Bradley Apartments provides accommodation, nursing and personal care to a maximum of 14 younger adults with a learning disability, some of whom may also have needs associated with their mental health and autism.

The service is purpose built and comprises of a range of two, three and four bedded apartments with kitchens and living areas on the first floor, there is an activity room and lounge area on the ground floor. The service is located on the same site as Bradley Woodlands Hospital on the outskirts of Bradley, which is on the south western edge of Grimsby. Bradley Apartments has an allocated garden area in the grounds.

We undertook this comprehensive inspection on the 19 and 20 January 2017 and there were seven people using the service.

At the last inspection on 4, 10 and 12 February 2016 we found the registered provider was in breach of two of the regulations we assessed. We issued requirement notices as there were shortfalls in providing sufficient numbers of staff and shortfalls in the staff supervision and appraisal programmes. We also found assessments of people’s mental capacity and records of best interest decisions were not in place to demonstrate staff were acting lawfully in relation to aspects of people’s care and treatment.

During this comprehensive inspection we found improvements had been made in two domains and have changed the rating for the domains ‘Safe’ and ‘Effective’ to 'Good'. We have kept the rating for ‘Caring’ and ‘Responsive’ as 'Good'. We identified a new shortfall in the ‘Well-led’ domain and have kept this rating at ‘Requires Improvement’. The overall rating for the service has improved and changed to ‘Good’.

The service had a registered manager in post. 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 CQC had not received a notification for a safeguarding incident as required by registration regulations and there were also delays in receiving the notifications for three other incidents. The registered manager confirmed this had been an error and they would notify us of any future safeguarding incidents as they occurred. We have written to the registered provider and registered manager to remind them of their responsibilities in this area.

We found the registered manager and staff better understood their responsibilities under the Mental Capacity Act 2005. They were aware of the need to gain consent when delivering care and support, and what to do if people lacked capacity to agree to it. People’s abilities to make decisions had been assessed and appropriate support had been provided to ensure that their views were taken into account when making decisions, where possible. Relatives and other professionals had been involved when important decisions about care had to be made including the use of any physical interventions.

Staffing levels had been better maintained through positive recruitment programmes and improved management of staff sickness. There had been and continued to be a reliance on qualified agency staff until full recruitment was in place. Improvements had been made to ensure staff were provided with regular support, supervision and an appraisal of their performance. This helped them to be confident when supporting people who used the service.

We found staff were recruited in a safe way and all checks were in place before they started work. The staff had received an induction and essential training at the beginning of their employment and we saw this had been followed by periodic refresher training to update their knowledge and skills. Staff had received more specialist training to support people’s individual needs, in areas such as communication and autism.

There were policies

Bradley Apartments provides accommodation, nursing and personal care to a maximum of 14 younger adults with a learning disability, some of whom may also have needs associated with their mental health and autism.

The service is purpose built and comprises of a range of two, three and four bedded apartments with kitchens and living areas on the first floor, there is an activity room and lounge area on the ground floor. The service is located on the same site as Bradley Woodlands Hospital on the outskirts of Bradley, which is on the south western edge of Grimsby. Bradley Apartments has an allocated garden area in the grounds. Both services are part of the same organisation.

On the day of the inspection there were eight people using the service. Another person was visiting the service for day-care support. People have varied communication needs and abilities.

The service has a registered 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.

When Bradley Apartments opened in 2014 a ‘clinical lead’ was appointed and given delegated day-to-day management responsibilities for the service and they reported to the registered manager. In October 2015 the clinical lead took the decision to resign their position and the deputy manager from the adjoining hospital site took over the day-to-day management of the service. A decision was made by the organisation to recruit a new manager for Bradley Apartments who would apply for registration with CQC; they considered the service would benefit from having their own registered manager who could focus on developing the service and establishing a clearer identity from the adjoining hospital service. The new service manager was appointed and commenced work at the service on 11 January 2016.

