The Brambles Apartments

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This is the first assessment for this service. This key question has been rated Outstanding.

This meant people were protected by a strong and distinctive approach to safeguarding, including positive risk-taking to maximise their control over their lives. People were fully involved, and the provider was open and transparent when things went wrong.
 

This service scored 88 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider always made sure people’s care and treatment was effective by thoroughly assessing and reviewing their health, care, wellbeing and communication needs with them.
People were at the centre of the holistic assessment process. Initial assessments and the ongoing review process were exceptionally thorough, robust, and person-centred. This approach enabled individuals and their families to share their personal history, preferences, routines, interests, and aspirations. As a result, care and support could be tailored to reflect what was most important to each person and to promote positive outcomes. A relative told us, “Before [person] went to The Brambles we were involved in [their] assessment, we had weekly zoom meetings and staff visited [person] at [their] previous place to meet them.”
Assessments fully considered people’s family relationships and the importance of maintaining meaningful connections. We saw an example of how the provider supported a family to extend the time the person would spend with them. They told us, “When we visit [person], they would have the sweets we bring them and then would want us to leave, staff are helping us to extend our visiting time with them, the last time we went, our daughter and grandchildren came too and The Brambles made a picnic for us all in the garden and we stayed an hour before [person] wanted us to leave.”
We reviewed some care plans and found these to be exceptionally detailed, reflective, and insightful. They provided a comprehensive overview of the person’s needs, progress,preferences and any changes required. The review of care records demonstrated an insightful knowledge of each person and ensured care remained responsive, proactive and reflective of any changes. This ensured people’s care plans remained accurate and up to date, supporting consistently effective care that met people’s needs as they changed. For example, we saw examples of people’s periods of distress being reduced through the consistent approach detailed within individual plans and understanding of what the person connected with, i.e. toy tardis for the person who had an interest in Dr Who.
Staff spoke positively of people’s care plans, informing us these were regularly reviewed and updated, and any changes communicated effectively and timely, by the updating of electronic care records, staff handovers and communications in the team app. Staff told us, “We get time to read documentation, anything can change at any time.”
This consistent, holistic approach to assessing, planning and delivering care meant people’s quality of life, outcomes and independence were maximised and often exceeded expectations.

The provider always planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation. They worked to develop evidence-based good practice and standards.

People received person-centred and tailored support in all aspects of their lives, including support with multiple health conditions and living a fulfilled life.
We observed staff supporting people with different needs with patience and compassion, promoting people’s independence and dignity using a seamless approach. Care and treatment were consistently planned and delivered in line with best practice, and evidence-based standards, documentation included links to best practice guidance, for example vitality for health. Staff worked collaboratively with people to ensure what mattered most to them was central to care decisions.
The service also implemented the Positive emotion, Engagement, Relationships, Meaning Accomplishment (PERMA) model which works alongside Positive Behavioural Support and focuses on what makes people happy and helps to support people to do what they enjoy. Forexample, through PERMA recording and reviews, staff consistently identified that one person responded positively to community-based activities, shopping experiences, family involvement, dining out, art and craft activities, cooking opportunities and recreational outings. Staff recognised that the person showed high levels of engagement, participation and enjoyment when these activities were incorporated into their support. This has resulted in the person experiencing increased community involvement, greater independence, meaningful family participation, sustained engagement in activities they enjoy and continued opportunities to develop new skills and experiences. Family feedback has also been consistently positive, with person’s relatives reporting that they have settled well, is accomplishing a great deal and is benefiting from the support provided.
People were engaged in cooking and preparing meals together every day with staff. Staff developed menu plans with individuals which included pictures of food choices and where able people were involved in preparing their own meals.
Nutritional needs were met including food that was Halal for people with different cultural needs.
A relatives told us, “Staff encourage [person] to choose healthy foods, their halal diet is catered for.”

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.
The registered manager and management team had developed good internal communication systems and processes to ensure important information was shared effectively with care staff and the wider staff team, enabling consistently high-quality care.
Staff worked together effectively and shared information through daily handovers, regular meetings and discussions with managers and senior staff. Staff told us, “We work as a team, the atmosphere here is good, feels like a second home,” and “We work as a team, if someone is struggling, we help each other, all of us achieve success together, help each other.”
A relative told us, “Appointments are made with dentist for [person] to attend, when [they] were at home, [they] wouldn't go so this is a big change,” and a health professional told us, “The team have an excellent understanding on risk, sensory and behavioural needs. We get monthlyupdates as to how each person has been and what they are doing etc. The staff seem knowledgeable and well trained and supported by the management team.”

