Boldshaves Oast

Boldshaves Oast 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. Boldshaves Oast accommodates 14 people across four buildings.

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.

The main building is a converted Oast where there are eight bedrooms set over three floors. There is a purpose built log cabin where two people's bedrooms are accommodated. In addition there is another self-contained log cabin and a cottage where two married couples live. There are a number of other buildings on site, including an art and craft room, woodwork room and horticultural area.

The service did not have a registered manager in post. The last registered manager left the service in March 2017, a new manager was appointed shortly after. The manager told us they had tried to submit an application to register to the CQC on more than one occasion but was unsure if it had been successfully received. After the inspection we checked this and a completed application had not been received. 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 last inspected Boldshaves Oast in December 2016 when three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. We issued requirement notices relating to safeguarding service users from abuse and improper treatment, good governance and fit and proper persons employed. At the last inspection, the service was rated 'Requires Improvement.' We asked the provider to take action and they sent us an action plan. The provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. Improvements had been made, and the previous breaches found at our last inspection had been met.

At our previous inspection we found that the provider had not always reported incidents under safeguarding procedures. Improvements had been made at this inspection and systems were more robust. We also found that people were not protected by robust recruitment procedures. During this inspection we found that all of the required checks had been completed.

Our last inspection found that systems were not consistently robust to monitor and improve the quality of services and mitigate risks relating to the health, safety and welfare of people. At this inspection we found that this had improved.

During this inspection we found that the manager had not notified the CQC of all events as they are required to do so, this is an area that requires improvement. We made recommendations around improving systems to review all feedback received and improving recording and monitoring systems.

Staff followed correct and appropriate procedures in the storage and dispensing of medicines. People were supported in a safe environment and risks identified for people were managed in a way that enabled people to live as independent a life as possible. People were supported to maintain good health and attended appointments and check-ups. Health needs were kept under review and appropriate referrals were made when required.

We found there were enough staff to keep people safe. Staffing levels varied according to planned activities or appointments. Staff had completed induction training when they first started to work at the service. Staff were supported during their induction, monitored and assessed to check that they had attained the right skills and knowledge to be able to care for, support and meet people's needs. There were staff meetings, so staff could discuss any issues and share new ideas with their colleagues, to improve people's care and lives. Staff worked well together and ensured that clear communication between themselves and external health professionals took place; for example with care managers, commissioner GP’s and district nurses.

People were protected from the risk of abuse. Staff had received safeguarding training. They were aware of how to recognise and report safeguarding concerns. Staff knew about the whistle blowing policy and were confident they could raise any concerns with the provider or outside agencies if needed.

Equipment and the premises received regular checks and servicing in order to ensure it was safe. The registered manager monitored incidents and accidents to make sure the care provided was safe. Emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do.

The care and support needs of each person were different, and each person's care plan was personal to them. People had detailed care plans, risk assessments and guidance in place to help staff to support them in an individual way.

Staff encouraged people to be involved and feel included in their environment. People were offered varied activities and participated in social activities of their choice. Staff knew people and their support needs well.

Staff were caring, kind and respected people's privacy and dignity. There were positive and caring interactions between the staff and people and people were comfortable and at ease with the staff.

People were encouraged to eat and drink enough and were offered choices around their meals and hydration needs. People were supported to make their own drinks and cook when they were able and wanted to. Staff understood people's likes and dislikes and dietary requirements and promoted people to eat a healthy diet.

Quality assurance audits were carried out to identify any shortfalls within the service and how the service could improve. Action was taken to implement improvements.

Staff told us that the service was well led and that they felt supported by the manager to make sure they could support and care for people safely and effectively. Staff said they could go to the manager at any time and they would be listened to.

The service was not currently supporting anyone at the end of their life.

Boldshaves Oast is registered to provide accommodation for up to fifteen adults with a learning disability, because none of bedrooms are used as double rooms the maximum number of people that can be accommodated is 14. The main building is a converted Oast where there are eight bedrooms set over three floors. There is a purpose built log cabin where two people’s bedrooms are accommodated. In addition there is another self-contained log cabin and a cottage where two married couples live. The service is situated down a quiet country lane, one and a half miles from the village of Woodchurch. Only one bedroom is suitable for a person with poor mobility. All bedrooms had ensuite facilities or sole use of a nearby shower or bathroom. There is a parking area along the driveway of the service. There were no vacancies at the time of the inspection.

The service has 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.

People were not fully protected by safeguarding procedures as incidents were not always properly reported to the local safeguarding team. Recruitment records lacked evidence that full checks had been carried out to ensure staff were suitable in order to protect people.

Quality assurance and monitoring systems had not been effective in identifying shortfalls found during this inspection. Relatives had not received feedback in relation to their comments about the service or how these may have been used to drive improvements.

People received their medicines when they should. Risks were assessed and staff took steps to keep people safe whilst encouraging their independence wherever possible.

People were involved in the planning of their care and support. Care plans contained adequate information about people’s wishes and preferences. People had reviews of their care and support where they and/or their representatives were able to discuss any concerns or aspirations.

People were supported to make their own decisions and choices and these were respected by staff. We found the home to be meeting the requirements of the Deprivation of Liberty Safeguards.

Staff had received training in the Mental Capacity Act (MCA) 2005. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant. The registered manager demonstrated they understood this process to ensure the principles of the MCA were followed.

New staff underwent an induction programme, which included shadowing experienced staff. Staff received training relevant to their role. Staff had opportunities for one to one meetings and team meetings, to enable them to carry out their duties effectively. Some staff had gained qualifications in health and social care. People had their needs met by sufficient numbers of staff. Staff rotas were based on people’s needs, health appointments and activities.

People were relaxed in staff’s company and staff listened and acted on what they said or gestures, noises and body language. People were treated with dignity and respect and their privacy was respected. Staff were kind and patient in their approach and often used good humour where appropriate. Staff had built up relationships with people and were familiar with their life stories and preferences.

People had a varied diet that met their needs. Some people were involved in planning the menus, shopping, preparing and cooking meals. Staff encouraged people to eat a healthy diet. People had a varied programme of interactive and leisure activities and often went out and about into the community.

People were supported to maintain good health and attend appointments and check-ups. Appropriate referrals were made to health professionals when required. People did not have any concerns, but felt comfortable in raising issues. Complaints had been taken serious and were used to improve the service. People’s and relatives feedback was gained both informally and formally. The registered manager had an open door policy and people were confident in approaching the registered manager to talk about anything that bothered them.