Brent Cottage

'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.

About the service

Brent Cottage is a residential care home which is registered to provide accommodation and personal care for up to 5 people, with 5 people living at the care home at the time of the inspection. The service is an adapted house providing people with separate bedrooms and shared communal areas.

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

Right Support

People at times were not able to spend their time freely and without pressure from others. People were supported with activities and pursuing hobbies and their interests, although improvements are required to look at longer term aspirations. Staff enabled people to access specialist health care support in the community. The environment and cleanliness within the home had improved and people were able to personalise their rooms. People received their prescribed medicines safely, from staff who had been appropriately trained. People were not always supported to have maximum choice and control of their lives. Staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care

People's specific care plan information promoted equality and diversity in their support. Weekday staffing levels were sufficient, but the provider was reviewing the weekend numbers to ensure support was provided equally. Staff understood people's cultural needs and people received kind and compassionate care. People were supported to eat and drink enough and had a varied diet offered to them. Staff mostly protected and respected people's privacy and dignity. Staff responded to people's individual needs but a culture of people needing to ask for permission for some things remained. Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it.

Right Culture

People were not always supported to achieve their individual goals and aspirations. Staff placed people's needs, at the heart of everything they did. People's relatives were involved where appropriate in the review of people's care plans. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect, and inclusivity. People's ability to access community activities had increased since the last inspection. The provider and people had redeveloped the ethos and values of the service, aligning this with what people wanted from the care and support.

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 was inadequate (published 05 September 2022) and there were breaches of regulations found. We imposed positive conditions on the providers registration in respect of those issues which required improvements.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. They met with CQC and the local authority regularly to review the improvements.

At this inspection we found some improvements had been made and the provider was no longer in breach of regulations. This service has been in Special Measures since 22 May 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated inadequate overall or in any of the key questions. Therefore, this service is no longer in special measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well led sections of this report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Brent Cottage on our website at www.cqc.org.uk.

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 continue to monitor information we receive about the service, which will help inform when we next inspect. We will continue to meet with the provider to monitor progress against their action plan.

About the service

Brent Cottage is a residential care home providing personal care to five people with a learning disability and/or autism at the time of the inspection. The service can support up to five people.

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

Right support

People were not always receiving support in a way to maximise their independence, learn new skills or enhance their existing skills. Information given to people about their care and support was not always done consistently to enable them to make informed choices about the support they received.

People were not involved in decisions about what information could be shared about them with their relatives or other visitors. People were not supported to play an active role in maintaining their own health and wellbeing.

Staff knew people well and were knowledgeable about triggers to behaviours which put people and others in danger. However, there were no support plans in place to prevent these behaviours.

Staff respected people’s choices and supported them in the least restrictive way possible.

Right Care

People were not always supported by a service that had safeguarding systems in place to report and respond to accidents and incidents. We found instances where there were safeguarding concerns, and these were not reported to CQC or local safeguarding authorities. Leadership was not effective and did not identify that people were put at risk or subject to potential abuse.

People’s care, treatment and support plans were not reflective of people’s needs. People had limited choices in pursuing activities or hobbies they had.

Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs.

Right culture

The provider failed to ensure staff received appropriate training and support to understand people’s individual needs and provide enabling support to people. The support people received was not in line with current best practice guidelines. We found evidence of a closed culture in operation.

Risk assessments in place were not encouraging positive risk taking for people, were not evaluated and measured at regular intervals to assess their effectiveness.

Rotas for staff were not planned to factor in the one to one support some people were assessed and funded for. Staff were not aware in all instances how many staff were required to support people safely when they went out for walks or into town.

There was a lack of appropriate planning and records kept showing how involved people were in planning their own support, what outcomes they achieved and what goals they had in life. They had health professionals and social care professionals supporting their care, however no consideration was given if people would benefit from the support of an independent advocate.

The provider failed to develop effective governance and quality assurance system to assess the quality and safety of the support people received. There were lack of audits and actions taken when things went wrong. Actions were not always documented, and it was unclear if actions were completed. This meant improvements were not always made to improve the care people received.

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 inspection for this service was not rated (published on 30 April 2021). The last rating for this service was good (published on 28 June 2019).

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right Support Right Care Right Culture. We received concerns in relation to how staff reported safeguarding concerns, how the registered manager responded to allegations of abuse and people had not received support in a personalised and safe way. A decision was made for us to inspect and examine those risks.

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. We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safeguarding people from abuse, safe care and treatment, staffing skills, personalised care and support and governance systems at this inspection. You can see what action we have asked the provider to take at the end of this full report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Brent Cottage is a residential care home providing accommodation for up to five people with a learning disability or autistic. At the time of the inspection five people were living at Brent Cottage.

People’s experience of using this and what we found

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People had choice and control of their support and we saw examples of this. People told us they were involved in things they enjoyed doing and staff were kind and caring. The staff spoke about how they were led by the people they supported and made sure people were supported to be independent and have empowered lives.

The provider acknowledged improvements were needed to the décor of the communal areas of the home and had developed a service improvement plan to highlight the works that were going to be completed.

Staff felt they had the right skills to support people and training had been completed to help support people’s specific needs.

