We reviewed our findings at the inspection to help answer the five questions we always ask: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led? Below is a summary of what we found. The summary is based on our observations during inspection, speaking with people who live and work at Boundary House, feedback from other professionals and from looking at records.If you want to see the evidence supporting our summary please read the full report.
Is the service safe?
People said that they liked the staff and we observed staff calmly reassuring one person who had become anxious. Visiting professionals felt that the service supported people safely and could meet complex needs. The content of records had been improved to ensure these provided reliable information about care. Assessments of risk had been updated so they reflected people's current needs and how they were to be supported safely.
There were systems in place to learn from events such as whistleblowing concerns and investigations. The new management team had plans to make it easier to review incidents so that action could be taken to reduce risks and to help the service to improve. They were working with the local environmental health team to further improve information, guidance and management of health and safety.
We looked at systems for managing medicines and found that these were not sufficiently robust to ensure people's safety and to minimise the risks associated with medication. We asked the provider to tell us what they are going to do to meet the requirements of the law in relation to managing medicines.
The home had procedures in place in relation to the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) and staff had training in this. We provided information to the manager about a recent Supreme Court decision regarding the DoLS. This was so that further advice could be taken if it was needed.
Is the service effective?
People's health and care needs were assessed with them. Advice from other professionals relating to care and welfare was sought when appropriate and incorporated into plans of care. Staff were able to tell us about people's needs. This meant that staff knew how to support people properly.
Staff had relevant training and staff meetings so that they knew what was expected of them and had underpinning knowledge to support people effectively. However, they were not appropriately supported by means of supervision and appraisal to carry out their work. We have asked the provider to tell us what they are going to do to meet the requirement to support staff in their work.
Is the service caring?
People said they liked the staff who delivered their care. We observed that staff spoke with people in a kindly manner and gave encouragement when supporting people. Where people refused care and support, staff approached them at a later time to offer any assistance that was required. Visiting professionals felt that standards of care were good.
Is the service responsive?
People had opportunities to engage in activities inside and outside the service. The management team recognised that further flexibility could be built into this and were reviewing one to one support for one person to reflect their needs and preferences. A survey for relatives and professionals providing support to people had been compiled and was being issued by the provider's head office so that improvements could be made if necessary.
Is the service well-led?
We acknowledged that all members of the management team were newly in post. The new manager was not registered with the Care Quality Commission but had started the registration process. The management team had already identified where improvements could be made and had looked at how these could be prioritised. There was a quality assurance system showing that the quality and safety of care was checked. The management team had displayed a checklist of notifications that needed to be made to the Care Quality Commission so that they were aware of their legal obligations. This represented an improvement from our last inspection.
Staff were clear about their roles and responsibilities and aware of forthcoming changes to the staff structure. These were aimed at strengthening leadership within the service to ensure people received good quality care.