Archived: Bradwell House

Bradwell House is registered to provide personal care and accommodation for up to 10 people. There were 10 people using the service at the time of our inspection who had a range of health and support needs, these included learning disabilities. Some people had additional conditions such as sensory impairment, epilepsy and autism. The service applied 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.

People’s experience of using this service:

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways; there were no signs outside the property to identify it as a care home. People were encouraged to be a part of the local community; attending clubs, the library, pubs, visiting local shops, cafes, swimming pools and gyms. People were supported to move on to supported living services to become more independent.

Staff were positive about the manager of the service and worked well as a team

The provider had been responsive to the recommendation we made at our last inspection about medicines. Peoples medicine was managed safely.

At our last inspection we recommended that the service provide furniture with different handles to reduce the risk of detachment and handles becoming a choking hazard or the risk of a fixing causing a skin tear. The provider had acted on this and this was no longer an issue at this inspection.

There were enough staff to support people with their needs. Staff had a good understanding of people’s specific needs and were consistent in their approach.

Staff were supported and trained to carry out their roles. People received personalised care that promoted their independence.

People were communicated with and supported in a person-centred.

People had access to health care professionals as required. Staff worked together and with other healthcare professionals to ensure people received joined up care and support.

The service was compliant with the Mental Capacity Act 2005.

Staff spoke to people with kindness and in a patient way. People were treated with respect and compassion.

Auditing and checking procedure’s continued to review the service to ensure people received safe care and support.

The service had a registered manager who promoted an open and fair culture.

Rating at last inspection:

This service was rated, “Good” at the last inspection on 20 and 21 July December 2016. We published this rating on 14 September 2016.

Why we inspected:

This was a planned comprehensive inspection to check the service remained Good. We found overall that the service continued to meet the characteristics of Good.

Follow up:

We will continue to monitor the service through the information we receive. We will carry out another scheduled inspection to make sure the service continues to maintain a Good rating.

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

Bradwell House is registered to provide personal care and accommodation for up to 10 people. There were 9 people using the service at the time of our inspection who had a range of health and support needs. These included moderate to severe learning disabilities and very limited or nonverbal communication. Some people had additional conditions such as sensory impairment, epilepsy and autism.

Bradwell house is a large detached house situated in a quiet residential area on the outskirts of Hythe. There is a large communal lounge and adjoining dining area. Each person had their own bedroom including any necessary aids to suit individual needs, such as, special chairs and adaptations to support people with visual impairment and other needs. There was a secure enclosed garden to the rear of the premises, with a large furnished patio and raised planting areas. A sensory cabin and an arts and craft cabin are set within the grounds of the service.

Bradwell House was last inspected in November 2014. At that inspection it was rated as ‘Requires improvement’. A breach of Regulation was found during that inspection and the provider sent us an action plan to tell us what they had done to make improvements. The action plan stated this breach had been addressed by June 2015.

This service had a registered manager in post. A registered manager is a person who is 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 was on holiday at the time of this inspection and the running of the service was overseen by the deputy manager. The locality manager was also present at Bradwell House to support staff and our inspection process.

Our inspection found the service offered people a homely, supportive environment and their care needs were being met.

A survey of people living in the service found they felt safe. Staff knew how to recognise signs of abuse and how to report it. They told us how they protected people from financial abuse and supported people to be safe in the community.

Assessments had been made about physical and environmental risks to people and actions had been taken to minimise these. Incidents and accidents were managed appropriately to avoid recurrences.

There were enough staff on duty to support people, and proper pre-employment checks had taken place to ensure that staff were suitable for their roles.

Medicines had been managed appropriately and equipment had been serviced on a regular basis to ensure that it remained safe for use.

Staff had received training in a wide range of topics and this had been regularly refreshed. Supervisions and appraisals had taken place to make sure staff were performing to the required standard and to identify developmental needs.

People’s rights had been protected by assessments made under the Mental Capacity Act (MCA).

Staff understood about restrictions and applications had been made to deprive people of their liberty when this was deemed necessary.

Healthcare needs had been assessed and addressed. People had regular appointments with GPs, health and social care specialists, opticians, dentists, chiropodists and podiatrists to help them maintain their health and well-being.

Staff treated people with kindness and respect for their privacy and dignity. Each person had a keyworker assigned to them to give individual and focused support.

Staff knew people well and remembered the things that were important to them so that they received person-centred care.

People had been involved in their care planning and care plans recorded the ways in which they liked their support to be given. Bedrooms were personalised and people’s preferences were respected. Independence was encouraged so that people were able to help themselves as much as possible.

Staff felt that there was a culture or openness and honesty in the service and said that they enjoyed working there. This created a comfortable and relaxed environment for people to live in.

Systems were in place to assess and monitor the quality and safety of the service. This was achieved by the effective use of auditing and through encouraging feedback from people, relatives and staff and continuous review.

We did not find any breaches of Regulations; however, we made some recommendations for the service to put in place.

We recommend the service review and amend their medication policy to ensure PRN practices conform with and reflect best practice in published guidance such as the Royal Pharmaceutical Society for The Handling of Medicines in Social Care or The National Institute for Health and Care Excellence (NICE) Managing Medicines in Care Homes.

We recommend that the medicines cabinet for medicines which require safer storage is secured in such a way as to conform to British Standard BS2881:1989 security level 1, Misuse of Drugs Act 1971. This will then provide suitable storage in the event it is needed.

We recommend the service provide furniture with handles appropriate to the environment. For example, larger handles, substantially attached to furniture. In the event of detachment the handle would not present a choking hazard or the fixing a skin tear risk.

There was choice in the food that was provided. People had their own snack box which was kept in the manager's office but which they could go to at any time.

The home was clean. There were policies to prevent the spread of infections. There were hand soap and antiseptic gel dispensers at frequent points in the service.

There were effective systems in place to monitor the quality of the service. We saw examples of where complaints or comments,were acted upon. Serious incidents were recorded and acted upon.

Staff had been properly assessed before being employed. There were Criminal Records Bureau checks (now Disclosure and Barring Service (DBS) in place for staff.

Records contained the proper information about people using the service, staff and management of the home to protect people against the risks of unsafe care.

People had a care plan that met their assessed needs and included their views. People were encouraged to be independent and were given support to learn new skills. Where there were risks to people's safety these had mostly been assessed and the risks reduced. However, we found that four people had restrictions on accessing bathrooms without there being a proper assessment of the risks. This meant that these people had to seek staff assistance to use the toilet. There was no record that showed how the decision had been made to put the restrictions in place.

People were supported to take part in activities that matched their interests. They used local community facilities such as the cinema, pubs, shops, gym and swimming pool. There were enough staff employed to meet people's needs and staff were skilled in supporting people. The environment of the service was well maintained and regular checks were made to ensure there were no safety issues. Repairs were made quickly. People had comfortable bedrooms which they had personalised to their own tastes.