Bradley Apartments

About the service

Bradley Apartments is a residential care home that provides accommodation, nursing and personal care to a maximum of 14 younger adults with a learning disability, some of whom may also have needs associated with their mental health and autism. At the time of our inspection there were 10 people using the service. The home provides five apartments consisting of bedrooms, bathrooms, communal area and kitchen.

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

The provider was not always able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right Support:

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Where people lacked capacity to make decisions, the provider had failed to put in place documents to support best interest decision making.

Medicines management was not always in line with best practice guidance; medicine administration records were not always fully completed and guidance for staff not always in place.

Risks to people had been assessed. People accessed specialist health and social care support where appropriate.

Right Care:

The provider had systems in place to report and respond to accidents and incidents. However, not all accidents, incidents or safeguarding concerns in the home had been investigated timely and thoroughly.

The service had enough staff to keep people safe. Staff received training and an induction to help them support people. We observed staff respecting people's privacy and dignity when providing care and support.

Systems to protect people from the risk of infection were effective.

Right Culture:

The provider's quality monitoring processes were not always effective at highlighting issues found at this inspection. They had offered assurances about actions they would take and were committed to making any necessary improvements as quickly as possible.

We received mixed feedback from staff about the support they received from management in order to fulfil their roles and responsibilities.

Staff knew people well and were responsive to their needs. People and their relatives were involved in their care.

Following our visit to the service, we asked the provider to send us an improvement plan which detailed the actions they had taken/were going to take in relation to the issues identified during our inspection.

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

Rating at last inspection and update

The last rating for this service was good (published 30 June 2021).

Why we inspected

We received concerns in relation to safeguarding and the quality of care being provided. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. 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 good to requires improvement based on the findings of this inspection.

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

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.

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

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

Enforcement

We have identified breaches in relation to medicine management, safeguarding, consent and good governance at this inspection.

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

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

Bradley Apartments is a residential care home that provides accommodation, nursing and personal care to a maximum of 14 younger adults with a learning disability, some of whom may also have needs associated with their mental health and autism. At the time of our inspection there were nine people using the service. The home provides five apartments consisting of bedrooms, bathrooms, communal area and kitchen.

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

Staff supported and engaged with people in the right way to keep people safe.

Staff knew people well and knew how to report any concerns. People were involved in reviewing their care plans and risk assessments and told us they felt safe.

For more details, please see the full report which is on the Care Quality Commission’s (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 2 July 2021).

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to initial inquiries to determine whether to commence a criminal investigation. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of people’s safety. This inspection examined those risks.

CQC have introduced targeted inspections to follow up on Warning Notices or 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 found no evidence during this inspection that people were at risk of harm from this concern.

The overall rating for the service has not changed following this targeted inspection and remains good.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bradley Apartments 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.

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

The provider safeguarded people from abuse. Staff recognised and reported concerns. Relevant risk assessments were completed. Accidents and incidents were monitored to identify and address trends and reduce risk. There were enough staff on duty who were provided with the appropriate training and support to enable them to carry out their roles effectively.

We have made recommendations in relation to information sharing with the local authority safeguarding team.

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.

People were supported to have their medicines safely. The service was involved in STOMP (stopping over medication of people with a learning disability, autism or both with psychotropic medicines).

There were enough staff to care for people. Core staff teams ensured continuity of care for people. Staff recruitment was safe and staff received the training they needed to develop the skills they required. Staff received regular supervision, an annual appraisal and delivered person-centred care.

People’s rights were protected. Staff gained consent before delivering care tasks. People were supported 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.

People's communication preferences were supported and they made their own decisions. People spent their time doing things they enjoyed, which maximised their time spent in the local community.

Staff supported people to have enough to eat and drink and supported healthy eating programmes. People had access to health care and support from other health and social care professionals, which ensured good health outcomes.

People's preferences and the views of their relatives were considered when care was assessed, planned and reviewed.

There was an open culture. The registered manager was approachable and they addressed complaints to make improvements.

