CQC report explained · a residential care home
What the CQC found at Bole Aller House
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Risk assessments and care plans were not always updated after incidents or clear enough for staff to follow. Fire drills had not been carried out as required, although medicines and infection control were found to be managed safely.
- Effective?
- Requires improvement
- Consent and best-interests decisions were not consistently recorded, and some restrictions were not shown to be least restrictive. Care plans were mixed in quality, although people received healthcare support and staff had relevant skills.
- Caring?
- Good
- The report does not give a current rating for Caring. Inspectors found warmth and kindness from staff, but said care was not always designed to promote people's human rights.
- Responsive?
- Good
- The report does not give a current rating for Responsive. People could make choices about daily routines, but some had limited opportunities to go out and did not have reliable internet access.
- Well-led?
- Requires improvement
- Quality systems did not always identify or fix problems. Records were not always accurate or consistent, and audits did not cover mental capacity and restrictions properly.
What inspectors found, November 2022
Rated Requires Improvement; inspectors found kind care and safe medicines, but concerns about risks, consent and management.
Inspectors visited without notice on 29 September and 3 October 2022. They spoke with 11 people, staff, relatives and health professionals. They observed care and checked records, medicines, training, audits and safety arrangements.
The home was rated Requires Improvement overall. Safe, Effective and Well-led were also rated Requires Improvement. Inspectors found gaps in risk assessments, care plans, consent records and the way restrictions were used. Records were sometimes inaccurate or inconsistent, and quality checks had not always found or corrected these problems.
There were positive findings too. Staff were described as kind and caring, people generally felt happy, medicines were managed safely and people received healthcare support. The senior team started work on some issues during the inspection, but inspectors could not yet check whether these changes would last.
Kind staff
There was a core team who knew people's needs. Most people experienced staff as warm, friendly and caring.
“There was a core team of staff who knew people's needs and were kind and caring.” from the report
Healthcare support
People were supported to see healthcare professionals when needed. Staff followed medical advice, and healthcare professionals gave positive feedback about the service's engagement.
“People were supported to access health care professionals according to their individual needs.” from the report
Daily choices
People could make choices about their daily routines, including when to get up and go to bed. The home also promoted a sense of community.
“People were able to make choices about their daily routines.” from the report
Risk planning
seriousRisk assessments and care plans were not always updated after incidents or clear enough for staff to follow. Fire drills had also not been completed as required.
“Risk assessments, and the related care plans, had not been completed or up-dated following incidents.” from the report
Consent and restrictions
seriousSome restrictions were used without clear consent, mental capacity assessments or recorded best-interests decisions. Restrictions affecting everyone were sometimes introduced because of the needs of particular people.
“People were not always receiving support in the least restrictive way or in their best interests.” from the report
Care plans
needs fixingCare plans did not always reflect people's views, needs and aspirations. Some lacked enough detail or contained information that contradicted other guidance.
“We found mixed evidence regarding the extent to which people's care and support plans were personalised to reflect their needs, preferences, aspirations and achievements.” from the report
Quality oversight
seriousAudits did not always lead to dated improvements and did not cover some important areas, including mental capacity and restrictions. Records about incidents and people's wellbeing were sometimes inconsistent.
“The provider had failed to ensure records were accurate.” from the report
Access and activities
minorThe rural location meant most people needed staff support to go into town. Some people could not go out when they wanted, and internet access was unreliable.
“People did not have reliable access to the internet.” from the report
- 01What changes have been made to ensure every restriction has the person's consent or a recorded best-interests decision?
- 02How are risk assessments and care plans now updated after incidents, and how is staff guidance kept consistent?
- 03Have the required fire drills been completed, and how often are they now checked?
- 04How does the home monitor whether each person gets the outings and internet access they want?
- 05What action has been taken in response to the three regulatory breaches, and how is progress being audited?
This was a focused inspection of Safe, Effective and Well-led; Caring and Responsive were not inspected and the report says ratings for uninspected questions carry over from the previous inspection. This explanation was written from the published report of 5 November 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, February 2019
Bole Aller House was rated Good overall; inspectors found kind, safe care and improvements after recent medicine errors and complaints.
The inspection was unannounced and took place over 31 January and 1 February 2019. It was brought forward because of complaints and concerns. The inspector reviewed records, medicines, staffing, training, incidents, complaints, building safety and quality checks. They spoke with nine people, five staff and a manager, and looked around the home.
All five areas were rated Good: Safe, Effective, Caring, Responsive and Well-led. People said they were happy. Inspectors found staff knew people well, treated them respectfully and supported their choices, activities, health and independence.
The home had made changes after concerns about medicine errors and some people's care. Inspectors found safer medicine systems, better admission checks, staff retraining and more monitoring. They also found that information about end of life wishes was limited and that some annex windows were in poor repair.
Kind and respectful staff
Inspectors observed staff treating people with kindness and respect. Staff were patient when people were anxious and helped them make choices.
“We observed staff treating people with kindness and respect.” from the report
Personalised support
Support plans described people's needs and preferences clearly. People were supported with activities, community life, family contact and personal beliefs.
“People were encouraged to have as much involvement as possible in drawing up their support plan and reviewing it.” from the report
Support for independence
Staff helped people gain skills, confidence and employment opportunities. Some people had moved on to live more independently in the community.
“They had also supported some people currently living in the home to plan towards living independently by setting goals, helping them learn new skills, and helping them find employment in the community.” from the report
Previous medicine errors
seriousMedicine administration errors had happened before the inspection. The home took action, including retraining staff, but ask how medicine safety is checked now.
“For example, before this inspection some medicine administration errors had occurred.” from the report
Limited end of life information
needs fixingSupport plans did not yet contain enough information about people's end of life wishes. The home said it planned to gather better information and provide more staff training.
“Support plans contained only limited information on people's end of life wishes.” from the report
Annex windows
minorThe flats in the annex were not being used because the windows were in poor repair. The provider said replacement windows were planned.
“At the time of this inspection the flats in the annex known as the Stables were not in use as the widows were in a poor state of repair.” from the report
- 01What checks are now in place to prevent medicine errors, and when were staff last assessed as competent to administer medicines?
- 02How do you make sure the home can meet a new resident's needs before admission, particularly if their needs change?
- 03When will the annex windows be replaced, and are any other parts of the building awaiting repair?
- 04How will you record and review my relative's end of life wishes, and what training have staff received?
- 05How are residents and relatives told about complaints, and how are actions from complaints checked?
This was an unannounced, scheduled inspection covering the premises, care and all five CQC questions; it was brought forward because of complaints and concerns, and the previous rating in 2017 was also Good. This explanation was written from the published report of 22 February 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Bole Aller House
5 rated inspections over 7 years: the service has held its Requires improvement rating throughout.
- November 2022Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- February 2019Goodstayed GoodSafe: GoodEffective: GoodWell-led: Good
- January 2017Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- May 2016Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodResponsive: Requires improvementWell-led: Requires improvement
- December 2015Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- May 2014
Report published without a new overall rating.
- October 2013
Report published without a new overall rating.
- May 2013
Report published without a new overall rating.
- June 2011
Report published without a new overall rating.
- November 2010
Registered with the Care Quality Commission on 18 November 2010.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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17 live-in carers within about an hour of Devon
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £1,020 to £1,270 a week. 15 can care for a couple. 13 years' experience on average.
“She is such a warm and gentle person while being professional and competent at the same time.”
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Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.