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.
People were supported to access healthcare when this was needed. Staff identified changes in people’s health and took appropriate action, including seeking advice from doctors, nurses and other healthcare professionals. People's care plans included information about any health conditions they were living with and the support they needed to manage these.
Annual health reviews were completed, and people were encouraged to eat healthier.
Relatives told us, “[Person] gets a healthy diet, but they can be adamant about want they want to eat,” and “Staff do really well to motivate [person] to do things, encouraging [them] to exercise, take bike rides, and go for walks.”
People had an annual health check and vaccinations where needed were administered following mental capacity assessments (MCA) and best interest decisions.
 

The provider monitored all people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they fully met both clinical expectations and the expectations of people themselves.
Care plans and records were holistic and outcome-focused, enabling staff to support people to set meaningful goals to improve and maintain health and well-being. This meant people experienced care that was safe and effective, and enhanced their quality of life. The registered manager maintained robust oversight of people’s health monitoring to support improved outcomes and had implemented a monthly summary from people’s keyworkers that evidenced people’s needs were being met. These summaries were then shared with appropriate organisations for monitoring purposes. A health professional from one of the organisations told us, “I am extremely pleased with how people are progressing. Both [people] are accessing the community a lot more. The team are experiencing less periods of agitation.”
People’s quality of life was tracked through the PERMA model with realistic goals being set around what the person enjoyed doing and what would make them happy. PERMA outcomes were reviewed every month which included an analysis of what has contributed to positive outcomes being achieved and embedding achieved goals into people’s daily routines, identifying new meaningful goals and ensuring staff consistently follow support plans. This means that staff actively identified what makes life more meaningful for people and using the information to create more opportunities for enjoyment, achievement, independence and community participation. Staff practice in relation to following people’s support plans are reviewed alongside PERMA meetings and incorporates feedback from families to ensure peoples preferences and aspirations are accurately reflected. This approach has ensured improvements are person-centred and outcomes are sustained and are not short-term achievements that continue to enhance people’s quality of life over time.

There were many examples of the positive impact staff support had on improving outcomes for people, linked to social opportunities and taking on new challenges. A family member shared how staff had supported their relatives to achieve their wishes and try new activities. They told us, “[Person] would never go out before coming to The Brambles, now staff take [them] to visit museums, go to the seaside, and a sports day is being arranged for people across the group of homes,” and “At [person’s] previous place [they] never went out at all and now [person] is out all the time, they’ve been to Blackpool and do different things.” Other relatives had documented the impact of the support they had received in A Parent’s Perspective of the person’s journey, for example one relative had recorded, “Seeing then thrive, enjoy daily activities and return homelooking healthy and content gives us reassurance he is receiving the best support possible,” another relative had recorded, “Most importantly, they see [person] for who they truly are and support [them] to be the very best version of [themselves].”
Staff told us, “[Person] is very attached to parents and mum comes and spends an hour with them on the swing, when [person] first came they didn’t want anyone else to push them but now they will tell her to go, they pick which staff they want to push them, it shows how different they are now and how happy they are, it is amazing to see,” and “We have encouraged [person] to do different things and have taken them rock climbing.”
Another staff member told us, “I am proud of being able to support people ‘to live their best life’, I feel fulfilled when the people we support are happy and enjoying doing things.”

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

People had been assessed for their capacity to consent to aspects of their care. When people were assessed as lacking capacity to make specific decisions, best interest decisions were carried out. These were documented and showed who was involved in the decision-making process and how the decision had been reached. We observed staff obtaining consent from people and encouraged them to make decisions. Where people were not able to communicate verbally staff used different methods to communicate and understood their response, for example, staff told us, “[Person] is non-verbal so we use pictures, they can hear so we also use now and next techniques and give the person time, if we are looking to encourage the person to have a shower the person would turn their back if they don't want one, so would try later, their choice.”
Staff had received training understood their responsibilities under the Mental Capacity Act and assessed people’s capacity appropriately, recognising capacity may vary and can change over time.