Archived: Bagatelle

Updated 19 September 2019

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 team consisted of one inspector and an Expert 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

Bagatelle 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. We returned for a second day because the registered manager had not been available on the first day we visited. The second days visit was announced.

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 we used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with two people who used the service about their experience of the care provided. We spoke with three members of staff including the registered manager and two support workers.

We reviewed a range of records. This included three people's care records and medication records. We also looked at a variety of records relating to the management of the service including policies and procedures.

Updated 19 September 2019

About the service

Bagatelle provides care for up to 10 people with a learning disability or who are on the autistic spectrum.

The service had not 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 service was a large home, bigger than most domestic style properties. It was registered for the support of up to 10 people. Five people were using the service. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home.

The service was due to close by the end of 2019 and people were being supported to find suitable accommodation elsewhere.

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

Systems and processes were in place to identify and manage risk. However, one person’s risk assessment did not sufficiently protect them from harm. The premises and equipment were not always managed to keep people safe. There were inconsistencies regarding the required frequency of testing the fire alarm and other fire safety equipment.

Peoples medicines were not always managed in a safe way because staff did not always sign the medicine chart when medicines were given. Medicines were not always stored within the limits required by the manufacturer. Staff had received training about managing people’s medicines and had their competency assessed.

Some areas of the service were not as clean as they should be. Staff were following daily cleaning schedules, but infection control audits had not identified the shortfalls we found.

People felt safe and were protected from abuse and avoidable harm. Staff knew when and how to report concerns.

There were enough staff with the right skills and experience to meet people's needs. People had their needs and choices assessed before they began using the service.

Care and support was delivered in line with evidence based best practice guidance. Staff received the training and support they required to meet people's needs. They had access to ongoing training and opportunities for professional development.

People were supported to eat and drink enough and had a varied and balanced diet which they enjoyed. Staff recognised changes in people's health and supported them to access the healthcare services they required.

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 received kind and compassionate care and support. They liked the staff and had developed positive relationships. Staff knew people well and understood how to meet their needs and how to provide comfort and reassurance. People were involved in making decisions about their care and support. People had their privacy and dignity protected.

Care and support was person centred and was delivered in the way people preferred and met their individual needs. Staff understood people's needs with regards to the protected characteristics of the Equality Act 2010. Information was available to people in accessible formats and staff communicated with people effectively.

People were occupied with activities and were able to pursue their interests and hobbies. People knew how to make a complaint and were supported to do so.

Staff had received training about supporting people at the end of their lives and people had been asked about their advanced preferences.

People and staff had confidence in their managers and felt supported. They told us the registered manager was accessible and approachable.

There was a quality monitoring system in place, but this had not identified all the maintenance and cleaning issues we found. The registered manager had identified that staff were not always signing medicine records but had not taken sufficient action to make improvements.

The registered manager was supported by senior managers from the wider organisation.

People, their relatives and staff were asked for their feedback and this was used to develop the service and ensure it was meeting people's needs and preferences. The registered manager and staff worked closely with healthcare professionals and other agencies such as the local authority to make sure people received joined up care and support.

Rating at last inspection:

The last rating for this service was requires improvement (published 6 August 2018).

Why we inspected This was a planned inspection based on the previous rating.

Follow up: We will continue to review information we receive about the service until the next scheduled inspection. If we receive any information of concern, we may inspect sooner than scheduled. For more details, please see the full report which is on the CQC website at www.cqc.org.uk