The Brambles is a residential care home for four people with learning disabilities. There were three people living in the home at the time of the inspection. The home is on one level and each person was provided with their own bedroom. There was a communal living room and kitchen and a large dining area that was at the centre of the home.

At our last inspection in February 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this unannounced inspection on 27 February 2018 we found the service remained Good.

The registered provider also manages the service which means there is no requirement to have a separate registered manager.

The service was not always safe because potential risks to people had been recognised but information on how to minimise risks had not always been recorded. However the staff were aware of how to reduce risks to people. Staff understood their roles and responsibilities in relation to keeping people safe from harm and abuse. Medicines were managed safely. There were enough staff on duty to meet people’s support needs.

The service was effective because people’s needs were met by staff who were trained and supported to do their job well. 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 were helped to eat and drink enough. People’s health and wellbeing was maintained and provided through a range of health and social care professionals who visited the home.

The service was caring because staff treated people with kindness, compassion, dignity and respect. People had choices in all aspects of their daily lives and the staff created a homely atmosphere.

The service was responsive because staff knew people’s care and support needs and helped them to make the lifestyle choices they wanted. People and their relatives were involved in their personalised care plans. These gave staff the information they needed to provide the care and support each person needed. People were encouraged to take part in a range of activities that they enjoyed.

The service was well led because there was a registered provider in post who was approachable and provided good leadership. Quality assurance systems were in place to check that the service provided quality care and made improvements where necessary. People, their relatives and staff were encouraged to share their views about the service being provided.

Further information is in the detailed findings below.

The Brambles is registered to provide accommodation and personal care for up to four people. At the time of this inspection there were four people living in the home who had a learning disability. Each person had their own bedroom in the bungalow. There was a communal kitchen, dining room and lounge for people and their visitors to use.

We carried out an announced inspection of this service on 4 February 2016. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were not always being followed. The provider sent us an action plan that stated that the required improvements would be completed by June 2016. We undertook this focused inspection on the 20 September 2016 to check they had followed their plan and to confirm that they now meet legal requirements. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Brambles on our website at www.cqc.org.uk”

The registered provider also manages the service which means there is no requirement to have a separate registered manager.

The CQC is required by law to monitor the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards and to report on what we find. The provider was acting in accordance with the requirements of the MCA including the DoLS. The provider could demonstrate how they supported people to make decisions about their care and the principles of the MCA were being followed.

The Brambles is registered to provide accommodation and non-nursing care for up to four people. At the time of this inspection there were four people living in the home who had a learning disability. Each person had their own bedroom in the bungalow. There was a communal kitchen, dining room and lounge for people and their visitors to use.

This unannounced inspection took place on 4 February 2016.

The registered provider also manages the service which means there is no requirement to have a separate registered manager.

The Care Quality Commission (CQC) is required by law to monitor the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The provider was not acting in accordance with the requirements of the MCA including the DoLS. The provider could demonstrate how they supported people to make decisions about their care but not how the requirements of the MCA were being followed. Where people were unable to do so, there were no records showing that decisions were being taken in their best interests. This also meant that people were potentially being deprived of their liberty without the protection of the law.

Staff knew what actions to take if they thought that anyone had been harmed in any way.

Staff confirmed and we saw that there were enough staff available to meet people’s needs. The recruitment process was followed to ensure that people were only employed after satisfactory checks had been carried out. Staff received the training they required to meet people’s needs and confirmed that they felt supported in their roles.

Staff were kind and compassionate when working with people. They knew people well and were aware of their history, preferences, likes and dislikes. People’s privacy and dignity were upheld.

Staff monitored people’s health and welfare needs and acted on issues identified. People had been referred to healthcare professionals when needed. People were supported by staff when they were admitted to hospital. People received their medication as prescribed. Medication was stored securely.

People were provided with a choice of food and drink that they enjoyed. Staff supported people to maintain their interests and their links with the local community to promote social inclusion.

Care plans and risk assessments gave staff the information they required to meet people’s care and support needs.

There was a complaints procedure in place and people’s relatives felt confident to raise any concerns either with the staff or the registered provider.

The registered provider obtained the views from the relatives of people living in the home and staff about the quality of the service and took action when improvements were identified.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we told the provider to take at the back of the full version of the report.

We considered our inspections findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? This is a summary of what we found-

Is the service caring?

Observation made during our inspection showed that people received consistent and respectful support from care staff and they were enabled to make choices and changes when required. Staff told us that they were well supported and supervised so that they could provide safe care and support to people.

Is the service responsive?

We saw that people’s personal care and social support needs were assessed and met. This also included people’s individual choices and preferences as to how they liked to be supported. We observed that people could make changes to their support and had been involved in reviews of their support. We saw that reviews were in place to update people’s care and support needs.

Is the service safe?

Risk assessments regarding people’s individual activities were carried out and measures were in place to minimise potential dangers. Carers understood their roles and responsibilities in making sure people were protected from the risk of abuse. The provider ensured that all staff were kept up to date with safeguarding training and accompanying reporting procedures. The premises were well maintained and met the needs of people living in the home.

Is the service effective?

We found that carers were knowledgeable about people’s individual care and support needs. Observations we made during our inspection confirmed that the care staff provided consistent support when assisting people with personal care and to make choices regarding how they wished to spend time during the day either at home, or when accessing facilities in the wider community.

Is the service well led?

The home was effectively managed and staff told us that they felt well supported and were regularly trained to safely provide care and support. Observations made during our inspection showed that staff were responsive and attentive so that people were supported consistently and safely. Health and safety checks were in place to monitor services provided. Surveys were carried out to gather opinions from people using the service, relatives and staff to identify any improvements that could be made to the service.

We found that staff knew the people who used the service well and treated them as individuals and cared for them in a way that promoted their independence and dignity. Although the people who used the service were not able to give us their views, we observed the way that staff supported them and the interaction between them and the staff was very positive.

We found that not all staff were aware of what procedure they should follow if they suspected someone had been abused. However the manager stated that he would take action immediately to improve staff’s knowledge.

Procedures were in place and being followed by staff to ensure that people got the right medication at the right time. Recruitment policies were being followed to ensure that the right people were employed to work with the people who used the service.

We talked to two people who had family members living at the home. Both were very complimentary about the service. One person told us, "My son lacks for nothing, they ensure he gets everything he needs and is well taken care of". Another other person told us, "The staff are lovely, I visit my relative every week and they always make me feel welcome and involve me in any major decisions."

During this review of compliance we did not ask any of the people who use the service for their views about how the service manages their records. However, during our previous visit to the service on 27 April 2011, none of the people who use the service were able to tell us their views about this, due to their complex communication difficulties.

We visited The Brambles on the 06 June and met with some of the people who lived there, a member of staff and the manager. On the 20 June we talked to two relatives of people who lived at the home.

We found that staff knew people very well and supported them to make choices about what they did and how they received care and support. The homes aimed to promote a culture that recognised people as people first, encouraging and enabling choice. One relative of a person living at The Brambles told us, "The home couldn't be better". Another relative told us "It's wonderful....It's just like one big happy family and even I feel part of that family".

We found that staff had received regular training and were aware of what they should do if they suspected anyone had suffered any type of abuse.

The manager had completed a detailed quality assurance assessment to ensure that they were offering a quality service and any necessary improvements had been made.