Bramerton is one of a number of care homes that the provider CHOICE is currently registered for. Although part of a corporate brand, Bramerton is an individualised service for the people who live there.

Bramerton provides residential care for up to 11 male adults with moderate to severe learning disabilities. Bramerton is situated in the village of Bray, close to the town of Maidenhead. The building is a large, detached house. There are 11 single bedrooms over two floors with two lounge areas, a separate dining room, kitchen, office and a large basement relaxation area. There is also a separate day services building adjacent to the main house, which provides a base for activities such as IT, arts and crafts etc. In addition the care home operates vehicles for leisure, recreational and educational trips and activities in the community.

At the time of the inspection, there was 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.

Since registration under the Health and Social Care Act 2008 on 8 December 2010, Bramerton has maintained compliance with the relevant regulations at each inspection by CQC. The most recent inspection was a routine planned visit on 10 December 2013. This inspection is the first visit under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the first rating under the Care Act 2014.

The feedback from people at Bramerton, relatives, staff and commissioners was overwhelming and outstanding. People were happy to live at Bramerton and felt they led fulfilling lives. They told us they felt safe and were excited to show and tell us about their lives. For people who were unable to verbally communicate with is, they demonstrated that they were also happy to live there. There was a sustained attitude of continuous improvement throughout all aspects of the service. We found people were safe and appropriately supported.

All risks for people and the service were thoroughly assessed, mitigated, documented and reviewed. Appropriate records were kept and readily available to demonstrate this to us at the inspection.

Proper maintenance of the premises and grounds was evident. The registered manager was knowledgeable about risks from the building and kept records of completed assessments and coordinated repairs to effectively prevent harm to people. Repairs and maintenance were completed by some external contractors and some minor delays occurred whilst waiting for their attendance. This did not impact on compliance with the safe use of the premises and equipment.

We looked at two staff personnel files. The location’s registered manager was responsible for ensuring fit and proper person checks were completed and recorded for new staff. We found the service had strong recruitment and selection procedures that ensured suitable, experienced applicants were offered and accepted employment. A high percentage of staff had long periods of service for the provider. Some new staff were recruited when others left the service. Staff we spoke with told us they had to pass a number of stages to be successful in gaining their employment. This included a face to face interview with a manager and question-based scenarios. Personnel files contained all of the necessary information required by the regulations and no documents or checks were missing. We found this included criminal history checks via the Disclosure and Barring Service (DBS), checks of previous conduct in other roles, and proof of identification. We also checked the staff’s legal rights to work in the UK.

Medicines were safely managed. We examined the handling of people’s medicines during our inspection and found that people were safe from

The people who live in the home have diverse abilities and needs. Some of the people do not communicate verbally. We spoke with three people who use the service during our inspection and observed staff interaction with others during the day.

We observed staff used a range of communication tools to ensure they understood people’s wishes. People were involved in activities in the home and local community. One person told us “It’s nice here. I like living here. I see my family.”

People told us they were cared for well. One relative said “Care staff are good at their job and have imagination. They work around concerns that seem insurmountable. X is very happy.” Staff ensured people’s support was provided in accordance with their plan of care. They were aware of how to maintain people’s health, safety and wellbeing.

Staff were trained to ensure people were not at risk of harm. They understood reporting procedures for safeguarding concerns. They knew how to safely manage behaviours that challenge the service. One relative told us their loved one was a “very demanding person, and was moved from other homes when they couldn’t cope. This home has stuck with X and persevered rather than given up. That’s everything to me.”

At the time of our inspection the registered manager was seconded on promotion. We met with the acting manager. The registered manager also attended the home during our inspection. We saw staff attended training to ensure they could support people’s needs safely. Supervisory and appraisal meetings provided opportunities for staff and managers to reflect on areas of good practice and discuss concerns and aspirations.

People who use the service and their relatives had opportunities to influence the service. One relative told us “There’s two way communication. It’s very good.” The provider carried out audits to ensure people were supported appropriately. They analysed information to identify trends, share learning and address concerns.

We spoke with four people who use services during visit. One person told us that they liked helping with around the home. He stated that he enjoyed doing some outdoor manual work. He also had a reward system which was in place for him which he was aware and completed with staff support. Another person showed us that notice board which had activities for the day, staff pictures and names on duty which he completed with staff support. He was able to talk us through the activity board and appeared to take pride in maintaining it accurate.

People told us that they were happy and that staff were good and helpful. People also told us that staff helped them by taking them out for activities and things they liked. People we spoke to told us that they did not have complaints about staff or the care they were receiving. They told us that staff spoke to the about their care and supported them to achieve their goals. We reviewed four folders during visit.

We also spoke with two staff and reviewed four staff files. Staff told us that they were happy with their work. One staff member told us that they felt supported and had opportunities to develop within the company. This was a good motivator and incentive for staff to enhance their skills and knowledge. Staff told us that the training was really good and was tailored to the service as well as the needs of people. Staff were also positive about the changes that had taken place within the management structure.

People told us they can take part in a variety of activities both in the service and local community. One person told us he likes to cook and we saw him preparing lunch, with staff support. People said they are supported to keep healthy and well. They told us there were staff around when they needed them and to support them.