Bowden-Derra Park

During this inspection we only visited the main house where there had been an outbreak of Covid -19.

We found the following examples of good practice.

The registered manager and staff had considered how best to organise the environment in order to protect people from the risk of infection. People, staff and visitors used separate doors to enter and exit the building. A room had been allocated for staff to use when changing into and out of PPE. There were several shared rooms and people were encouraged to use previously underused rooms. This meant people were able to socially distance more easily.

People and staff regularly tested so any positive Covid cases were quickly identified. Some people had initially found it distressing to complete tests. Staff had worked with over a period of time until they were comfortable and happy to test with minimal staff support.

When people had tested positive for Covid-19 they isolated in line with government guidance. People told us staff regularly checked on them, brought them regular meals and took their laundry. Easy read information had been developed to help people understand the risks associated with Covid-19. They told us they had needed to isolate “because of the virus.” Staff explained how visual aids had been used to support people to understand the importance of handwashing.

During this inspection we only visited one house where 22 people lived and there had been an outbreak of Covid -19.

We found the following examples of good practice.

The registered manager had communicated effectively with people, staff and relatives to make sure everyone understood the procedures and precautions in place to keep people safe during the current outbreak. Actions taken and the additional restrictions introduced in response to the outbreak had been successful in preventing the spread of the infection to other buildings on the campus.

Each house had a dedicated staff team who were supported by specific members of agency and bank staff. The provider had commissioned a guaranteed minimum number of shifts, each week, from the staffing agency and this had enabled agency staff to be allocated to support specific houses. Although a significant number of staff had needed to isolate during the outbreak, the house had always been safely staffed without impacting on staffing levels of other houses.

The service had extensive stocks of PPE (personal protective equipment) and additional items of protective equipment such as ‘scrubs’ had been provided to give staff additional protection during the outbreak. Scrubs had been issued and staff for each house allocated separate changing areas to reduce the risk of transmission between houses.

The service’s Infection control policies had been updated in response to guidance provided during the Covid-19 pandemic.

Staff and people the service supported had been provided with additional training on infection control practices and hand hygiene prior to the outbreak. Staff were following up to date infection prevention and control guidance and had worked with people to help them understand why the additional infection control measures were necessary. Most people understood the need for self-isolation and staff had supported people to engage with a variety of activities while these restrictions were in place.

The service had been well supported by the local GP practice and other health professionals during the outbreak.

Although the service was currently closed to all visitors, staff helped people to stay in touch with family and friends through phone and video calls. Relatives had complemented the service and staff team on the quality of support they had provided.

Further information is in the detailed findings below.

Bowden-Derra Park provides accommodation and care for a maximum of 46 adults, who may have mental health needs, learning disabilities and/or physical disabilities. On the day of the inspection 36 people were using the service. Bowden-Derra Park is made up of four separate houses which are part of a larger complex of residential accommodation. 21 people were living in the main house known as Bowden Derra House and one person was staying there on respite, nine people were living at Orchard House, four in Medrow House and one person in Meadowside. Bowden-Derra Park is owned by Bowden Derra Park Limited. Bowden Derra Park Limited also provides care in five other residential homes and one nursing home on the same site in Polyphant village, near Launceston.

People in care homes receive accommodation and nursing or personal care as a 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 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.

Staff had received training for safeguarding and this was updated regularly. Accidents and incidents were reported and systems were in place so lessons could be learned following any untoward event. Staff were aware of identified risks to people’s safety and were clearly guided as to the action they should take to protect people from foreseeable harm.

There were normally sufficient staff available to meet people’s needs. On the day of the inspection Bowden-Derra House was short staffed due to unforeseen absences. Agency staff were frequently used and these were normally workers who were familiar with the service. Staff breaks were staggered to ensure there were always enough staff available to respond to any requests for support. Recruitment processes protected people from the risk of being supported by staff who were not suitable for the role.

Staff spoke of people fondly and with respect. They frequently engaged people in conversation and checked on their well-being. When people were distressed for any reason staff were patient and reassuring in their approach. Staff told us they worked well together and had shared value base which focused on meeting people’s needs. One commented; “We’re quite a solid bunch of people and there is a core team that helps each other out.”

There was a well-established management structure in place with clear lines of accountability and responsibility. Staff told us there was always a manager available for support including at weekends and in the evenings.

Audits were carried out over a range of areas. There were systems in place to gather the views of people who used the service and their families. Staff meetings enabled staff to voice their ideas and suggestions about how the service was organised.

