• Care Home
  • Care home

Archived: The Brambles

Overall: Good read more about inspection ratings

Beverley Close, Basingstoke, Hampshire, RG22 4BT (01256) 479556

Provided and run by:
B.L.I.S.S. Residential Care Ltd

All Inspections

20 May 2021

During an inspection looking at part of the service

About the service

The Brambles is a residential care home providing personal care to up to six people with a learning disability and/or autism. At the time of the inspection there were two people living in the home. During the course of the inspection both people were supported in planned moves into new services.

The Brambles is an adapted residential building located close to local amenities. Accommodation is spread across two floors. There are six ensuite bedrooms, a shared living space and kitchen and secure garden.

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

The service had made considerable improvements since the last inspection. There was a clear plan of action which had been completed to ensure the service was now safe, effective, caring, responsive and well-led.

There were policies and procedures in place which were followed to protect people from abuse and the risks of avoidable harm. People had risk assessments and care plans which supported them, helped reduce risks and promoted their independence.

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.

Staff were caring towards people and understood how they expressed themselves. The service had worked to improve focus on promoting people’s life skills and independence. Staff supported people to participate in activities which interested them, and had supported people through the pandemic to keep in touch with loved ones.

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. The service was small and gave people access to the local community. People’s independence was promoted in how they were supported for personal care and activities. Staff understood how to maintain people’s dignity and treated them with respect. There were clear values established for staff and role modelled by senior staff to ensure the culture was inclusive.

Right support:

• Model of care and setting maximises people’s choice, control and independence.

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

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 for this service was requires improvement (published 13 February 2021).

The provider completed an action plan after the last 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 carried out an unannounced inspection of this service on 3-14 September 2020. Breaches of legal requirements were found related to safe care and treatment, and good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this inspection to check they had followed their action plan and to confirm they now met legal requirements.

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 inspection, by selecting the ‘all reports’ link for The Brambles 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.

3 September 2020

During an inspection looking at part of the service

About the service

The Brambles is a residential care home providing personal care to up to six people with a learning disability and/or autism spectrum disorder. At the time of the inspection there were four people living in the home.

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

People using the service were not always safe as the service had not fully assessed and put in place measures to reduce risks to their health, safety and wellbeing. This included management of their risks from Covid-19.

There had been improvements in the management of medicines. The service had responded to medicines errors and had sought an alternative administration method to reduce the risk of errors.

There had been some improvements in the reporting of incidents, however further improvements were required to ensure any learning could be identified. Staff had a good understanding of what needed to be reported internally as an incident and about types of abuse that needed reporting.

We identified records were not always up to date, complete or accurate and systems to review the quality of the service did not always identify issues for improvement.

The management team were aware of the culture in the home and were working to promote a more proactive approach within the staff team which promoted people’s independence. Staff told us they felt supported by the team and worked well together. Most staff felt confident to raise concerns, however one staff member told us they did not feel information was kept confidentially.

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 guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Right support:

• Model of care and setting maximises people’s choice, control and independence

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. The environment was suitable for people to live a life like any other citizen. The service is small and located in a residential area with access to local facilities.

Staff understood how to promote independence. Records could be improved to ensure this was consistent. We could not be assured that risks were considered in line with best interest and least restrictive practices. Some aspects of care planning were not person-centred and it was not clear how people’s skills were being built upon to further improve their choice, control and independence.

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 for this service was requires improvement (published 19 November 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found that some improvements had been made, however the provider had not made sufficient improvement and so was still in breach of regulations.

Why we inspected

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

We previously carried out an unannounced comprehensive inspection of this service on 29 August and 04 September 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of Safe and Well-led which reflect those requirements.

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 remained requires improvement. This is based on the findings at this inspection.

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

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

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified continued breaches in relation to safe care and treatment and good governance at this inspection.

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.

29 August 2019

During a routine inspection

About the service

The Brambles is a residential care home providing personal care for up to five people living with a learning disability, autism spectrum disorder or Down’s Syndrome. At the time of the inspection there were five people living in the home.

The service has been 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. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a small home which fit with the local domestic style properties. It was registered for the support of up to five people, in line with best practice guidance. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

Risks to people’s safety and wellbeing were not always managed effectively, which put people at risk of harm. Infection control and fire risks were not managed safely and people did not always receive their medicines as prescribed.

Though some support interventions were effective and achieved positive outcomes, not all support plans reflected best practice and professional advice. Risks relating to eating and drinking were not effectively managed.

The service didn’t always consistently apply 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 outcomes for people did not fully reflect the principles and values of Registering the Right Support for the as they had limited choice and control and were subject to unjustified restrictions of their liberty.

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.

