Background to this inspection
Updated
17 November 2021
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was completed by one inspector and an Expert by Experience made telephone calls to people and relatives using the service to gain their feedback. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service provides care and support to people living in six ‘supported living’ settings, so that they can live as independently as possible. 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 service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave a short period notice of the inspection as we needed to be sure the provider or registered manager would be in the office to support the inspection. The service also needed to seek people’s consent to a home visit from an inspector.
Inspection activity started on 30 September 2021 and ended on 28 October 2021. We visited the office location on 19 October 2021.
What we did before inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.
During the inspection
We spoke with four people who used the service and 15 relatives about their experience of the care provided. We spoke with 13 members of staff including care workers, the nominated individual, head of regulated services, registered manager, quality and compliance manager, deputy manager, two service managers, a senior support worker and the administrator. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We observed staff interactions with people to help us understand the experience of people who could not talk with us. We sent email questionnaires to staff employed by the service and received three responses.
We reviewed a range of records. This included five people’s care records and two medication administration records. We looked at four staff files in relation to recruitment checks and supervision, including agency staff. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We received email correspondence with feedback from a professional who was involved with the service.
Updated
17 November 2021
About the service
Brill House Supporting living service is a supported living service providing personal care to 31 people. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.
People’s experience of using this service and what we found
Overall, people’s care and support was provided safely through risk assessment of people’s needs. Where we identified staff guidance was needed to monitor air-flow mattress specialist equipment ( to help prevent pressure ulcers) , the management team took immediate action to address this. The fire evacuation procedure at one setting was not frequently tested through fire drills to ensure it was effective. The registered manager took action to address this and sought advice from the fire service.
We have made a recommendation about the ongoing management of fire safety.
People who¿were known to experience emotional distress which could put themselves and others at risk had proactive plans in place to reduce the need for restrictive practices. Staff received input from specialists, however the provider did not arrange staff training for positive behaviour support. This is important to make sure all staff had the skills and knowledge to support people effectively. Staff received mandatory and other specific training to meet people’s needs.
We have made a recommendation about staff training for positive behaviour support.
Governance systems monitored the quality and safety of care provided, however, provider audits had not identified the areas we found in relation to safeguarding reporting, fire safety and risk assessments.
We have made a recommendation for the provider to ensure monitoring systems cover all areas of people’s needs and support.
People and relatives told us they felt the service was safe, for instance one relative said, “Yes [it’s safe] because [family member] gets exceptional care. I can’t fault it. The way they are encouraged to speak, take part in activities, to help themselves. It’s every aspect of their life staff help them participate in, and it’s a big marvellous place. I have absolute faith as the staff have been with [family member] for years.” The service had not always reported concerns to the safeguarding authority as required, although we found other appropriate action was taken to protect¿from abuse and poor care. The registered manager reported concerns retrospectively in response to our visit. The¿service had¿enough¿appropriately skilled¿staff to meet¿people’s¿needs and keep them safe. Medicines were managed safely and staff followed infection control and prevention guidance to reduce the risk of COVID-19 transmission.
¿¿
People received¿kind and compassionate care from staff who protected¿and respected¿their privacy and dignity and understood each person’s individual needs.¿People¿were¿supported to be independent and had control over their own lives and had¿their communication needs met. Staff used Makaton sign language to a high level of skill which empowered people to express themselves and be involved in decisions about their care.
People’s care, treatment and support plans,¿reflected¿their sensory, cognitive and functioning needs.¿ People received¿support that¿met their needs¿and aspirations.¿Support¿focused on¿people’s¿quality of life and¿followed¿best practice.¿Staff regularly evaluated¿the quality of¿support given, involving the person, their families and other professionals¿as appropriate.¿
People, relatives and professionals were positive about the standards of care provided by the service. We found the registered manager fostered an open culture and staff were committed to providing person-centred care.
We expect health and social care providers to guarantee autistic people 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 statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.
Right support:
• The model of care and setting maximised people’s choice, control and independence. People lived in a residential estate and had access to local amenities.
Right care:
• Staff understood their role¿in making sure that people were always put first. They provided¿care that was genuinely person centred.¿¿¿
Right culture:
• People lead¿confident, inclusive¿and empowered¿lives because¿of the¿ethos, values,¿attitudes and behaviours¿of the management and staff.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
This service was registered with us on 2 May 2019 and this is the first inspection.
Why we inspected
This was a planned inspection for newly registered services.
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.