CQC report explained · a residential care home
What the CQC found at Boulevard House
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, April 2024
Boulevard House is rated Requires Improvement; it improved from Inadequate and left special measures, but inspectors found continuing safety and management breaches.
This was an unannounced follow-up inspection after the previous Inadequate rating. Two inspectors visited, an Expert by Experience spoke with relatives by phone, and inspectors spoke with people, staff and management. They checked care records, medicine records, staff files, training and how the home was managed.
There were enough staff, and most staff had the skills to support people. People had person-centred care plans, choices about food and opportunities for activities, independence and social inclusion. Incidents and the use of restrictive interventions had reduced.
However, inspectors found important safety problems. Risk assessments, safeguarding arrangements, medicines administration, injury records and emergency evacuation plans were not always reliable. Management checks had not found or properly dealt with these issues. The home breached Regulations 12, 13 and 17, and CQC imposed conditions on the provider's registration.
Enough staff
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
Person-centred plans
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
Less restrictive practice
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
Food and choice
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
Restrictive interventions
seriousPositive 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
Medicines administration
seriousA 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
Safeguarding systems
seriousThe 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
Risk and emergency planning
seriousSome 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
Weak management checks
seriousManagement 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
- 01How are you now checking that staff follow the medicine administration record every time medicines are given?
- 02What has changed in each person's positive behaviour support plan about restrictive interventions, and how do you check that staff understand it?
- 03How do you record and refer safeguarding incidents, and are all new staff completing safeguarding training before working directly with people?
- 04What changes have been made to personal emergency evacuation plans, door safety and the garden for people who may be at risk if they leave without support?
- 05How are you now checking body maps, fluid monitoring, incident records, maintenance problems and hot-water temperatures?
This was an unannounced follow-up inspection that considered the overall service and infection control, but the report gives ratings only for Safe, Effective and Well-led; Caring and Responsive were not rated. This explanation was written from the published report of 25 April 2024 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 2023
Boulevard House is rated Inadequate and is in special measures; inspectors found serious risks involving restraint, medicines, consent, staff training and management.
The inspection was unannounced and took place on 7 November and 24 November 2022. One inspector spoke with five people, one family member and five staff. Records about care, medicines, staff and management were also checked.
Inspectors found people were at risk of avoidable harm. Physical interventions had been used by staff without the necessary training. Records did not clearly explain what had happened, risks were not always assessed, and medicines were not always stored or recorded safely.
People were not always involved in decisions about their care. Mental capacity assessments and best-interest decisions were missing for some restrictions. Inspectors also found a controlling and closed culture, weak checks by managers and failures to learn from incidents.
The overall rating fell from Good at the previous inspection, published on 22 January 2020, to Inadequate. The report says the home is in special measures and will be kept under review.
Recruitment checks
Inspectors found that staff recruitment checks had been completed before staff started work.
“Staff were safely recruited. Pre-employment checks such as Disclosure and Barring Service (DBS) had been completed before staff started work.” from the report
Staff support
Staff received regular supervision and appraisals. Staff told inspectors they felt supported in their roles.
“Staff received regular supervisions and appraisals. The manager showed us their schedule which ensured staff were receiving regular support.” from the report
Food and choice
People were offered home-cooked food, choices at mealtimes and the opportunity to request something different.
“Food was home cooked and of good quality. There were options available at mealtimes and people could request something different” from the report
Healthcare support
Inspectors saw examples of people being supported to attend GP appointments and annual health checks.
“People were referred to healthcare services when required. We saw examples in care plans of people being supported to visit GP's and attend annual health checks.” from the report
Unsafe restraint
seriousStaff used physical intervention techniques without the necessary training. Records did not give enough detail to show whether restraint was safe or justified.
“Staff used physical intervention techniques they had not been trained in to restrain people.” from the report
Missing risk assessments
seriousImportant risks, including running away, self-harm and swallowing unsafe items, had not always been assessed or followed up.
“There were no risk assessments in place to support someone who was known to self-harm and no risk assessments were undertaken following another person going to hospital following ingesting something not safe for consumption.” from the report
Medicine problems
seriousSome medicines were stored incorrectly, stock checks were unreliable and instructions for as-required medicines and creams were missing or incomplete.
“Protocols were not in place for people's 'as required' (PRN) medicine. When people were prescribed medicine to help with anxiety or distress, staff did not have the appropriate information” from the report
Consent and restrictions
seriousThe home had not completed mental capacity assessments or best-interest decisions for some restrictions, including locked wardrobes and room searches.
“There was no evidence capacity assessments or best interest meetings had been carried out in relation to these decisions to ensure they were in people's best interests and the least restrictive options.” from the report
Weak management oversight
seriousGovernance checks failed to identify or correct serious problems. Care plans, medicine audits and incident reviews were not effective.
“Governance systems and provider oversight were not effective in ensuring people were safeguarded from abuse and discrimination.” from the report
- 01What training have all staff now completed before using any physical intervention?
- 02How are restraint incidents recorded, reviewed and checked to ensure they are safe and justified?
- 03Have current mental capacity assessments and best-interest decisions been completed for every restriction on a person's freedom or belongings?
- 04How are as-required medicines and topical creams now authorised, recorded and checked?
- 05What changes have been made to risk assessments, care plans and management audits since the inspection?
This inspection covered Safe, Effective and Well-led, while no ratings were given for Caring or Responsive in this report. This explanation was written from the published report of 11 February 2023 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 Boulevard House
5 rated inspections over 9 years: the service has slipped, from Good to Requires improvement.
- April 2024Requires improvementcurrent ratingup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- February 2023Inadequatedown from GoodSafe: InadequateEffective: InadequateWell-led: Inadequate
- January 2020Goodstayed GoodSafe: GoodEffective: GoodWell-led: Good
- June 2017Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- June 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2014
Report published without a new overall rating.
- June 2013
Report published without a new overall rating.
- July 2012
Registered with the Care Quality Commission on 10 July 2012.
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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9 live-in carers within about an hour of Lincolnshire
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.
8 can care for a couple. 10 years' experience on average.
“Martin was more than a carer, he managed the home and became my uncle's best friend, enriching his life during his last few years.”
“Magda was always positive and proactive about trying new things to keep dad busy. She also introduced new ideas for keeping dad healthy.”
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.