The service did not have effective measures in place to ensure that quality and safety issues were identified and addressed in a timely way. Records were not always up to date, accurate, complete and available. The home was going through a period of change and staff reflected there was an improving picture. Some areas highlighted on this inspection had been identified by the management team as areas for improvement, and some improvements had been made.

People’s interests and preferences were taken into account and they had access to activities which reflected this. People were supported to avoid social isolation. Some staff had a very kind and patient approach, where others were directive and did not treat people with respect.

The service did not consider people’s wishes ahead of reaching the end of their life. We recommended the service apply guidance on advanced care planning, so that people and those important to them can have their wishes and preferences considered ahead of making urgent care decisions when they become unwell.

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

The last rating for this service was good (published 16 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches of regulations in relation to managing risks of people’s health and wellbeing; using disproportionate restrictions of people’s freedom and control; failing to treat people with dignity and respect and failing to implement robust quality assurance measures 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 for 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.

12 September 2016

During a routine inspection

This unannounced inspection of The Brambles took place on 12 and 13 September 2016. The home provides accommodation and support for up to six people who may have learning disabilities or autism. The primary aim at The Brambles is to support people to lead a full and active life within their local communities and continue with life-long learning and personal development. The home is a detached house, with a substantial rear garden, within a residential area, which has been furnished to meet individual needs.

We last inspected The Brambles on 30 September and 1 October 2015 and found the provider to be in breach of regulations in relation to staffing and good governance. We issued warning notices for the breaches of regulations. The provider was required to meet the regulations relating to the warning notices by 31 January 2016. During this inspection we found the provider had taken action to ensure the requirements of the regulations had been met.

The service did not have 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. The previous registered manager had deregistered on 11 August 2016. A recently appointed home manager was currently responsible for the day to day running of the home. They had submitted an application to CQC to become the registered manager.

People were protected from abuse because staff were trained and understood the actions required to keep people safe. Staff had completed the provider’s required safeguarding training and had access to guidance to help them identify abuse and respond appropriately if it occurred. Staff were able to demonstrate their role and responsibility to protect people.

Risks specific to each person had been identified, assessed, and actions implemented to protect them. Risks to people had been assessed in relation to their mobility, social activities and eating and drinking. Staff were able to demonstrate their knowledge of individual risk assessments and how they supported people in accordance with their risk management plans.

The home manager completed a daily staffing needs analysis to ensure there were always sufficient numbers of staff with the right skills mix and experience to keep people safe. We reviewed staff rotas between January 2016 and September 2016 which confirmed that people had been supported by sufficient numbers of suitable staff to keep people safe, in accordance with the staffing needs analysis, including times when increased staffing ratios were required.

Staff had undergone pre- employment checks as part of their recruitment, which were documented in their records. These included the provision of suitable references in order to obtain satisfactory evidence of the applicants conduct in their previous employment and a Disclosure and Barring Service (DBS) check. Where DBS checks had raised concerns over candidates suitability these issues had been explored in depth by the home manager and subject to risk assessments, to confirm they were suitable for employment.

People received their medicines safely, administered by staff who had completed safe management of medicines training and had their competency assessed annually by the home/registered manager. Staff were able to tell us about people’s different medicines and why they were prescribed, together with any potential side effects. Staff supporting people in the community ensured they took the person’s prescribed emergency medicine in case they experienced a seizure, which was effectively recorded.

The provider’s required staff training was up to date, including safeguarding people from abuse, moving and positioning, the Mental Capacity Act 2005, fire safety, food hygiene and infection control. This ensured staff understood how to meet people’s support and care needs. Training was refreshed regularly to enable staff to retain and update the skills and knowledge required to support people effectively. The provider had recognised that staff required further training to meet people’s specific needs, for example; training in relation to autism, intensive interaction and Makaton language. Makaton is a language programme using signs and symbols to help people to communicate. Records and staff confirmed this training had been completed. Training was refreshed regularly to enable staff to retain and update the skills and knowledge required to support people effectively.

Staff had received regular individual supervisions from their supervisors, and monthly group supervisions, where aspects of training were also refreshed. Bi-monthly staff meetings had protected time in the home calendar to ensure attendance. Records demonstrated that the previous registered manager, deputy manager and team leaders had completed courses relevant to their role and responsibilities, for example; all of the management team had completed a management course in relation to effective supervision.

Staff supported people to make as many decisions as possible. People’s human rights were protected by staff who demonstrated a clear understanding of consent, mental capacity and deprivation of liberty legislation and guidance.

The home manager and staff demonstrated that a process of mental capacity assessment and best interest decisions protected people’s human rights. The provider ensured that all best interest decisions by visiting health professionals were effectively recorded within people’s care records, as well as their medical notes.

People were supported to have enough to eat and drink and were provided with a balanced, healthy diet. We observed the provision of meals during breakfast, lunch and dinner time. People were supported to consume sufficient nutritious food and drink to meet their needs, in accordance with their care records.

