Brambledown Road

Brambledown Road is a residential care home providing accommodation and personal care to support up to 7 adults with a learning disability and/or autism. At the time of our inspection 7 people were using the service.

People’s experience of using this service and what we found

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 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.

Right Support: People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff supported people to manage and mitigate any risks to their safety. Staff only used physical restraint as a last resort and any chemical restraint was clearly documented and reviewed by senior members of staff. People received their medicines safely.

Right Care: The service had enough appropriately skilled staff to meet people’s needs and keep them safe. However, there were concerns from staff and relatives that recent changes to staffing levels were impacting on the level and quality of engagement with people at the service and opportunities to access activities in the community.

Right Culture: In the months preceding our inspection the service had been without a permanent manager. During this time there had been a lack of oversight and leadership at the service to ensure consistent good practice. However, there was a new manager who was in the process of identifying and addressing areas that required improvement. This included improvements required to ensure a safe, clean and hygienic environment was provided.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 2 July 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Independence Homes Limited – 44 Brambledown Road accommodates seven people with a learning disability in one adapted building. The care service has been developed and designed 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. At the time of this inspection there were six people using the service.

This inspection took place on 22 May 2018. At our last inspection of the service we rated the service ‘good’. At this inspection we found the evidence continued to support the rating of ‘good’. There was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns.

People were safe living at Independence Homes Limited – 44 Brambledown Road. Staff were supported to safeguard people from the risk of abuse and knew to report any concerns about people to the appropriate persons or authorities. Staff understood the risks posed to people and how these should be minimised to keep them safe from injury or harm. The provider acted to make improvements when things went wrong. At this inspection we saw improvements had been made following an injury incurred by a person that would help to reduce the risk of a similar injury reoccurring.

The majority of risks posed by the premises were appropriately managed but we noted that a fire extinguisher was not immediately to hand in the designated smoking area. We discussed this with the registered manager who said they would take action to address this immediately after our inspection. The provider maintained a servicing programme of the premises and the equipment to ensure areas covered by these checks did not pose unnecessary risks to people. The premises was clean and clear of slip and trip hazards. Staff followed good practice to ensure risks to people were minimised from poor hygiene and cleanliness when providing personal care, cleaning the premises and when preparing and storing food. Medicines were stored safely and securely and people received them as prescribed.

There were enough staff at the time of this inspection to keep people safe. The provider maintained robust recruitment checks to verify staff's suitability to support people. Staff had regular and relevant training to keep their knowledge and skills up to date with best practice. Staff were supported by the provider to meet the values and vision of the service which were focussed on people experiencing good quality care and support. Staff knew people well and understood people’s needs, preferences and choices. They were aware of people’s preferred communication methods and how people expressed their needs.

People continued to be involved in planning and making decisions so that they received personalised care and support tailored to their individual needs. Staff adhered to current best practice, legislation and standards in the delivery of people's care to support people to experience good outcomes in relation to their healthcare needs. People’s needs were discussed and reviewed with them regularly to ensure the support provided continued to meet these needs and to identify any improvements or changes required.

People were supported to keep healthy and well, to maintain a healthy and well-balanced diet and helped to access healthcare services when needed. The provider’s epilepsy alarm system ensured people received timely support from staff when required.

People were encouraged to do as much as they could for themselves to maintain their independence. The design and layout of the premises provided people with flexibility in terms of how they wished to spend their time when at home. People were supported to participate in a wide range of activities and events to meet their social and physical needs. Staff were kind, attentive and caring and treated people with dignity and respect. Staff ensured people's privacy was maintained when being supported with their care needs. Staff were warm and welcoming towards people’s relatives.

People were asked for their consent before care was provided and prompted to make choices. Staff were aware of their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and supported people in the least restrictive way possible. The policies and systems in the service supported this practice.

People and their relatives were satisfied with the quality of care and support provided. People, relatives and staff were encouraged to give their feedback about how the quality of care and support could be improved. The provider also worked in partnership with others to develop and improve the delivery of care to people.

The service had a registered manager in post who was aware of their registration responsibilities particularly with regards to submission of statutory notifications about key events that occurred at the service. The registered manager had additional management responsibility for two of the provider’s other services which meant their working week was split across three different locations. Staff spoke positively about the support they received from the registered manager. Relatives had differing views and experiences of the support they received. A new acting deputy manager had been appointed at the service which the registered manager said would strengthen current management arrangements at this service.

Senior staff monitored the quality of care and support provided. They undertook surveys and regular audits of the service and took appropriate action if any shortfalls or issues were identified through these. If people were unhappy and wished to make a complaint, the provider had arrangements in place to deal with their concerns appropriately.

Further information is in the detailed findings below.

Independence Homes – 44 Brambledown Road provides accommodation, care and support to up to seven adults who have epilepsy, some of whom have a learning disability and/or an acquired brain injury. At the time of our inspection seven people were using the service.

The service had a registered manager in place. 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. In addition to the registered manager, the service had a manager who was allocated to manage the service on a day to day basis. This person was in the process of completing their application to take on the role of the registered manager.

Staff supported people to stay safe and well. Staff were aware of the risks to people’s safety, and worked with people to manage those risks. This included the risks to their safety at the service and in the community. Technology was used to support with risk management, including technology which was able to identify if a person was experiencing a seizure during the night.

