Archived: The Bungalow

The Bungalow is a supported living service. At the time if the inspection three people were receiving a service who all lived together in one house. The service shares the same staff, office and manager as another supported living service (Grove Villa Supported Living) which is based on the same site. The Bungalow and Grove Villa Supporting Living were inspected on the same dates. The house was a single-story building based on a large site where there were two other services provided by the same provider.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service:

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question Well-led and Responsive to at least Good. We found that the provider had not undertaken all of the actions in their action plan. The service was previously Requires Improvement Responsive and in Well-led, we found that it was now Inadequate in Well-led and remains requires improvement in Responsive. All other key questions had deteriorated: Safe is now rated Inadequate, and the key questions of Effective and Caring are rated Requires Improvement.

There was no management oversight of the service and no oversight by the provider. For example, there was a lack of auditing, complaints were not always recorded, and staff performance was not monitored. This meant that there was a risk that people were not always receiving the high quality, person centred, safe service they should expect the receive.

People were at risk of harm. Risks to people were not always assessed, managed or monitored safely. This impacted on individual’s safety in their day to day lives. People could not be assured that the provider, manager or staff would provide the right support to keep them safe from harm. People were not always receiving their medicines as prescribed which could have a possible impact on their health or well-being. People were not always protected from risks and when things went wrong there was a lack of action and learning to ensure that concerns did not escalate or happen again. The service did not always report concerns to safeguarding or CQC. This meant that neither CQC nor the local authority safeguarding team could check that staff had protected people from the risk of abuse or other harm at the time of the incident.

Staff did not have the training they needed to support people and undertake some of the tasks they were asked to do. Staff were not up to date with best practice which could have an impact on people’s safety. For example, staff were supporting people to cook for themselves but did not always have food hygiene training. There were also concerns about the providers staff recruitment practices, for example some staff had been recruited without the references the provider’s policy stated that were required.

People were happy with the service they received and told us that they liked the regular staff. People led busy lives and we often out. They were able to be independent at the service and staff supported and encouraged them to be so. However, people were not always supported to keep their home clean and we made a recommendation about this. When people were unwell they were assisted to access healthcare and people were supported to remain active and to live healthily.

People did not have care plans in place which fully described their support needs, preferences and interests. When people’s needs and wishes changed, their care plans had not been updated to reflect this. There were enough staff to support people: Regular staff knew people well and knew people’s likes and dislikes. However, some non-regular staff provided support for people and the absence of accurate care plans and risk assessments meant people could not always be assured their needs would be known or met. The service had not asked people about their preferences for the end of their life. This meant that staff may not have known people’s preferences.

The outcomes for people using the service did not always reflect the principles and values of Registering the Right Support; Although staff recognised that people had the capacity to make day to day choices, people did not always receive the right support to keep them safe. People were supported to be independent and undertake daily living activities. People were engaging in the community, for example through attending clubs, accessing local shops and visiting local pubs.

We found a number of breaches of the regulations. The service did not meet the characteristics of Good in any area; more information is in the full report.

Rating at last inspection:

At the last inspection on the 31 May 2018 the service was rated Requires Improvement for the second consecutive time.

Why we inspected:

This inspection was brought forward due to information of concern.

Enforcement and Follow up:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

This service provides care and support to people living in a ‘supported living’ setting, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

People using the service lived in a ‘house in multiple occupation’. Houses in multiple occupation are properties where at least three people in more than one household share toilet, bathroom or kitchen facilities. There were sleep in arrangements for staff on site. There were seven people using the service at the time of our inspection.

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 provider’s vision of the service was to support people to be as independent as possible

A registered manager was working at the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 was not in day to day charge of the service and had delegated many responsibilities to the acting manager, who planned to apply to be registered by CQC.

At the last inspection in April 2017 and the service was rated Requires Improvement. We found that the provider was in breach of four regulations in relation to staff training, the assessment and management of risks to people, people’s involvement in planning their care, records and checks of the service. Following the inspection, the provider sent us an action plan of how they would address the shortfalls. At this inspection we found that the action plan had not been consistently followed and further improvements were needed.

Checks on the quality of the service had improved since our last inspection, however, further improvement was required to make sure all areas of the service were reviewed and actions were taken to make improvements where necessary. Shortfalls we found had not been identified. Accidents and incidents had been analysed and action had been taken to stop them happening again.

The provider had not send us information we require to us at least once a year, about what the service does well and improvements they plan to make.

People had not been asked about their end of life care preferences and had not been supported to make plans for the future. We made a recommendation about this.

Staff knew the signs of abuse and were confident to raise any concerns they had with the registered manager and acting manager. The local authority and CQC had been informed any incidents of possible abuse so they could be investigated.

People were not discriminated against and received support tailored to their needs and preferences. Assessments of people’s needs and any risks had been completed. Staff knew people well and provided their support in the way they preferred. Guidance about people’s support had improved and detailed guidance was now in place about the support people needed to manage behaviours that challenge. Each person had planned their support with staff, including taking their goals and aspirations. People had opportunities for lifelong learning and some people had jobs.

