the provider. The registered manager confirmed no-one currently living in Garden House worked paid or unpaid at any Bowden Derra services or facilities. We found no information to suggest people living at Garden House were undertaking paid or unpaid work at Bowden Derra Park.
People received support from staff who knew them well and had the knowledge and skills to meet their needs. People and their relatives spoke highly of the staff and the support provided. Comments included, “Staff are caring and cheery. They have a bit of a spark and are creative.”
There was a positive culture within the service. The registered manager had clear values about how they wished the service to be provided and these values were shared by the whole staff team. Staff talked about ‘personalised care’ and ‘respecting people’s choices’ and had a clear aim about improving people’s lives and opportunities.
Staff were recruited safely. Checks were carried out prior to staff commencing their employment to ensure they had the correct characteristics to work with vulnerable people. Staff had received training in how to recognise and report abuse and were confident any allegations would be taken seriously and investigated to help ensure people were protected. Staff were supported in their role by an ongoing programme of supervision, appraisal and competency checks.
The registered manager and staff had attended training on the Mental Capacity Act 2005 (MCA).
Staff were knowledgeable about the Mental Capacity Act and how this applied to their role. Where people lacked the capacity to make decisions for themselves, processes ensured that their rights were protected. Where people’s liberty was restricted in their best interests, the correct legal procedures had been followed.
Learning from events, feedback received about the service and outcomes from audits were used to aid change and drive improvement across the service. The manager and staff monitored the quality of the service regularly by undertaking a range of regular audits and speaking with people to ensure they were happy with the service they received. People and their relatives where appropriate, told us the management team were approachable and included them in discussions about their care and the running of the service.