Archived: Brimley

Updated 26 September 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 14 and 16 August 2017 and was unannounced. The inspection was carried out by one Adult Social Care inspector on the first day, who was accompanied by an expert by experience on the second day. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert-by-experience had experience of working with older people, working with people with a learning disability and autism, as well as people living with dementia.

Prior to the inspection we reviewed information we held on our systems. This included reviewing whether any statutory notifications had been submitted to us. A notification is information about important events which the service is required to tell us about by law. The provider had completed a Provider Information Return (PIR) in June 2017. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

We spoke to three staff working at the home on the days of inspection, one of whom had been recently appointed to take on the role of manager. We also met and spoke with an area manager who had been involved in running the home in recent months.

At the time of this inspection, six people were living at Brimley. We met all the people living in the home and spoke with four of them about their experiences. We also spent time observing people who were unable to communicate verbally with us. After the inspection we contacted relatives of the people living at Brimley to ask about their views of the service. We received three responses.

We looked at a sample of records relating to the running of the home and to the care of people. We reviewed three care records, including risk assessments, care plans and the medicine administration records for everyone living at Brimley. We reviewed three staff records. We were also shown policies and procedures and quality monitoring audits which related to the running of the service.

Prior to the inspection we had received positive feedback about the service from a visiting health professional. After the inspection we contacted five health and social care professionals. We received one response. We also contacted the GPs and community nurses at two local GP surgeries but did not receive a response.

Updated 26 September 2017

This comprehensive inspection took place on 14 and 16 August 2017 and was unannounced on the first day.

Brimley provides accommodation and personal care for up to six adults who require personal care. The service specialises in providing care for both younger and older adults with a learning disability and/or autism. The home is a large bungalow in a quiet cul-de-sac in a residential area of the seaside town Exmouth in Devon.

The registered manager had left the service in April 2017 and was in the process of de-registering as the 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. After the inspection, the de-registration process of the registered manager was completed.

An area manager in the provider organisation had been overseeing the home and spent several days each week working at Brimley. A recent appointment to the role of manager had been made and this person was in the process of applying for registration as the manager.

The provider organisation Robert Owen Communities has been taken over by another provider, United Response. Senior staff had been in contact with the CQC to arrange to register the service with the new provider.

The service was previously inspected in May 2016 when the service was rated as requiring improvement. At that inspection we found four breaches of regulations and improvements were required as the service was not fully safe, effective, responsive or well-led. The home was the subject of a whole home multiagency safeguarding investigation at the time of our 2016 inspection. These concerns related to staffing, safe care and treatment and records not demonstrating that people’s care and welfare needs were always being met. The local authority, who lead on safeguarding, had monitored the improvements made to the service. They had subsequently closed the safeguarding investigation as they were satisfied with the improvements made.

At this inspection, we found the service had made and sustained improvements and was now meeting all the regulations.

There was a governance system which ensured that the quality and safety of the home was monitored. Where improvements were required, there was a service improvement plan which was updated regularly with actions that had been completed and new actions identified. Checks and audits of the service were routinely carried including audits of medicine administration, fire safety, building maintenance and care records. Senior staff from the provider organisation undertook quality assurance visits on a regular basis.

People were clearly happy and relaxed in the home. Throughout the inspection, we observed people laughing and showing affection towards staff. Comments included “They are very nice, [Manager] is ever so lovely” and “I like it here."

People were encouraged to do activities both outside and in the home. This included going to weekly clubs where people got involved in arts and crafts as well as going out for coffee and lunch. Staff helped people celebrate special occasions by going out to somewhere of the person’s choice. For example, one person who was celebrating their birthday chose to go to the pub with everyone from the home. People were also supported to be involved in day to day living skills such as cooking, shopping, cleaning and personal hygiene.

Staff understood the need to support people to remain as independent as possible. Staff were able to communicate with people using a range of methods both verbal and non-verbal. Some people were able to go out unaccompanied by staff. Care plans showed that this had been risk assessed and systems had been put in place to enable them to contact the home if needed. The service worked within the requirements of the Mental Capacity Act 2005. Where people lacked capacity, best interest meetings had been held and Deprivation of Liberty authorisations had been applied for.

The home was well maintained, clean and comfortable. Some areas had been redecorated and refurbished to support people with specific needs. People’s bedrooms were furnished and decorated in colours chosen by the person. Regular maintenance and safety checks were carried out to ensure the home, its furnishings and equipment were safe and fit for purpose. Staff used followed infection control procedures; this included using personal protective equipment when supporting people with personal care to ensure that the risk of infection was minimised. There were emergency plans for staff to follow in the event of an incident such as a fire.

Staff were recruited safely and received an induction when they first started working at the home. People were supported by sufficient staff who knew them well. Senior staff were working with the local authority to review each person’s needs as they changed. Staff had received training and supervision and were able to describe how they worked with people to meet their needs.

Staff understood their responsibilities to keep people safe and were able to describe what actions they would take if they had a concern. This included reporting the concern to senior staff. Where concerns had been raised, senior staff had reported them to the local authority. Appropriate actions had been taken to reduce the risk of recurrence.

Staff administered medicines to people following national guidelines. Medicines were stored safely and audits were regularly undertaken to ensure that stocks of medicines and medicine records were accurate. Records showed that the person’s GP had been involved in decisions about administration of non-prescription medicines, such as homely remedies.

Risk assessments and care needs were fully described in people’s care plans. Care records were updated regularly and whenever people’s risks or needs changed. Where necessary, staff had contacted health professionals for support and advice. Observations and records showed that this advice was followed. For example, some people were at risk of choking so speech and language therapists had provided guidance for staff to follow at mealtimes.

People were supported to have a varied diet with food of their choice. Individual dietary needs were catered for and people’s fluid intake was also monitored to ensure they remained well hydrated. People said they liked the food; one person commented “Good food, plenty.”

People said they knew how to complain but had not felt the need to make a formal complaint. One complaint had been received by the service since our last inspection. This had been investigated and resolved.

Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work at there.