The Brambles Apartments

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

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

This meant people were safe and protected from avoidable harm.

This service scored 84 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff had a clear understanding of the action to take in the event of an accident or incident.
Accidents and incidents were reviewed and analysed and lessons learned shared with staff through supervision, team meetings and workshops. Support plans and risk assessments were reviewed and updated following incidents to reflect any changes in people’s needs.

Staff knowledge was checked during handover meetings with senior staff asking two questions either relating to individual people or specific understanding, for example, “What does person-centred care mean?”

Knowledge and learning were also set agenda items within staff supervisions. Staff told us, “We get asked, ‘what could be better.’”

A family member told us, “If we have any concerns we can talk to [registered manager] directly, when we’ve had any issues, they have been dealt with quickly.”

As a result, learning was meaningful, well embedded and led to safer care, greater consistency and better outcomes for people.
 

The provider always worked with people and healthcare partners to design, establish and maintain safe systems of care, in which safety was always well managed and monitored. They made sure there was always continuity of care, including when people moved between different services.
The provider demonstrated a strong culture of collaborative working and had established effective, proactive, and innovative approaches to delivering coordinated care and support by working closely with other services. Robust systems and processes ensured that care was planned and discussed with the active involvement of people, their relatives, and relevant professionals. As a result, individuals' needs were thoroughly assessed and understood, enabling them to be met safely and effectively before any transition took place. This person-centred approach supported smooth transitions and helped maintain continuity of care.
In addition, the provider had access to a specialist support team, employed by The Bridge, (the parent provider), who provided support when people experienced episodes of distress. The team were available during the transition period, if needed, to support staff and the registered manager.
For example, one person moving into the service from hospital took several months to transition in a safe and planned way. Staff from the service regularly visited the person in hospital and worked closely with hospital staff. This helped the person become familiar with the staff who would be supporting them and enabled staff to understand the person's needs, preferences, and how best to provide care. When the person moved into The Bramble Apartments, hospital staff worked alongside the providers core staff team to ensure a smooth handover and continuity of care. This approach went beyond the usual discharge planning process and helped achieve a safe and seamless transition, reducing risks and minimising distress for the person.
A relative told us, “There was a good handover to staff before [person] arrived, the [health professionals] presented information about [person] to the staff team here to make sure they understood what they needed.”
When people moved into the service staff told us, “An assessment and care plan are completed, MDT meetings are held with families, and the environment is personalised to support the person.” Staff also told us they have enough time to read through people’s care records, and any updates are provided via handover meetings and a communication app.
 

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.
There was a strong understanding of safeguarding and how to take appropriate action, underpinned by safe systems, processes and practices to make sure people were protected from abuse and neglect. Staff told us, “I would report it [abuse] immediately to a senior, if not addressed I would escalate it further, we have a safeguarding officer and can email them too.”
The registered manager operated an open-door policy, to support both visitors and staff to raise concerns, and seek advice without fear of judgement of repercussion. CCTV was installed within some people’s flats, which provided an additional tool to support individuals allowing them a safe space and time alone. Where CCTV was used risk assessments and Mental Capacity Assessments (MCA) were in place. A relative told us, “This is a safe place" and “[person] is happy.”
People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found that the registered manager kept a record of DoLS applications and authorisations, and this was regularly reviewed to make sure authorisations were current.
 

The provider always worked well with people to fully understand and manage risks by thinking holistically. Staff provided care that fully met people’s needs and was safe, supportive and enabled people to do the things that mattered to them.
People and their families were supported and encouraged to understand potential risk. A proportional, and person-centred approach was taken to the mitigation of risk, maximising opportunities for people to maintain their independence and live an active and fulfilling life in line with their wishes, personal goals and aspirations. For example, where a person had a real fear of dogs and wished to walk to the local shop, staff worked with them to identify any risks and implemented tailored measures to support this safely. This included working with neighbours to understand the person’s fear. This approach meant the person could walk safely to the shops with neighbours crossing the road if out walking their dog. A further example was staff facilitating a person to go rock climbing, working with the person to assess and mitigate risk, enabling them to achieve their personal goal. The staff member told us they felt proud when [person] told them, “Thank you for being my keyworker and helping with activities."

In another example, a relative told us, “[Person] wants to be a handyperson – they have painted the garden fence and designed and created a peacock on the fence.” Staff worked with the person to visit a local DIY store to choose their materials. The person liked to sit on the shop floor while deciding what they wanted. The service worked with the store to ensure the person could visit safely.
This demonstrated a service that embraced positive risk taking and supported people to achieve what was important to them. People’s care records provided clear guidance as to how identified risks were to be mitigated and were regularly reviewed. These focused on all aspects of people’s lives, including personal care, eating and drinking, and social events and activities. All were tailored to the individual and personalised in line with their goals and aspirations.
 

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The environment in which people resided was planned and adapted to meet their diverse needs. The facilities, equipment and technology were well-maintained and supported staff to deliver safe and effective care.
The service had up to date Personal Emergency Evacuation Plans (PEEP). These were kept within the person’s individual grab folder in their apartment and included the persons care plan, torch, high visible vest, emergency blanket and an item that the person would connect with, for example for one person it was cup, for another person it was a small Tardis. PEEPs provide staff and emergency service personnel with critical information on the evacuation needs of each person in the event of an emergency.
Essential checks on equipment and services were carried out in line with regulations and expected standards.
Each apartment was individually adapted to reflect people’s preferences, meet their specific needs, and promote their safety. For example, one person was known to damage their surroundings when experiencing distress, creating a potential risk of harm to themselves and staff. Following discussions with the person, their relatives, and relevant professionals, the provider introduced a range of environmental safety measures. These included fixed furniture and fittings, protective coverings for windows and electrical switches, and access to a secure enclosed garden. These adaptations helped to reduce distress, enhance safety, and increase the person’s overall sense of security.
A family member told us, “I am 99.9% sure they wouldn't get anywhere better.”
 

