We carried out a review of the data available to us about Bracken Tor House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Bracken Tor House, you can give feedback on this service.
The service was a four-storey house in a residential area of Okehampton. The home was in keeping with other residential properties in the local area.
People’s experience of using this service:
• The service reflected the principles and values of Registering the Right Support by promoting people’s choice and independence. People were encouraged to live as independently as possible.
• People were encouraged to access activities they enjoyed both in the home and through inclusion in the local community.
• Care records reflected the risks, needs and preferences for each person. Care plans described how staff should work with people to meet each person’s individual requirements. Daily notes described how staff were following care plans.
• Where people were subject to restrictions to ensure their safety, this was not always in line with the requirements of the Mental Capacity Act 2005. However, after the inspection, the registered manager provided evidence they had acted to address this.
• People were supported by staff who were recruited safely and underwent an induction to ensure they understood the principles of good care. Staff were expected to update training at regular intervals.
• People were supported by staff who were supervised and appraised to ensure they had opportunities to reflect on their work.
• People were protected from the risks of abuse by staff who were understood how to keep vulnerable people safe.
• People received their medicines from staff who had been trained to administer them safely.
• Where people did not have good verbal skills, they were supported by staff who understood how to communicate with them using appropriate methods.
• People were involved in choosing and preparing meals they liked and were encouraged to eat healthily.
• The home was clean and well maintained.
• People were encouraged to select the décor and furnishings for their bedrooms. People were also involved in decisions about the décor of communal areas.
• Families and friends were welcomed into the home and encouraged to visit people at times to suit them.
• People, their relatives and staff were involved in developing and improving the service.
• There was an experienced manager in post who had been registered with the Care Quality Commission for a number of years. They stayed up to date with best practice and guidance through involvement with external groups.
• There were systems in place to monitor the quality of the service. Where issues were identified, action was taken to address them.
Rating at last inspection: Good (The last report was published on 13 October 2016)
Why we inspected: This was a planned comprehensive inspection based on previous ratings
Follow up: Going forward we will continue to monitor this service and plan to inspect in line with our re-inspection schedule for those services rated Good.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Bracken Tor is a care home providing accommodation, care and support for a maximum of seven adults who have a learning disability. The service also provides care in people's own homes and those people know this service as Reach Out. At the time of the inspection there were six people living in Bracken Tor and three people receiving personal care through Reach Out.
The service is required to have a registered manager. 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. Bracken Tor had a registered manager.
People using Bracken Tor and Reach Out received a person centred service from staff who knew them well. Care was well planned, in consultation with people where possible. People’s views were sought on a daily basis at Bracken Tor, through weekly discussions about activities and menus and at house meetings.
Staffing arrangements were flexible and met the needs of people at Bracken Tor and Reach Out. People were protected through robust recruitment, which checked staff were suitable to work with people using the service. Staff received induction, training, supervision and support to ensure they were effective in providing the care people needed in a safe way. Staff said, “I love it here and we all get on with each other.”
Staff were considered to be kind, compassionate and caring. People’s privacy, dignity and respect were upheld. A health care professional said, “I have always found (the staff) to be compassionate and treat the individual with kindness, dignity and respect.” People’s health care needs were promoted through timely access to health care professionals and support from staff.
People were protected through a well maintained premises, staff knowledge about how to protect them from abuse and harm, and assessment and management of risk, such as swimming and using a kettle. Medicine management helped people get their medicines as they were prescribed.
People had a wide range of activities available to them, based on their choices and abilities. They were supported to spend time in the community as they wished. People were involved in choosing their menu options and enjoyed a weekly take away.
The Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they live in a care home and do not have capacity to make decisions, and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. People's consent to care and treatment was sought. Where they were unable to provide informed consent the principles of the MCA and DoLS were followed, so people's legal rights were upheld.
People said they would tell staff if they had any worries or complaints and staff knew how to respond to any issue raised. There had been no complaints about the service.
