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Inspection carried out on 27 September 2018

During a routine inspection

We carried out a comprehensive inspection of Bramshaw House on 27 September 2018.

Bramshaw House is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Bramshaw House is registered to provide accommodation for people requiring personal care for up to 10 people, older people and younger adults with learning disabilities or autistic spectrum disorder, physical disabilities, sensory impairments and mental health support needs. Bramshaw House is a large detached premises in a residential street that is split across two floors. At the time of the inspection, 10 people were living in Bramshaw House.

Bramshaw House 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 this service can live as ordinary a life as any citizen.

The service had a registered manager in post. 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.

This was the first inspection of the service since it was registered with the Care Quality Commission (CQC) in June 2017.

People felt safe and there were systems and processes in place to keep people safe from abuse. Staff and people had support to knew how to recognise and report abuse. Any concerns were reviewed by the registered manager and reported to the local authority safeguarding team. People were helped to understand what discriminatory abuse was and who they could speak with to get help to prevent this. People said this was useful and made them feel safe.

People had assessments that identified potential risks to their safety. People, or people acting in their best interests, were involved in deciding how to take appropriate actions to manage these risks and made sure people’s personal freedom, independence and choices were respected. Accident and incidents were responded to quickly to keep people safe and reviewed to look at how to prevent them happening again.

There were safe recruitment processes and the service had enough staff to meet people’s needs. Staff had regular medicine administration training and competency assessments and there were systems and processes to help make sure that people received their medicines safely. Infection control risks were well managed and the premises were clean and hygienic. Staff had received food hygiene training to know how to safely support people with any food preparation and handling support they needed.

People told us the service was effective and they had a good quality of life. One person said, “They look after me very well, they know what they are doing”. Another person said, “I am happy”. People were supported to achieve the outcomes they needed and wanted support with. Staff received equality and diversity training and did not focus on people’s disabilities when supporting them to achieve their choices. One person said, “They help me do everything that other people do.”

Staff worked well with each other and with other organisations to co-ordinate people’s support to help make sure people’s needs and choices were met consistently. Staff had a comprehensive induction and probation programme and on-going training and supervisions to give them the necessary skills and knowledge to deliver effective care and support. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People had effective support with their healthcare needs. Staff supported them to share information with health professionals and to understand information about their care and treatment options were and what the outcomes could be. People were involved in decisions about what they ate and drank and had support with any specific or more complex eating and drinking needs, including managing any risks associated with these. The service had been adapted to meet people’s needs and people had personalised their bedrooms and communal areas to their choosing. There were spaces for people to socialise together or with visitors or spend time alone if they chose.

Staff were caring and respected people’s privacy, dignity and confidentiality. People were involved with making choices about how they were supported and staff communicated with them in accessible ways. Staff encouraged people to be as independent and made sure that they had time and space to make their own choices and do as much as they could for themselves.

People received personalised care and were involved with planning their support. Staff knew people well people had care plans that reflected their personal preferences and life history as well as their physical, mental, emotional and social strengths and levels of independence. Staff helped support people to share and receive information about their support in the most accessible way so they could remain in control of the planning and delivery of their support as much as possible.

People had support to follow their personal interests and goals and regularly took part in activities in the community. People were encouraged and supported to maintain relationships with important people in their lives, including with family, friends and partners. People’s care was reviewed regularly to check they were achieving the support they wanted and had a good overall quality of life.

Leadership and management promoted an open, positive person-centred culture at the service. People had contributed to agreeing the vision and values of the service. One staff explained what the vision was and what this meant for them “We make sure we respect people and make sure they are treated equally. This helps them to be happy and get the same opportunities as anyone”.

Staff had regular meetings supervisions and appraisals to help them share information and ideas about how to deliver the best possible support for people. The registered and deputy manager made sure they were always approachable and available and staff well-being and quality and diversity rights were respected. There was a 24 hour on-call service for when the managers were not on-site to support staff. Staff said managers were capable and did what they said they would if they needed support, “There is always someone on the end of a phone or on-shift, they are brilliant like that.”

Quality assurance systems and governance frameworks helped make sure the service was operating in line with current best practice guidance and legal and contractual requirements. The registered manager and the staff were aware of any quality and safety risks and acted to make sure they were addressed on time.

People and relatives were listened to and open communication was encouraged so they could say about what was working well and what wasn’t. Staff and management worked with external agencies in an open way to share appropriate information about people’s support. This helped to achieve consistency in people’s support and offered an opportunity to review how services could learn from each other to improve people’s overall care provision.