Bridge House Care Home

Bridge House Care Home is a residential care home providing personal care to up to 30 people. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 25 people using the service. Bridge House Care Home is an adapted building that accommodates people over two floors. The ground floor holds all available communal areas such as the lounge, living area and dining room.

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

People were kept safe from harm and their risks were managed. There were enough staff to meet people’s needs and lessons were learned when things went wrong.

People’s care was reviewed regularly to ensure the home could meet people’s needs. People were supported to maintain a balanced diet. 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 were supported by kind and caring staff who promoted their independence. Staff respected people’s privacy and treated them in a dignified way whilst delivering their support.

People received person-centred care and a range of activities in the home. People were supported at the end of their lives with compassion. There was a complaints process in place and people and relatives felt comfortable to raise any concerns.

There was an inclusive culture in the home and people, relatives and staff felt supported by the registered manager and the wider management team. Quality audits were being completed to identify any areas for improvement. Staff were working well with professionals to ensure timely care for people.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 10 August 2021). At our last inspection we recommended that full analysis of accidents and incidents were introduced. At this inspection we found trend analysis had been introduced.

Why we inspected

We undertook this inspection as part of a potential improvement review.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

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

Bridge House is a residential care home providing personal care to 10 people aged 65 and over at the time of the inspection. They are also registered to provide personal care to people in their own homes, however, this registered activity was not being completed. The service can support up to 30 people. Bridge House accommodates people in one adapted building over two floors. At the time of the inspection all people were living on the ground floor apart from one person who had chosen to remain on the first floor.

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

Improvement had been made to the home overall since the last inspection.

Accidents and incidents analysis was a lot more consistent and a falls analysis had been introduced. There were plans to introduce other analysis tools relevant to the remaining incidents. We made a recommendation in relation to this.

Quality audits had improved and the management team were positive about how they were going to sustain this progress. A recommendation was made in relation to this.

People were supported by caring staff. The staffing team had settled and returned to work since the last inspection. Staff felt confident that there were enough staff to meet people’s needs. People told us that they were supported well with their medicines.

People were kept safe from the risk of infection and staff knew how to report safeguarding concerns if required. People were treated with respect by staff that had undertaken equality and diversity training and applied this into their day to day role.

Staff and management had worked well with other health and social care professionals since the last inspection to drive improvement. People and staff felt involved with the running of the home. Communication with relatives had improved.

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

Rating at last inspection (and update)

The last rating for this service was inadequate (published 26 March 2021).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. The provider was also served with two warning notices regarding safe care and treatment and good governance of the home. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 26 March 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We carried out an unannounced comprehensive inspection of this service on 18 January 2021. Several breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. We were also required to check whether the Warning Notices we previously served in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met on specific concerns we had about safe care and treatment and good governance at Bridge House. This report only covers our findings in relation to the Key Questions Safe, Caring and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the Safe and Well-Led sections of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bridge House Care Home on our website at www.cqc.org.uk.

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.

Bridge House Care Home is a residential care home providing personal care to up to 30 people aged 65 and over. At the time of the inspection there were 13 people living there. The home accommodates people over two floors separated in to four wings, some of who have physical needs and some people who are living with dementia.

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

Risks were not always managed correctly and accidents and incidents continued to be inconsistently recorded leaving people at risk of further harm.

There were not enough staff to meet the needs of people living in the home. The home was relying heavily on agency staff during an outbreak of Covid-19. This, in addition to the lack of details in risk assessments meant people’s care needs were not always known by the staff supporting them.

People were not always being kept safe from the risk of the spread of infection. The provider had not implemented regular environment checks or ensured staff knowledge was up to date with the most recent guidance.

Since the last inspection there was a new manager in post who had started to implement changes. However, enough time had not passed for these to be embedded in the service or to confirm whether any changes were sustainable. People, staff and relatives did not always feel supported by the provider.

Quality assurance audits had not highlighted the shortfalls found in the inspection. The action plan from the last inspection had not yet been fully implemented.

Recruitment processes had improved and staff received regular training. People were supported with their medicines at the correct times of day by competent staff.

Staff knowledge in identifying safeguarding and reporting incidents correctly had improved. Staff were confident to discuss this topic and new, improved training had been delivered since the last inspection.

The manager and the management team were working closely with the local authority and health professionals to drive improvement within the home.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 2 December 2021) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about the management of infection control, staff knowledge of the use of personal protection equipment (PPE) and staff levels in the home. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

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 focused and comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement to inadequate. 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 Bridge House Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the safe care and treatment of people, the management and provider oversight of the home and staff levels at the inspection.

Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Bridge House Care Home is a residential care home providing accommodation and personal care to 22 people aged 65 and over at the time of the inspection. The service can support up to 30 people in one adapted building and one separate annexe building with four bedrooms which was vacant at the time of the inspection.

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

People told us they felt safe with the current staffing team, however, this had not been the case prior to certain staff members leaving the home. People told us how they had felt uncomfortable with night staff workers and felt unfairly treated. Previous staff members had made some people feel that they were not always treated with dignity and respect.

People told us staff supported them with medicines. However, the previous medicines procedure had not established why a controlled drug had been unaccounted for. This had not been reported correctly through the safeguarding channels to the local authority and CQC had not been made aware of this as a police incident.

Staff had not always been recruited in a safe way. When previous employment references had raised concerns no thorough investigation or risk assessment had been completed.

We found examples where accidents and incidents were not recorded correctly or not always analysed in a timely way. This prevented the registered manager from identifying patterns and required preventative actions to protect people from risks.

Monthly quality assurance visits had not identified concerns at the home. Regular audits had not highlighted missed safeguarding referrals to the local authority, missed notifications to CQC and the effectiveness of training. Audits around record keeping, analysis of trends and patterns relating to accidents and incidents and training for staff had been implemented in the seven weeks prior to the inspection. We will check whether this has been fully embedded in to the service at our next inspection.

Although safeguarding training had been received by all staff, it was apparent it was not effective as staff were not always confident in how to report safeguarding concerns. New, thorough training was provided to staff the day after the inspection and staff feedback from this training was positive.

Staff told us how they often felt rushed in their role and people told us the home felt short-staffed. There had been a sudden gap in staff resources with five members of staff leaving the home in close succession, including the management team. We could establish by the dependency tool the staffing levels met a “safe” level, however, this level with the absence of a permanent management team was not always effective. People told us that at times staff didn’t have time for much more than meeting their basic care need support. We have made a recommendation in relation to this.

People, staff and relatives have told us that in the past they had not felt that concerns were addressed in a timely way. Since the new temporary management structure had been put in place positive feedback was received. People and staff told us about the improvements to the home that had already been implemented and ongoing improvement plans were in place.

We received mixed feedback from people and relatives with regards to the provider listening to concerns, taking action and involving people in their care.

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. Risks to people were assessed and all staff were knowledgeable in people’s individual needs.

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 14 December 2019).

Why we inspected

The inspection was prompted in part by notification of a specific incident in which a person using the service sustained a serious injury. This incident is subject to a criminal investigation, of which the provider was aware. As a result, this inspection did not examine the circumstances of the incident.

The inspection was also prompted due to concerns received about the safety of the home, the quality of recording and analysis of accidents and incidents and the safety of the recruitment processes for staff. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. Due to other information gained during the inspection the key question of caring was also added.

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.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe, Caring and Well-Led sections of this focused report. You can see what action we have asked the provider to take at the end of this focused report. The provider has taken some action to mitigate the risks and this appears to be effective, albeit these changes were only made in the weeks prior to our inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bridge House Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These relate to safeguarding service users from abuse and improper treatment safe care and treatment, correct recruitment practices and accurate and timely record keeping.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Bridge House Care Home is a residential care home providing personal care to up to 30 people aged 65 and over at the time of the inspection.

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.

Bridge House Care Home accommodated 25 people in one adapted building at the time of inspection.

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

On the day of inspection, we noted a staircase on the top floor required a secure gate and repair to the bannister to minimise a falls risk. We raised this with the registered manager who sent us evidence to show remedial action had been taken the following day, to ensure this was made safe. We were satisfied with their response.

People were supported by a suitable ratio of staff, that had been safely recruited. Any potential safeguarding allegation were reported and managed appropriately, with any learning from incidents and accidents shared. Medicines were safely managed to ensure people received them at the right time and as correctly prescribed.

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.

Meals were enjoyed and where necessary people were supported with the uptake of fluid and regular snacks. People were supported to access a range of healthcare professionals.

People and relatives felt staff knew them well and were attentive to their needs. Staff respected people’s privacy and dignity. People were supported to be as independent as they were able to.

Activities were regularly on offer to help keep people active and engaged, and people’s choice to participate were respected. People and those important to them were involved in the review of their care, including discussion in relation to any end of life wishes. Any complaints were promptly and effectively responded to.

Management support was highly spoken of, where people, relatives and staff felt the home was well managed. Quality assurance systems were effective in highlighting and driving improvement across the home. The provider made key links with the community to enhance the care experience and sense of wellbeing for people at the home.

