The Boat House

About the service

The Boat House is a residential care home providing personal care to up to 8 people. The service provides support to younger adults with a learning disability or autism. At the time of our inspection there were 8 people using the service.

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

Right Support:

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. Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life. People were supported by staff to pursue their interests. Staff enabled people to access specialist health and social care support in the community.

Right Care:

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs. People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life.

Right Culture:

People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. People received good quality care, support and treatment because trained staff and specialists could meet their needs and wishes. Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing. Staff turnover was very low, which supported people to receive consistent care from staff who knew them well.

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 3 September 2019).

Why we inspected

We received concerns in relation to people’s safety monitoring. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 remained good based on the findings of this inspection.

We found no evidence during this inspection that people were at risk of harm. Please see the safe and well led sections of this full report.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Boat House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

¿ The provider had an outbreak of Coronavirus within in the home. The providers management team had regular contact with Public Health England team to monitor the outbreak. The outbreak had impacted staffing levels, however, the use of consistent agency staff ensured people’s needs were met.

¿ At the time of our inspection, the provider had not recently admitted people to the service because of the outbreak. Their plans to admit people were in place and followed best practice guidance.

¿ Staff were seen wearing PPE correctly at all times and there was plenty of replacement PPE in the home.

¿ There was regular testing of staff and residents for COVID-19. The staff had received external training in the correct use of PPE. Further e-learning had also been undertaken as part of their ongoing learning and development.

¿ Arrangements were in place for safe visiting, once the national lock down has finished. This will include testing, temperature checks and a booking system. In the meantime, people were supported to maintain contact with their friends and relatives through telephone and video calling.

The Boat House is a purpose -built care home that provides accommodation with personal care and is registered to accommodate eight younger adults with a learning disability/autism. There is one ground floor self-contained flat where one person will receive support and assessment for developing their life skills and independence. There were seven people living at the home at the time of our inspection.

The accommodation consists of two large lounge/dining areas, a kitchen and accessible garden area with a scenic outlook of a canal. There are seven ensuites bedrooms on the first floor with a lift to access these. There are good links to public transport and local community facilities.

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 service did not have a registered manager. There was a project manager who was running the service with the support of the provider. Some people were unsure who the manager was.

While visibly clean there was scope to make the environment more interesting and ensure all furniture was clean. The provider was aware and has allocated resources for refurbishment.

People and relatives received support from staff in a timely way and were not kept waiting for assistance. People looked comfortable in the presence of staff and we heard they were safe. Staff were knowledgeable about potential risks to people and were able to tell us how these would be minimised.

People were supported by staff who were caring, responsive and knowledgeable about people’s needs and preferences. We saw staff consistently respected people and promoted their privacy, dignity and independence.

People received effective person-centred care and support at the point this was provided and based on their individual needs and preferences. Staff were knowledgeable about people’s needs and preferences and there were good relationships with the people. Supporting people’s communication preferences did need development to aid consistency, this is an area the provider had already identified needed improvement. People and relatives told us they had a positive experience in respect of the care and support they received. They told us they received support from staff in a timely way and were not kept waiting for assistance.

We saw people looked comfortable in the presence of staff and people told us they felt safe at the home. Staff were knowledgeable about potential risks to people and were able to tell us how these would be minimised.

Staff respected people and promoted their privacy, dignity and independence.

People received person-centred care and support at the point this was provided and based on their individual needs and preferences.

People were supported by care staff who had a range of skills and knowledge to meet their needs. Staff understood their role, felt confident and well supported. Staff received supervision from the provider. People's health was supported as staff worked with other health care providers to ensure their health needs were met.

People were supported by staff to have choices, and the provider’s policies supported this practice.

People knew how to complain. Staff knew how to identify and respond if people were unhappy with the service. People were able to communicate how they felt to staff, and said staff were approachable and listened to what they had to say. Relatives said concerns raised were addressed appropriately.

Quality monitoring systems were in place, and the provider used this to aid their learning and improve people’s experiences and safety.

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.

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 (last report published 10 February 2018)

Why we inspected

The inspection was prompted due to concerns received that alleged people were not always safe due to inappropriate use of restraint. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe section of this full report.

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.

The accommodation at The Boat House consists of a large lounge and dining room, a kitchen and sensory room for seven people to use; there are seven bedrooms on the first floor with a lift to access these. There is one self-contained flat on the ground floor, for one person. This area has a bedroom, lounge and kitchen and has its own front door which leads into the service. The home is located in the town of Tamworth next to the canal. The service has a vehicle people can use and there are good links to public transport and local community facilities.

The Boat House 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 care service has been developed and designed in line with the values that underpin the Registering the Right Support 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.

At the time of our inspection five people were using the service as we placed a condition on the provider’s registration to restrict new admissions into the service, unless we gave written permission. On our previous inspection in July 2017 we found improvements had been made and agreed that the provider could admit one person into the service. During this inspection the provider demonstrated to us that improvements have been made and could now be sustained and as a result we will remove this condition to enable the provider to admit new people.

The service had 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 last inspection on 18 July 2017 we rated the service as ‘Requires Improvement’ and we asked the provider to take action to make improvements. We did this as where systems were in place to ensure people’s safety, such as monitors, the provider needed to ensure this did not place restrictions on people. The provider needed to review how people were supported, to ensure they received additional staff support to enable them to be involved with the activities they enjoyed. On this inspection, we found this action had been completed.

