People’s experience of using this service:

The Provider had not ensured that information relating to infection control was available and there was no food hygiene rating completed for the home. Risk assessments had been completed, however they had not always been reviewed following incidents or when areas of concerns were raised.

Staff had not all received the training they required to support their role and this had not been followed up with structured support. People had not always been supported to access information or receive it in a different format to support their understanding.

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not always support this practice.

Audits had been completed, however not for all areas of the home. These had not always been used to drive improvements or reflected the areas requiring improvement. Notifications had not always been completed to reflect events or incidents which had occurred.

People’s views were mixed about the approach to the meals at the home. Some people were supported and had their meals made. Other people were encouraged to make their own meals and were not in favour of a structured support approach. People were encouraged to attend a weekly meeting to discuss the events at the home.

People felt that they could receive support from staff when they required it and this was provided by kind and considerate staff. Peoples dignity was protected. When people required support from an advocate this was made available. Complaints had been addressed and people felt able to approach the management team.

There was enough staff to support people’s needs and the staffing had been increased to reflect the areas were additional staffing was required. Medicine was managed safety and people had received reviews for their medicine to continue to manage their mental health condition.

People felt safe and when incidents had occurred lessons had been learnt and shared with the staff. People’s health care had been considered and referrals had been made when required for all aspects of people’s health and wellbeing.

Care plans had been developed with people and they contained the detail about their history and needs. Some aspects needed to be improved and this had been recognised and there were planned improvements. People could access support with their cultural or religious needs.

Staff felt supported by the management and we saw that partnerships had been developed with a range of health and social care professionals.

Rating at last inspection: Good (report published September 2017)

About the service: Boden House is a care home that provides a recovery service and when required personal care for up to 27 people. The provider supported people with severe and enduring mental illness, learning disability and personality disorders. At the time of the inspection 16 people lived at the service. The home was established over four floors, each person had their own flat with the option of communal spaces on each floor. There was also an activities room and a garage area which was available for people to use for smoking or storage of outdoor items.

Why we inspected: This inspection was brought forward due to information of risk and concerns.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

We identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around governance and the environment. Details of action we have asked the provider to take can be found at the end of this report.

This inspection visit was unannounced and took place on 29 August 2017. This was the services first inspection since their registration with us in February 2017. The service was registered to provide accommodation for up to 18 people. People who used the service had physical health needs and/or enduring mental health needs. At the time of our inspection 16 people were using the service.

There was 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.

When people lacked capacity there was not always an approach to record how the assessment had been completed and how the decisions had been made. We have asked the provider to review current guidance on this practice.

People felt safe at the service and staff understood the importance of reporting any concerns. Each person had their risks assessed to consider guidance and how the risks could be reduced or managed. Other risk assessments had been completed for the environment. There was sufficient staff to support people’s needs and this was reviewed to ensure it reflected any changes. Medicines were managed safety.

Staff received training to support their role and had the opportunities to develop their learning. People had been supported with their meals and further developments were planned to consider how this could be improved. Referrals had been made to health care professionals when needed.

People felt their care needs had been met and they received care which was respectful and considered their levels of privacy, in relation to individual risk.

Care plans were individual and had been reviewed to reflect changes. They contained a range of information which enabled people to be supported in a way they wished and to understand their health care needs. There was a complaints policy available and people felt able to raise concerns directly.

The provider completed audits to reflect the changes in people’s needs and to consider improvements. People had the opportunity to provide feedback on their care and how to develop the service. Staff felt supported by the provider and registered manager and they had a range of opportunities to seek guidance in their role. The registered manager understood their role and ensured we received notifications about events effecting people which occurred at the service.