Staff felt supported by the management team and felt that during the COVID-19 pandemic they had come together as a team.

Infection prevention control measures were in place to keep people and staff safe. The provider had robust contingency plans in the event of an outbreak.

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 28 June 2019)

Why we inspected

We undertook this targeted inspection to check on a specific concerns received about the wellbeing of people being supported at Brent Cottage. The overall rating for the service has not changed following this targeted inspection and remains good.

CQC have introduced targeted inspections to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

Follow up

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

Brent Cottage is a residential care home that provides personal care to five adults all of whom have a learning disability.

People’s experience of using this service:

People showed they were happy living at Brent Cottage, they felt safe and comfortable with the staff team.

Staff were kind and caring and knew each person well. Staff enjoyed working at the service and felt the they received good support. There were enough staff to support people in the way they wanted. Staff received training, supervision, guidance and support so that they could do their job well. Staff respected people’s privacy and dignity and encouraged independence wherever possible.

The provider had systems in place to manage risks and keep people safe from avoidable harm. Staff followed good practice guidelines to prevent the spread of infection and gave people their medicines safely. People were supported to be as active as possible. The staff looked for ways to continually make improvements, worked well with external professionals and ensured that people were part of their local community.

Staff supported people to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways: promotion of choice and control, independence and inclusion. People's support focused on them having as fulfilling and enjoyable a life as they chose to lead.

Rating at last inspection:

At the last inspection we rated this service Good (report published on 2 December 2016).

Why we inspected:

This was a planned inspection based on the previous rating.

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 we receive any concerning information we might inspect sooner.

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

Brent Cottage is registered to provide accommodation and personal care for up to five people who live with complex learning disabilities. There were five people accommodated at Brent Cottage at the time of this inspection.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

When we last inspected the service on 29 July 2015 we found breaches of regulations 9, 11, 12, 13, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had failed to provide care and treatment that was always appropriate to meet people’s needs, people’s medicines were not always managed safely and people were not always protected from improper treatment. We had also found there was no effective system in place to assess the quality and safety of the services provided, the legal requirements of the Mental Capacity Act 2005 had not always been followed and notifications of incidents had not always been made when required.

Following the comprehensive inspection, the provider wrote to us on 22 September 2015 to tell us how they would make the required improvements to meet the legal requirements. At this inspection we found that the provider had made the necessary improvements to help ensure that care and support was provided safely for people in accordance with the fundamental standards of quality and safety.

People felt safe living at Brent Cottage. Staff understood how to keep people safe and risks to people's safety and well-being were identified and proactively managed. People's needs were met in a timely manner by sufficient numbers of skilled and experienced staff. The provider operated robust recruitment processes which helped to ensure that staff employed to provide care and support for people were fit to do so. People's medicines were managed safely.

Staff received regular one to one supervision from the registered manager which made them feel supported and valued. People received support they needed to have a healthy diet and their health needs were well catered for with appropriate referrals made to external health professionals when needed.

People and their relatives complimented the staff team for being kind and caring. Staff were knowledgeable about individuals' care and support needs and preferences and people had been involved in the planning of their care as much as they were able. Visitors to the home were encouraged at any time of the day.

The provider had arrangements to receive feedback from people who used the service, their relatives, external stakeholders and staff members about the services provided. People’s relatives were confident to raise anything that concerned them with staff or management and were satisfied that they would be listened to.

There was an open and respectful culture in the home and relatives and staff were comfortable to speak with the registered manager if they had a concern. The provider had arrangements to regularly monitor health and safety and the quality of the care and support provided for people who used the service.

However, although suitable arrangements were in place to assess people's ability to make decisions in line with published guidance relating to the Mental Capacity Act (MCA) 2005, assessments we looked at had not been regularly updated or reviewed.

Care plans we looked at showed that people's needs and preferences were thoroughly assessed, documented and reviewed. A relative told us, 'They really care and go the extra mile. The care is really first class.'

We saw evidence that people were provided with a good choice of food and drink in a way that both encouraged and promoted a healthy balanced diet.

The premises were safe, suitable and fit for purpose. Adequate emergency procedures were in place and the safety equipment we saw had been regularly checked and well maintained.

The provider has put a 'concerns, suggestions and complaints' policy and procedure in place. 'Easy read' guides appropriate to people with learning disabilities have been produced to support people who wish to complain or make comments.

We spoke with the relatives of four people, who told us they were pleased with the care and support the service provided. One person said, 'My [relative's] physical care has improved greatly since they have lived in Brent Cottage. They are able to do so much more independently now.'

Relatives we spoke with all said that the staff team were very responsive and communicated clearly with them about their relative's care and support. Comments made included, 'They talk to us'.a lot, I visit weekly' and another person said, 'We do have input, they do listen to us.'

Relatives of people who used the service told us that they felt comfortable to raise any concerns they may have directly with the staff and management team. One person told us, "If I have any issues concerning me I would ring up and speak with someone, they always sort it out for me."

We looked at records during the course of our visit to Brent Cottage on 5 December 2012. We found that there was good detail with care plans to support the care workers to provide individualised care for the people living there.