Records showed that people had regular access to healthcare professionals such as GP’s, psychiatrists, opticians, dentists and occupational therapists. Each person had an individual health action plan which detailed the completion of important monthly health checks. People were supported to maintain their health and welfare.

People and, where appropriate, their relatives were supported to be actively involved in making decisions about the care they received. Staff had developed positive caring relationships with people and spoke with passion about people’s needs and the challenges they faced. They were able to tell us about the personal histories and preferences of each person they supported. Health professionals made positive comments about the positive impact on people’s well-being due to how well they had implemented their guidance, for example; reducing people’s anxiety.

People’s privacy and dignity were maintained by staff who had received training and understood how to support people with intimate care tasks. Staff were able to clearly describe and demonstrate how they upheld people’s privacy and dignity. They also demonstrated how they encouraged people to be aware of their own dignity and privacy, for example; supporting them to replace clothing and holding personal conversations in private.

The management team completed the local authority training on person centred care planning in February 2016. The management team told us they were committed to ensuring people were involved as much as they were able to be in the planning of their own care. The provider reviewed people’s needs and risk assessments regularly to ensure that their changing needs were met. People’s needs tended to change frequently and plans were reviewed whenever a change was required.

The home manager and provider sought feedback in various ways, including provider surveys, visitor’s questionnaires, house meetings, and staff meetings, which they used to drive continuous improvement in the service. Since our last inspection there had been no complaints raised about The Brambles. People had access to information on how to make a complaint, which was provided in an accessible format to meet their needs.

Staff told us the home manager, deputy manager and team leaders were a source of encouragement to them and made them feel their opinions were valued. Staff were able to tell us about the values of the provider and we observed staff followed these in practice.

Staff told us the management team had improved the culture within the home to make it more open, where people and staff felt safe and confident to express their view. We observed the management team providing one to one support for people regularly during the inspection, which enabled them to build positive relationships with people and staff, which records confirmed.

The home manager had established systems and processes that enabled them to identify and assess risks to the health, safety and welfare of people who use the service and to ensure compliance with legal requirements. The provider had maintained accurate, complete records in relation to people, including a record of the care and treatment provided and decisions taken.

30 September and 1 October 2015

During a routine inspection

This unannounced inspection of The Brambles took place on 30 September and 1 October 2015. The home provides accommodation and support for up to six people who may have learning disabilities or autism. The primary aim at The Brambles is to support people to lead a full and active life within their local communities and continue with life-long learning and personal development. The home is a detached house, with a substantial rear garden, within a residential area, which has been furnished to meet individual needs.

The service had 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. The registered manager told us they had begun the process to deregister as they had also assumed the responsibilities of registered manager at another home within the provider’s care group. A recently appointed home manager had submitted an application to become the registered manager, who was being supported in the day to day running of the home by the registered manager and the provider.

The provider did not make sure there were sufficient numbers of suitable staff to keep people safe and meet their needs. Relatives and health professionals were concerned about the high turnover of staff and the loss of several experienced members of staff. Experienced staff who had left The Brambles had built close relationships with people who had been reassured by their presence. Their departure had left a void in some people’s lives. These experienced staff had also been a point of reference for less experienced staff with regard to people’s complex behaviours.

Everyone at The Brambles had been assessed as requiring one to one support whilst in the home and two to one support whilst accessing the community. The provider could not be assured that people’s needs were met safely because there were not always enough suitable staff on duty to provide the required staffing ratio to meet people’s assessed needs. Records showed that on numerous occasions the required number of staff were not on duty.

The provider had not completed a risk management plan to ensure people’s safety where there were reduced staffing levels. When asked how the provider assured that people were safe when there was insufficient staff, demonstrated by the provider’s rosters, the registered manager said , “The only answer is that there can be no reassurance of their needs being met, but knowing the staff at the Brambles they would have endeavoured to do their utmost to ensure this happened.”

We observed people receiving their prescribed medicines safely, administered in a way they preferred, by trained staff who had their competencies assessed to do so.

Appropriate checks to ensure staff were recruited safely were not carried out. Staff did not always have appropriate references in relation to their previous employment and there was not always evidence supporting how the provider had assessed the applicant’s suitability for the post. Where references had been requested these had not always been received or did not address the suitability of staff to support vulnerable people. Where there were identified gaps in people’s employment history the provider had not ascertained the reasons for this. This meant that the provider could not be assured that staff were suitable to provide care and support for the people living at the Brambles.

The registered manager and provider did not complete regular audits to monitor the quality of the home and plan improvements. The provider did not complete audits of medicines management, staffing needs analysis or care records. They had failed to identify potential risks to people that may compromise the quality and safety of their care.

