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Reports


Inspection carried out on 10 April 2019

During a routine inspection

About the service: Brackenley provides support for younger adults and older people who may be living with a learning disability or autistic spectrum disorder, dementia, a physical disability, sensory impairment, mental health needs or an eating disorder.

The service was registered for the support of up to 13 people, and 13 people were using the service at the time of our inspection. This is larger than current best practice guidance for a service supporting people with a learning disability. However, the size of the service having a negative impact on people was mitigated. The service was in a residential neighbourhood, close to local amenities, and by the building design fitted into the local area.

People’s experience of using this service:

People received kind, caring and effective support to meet their needs. The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The provider and registered manager were exceptionally committed to continually improving and developing the service to meet people’s individual needs and improve their quality of life. They promoted an open, transparent and very person-centred culture. People were at the heart of the service; management consistently recognised what was important to people and were very responsive and passionate about providing high-quality care to meet their needs. Staff praised the communication and strong leadership and were proud of the service they provided. There was high levels of engagement and a strong focus on staff development to continually improve the quality of care provided.

Staff provided effective care; they were confident in their knowledge and skills, understood people’s needs and knew how best to support them. Staff worked closely with professionals; they sought advice and guidance to make sure they provided the most effective care they could to meet people’s needs. If people were unwell, staff advocated on people’s behalf to make sure they received the medical attention they needed.

Staff were caring; they were attentive to people’s needs and provided dignified and respectful support. People told us they felt safe and praised the care and support that staff provided. Staff treated people with kindness, dignity and respect.

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 routinely made choices about all aspects of their care. Staff supported people to express their wishes and views and were proactive in using accessible information to help people make decisions.

People were supported to access a very wide range of meaningful activities and to pursue their hobbies and interests. People had access to a varied choice of meals and snacks were available. Staff monitored people’s needs, promoted health choices and provided support if necessary to make sure people ate and drank enough.

Supervisions and appraisals provided an opportunity for staff to reflect on their performance and identify goals for the future.

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: At the last inspection service was rated Good (report published 24 October 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 any concerning information is received, we may inspect sooner.

Inspection carried out on 5 July 2016

During a routine inspection

We undertook this inspection on 5 July 2016. Our inspection visit was unannounced.

Our previous inspection took place in March 2015, when the service was found to be meeting legal requirements, but was given an overall rating of: Requires improvement. Improvements were recommended to ensure people had maximum choice and control over their lives and were always treated with dignity and respect by staff.

Brackenley is a residential care home. It is registered to provide care for up to 13 people who are younger adults, older people and may have sensory impairment and eating disorders. At the time of this inspection 12 people were living at the home.

The home is located on a main road into Harrogate. The property is a detached house that has been adapted for use as a care home and has its own driveway and gardens.

The service had a registered manager who had been registered with us since August 2015. 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 registered manager was appropriately supervised and supported by the registered provider. Staff and people who used the service were positive about the registered provider and manager and the changes and developments that had taken place since the last inspection.

People using the service told us they felt safe. Staff knew how to report any concerns about people’s welfare and felt that they would be listened to.

Staff had received training on how to assist people with their medicines and could explain how medicines were managed safely. Some improvements were needed to records, to ensure that clear and up to date guidance and information was available to staff about medicines prescribed on an ‘as required’ basis.

Staff were recruited safely and there were enough staff on duty to provide the care people needed. Staff felt supported and had received training that was relevant to their roles.

The service was following the principles of the Mental Capacity Act 2005, but needed to improve how information about decision making and consent was recorded in people’s records. At the time of the inspection four people had deprivation of liberty authorisations in place and one authorisation request was awaiting assessment by the local authority.

People told us that they were supported well and treated with dignity and respect by staff. Staff could describe how they involved people in decisions and supported people to live fulfilling lives.

People were involved in planning and reviewing their support. The staff we spoke with knew people well and were able to describe people’s individual needs. We found that some care plans and records had not been updated to reflect changes in people’s needs and did not accurately reflect the care that was actually being provided.

People told us how staff supported them to access the local community and attended activities that interested them. People also told us about recent holidays and events they had taken part in.

A complaints procedure was in place and a record of concerns and complaints showed what had been done in response. Where it was felt to be appropriate apologies had been given.

People had been encouraged to be involved and provide feedback through their keyworkers, reviews, meetings and surveys.

The registered provider had recognised that quality assurance and governance systems could be developed and were in the early stages of implementing a quality monitoring package and undertaking an accreditation scheme.

We found a number of examples where records were not up to date and have recommended that the provider takes action to improve record keeping practices.

Inspection carried out on 10 March 2015

During a routine inspection

This inspection took place on 10 March 2015 and was unannounced.

This inspection follows the registration of Harrogate Skills 4 Living Centre (HS4LC) with the Care Quality Commission (CQC) on 24 September 2014. It was the first inspection of the service under the new provider..

When we visited the provider had recently completed a consultation period with staff. This had resulted in significant changes to the structure of the home and the management team. Both the registered manager and the deputy manager were present throughout our inspection. However, they told us they were due to leave the home shortly after our inspection visit. The provider subsequently informed us they had appointed a new manager and an application to be the registered manager with the Care Quality Commission (CQC) was in progress. A registered manager is a person who has registered with the 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.

People had an individual care plan that detailed the support they needed and how they wanted this to be provided. However, improvements were needed to make sure that all staff in the service could consistently and promptly respond to people’s care, treatment and support needs.

Although people were positive about the home we identified some improvements were needed to make sure that people were supported to be able to live their lives fully and be in charge of their decisions’

Risk assessments had been developed and these were monitored to ensure that people received safe care that met their needs. We observed staff responded and dealt with situations that arose in a timely way to safeguard people and promote their wellbeing. Staff knew people well and we observed they were at ease and comfortable with the staff who supported them. Staff took time to speak with the people they were supporting and we saw friendly, relaxed interactions between staff and people living in the home. People were able to see their friends and families as they wanted. There were no restrictions on when people could visit the home. However, we also identified that there were established care practices that affected people’s ability to be able to take control and make decisions about their lives. For instance, the home had rules about rising and retiring times, which meant that people were expected to be in their bedrooms between 11pm and 8am.

People had a choice of meals, snacks and drinks, which they told us they enjoyed. The deputy manager had developed the menus and had included people in planning menus. However, there were times when the kitchen was kept locked which prevented people from routinely accessing the kitchen to be able to make their own drinks, which people told us they liked to be able to do.

Staff we spoke with confirmed that they were committed to working together as a team to drive forward improvements and to promote good quality, individualised care. There were safe systems in place for recruiting staff and both staff and visitors knew the action to take if they had any concerns. They knew how to raise their concerns outside the organisation if they needed to do so.

Appropriate arrangements were in place to make sure that staff were trained to be able to carry out their role and responsibilities effectively. Staff knew about the Deprivation of Liberty Safeguards and the key requirements of the Mental Capacity Act 2005 and had put these into practice effectively. People had access to a range of health and social care professionals such as speech and language therapists and doctors.

There was a programme of repair and refurbishment in place, which included new wet rooms and replacement windows. We have asked the provider to ensure that their risk assessments also take into account the outside areas of the home.