Bonhomie House

This unannounced assessment was completed in response to concerns received about the service relating to the environment, staffing and safe care and treatment. We also checked to see if improvements had been made following the Warning Notice issued in relation to good governance at the last assessment. We undertook a comprehensive assessment and reviewed all 33 quality statements related to the 5 key questions, Is the service safe, effective, caring, responsive and well-led?

At the last assessment we found 5 breaches of the legal regulations in relation to dignity and respect, need for consent, safeguarding people from abuse and improper treatment, good governance and staffing. At this assessment we found 4 continued breaches of the legal regulations in relation to dignity and respect, safeguarding, good governance and staffing, as well as a breach in relation to safe care and treatment.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance Care Quality Commission (CQC) follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it. We found the provider did not always meet the requirements of this guidance. People were not consistently treated with dignity and respect, and care plans lacked sufficient detail to guide safe, effective, and person-centred care. The provider did not always have arrangements in place to protect people from improper treatment, and consent was not always obtained in line with legislation and best practice.

The provider had an inconsistent approach to risk management. Risks to people’s health and safety were not always assessed, and appropriate actions were not consistently taken to reduce these risks. Systems and processes for managing medicines safely were not always effective.

The provider did not always ensure there were enough qualified, skilled, and experienced staff to deliver effective, person-centred care. This meant people’s needs were not consistently met. Leadership instability had affected oversight and weakened risk management. Although governance arrangements existed, they were not operated effectively to monitor and improve the quality of care. However, we found no evidence that people had been harmed.

The provider was previously in breach of the legal regulations in relation the need for consent. Enough improvements were found at this assessment, and the provider was no longer in breach of this regulation.

Progress since the last inspection had been slowed by leadership instability, which had impacted oversight and delayed improvements. Recent actions to strengthen leadership were beginning to drive more consistent progress. Staff and leaders engaged openly and transparently throughout the assessment, demonstrating a commitment to learning and improvement. The provider had a detailed service improvement plan and was responsive to feedback throughout the assessment, taking action and identifying steps to address the concerns and strengthen their improvement plan. They worked collaboratively with external professionals and organisations to support and drive improvements. Leaders acknowledged that improvements were still underway but demonstrated a clear commitment to making changes that would be sustained and fully embedded.

We have asked the provider for an action plan in response to the concerns found at this assessment, and we will meet with them once it is received to closely monitor progress and ensure all improvements started during the inspection are fully completed.