Brandon Supported Living - Cornwall

About the service

Brandon Supported Living - Cornwall is a domiciliary care agency providing care and support to people with a learning disability and autistic people in their own homes. Support can range from enabling people to access the community for a few hours a week, to 24-hour care and support for people living in supported living accommodation. The agency works across Cornwall and Plymouth and provides support to 211 people in 59 different supported living settings.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of inspection 90 people were in receipt of personal care.

People’s experience of using this service and what we found

Right Support:

People had choice and control and were able to make decisions about their daily lives and how their care and support was organised.

The organisations values and ethos reflected the underlying principles of Right support, right care, right culture.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The service worked with people to plan for when they experienced periods of distress. Staff knew how to support people at these times and had received the relevant training.

Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome.

We have made a recommendation about the supporting information in place for some medicines in the report.

Right Care:

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

The service had enough appropriately skilled staff to meet people’s needs and keep them safe. Permanent staff were supported by bank staff and agency staff. Managers checked all staff had the relevant skills and experience.

Right Culture:

The service enabled people and those important to them to work with staff to develop the service. Staff valued and acted upon people’s views.

People’s quality of life was enhanced by the service’s culture of improvement and inclusivity. The organisation’s values were known by staff and these were reflected in their practice.

Managers ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 3 February 2021).

At our last inspection we recommended that staff training needs were identified and met in a timely manner. At this inspection we found improvements had been made.

Why we inspected

This inspection was prompted by a review of the information we held about this service. We undertook a focused inspection. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Requires improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Brandon Supported Living - Cornwall on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Brandon Supported Living - Cornwall is a domiciliary care agency providing care and support to people in their own homes. Support can range from enabling people to access the community for a few hours a week, to 24-hour care and support for people living in supported living accommodation. The agency works across Cornwall and Plymouth and provides support to people in 50 different supported living settings.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of the inspection 144 people were receiving support with personal care in supported living settings.

People’s experience of using this service and what we found

Staff had completed training looking at how restrictive practices might impact on people. This had made them reflect on how they supported people which they had reported. The provider had taken the appropriate action, but we were concerned staff had not had the relevant training in a timely manner. We have made a recommendation about this in the report.

Following any untoward event, incident and accident forms were completed to enable managers to have an oversight of events and take action to mitigate risk. These were completed shortly after the event but several weeks had passed before they had been signed by a manager to evidence they had reviewed the information. We have made a recommendation about this in the report.

Relatives told us they were confident their family members were safe. We observed people interacting with staff and saw they were relaxed and at ease. Staff were gentle in their approach and gave people time to express themselves.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were working towards consistently meeting the underpinning principles of Right support, right care, right culture.

Right support:

People were supported to be independent and have choice and control. There were systems in place to make sure their voices were heard.

Right care:

Care had not always been delivered in a way which meant people’s human rights were respected. This had been identified and action taken to mitigate the risk of reoccurrence. This work was on-going to help ensure it was well embedded in staff practice.

Right culture:

The Brandon Trust were working with management and staff at all levels to continually improve the culture of the service. Staff were aware of the organisations visions and values which were centred around supporting people to have a voice and live meaningful lives.

Support staff told us they had not always felt well led and morale had been low. This had been identified by senior management and action taken to address communication between management and support workers. Staff told us the changes and additional platforms for communicating were positive and they were more optimistic.

Locality managers told us they were proud to work for Brandon Trust and felt well supported. There was regular contact with the area manager and the senior management team.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (report published October 2019). No breaches were identified at that inspection.

Why we inspected

The inspection was prompted following concerns received about staff culture in one particular home. The information raised concerns regarding people’s safety and dignity, unlawful use of restraint and oversight of the service. A decision was made for us to inspect and examine those risks at that specific service and one other.

We undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

Since the concerns were raised the provider had taken action to address the issues. This has included a full investigation into the concerns raised, additional training and support for staff, and improved oversight of services.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Brandon Supported Living - Cornwall on our website at www.cqc.org.uk.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of the inspection 135 people were using the service. 76 of these people were receiving support with personal care in supported living settings.

People’s experience of using this service and what we found

Feedback from external healthcare professionals varied according to the specific setting they had experience of working with. While most feedback was positive this was not consistent across all areas and we have made a recommendation about this in the report.

People's needs were assessed when they first started using the service. Managers considered how people's needs and personalities might impact on each other. Ongoing assessments did not fully take into account how people's changing needs might affect the people they lived with and we have made a recommendation about this in the report.

Some people's homes had been through a period of instability with changes to the staff team and team leaders. Locality managers were working closely with the services to support them and told us they believed the situation was improving.

Staff had high expectations for people and were committed to supporting people to have full and meaningful lives. There was an emphasis on supporting people to develop and maintain their independence. Staff were clearly proud when people achieved their goals, no matter how small they might appear.

People and relatives were positive about the way in which Brandon Supported Living – Cornwall was managed. Relatives told us they worked with people and staff to ensure support was delivered according to people’s needs and preferences. They frequently referred to “working together” and “family” environments. We observed staff and people spending time together and saw staff were inclusive in their approach, always bringing people into conversations and supporting them to express their opinions.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible, to gain new skills and become more independent. People’s routines were known and respected.

