Bramerton

We found the following examples of good practice:

On arrival at the service, there was an infection control process which included checking a negative lateral flow test had been undertaken on the day of inspection. Temperatures were also taken and noted. Staff were wearing face masks during the inspection in line with government guidance. Vaccination status was checked.

There was a donning and doffing area outside of the main entrance to the home. This had been situated in order to reduce particular risks to people living in the home. There were facilities to put on and take off personal protective equipment before entering, or on leaving, the premises.

We saw a very thorough mental capacity assessment and best interest document used in respect of people having the capacity to be vaccinated. This was detailed and documented very well how decisions were made in people’s best interests with the relevant parties involved.

The home was clean, and a regular cleaning schedule was in place and followed by all staff in the service. Regular audits took place which led to improvements and safety.

Staff had been trained and followed PPE [personal protective equipment] protocols. The provider ensured there was a sufficient stock of personal protective equipment (PPE). Staff had infection control training and understood the correct donning and doffing procedure.

The provider participated in the COVID-19 regular testing programme for both people and staff.

Additional, regular communication took place with relatives of people in the service. This included updates on the current government guidance and advice.

The provider ensured people's relatives were able to stay in touch with people. For example, through visits in line with government guidance.

Bramerton is a residential care home. It provides accommodation and personal care

for up to 11 adults living with learning disabilities or autistic spectrum disorder. At the time of the inspection there were 11 people living at the service.

People's experience of using this service:

The service effectively applied the principles and values of Registering the Right Support and other best practice guidance. These ensured that people who used the service lived as full a life as possible and achieved the best possible outcomes, that include control, choice and independence.

People and relatives consistently praised the exceptional and distinctive way the home was managed. People, relatives and staff overwhelmingly told us they felt their opinions and ideas mattered, which made them feel valued and part of something ‘special’. The management team and deputy manager consistently motivated and inspired their staff, which had resulted in exceptional staff morale and very high levels of staff satisfaction. Professionals consistently described the home managers as excellent role models, who led by example and continually strove for excellence.

Governance and quality assurance were exceptionally well-embedded within the service. Quality assurance surveys were overwhelmingly positive.

The service had a track record of being an excellent role model for other services within the provider’s care group. Professionals consistently praised the registered manager for the “meticulous attention to detail” within people’s care records.

The service provided exceptionally responsive, person-centred support to people.

Excellent consistency and continuity of care provided by a stable staff team had a positve impact on people’s quality of life.

People consistently experienced exceptional person-centred care, which has significantly reduced the level of behaviours that may challenge others, the incidence of self-injurious behaviour and the level of prescribed medicines to control people’s behaviour.

Visiting professionals consistently told us that the service was focused on providing person-centred care and support, which achieved exceptional outcomes for people.

Staff were particularly skilled at helping people and their families to explore and record their wishes about care at the end of their life, which made them feel empowered, valued and listened to.

People were supported by a stable core staff group who were kind, caring and inspired by their manager to deliver high quality, personalised care.

People were protected from discrimination, neglect, avoidable harm, and abuse by staff.

Staff ensured the human rights of people who lacked a voice, were upheld and respected.

Risks to people's safety had been identified and assessed. Staff followed people’s risk management plans to keep them safe.

Staff felt valued and respected by the management team, and consistently demonstrated high levels of morale.

Staff had the required skills to meet people’s needs effectively, which led to successful outcomes for people’s care and support and promoted their quality of life.

People’s care plans were comprehensive, providing staff with the required information about people's needs and how to meet them.

Rating at last inspection:

At the last inspection the service was rated Good (13 October 2016).

Why we inspected:

This was a planned inspection to review whether the service remained good.

Follow up:

We did not identify any concerns at this inspection. We will therefore aim to re-inspect this service within the published time scale for services rated good. We will continue to monitor the service through the information we receive.

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

Bramerton provides residential care for up to 11 male adults with moderate to severe learning disabilities. Bramerton is situated in the village of Bray, close to the town of Maidenhead. The building is a large, detached house. There are 11 single bedrooms over two floors with two lounge areas, a separate dining room, kitchen, office and a large basement relaxation area. There is also a separate day services building adjacent to the main house, which provides a base for activities such as IT, arts and crafts etc. In addition the care home operates vehicles for leisure, recreational and educational trips and activities in the community.

At the time of the inspection, there was 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.

Since registration under the Health and Social Care Act 2008 on 8 December 2010, Bramerton has maintained compliance with the relevant regulations at each inspection by CQC. The most recent inspection was a routine planned visit on 10 December 2013. This inspection is the first visit under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the first rating under the Care Act 2014.

The feedback from people at Bramerton, relatives, staff and commissioners was overwhelming and outstanding. People were happy to live at Bramerton and felt they led fulfilling lives. They told us they felt safe and were excited to show and tell us about their lives. For people who were unable to verbally communicate with is, they demonstrated that they were also happy to live there. There was a sustained attitude of continuous improvement throughout all aspects of the service. We found people were safe and appropriately supported.

All risks for people and the service were thoroughly assessed, mitigated, documented and reviewed. Appropriate records were kept and readily available to demonstrate this to us at the inspection.