On this inspection we found there were sufficient numbers of staff to meet people’s individual needs and keep them safe. People were supported to take part in a variety of activities and hobbies and to maintain their interests. We found people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People were supported to make decisions about their care and where restrictions were identified; applications to ensure these were lawful had been made.

People received care from staff who had a good understanding of what constituted abuse and knew what actions to take if they had any concerns. Identified risks were assessed and managed in a way that promoted people’s safety. There was a safe procedure for managing people’s medicines and people received these as prescribed.

The staff were friendly and caring and had the right skills to provide the care and support they required. Staff received an induction when they started working for the service and completed training to support them in meeting people’s needs.

Each person had a support plan with detailed information and guidance personal to them. People were able to choose what to eat and drink and provided with photographs and pictures to support them to make this choice. People were supported effectively with their health needs and had access to a range of healthcare professionals.

There was a consistent staff team who knew people’s abilities, support needs, preferred routines and social preferences. Staff respected people’s privacy and dignity and treated them as individuals. People were able to maintain personal relationships with people that were important to them.

Quality assurance systems were in place to review the care and support people received and to take action to continuously improve the service. Staff felt supported by the registered manager who was approachable and open to suggestions about the service people received.

During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures. This inspection found that there was enough improvement to take the provider out of special measures, however we need to ensure the provider can sustain these improvements and we will keep the service under review.

There was a manager in the service who was undergoing our assessment to become the registered manager of the service. 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.

Where people’s liberty was restricted, this had been done lawfully to safeguard them. Where systems were in place to ensure people’s safety such as monitors, the provider needed to ensure this did not place further restrictions on people. When people did not receive the support they needed for some activities this needed to be reviewed to ensure people received their care as planned.

People were protected from the risks of abuse because staff now understood where harm may be caused and took action when people were at risk. People were cared for by staff that had the knowledge and skills required to support them. The training was designed to support staff to meet the specific complex needs of people who used the service. Medicines were managed safely to ensure that people received their medicines as prescribed and to keep well.

Staffing was organised flexibly to enable people to be involved with activities and do the things they enjoyed. The staff were developing good relationships with people so they understood how to help them participate with activities that they enjoyed. People were treated with dignity and respect and the staff were kind and caring.

People had access to health care and were supported to attend healthcare appointments when they needed it. People could eat and drink the food they liked and given the time they needed to eat independently. A variety of food was offered and meal times were a relaxed experience.

There were now systems in place to review the quality of the service provided and the provider was committed to developing and improving the service.

The Boat House provides accommodation and personal care for up to eight people with a learning disability. There were four people living in the home on the day of our inspection.

There was not a registered manager in post as they had left the service. An interim manager was managing the service. 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 overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

People were not always protected from harm and abuse because the provider and staff did not recognise that some incidents should have been reported externally. Concerns identified during the recruitment process were not fully investigated before staff were able to work with people. People who received additional funding for their support did not always have staff with them as planned. Environmental risks had not been considered to ensure people remained safe whilst they were in the home.

Staff induction training did not provide sufficient information and skills for staff to provide effective care to support people living in the home. Some staff had not received a full induction when they started working in the home. People’s diet needed improvement to ensure their health and wellbeing was maintained. There were arrangements in place to support people with their decision making but this had not been maintained to ensure all decisions made were in the person’s best interest.

People’s care plans did not provide an accurate record of their care, diet and the activities they had taken part in. Care plan reviews did not provide information about changes in care and support needs.

Staff morale was low. Staff felt unsettled because management arrangements were regularly changed. People’s records had not been written by staff with an understanding of learning disability. The provider’s audit programme had identified some shortfalls in the service but no improvements had been made in response to their findings.

People received their medicines at the right time and in the correct way. People had access to healthcare professionals to support their physical, psychological and mental health. Staff knew people well and interacted with them in a positive way. Relatives were welcomed and knew how to raise complaints and concerns.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we told the provider to take at the back of the full version of the report.

The Boat House provides accommodation and personal care for up to eight people with a learning disability. There were three people living in the home on the day of our inspection.

There was no registered manager in post at the time of our inspection but a new manager had been appointed and had been in post for four weeks. The acting manager had started the process to register with us. 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.

People living in the home were funded for one-to-one support however there were times when this wasn’t maintained. Some members of staff did not demonstrate a positive caring relationship with people. People were not encouraged to eat a healthy and balanced diet. The management changes had affected the morale of staff.

Staff understood their responsibility to protect people from avoidable harm and potential abuse and knew how to report concerns. There were processes in place to ensure that staff were trained to care for people and suitable to work within a caring environment. People were supported by staff to manage their behaviours to protect them and others from harm. There were arrangements in place to ensure people received their prescribed medicines at the right time and the correct dose.

Relatives were happy with the care and felt welcome to visit at any time. Complaints and concerns were listened to and reassurance was provided that improvements would be made. There was an effective audit programme in place which identified areas for improvement. Relatives were encouraged to take an active part in their relations care and asked to share their views on the service. People’s care had been reviewed to ensure it met their needs.