We carried out this unannounced inspection on 20 and 21 September 2017.

The Brambles is registered to provide accommodation and personal care for six people who have a learning disability and/or a sensory disability. At the time of our inspection visit there were six people living in the home.

There was 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.

At our previous inspection we found this service to be Good. At this inspection we also found the overall quality rating for the service was Good.

People and their relatives told us that they felt safe and well cared for. Staff knew how to keep people safe from the risk of abuse. Accidents and incidents were recorded and investigated. Medicines were safely managed, however m medicine administration records were not always completed according to the provider’s medicine policy.

There were sufficient staff to meet people’s needs and staff responded in a timely and appropriate manner to people. Staff were kind and sensitive to people. Background checks had been completed before new care staff had been appointed.

Staff had received training and support and they knew how to care for people in the right way. Staff were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs. The provider had a training plan in place and staff had received supervision. This included knowing how to communicate with people who did not use verbal communication.

People enjoyed their meals and had choices about what they wanted to eat. People had access to drinks and snacks during the day. Where people had special dietary requirements we saw that these were provided for. People had access to healthcare and were supported to access these.

People were supported to make choices and be involved in decisions about their lives. Care staff supported them in the least restrictive way possible. The provider acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People who lack mental capacity to consent to arrangements for necessary care or treatment can only be deprived of their liberty when this is in their best interests and legally authorised under the MCA. The procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).

People were treated with compassion and respect. Care staff recognised people’s right to privacy and promoted their dignity. There were arrangements to help people access independent lay advocates if necessary and confidential information was kept private.

People were supported to pursue their hobbies and interests. They were supported to maintain relationships that were important to them. There were arrangements in place for dealing with complaints. People were supported to make complaints.

People had been consulted about the development of their home and quality checks had been completed. Good team work was promoted and care staff were supported to speak out if they had any concerns.

The provider had informed us of notifications. Notifications are events which have happened in the service that the provider is required to tell us about.

Further information is in the detailed findings below.

The inspection took place on 12 October 2015 and was unannounced.

Brambles is registered to provide accommodation and personal care for up to six people who have a learning disability. There were five people living at the service on the day of our inspection.

There was not a registered manager in post at the time of our inspection. However, the acting manager had submitted their application to CQC to become 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 the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act, 2005 and 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. This is usually to protect them. The management and staff understood their responsibility and made appropriate referrals for assessment. Four people living at the service had their freedom lawfully restricted under a DoLS authorisation.

People were kept safe because staff undertook appropriate risk assessments for all aspects of their care and care plans were developed to support people’s individual needs. The acting manager ensured that there were sufficient numbers of staff to support people safely and this varied depending on the activities and outings that people were involved in.

People were cared for by staff that had knowledge and skills to perform their roles and responsibilities and meet the unique needs of the people in their care. Staff received feedback on their performance through supervision and appraisal

People had their healthcare needs identified and were enabled to access healthcare professionals such as their GP, dentist and specialist services.

People where able were supported to make decisions about their care and treatment and staff supported people to enhance their skills and improve their independence. People were treated with dignity and respect by kind, caring and compassionate staff and staff acknowledged that the service was like the person’s own home.

People were treated as individuals and were supported to follow their hobbies and pastimes. People were involved in planning the menus and staff supported them to have a nutritious and balanced diet.

The registered provider had robust systems in place to monitor the quality of the service, including regular audits and feedback from people, their relatives and staff.