Bradfield House

At this inspection on 28 November 2018, there were 10 people living at the home. There were both young men and women living at the home. Accommodation is provided over two floors and people have their own rooms and en-suite bathrooms. People had access to two communal lounges, a dining area and garden.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The care service has been developed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

The home remained safe. A relative told us, “My son is completely safe, when he visits us he is always happy to go back to the home, we know he must feel safe and content or he wouldn't want to be there.” Systems and processes were in place to safeguard people from abuse. Accidents and incidents continued to be recorded and analysed and action taken to improve and learn when issues were identified. Medicines management remained safe. The home was clean and people were protected from infection control risks.

People's needs and choices continued to be assessed before they moved into the home and regularly thereafter. Staff had the skills and knowledge to deliver effective care and support and received a range of training opportunities. People were asked consent before being supported. People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People continued to be supported to maintain a balanced diet and had access to healthcare professionals when needed. People's needs were met by the design and adaptation of the building. People could move freely around the communal areas and the garden which were secure.

People continued to be treated with kindness and respect. A relative told us, “The staff are so very caring and know our son so well.” People were supported to be as independent and active as possible. People continued to be involved in decisions about their care and given support to express their views. Staff remained respectful of people’s privacy and people’s dignity was maintained.

People continued to receive care that was personalised and responsive to their needs. People were at the centre of care planning and fully involved in the process. People had access to a variety of activities that met their interests. There was a robust complaints policy in place.

Management of the home was robust and the culture was positive. A relative told us, “The home is very well managed, the manager is great and always on top of everything.” There was a relaxed and friendly atmosphere within the home. Systems and processes were in place to assess, monitor and improve the quality of the service being delivered. Staff worked in partnership with other organisations to ensure people's needs were met.

The service did not have a registered manager in post on the day of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A new manager was in post and they had previously been the deputy manager at the service. The new manager had been in post for one week before our inspection.

Staff were aware of their responsibilities in relation to keeping people safe. A member of staff explained that they would discuss any concerns with the manager and were confident they would take these seriously and respond appropriately. If they did not feel the response was appropriate they knew which outside agencies to contact for advice and guidance.

Risk assessments were in place and reviewed monthly. Where someone was identified as being at risk, actions were identified on how to reduce the risk and referrals were made to health professionals if needed.

Safe staff recruitment practices were followed. Disclosure and Barring Service checks (DBS) had been requested and were present in all checked records. There were sufficient numbers of staff on duty to keep people safe and meet their needs.

Policies and procedures were in place to ensure the safe ordering, administration, storage and disposal of medicines. Medicines were managed, stored, given to people as prescribed and disposed of safely.

Staff had undertaken a comprehensive training programme to ensure they were able to meet people’s needs. New staff received an induction to ensure they were competent to start work.

People’s rights were upheld as the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) had been adhered to. DoLS applications had been made for three people at the service. We reviewed the Mental Capacity Act and Deprivation of Liberty policy and saw that there guidance for staff was not always clear and it had not been updated to reflect the most recent judgements on when a DoLs application should be made.

People received enough to eat and drink. Staff encouraged people to eat and offered to refill drinks when needed. People were encouraged to be as independent as possible with tasks.

Staff knew people well and they were treated in a dignified and respectful way. A relative told us, “The staff are super, I think they’re all wonderful, in every way they possible can they support her, they go above and beyond”.

People were involved in the decisions about what care they received and in their decisions about daily routines. Staff spoke with people and gained their consent before providing support or assistance.

Relatives were made to feel welcome and felt comfortable discussing any changes or updates to the care their relative received. One relative told us they enjoyed the family events which were arranged, they told us, “I really like the way they get the family together for things like Easter”.

The care and support that people received was responsive to their needs. People’s care plans contained information about their life history and staff spoke with us about the importance of knowing people’s history. People’s care plans detailed their preferences such as what time they liked to go to bed and get up in the morning. We reviewed a care plan and saw it detailed what time the person liked to go to bed and what routine helped them to settle and enjoy a good night’s sleep.

People’s social needs were assessed and their care plan contained information on what hobbies and interests they had taken part in before moving to the home. Each person had a planned schedule of activities which they chose to do. Some people chose to attend a local day centre.

Relatives and staff told us the service was well led and spoke positively of the manager. A staff member told us they felt well support by the manager, they said “(manager) is amazing, she offers really good support, and she listens and helps”.

Quality assurance systems were in place to regularly review the quality of the service provided. A director’s audit was completed by a member of the senior management team once every four months and the manager completed monthly and weekly audits.

We observed that people had different ways of communicating and that care staff were able to understand each person's manner of communicating and respond to it appropriately. Care plans assisted staff in meeting people's needs. A relative told us 'We're completely happy. The staff group is now more settled and the manager runs a happy ship.' Another relative said their relative had greatly enjoyed a holiday abroad with staff which had been 'well planned and organised. We had a recent review which was very positive and we've been involved in decisions about care and treatment.'

The four relatives told us that they found the staff and managers approachable, and that they handled concerns appropriately. A relative said 'Any concerns I would go to the manager'. Staff had received training in protecting vulnerable people and managing incidents, and understood how to implement the service's safeguarding policies and procedures.

Staff had received relevant training and support to enable them to carry out their roles. Care staff told us that while the work had been difficult at times they felt consistently well supported by the management team at the service. A staff member told us 'It's helpful that the manager has been with us for a year.'

People had been provided with copies of the service's complaints procedure, which had also been made available in an easy read and pictorial format. People felt confident that complaints would be handled fairly and any necessary action taken.

People told us they were happy. We saw people being treated with dignity and respect, and supported by staff who promoted their privacy and independence. We found good quality information to advise prospective service users, their families and/or representatives about the type of service provided. There were good systems of assessment and risk management, leading to a pro-active approach toward the care and support of people using the service.

People had personalised plans of care and support and those people lacking capacity were supported in decisions about their care. There was clear guidance to support staff dealing with emergency situations.

People told us they felt safe at the home. Staff had been trained in safeguarding and had a good understanding of adult protection issues related to the needs of service users.

Staff said they felt well supported and valued by the organisation running the service.

There were good arrangements in place to monitor and assess the quality and safety of the service, including investigating and responded to complaints.