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.

Although the size and structure of the service does not reflect the underpinning principles of Right support, Right care and Right culture. Accommodation within the service is provided in five apartments to support this model. People were supported within their own apartments. Care is person-centred and promotes people’s dignity, privacy and human rights. Staff were discouraged from wearing clothing that suggested they worked on the premises

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 requires improvement (published 11 September 2019) and there were multiple breaches of regulation. The provider completed an action plan after the 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

We undertook this focused inspection to check improvements had been made since the last inspection. This report only covers our findings in relation to the review of the key questions Safe, Effective and Well-led only.

We received information of concern from a relative following our first visit to the service. We returned to the service for a second day to meet and discuss the concerns with the clinical team. We reviewed information relating to the person's care and we also spoke with a commissioner of the service. We were subsequently assured that the person concerned was receiving safe and appropriate care and treatment.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this 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.

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

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.

Bradley Apartments is a residential care home that provides accommodation, nursing and personal care to a maximum of 14 younger adults with a learning disability, some of whom may also have needs associated with their mental health and autism.

The service is purpose built and comprises of a range of two, three and four bedded apartments with kitchens and living areas on the first floor and an activity room on the ground floor. The service is located on the same site as Bradley Complex Care on the outskirts of Bradley, which is on the south western edge of Grimsby. Bradley Apartments has an allocated garden area in the grounds.

The service has not been fully 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.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 14 people. Ten people were using the service at the time of the inspection. This is larger than current best practice guidance. The size and location of the service having a negative impact on people was not mitigated by the building design. The service was located on the same site as Bradley Complex Care a locked rehabilitation facility and on occasion staff were shared across both sites. Although staff were discouraged from wearing anything that suggested they were care staff when coming and going with people, identifying signage clearly indicated it was a care home.

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

There was a new registered manager in post, who had started to implement the provider’s quality monitoring system. However, for several months the system had not been wholly effective in identifying the issues we found during the inspection or shortfalls had not been addressed in a timely way.

Not all staff received an induction. Staff completed a planned training programme. There were gaps in staff supervision and appraisal programmes.

There had been a need for the use of agency staff recently, despite this, there were still occasions when there was not enough staff on duty.

Positive behaviour support plans did not detail which interventions were used and in which circumstances these would be considered appropriate. Records of debriefings carried out following incidents where physical interventions were used were not available for all incidents that had taken place. This meant there was not always enough information to direct staff to meet people’s need’s effectively, or to learn from incidents.

People were supported 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. Staff were trained in mental capacity legislation and understood their responsibilities. They gained consent before providing care and supported people to make their own decisions and choices.

People were safely supported and protected from harm or abuse. Safeguarding systems in place supported this. New staff were recruited using robust procedures. The management of medicines was safe.

People’s health and nutritional needs were met. Staff ensured people received care and treatment from health professionals when required. People who used the service liked the meals provided.

Staff ensured relatives were welcome to visit at any time and provided activities daily, so people could choose to participate if they wished. Staff were described as friendly, kind and caring.

The environment was warm, welcoming, clean and free from malodours. People’s rooms were personalised.

Care plans contained relevant information about how to meet people's needs and were regularly reviewed.

Rating at last inspection.

The last rating for this service was Good (published 28 February 2017). Since this rating was awarded the registered provider of the service has changed. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected

This was a planned inspection based on the date of registration.

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 safe care and treatment, good governance and staffing.

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.

The service is purpose built and comprises of a range of two, three and four bedded apartments with kitchens and living areas on the first floor, there is an activity room and lounge area on the ground floor. The service is located on the same site as Bradley Woodlands Hospital on the outskirts of Bradley, which is on the south western edge of Grimsby. Bradley Apartments has an allocated garden area in the grounds.

We undertook this comprehensive inspection on the 19 and 20 January 2017 and there were seven people using the service.

