Bracken Lodge is residential care home providing support to up to ten people with learning disabilities and some people also had physical disabilities. Care is provided across two floors of an adapted house. At the time of our inspection there were eight people living at the home.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good but we found the service had improved since our last inspection and we have rated Bracken Lodge ‘Outstanding’ in the Caring domain.

Why the service is rated Good

Staff provided an exceptionally caring service to people. People lived in an inclusive and homely environment in which they were empowered and given ownership over their care. The provider had an attention to detail when it came to involving people and creating strong bonds between people, relatives and staff. Relatives and healthcare professionals emphasised how homely the environment was and the caring nature of staff. People were supported by kind staff who knew them well and routinely advocated for them. Staff were dedicated to the people that they supported and were passionate about finding ways to make people happy and improve their lives. Staff respected people’s privacy and dignity when providing care.

Staff managed risks to people safely whilst promoting their independence. Where incidents had occurred, the provider took appropriate action to keep people safe. Staff understood how to identify and respond to suspected abuse. People lived in an environment in which the risk of infection spreading was appropriately managed.

People were supported to prepare and eat food that they liked in line with their dietary needs. Staff had sufficient training to carry out their roles and had regular meetings with their line managers. 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 needs and choices were assessed and people were involved in important decisions and choices. Staff worked alongside healthcare professionals and other organisations to meet people’s needs.

People received personalised care that reflected their needs, interests and preferences. People had access to activities that reflected what was important to them. Regular reviews were undertaken and any changes to people’s needs were actioned by staff. The provider had a clear and accessible complaints procedure and

The registered manager worked alongside staff and was actively involved in people’s care. Systems were in place to involve people and staff in the running of the home. The provider carried out checks on the quality of the care that people received and maintained up to date records. The provider built links with organisations and agencies to ensure that people benefitted from.

Further information is in the detailed findings below

Bracken Lodge is a residential home which provides care and accommodation for up to ten adults with moderate learning difficulties, autism and display behaviours that may challenge others. The home is located in Caterham. On the day of our inspection ten people were living in the home.

The home had a registered manager, who was present on the day of the inspection visit. 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 and associated Regulations about how the service is run.

People were kept safe because staff had written information about risks to people and how to manage these. We found the registered manager considered additional risks to people in relation to community activities and changes had been reflected in people’s care plans.

Staff had received training in safeguarding adults and were able to evidence to us they knew the procedures to follow should they have any concerns. One staff member said they would report any concerns to the registered manager. They knew of types of abuse and where to find contact numbers for the local safeguarding team if they needed to raise concerns.

Care was provided to people by a sufficient number of staff who were appropriately trained. Staff were seen to support people to keep them safe. People did not have to wait to be assisted.

People received their medicines when they needed them. Processes were in place in relation to the correct storage and audit of people’s medicines. All of the medicines were administered and disposed of in a safe way.

Clear plans were in place to support people in an emergency. Staff were aware of the home’s contingency plan, if events occurred that stopped the service running. They explained actions that they would take in any event to keep people safe. The premises provided were safe to use for their intended purpose.

The Care Quality commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLs) which applies to care homes. The registered manager and staff explained their understanding of their responsibilities of the Mental Capacity Act (MCA) 2005 and DoLS and what they needed to do should someone lack capacity or need to be restricted.

People had enough to eat and drink. People were provided with homemade, freshly cooked meals each day and facilities were available for staff to make or offer people snacks at any time during the day or night. We were told by the registered manager that people could go out for lunch if they wished.

People were treated with kindness, compassion and respect. Staff took time to speak with the people who they supported. We observed positive interactions and it was evident people enjoyed talking to staff. People were able to see their friends and families as they wanted and there were no restrictions on when people could visit the home.

People took part in community activities on a daily basis; for example trips to the shops. The choice of activities was specific to each person and had been identified through the assessment process and the regular house meetings held.

People had an individual care plans, detailing the support they needed and how they wanted this to be provided. We read in the care plans that staff ensured people had access to healthcare professionals when they needed. For example, the doctor, learning disablement team or the optician.

The registered manager told us how they were involved in the day to day running of the home People felt the manager of the home was approachable.

People and relatives told us they would know how to make a complaint. Complaint procedures were up to date accessible to people. Confidential and procedural documents were stored safely.

The home had a satisfactory system of recording the auditing processes that were in place to regularly assess and monitor the quality of the service or manage risks to people in carrying out the regulated activity. The registered manager had assessed incidents and accidents, staff recruitment practices, care and support documentation, medicines and decided if any actions were required to make sure improvements to practice were being made.

People’s views were obtained by holding residents meetings and sending out an annual satisfaction surveys which was used to drive improvement in the service.

We Visited to follow up on 2 compliance actions from out last inspection and found the home was now compliant in both areas.

We found people’s rights were upheld as people's capacity to make decisions had been assessed under the Mental Capacity Act before people were subjected to decisions made for them and restrictions of liberty which were legally assessed as needed or in their best interests under the Act.

We also found people were protected against the risks associated with unsafe or unsuitable premises.

People spoke about activities they were involved in, such as going for walks, shopping, trips out and holidays they had planned.

People told us they had enjoyed their meal and the food was good at Braken Lodge, the staff offered them choices of food and they could have a snack or a drink at any time.

Four people who use the service told us the dining room was too hot and one person signed that they agreed it was too hot. One person said the heat was affecting their bad leg.

Staff told us the dining room was too hot.

People told us that no one upset them but they would make a complaint to the manager if they needed to.

We saw that people’s rights were not always upheld as people's capacity to make decisions had not been assessed under the Mental Capacity Act but people were subjected to decisions made for them and restrictions of liberty which were not legally assessed as needed or in their best interests.

People were supported to be able to eat and drink sufficient amounts to meet their needs.

We found that people were not always protected against the risks associated with unsafe or unsuitable premises. This was because staff were wedging fire doors open, leaving open electrical cupboards that were required to be locked, and not providing an adequate heating and ventilation system in the dining/activities conservatory room.

We found that comments and complaints that people made were responded to appropriately.

We found the home to be well maintained hygienic and clean.

People spoke about being able to choose what they wanted to do, and being able to discuss food choices with staff and if they didn’t like what was on the menu they could choose another option.

People told us that the staff were nice and treated them well, and they liked the home and their rooms.

One person told us they felt safe at the home and if they were worried about anything they would tell their key worker.

It was observed that some people who live at Bracken Lodge were not able to use traditional forms of communication. Some people used single words and some sentences, other people had their own style of communicating, for example, the use of body language, facial expressions or other forms of behaviour which staff clearly understood and respond to. We observed that people living there were generally content with the service they received. They were given time to express their needs, be involved in making some decisions and were supported by staff in a way that was mindful of their rights to respect, dignity and privacy. People using services that were spoken with were positive about the care and support they received at Bracken Lodge and said they liked living there and staff were kind to them. They said they felt safe and secure in the home. Observation showed that people who use services enjoyed home cooked food, were involved in grocery shopping and in menu planning and were supported to maintain contact with their family and friends.