People’s needs were assessed before they began using the service to make sure staff could offer them the support they wanted. People were able to visit and meet the other people using the service before they decided to have a service from The Bungalow.

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 supported this practice. Staff assumed people had capacity and respected the decisions they made. When people needed help to make a particular decision staff helped them. Decisions were made in people’s best interests with people who knew them well. Staff worked with community professionals, including care managers to support people to be more independent.

Changes in people’s health were identified and staff supported people to contact the relevant health care professionals. People’s medicines were managed safely and people received their medicines in the ways they preferred and as their healthcare professional had prescribed.

People were encouraged to eat a balanced diet which met their health needs. People planned what they wanted to cook and staff supported them to do this when it was necessary. People were supported to clean their bedroom and communal areas of the service including the kitchen.

There was a culture of openness; staff and managers spoke to each other and to people in a respectful and kind way. Staff were kind and caring to people and treated people with dignity and respect. Staff gave people privacy. Everyone was supported to be as independent as they wanted to be. People had enough to do during the day and were involved in their local community. They used community facilities such as the local leisure centre.

People were asked if they had any concerns about the service so they could be resolved. The complaint process was accessible to everyone in a way they understood. People, their relatives, staff and visiting professionals shared their views and experiences of the service and these were acted on.

There were enough staff to provide the care and support people needed. Staff were recruited safely and Disclosure and Barring Service (DBS) criminal records checks had been completed. Staff were supported to meet people’s needs and had completed the training they needed to fulfil their role. Staff were clear about their roles and responsibilities and worked as a team to meet people’s needs.

Staff felt supported by the registered manager and acting manager, were motivated and enthusiastic about their roles. A manager was always available to provide the support and guidance staff needed.

Records in respect of each person had improved and were now complete. Information about people was stored securely.

Services that provide health and social care to people are required to inform the CQC, of important events that happen in the service like a serious injury. This is so we can check that appropriate action had been taken. We had received notifications as required.

Services are required to prominently display their CQC performance rating. The registered manager had displayed the rating in the entrance hall of the service. The provider does not have a website.

This is the second consecutive time the service has been rated Requires Improvement. You can see what action we told the provider to take at the back of the full version of the report.

The inspection took place on 13 April 2017 and was announced.

The Bungalow provides domiciliary care and support services to people with a learning disability living in their own home. The service has an office in the home where the people they support live, which shares a site with other services owned by the same provider. The service currently provides support to 7 people in Deal who share a house. There were staff at the service 24 hours a day, including a member of staff who stayed awake all night.

The service has a registered manager in place and they have been in this role since 2016. The registered manager had worked at the service for many years and knew people well. 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.

Risks to people were assessed and people were supported to take risks and try new things. However, staff would benefit from more detailed guidance about how to minimise risks to people. Staff could recognise the different types of abuse and knew who to report any concerns to, both within the organisation and externally.

Staff had some understanding of the Mental Capacity Act (MCA) and followed the principles on a day to day basis. However, people’s ability to make a decision had not been assessed before decisions were made on their behalf. There was a risk decisions could be made for people who were in fact able to decide for themselves. The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). For people who live in their own homes this is managed by the Court of Protection (COP). No applications had been made for people as none were needed.

Staff were recruited safely and people were involved in the interview process. Staff had induction training and were introduced to people by established staff before supporting them. Staff completed basic training; however further training was required to meet people’s needs. Staff were in regular contact with the management team and had regular one to one meetings, but appraisals had not been completed. There were enough staff to meet people’s needs and people told us they felt supported.

Medicines were managed safely and people were encouraged to be as involved as possible with their medicines. Protocols around the use of ‘as and when needed’ medicines needed improvement. Staff worked closely with local health and social care professionals to manage people’s health and develop new opportunities for them. When people’s needs changed advice was sought and followed to make sure the staff could still meet people’s needs safely. However, staff would benefit from more detailed guidance about how to manage risks related to people’s health.

People had good relationships with the staff who supported them. Staff knew people well and treated them with dignity and respect. People had some opportunities to express themselves and have a say about their care on a day to day basis but people were not involved planning their support or writing their care plan. People’s care plans needed more detail about how they preferred to be supported. Some care plans contained derogatory language about people.

Some people attended local day services, went to college or completed voluntary work. People were supported to be part of their local community and follow their interests or hobbies. However, there were no personal goals recorded for people or plans to help people reach their goals.

People had support to eat healthily and planned their own menus. Some people were using communication tools, such as pictures to make choices, however, this was limited and the registered manager agreed this could be developed to include other areas for example, to help with menu planning.

No complaints had been received, the service had an accessible complaints procedure and people knew who to speak to if they had a complaint. People’s confidentiality was respected and records were stored securely.

There was an open culture, people and staff could contact or visit the registered manager whenever they wanted to. The registered manager spent time with people regularly to check if they were happy with the service and they were accessible to people, professionals and staff. However, the registered manager did not have a plan to develop or maintain their management skills.

Views were sought from people, relatives and professionals and were acted on. Audits were completed but had not identified the issues found at this inspection.

The CQC had been informed of any important events that occurred at the service, in line with current legislation.

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 the report.