Archived: Choice Support - 5 Bowley Close

About the service

Choice Support - 5 Bowley Close is a residential care home providing personal care that accommodates up to four people. The service specialises in supporting people with learning disabilities and those with autistic spectrum disorders. At the time of our inspection there were 3 people receiving care and support.

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

Right support

The model of care did not maximise people’s choice and independence and people were not always protected from the risk of harm. Risks to people were not always identified and mitigated. People’s medicines were not always managed safely. The provider’s systems did not ensure staff received a suitable induction, ongoing support and training to ensure they had the skills and abilities to meet people’s needs. Some staff showed a lack of understanding about people’s support guidelines which placed people at risk.

Right Care

People’s care was not always person-centred. Staff did not always support people with all of their cultural needs. There was limited information about how people were being supported to pursue interests and hobbies and people were not supported to acquire/maintain daily living skills. There was a lack of support towards aspirations and goals.

People’s home environment was not always a reflection of their personal preferences. Not all people had been supported to personalise their rooms and some communal areas were being used as storage. The service did not make reasonable adjustments for people to be fully involved in discussions about their care and support. Staff did not always support people to make decisions. Information for and about people was not presented in ways that facilitated people’s understanding and involvement.

Right culture

The provider did not ensure people using services lead confident, inclusive and empowered lives. People and those important to them were not asked for feedback in order to develop the service. The provider had identified many shortfalls with the service and made many improvements in a short period of time. However, they had not identified all the issues we found with, risk management, medicines, fire safety, and staff training and further improvements were required to ensure people received safe and compassionate care.

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 6 November 2020).

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risks. This inspection was carried out to seek assurance that people were being protected from harm.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to inadequate based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive 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 Choice Support – 5 Bowley Close on our website at www.cqc.org.uk.

Enforcement and recommendations

We have identified breaches in relation to person-centred care, consent to care, risk management, medicines, staffing and good governance. Please see the action we have told the provider to take at the end of this report. We have also made a recommendation in relation to recruitment checks.

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

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements. If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Choice Support - 5 Bowley Close is a residential care home providing personal care and accommodation for up to four people. The service specialises in supporting people with learning disabilities and those with autistic spectrum disorders. At the time of our inspection there were four people receiving care and support.

Choice Support - 5 Bowley Close accommodates people in one building with each person having their own bedroom. There are two communal bathrooms, a communal living and dining area, a kitchen and access to a secure garden.

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

People’s relatives were positive about the supportive and caring attitude of the staff team and were confident staff knew their family members well and how they liked to be supported. Relatives were reassured their family members were kept safe.

We observed positive interactions between people and staff throughout the inspection. Staff responded appropriately to changes in people’s needs and were aware if they needed any further support.

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.

Staff supported people to be active and involved in every day choices, including communicating as best as possible with them to help explain information about COVID-19 and how they were working to minimise any infection control risks.

People were kept safe as there were robust systems in place to ensure safe infection control procedures were followed. These practices were regularly discussed, with updates and reminders being shared across the staff team.

The staff team were very proud of how they had worked together during challenging periods during the peak of the COVID-19 pandemic. Staff praised the work environment and how they had all looked out for each other to ensure they had not had any COVID-19 cases within the home.

Relatives were confident about the management of the service and told us they had been kept updated with what had been happening in the home when they had been unable to visit. The new manager had contacted people’s relatives to introduce themselves and we received positive comments about how the staff team had managed the service without a manager in place.

For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk.

Rating at last inspection and update

The last rating for this service was requires improvement (published 20 August 2019).

Why we inspected

We carried out this inspection to follow up on concerns found at our last inspection in relation to recruitment, safeguarding investigations, quality monitoring checks and how the provider sought people’s views about the service. As a result, we undertook a focused inspection to review the Key questions of Safe and Well-led only.

This report only covers our findings in relation to the Key Questions Safe and Well-led. Ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Choice Support - 5 Bowley Close 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.

Follow up

We will continue to monitor information we receive about the service. If we receive any concerning information we may return to inspect.

Choice Support - 5 Bowley Close is a residential care home providing personal care that accommodates up to four people. The service specialises in supporting people with learning disabilities and those with autistic spectrum disorders. At the time of our inspection there were two people receiving care and support.

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.

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

The provider had appropriate risk assessments in place with guidance for staff about how to mitigate risks. The provider supported people to take their medicines safely. People were supported to maintain a clean and tidy home.

The provider met people's nutritional needs and supported them to make healthy food choices. People were supported with their physical and mental health needs and care records contained good information on these. People were supported to attend all necessary healthcare appointments.

People told us the staff were kind and caring and knew people using the service well. Staff supported people to be active and involved in every day choices. People's privacy and dignity was maintained.

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.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

There were quality monitoring systems in place, however due to changes in the management we found these systems were not always effective and actions were not always achieved. A new manager had just started, and an action plan was in place for all the issues to be addressed.

We have made a recommendation about the effectiveness of their quality monitoring.

The service responded to serious allegations appropriately and took immediate action to ensure people were kept safe. However, the service did not always complete investigations into allegations and ensure agreed actions were completed in good time.

We have made a recommendation about how the service conducts and completes investigations.

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 23 March 2017). Since this rating was awarded, the registered provider of this service merged with another provider and altered its legal entity. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

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.