The manager was well known to people and considered by people using the service, staff and health care professionals to be an effective manager. The service was run with the needs of people using it at the heart of decision making. There were systems in place to monitor the service including getting feedback from people and auditing to ensure the service was safe.
People commented: 'I like living here'; 'The staff are nice'; 'Been shopping today': 'I am happy' and 'Activities are enabled to promote independence. Cinema, shopping and pub. Requests are always filled and I am kept informed.'
Staff demonstrated a good understanding of what kinds of things might constitute abuse, and knew where they should go to report any suspicions they may have.
At our previous inspection in April 2013 we found that appropriate arrangements were not in place to ensure sufficient numbers of suitably qualified, skilled and experienced support workers and this had led to inconsistency in the service provided. During our most recent this we saw that improvements had been made.
We spoke to people using the service and their families. Comments included: 'Always have the same carer'; 'Very good, flexible and accommodating service'; 'The staff are always on time, consistent service.' We observed that staff were well organised, motivated and competent in their roles. Staff provided support in a caring manner making sure that people were comfortable and content.
Bracken Tor is both a care home and an agency. The agency only provided personal care to three people. That care was mostly support to access activities in the community. We found that people had been given the opportunity to express their views about the support they wanted and were involved in making decisions about their care and support.
We were shown how the agency had tried to arrange what people wanted. This had included finding accommodation for activities that were not available in the local community, such as arts and crafts.
People we spoke with were still unhappy with some aspects of the service. They told us, 'Nothing seems to change' and 'It is all up in the air again'. We found that the agency was trying hard to recruit suitable support workers who would be able to provide the support which people had chosen. However many of the applicants were unsuitable and so the service was inconsistent and so people's wishes and choices were not always met as they wanted. There was an active recruitment campaign to try to provide the consistent support which people wanted.
We visited the home and met people. We then rang people receiving care at home.
One person told us, "I choose myself what I do" and we saw many examples of people leading their own lives with staff support. People's health care needs were well met. A district nurse praised the staff's response to a medical crisis. She said she had no concerns. People's care within Bracken Tor, but not those in their own home, was planned and delivered with their involvement.
Care workers were recruited in a safe way. They were receiving training, support and supervision. We saw laughter and banter and a good rapport between people living at Bracken Tor and care workers. There were many activities of interest, including digital bowling, the cinema, theatre, drama groups, swimming and pub visits.
There were plans to seek people's feedback about the service. People receiving personal care in their own homes told us that they were not happy with the service and did not feel properly informed. However, the new manager listed the changes which were already being arranged, which include the recruitment of a care coordinator specifically to oversee the domiciliary service provided.
The home was clean and hygienic.
During our visit we met four people who live at Bracken Tor and one who person who received a service in their own home. We found that communication with people at the home was limited due to their condition. However, we observed care workers providing care. We also spoke to three care workers and the manager. We were shown some records of people's care.
Following our visit we rang and spoke to the family of one person who received a service at the home and three who received a service in their own home.
People's family told us:
"The staff understand Xxx's communication and his moods. Activities have increased. His diet has also improved. We are incredibly happy. We're delighted with the new manager; so much enthusiasm and organisation. He has made so many changes which have lifted the atmosphere. One example is the sitting room, which was dismal but is now homely. Everybody looks happy."
"Can't fault it. The girls are fantastic. They do exactly as Xxxx wants to do and they ring me if there are any problems which gives me confidence."
"Excellent. Xxx is doing very well and looks forward to the visits. Would highly recommend them. If I had any concerns I would not hesitate to complain and I feel it would be properly dealt with."
"I would definitely have confidence that any concerns would be dealt with by the manager."
We saw that care workers understood and could meet the needs of the people who use the service. Staff were friendly and professional. They received training and support to do their work well. They knew how to safeguard people from abuse and reduce risk in people's day to day lives whilst promoting their independence and helping them lead interesting and valued lives. However, improvement at the home was still a work in progress, such as producing individualised care plans and risk assessments for people.