There were systems in place to capture people’s views and these were continually assessed to help ensure they were effective. The Brandon Trust were piloting a Quality Checkers team so people using the service could support and assess service development. Surveys had been produced in various formats to make them more meaningful for people. A system for gathering the views of people who did not use words to communicate was being trialled.

Staff were valued and there were a variety of support mechanisms in place including helplines and personal development programmes. Staff told us the organisation was a good place to work and were enthusiastic about their roles.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 03 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

There were twelve registered managers in post as they cover the whole of the county of Cornwall, Plymouth and Devon. 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.

Brandon trust is a domiciliary care service that provides care and support to people in their own homes. This includes people with general health needs, mental health needs, and learning disabilities. The care ranges from a minimum of six hours support , up to 24 hour care for people in supported living. A supported living service is one where people live in their own home and receive care and support in order to promote their independence. People have tenancy agreements with a landlord and receive their care and support from the domiciliary care agency. As the housing and care arrangements are separate, people can choose to change their care provider without losing their home.

We visited by agreement, people living in their homes where supported living support was being provided by this service. Some people lived in their own homes and others lived in a shared house where people had their own bedrooms and collectively used the other parts of the house with staff supporting them throughout the 24 hour period.

People told us the care staff that supported them were “good” and felt they were safe. Relatives echoed this view. Staff were confident about the action to take if they had any safeguarding concerns and were confident the registered managers would follow up any worries they might have.

The service strived to develop their knowledge and expertise in the area of learning disability. They were awarded the Autism Accreditation by the National Autistic Society due to the work they had undertaken at some of the supportive living services.. The team leader of one of the supportive living homes provided a presentation at the ‘National Autistic Society Positive Outcome Events’ to explain their work. The team leader had now gained the ‘Autism experienced practitioner’ qualification of which there were only two in Cornwall. This had led to the team leader being asked to publish articles for the national Autistic Society on the work they have undertaken in how they support people. This demonstrated the service was committed to ensuring staff had the specific knowledge and skills to support people who required specialist support.

Team leaders also had specific roles in training as ‘champions’. This meant that they had a specific area of expertise such as, positive response training (PRT), autism, epilepsy, dementia, communication and assistive technology.

The training department had sourced bespoke specialist courses including end of life care and ‘young people self- harm’ when the need for this was identified. This demonstrated the level of commitment from the service to ensure that staff had access to relevant training courses so that it could provide bespoke care to the people they supported. It also demonstrated the commitment staff had to broaden their expertise and knowledge in care.

People were supported by stable and consistent staff teams who knew people well and had received training specific to their needs. People and their advocates, were involved in recruiting and choosing the staff who supported them. Efforts were made to match staff with people by identifying any shared interests and hobbies.

Staff told us they enjoyed their work and were well supported through supervision, appraisals and training. The area managers and registered managers spoke highly of the staff team describing them as committed and enthusiastic in their approach to their work.

Staff had high expectations for people and were positive in their attitude to support. Staff were respectful of the fact they were working in people’s homes.

Care plans were personalised and clearly guided staff in how to support people well at various times of the day and in different situations. This allowed a consistent approach from staff when supporting people in their own homes.

Risk assessments clearly identified any risk and gave staff guidance on how to minimise the risk. They were designed to keep people and staff safe while allowing people to develop and maintain their independence.

The management team had a clear set of values which was also apparent in our discussions with staff. People and staff told us they felt involved in the development of the service and that management listened to any ideas and suggestions they had and took them on board.

The majority of people who used the service, who we met with, had very limited verbal communication skills. The people we were able to speak with were very happy with the support they received from Brandon Trust. Everyone we met looked well cared for. We observed the support people received and saw this to be professional and caring.

We spoke with seven Brandon Trust support staff, and all were very positive and passionate about the service, and about their experience of working for Brandon Trust.

During our visit to the Brandon Trust office in Bodmin we met and spoke with the area manager, three registered managers, and personnel responsible for training, finance and quality assurance.

Documentation regarding the service provided was to a good standard. For example care plans provided clear information regarding care and what support staff needed to assist people with.

Staffing levels were satisfactory, and there was evidence that staff had received suitable recruitment checks. Staff training was to a good standard. The service had a satisfactory quality assurance system in place which should ensure the service was maintained to a good standard and improvements were made as necessary.

The majority of people who used the service, who we met with, had very limited verbal communication skills. The people we were able to speak with were very happy with the support they received from Brandon Trust. Everyone we met looked well cared for. We spoke with several Brandon Trust support staff, and all were very positive about the service, and about their experience of working for Brandon Trust.

Documentation regarding the service provided was to a good standard. For example care plans provided clear information regarding care and what support staff needed to assist people with.

Staffing levels were satisfactory, and there was evidence that staff had received suitable recruitment checks. Staff training was to a good standard. The service had a satisfactory quality assurance system in place which should ensure the service was maintained to a good standard and improvements were made as necessary.