Bon Secours

Bon Secours is a residential care home providing care for up to three people. At the time of our inspection, the service supported three people who were living with a learning disability, two of whom are also supported with their mental health. Two people who used the service received support with personal care. This is help with tasks related to personal hygiene and eating. Where people received this support, we also considered any wider social care provided.

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

People told us they felt safe, they were happy living at Bon Secours and liked the staff who supported them.

The premises looked clean and tidy and had controls in place to minimise the risks posed by COVID-19. However, the provider was sharing some staff between two locations run by the same registered manager and operated by the same provider. This was contrary to current guidance and following the inspection the provider was told to stop this practice.

People received care and support personalised to their individual needs and suited to their communication preferences. Risks had been identified and care plans mostly provided guidance how to minimise risk. When pointed out to them, the registered manager gathered more information for people who may be at risk of epileptic episodes. Staff had received training about how to meet people’s needs and how to identify areas of concern.

The registered manager had identified outstanding notifications of events which should have been sent to CQC, when they had occurred. These were retrospectively submitted to us before this inspection. However, this had not permitted our oversight of events at the service as and when they occurred; without notification, CQC would not have known to take action if required. This demonstrated a lack of effective oversight and systems within the service.

Medicines were stored and managed safely; people received their medicines as prescribed. Guidance set out when ‘as and when needed’ (PRN) medicines should be given. However, administration of some PRN medicine was not always recorded in line with the protocol relating to it. The registered manager reviewed and revised this process immediately following the inspection.

Staff told us how they would recognise signs of abuse and the actions needed if abuse was suspected. There were enough staff to provide safe care. Safe recruitment checks were completed to ensure staff were suitable to work with people.

The registered manager had a clear vision for the service and had developed an action plan for ways to improve the service.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

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. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Right support:

• The model of care and setting maximised people's choice, control and Independence.

Right care:

• Care was person-centred and promoted people's dignity, privacy and human Rights.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensured people using services could lead confident, inclusive and empowered lives.

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 1 March 2018).

Why we inspected

There have been significant concerns identified at other locations run by the same provider. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well led sections of this full report.

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

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Bon Secours on our website at www.cqc.org.uk.

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 coronavirus and other infection outbreaks effectively.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified three breaches at this inspection in relation to safe care and treatment, governance and notification of other incidents.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection, the service was rated ‘Good.’ At this inspection we found the service remained Good.

Bon Secours 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 provides accommodation and personal care to up to three people who might need support with the mental health or may be living with a learning disability.

The service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities using the service can live as ordinary a life as any citizen.

The service continued to be well managed by the long standing registered manager and staff team. Staff continued to be supported and had a yearly appraisal and the training they needed to meet people’s specific needs. There were enough staff on duty and they were recruited safely.

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 continued to lead the lives they wanted to, people were supported to meet friends, follow their hobbies and interests and to get a job if this is what they wanted.

People said they felt safe and said they had the support they needed to achieve their goals and hopes for the future. Risk taking was encouraged so that people were not restricted.

There was a feeling of trust and mutual respect, there was laughter and joking and people seemed at ease with the staff and each other. Everyone was involved in the cooking and cleaning and achievement however small was celebrated. People were supported to eat well and healthy life styles were promoted, people told us about their swimming sessions and recent gym membership. People attended college and had work placements and were leading fulfilling lives.

Staff were caring and kind and respectful. People said they had the privacy they needed. People were supported to be as independent as they wanted to be and were fully involved in making decisions about things that affected them.

People felt safe, they were protected from abuse and knew about personal safety. People had control over what went on at the service including taking more control of their medicines and taking more responsibility to travel independently with the right amount of support. Staff responded well to people’s needs especially when they became anxious and we saw this during the inspection.

The service was clean, hygienic and well maintained. People told us about plans for redecoration and about a plan to develop the garden as they wanted to grow more vegetables. Staff worked with other organisations including care managers and health professionals to make sure people had the support they needed.

Incidents and complaints were reviewed so that lessons could be learned. The registered manager continued to learn from when things went wrong and from when things went right and continued to have the oversight they needed to make sure staff continued to provide good support.

People’s needs were thoroughly assessed with their involvement and the senior staff was reviewing and developing support plans. People received person centred care and they had a say about their care and support. Any complaints and concerns were acted on and everyone had a say about what might be improved.

The provider’s philosophy was based on maximising people’s ability to make choices, respecting basic human rights, fostering inclusion in wider society, and encouraging people to gain the maximum level of independence they were able to. Staff shared this vision and spoke passionately about wanting to provide the best support they could. They were committed to providing good support and team work had improved since the last inspection. Regular checks and audits were carried out including regular observation of staff practice so they could have feedback and continuously improve. People and staff felt involved and engaged and felt like their opinions mattered. Staff worked closely with other organisations to make sure the home ran smoothly and people had the support they needed.

The registered manager had notified the CQC of events that were reportable. The rating of ‘Good’ was displayed at the service and on the provider’s website.

The interactions we saw between staff and people using the service were friendly and respectful. The people we spoke with said they found the staff supportive. One person told us 'The people who work here treat me good.' Another said 'I love it here.' The people we spoke with told us what they liked to do, and they said they were able to make choices about their lives and pursue their interests. People told us that they were satisfied with the care and support that they received. One person said "The food is good, there is a good choice or I can ask for something different". Another person commented when asked, I like the food, we get treats and the staff makes cake for us.

The home was clean and tidy throughout.

There were effective recruitment and selection procedures in place. The service had processes in place for the recruitment and management of staff, and the staff working at the service had had the necessary recruitment checks.

The provider had an effective system to regularly monitor the quality of the service that people receive. There was an effective system in place to identify, assess and manage risks to health, safety and welfare of the people who used the service and others.