Archived: Besford House

Besford House is located in the Belle Vale area of Liverpool. There are three bungalows on the site which provide accommodation for up to six people in each bungalow. One bungalow provides permanent accommodation, care and support for people with learning disabilities and the other two provide emergency and respite care. There is an additional bungalow on the site which houses the office, staff rooms and storage facilities. The site is large and spacious and the buildings are situated around a central garden area. Besford House is within easy reach of supermarkets and shops, leisure and public transport facilities.

The home is registered to provide accommodation and care for up to 18 adults between the ages of 18 to 66. One bungalow was dedicated to providing planned respite, one was for emergency respite or placements and the third bungalow was a permanent home to five people, all who had been there for some years.

The home required a registered manager. 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.

At the time of our inspection, there was an interim manager in post as the previous registered manager had been absent from the service for several months. We were told by staff and senior managers that the home’s future was uncertain and that several options were being considered both for the service users, the site and the staff. There was ongoing consultation with users of the service, their relatives and staff. Because the home’s future was uncertain, there had been no appointment of a registered manager since the previous one had left.

Before our inspection, we looked at information the Care Quality Commission (CQC) had received about the service including notifications received from the manager. We checked that we had received these in a timely manner. We also looked at safeguarding referrals, complaints and any other information from members of the public. We had not received any information of concern about the home. We looked at the information contained on the Healthwatch Liverpool website. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.

We found that the home operated safely and that staff were able to tell us about safeguarding procedures. There were appropriate health and safety checks made in the home and staff were recruited with the relevant checks made prior to their employment.

The provider had complied with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and its associated codes of practice in the delivery of care. We found that the staff had followed the requirements and principles of the Mental Capacity Act 2005 (MCA). Staff we spoke with had an understanding of what their role was and what their obligations where in order to maintain people’s rights.

The care records were person centered and we saw that staff treated people as individuals and respected their privacy, dignity, choice and need for confidentiality.

There was no registered manager in post and the interim manager was dealing with a difficult situation as the home was in a period of great change for everyone associated with it, which involved moving people living there to other accommodation and re-locating staff to other jobs.

As part of this inspection we spoke with the two people who used the service, a relative, two carers, the registered manager and the care co-ordinator. We also reviewed records relating to the management of the home which included care plans for three people, staffing rotas, staff training records, policies and quality audits.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

We saw that comprehensive risk assessments had taken place before people had received care and support. These had led to detailed care plans that aimed to prevent or minimise risks for people. There were enough staff on duty to meet the needs of the people living at the home. Carers had a good understanding about how to safeguard vulnerable adults from abuse and all staff had annual update training about safeguarding. CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The manager told us that four applications had recently been submitted and we saw that proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. One person told us they had been unable to walk or eat much when they had first arrived at the service and that the carers had helped them to become well. They had learnt new skills and gained some independence living at the service. People received enough food and drink, which they enjoyed. It was clear from what we saw and from speaking with staff that they understood people's care and support needs. Carers had received enough training to meet the needs of the people living at the home.

Is the service caring?

The service was caring. A person said, 'All the carers are kind and friendly.' People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this. We spoke with carers who knew people's needs and we observed them interact with different people in a pleasant and caring way. The way that they talked about people using the service showed us that they knew people well and cared about them.

Is the service responsive?

The service was responsive to the changing needs of people using the service and to comments and suggestions. We saw that assessments of people's needs resulted in care plans that staff read. The care plans helped staff to know the needs and care that individual people required. Care plans were changed if people's needs changed. A person said, 'I just ask, if I need anything or I'm unsure about things; all the carers are good.' A relative said that they had made suggestions several years ago which were listened to and implemented. The manager discussed changes that had been implemented in response to suggestions made by people using the service.

Is the service well led?

The service was well led by a registered manager. People who used the service said the manager was, 'Very nice.' Staff said the manager was 'approachable and reliable.' The service had a system in place to monitor and assess the quality of the service. Staffing numbers were carefully planned to meet the diverse needs of people using the service.

We used a number of different methods to help us understand the experiences of people living at Besford House because some of the people using the service had complex needs which meant they were not able to tell us their experiences. During our inspection we observed staff being kind, caring and respectful in their interactions with the people they cared for. We were able to speak with two people who used the service who told us the care they had received at Besford House had been 'smashing', and that 'all the carers are lovely and fantastic". However, we found that for some people decisions had been made in their best interests without the appropriate assessments and procedures being followed.

People who accessed the service provided at Besford House were cared for by staff who had been provided with suitable training and support with which to undertake their roles and responsibilities. We also saw evidence that the organisation was monitoring the quality of the service provided on a regular basis.

We observed during our inspection that the people living at Besford House appeared happy and content living there. We found people were treated respectfully and given support to have their say in how they wanted to be helped and were supported to do the things they wanted to do. One person told us, 'I like living here', and 'I'm happy'.

The people who accessed the service provided at Besford House were provided with a choice of suitable and nutritious food and drink and cared for in surroundings that were appropriate for their needs. They were supported by staff that were appropriated recruited, trained and experienced at supporting them.

During our visit we observed that care plans were so out of date it not possible for the staff to deliver appropriate care using the information available in the care plans. We also found that there were insufficient quality assurance systems in place to ensure people received safe and appropriate care, treatment and support.