Archived: Bonhomie House

Bonhomie House is a care home with nursing. 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.

Bonhomie House provides care and support for up to 78 people living with a wide range of complex healthcare needs. These include acquired brain injuries, neurological conditions, physical disabilities and mental health issues. At the time of our inspection there were 59 people living at the service. Bonhomie House provides a range of accommodation. The main house is spread over three floors. The people living in the main house receive a mixture of one to one and shared care provided by a team of nursing and care staff. Also on site are a number of both shared and single dwelling bungalows where people receive either shared care or one to one support. The service has an activity hall with a swimming pool and Jacuzzi which can be used for therapeutic and leisure activities.

This service has been rated as requires improvement since the introduction of ratings in 2014. At the last inspection in March 2017, we rated the service as requires improvement and found breaches of three Regulations. This was because risks to people were not always well managed. There were not always sufficient numbers of suitably skilled staff deployed to meet people’s needs, improvements were needed to the accuracy of care records and to the robustness of the governance arrangements. An action plan was submitted which identified the steps that would be taken to address the breaches of the Regulations. This inspection checked whether the service was now compliant with the Regulations.

Bonhomie House 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.

Most of the issues identified at the last inspection relating to how risks to people were assessed and managed had been adequately addressed. However, records did not reflect that action had been taken to adequately protect people against the risk of scalding from hot water.

We continued to receive mixed feedback about the number of staff deployed and the continuity of care provided. There continued to be a high use of agency staff to cover staff vacancies. People, however, told us they felt safe and that their needs were generally met.

We found evidence that infection control measures, such as wearing personal protective clothing, were not consistently followed. The systems to manage cross infection needed to be more robust.

Some relatives felt their family members did not consistently receive basic care effectively.

The completion rates for training were variable and action was still needed to help ensure that staff had all of the skills and knowledge needed to consistently meet people’s needs effectively.

Improvements were needed to ensure that the food provided was enjoyed by people and consistently met their needs.

The care plans were more personalised and reflective of people’s individual wishes and preferences.

Improvements had been made to the activities provided, however, some people, and some relatives felt more could still be done to support people to follow their interests and to take part in a range of activities. The registered manager was confident that through embedding an active support approach people would be provided with more regular and meaningful opportunities to engage in activities.

Whilst some improvements had been made, the quality assurance systems in place were still not being consistently effective at identifying areas where the safety of the service might be compromised.

Some staff felt that support from the senior management team was not consistently good. They felt they were not always valued for their hard work or that their concerns about not being able to perform their role effectively were being listened to.

Medicines were managed safely.

Systems were in place to report and review the incidents and accidents that occurred within the service and to ensure lessons were learnt from these events.

Relevant checks had been completed before staff worked unsupervised.

People were protected from the risk of abuse.

Staff received a suitable induction and a system of supervision and appraisal was in place, although we have recommended that the provider review the frequency with which supervision is provided.

There were systems in place to seek and document people’s consent to their care and treatment. Where a person did not possess mental capacity, mental capacity had been assessed in line with legislation.

People’s health care needs were met and there was some evidence that people’s care was planned and delivered in line with current evidence based guidance. Staff worked effectively with other organisations to help ensure that people’s move to and from the service was coordinated and effective.

Overall the design and layout of the premises met people’s individual needs some aspects of the décor and fittings needed repair or replacement. We have recommended that the security measures of the building are reviewed.

People told us staff were kind and caring and overall, staff were observed to be attentive and reassuring to people.

We did observe a small number of interactions where the care could have been provided in a more person-centred manner.

People choices were respected and care was provided in a manner that mindful of people’s need for privacy.

People’s families were welcome to visit at any time and we saw a number of relatives sharing in aspects of their family member’s care.

People's religious and cultural needs were recorded in their care plans an action was taken to meet these.

Complaints policies and procedures were now displayed within the home and accessible to people and complaints had been investigated and a response made to the complainant.

