Archived: The Brambles

The Brambles accommodates up to ten people in one adapted residential house in a residential area. At the time of the inspection there were seven people living there. 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. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

This inspection took place on the 10 and 11 April 2018 and was unannounced. We had previously inspected this service in April 2016, at that inspection the service was rated ‘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 on- going 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.

There was a registered manager in post. 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.

People were consistently protected from the risk of harm and received their prescribed medicines safely. Staff were appropriately recruited and there were enough staff to provide care and support to people to meet their needs.

The care that people received continued to be effective. Staff had access to the support, supervision and training that they required to work effectively in their roles. People were supported to maintain good health and nutrition and live fulfilled lives.

People developed positive relationships with the staff. The staff were friendly, passionate about their work and caring; they treated people with respect, kindness, dignity and compassion. People had detailed personalised plans of care in place to enable staff to provide consistent care and support in line with people’s personal preferences.

Staff knew their responsibilities as defined by the Mental Capacity Act 2005 (MCA 2005). The provider was aware of how to make referrals if people lacked capacity to consent to aspects of their care and support and were being deprived of their liberty. People were supported to use communication aids and information was provided to people in an accessible format to enable them to make decisions about their care and support.

People knew how to raise a concern or make a complaint and the provider had implemented effective systems to manage any complaints received. Information was available in various formats to meet the communication needs of the individuals.

The service had a positive ethos and an open culture. The registered manager was approachable, understood the needs of the people in the home, and listened to staff and relatives. There were effective systems in place to monitor the quality of the service and drive improvements.

The service is registered to care for up to 10 younger adults with learning disabilities including autistic spectrum disorder. At the time of our inspection seven people were using the service.

A registered manager was not in post. 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 manager had submitted their application to register with the Care Quality Commission in October 2015 and their application was in progress.

The support workers had a good understanding of what constituted abuse and of the safeguarding procedures to be followed to report abuse and we found that appropriate systems were in place to safeguard people from the risk of harm and abuse.

Risk assessments and accident management systems were in place and used to identify and manage risks to peoples’ health and welfare. The support workers were aware of the risks, specific to people using the service and followed the risk management plans to promote people’s safety and independence.

Appropriate systems were in place to protect people from risks associated with medicines and ensured people received their medicines safely.

The staffing arrangements ensured there was enough support workers available to continually meet people’s needs. The provider’s recruitment systems ensured that only staff suitable to work with people using the service, were employed at the service.

Support workers were provided with comprehensive induction training and on-going training. A programme of staff supervision and annual appraisals enabled them to reflect on their work practice and plan future learning and development needs.

The support workers treated people with dignity and respect and ensured their rights were upheld. Consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 and associated Deprivation of Liberty codes of practice were met.

People had varied and nutritious meals and healthy eating was promoted. People were supported to acquire the skills of meal preparation and cooking within their capabilities.

The support workers cared for people with kindness and compassionate. Trusting partnerships were forged and the support workers and relatives worked in collaboration to care for people using the service. The views of people living at the service and their representatives were sought and areas identified for improvement were acted upon to make positive changes.

Information was made available to people and their representatives on how to raise any concerns or complaints and they were dealt with appropriately.

People and their families were fully involved and in control of their care. The care plans were detailed and reflected people’s needs and choices on how they wanted their care and support to be provided.

The service was led by a manager, who continually strived to provide a quality service. The support workers met regularly with the manager and the deputy manager to receive information and discuss plans for the service.

Regular audits were carried out to assess and monitor the quality of the service. The vision and values of the service were person-centred and made sure people were at the heart of the service.

We found that works had been carried out or planned to be carried out in the near future, as to the issues we had identified as in need of attention.

We spoke with the relatives of four people. They all told us that they had been fully satisfied with the care their relatives received.

One relative said; 'The home is perfect. When my son had an accident they dealt with it very well. I could not have wished for a better service'.

We observed the relationship between staff and people who lived in the home. This was friendly and helpful. For example, staff helped a person maintain her dignity by assisting her with her clothes.

This was a generally positive inspection. People we spoke with told us they were satisfied with the care provided. All the relatives we spoke with also said that they had no concerns. The essential standards we inspected were found to have been met, except for the maintenance of the premises.

There was one suggestion made; for the d'cor of the premises to be fully upgraded.

We briefly observed care being supplied to one person. This was carried out in a calm and friendly manner.

This was a positive inspection. Requirements from the previous inspection had been followed up. There was one main suggestion; for people at home during the day, and when people are in the home in the evening, to have meaningful activities. This is so that people do not become bored. The manager said he would follow this issue up.

We spent time in communal areas observing staff and people living in the home. .

This person told us that he liked living in the home and he thought the staff were friendly. He said ; 'I have lived here a long time and its good''.

We spoke with five relatives. They all told us that the care was of a high standard. One relative said; 'My daughter is happy living here. She is always pleased to come back after seeing us. Staff are friendly and professional'. Another relative said; 'My daughters key worker is excellent. Nothing is too much for her'.

Our main concern on the last inspection was about having proper systems in place to keep people safe. We found that this issue had been followed up. However, we were concerned on this inspection about the lack of proper care planning for one person with challenging behaviour. We also noted that maintenance was not attended to thoroughly. Current procedures do not produce swift arrangements to ensure good maintenance.