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 12 April 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.

Bridge House Care Home is registered to provide the regulated activity of accommodation for persons who require personal care to a maximum of 30 people.

A registered manager was not in post. On the day of our inspection a new manager had been in post for six days. The manager had commenced the process to register with the Care Quality Commission to carry out he regulated activity. 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.

People and their relatives told us they felt the home was safe. People told us that staff were ‘excellent,’ they were very kind and treated them with respect. Relatives were very complimentary about the staff and felt that their family members were safe living at the home. Staff had received training in relation to safeguarding and they were able to describe the types of abuse and the processes to be followed when reporting suspected or actual abuse. The provider ensured that full recruitment checks had been carried out to help ensure that only suitable staff worked with people at the home. Medicines were managed in a safe way and recording of medicines was completed to show people had received the medicines they required. Risks to people had been identified and documentation had been written to help people maintain their independence whilst any known hazards were minimised to prevent harm.

Training, regular supervisions and annual appraisals were provided to staff that helped them to perform their duties. New staff commencing their duties undertook induction training that helped to prepare them for their roles. There were enough staff to ensure that people’s assessed needs could be met. It was clear that staff had a good understanding of how to attend to people’s needs.

Where there were restrictions in place, staff had followed the legal requirements to make sure this was done in the person’s best interests. Staff understood the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure decisions were made for people in the least restrictive way. People were not prevented from doing things they enjoyed as staff had identified and assessed individual risks for people. The registered manager logged any accidents and incidents that occurred and discussed these with staff so lessons could be learnt to help prevent a repeat of these.

People were supported by staff to have a choice of different foods. People with specific dietary needs were provided with appropriate meals. The chef and staff were aware people’s dietary requirements, likes, dislikes and food allergies. The chef attended resident and relatives meetings to discuss the menus and to ascertain people’s views about the food provided.

People were able to access external healthcare services when required and professional involvement was sought by staff to help people maintain good health.

People were treated with respect and their privacy and dignity was promoted by staff. People were able to spend time on their own in their bedrooms and their personal care needs were attended to in private. There was a variety of activities that people could choose to take part in. People’s independence was encouraged and supported by staff. Relatives and visitors were welcomed and there were no restrictions of times of visits.

Documentation that enabled staff to support people and to record the care they had received was up to date and regularly reviewed. People and their relatives were involved in their care.

A complaints procedure was available for any concerns. This was displayed at the service. Complaints received had been addressed and resolved within the stated timescales set out in the provider’s complaints policy.

Staff and the provider undertook quality assurance audits to ensure the care provided was of a standard people should expect. Any areas identified as needing improvement were attended to by staff.

People, relatives and associated professionals had been asked for their views about the care provided and how the home was run. Regular resident and relatives and staff meetings took place.

We reviewed six people's records including care plans, daily records, charts held in people's room s and when appropriate, complaints records. The care plans were reviewed regularly and updated in response to changes. However, we found that some care planning records were not complete and were missing information that could impact on care.

The provider had effective systems to regularly assess and monitor the quality of service that people received. These included audits of care plans on a monthly basis. We saw evidence that audits were carried out on all aspects of the care plan.

We found improvements had been made in assessing people's needs and support. This meant people were involved and agreed with the assessment of their care needs.

We found improvements had been made to support people who lacked capacity. The provider acted within legal requirements to ensure people's rights were promoted.

We found improvements had been made as people's care plans reflected their current care, treatment and support required to meet their needs and protect their rights.

Processes had been introduced to monitor the standards of hygiene and cleanliness in the service. This meant people were protected from the risk of infection.

Improvements had been made to ensure there were sufficient staff available to support people who used service. This meant there were enough staff to meet people's needs.

The service's statement of purpose and complaints procedure had been revised and improved.

The management of records had been improved. Changes had been made to the security of records and the accuracy of entries made by staff in records of care.

People told us that they felt safe and were well looked after. All the people and a visitor that we spoke with said that there were not enough staff. We observed that staff were busy and at times people were not given prompt assistance when they required it.

People's comments about the standard of food served were varied. Some people said they felt they did not always have enough to do and several people told us that they missed talking to people and sometimes felt lonely.

At the time of our inspection there was no registered manager employed at Bridge House Care Home. During the inspection the organisation informed us that the previous manager had left but had not deregistered with CQC at the time of the inspection. Therefore their name still remains on this report. The organisation has, following the inspection, sent us the required information to deregister the previous manager. This application is currently being processed.