The registered manager had over the last year demonstrated a commitment to driving improvements within the service. They had worked effectively with a range of health and social care professionals to address the areas where concerns had existed about the quality of care provided.

A number of the professionals we spoke with talked of seeing positive changes within the service driven by the leadership team.

Improvements had been made which helped to ensure that people’s views about the quality of the care and support provided were sought and used to drive improvements within the service.

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

This is the third consecutive time the service has been rated Requires Improvement. Whilst this inspection has noted a number of improvements, the service is not yet consistently providing good care. We will meet with the provider to discuss the findings of this report and continue to monitor the service to ensure that improvements are ongoing.

Bonhomie House is a nursing home which provides care and support for up to 78 people living with a wide range of complex healthcare needs. These include acquired brain injuries, neurological conditions, physical disabilities and mental health issues. At the time of our inspection there were 70 people living at the service. Bonhomie House provides a range of accommodation. The main house is spread over three floors. The people living in the main house receive a mixture of one to one and shared care provided by a team of nursing and care staff. Also on site are a number of both shared and single dwelling bungalows where people receive either shared care or one to one support. The service has an activity hall with a swimming pool and Jacuzzi which can be used for therapeutic and leisure activities.

At the last inspection in January 2016, we rated the service as requires improvement and found breaches of three Regulations. An action plan was submitted which identified the steps that would be taken to address the breaches of the Regulation. This inspection was to check whether the service was now compliant with the Regulations.

Bonhomie House 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.

Issues identified at the last inspection relating to how risks to people were assessed and managed had not been adequately addressed. We have identified a continuing breach of the Regulations with regards to this.

Improvements had been made to ensure that following incidents involving people and aspects of their care, remedial actions were taken to reduce any ongoing risks. However, the investigations were not always well documented and one incident of concern had not been escalated to the relevant authorities.

Staff were having more frequent supervision and appraisals, although we have made a recommendation about how the provider should ensure supervision is provided in line with best practice guidance.

Sufficient improvements had been made to the management of people’s medicines. The service was generally clean.

We did however identify new breaches of the regulations.

There were insufficient staff deployed to meet people’s needs. The provider was continuing to recruit new staff but there remained a high use of agency staff, some of whom people found it difficult to communicate with. People told us this sometimes had a negative impact on their care.

Records relating to assessment and care planning were not consistently completed to a good standard. Care plans were not always accurate and fully reflective of people’s needs or of the care delivered. We could not be confident that there were effective arrangements in place to seek and act on feedback from people, their relatives and staff.

Whilst we were able to see that some improvements had been made since our inspection many of these systems were still in their infancy or needed to be further developed in order to bring about lasting improvements and support the management functions of the home.

An activities programme was in place but some people and professionals told us more still needed to be ensure people had access to a meaningful and varied programme of activity and engagement that helped to improve their wellbeing. We have made a recommendation about this.

Improvements were needed to ensure that staff had all of the training relevant to their role. We have made a recommendation about this.

Whilst staff demonstrated a good understanding of the Mental Capacity Act 2005, not everyone who needed an assessment of their mental capacity to make decisions about their care, had one in place. Best interest’s consultations needed to be more clearly documented. Applications for deprivation of liberty safeguards had been appropriately submitted.

People were provided with adequate food and fluids and were able to choose from a range of suitable meals. Staff were attentive to people and assisted them to eat and drink in a person centred manner. However, we felt that some aspects of the dining experience could be improved.

Whilst a complaints procedure was in place, this was not displayed anywhere within the service. The complaints that had been received had been responded to.

People told us that staff were kind and caring. We observed a number of positive and warm interactions between people and staff and staff demonstrated a good understanding of the meaning of dignity and how this encompassed all of the care provided to each person.

We identified one continuing breach and two new breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the registered provider to take at the end of this report.