Bowden-Derra Park provides accommodation and care for a maximum of 46 adults, who may have mental health needs, learning or physical disabilities. On the day of the inspection 34 people were using the service. Bowden-Derra Park is made up of four separate houses which are part of a larger complex of residential accommodation. 21 people were living in the main house known as Bowden-Derra House, eight in Orchard House, four in Medrow House and one person in Meadowside. Bowden-Derra Park is owned by Bowden-Derra Park Limited. Bowden-Derra Park Limited also provides care in five other residential homes and one nursing home on the same site and in Polyphant village, near Launceston.

People in care homes receive accommodation and nursing or personal care as a 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 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 care service was established before the introduction of Registering the Right Support and had not been developed and designed in line with the values that underpin this and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. Although some actions had been taken in line with the guidance there was no formal plan regarding how the provider would ensure the service reflected the values of Registering the Right Support in the future. We have made a recommendation about this in the report.

Care plans reflected people’s needs and preferences and were regularly reviewed to help ensure they were accurate and up to date. They contained information to help guide staff on how best to support people in all areas of their life, including their health, social needs and communication styles. Risks were clearly identified and guidance given to support staff to mitigate risk.

Staff had received training for safeguarding and this was updated regularly. Accidents and incidents were reported and systems were in place so lessons could be learned following any untoward event. Recruitment processes protected people from the risk of being supported by staff who were not suitable for the role.

People received their medicines as prescribed. Medicines were stored appropriately and creams and liquid preparations were dated on opening. Auditing systems for medicines were infrequent and we have made a recommendation about this in the report. Some people self-administered their medicines with the support and supervision of staff. There were no plans in place to support people to increase their independence in this area.

Staff were supported to carry out their roles through a system of induction, training and supervision. Training included areas which were specific to the needs of people living at Bowden-Derra Park. Staff felt valued and supported and were happy in their work.

Staff worked according to the principles of the Mental Capacity Act and associated Deprivation of Liberty Safeguards. 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 had formed positive relationships with people and spent time chatting and laughing with people. Interactions were supportive and encouraging. Staff helped ensure people were occupied and engaged in activities they enjoyed. There were enough staff to support people to take part in individualised activities according to their preferences.

There was a well-established management structure in place with clear lines of accountability and responsibility. Audits were carried out over a range of areas. There were systems in place to gather the views of people who used the service and their families. Staff meetings enabled staff to voice their ideas and suggestions about how the service was organised.

Following the inspection the registered manager contacted us outlining the steps they would take to meet the relevant legal requirements. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements.

Bowden-Derra Park provides accommodation and care for a maximum of 46 adults, who may have mental health needs, learning or physical disabilities. On the day of the inspection 36 people were using the service. Bowden-Derra Park is made up of four separate houses which are part of a larger complex of residential accommodation. 23 people were living in the main house known as Bowden Derra House, eight in Orchard House, four in Medrow House and one person in Meadowside. Bowden-Derra Park is owned by Bowden Derra Park Limited. Bowden Derra Park Limited also provides care in five other residential homes and one nursing home on the same site and in Polyphant village, near Launceston.

The service had 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.

We found that one person, who had moved into the service the month before the inspection, did not have a care plan in place. Another person's care plan had not been updated since 2015 and contained information that could mislead staff. This meant staff did not have access to relevant information and guidance to help them support people in line with their needs and preferences.

Where people had been identified as being at risk this was recorded. There was clear guidance for staff on how to support people in order to minimise any identified risk. Staff had received training for safeguarding and this was updated regularly. Recruitment processes protected people from the risk of being supported by staff who were not suitable for the role.

Systems for the management of medicines were robust. Medicine Administration Records (MAR) were completed appropriately. Medicines were stored appropriately and creams and liquid preparations were dated on opening.

Staff were supported to carry out their roles through a system of induction, training and supervision. Training included areas which were specific to the needs of people living at Bowden Derra Park. Staff felt valued and supported and were happy in their work.

Staff worked according to the principles of the Mental Capacity Act and associated Deprivation of Liberty Safeguards. 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 were mindful of people's changing needs and adapted their support as necessary. Communication styles were recognised and respected. Care plans contained detailed information for staff on how best to interact with people and, where relevant, described how people might use facial expressions or body language to communicate.

People's opinions in relation to activities and pastimes had been sought out. In-house activities were varied and creative. There were enough staff to support people to take part in individualised activities according to their preferences.

There was a well established management structure in place with clear lines of accountability and responsibility. Audits were carried out over a range of areas. However, the system had failed to alert the registered manager to the fact that a care plan had not been developed for one person.

There were systems in place to gather the views of people who used the service and their families. Staff meetings enabled staff to voice their ideas and suggestions about how the service was organised.

