Bourne Hill Care Home

Updated 22 October 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 carried out by one inspector.

Service and service type

Bourne Hill Care Home 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 had a manager registered with the Care Quality Commission. This means that they and the provider are 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

Prior to the inspection, we reviewed the information that we held about the service and the provider including notifications affecting the safety and well-being of people who used the service. We also looked at the action plan that the provider had submitted following the last inspection in August 2018 which listed the improvements they planned to make. Due to technical problems, the provider was not able to complete a Provider Information Return. 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 also used all of this information to plan our inspection.

During the inspection we spoke with three people using the service and four relatives to obtain their feedback on the care and support that they or their relative received. Only one person we spoke with was able to communicate and respond to the questions we asked. Other people responded through some use of words or through expressions. We also observed interactions between people and care staff. We spoke with the nominated individual, registered manager, and four care staff. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We looked at three care records and medicines administration records and medicine supplies for four people who used the service. We also looked at the personnel and training files of three staff. Other documents that we looked at relating to people's care included risk assessments, staff meeting minutes, handover notes, quality audits and policies and procedures.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We also received feedback from one health care professional.

Updated 22 October 2019

About the service

Bourne Hill Care Home is a residential care home providing accommodation and personal care for people living with autism and learning disabilities.

Bourne Hill accommodates up to five people in one adapted building. At the time of the inspection there was four people living at the service.

The service has been developed and designed 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 receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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.

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

We observed throughout the inspection that people were supported by staff who were kind, caring and respectful in their approach.

People knew the staff team that supported them and were observed to be at ease and reassured in their presence.

Care staff knew people well. We saw staff communicate and respond to people using ways and methods which people understood, especially where some people were non-verbal or presented with behaviours that challenged.

Relatives complimented the ways in which their relative was supported by the service and were re-assured that their relative was safe whilst in the care of Bourne Hill Care Home.

People were supported and encouraged to access the community, participate in activities as well as be involved with daily living tasks where possible. However, we found that the service did not always focus or take a creative approach on activities that took into consideration people’s hobbies and interests.

Risk assessments in place were comprehensive and person centred. Assessments provided clear guidance and information to care staff on how to minimise identified risks and keep people safe.

People received their medicines safely and as prescribed. Policies in place supported this.

All staff recruited to work at Bourne Hill Care Home had been assessed as safe to work with vulnerable people. Staffing levels were enough to ensure that people’s needs were met.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Care plans were person centred and gave comprehensive information about the person, their needs and how they wished to be supported.

People were appropriately supported with their meals. Identified, specific dietary requirements had been recorded in people’s care plans. Care staff knew about people’s specialist needs and supported them accordingly.

Care staff told us that they were supported well in their roles. Records confirmed that they received regular training, supervision and annual appraisals.

Complaints were investigated and responded to according to the providers policy.

Management oversight process in place monitored the quality of care people received. Issues and concerns were identified and addressed to further support improvements and learning.

We have made a recommendation about the provision of activities 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 and update

The last rating for this service was requires improvement (published 20 September 2018) and there were multiple breaches of regulation. We found areas of concern around risk management, staff support and ineffective management oversight processes. 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.

Why we inspected

This was a planned inspection based on the previous rating.

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.