Bonhomie House is a nursing home which provides care and support to people living with a wide range of complex healthcare needs. These include acquired brain injuries, neurological conditions, physical disabilities and mental health issues. At the time of our inspection there were 67 people living at the service. Bonhomie House provides a range of accommodation. The main house is spread over three floors. The people living in the main house receive shared care provided by a team of nursing and care staff. Also on site are a number of both shared and single dwelling bungalows where people receive either shared care or one to one support. The service has an activity hall with a swimming pool and Jacuzzi which is used for therapeutic and leisure activities.

Bonhomie House 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. The registered manager had recently resigned from his post and left his position during our inspection. The provider had already recruited a new manager who was due to start the week following our inspection. Throughout this report the registered manager is referred to as the ‘manager’.

Improvements were needed to ensure that all of the risks to people’s health and wellbeing were adequately assessed and planned for. Incidents involving people and aspects of their care were not always being investigated robustly or escalated to the local safeguarding authority. Safeguarding investigations help to establish the facts about incident, understand the risk of further harm and make plans about how to ensure that people are safe in the future.

Some aspects of how people’s medicines were managed needed to improve and parts of the environment or equipment used by people were not always clean or for purpose.

Whilst some staff told us they had received some supervision, many had not. There was no effective process in place to record and monitor the frequency with which supervision was taking place. The manager could not therefore be reassured that staff were being adequately supported to perform their role effectively.

We were concerned that ‘blanket rules’ were being used to manage people’s smoking and that this was not always in line with people’s choices or wishes. We have made a recommendation about this.

Whilst staff demonstrated a good understanding of the Mental Capacity Act 2005 it was not always clear that the principles of the MCA 2005 were being consistently and effectively applied. The provider had taken action to ensure that people were not were not unlawfully deprived of their Liberty.

People using the service told us they felt safe. Improvements were underway to help ensure that people received care from a stable staff team who were familiar with their needs.

Staff worked effectively with a range of healthcare professionals to ensure that people’s healthcare needs were met.

People were provided with adequate food and fluids and were able to choose from a range of suitable meals.

People told us that staff were kind and caring. We observed a number of positive and warm interactions between people and staff and staff demonstrated a good understanding of the meaning of dignity and how this encompassed all of the care provided to each person.

Staff had a good knowledge of people’s individual needs and wishes and their likes and dislikes. This enabled staff to respond effectively to any concerns or issues they might have about people’s care. People were supported to take part in a range of activities both within and outside of the home.

Quality Audits needed to be more effective at driving improvements. We have made a recommendation about this.

The registered manager had cultivated positive relationships with people and the staff team and the organisation was committed to actively seeking the engagement and involvement of people and staff in developing the service.

We found a number of 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 this report.

The ages of people who lived at the home ranged from 36 to 92 years and approximately 70% were under the age of 65 years.

During our inspection we followed up two outstanding requirements that had been made following our last inspection of the home on 24 October 2013. They had been about meeting people’s nutritional needs and keeping records properly. On this occasion we found that these matters had been put right.

We used a number of different methods to help us understand the experiences of people using the service. This was because they had complex needs such as mental health problems and/or physical disabilities, or acquired brain injuries, which meant they were not always able to tell us about them.

We "pathway tracked" seven people who lived at Bonhomie House. This meant we looked at records the home kept about them including care plans that contained information about how they were given assistance and support to meet their needs. We spoke with five of the people we pathway tracked.

We also spoke with a range of other people. They included ten other people who lived at the home, relatives of one person and friends of another person we pathway tracked, two visiting social care professionals and ten members of staff.

Where it was appropriate such as at mealtimes we observed the care and support people received. We also observed the day to day activities in communal lounges and other shared areas such as the hall used for some social activities.

We looked at other documents that helped us understand how people were supported, such as staff training records, surveys, complaints, risk assessments and equipment servicing and maintenance records.

We considered our inspection findings to answer five questions we always ask. Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Is the service caring?

People who used the service expressed their views, were involved in making decisions and understood the care and treatment choices available to them.

