Smithy Bridge Court

Smithy Bridge Court is a residential care home providing personal and nursing care for to up to 51 people. The building has 4 different floors. The lower ground floor has 6 beds for females only and an assisted living kitchen; the upper ground floor has 18 beds; the first floor has 17 beds for males only and the second floor has 10 beds. All bedrooms are ensuite, and all floors have shared lounge and dining areas. There are several landscaped garden areas including a sensory garden. At the time of our inspection there were 44 people using the service.

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

Systems in place helped safeguard people from the risk of abuse. Assessments of risk and safety and supporting measures in place helped minimise risks. Staff managed people’s medicines safely. Staff followed infection prevention and control guidance to minimise risks related to the spread of infection. Staffing levels were sufficient to meet people’s needs and managers recruited staff safely.

Care plans included information about support required in areas such as nutrition, mobility and personal care to help inform care provision. Staff made appropriate referrals to other agencies and professionals when required.

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 told us they were well treated, and their equality and diversity respected. People felt staff respected their privacy and dignity and took into account their views when agreeing on the support required. Staff identified people’s communication needs and addressed these with appropriate actions.

The provider and manager responded to complaints appropriately and used these to inform improvement to care provision. The provider was open and honest, in dealing with concerns raised. The manager was available for people to contact, and managers undertook regular quality checks, to help ensure continued good standards of care.

The provider and manager followed governance systems which provided oversight and monitoring of the service. These governance systems and processes ensured the service provided to people was safe.

Rating at last inspection and update

The last rating for this service was requires improvement (published 31 May 2022).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

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 based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Smithy Bridge Court 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.

Smithy Bridge Court is a residential care home providing personal and nursing care to up to 51 people. At the time of our inspection there were 24 people using the service.

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

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.

There were sufficient staff, who knew people well, but there was a significant reliance on agency staff. There was an ongoing programme of recruitment.

There were activities available, but these needed to be developed for those people living with a dementia.

Safe systems of staff recruitment were in place. Risks to individuals and staff were identified and well managed. All the required health and safety checks were taking place. People received their medicines as prescribed, but some records were not complete. Staff had received training in safeguarding and were aware of their responsibilities. The home was very clean. The provider was managing the risks related to COVID-19 well.

Staff received the induction, training and support they needed to carry out their roles effectively. People’s nutritional needs were met and people told us the food had improved. The home was well furnished, very clean and brightly decorated. People’s health needs were met.

Throughout the inspection, staff were observed to have a kind and caring, unrushed approach. People told us they were treated with respect and involved in decisions about their care and support.

Person-centred support plans and risk assessments, that reflected people’s needs, were in place to guide staff.

The management team and staff had a clear passion and commitment to continuing with improvements and providing safe, quality care. People were positive about the improvements since our last inspection and about the new registered manager. Systems for auditing and quality monitoring and oversight had been improved. The systems and improvements we saw during our inspection needed to be embedded further and required a longer-term track record of sustained improvement and good practice.

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 16 December 2021) and there were 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 we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended that the provider; reviewed the menu and dining experience, ensured all staff understood the principles of MCA and DoLS and records relating to assessment and consent were clearly documented, and reviewed good practise guidance to ensure premises were adapted to meet the complex needs of people living at the service. At this inspection we found the provider had acted on the recommendations and improvements had been made.

This service has been in Special Measures since 16 December 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.

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

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 and will take further action if needed.

Follow up

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

Smithy Bridge Court is a newly built residential care home providing personal and nursing care to working-aged and older adults with complex care and mental health needs. The home is registered to support up to 51 people and was supporting 28 people at the time of the inspection. Care is provided over three units on separate floors, which have communal living areas and single occupancy en-suite bedrooms.

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

People did not have their risks and needs accurately assessed and there was not always a detailed and personalised plan of support in place to ensure people received the support they needed. There was not always enough staff on duty to support people and recruitment processes were not robust. People were not protected from avoidable risk and restricted areas were not always secure. People’s medicines were not safely managed, and we identified shortfalls in the storage of medicine and the administration and recording practices. The service was not clean, and staff were not consistently wearing personal protective equipment in line with the government guidance for care homes.

People were not protected from potential harm through good oversight and effective action by staff and the provider. Systems for audits and checks were not being effectively used to monitor the service and drive improvement. Feedback from people and families had not yet been formally obtained, although structures were in place to do this once the service was more established. The service worked in partnership with internal and external services as needed.

People’s assessments and care plans were not always accurate and detailed. People had limited choices for meals and at the time of inspection there was no chef in post. We have made a recommendation that the service review the menu to ensure it is suitable for the needs and preferences of the people living at the service. The building was new but was not suitable for the needs of everyone living at the service. We have made a recommendation that the provider review good practice guidance when considering the adaptations required to meet the needs of the people living at Smithy Bridge Court.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service were in place but had not been effective in ensuring good practice. We have made a recommendation that the service ensure staff are knowledgeable in this area and that assessment and consent documentation is accurately recorded in people’s records.

People’s privacy and dignity was not always maintained when being supported by staff and not all staff had completed training in this area. People were not always encouraged to make choices and remain independent and care plans did not always contain enough detail about people’s abilities. People and families spoke highly of the care staff and although staff were busy and task focused, they generally spoke kindly with people. People with specific cultural or religious needs were supported and care plans reflected these needs.

People’s care plans did not contain enough detail about likes and preferences to ensure that people were supported in a person-centred way. The service was not currently supporting anybody who was at end of life, but the care plans were not always detailed and accurate in this area. The service could provide information in a variety of formats and used technology to support different communication methods. People were not always supported to engage in a varied and meaningful program of activities, but families spoke positively of their experiences of contacting and visiting people living at the service.

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

Rating at last inspection

This service was registered with us on 23 February 2021 and this is the first inspection.

Why we inspected

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.

The inspection was prompted in part due to concerns received about staffing levels, management of medicines, safeguarding concerns and management of individual risk. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective caring, responsive 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.

The provider took steps to address some of the concerns we found during the inspection including focusing on ensuring sufficient staffing levels are in place and recognising situations where they were not able to meet a person’s needs.

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 individualised care planning; managing individual and environmental risk and people’s medicine; ensuring there were enough staff to support people and that these staff were safely recruited and trained, supported and competent to perform their role; and ensuring that the service had enough oversight to address shortfalls and concerns and improve the service in a timely way at this inspection.

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 from 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 program. If we receive any concerning information we may inspect sooner.

Special measures

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 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 of 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.