People’s healthcare needs were met. The provider had a medical team which was available to support and advise staff about how to support people, particularly in regards to their epilepsy. People were aware of when they were required to take their medicines, but did not know what medicines they were required to take. Staff supported people to ensure they received their medicines as prescribed, and arranged for medicines reviews to take place if they observed adverse side effects of their medicines. People were supported to attend healthcare services when required, including their GP, dentist, optician and hospital appointments.

People were involved in decisions about their care. Staff were aware of their responsibilities under the Mental Capacity Act 2005 and ensured they supported people in line with the principles of the Act. Where people were unable to make important decisions about their care, staff arranged for ‘best interests’ meetings to be held. People were encouraged and supported to make day to day decisions.

People were given choice and staff supported people in line with their preferences. Staff were aware of people’s interests and hobbies. People were supported to undertake activities in line with their interests. Some people were also accessing college courses and undertaking work experience in line with their interests and hobbies.

Staff had built caring and trusting relationships with people. People felt comfortable speaking with staff, and spoke with staff if they felt unwell or were upset. We observed people asking for support from staff and people received the support they requested. Staff spoke to people politely, respectfully and in a friendly manner. Staff respected people’s privacy and maintained their dignity. People were supported in line with their religion and cultural heritage.

Staff had the knowledge and skills to support people. Staff attended regular training that the provider considered mandatory to their roles as well as additional training relating to people’s individual diagnoses and communication needs. Staff were supported through supervision and appraisal processes. The manager worked with staff to ensure they understood and adhered to their roles and responsibilities.

People, their relatives and staff were asked for their feedback about the service. They were invited and encouraged to express their opinion about the service. Where suggestions were made to improve the service or to offer additional opportunities for people these were listened to and implemented.

Systems were in place to review the quality of the service. This included reviewing complaints, incidents and accidents. The provider’s management team worked with the manager of the service to review and implement any improvements required to service delivery. A regular programme was in place to review the quality of care provided to people and support provided to staff.

The registered manager was aware of and adhered to the requirements of their registration.

If you want to see the evidence supporting our summary please read the full report.

We considered our inspection findings to answer five questions we always ask:

' Is the service safe?

' Is the service caring?

' Is the service responsive?

' Is the service effective?

' Is the service well led?

Is the service safe?

We found the home's safeguarding procedures were robust and staff understood how to safeguard the vulnerable people they supported. The home had proper policies and procedures in relation to the Deprivation of Liberty Safeguards (DoLS) and the manager understood when an application should be made.

The home was kept clean and effective infection control systems were in place.

We saw that the home was well maintained, with various regular health and safety checks carried out. People had safe access to a well-kept garden. Procedures in relation to fire safety were in place.

There were enough suitably competent staff employed to meet the needs of the people who lived at the home. Staff recruitment procedures were robust to ensure that only suitable people were employed. People's personal records, and other records relevant to the management of the service, were accurate and fit for purpose.

Is the service caring?

The feedback we received from people who used the service was positive about the standards of care and support they received at the home. We saw people who used the service were supported by kind, patient and compassionate staff. People were treated with respect and were supported to build their independent living skills.

Staff had a good understanding of the Mental Capacity Act. Staff were aware of the need to gain people's consent, if they were able to give it, prior to giving care. Staff were also aware of the meaning of 'best interests decisions' made when a person does not have capacity to make a particular decision. The manager gave us several examples of when 'best interests meetings' had been held regarding various decisions about people's care and treatment.

Is the service responsive?

We saw that the home regularly sought the views of people using the service, staff and relatives. We found that the home had responded positively to comments and suggestions that had been made.

Is the service effective?

People were protected from the risks of inadequate nutrition and hydration. People told us that they liked the food they were provided with, and we found that they had choice.

People's needs were assessed regularly. People had care plans in place which were 'person-centred' so people had been fully involved in creating them. We found that care was delivered in line with these care plans.

Is the service well-led?

The provider had effective systems in place to routinely gather the views of the people who used the service. Systems were in place to effectively assess and monitor the quality of the care provided at the home. This meant the views of people were taken into account in the way the service was provided.

Systems were in place to co-operate with other providers, sharing information effectively when people were cared for by more than one provider.

We found that care, support and treatment were provided by appropriately trained staff in line with detailed person centred care planning. There were robust systems in place for the management of medicines and to monitor and assess service provision.

People said that they were happy at the service and were involved in making decisions about their daily lives. They told us they enjoyed various activities, outings and regular holidays. One person said 'the staff are helpful, nice and ask what I want to do'.

People's care records were person centred and up to date so that staff understood what people's needs were and how to support them.

People told us that they felt safe and could tell staff if they were unhappy about something.

At the time of our visit, 44 Brambledown Road was well furnished, homely and decorated to comfortable standards. The premises were clean and safely maintained.

Staff told us that they felt well supported and had good training to meet the needs of people who have epilepsy. Staff in the home and other health professionals closely monitored each person's epilepsy needs to ensure they stayed as well as possible.

The provider had effective systems for assessing and monitoring the service they provided. People told us that they were often asked what they thought about the home and the support they received through monthly meetings and person centred planning.