Boulevard House

There were enough staff to meet people's needs and support their interests and social opportunities. Recruitment checks had also been completed before staff started work.

“People were supported by adequate staffing levels to keep them safe and enable them to pursue individual interests and social opportunities.” from the report

People had care plans that described their needs and preferences. Inspectors saw staff using these plans to support people in a way that helped prevent distress from escalating.

“People's needs were assessed and person-centred care plans were in place to instruct staff on how to support them in ways that upheld personal preferences.” from the report

The use of incidents and restrictive interventions had reduced since the previous inspection. The home showed a commitment to preventing distress early and avoiding physical intervention.

“Incidents had significantly reduced since the last inspection. There was a clear commitment to minimising the use of restrictive interventions and other restrictive practice.” from the report

People said they enjoyed the food and could choose what to eat. Staff took account of personal preferences and introduced people to food from different cultures.

“People told us they enjoyed the food and liked to choose what they were going to have.” from the report

Positive behaviour support plans did not clearly say which restrictive interventions could be used when people were distressed. Inspectors were not assured that staff understood which interventions had been agreed for each person.

“We could not be assured staff were sure what restrictive interventions had been agreed for each person to keep them safe.” from the report

A staff member was seen giving morning medicines without checking the medicine administration record. Inspectors were also concerned that some medicines had not been properly reviewed for continued need.

“We observed a staff member administering morning medicines to people without consulting the medication administration record (MAR).” from the report

The home did not have a safeguarding log showing which incidents had been referred. Two new staff members had also worked directly with people before completing safeguarding training.

“Systems and processes were not robust enough to ensure people were protected from the risk of potential abuse or harm.” from the report

Some people could leave the home when distressed, but the available controls were not suitable. Emergency evacuation plans were not realistic or person-centred, and some important medical risks had not been assessed.

“Personal emergency evacuation plans (PEEP) were not person-centred or realistic on how staff would support people in the event of a fire.” from the report

Management systems did not reliably identify or resolve problems. Examples included incomplete incident reviews, unreviewed body maps, unclear fluid monitoring, missing action on high hot-water temperatures and incomplete maintenance records.

“The provider's governance arrangements did not provide assurance the service was well-led.” from the report