5-6 Prior's Court Cottages: Bradbury House

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 ongoing 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.

People continued to be cared for in a safe environment where potential risks were identified and action taken to reduce them as far as possible. Action was also taken to minimise any risks presented by the environment or equipment. Regular servicing and safety checks were carried out. Staffing levels were assessed based on the needs of the people supported.

People were safeguarded from abuse and staff knew how to respond to any concerns they might have. Staff and relatives were confident the service would respond appropriately to any concerns. People were supported to receive the correct medicines at the right dosage and times and their preferences on how to take them were acted upon.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. People’s rights, privacy and dignity were supported in the way staff worked with them.

Staff received an effective induction and completed appropriate core training upon which their competency was assessed. A planned cycle of regular training updates was provided. Staff received ongoing support through individual supervision and development appraisals. Regular staff meetings helped ensure the effective exchange of important information.

A robust procedure was used as part of a values-based recruitment system to try and ensure staff had the right approach and skills to care for people effectively. Ongoing difficulties with recruitment led to use of a number of agency staff which had some impact on continuity and consistency of care. The service mitigated this through using familiar agency staff who knew the needs of the people they were supporting.

People received effective support with their healthcare needs and were supported to have a varied and healthy diet. Day to day support was provided responsively based on individual needs. Permanent staff were knowledgeable about people’s needs and were more proactive in helping them manage situations which may cause them stress.

The service had an appropriate complaints procedure. Where concerns had been raised they had been addressed. Relatives felt listened to and had confidence the service would resolve any issues brought up.

The service was well-managed. The provider and registered manager had effective systems in place to monitor its effectiveness and identify issues for improvement. Action plans showed that identified issues were addressed. Work was ongoing towards a new quality assurance framework and identifying ways to obtain more systematic feedback from people about their experiences of their care.

Further information is in the detailed findings below.

The provider offers on-site educational and vocational services via the learning centre, attended daily by the young adults, based on individual assessments and needs. Some people also attend off-site supported work placements.

The service has 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.

The service provides safe and effective care to people on the autistic spectrum. People’s support needs around their behaviours were well managed and regularly reviewed. People retained appropriate control over their day to day lives and were encouraged to make day to day decisions and choices.

Parents were very happy with how the service met people’s needs and were appropriately involved in decision-making about people’s care. They felt their views were sought, listened to and acted upon.

People’s legal rights and freedom were protected by the staff. Their health, dietary and emotional wellbeing were well supported. Care plans and related records were detailed, individualised and regularly reviewed.

A robust recruitment process helped ensure that staff had the necessary skills to meet people’s support needs.

Staff received appropriate training which was updated on a rolling programme. They received ongoing support and supervision and felt their views about people’s needs and the service itself were listened to.

The service was well led and effectively monitored by management and sought to constantly develop and improve.

As part of this inspection we spoke with the parents of each of the six people who use the service, the manager and five staff. We also reviewed records relating to the management of the service which included care plans, risk assessments and other records.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us and the records we looked at.

Is the service safe?

People received care and support in accordance with agreed care and approved behaviour management plans which were regularly reviewed. Appropriate professionals were involved in reviews as well as family representatives. Incidents were monitored and analysed by the psychology team who revised behaviour management plans in the light of these.

People's healthcare needs were monitored by staff and the in-house nurse team. The service had sought the advice of external healthcare specialists where necessary to maintain their wellbeing and safety.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the home had liaised effectively with the local authority DoLS team and were making applications as appropriate.

The parents we spoke with told us the service was safe and well run.

Is the service effective?

People's needs were met by a knowledgeable and well-trained staff team. The people supported and their families enjoyed positive relationships with the staff. The parents we spoke with told us the home met people's needs effectively and provided them with a fulfilling lifestyle. Parents felt the staff supported family contact very well. One parent said the staff were: 'sensitive to the parent's role when supporting outings.'

The parents told us that the home was effective in meeting people's needs and praised the way the transition to the service had been handled. One described the transition as: 'fantastic' and another told us they were: 'hugely impressed with the transition.' Others felt staff had done everything to make the change as smooth as possible.

Is the service caring?

We saw examples of staff working in a caring and respectful way while supporting people. Staff understood people's individual communication well and responded proactively when someone was unhappy.

Parents felt the service was very caring. Staff were described as: 'excellent', 'sensitive', 'very flexible' and 'very good.' Parents were happy that they were kept informed about any incidents or changes in wellbeing. One parent told us: 'they have X's best interests at heart.'

Is the service responsive?

We saw that people's care plans and other documents recorded people's needs and where these had changed. Care files showed that the home responded promptly to any changes and sought appropriate specialist advice where necessary. Incidents and physical interventions were monitored and analysed and new behaviour support strategies were tried when existing ones were not working.

Care was provided based on people's known and indicated wishes and preferences. People had chosen the colour and decor within their bedroom and flat. People had access to meaningful activities, events in the community and opportunities to develop skills and broaden their experiences.

Parents felt they were involved and consulted and that the service responded to people's needs. One said: 'they respond to my comments.' and another told us: 'they involve me well.'

Is the service well-led?

The set-up of the service was planned carefully and people's transitions were discussed and appropriately phased. Consistent and effective management meant that staff have been supported to work effectively with the young people.

There were clear lines of managerial responsibility. A range of monitoring systems were used by the management team to maintain an effective overview of the home's operation. Action had been taken to address issues where these were identified. The views of people's relatives were sought both formally and informally and acted upon.

The trustees also monitored the operation of the service and management provide regular reports to them.