The provider made sure there were always enough qualified, skilled and experienced staff, who received thorough support, supervision and strong development opportunities. They worked together well to provide safe care that met people’s individual needs.
Robust and safe recruitment procedures ensured only suitable staff were employed. Following a successful interview staff were shown around the service and introduced to people to make sure they were right for the role.
There was an excellent induction and training programme which included training on legislation, for example MCA and specific conditions, for example epilepsy and diabetes as well as training to support people with a learning disability. The provider employed a training mentor who supported new members of staff as well as working alongside experienced staff members to ensure staff had the right skills to support people effectively and ensure practice remained up to date and evidenced based.
By investing in high quality training and structured development, staff were well prepared for their roles and felt valued from the outset. This contributed to a positive culture and consistently safe, compassionate care for people using the service.
Staff told us, “I was encouraged to develop even when I didn’t believe I could do it,” and “The more I know, the better I provide person centred care.”
The registered manager told us they were, “Keen to develop staff, and teach staff why things are important, the biggest thing is my practice leadership, showing and teaching staff.”
Staffing numbers facilitated a person-centred approach to care, which considered people’s physical, emotional and psychological needs, both during the day and night, and enabled staff to respond to events within the service. Each person had a core team of staff whose skills and experience were matched to people’s needs and staff deployment was carefully planned around individual needs and enabled daily activities for each person. Workforce planning ensured people received exceptional continuity of care which improved outcomes for people, for example, we saw evidence that people were content and accessing the community and undertaking different activities on a daily basis. A relative recorded that “[person] is happier, more confident and enjoying opportunities that were not available to them before.”
Other relatives told us, “[Person] has a core team, they will request who they want to work with” and “[Person] has 2 workers with them and if they need more when distressed, other staff will come if needed, the management try to match the staff.”

Staff told us, “There are lots of staff here to meet the needs of people we support, the staffing is always good,” and “Risk assessments are in place that identify what staff are needed for each person, there is always enough staff, if someone is sick and not able to come to work, we have a standby person that will come in to cover.” This meant that the provider did not rely on agency staffing and people were always supported by people who knew them well.

Staff received regular supervision and an annual appraisal, staff told us, “We are asked about our welfare in supervision, and if anything is bothering us, if we raise any issues they would be sorted. We can ask questions and put things on agenda it’s like having a ‘shoulder to lean on’" and “I am doing an apprenticeship in level 2 diploma and its free.” Another staff member told us, “My goal from my last appraisal was to complete level 2 diploma in adult social care, I am 7 months into completing it now.”
 

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff completed Infection Prevention Control (IPC) training and understood their responsibilities for infection prevention and demonstrated good practice, including hand hygiene and maintaining clean environments. A cleaning schedule was in place for each apartment and communal areas, staff supported people to undertake cleaning tasks in their apartments.
Managers completed regular IPC audits. These included audits of the environment, equipment, and staff spot checks. Any actions needed were monitored through the compliance system until completed.
We observed staff wearing PPE appropriately and in line with people’s care plan, for example bite jackets.
 

The provider always made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff always involved people in planning, including when changes happened.
The service demonstrated a proactive and person-centred approach to medication optimisation, ensuring all medicines were appropriate for each person’s condition and regularly reviewed to support the effective management of long-term health conditions. The service had worked with the person, their relatives and relevant health care professional to ensure the medicines were appropriate and maximised the person’s quality of life. They continuously liaised with healthcare professionals to minimise unnecessary or excessive use of multiple medicines wherever possible, reducing associated risks and ensuring each treatment remained clinically appropriate. The registered manager understood and followed the principles of stopping over medication of people with learning disability, autism or both (STOMP). This approach significantly enhanced people’s quality of life by limiting avoidable side effects such as drowsiness, confusion, and more time to enjoy their hobbies and interests.

An electronic medicine management system was used by the service to record medicine administration, instruction and guidance. The deputy manager stated this had supported medicine management, and enhanced oversight and reduced potential human error. Systems, processes and responsibilities for ordering, collecting, and returning unused medicines were clearly documented.
Staff responsible for medicines undertook training and were knowledgeable about safe systems of medicine administration. We saw evidence of lessons learnt from medication error occurring with staff undertaking refresher training and additional measures being put in place to prevent a repeat of the error.
Protocols were in place for medicines which were prescribed for use as a PRN, ‘as and when needed’. For example, to manage pain or support people during periods of distress and agitation. The use of PRN medication was monitored which enabled staff to provide information to health care staff who prescribed the medicine as to its need and effectiveness, as part of a medicine review. This had resulted in PRN medication being significantly reduced and stopped completely for some people.
Regular auditing of medicine procedures had taken place, including checks on accurately recording administered medicines as well as temperature checks of medicines storage areas. This ensured the system for medicine administration worked effectively and any issues could be identified and addressed.