At the last inspection on 4, 10 and 12 February 2016 we found the registered provider was in breach of two of the regulations we assessed. We issued requirement notices as there were shortfalls in providing sufficient numbers of staff and shortfalls in the staff supervision and appraisal programmes. We also found assessments of people’s mental capacity and records of best interest decisions were not in place to demonstrate staff were acting lawfully in relation to aspects of people’s care and treatment.

During this comprehensive inspection we found improvements had been made in two domains and have changed the rating for the domains ‘Safe’ and ‘Effective’ to 'Good'. We have kept the rating for ‘Caring’ and ‘Responsive’ as 'Good'. We identified a new shortfall in the ‘Well-led’ domain and have kept this rating at ‘Requires Improvement’. The overall rating for the service has improved and changed to ‘Good’.

The service had 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.

The CQC had not received a notification for a safeguarding incident as required by registration regulations and there were also delays in receiving the notifications for three other incidents. The registered manager confirmed this had been an error and they would notify us of any future safeguarding incidents as they occurred. We have written to the registered provider and registered manager to remind them of their responsibilities in this area.

We found the registered manager and staff better understood their responsibilities under the Mental Capacity Act 2005. They were aware of the need to gain consent when delivering care and support, and what to do if people lacked capacity to agree to it. People’s abilities to make decisions had been assessed and appropriate support had been provided to ensure that their views were taken into account when making decisions, where possible. Relatives and other professionals had been involved when important decisions about care had to be made including the use of any physical interventions.

Staffing levels had been better maintained through positive recruitment programmes and improved management of staff sickness. There had been and continued to be a reliance on qualified agency staff until full recruitment was in place. Improvements had been made to ensure staff were provided with regular support, supervision and an appraisal of their performance. This helped them to be confident when supporting people who used the service.

We found staff were recruited in a safe way and all checks were in place before they started work. The staff had received an induction and essential training at the beginning of their employment and we saw this had been followed by periodic refresher training to update their knowledge and skills. Staff had received more specialist training to support people’s individual needs, in areas such as communication and autism.

There were policies and procedures in place to guide staff and training for them in how to keep people safe from the risk of harm and abuse. In discussions, staff were clear about how they protected people from the risk of abuse. In recent months the senior management at the service had worked closely with the local adult safeguarding team to investigate some safeguarding concerns. Some issues around staff culture had been identified which the management team were addressing robustly.

People had access to a variety of food and were encouraged to be involved in the sourcing and cooking of food as part of initiatives to improve their skills and independence. Healthy living choices were being encouraged and promoted more to help manage some people’s weight gain.

Assessments of people’s needs were completed and care was planned and delivered in a person-centred way. The service used tailored communication techniques to help ensure effective communication with people. People’s independence was promoted through the setting of goals to help people develop life skills. Improvements had been made with transition arrangements to ensure people’s admission and transfer on to other placements was appropriately supported.

Risk assessments had been developed to provide staff with guidance in how to minimise risk without restricting people’s independence. We saw arrangements were in place that made sure people's health needs were met. The service worked closely with community healthcare teams. People received their medicines as prescribed.

We found positive behaviour plans were in place which effectively directed staff to support people’s behaviour that challenged the service. Social care professionals considered some people had continued to make good progress in this area. Robust systems to monitor and review all incidents were in place.

People were supported to maintain friendships. We saw care plans contained information about their family, friends and people who were important to them. People had access to an activity programme that was tailored to their individual needs and interests. People told us they enjoyed the activities they took part in.

We found positive and caring relationships had been developed between staff and people who used the service. We saw people were treated with respect and their dignity was maintained. Staff were overheard speaking with people in a kind, attentive and caring way.

We saw the complaints policy was available to people who used and visited the service. The people we spoke with told us they would feel comfortable speaking with any of the staff if they had any concerns. We saw where concerns had been raised these had been appropriately recorded and addressed.

The registered provider had systems in place to check and audit the quality of the service. People who used the service, relatives and staff were able to express their views on how the service was run through surveys and a range of meetings.

