Bricket Wood Care Limited Also known as Uplands

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; although the policies and systems in the service did not wholly support this practice.

Right Support

Staff were aware of people's strengths and what they could do and supported people to make their own choices about their care and support needs. People were being supported by staff to be actively involved and engaged in cooking and completing their own household tasks. People valued these opportunities and they helped to maximise people's independence.

The service had worked hard since the last inspection and improved staff knowledge had supported positive improvement. Staff learned from incidents and how they might be avoided or reduced, although this was not embedded within the day to day management of the service. Staff followed safe practices when wearing personal protective equipment (PPE). Improvements had been made to the environment people lived in to ensure it was clean, supported their needs, was well maintained and appropriate equipment was in place.

Right Care

People experienced an improved quality of care. People and their families told us staff were kind and supported them well. Staff understood how to protect people from poor care and abuse, they had received training on how to recognise and report abuse, and were able to tell us when they would report any concerns. We observed staff interacting with people in a kind and compassionate way and in a way that promoted people’s independence. Staff and people worked together and were continuing to develop positive risk assessing to encourage more positive risk taking and independence.

Right culture

People did not always have risk assessments fully completed to support their support needs. Staff were knowledgeable about the risks to people and were able to mitigate those risks, For example, people at risk of harm People were supported by staff who continued to undergo training to deliver best practice in relation to supporting people with a learning disability. Although further training was required to ensure staff had all the right skills.

The service had a recent change in management which had been positive in bringing about the improvements in the service. People and staff were very positive about the manager. Work had been undertaken to improve the providers quality assurance system, but actions were not always documented, and some audits were not in place. This did not have an impact on people's care. People's opportunity to lead inclusive and empowered lives had improved since the last inspection. This is because staff knowledge and understanding had improved, and management led the development of an open and transparent culture. Managers understood that further work was needed.

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

Rating at last inspection and update

The last rating for this service was inadequate. Report published: 22 June 2022

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection provider was no longer in breach of regulation.

This service has been in Special Measures since 16 May 2022. 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 inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has improved to requires improvement.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Bricket Wood Care Limited on our website at www.cqc.org.uk.

Follow up

We will work alongside the provider and local authority to monitor progress and will continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

Bricket Wood Care Limited is a residential care home which was providing personal care to four people at the time of the inspection. The service can support up to six people.

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

Right Support

Staff were aware of people’s strengths and what they could do, however they did not always ensure this was promoted. Due to staffing restrictions there were times where people could not have a fulfilling and meaningful everyday life.

The service was focusing on improvements to the environment people lived in to ensure it was clean, well maintained and appropriate equipment was in place. People were able to personalise their rooms.

Staff did not adhere to safe practices when wearing personal protective equipment (PPE). This meant that staff were at risk of spreading infection.

Staff supported people to play an active role in maintaining their own health and wellbeing.

Right Care

People were not always supported by a service that had systems in place to report and respond to accidents and incidents. Staff did not always understand how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse, however staff knowledge and actions did not show they understood this.

There was fluctuation of staffing within the service. Although this was actioned and improved during the inspection, people and staff shared there were times where they were short staffed, and this affected people’s care.

We observed staff interacting with people in a kind and compassionate way. Staff protected and respected people’s privacy.

Right culture

People did not always have risk assessments in place, to identify risks people faced and how staff should manage these. Staff were not always knowledgeable about the content of these risk assessments. When risks to people were identified actions to mitigate the risks were not always resolved in a timely manner which put people at risk of harm.

People were not always supported by the provider to ensure all staff had the correct employment records present upon commencing employment.

People were supported by staff who understood best practice in relation to supporting people with a learning disability, however there were areas of improvement needed in relation to training and ensuring staff had the right skills.

The service had a recent change in management. Staff acknowledged this had helped improve the service and the support they received.

People’s quality of support was not always enhanced by the providers quality assurance system the provider had in place. Actions were not always documented, and it was unclear if actions were completed. This had an impact on people’s care.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 25 February 2021).

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 the provider remained in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service. We undertook this inspection to assess that the service was applying the principles of Right support, right care, right culture.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the safe employment of people, mitigating risks, people receiving care that is person centred and overall governance and culture of the service at this inspection.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Bricket Wood Care Limited also known as Uplands is a residential care home providing personal and nursing care to five people at the time of the inspection. The service can support up to six people.

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

Staff had not received training when they started working at the service and they were inducted in their role by working with the registered manager or more experienced staff. This meant that there was a risk that staff were not delivering care and support for people safely and in line with current best practice. The recently employed manager arranged for staff to receive training.

Not all staff were knowledgeable about how to report their concerns to local safeguarding authorities or best practice guidance relevant to their roles. They told us they would report or ask support from their managers if they needed.

At the time of the inspection, staff’s recruitment files had little evidence that all pre-employment checks were carried out. Following our visit, the newly employed manager carried out an audit and found that not all employees had two references on their file, an application form or if some staff’s eligibility to work was checked.

People’s care plans lacked personalization and risk assessments were not always in place for known risk like fire or Covid-19.

On the day of our visit we observed the registered manager signing the medicine administration record for people in the office after they administered the medication. This was not in line with current best practice and increased the risk of errors happening.

There were no quality assurance audits or systems used by the registered manager to ensure they were able to effectively assess the quality and safety of the service provided. The recently employed manager carried out a range of audits we requested to ensure they could prioritize actions needed to improve the service. They developed a service improvement plan to ensure a systematic and planned approach to improve people’s experience of the care they received.

People told us they felt safe in the home. They told us current lockdown measures meant they spent more time in the home and at times they found this difficult.

We expect health and social care providers to guarantee people with autism and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or people with autism.

The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. Staff used labelling language for people who may have had behaviours that challenged others. Positive behaviour support plans were not developed, and staff could not tell us if the methods they used to manage people’s behaviours was in line with best practice guidance. People were not supported to set and achieve goals.

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 good (published 26 July 2018).

Why we inspected

The inspection was prompted in part due to concerns received about lack of training for staff and employment procedures not being robust. A decision was made for us to inspect and examine those risks.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Uplands is registered to provide accommodation and support for up to five people with learning disabilities and or a mental health condition. At the time of our inspection three people were living at the service. The care service 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.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People felt safe using the service. Staff and the management team demonstrated a good understanding of the different types of abuse that could occur and their role in protecting people from abuse. There were enough staff available to meet people’s needs safely. Pre-employment checks were completed as part of the recruitment process.

People and their relatives told us that the care and support provided was appropriate to meet people's needs. Staff received training to help them to provide people’s care and support. Staff sought people's consent to care. People were supported to access various healthcare professionals when required.

People and their relatives told us that the staff were very good and supported people in all aspects of their lives. This helped to develop people’s confidence and improve people’s experiences. People were involved in making decisions about their own care, and felt their views were listened to, and respected. People felt that they were treated with dignity and respect.

People told us they had been involved in developing their care plans and felt that their opinions were valued and taken into account. People told us they felt the registered manager took them seriously and if they needed to change anything about their care they spoke to their keyworker or the registered manager.

The provider had policies and procedures in place to help ensure that any concerns and complaints raised by people who used the service or their relatives were appropriately investigated and resolved.

People and their relatives felt that the registered manager was always approachable with any problems. The registered manager demonstrated a good knowledge of the people who used the service and the staff they employed. The registered manager was in the process of completing an annual survey as part of the provider’s quality assurance system. Other quality assurance measures were in place which included completion of audits. These were being introduced as the service developed.