Archived: Bagatelle

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

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.

Bagatelle provides accommodation and personal care and is registered to accommodate ten people with learning disabilities; at the time of our inspection there were six people living in the home.

At our last inspection in January 2016, the service was rated overall as good. At this inspection, we found that improvements were required and the service was overall rated as requires improvement.

There was a registered manager in post. 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 systems and processes in place to assess, monitor and manage the service required strengthening. The audits in place required more detail to ensure they were effective.

Infection control and medicine auditing processes required improving to ensure they were effective.

People received care from staff that knew them and were kind, compassionate and respectful. Staff spent time with people and understood their individual needs.

People’s needs were assessed prior to coming to the home and detailed person-centred care plans were in place and were kept under review. Risks to people had been identified and measures put in place to mitigate any risk.

There were sufficient staff to meet the needs of people; staffing levels were kept under review. Staff were supported through regular supervisions and undertook training, which helped them to understand the needs of the people they were supporting.

There were appropriate recruitment processes in place to protect people from being cared for by unsuitable staff and people were safe in the home. Staff understood their responsibilities to keep people safe from any risk or harm and knew how to respond if they had any concerns.

People were involved in decisions about the way in which their care and support was provided. Staff understood the need to undertake specific assessments where people lacked capacity to consent to their care and /or their day-to-day routines. 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’s health care and nutritional needs were carefully considered and relevant health care professionals were appropriately involved in people’s care.

People were cared for by staff who were respectful of their dignity and who demonstrated an understanding of each person’s needs. This was evident in the way staff spoke to people and the activities they engaged in with individuals. Relatives spoke positively about the care their relative received and felt that they could approach management and staff to discuss any issues or concerns they had.

The registered manager and new manager were approachable and people felt confident that any issues or concerns raised would be addressed and appropriate action taken.

The service strived to remain up to date with legislation and best practice and worked with outside agencies to look at ways to improve the experience for people.