Bonhomie House

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We assessed 2 quality statements from this key question. We have combined the score for this area with scores based on the rating from the last inspection, which was good. The Mental Capacity Act 2005 (MCA) provides a legal framework for making decisions on behalf of people who may lack capacity to. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. The service did not always support people in line with the MCA. This was a breach of regulation.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We found evidence people were not always involved in their care planning or reviews. A November 2023 provider survey seeking people’s views showed 10 people said they had not been involved in a recent review of their needs, and 7 said they had not been involved in their care plan. A further survey completed in September 2024 showed 6 people said they were not involved in their care plan, and 8 said they had not been involved in a recent review of their needs. Meeting minutes from 04 December 2024 stated ‘some’ people said they did not know they had a care plan, and did not feel involved in their care reviews.

We found some staff we spoke with clearly knew people and their needs well. However, there was a high level of agency staff and while some of these were regular staff, others were not. When staff told us how they supported different individuals, this was not always consistent with information in the person’s care plan, or with other staff members. This meant we could not be assured people would always be supported consistently in line with their assessed needs.

Although some sections of some people’s care plans were detailed and person-centred, this was not consistent. When care plans described people’s assessed needs, they did not always provide guidance for staff on how to support the person to meet those needs. For example, 1 person’s care plan said, “try to understand what [person] would like if you are unable to understand [person]”. Another person’s care plan said they could become agitated if they were not able to communicate with others, but there was no information about how they communicated or how staff could support this.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

Some people felt they were supported to make decisions, but others did not.

Staff and leaders did not always demonstrate an understanding of their responsibilities under the Mental Capacity Act. Staff told us about actions they took in people’s best interests but were unable to evidence whether the person’s capacity had been assessed or how the decision had been made.

When decisions were made on people’s behalf, mental capacity assessments and best interest meetings were not always completed in line with legislation. For example, a mental capacity assessment was not completed when staff were restricting someone’s access to their money against their wishes, which caused them distress. Although staff stated this was in their best interests, they were unable to provide evidence the person lacked capacity or how the decision had been made to ensure this was the least restrictive option. In addition, we were provided with 3 care plans that all contained different information about how staff should support the person to manage their money. Meeting minutes showed another person had requested not to be checked on at night, so staff were instructed to check through their window instead. This did not respect the person’s right to privacy and we saw no evidence their capacity had been assessed or a best interest decision was made.