In our previous inspection report we identified that the provider had taken a decision not to allow representatives from the local authority onto the premises. We were concerned the provider was not working with outside agencies to ensure people's safety and welfare. At this inspection the registered manager told us they met regularly with the local authority safeguarding team and a meeting had been held with senior representatives of the council very recently. They told us the meeting had been positive and a strategies for future working had been discussed.

We identified a breach of the regulations. You can see what action we told the provider to take at the back of the full version of the report.

The service had 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 inspection was carried out in response to concerns raised by the local authority about the services run by Bowden Derra Park Limited. We also inspected another service run by Bowden Derra Park Ltd on the same day.

The concerns raised were in relation to alleged high levels of staff turnover, staff working long hours, lack of staff training, staff not seeking advice from external professionals or following guidance supplied and people’s personal safety, including from risk of fire and risks posed by other people’s behaviour. Concerns were also raised about people having a lack of choice and control over their day to day lives. For example, living with people that they were not compatible with, not being supported according to their assessed needs, having their choices restricted particularly regarding food and activities, carrying out work they were not paid for and being charged for using facilities owned by the provider.

Information in risk assessments and guidance from healthcare professionals was not consistently followed to help ensure people were protected from identified risks. Some information in care plans was missing or contradictory. Information in daily notes, used to record how people had spent their day, lacked detail. PEEPS contained limited information to enable emergency responders to support people from the premises safely.

People had access to activities on site and at the provider’s day centre based in the nearby town. Staff told us they often held impromptu and planned parties when they would invite people from other services to join them. Activities in the wider community and during the evenings were more limited. Although some people had taken part in activities identified as rewarding for them there was little evidence that other people were offered activities to meet their individual needs and interests. Staff shift patterns meant people’s access to evening activities were limited. We have made a recommendation about this in the report.

The registered manager was responsible for all the services on the complex. Bowden-Derra House had two deputy managers and two team leaders. The other three houses were organised on a day to day basis by a deputy manager and one or two team leaders. There were clear lines of accountability and responsibility in place. Staff told us the service was well managed and the management team were open and approachable. Following the inspection the provider took the decision not to allow the local authority onto the premises as they claimed their presence was disrupting the running of the service. The decision not to allow access to representatives of the local safeguarding team meant people’s rights might not have been protected.

Bowden-Derra Park Limited is situated in a rural setting. The main house is a large older style property. Bedrooms were on the ground and first floor and there were a limited number of bathroom facilities available for people. Some adaptations had been made to accommodate people’s needs. Other properties were more modern and had been specifically arranged to meet people’s needs and give them privacy and access to personal space if they wanted it.

People and their relatives spoke highly of the care and support provided. Everyone, including staff frequently referred to the theme of family when talking about the service. Staff had received training in recognising the signs of abuse and were confident any concerns would be acted on. People, families and external healthcare professionals told us they believed people were safe living at Bowden-Derra Park.

There were sufficient staff to meet people’s needs. Some people’s health conditions meant their needs could be particularly demanding at times. Staff rotas were organised to help ensure staff working with them had frequent breaks and other staff were available to take over or assist if required. Any incidents were recorded and checked by management to allow them to monitor any patterns of behaviour. Behaviour which might have put people or others at harm was directed at staff and not other people. Staff told us they were confident supporting people at all times. Training for staff on how to support people well in difficult situations was available. Two deputy managers had recently updated their training in this area and were planning to develop this within the staff team.

People had access to varied diets and were able to choose whether to eat in their own homes or at the onsite café. The menu provided at the café offered choice and variety. People were not charged for their meals. One person worked at the café with support and received payment for this.

People’s medicines were managed safely. People received their medicines as prescribed, received them on time and were told what they were for. People were supported to maintain good health through regular access to healthcare professionals, such as GPs, social workers, community psychiatric nurses and speech and language therapists.

People told us they felt safe and staff described the systems and procedures in place to help keep people safe. All staff had undertaken training on safeguarding vulnerable adults from abuse and demonstrated a good knowledge of how to identify and report concerns. Staff described what action they would take to protect people from harm. Staff felt confident any incidents or allegations would be fully investigated. People were protected by safe recruitment practices. Staff underwent the necessary checks which determined they were suitable to work with vulnerable adults, before they started their employment.

Relatives and friends were made to feel welcome and people were supported to maintain relationships with those who mattered to them. On-site facilities meant families had opportunities to meet together and with staff frequently. This enabled them to discuss any concerns they might have as they arose.

Staff received a comprehensive induction programme and then received on-going training which was regularly updated to ensure they had the correct skills to carry out their roles effectively. Training specific to people’s individual needs was also made available for staff. Some staff were taking more than the 12 weeks recommended to complete the Care Certificate and we have made a recommendation about this in the report.