People living at Bonhomie house used facilities in the local community such as local pubs, restaurants, shops and visited places of interest. There were also a range of activities people in which people could participate. They included daily clubs, such as gardening, art and craft, music and dance, cooking and nutrition. Groups took place such as current affairs, coffee meetings, films, bingo, poetry and chocolate fountain. One to one activities included hobbies, animal care and walks.

People we spoke with told us they usually received the assistance and support they needed. One person said, “They look after me well. They help me when I need helping. Another person said, “They are good. They get me out of bed into my wheelchair and take me outside for a cigarette”.

Is the service responsive?

During our inspection we saw staff were attentive, calm, considerate and sensitive. We noted they checked with people that they were comfortable, asked people what help they wanted and anticipated the needs of people who were unable to communicate verbally.

People were supported to participate in a range of social, leisure activities and personal interest activities. We saw evidence in minutes of regular meetings that showed people were consulted about the sort of activities they wanted to be arranged.

There were arrangements in place that ensured people who used the service, their representatives and staff were asked for their views about their care and treatment the service provided. Where the need for improvement was identified action was taken to do this.

Is the service safe?

The home had properly followed procedures in accordance with the law that ensured the people did not have their freedom restricted arbitrarily.

Risks to people who lived, worked and visited the home were identified and measures put into place to manage them.

The provider made arrangements with specialist contractors for regular checks and servicing of equipment and aids people needed to promote their independence and welfare. This ensured such equipment was safe to use and worked effectively.

There were enough qualified, skilled and experienced staff on duty at all times to meet people’s needs.

People were protected from the risks of unsafe or inappropriate care and treatment because information about them was complete and accurate.

Is the service effective?

A choice of suitable and nutritious food and drink was available to people and they were protected from the risks of inadequate nutrition and hydration.

The premises, equipment and utilities were regularly checked and tested by appropriately qualified personnel to ensure they were safe and effective. Tests and checks of such things included fire safety systems, the passenger lift, portable electrical equipment, central heating, electrical systems and water supplies.

Risks to people’s safety, health and welfare had been identified in order that measures could be taken to prevent people who lived at the home, staff and visitors being harmed.

Is the service well led?

The provider had effective arrangements in place to regularly check and monitor the quality of the service and assess and manage risks to the health, safety and welfare of people.

Social care professionals told us they were confident Bonhomie House provided a high standard of care. One said, “The staff have lots of skills and are knowledgeable about people’s needs. I would put a relative of mine here if they needed care”. Another said, “They care for people with very complex needs. They have structured plans in place about how to support people and work collaboratively with us and other agencies. Nothing is too much trouble to them. They have a solid understanding of risk management. I can’t fault them”.

We spoke with staff, reviewed records and observed the care and support people received. We found care and support were provided with people's consent and staff followed proper procedures if people did not have capacity to make decisions about their care. The service provided support and treatment that was caring and responsive to people's needs. People were protected from risks associated with the management of medicines.

The provider had effective recruitment processes and made the necessary checks before employees started work. Staff were supported to provide care that met people's needs. There were effective processes in place to monitor and assess the quality of service provided.

We found the food provided met people's nutrition needs, but was not always presented suitably so that it was appetising and enjoyable. Staff and management records were maintained professionally, but people's care records were not managed so that people were protected from the risk of unsafe or inappropriate care.

At the time of our inspection the provider did not have a registered manager in place. Although registered for the regulated activity "Diagnostic and screening procedures", the provider was not carrying on this activity at this location.

We found people were treated with respect and their dignity and privacy were preserved. They were involved in their own care and support, which was delivered according to their personal care plans. Risk assessments were in place to ensure people's safety and welfare. Staff received appropriate support and training, and had adequate equipment to deliver care and treatment effectively and safely. The service was open to complaints and comments, but had not received any recent formal complaints.

There was no registered manager at the time of our visit. We spoke with the acting manager who told us the regulated activity 'Screening and Diagnostic Procedures' was not currently being carried out at the location.