We found the registered provider had not always met the requirements of the Mental Capacity Act 2005. People’s consent was not always sought about the care and support they needed. Staff were using physical interventions with one person to manage their behaviours that challenged the service and we found there was no capacity assessment record and best interest decision records in place to support this approach. We also found the management team had made changes to the occupancy arrangements in some apartments without consulting the people who this affected, their relatives or relevant care professionals.

There were times when there were not always enough staff deployed to meet the needs of people. High staff turnover and staff sickness levels contributed to the staffing shortfalls and maintaining the continuity of care. Staff had not received all the support, formal supervision and appraisal they required over the last 12 months.

This meant the registered provider was not meeting the requirements of the law regarding consent and staffing. You can see what action we told the registered provider to take at the back of the full version of the report.

We found staff were recruited in a safe way; all checks were in place before they started work. The staff had received an induction and essential training at the beginning of their employment and we saw this had been followed by some periodic refresher training to update their knowledge and skills. We found shortfalls in training to meet the needs of individuals such as: epilepsy management, specific communication techniques and understanding autism, but saw that arrangements to address this shortfall had been planned.

There were policies and procedures in place to guide staff and training for them in how to keep people safe from the risk of harm and abuse. In discussions, staff were clear about how they protected people from the risk of abuse.

Assessments of p

We undertook this unannounced inspection on the 28 January and 2 February 2015. This was the first inspection of this service; it opened on 29 May 2014.

Bradley Apartments provides nursing and personal care to a maximum of 14 younger adults with a learning disability, some of whom may also have needs associated with their mental health and this may include needs that could not be met within a care home setting.

On the day of the inspection there were four people using the service. Another person was visiting the service as part of their structured assessment and transition programme to support their admission.

The service comprises of several small apartments with kitchens and living areas on the first floor, there is an activity room and lounge area on the ground floor. The service is located on the same site as Bradley Woodlands Hospital. Bradley Apartments has an allocated garden area in the grounds.

The service has a registered 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.

Although we found some people had detailed and personalised care plans in place, the standard of recording was inconsistent and we found some people’s needs had not been fully assessed and planned. This meant there was a risk they may not receive all the support they needed and in the way they preferred.

We found there were a range of safety systems and checks in place on the premises and equipment. However, we identified some concerns in relation to the management of the water systems and fire safety systems, which meant there was a risk people’s health and safety may not be properly protected. These issues meant the registered provider was not meeting the requirements of the law regarding the safe operation of the premises and assessing and planning care for people. You can see what action we told the registered provider to take at the back of the full version of the report.

People we spoke with, and their relatives, told us they were able to raise any issues or concerns. They said action would be taken by the staff and registered provider to address them. Comments from people who used the service included, “I would talk to the staff if I had a complaint” and “The nurses sort things out, I speak to them when I’m upset about things.”

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA), Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection three people who used the service had their freedom restricted. Records we checked demonstrated the registered provider had acted in accordance with the MCA.

A thorough recruitment and selection process was in place, which ensured staff employed were suitable to work with people who used the service. Staff told us, and rotas showed, there was consistently enough staff on duty to keep people safe. Staff generally had access to training relevant to their roles; further training courses were arranged following the inspection.

Staff had developed positive relationships with people and treated them with respect and kindness.

People were involved in determining the kind of support they needed. Staff offered people choices, for example, how they spent their day and what they wanted to eat; these choices were respected. People were observed carrying on with their usual routines, going to community day services, shopping and accessing places of interest in the community.

People who used the service and their relatives told us the service was a safe place to live. Staff understood the various types of abuse that could occur and knew who to report any concerns to. There were appropriate arrangements in place to ensure people’s medicines were obtained, stored and administered safely.

There was a programme in place to monitor the quality of the service provided to people. We found some areas of this could be improved to make sure any shortfalls in care or services were picked up quickly and addressed. The registered manager’s presence at the service and their management oversight would benefit from review to ensure the clinical lead was properly supported and understood the responsibilities of their role.