The Bromford

The Bromford is registered to provide personal care as part of a supported living setting. At the time of this inspection 14 people were receiving personal care. The Bromford was purpose built and comprises of individual flats over two floors with communal areas on each floor.

Some aspects of the service have 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.

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

Improvements had been made since the last inspection where The Bromford was rated as inadequate. Systems had been put in place to improve people’s safety and the management of the service. However, we need assurances the improvements made so far, will be sustained and will remain embedded.

There were enough staff to support people safely. The provider completed employment checks to ensure staff were suitable to deliver care and support before they started work. They need to strengthen the process further and ensure a full employment history was completed for all staff. People we spoke with told us they felt safe with the care staff who supported them. Where people were supported with medicines this had been provided safely. Care plans we sampled had improved and demonstrated that people who lived at the home had risk assessments in place in relation to their specific conditions and to keep them safe. Some further improvement was needed to one person’s risk assessments.

People’s care and support reflected their individual assessed needs. Staff had the appropriate skills and knowledge to meet people’s needs and received training and ongoing support. People had been supported to maintain their health and wellbeing and had access to healthcare services when required.

People received help and support from a kind and compassionate staff team with whom they had positive relationships with. Staff showed respect for people's rights, privacy, dignity and independence. Staff providing care to people were limited to a small number to aid consistency of care and ensure positive relationships were maintained with people.

People were supported to have maximum choice and control of their lives and staff them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent. People received personalised care that was responsive to their needs. The provider had a complaints process and people felt confident to raise any concerns.

Action had been taken to improve the systems used to check and audit the quality of the care provided at the service. However, further improvement was needed. People told us that the manager was approachable and responsive and staff felt supported.

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 inadequate (published 2 July 2019) and there were multiple breaches of regulation. We imposed conditions on the provider's registration. 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.

This service has been in Special Measures since 2 July 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

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.

People’s experience of using this service:

People were not supported to stay safe as risks were not managed well. Where safeguarding concerns arose, these were not consistently identified and acted upon. Records around the use of restraint did not provide assurance that this was done safely.

A lack of oversight from the provider and management meant that risks to people’s safety had not been responded to appropriately. Systems to monitor the quality and safety of the service had not identified the areas for improvement found at this inspection.

People received support from staff who had received training but did not always apply their learning in their practice. People had their dietary needs met and had access to healthcare services where required.

People told us that staff treated them with dignity and promoted their independence.

Records held personalised information about people and staff knew people’s preferences with regards to their care. Complaints made had been investigated and people’s end of life needs had been considered.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

Rating at last inspection: Good (Report Published 09 March 2019)

Why we inspected: The inspection was bought forward following receipt of information that indicated people were not receiving safe care and treatment. Our findings at this inspection confirmed these concerns.

Enforcement : Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

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

The Bromford is registered to provide personal care as part of a supported living setting. On the day of this inspection site visit 24 people were receiving personal care. The Bromford was purpose built and comprises of individual flats over two floors with communal areas on each floor.

The Bromford had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

People’s experience of using this service:

People received safe care and support as the staff team had been trained to recognise signs of abuse or risk and knew what to do to safely support people. People received safe support with their medicines by staff members who had received appropriate training and had been assessed as competent. People were supported by the right amount of staff to meet their needs. The provider followed effective infection prevention and control procedures when supporting people.

The provider supported staff in providing effective care for people through person-centred care planning, training and one-to-one supervision. Staff members were knowledgeable about the relevant legislations that informed their practice and supported the rights of those receiving personal care at The Bromford. People were promptly referred to additional healthcare services when required. People were supported to maintain a healthy diet and had choice regarding food and drink.

People received help and support from a kind and compassionate staff team with whom they had positive relationships with. People were supported by staff members who were aware of their individual protected characteristics. People were supported to develop their independence and to set achievable goals in life.

People were provided with information in a way that they could understand. Policies and guidelines important to people were provided in an easy to read format with pictures to aid their understanding. The provider had systems in place to encourage and respond to any complaints or compliments from people or their relatives.

The provider had systems in place to ensure the Care Quality Commission was notified of significant events in a timely manner and in accordance with their registration. The provider had effective systems to monitor the quality of the service they provided and to drive improvements where needed. The provider, and management team, had good links with the local community which people benefited from.

More information in Detailed Findings below.

Rating at last inspection:

‘Good’ overall with requires improvement for the key question ‘Safe,’ (date last report published 11 September 2018). At that inspection we found the provider needed to improve the consistency of their risk assessments regarding the care and support people received. At this inspection we found improvements had been made.

Why we inspected:

The inspection was prompted following concerns raised by the Local Authority (who commission services for people at The Bromford). We had received concerns in respect of the risk assessment processes completed by the provider, staff training and knowledge of people’s needs, care planning and overall staffing.

Follow up:

We will continue to monitor all intelligence received about the service to ensure the next planned inspection is scheduled accordingly.

This was the first inspection of the service since they were registered to provide personal care on 11 December 2017 and there has been no previous rating for the service.

People receiving personal care live in a ‘supported living’ setting, so that they can live in their own home as independently as possible. Some people live there as permanent tenants while others live at The Bromford on a short-term tenancy agreement while receiving ‘respite care’ from the service. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. The Bromford was purpose built and comprises 20 flats over two floors with a communal lounge on each floor. In addition, there are several stand-alone flats on site. Not all tenants receive a personal care service.

The service may provide personal care to younger adults or older people that may be living with dementia, learning disabilities/autistic spectrum disorder, mental health, physical disability or sensory impairment. On the day we visited the site there was 24 people receiving personal care, seven of these people living in a flat on a short-term tenancy with personal care provided. CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service has a registered manager who was present during our inspection. 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.

Staff were aware of the risks to people and how to keep them safe but inconsistencies in the recording of risk assessments meant that these records were not always up to date or available. People thought there was sufficient staff available throughout the day and night and this made them feel safe. People felt safe when receiving care from staff who were aware of how to respond to allegations of abuse. People were happy with the way their medicines were managed. The provider carried out appropriate checks on new staff which ensured they were safe to work with people living at The Bromford.

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 had confidence in staff and felt they were well trained and knowledgeable. People received the level of support they wished with food and drink, whether preparing their own food or having meals cooked for them. People had access to community healthcare as needed.

People felt the staff were kind, caring and respectful. People thought they were treated well and had their privacy respected. Encouraging people’s independence was an integral part of the service. People were supported to make choices regarding their daily living. People could maintain relationships with friends and families, with access to advocates promoted where needed.

People’s care plans contained information about their needs, wishes and preferences, and people, and they and/or their representatives were involved in care planning. Staff understood what people’s needs likes, dislikes and personal preferences were and the importance of meeting these. People could access activities if wished. People felt able to raise complaints and were confident they would be resolved.

There had been difficulties when the service first opened, that had led to the provider making changes to prevent reoccurrence of these incidents, and ensure people were safe. We saw the provider was working in conjunction with commissioners to ensure their systems for governance were more effective. People and relatives knew who managers were and felt they could easily approach them to discuss any matters. The staff team felt well supported by managers and the provider.