Bramshaw House

This service supports people living with a learning disability and autistic people. Some people have complex health, wellbeing and communication needs. The service is fully accessible to support people the needs of people with a physical disability. The service uses a household model of care. People have their own bedrooms and share a kitchen, lounge and dining area. This helps create a familiar home environment where staff can support people in a more personal and flexible way.

This service was previously rated as good. We carried out this assessment to confirm whether the rating of good remains accurate. This report does not provide detailed information on areas where we found practice continues to meet a good standard. Instead, our findings focus on any areas where the service needs to improve or where we found exceptional practice.

We assessed the service in line with CQC’s ‘Right Support, Right Care, Right Culture’ best practice guidance to judge whether people received respectful, dignified, and person-centred care that promoted their independence, choices, and inclusion in the community. The provider was working in line with national best practice guidance for supporting people with a learning disability and autistic people.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found staff and management worked within the MCA. DoLS authorisations were appropriately applied for and overseen. People were not subject to unlawful or excessive restrictions they had choice, control and freedom over their lives.

People, their relatives and those important to them told us they were involved in MCA assessments and best interest decisions and there was evidence of this. For example, the decision to fit a Percutaneous Endoscopic Gastrostomy (PEG) tube when a person was unable to swallow safely and maintain sufficient oral intake. Feedback received from a person’s court-appointed representative informed us they felt appropriately involved in decisions about a person’s care. A relative told us that, when their loved one experienced serious health issues, they were involved in best interests’ meetings with staff and medical professionals to discuss and agree the most appropriate way forward. This demonstrated relatives were involved in important decisions about their loved one’s care and treatment.

People received safe, effective and well-planned support that reflected best practice guidance for people with a learning disability and autistic people. People were supported by enough suitably skilled staff, with safe recruitment processes in place. A family member told us, “The selection of good staff seems to be a strong point of the home.” Risks were assessed, managed and reviewed, and people were involved in decisions about their safety. Effective systems were in place for safeguarding, medicines management and environmental safety. Care plans provided clear guidance to staff to support people safely, including how to respond to epileptic seizures and complications associated with PEG and stoma sites, and when to seek medical advice. Staff had received appropriate training to support people’s needs well, including training required to support people with a learning disability.

Systems were in place to assess, monitor and review people’s care and changing needs. People had timely access to healthcare professionals and routine health screening to support their health and wellbeing. Referrals were made promptly when people’s needs changed, including to speech and language therapy (SaLT) for safe eating and drinking and physiotherapy for mobility support. A family member told us the registered manager and staff consistently advocated for their relative during hospital admissions and visits, ensuring they were appropriately supported in what could be stressful situations. They said they were kept informed and involved in decisions about their relative’s care. Another relative told us their loved one’s complex healthcare needs were being met “above and beyond what could perhaps have been expected of a typical care home.” They also highlighted the positive benefits of additional support provided by the district nursing team.

Throughout the inspection, we observed people being treated with dignity and respect. Staff supported people to make choices and decisions about their care and daily lives, while promoting and encouraging their independence. Staff knew people well and understood what was important to them. A relative highlighted the importance of weekly video calls which helped their loved one maintain meaningful contact with their family. Another relative said, “They understand [name’s] needs to the minutest detail. In my experience, every member of staff gives 100% to the person they are caring for, and this shows.”

People received care and support that was responsive to their individual needs, preferences, strengths and aspirations. Staff worked flexibly to enable people to make choices, maintain relationships, pursue their interests and participate in activities that reflected their individual preferences. For example, one person regularly attended Brighton and Hove Albion football matches and told us how much they enjoyed this. Their bedroom reflected their passion for the football team. Staff arranged wheelchair-accessible transport and ensured appropriate stadium access so the person could continue to participate in an activity that was important to them. A relative told us, “The vibe at Bramshaw is very much that it is a home not just a care residence. It has that feel for everyone including the staff.” Another relative said, “I cannot thank the team enough for what they do for [name].”

Staff felt valued, respected and supported by management and described a positive and inclusive culture. Comments included, “There is excellent team work here.” And “The manager is amazing and very supportive.” A relative told us, “The registered managers selection of staff is excellent, leading to a wonderful caring group, who treat the residents as if they were part of their own family.” Governance systems were effective in monitoring quality and driving improvements. Audits identified issues promptly and leaders took action to address concerns and monitor progress. Records were accurate, up to date and used to enhance service delivery. The provider worked collaboratively across teams and services to ensure seamless care, with effective information sharing. The registered manager promoted openness and continuous improvement. There were opportunities for staff, residents and families to feedback and be involved in shaping and developing the service. Throughout the inspection we received consistent support and praise for the registered manager from people, visitors and staff. A relative told us, “We felt very fortunate to find Bramshaw and instantly got a good feeling of warmth and openness from everyone we encountered.” Another said, “A care home is as good as its manager, and we can only sing her praises and hope she never retires.”