The service is purpose built and comprises of a range of two, three and four bedded apartments with kitchens and living areas on the first floor, there is an activity room and lounge area on the ground floor. The service is located on the same site as Bradley Woodlands Hospital on the outskirts of Bradley, which is on the south western edge of Grimsby. Bradley Apartments has an allocated garden area in the grounds. Both services are part of the same organisation.

On the day of the inspection there were eight people using the service. Another person was visiting the service for day-care support. People have varied communication needs and abilities.

The service has 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 Bradley Apartments opened in 2014 a ‘clinical lead’ was appointed and given delegated day-to-day management responsibilities for the service and they reported to the registered manager. In October 2015 the clinical lead took the decision to resign their position and the deputy manager from the adjoining hospital site took over the day-to-day management of the service. A decision was made by the organisation to recruit a new manager for Bradley Apartments who would apply for registration with CQC; they considered the service would benefit from having their own registered manager who could focus on developing the service and establishing a clearer identity from the adjoining hospital service. The new service manager was appointed and commenced work at the service on 11 January 2016.

We found the registered provider had not always met the requirements of the Mental Capacity Act 2005. People’s consent was not always sought about the care and support they needed. Staff were using physical interventions with one person to manage their behaviours that challenged the service and we found there was no capacity assessment record and best interest decision records in place to support this approach. We also found the management team had made changes to the occupancy arrangements in some apartments without consulting the people who this affected, their relatives or relevant care professionals.

There were times when there were not always enough staff deployed to meet the needs of people. High staff turnover and staff sickness levels contributed to the staffing shortfalls and maintaining the continuity of care. Staff had not received all the support, formal supervision and appraisal they required over the last 12 months.

This meant the registered provider was not meeting the requirements of the law regarding consent and staffing. You can see what action we told the registered provider to take at the back of the full version of the report.

We found staff were recruited in a safe way; all checks were in place before they started work. The staff had received an induction and essential training at the beginning of their employment and we saw this had been followed by some periodic refresher training to update their knowledge and skills. We found shortfalls in training to meet the needs of individuals such as: epilepsy management, specific communication techniques and understanding autism, but saw that arrangements to address this shortfall had been planned.

There were policies and procedures in place to guide staff and training for them in how to keep people safe from the risk of harm and abuse. In discussions, staff were clear about how they protected people from the risk of abuse.

Assessments of people’s needs were completed and care was planned and delivered in a person-centred way. The safety of people who used the service was taken seriously and managers and staff were well aware of their responsibility to protect people’s health and wellbeing. Risk assessments had been developed to provide staff with guidance in how to minimise risk without restricting people’s independence. People we spoke with told us they felt safe living in the home.

Positive behaviour plans directed staff to support people’s behaviour that challenged the service effectively. Social care professionals considered some people had made very positive progress in this area. Robust systems to monitor and review all incidents were in place.

Some people participated in a range of vocational, educational and personal development programmes at community day services. People also accessed a range of activities in the service and in the community, although staffing shortages had impacted on this recently. They were encouraged to follow and develop social interests and be active and healthy. The programmes and support were geared to maximise the person’s independence.

Staff had developed good relationships with people living at the service and respected their diverse needs. Staff knew people's individual care and support needs well. People told us staff looked after them well, were kind and caring and respected their privacy and dignity. Staff supported people to maintain their relationships with friends and family.

The environment was accessible and safe for people. Equipment used in the home was serviced.

We saw arrangements were in place that made sure people's health needs were met. The service worked closely with community healthcare teams. Medicines were stored safely and people were given their medicines at the right time in a safe way.

We found people had enough to eat and drink, and we found improvements had been made to the specialist diet provision for one person to ensure their needs around swallowing were being met consistently and safely.

People felt their concerns were taken seriously, and we saw where complaints had been made these had been addressed and acted upon.

The registered provider had systems in place to check and audit the quality of the service. People who used the service, relatives and staff were able to express their views on how the service was run and felt their comments and suggestions were taken seriously.