Livability Bradbury Court

About the service

Livability – Bradbury Court is a care home that accommodates up to 21 people across two floors, each of which has separate adapted facilities. At the time of the inspection 18 people lived at the service. People who used the service had physical disabilities. Five people living at Bradbury Court had a diagnosis of a learning disability as well as a physical disability. Most people lived there permanently, and some people spent short periods there to receive respite from their main carers.

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

People’s experience of the service was positive. They were protected from the risk of harm and abuse. There were effective systems and processes in place to minimise risks. Medicines were managed safely, and care staff had been recruited safely. Feedback from people showed there were no issues with the number of staff deployed.

People’s needs were assessed, and care plans reflected their needs. Meals provided were discussed with people who used the service and where people required support to eat this was done appropriately. Staff were skilled and knowledgeable about people’s needs and had access to an extensive training programme to learn new skills and update their knowledge. The environment was well maintained and decorated and suitable to people’s needs. 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.

The provider had a range of quality assurance processes, including systems necessary to maintain safe environments. The registered manager and their deputy ensured policies and procedures met current legislation and were up to date. People who used the were asked of their views about the quality of the service.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support: Model of care and setting maximised people’s choice, control and Independence. For example, people were encouraged and empowered to make their own decisions. Care staff ensured that people were supported and gave people daily choices which were appropriate to their needs and level of understanding and ability.

Right care: Care was person-centred and promoted people’s dignity, privacy and human rights. Staff knew people well and established positive relationships with them. Peoples dignity, privacy and human rights were maintained. While people were treated and supported as an individual and we saw that the service had made improvements around providing individual stimulating activities.

Right culture: Ethos, values, attitudes and behaviours of leaders and care staff ensured people using services lead confident, inclusive and empowered lives. People who used the service accessed the local community for activities and day to day tasks such as shopping for personal items independently or with staff support. People were put first, and activities and facilities were tailored towards peoples wishes and needs. The new leadership team was open and transparent and easy to talk to. They listened to people who used the service, staff and visitors to discuss concerns and improve the service for people who used the service.

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

Rating at last inspection and update - The last rating for this service was requires improvement (published 24 December 2019)

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

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

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

We carried out an unannounced comprehensive inspection of this service on 25 September 2019. We found breaches of legal requirements during this inspection. The provider completed an action plan after the last inspection to show what they would do and by when to improve the management of medicines and the effectiveness of the quality monitoring of medicines administration

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bradbury Court on our website at www.cqc.org.uk.

Follow up

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

Livability Bradbury Court is a care home that accommodates up to 21 people across two floors, each of which has separate adapted facilities. At the time of the inspection 20 people lived at the service. People who used the service had physical disabilities, some of whom also had a learning disability. Most people lived there permanently, and some people spent short periods there to receive respite from their main carers.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

Staff had received training in the safe administration of medicines. However, some staff members were not suitably trained and competent in managing high risk medicines or medicines that had to be administered from original packaging. There were procedures for investigating and learning from accidents. However, we judged there was limited organisational learning because investigations focussed on the errors of individual staff members, with less attention on root causes.

Apart from the shortfalls identified with medicines management, we found people were protected from the risk of harm and abuse. Safeguarding procedures were in place, which staff were aware of. Staff were recruited safely. Even though there were staff shortages, a contingency plan was in place.

People’s care records showed relevant health and social care professionals were involved in their care. People receiving care told us staff were competent. However, we noted staff required tailored training to improve their awareness of how to properly administer specific medicines. There were arrangements to ensure people’s nutritional needs were met. The home environment was adapted to make it accessible to people who used wheelchairs. One of the two lifts was not working, and there were arrangements for repairs.

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. When people were unable to make decisions about their care and support, the principles of the Mental Capacity Act (2005) were followed.

People’s privacy and dignity were respected. Staff protected and respected people's human rights. They had received training in equality and diversity. People’s spiritual or cultural wishes were respected. Staff maintained people's independence by supporting them to manage as many aspects of their care as they could. People’s privacy was also upheld in the way their information was handled. The service recognised people’s rights to privacy and confidentiality.

People told us their needs were met. We observed a range of practices that reflected person centred care. People’s values and preferences were respected. Their families were involved in care as appropriate. We also saw people had access to appropriate care and information, which was presented in an accessible way for people to make decisions about their care. This was regularly reviewed to monitor whether care was up to date and reflected people’s current needs. We discussed with the registered manager the need to develop more creative ways for people having more control over their own medicines and money.

Although improvements had been made in the monitoring systems, we judged further improvements were required in the way accidents were investigated in order to enhance learning from them.

Rating at last inspection

The last rating for this service was requires improvement (published 25 March 2019) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough, improvement had not been made and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about medicines and staffing. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to how certain medicines were managed, and how well accidents were managed.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

there permanently, and some people spent short periods there to provide respite to their main carers. The home is over three floors with a range of communal areas on each floor. These included dining spaces, an activities room and smaller lounge spaces.

People’s experience of using this service:

Medicines were not always managed safely. Liquid medicines were not measured safely to reflect the prescribed amount. Medicines Administration Record Sheets (MARs) did not allow for topical creams to be recorded separately and some information regarding the administration for covert medicines was conflicting. Appropriate staff recruitment checks were carried out, however, staff recruitment files were disorganised and needed attention. Audits were in place to monitor the service. However, these were not always effective and did not always identify issues we found as part of this inspection.

Most of the time sufficient staff were deployed to meet people’s needs. Risk assessments had been developed across a range of areas. Risks specific to people’s health conditions were in place and described their individual needs and provided guidance for staff. Systems to prevent cross infection were robust. Cleaning schedules were in place and a designated team of staff ensured that the service was cleaned regularly.

