Bole Aller House

Right Support: People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Where people lacked capacity to make decisions, the provider had failed to put in place documents to support decision making. Restrictions in people's lives had not been considered to ensure the least restrictive options for individual people were identified.

The senior team in the home were responsive to our questions about restrictive practices and started to implement a program of review and change.

People did not all have up to date outcome focused support plans. People were not always supported to contribute to and agree support plans in ways that were meaningful to them.

Risk management was inconsistent. A lack of support plans and assessments in place meant the staff approach to risk varied. People were mostly not put at risk of harm due to this inconsistency however, it did lead to people being required to accept varying levels of restrictions in their lives.

A failure to record and monitor incidents consistently meant there were missed opportunities to avoid and reduce risks in ways that respected people's views.

People lived in an isolated physical setting that meant most people needed staff support to go into town. Staff were alert to the potential risks associated with this, and most people went into town on a minimum of a weekly basis. The physical environment also had an impact on people's access to the internet which put

people at risk of reduced access to information and online activity. The provider was seeking to redress this issue.

People accessed specialist health and social care support where appropriate. People's medicines were managed safely, and they received them in the way prescribed

Right Care: People's care plans did not show how restrictions had been agreed upon with them. There was little evidence that historical restrictions were reviewed to enable people more responsibility and freedom. In some instances, restrictions were imposed on people because of the assessed needs of other people living at the home.

Staff spoke with genuine warmth and affection for people and this care and warmth was felt by the majority of people living in the home. However, this care was not always designed to promote people's human rights.

There was a core team of staff who knew people's needs and were kind and caring.

Right Culture: There was a failure to identify and mitigate institutionalised practices. A number of restrictive practices were found, and the routines within the home were not always personalised to individual people. The service had not been supported by the provider to ensure they were aware of and implementing current best practice and guidelines.

Internal quality assurance systems and governance processes were in place to audit or review service performance and the safety and quality of care. This oversight had not always identified or prevented issues occurring or continuing at the service. People's rights were not embedded in these oversight tools.

There was a caring culture evident in the service. The senior team were available to the people and staff team.

The senior team in the home were committed to ensuring the best possible care and support for people.