Brain Injury Rehabilitation Trust - Bristol Road

We found the following examples of good practice.

Personal Protective Equipment (PPE) stations where staff could sanitise their hands, put on and take off the appropriate PPE were placed throughout the building in key areas. Staff wore gloves, masks and aprons as a minimum during the outbreak and also wore visors when supporting people who had tested positive for COVID-19.

The home was not currently allowing visitors because of the outbreak of COVID-19 in the home. Prior to the outbreak visits were supported in the garden where social distancing and PPE were required.

Staff took the time to support people to understand why staff were wearing PPE and why they had to isolate. People had adapted to the restrictions well and were supported to maintain contact with families through phone and video calls.

Staff received additional Infection control training and PPE training remotely. The training materials were also sent to each staff member for reference should they need it.

The provider responded swiftly when people tested positive for COVID-19 and supported them to isolate immediately and ensure all areas of the home were sanitised and disinfected through a deep clean.

The provider has established a COVID-19 response team that supports all staff members in their employment during the pandemic with any concerns or requirements they may have. The provider also utilises an employee assistance helpline for staff to use should they require.

Further information is in the detailed findings below.

The Brain Injury Rehabilitation Trust – Bristol Road is a rehabilitation service for up to eight people who have acquired brain injury. At the time of inspection, the service was providing accommodation and personal care to eight people living at the service. The home is a large specifically adapted building with seven ensuite rooms on the ground floor and one self-contained flat on the first floor. Since the last inspection the service has added supported living accommodation which provides care to six people across two locations. The two locations are large town houses accommodating three people in each house with an office in each and an allocated staff team.

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

The registered manager and the staff team presented as extremely caring, ensuring they put people at the centre of their care, they considered the service peoples home and not their work place. The staff team made every effort to know and understand each of the people living in the service. The staff and registered manager considered the service users equality, dignity and respected people. People’s views were actively sought by which were listened to and actioned.

Risks were identified and mitigated through comprehensive risk assessments. The staff team were experienced with a varying skill mix benefiting the complex needs of people. Medicines were stored and administered safely. Infection control procedures were in place and all staff were aware of these. When incidents occurred, the staff learned lessons through investigation procedures and made amendments where necessary.

The staff team were trained and skilled in relation to the needs of the people living there. People’s needs were detailed and care planned for. Their care plans identified involvement from people in the design of their care. People were asked for their consent when being supported by staff and consent was recorded. Care was personalised with a focus on the individual needs and goals of the service users. While no-one was receiving end of life care there were end of life care plans in place. The complaints and compliments procedure was displayed and discussed with people, all complaints had been responded to and actioned appropriately.

There were clear objectives which were achieved through robust audits and spot checks. There were quality assurance systems and processes in place to ensure the service was meeting its purpose. The registered manager lead from within the team, setting out the person-centred nature of the service. The staff worked effectively with healthcare professionals in meeting the needs of people living in the service.

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. People are involved in the development of the menu, meals were nutritious as well as varied.

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 17 May 2017).

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.

People were supported to remain safe by staff who were aware of the risks associated with their support needs and how to minimise these risks to help keep people safe. Staff had knowledge about safeguarding procedures and action they would take should they have concerns. People were supported by sufficient staff who had been recruited safely.

People received support to take their medicines safely by staff who had been assessed as competent to provide this support. Medicines were stored safely and there were systems in place to regularly check that people’s medicines were given as prescribed.

People were supported by staff who had the skills and knowledge to meet their needs. Training had been provided to staff around people’s individual needs including training on brain injuries. People had their healthcare needs met and were assisted to have foods and drinks they enjoyed.

People were supported to have maximum choice and control of their lives and staff supported people in the least restrictive way possible. The policies and systems in the service supported this practice. People were supported by a range of healthcare professionals as required to promote their health.

People told us that they felt cared for by staff who knew their preferences for care well. Staff demonstrated that they enjoyed their work with the people who lived at the service. People had their independence encouraged and promoted in many aspects of their lives.

People were involved in planning and reviewing their care to ensure it continued to meet their needs. People were supported to partake in activities that were of interest to them on a regular basis.

People, their relatives and staff were happy with how the service was managed. Quality monitoring systems, and methods of seeking feedback from people, were in place to ensure the service continued to be safe and of a good quality in line with people’s needs and wishes.

Further information is in the detailed findings below.

People living at the home told us told us they were satisfied with how their care needs were being met. One person told us, 'It's a nice home, they look after me.' Another person told us, 'I'm generally happy here, I could not think of anything I do not like.' People confirmed they felt safe there. One person told us, 'I feel 100% safe living here.'

People were protected against the risks associated with medicines because the provider had the appropriate arrangements for managing medicines safely.

Sufficient staff were not always available to meet the needs of people who used the service.

An effective system to regularly assess and monitor the quality of service that people receive was not consistently in place.

Improvements in the service had been made so that people experienced care, treatment and support that met their needs and protected their rights. We found that people's weight was now being monitored on a regular basis and recording systems to show the health appointments attended by people had been improved.

We found that the health and safety systems that were in place now helped to protect people from the risk of water that was too hot.

We met with five people who lived at the home during our visit. Some people were out at appointments when we visited. We spent some time in the lounge area of the home. Staff treated people with respect and supported them in a friendly, engaging manner. We heard staff speaking nicely and respectfully with people.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

Everyone we spoke with told us that they felt safe. People told us that they would talk to staff if they had any concerns or complaints. A relative of a person living at the home told us they would feel able to raise any complaints directly with staff at the home.

Assessment procedures prior to people moving in needed to be improved, to ensure people could be confident the home could meet their needs. Support for people was not always provided in line with their care plan and outcomes of assessments from health professionals were not always available. Systems in place did not ensure people's oral health and weight monitoring needs would be met.

The health and safety systems that were in place may not have ensured that people were protected from the risk of water that was too hot.