Bannigans

Bannigans is a residential care home providing accommodation and personal care for up to 4 people with Prader Willi syndrome, learning disabilities and/or autism. At the time of the inspection 4 people were receiving support. The property is a large detached two storey building with individual bedrooms and communal living areas with a small garden to the rear of the property. The service offers 24-hour support.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not always able to demonstrate how they were meeting underpinning principles of “Right Support, Right Care, Right Culture".

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.

Support plans required more information for staff to understand how to support people to mitigate risks. People’s plans were person-centred and reflected people’s views and wishes.

People received their medicines safely and had access to appropriate health and social care support.

People were supported to maintain meaningful relationships with people who mattered to them.

Right Care

People’s care, treatment and support plans reflected most of their needs and this promoted their wellbeing and enjoyment of life. Improvements were being made to incorporate all areas of people’s lives.

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

The service deployed appropriately skilled staff to meet people’s needs and keep them safe.

Right Culture

Systems to monitor the quality of the service required improvement to ensure audits were effective and actions were completed in a timely way.

The values and attitudes of managers and staff supported people to live inclusive and empowered lifestyles. Staff promoted equality and diversity when supporting people.

People and staff had opportunities to give feedback about the service and contribute their thoughts and ideas for improvement. They felt listened to and were confident that any issues would be resolved.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection:

The last rating for this service was good (published 16 July 2018).

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.

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

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well led sections of this full report.

Enforcement

We have found breaches in relation to consent and management oversight at this inspection.

You can see what action we have asked the provider to take at the end of this full 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.

Bannigans provides accommodation and care for up to four people.There were four people in residence when we inspected. This is a service that specialises in supporting adults with a range of complex needs and behaviours associated with Prader-Willi Syndrome (PWS). This is a genetic condition that predominantly manifests with early years onset of hyperphagia which is an abnormal unrelenting great desire for food driving the person towards excessive eating and, left unchecked, life threatening obesity. Other characteristics of PWS include, for example, learning disabilities that may range in severity.

At our last inspection on 12 May 2016 we rated the service good. At this inspection on 24 May 2018 we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service had a registered manager. 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 and associated Regulations about how the service is run.

The service met all relevant fundamental standards related to staff recruitment, training and the care people received. People’s care was regularly reviewed with them so they received the timely care they needed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People said they felt safe and happy living at Bannigans. There were sufficient numbers of trained and experienced staff to keep people safe. The staff team enabled people to live fulfilling lives and make positive choices that enhanced their quality of life. Staff were conscientious and mindful of providing the support people needed in a sensitive way that respected each person’s individuality and their aspirations to have control over their lives. People were listened to, their views were acknowledged and acted upon and care and support was delivered in the way that people chose and preferred.

People's individual nutritional needs were assessed, monitored and met with appropriate guidance from healthcare professionals with expertise in PWS. People were supported to have a balanced diet they enjoyed. Their healthcare needs were met through regular check-ups and they had the treatment they needed whenever necessary. People were supported to manage their medicines.

There were arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong or new challenges emerged.

Bannigans provides care and support for up to four people with a learning and physical disability. It specialises in dealing with people with Prader-Willi Syndrome. There were four people living at the service when we visited.

The service has a registered manager. 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.

Staff had been trained to recognise signs of potential abuse and how to report them. People felt safe living at the service. There were processes in place to manage identifiable risks and to enable people to maintain their independence.

The provider carried out recruitment checks on new staff to make sure they were fit to work at the service. Suitable and sufficient staff with the appropriate skill mix were available to support people with their needs. Systems were in place to ensure that people were supported to take their medicines safely and at the appropriate times.

Staff had been provided with induction and on-going essential training to keep their skills up to date. There was a supervision and appraisal framework in place. This enabled staff to be supported by the registered manager.

People were supported to make decisions about their care and support needs. This was underpinned by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff ensured that consent was gained from people before providing them with care and support.

Staff supported people to maintain a balanced diet and provided them with healthy options on what to eat and drink. If required, people were supported by staff to access other healthcare facilities and were registered with a GP.

Positive and caring relationships had been developed between people and staff. Processes were in place to ensure that people’s views were acted on. Staff provided care and support to people in a meaningful way. Where possible people were encouraged to maintain their independence and staff ensured their privacy and dignity was promoted.

People’s support plans reflected how they wished to be cared for; and they received care that was responsive to their needs. A complaints procedure had been developed in an appropriate format to enable people to raise concerns if they needed to.

There was a positive, open and inclusive culture at the service. The registered manager was transparent and visible. This inspired staff to provide a quality service. Effective quality assurance systems were in place to monitor the quality of the service provided and to drive continuous improvements.

We spoke with the three relatives. They told us that they had been fully satisfied with the care their relatives received.

One relative said; 'Staff are brilliant. I could not ask for better care'.

We briefly observed the relationship between staff and people who lived in the home. This appeared encouraging and helpful.

This was a generally positive inspection. Both people and their relatives told us they had no concerns. The essential standards we inspected were found to have been met.

There were a small number of recommendations/suggestions of good practice; that head office responds to any queries or concerns in quality assurance questionnaires. Also for the company to reinstate people's annual holidays.

A person told us that staff were helpful; 'I have no problems with any staff. They are friendly and help when I need them'.

We received one comment of concern: That, at times, the home was cold.

This was generally a positive inspection. People living in the home stated that they were satisfied with care provided by staff. One person were satisfied with the reward system set up to encourage good behaviour. Another person said she did not like this system. (The manager later informed us that the reward system would be replaced by a support plan). The standards not met at the last inspection had been followed up.

We received a number of comments - about having a pet, having a new sofa in the lounge and the home's car often breaking down. The manager sent us a response which stated that the car had not broken down since 2009. If it did then other transport was made available.

We received two comments that heating was not always sufficient in the home.

We received another comment that stated that there was favouritism from staff towards two residents, and one resident in particular was treated unfairly. The manager said that this would be followed up and monitored. She later reported that she had investigated this and had found no evidence of this behaviour.

A person told us that she thought most staff members were good. She said; 'I don't have a problem. I prefer living here to the home I lived in before'.

We spoke with three relatives. They all told us that the care was of a high standard. One relative said; 'Care is fantastic'. Another relative said; 'I have no doubt my daughter is being properly cared for'.

In many ways this was a positive inspection. However, we were concerned that people were not always fully respected and their rights were not always protected. Premises issues have not always been swiftly attended to by the company.