People were supported to have maximum choice and control of their lives and staff supported people in the least restrictive way possible; the policies and systems in the service were designed to offer people maximum choice.

Healthcare professionals were requested when people needed their support and guidance. Staff we spoke with confirmed they received training and support to carry out their roles and responsibilities. People received a balanced diet which met their needs and dietary requirements. Drinks and snacks were provided throughout the day.

During our inspection we observed staff interacting with people and found they were kind and caring and treated people with dignity and respect.

Care records were clear and concise and contained relevant information. Staff supported people in line with their individual care plans. People were offered social stimulation. However, a wider ranging activity programme would benefit people.

We identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around medicines administration and governance. Details of action we have asked the provider to take can be found at the end of this report.

More information is in the full report

Rating at last inspection: Good (report published August 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection we found that improvements had been made to the quality of food provided to people who used the service. However, we also identified some areas which required Improvement.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

During our comprehensive inspection on 6 & 10 March 2015 we rated the service as ‘Requires Improvement’. The service was in breach of Regulation 9 HSCA (RA) Regulations 2014 Person-centred care and a number of recommendations were made. In response to the breach of Regulation 9 and the recommendations made we undertook a focused inspection on 2 July 2015. During the focused inspection on 2 July 2015 the provider responded to the breach of Regulation 9 and put systems in place to address the recommendations made. As a result of this we rated the service overall as ‘Good’.

Bradbury Court is a care home providing accommodation and support for 21 adults with physical disabilities. Bradbury Court was purpose built and fully accessible for wheelchair users. Appropriate adaptations such as a passenger lift, accessible bathrooms and toilets ensured that people were able to access all areas in the home independently. The home is in a residential area in Harrow close to public amenities.

There was 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.

Staff received the training and support required to meet people's needs. However staff did not receive monthly supervisions as stated in the providers supervisions policy.

Staff had a good understanding and knowledge of safeguarding procedures and were clear about the actions they would take to protect people they supported. People told us they felt safe with staff and we saw there were systems and processes in place to protect people from the risk of harm.

We found people were cared for, or supported by, sufficient numbers of suitably qualified and experienced staff.

Robust recruitment procedures were in place to make sure suitable staff worked with people who used the service.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines safely.

There was opportunity for people to be involved in activities within the home or the community. The home did not have an activity coordinator in the home at the time of this inspection. The registered manager told us they were currently in the process of recruiting a suitable person.

Staff understood people's needs and provided care and support accordingly. Staff were aware and knew how to respect people's privacy and dignity.

The registered manager and staff understood the requirements of the Mental Capacity Act 2005. Care plans contained relevant mental capacity assessments where appropriate.

People were supported with their nutritional and hydration however people told us that on some occasions they didn’t like the food. The service recently employed a new part-time cook and was recruiting to find a permanent cook to address this.

Care plans were detailed and provided an accurate description of people's care and support needs.

There was an effective system in place to respond to complaints and concerns. Effective systems were in place which ensured people received safe quality care.

People had opportunity to comment on the quality of service and influence service delivery.

We spoke with six people who used the service, the manager and four staff. We viewed three care plans and other documents requested during our inspection.

If you want to see evidence that supports our summary please read the full report. This is a summary of what we found:

Is the service safe?

The people who used the service we spoke with told us they felt safe in the care of staff. All four staff we spoke with understood about the safeguarding procedures required to protect the people they supported. Staff received safeguarding training.

During our inspection we assessed how the Mental Capacity Act (MCA) 2005 was being implemented. This is a law that provides a system of assessment and decision making to protect people who do not have capacity to give their consent. We also looked at Deprivation of Liberty Safeguards (DoLS). DoLS aim to make sure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. We saw that some people were unable to leave the home without the assistance of staff. This may mean deprivation of liberty authorisations were required.

We saw evidence of systems which had been put in place to ensure staff learnt from events such as accidents and incidents. For example, staff told us they learnt from such events at handover meetings and staff meetings.

We saw that systems were not in place to protect people against the risks associated with medicines. We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to storage of medicines.

Is the service effective?

People's health and care needs were assessed and the assessment involved them and their family members. Staff told us care plans assisted them to meet people's needs.

Is the service caring?

Care workers showed patience when supporting people. We spoke with people and asked them their views on the staff. Responses included, 'Friendly and O.K,' 'All of them are nice in different ways, all are nice to talk with and all are good care givers.' and, 'I get excellent care here, staff are wonderful, everybody is so kind.'

People's preferences, interests and diverse needs were recorded in their care plans.

Is the service responsive?

People took part in activities within the home and the wider community.

All the people told us they knew how to make a complaint.

Is the service well-led?

The service had quality assurance systems to identify problems and address them. This included a recently introduced system to audit information in people's care plans.

All members of staff we spoke with told us they were clear about their roles and responsibilities.

People told us they were happy with the care they received. Comments included, "It's a nice place here" and "I'm happy with the efforts staff are making". Although people told us that they wanted to go out more we found people were supported to promote their independence. We observed care being provided safely and viewed records that could enable staff to meet people's needs.

None of the people who use the service had any concerns about the care they received. Staff were aware of their responsibilities in preventing and reporting abuse. The provider kept records that were fit for purpose to help prevent abuse.

The provider undertook checks to ensure staff that were recruited were qualified and skilled to meet people's needs.

All the people we spoke with said the provider arranged regular meetings between staff and people who use the service to discuss the quality of the service they received. We saw that staff checked different parts of the service to ensure care was meeting people's needs.

Three people we spoke with said they did not feel there were enough staff. Two people said there was a delay in receiving support when they used their call bell and one person said they did not get to do activities they wanted as often as they would like due to a lack of staff. However, there were sufficient members of staff to meet people's needs.