Proper maintenance of the premises and grounds was evident. The registered manager was knowledgeable about risks from the building and kept records of completed assessments and coordinated repairs to effectively prevent harm to people. Repairs and maintenance were completed by some external contractors and some minor delays occurred whilst waiting for their attendance. This did not impact on compliance with the safe use of the premises and equipment.

We looked at two staff personnel files. The location’s registered manager was responsible for ensuring fit and proper person checks were completed and recorded for new staff. We found the service had strong recruitment and selection procedures that ensured suitable, experienced applicants were offered and accepted employment. A high percentage of staff had long periods of service for the provider. Some new staff were recruited when others left the service. Staff we spoke with told us they had to pass a number of stages to be successful in gaining their employment. This included a face to face interview with a manager and question-based scenarios. Personnel files contained all of the necessary information required by the regulations and no documents or checks were missing. We found this included criminal history checks via the Disclosure and Barring Service (DBS), checks of previous conduct in other roles, and proof of identification. We also checked the staff’s legal rights to work in the UK.

Medicines were safely managed. We examined the handling of people’s medicines during our inspection and found that people were safe from harm. The home manager explained there were no medicines incidents. However, even potential failures in practice that did not result in harm to people required reporting. We advised the provider to seek guidance and support to ensure any medicines incidents were always recorded and reviewed.

Staff training, supervision and performance development was effective. Induction programmes and training was evident, competency checks and repetition of training was used at the service to ensure the best effective care for people. The provider sent us further information after the inspection which demonstrated they listened to our feedback, and had further evidence for us to consider.

The service was compliant with the requirements of the Mental Capacity Act 2005 (MCA). The recording of consent and best interest decision making ensured the service complied with the MCA Codes of Practice. The service demonstrated that, where necessary, standard deprivation of liberty (DoLS) authorisations were recorded to deprive people of their liberty for various decisions.

People received nutritious food which they enjoyed. Hydration was offered to people to ensure they did not become dehydrated. Snacks and treats were available if people wanted or chose to have them. People assisted with shopping and cooking and had the right to choose their own meals.

Staff had put in extra effort to ensure that the service was caring. We observed staff were warm and friendly. As staff had worked with most people over an extended period of time, they had come to know each person well. People who used the service, relatives and staff described Bramerton as a ‘family’. Many of the people who used the service had lived there for long periods of time, and staff had enjoyed watching them develop as adults and increase their independence. This reflected in the care that people received in an ongoing way. The environment was maintained as a house rather than a care facility.

Personalisation of bedrooms and communal areas was evident. External agencies we spoke with, such as commissioners, praised the service when we asked. We found people had the right to choose or refuse care or activities and this was respected by staff. People led the life they chose to and this was not changed by anyone at the service. We saw people’s privacy and dignity was respected at all times.

People were involved in the service in a number of ways and attended a wide variety of activities and events. This included the planning of social activities as well as normal functions of running the service. People were encouraged to gain employment where possible, undertake meetings, go to the provider’s other services, and make friends with a variety of people in the community.

Responsive care was provided to people. Their wishes, preferences, likes and dislikes were considered and accommodated. Staff knew about the complaints procedure and people had the ability to complain. There were no complaints since our last inspection, although the management had the knowledge and skills to investigate if a complaint was raised.

The workplace culture at Bramerton was good. Despite changes, management was stable at the service and there was a low staff turnover. Staff described a positive place to work and care for people. Staff told us they enjoyed their roles and found management approachable and reasonable. The deputy manager, home manager and assistant regional director were knowledgeable about quality care and accountable in their roles. A series of audits and checks was routinely conducted to ensure good governance.

We observed staff used a range of communication tools to ensure they understood people's wishes. People were involved in activities in the home and local community. One person told us 'It's nice here. I like living here. I see my family.'

People told us they were cared for well. One relative said 'Care staff are good at their job and have imagination. They work around concerns that seem insurmountable. X is very happy.' Staff ensured people's support was provided in accordance with their plan of care. They were aware of how to maintain people's health, safety and wellbeing.

Staff were trained to ensure people were not at risk of harm. They understood reporting procedures for safeguarding concerns. They knew how to safely manage behaviours that challenge the service. One relative told us their loved one was a 'very demanding person, and was moved from other homes when they couldn't cope. This home has stuck with X and persevered rather than given up. That's everything to me.'

At the time of our inspection the registered manager was seconded on promotion. We met with the acting manager. The registered manager also attended the home during our inspection. We saw staff attended training to ensure they could support people's needs safely. Supervisory and appraisal meetings provided opportunities for staff and managers to reflect on areas of good practice and discuss concerns and aspirations.

People who use the service and their relatives had opportunities to influence the service. One relative told us 'There's two way communication. It's very good.' The provider carried out audits to ensure people were supported appropriately. They analysed information to identify trends, share learning and address concerns.

People told us that they were happy and that staff were good and helpful. People also told us that staff helped them by taking them out for activities and things they liked. People we spoke to told us that they did not have complaints about staff or the care they were receiving. They told us that staff spoke to the about their care and supported them to achieve their goals. We reviewed four folders during visit.

We also spoke with two staff and reviewed four staff files. Staff told us that they were happy with their work. One staff member told us that they felt supported and had opportunities to develop within the company. This was a good motivator and incentive for staff to enhance their skills and knowledge. Staff told us that the training was really good and was tailored to the service as well as the needs of people. Staff were also positive about the changes that had taken place within the management structure.