The provider was not always supportive of staff. Staff told us that the home manager was approachable and readily available but they were disillusioned with the support from the provider. This had led to staff leaving the home, which meant there were not always staff with the right mix of skills, competence or experience to meet people’s needs. Health professionals told us they were concerned that whilst new staff were dedicated they may not have the required level of experience to always meet people’s needs.

The provider did not promote a positive culture, where staff were supported to question practice, and be actively involved in developing the service. Where staff had raised concerns there was no evidence that any action had been taken to investigate or address the issues to improve the service.

The provider recognised that staff required training and support but did not ensure this covered the areas identified as a further requirement to meet people’s needs, for example staff had not completed autism training. Staff were not always supported to provide safe and effective care for people.

Relatives told us they trusted the staff who made their family members feel safe. Staff had completed safeguarding training and had access to current guidance. They were able to recognise if people were at risk and knew what action they should take to protect them. People were safeguarded from the risk of abuse. Staff had responded appropriately to safeguarding incidents to protect people.

People’s safety was promoted through individualised risk assessments. Risks had been identified, and plans were in place to manage these effectively. Staff understood the risks to people’s health and welfare, and followed guidance to safely manage them.

People, or where appropriate their relatives, and care managers were actively involved in making decisions about their care and were asked for their consent before being supported. Staff had completed training on the Mental Capacity Act (MCA) 2005 and understood their responsibilities. The MCA 2005 legislation provides a legal framework that sets out how to support people who do not have capacity to make a specific decision. Where people lacked the capacity to consent to their care, legal requirements had been followed by staff when decisions were made on their behalf. People were supported by staff to make day to day decisions.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS provide a lawful way to deprive someone of their liberty, where it is in their best interests or is necessary to protect them from harm. The registered manager had completed the required training and was aware of relevant case law. The registered manager had made DoLS applications for each individual which had been authorised, which demonstrated they had taken the necessary action to ensure people’s rights were recognised and maintained.

People were provided with nutritious food and drink, which met their dietary preferences and requirements. People were supported to eat a healthy diet of their choice.

There was a friendly and relaxed atmosphere within the home, where people were encouraged by staff to express their feelings, whilst respecting others. Whenever relatives had raised concerns or issues prompt action had been taken by the registered manager to address them.

People’s dignity and privacy were respected and supported by staff, who were skilled in using individual’s specific communication methods. Staff were aware of changes in people’s needs. Referrals to relevant healthcare services were made promptly when required.

People’s needs were accurately reflected in detailed plans of care and risk assessments, which were up to date. These plans contained appropriate levels of information for staff to provide individualised support.

Staff did not all know the provider’s motto, ‘Creating changes, changes lives.’ However during the inspection we observed staff demonstrate values in their care practice which included compassion, dignity, respect, equality and safety.

People’s and staff records were stored securely, protecting their confidential information from unauthorised persons, whilst remaining accessible to authorised staff.

During the inspection we identified a number of serious concerns about the care, safety and welfare of people who received care from the provider. We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are taking further action in relation to this provider and will report on this when it is completed.

14 January 2014

During a routine inspection

People received appropriate care and treatment in line with their care plans. We were unable to easily communicate with people living in the home. However, with the support of staff one person was able to confirm that they liked living at The Brambles and they were well looked after.

People were provided with a suitable and nutritious diet. Each person had a comprehensive nutritional care plans which identified people's needs, likes and dislikes. We observed how staff appropriately supported people with eating and drinking.

People were protected from the risk of abuse because the staff were aware of the different types of abuse and how to report a concern. A relative we spoke with told us that they felt people living in the home were safe and well cared for.

There were adequate levels of staff on duty on the day of inspection with appropriate skills and qualifications. We found people were supported in line with their plans.

The provider had an effective system to assess and monitor the quality of service. People were asked for their views and the provider acted upon these, where appropriate.

11 December 2012

During a routine inspection

On the day of our inspection there were three people living in the Brambles. They all had complex needs and as such were not able to talk to us about their experiences. However, they welcomed us into their home and indicated that they were happy for us to spend some time with them.

We were invited to look at two of the people's bedrooms and could see that these provided a clean, comfortable and homely environment.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare

People were called by their preferred name and staff treated them with dignity and respect. We observed people being involved in activities, being read stories and undertaking gentle exercise. Staff used Makaton 'sign' language to help them communicate with those people who were familiar with it.

We spoke with three staff members and the manager. They all told us they felt supported. One told us 'I love my job; this is by far the best place I have worked'. Another said 'there is lots of support, and communication is excellent'. They told us that the training was 'excellent and constantly available'

20 October 2011

During a routine inspection

All the people at this care home were unable to communicate verbally and were not able to tell us about their experiences.

Staff told us that they tried to promote an active life for the people living at The Brambles by organising different activities. These included shopping, walks, drives and feeding the ducks which was a favourite pastime. A weekly sensory activity schedule was in place for some residents.