Staff understood their role with regards to the Mental Capacity Act (2005) (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). People were assessed in line with the MCA as required and applications for DoLS were made appropriately. Staff understood the underlying principles of the legislation and checked people consented to care before giving it. Staff used communication tools, in line with people’s preferences, to help people make day to day choices. For example pictures were used to help people choose what they wanted to eat.

People, relatives and staff felt confident in how the service was run. There were effective quality assurance systems in place. Members of the management team attended various events to enable them to receive information about any changes or developments in the care sector.

We identified breaches of the regulations. You can see what action we have asked the provider to take at the back of the full report.

accommodation and care to a maximum of 46 adults, who may have mental health needs, learning or physical disabilities. Bowden Derra Park is comprised of four separate houses which are part of a larger complex of residential accommodation.

On the day of the inspection 37 people were using the service. The service had 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 registered manager was responsible for all the services on the complex. Bowden Derra Park had a deputy manager and each individual house had a team leader who oversaw the day to day running of theservice.

People and their relatives spoke highly of the care and support provided. People’s records were personalised and were in the process of being updated to include more detail about how people wanted to be supported. Staff responded quickly to people’s changing needs and these were recorded in care plans which were described as “working documents”.

People or, where appropriate, those who mattered to them were involved in reviewing their needs and how they would like to be supported. There were sufficient staff to meet people’s needs and enable their preferences to be respected. Staff were described as happy and caring and exhibited this in the way they talked about the people they supported. Strong relationships had been developed and people were made to feel they belonged and were central to the service.

Staff were highly knowledgeable about the people they were supporting and respected people’s individual needs around their privacy and dignity. People’s risks were managed well and monitored.

People took part in a variety of activities and were supported to maintain independence with their care needs.

People’s medicines were managed safely. People received their medicines as prescribed, received them on time and were told what they were for. People were supported to maintain good health through regular access to healthcare professionals, such as GPs, social workers, community psychiatric nurses and speech and language therapists.

People told us they felt safe and staff described the systems and procedures in place to help keep people safe. All staff had undertaken training on safeguarding vulnerable adults from abuse and demonstrated a good knowledge of how to identify and report concerns. Staff described what action they would take to protect people from harm. Staff felt confident any incidents or allegations would be fully investigated. People were protected by safe recruitment practices. Staff underwent the necessary checks which determined they were suitable to work with vulnerable adults, before they started their employment.

Relatives and friends were made to feel welcome and people were supported to maintain relationships with those who mattered to them. People and those who mattered to them knew how to raise concerns and make complaints. Complaints had been recorded, investigated and the outcome fed back to the complainant. Relatives told us any concerns they raised were always dealt with quickly and efficiently.

Staff received a comprehensive induction programme and then received on-going training which was regularly updated to ensure they had the correct skills to carry out their roles effectively.

Staff understood their role with regards to the Mental Capacity Act (2005) (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). People were assessed in line with the MCA as required and applications for DoLS were made or advice sought to help safeguard people and respect their human rights.

People, relatives and staff felt confident in how the service was run. There were effective quality assurance systems in place. The registered manager followed a monthly and annual cycle of quality assurance activities which involved people, staff, relatives and professionals and ensured the service was constantly being improved. Staff described the management as supportive and approachable. Staff talked passionately about their role. Comments included, “I really do enjoy my job, it’s quite rewarding. You go home happy and feeling like you’ve made a difference.”

Before people received any care or treatment they were asked for their consent and staff acted in accordance with their wishes.

We spent time talking to people who lived at Bowden Derra and observing the interactions between them and staff. Comments included: 'I like living here'; 'The staff are nice' and 'I am going on holiday.' During our visit, we saw that people appeared relaxed and contented.

Care plans reflected people's health and social care needs and demonstrated that other health and social care professionals were involved to ensure all people's needs were met.

Medicines were safely administered. We saw the medication records which were appropriately signed by staff when administering a person's medication.

Staff confirmed that people's needs were met in a timely manner and felt that there were sufficient staffing numbers.

People were made aware of the way to make a complaint. This was provided in a format that met their needs.

We saw that people's rights were upheld and they were treated with respect. Their physical, emotional, social and mental health needs were understood, planned and met. They were protected from abuse and risks were assessed and managed, whilst restrictions were agreed and kept to a minimum. Health and social care professionals were involved and consulted regularly.

The fabric and furnishings in the home were under regular review but, where some areas were homely and in a good decorative state, some appeared to need attention. No person using the service mentioned this.

Staff recruitment arrangements were robust and members of staff were trained and supported in their work. The quality of the service provided was monitored by the organisation and people's opinions were taken into account. The registered manager was said to be very responsive to any concerns.