About the service:

Bollingbroke House is a care home that provides accommodation for people who require personal care. The home can accommodate up to 33 people. At the time of this inspection there were 21 people using the service.

People’s experience of using this service:

People told us they felt safe living at Bollingbroke House. Risks to people were assessed and kept under review so staff knew how to support people safely. All staff knew what action to take if they were concerned about a person’s safety. People using the service, their relatives and staff told us any concerns would be acted upon promptly.

People received their medicines as prescribed, from staff who were trained in medicines administration.

There were enough staff on each shift to meet people’s needs. Staff told us they were able to care for people in an unrushed manner.

The premises were undergoing some refurbishment at the time of this inspection. This was welcomed by people using the service, their relatives and staff who all told us improvements were needed to the home environment. People could not easily access the garden area however the manager had plans in place to improve accessibility.

People were supported to eat a balanced diet. People told us they enjoyed the food, however they said they did not have a choice of hot options at lunch time. The manager agreed to review this.

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. We observed staff ask for consent before providing people with care.

People were cared for by staff who knew them well. People told us staff were always kind and caring and treated them well. We observed staff treat people with dignity and respect throughout this inspection.

People told us staff supported them with their health needs and were quick to refer them to other professionals when necessary.

People were asked to provide information about their life history and their preferences for receiving care. This information was recorded in their care plan. This helped staff to provide personalised care to each person. People were involved in developing their care plan during a pre-admission assessment process, however people’s ongoing involvement in reviews of their care was not clearly recorded on the care planning system.

People told us they did not have enough to do to keep them occupied throughout the day. We saw some activities had taken place recently and some people had been supported to access the community, however improvements were required in this area. We have made a recommendation about the development of activity provision in the home.

The provider had a complaints procedure in place. People knew how to complain and were confident any concerns they raised would be acted upon. People told us the manager had swiftly acted upon any minor issues they raised.

Without exception, we received positive feedback about how the home was run by the new manager. People using the service, their relatives and staff all told us the manager was approachable and they had made a positive impact on the service since they had started working at the service.

The manager and provider monitored the quality of the service by completing a range of audits. The manager had made improvements to the service as a result of the audits they completed. They had a clear plan in place for the further improvements that were required.

The manager made themselves accessible to people using the service, their relatives and staff so they could share any feedback or concerns about the service. They planned to hold resident and relative meetings to obtain feedback about the service. Surveys were also completed to obtain feedback from people, relatives, staff and visiting professionals and the results were used to improve the service.

More information is in the full report.

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The inspection took place on 17 October 2016 and was unannounced, which meant the provider did not know we were coming. At the last inspection, in January 2014, the service was judged compliant with the regulations inspected.

The service has a manager who has been registered with the Care Quality Commission since July 2013. 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.

Bollingbroke House is located on the edge of Brierley village close to the border with West Yorkshire. The home is a large detached property, which was formerly a private residence. The home provides personal care for up to 33 older people. At the time of the inspection the home was providing residential care for 27 people. Some people living at the home had been diagnosed with a dementia type illness. The service had several communal areas and dining room and limited accessible secure gardens. The home is close to local amenities of shops and healthcare facilities.

CQC is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS), and to report on what we find. The members of the management team we spoke with had a full and up to date understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). These safeguards protect the rights of adults by ensuring that if there are restrictions on their freedom and liberty these are assessed by appropriately trained professionals. We found that appropriate DoLS applications had been made, and staff were acting in accordance with DoLS authorisations.

The environment could be improved to make it more dementia friendly. We have recommended that the provider finds out more information based on current best practice, in relation to the specialist needs of people living with dementia. In particular about the environment including, signage in the dining area in relation to meals, flooring and the use of contrasting colours on the corridors.

People’s physical health was monitored as required. This included the monitoring of people’s health conditions and symptoms, so appropriate referrals to health professionals could be made. For example, we saw evidence that the home regularly makes contact with district nurses, community nurses for mental health issues, and peoples own doctors. Other health professionals such as dieticians, dentists, occupational therapists and opticians were also requested as needed.

Our observation of medication being administered, together with our review of records, provided evidence that medicines were safely stored and administered.

There were robust recruitment procedures in place. On the day of our inspection there were sufficient staff with the right skills and competencies to meet the assessed needs of people living in the home. Staff told us they felt supported by the registered manager, and they confirmed that they had received formal supervisions and appraisals of their work.

Staff were aware of people’s nutritional needs and made sure they supported people to have a healthy diet, with choices of a good variety of food and drink. People we spoke with told us they enjoyed the meals and there was always something on the menu they liked. We observed people being offered a second helping of the main course during lunch. Snacks of biscuits and drinks were also available for people throughout the day.

People were able to access activities. We spoke to the activity co-ordinator about forthcoming events which included Halloween and Christmas.

Staff and relatives we spoke with were positive about the registered manager and the way in which she led the service. They told us that the registered manager was always aro

We spoke with five people who used the service. People told us that they were happy living at the home. Their comments included, "It's home from home and the staff are lovely," "We all get very well looked after" and "It's brilliant here."

We found that people were asked for their consent to care and treatment and the staff acted in accordance with their wishes.

We spent time sitting with people in the communal areas of the home and with people individually in their rooms. We found that care and support was offered appropriately to people.

We spoke with three relatives. They told us, "I couldn't wish for anything better, it's sweet and clean, not posh" and "The staff have been absolutely fantastic."

During our inspection we conducted a tour of the premises and found it was clean, tidy and free of any unpleasant odours. There were systems in place to reduce the risk and spread of infection.

We found that new members of staff had completed an induction and worked alongside other more experienced members of staff before they started to work unsupervised. We found that not all staff had received formal one to one supervision or a yearly appraisal.

We found people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

People who we were able to communicate with told us that they were happy living at the home and that they were satisfied with the care they received. People said,

"this is a lovely place with lovely people," "the staff are all very good" "I feel safe here and nobody bothers me," "it's alright here and the staff are alright" and "staff are brilliant."

We spoke with one relative. They spoke very highly about the home and the care that was provided. They told us "If you asked me how many I would give them out of ten my answer would be twelve. My family member has stayed in other homes and they didn't compare with this home at all. I cannot find fault with anything."

We saw that Barnsley Local Involvement Network (LINK) had carried out an 'Enter and View Visit' in January 2012. Their report confirmed that people living in the home and relatives that were spoken to, were very pleased and satisfied with the home and the care and support they were provided with.

We spoke with Barnsley Local Authority, Contracting, Commissioning and Safeguarding

and they told us that they had not identified any concerns at the home.

People that were able told us that overall they were happy living at the home and

satisfied with the care and support they were receiving. People said:

"I’m fine living here, no problems."

"I think the staff are good."

"Some staff are better than others."

"The atmosphere’s good."

Relatives said that they were satisfied with the support provided to their loved ones

and were always made to feel welcome at the home when they visited. Relatives

said:

"She (my relative) looks better now than she did before coming into this home."

"I am able to talk to staff about any issues."

In the main people that were able told us that overall they were happy living at the home

and satisfied with the care and support they were receiving. Their comments included:

"I am happy here, things are OK".

"It's OK here".

"I'm comfortable".

"The staff are very good to me".

Relatives told us:

"This is the first home that mum has settled in".

"There's always plenty of drinks available".

"The staff are extremely good. I do worry that they are so short staffed. I sometimes come and there's only 2 staff here. Relatives end up watching people for the staff".