Bridgemead

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to safe care and treatment.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty.

Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Accidents and incidents were clearly documented and investigated by management. Actions were taken to reduce the risk of incidents happening again. For example, analysis of falls was undertaken when people fell and actions such as more regular monitoring was put in place.

Learning from incidents was cascaded to staff and staff had a good understanding of how to deal with incidents when they occurred.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People were positive about the transition into the home. One person said, “The staff were really good settling [Person] in.” Staff said the manager gave them information about people when they came to live in the service.

The service operated a day centre once a week for people living in the community to attend. There was evidence of people from the day centre transitioning into the home to live. The service also provided opportunities for short term respite stay and people had chosen to permanently reside in the service. This allowed people to get to know the environment and staff before living in the service.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect.

The provider shared concerns quickly and appropriately. People told us they felt safe in the home. Relatives felt their family members were safe and well cared for in the home. We observed people felt safe around staff. Staff and leaders were knowledgeable about safeguarding and knew how to escalate concerns. Staff had received training in safeguarding and there was a safeguarding policy which was appropriate for the service.

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 that the provider was able to identify when people were potentially being deprived of their liberty, complied with the basic principles of the Act, and made applications and urgent authorisations in a timely manner.

The provider did not work well with people to understand and manage risks. Staff did not provide care to meet people’s needs that was safe.

The provider had identified 2 people who were at risk of pressure wounds. However, records we saw did not consistently show these people had been re-positioned in line with their care plan. For example, 1 person needed repositioning every 2 hours during the day and 4 hours at night. Within a 3 day period, we identified 11 instances where records did not demonstrate the person had been repositioned within the time frames. Another person needed repositioning every 2-3 hours daily. Records showed the person had not been repositioned for over 13 hours on one occasion and over 9 hours on another day. There were other occasions where the person had not been repositioned for 6 hours. Although we saw no harm had come to people due to the lack of recording, people not being repositioned regularly means there is the risk of potential pressure wound damage

We also identified a lack of monitoring in place for 1 person who required bowel monitoring. Care plan information stated the person should be monitored daily. However, we found gaps in monitoring charts for 7 days during a 1 month period. Another person’s care plan said they needed daily food monitoring, but we saw missing entries on 2 days during a 1 month period. Although we saw no harm had come to people, gaps in monitoring means the provider may not be able to actively identify escalation in people needs and activate preventative measures in a timely manner.

Some staff told us alerts on their handheld monitoring devices had been switched off. Therefore, they were not always able to see what actions needed to be taken and were not always sure if things had been missed. Leaders told us the alerts were turned off due to learning about the new system and they would ensure they were reinstated so staff could see the information. They believed this would strengthen their approach to monitoring people’s outcomes. However, this had not been embedded at the time of the assessment.

We also saw 2 people’s care plans where mattress settings were not recorded. The provider updated this during the inspection.

However, where people had been assessed at risk of pressure wounds, pressure relieving equipment was available. Pressure relieving mattresses were set at the correct settings.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

People said they had access to the equipment they needed to stay safe. One person said, “Absolutely safe, my (relative) has to be hoisted and the staff are competent.” We observed staff using equipment and supporting people to move throughout the building safely. We also observed staff supporting people with their mobility aids. Staff knew what to do in an emergency and had received training in fire safety and manual handling.

Regular safety checks were being completed by qualified external contractors. Maintenance checks were being completed by onsite maintenance staff and there was clear fire safety signage.

There was a business continuity plan which highlighted what to do in an emergency. At the time of the inspection, work was being completed to strengthen the flood defences around the property to prevent the risk of flooding.

The provider had recently received their fire safety risk assessment and plans were in place to address actions.

The provider did not always make sure staff received effective support and supervision. Some staff did not have regular supervisions, and some staff confirmed this. Leaders said they had identified this and put a schedule in place for the future.

Staff were not always safely recruited. For example, we identified 3 staff members who had gaps in their employment history which had not been explored. Leaders told us the staff had been recruited into the service prior to them taking ownership. Gaps in people’s employments means the provider could not assure themselves staff were recruited safely and in line with policy and legislation.

However, people told us staff were well trained, and staff confirmed they had received adequate training to support people effectively. There were several long-standing staff members who had knowledge and experience of working in a care home setting.

People provided positive comments about the staff such as, “The staff are summed up as 100% good.” People said there were enough staff available to meet their needs. Staff told us they thought there was adequate staffing levels in the service and did not feel rushed in the role except when there were emergencies, which did not happen often. We observed there were enough staff to meet people’s needs and staff responded in a timely way.

Staff completed health questionnaires, references had been sought, and Disclosure Barring Certificates (DBS) had been appropriately applied for. Since taking over ownership, leaders had ensured staff had contracts of employment in place.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

We observed the service was clean, tidy and free from strong odours. Overall, people and their relatives provided positive comments about the cleanliness. One person said, “The cleaning is of a good standard.”There were cleaning schedules which was monitored by leaders. Staff had a good understanding of infection, prevention and control (IPC) and had received training.

There was enough personal protective equipment available throughout the service. We saw communal hand sanitisers throughout the home. The laundry room was visibly clean, including high areas. There was an IPC policy in place.

However, we identified one pull cord was missing from a communal bathroom which could cause some IPC concerns around hygiene. We also saw the sluice room did not have a lock on the door, and we were able to access the room. A sluice room is used to dispose human waste and soiled items safely and prevents the spread of infections within a service. The provider took action during the assessment to rectify these concerns.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

There were some concerns identified in relation to medicines governance. For example, documentation of allergies on medicines administration records (MAR) was inconsistent, with missing entries noted for some people. Stock running balances, particularly on ‘as and when’ (PRN) medicines and those for people self-administering, were also variable. Some PRN protocols lacked a countersignature or clear dose instructions. This meant the information was not always clear for staff to follow and could lead to an increased risk of medicine errors.

While medicines were stored securely, temperature monitoring records for medicine fridges and rooms showed gaps across several months. This meant the provider could not be assured medicines were fit for purpose at the point of administration to people because temperatures had not been monitored consistently.

Emollient cream risk assessments were not consistently in place for people. This meant the risks associated with paraffin-based emollients had not always been assessed for staff to follow and manage risks associated with fire.

However, staff were knowledgeable about medicines processes. Medicines were administered as prescribed, with MAR charts showing no missed doses of regular or high-risk medications.

People’s medicines were usually available in sufficient quantities, reducing the risk of running out. Care plans for medicines were found to be completed to an acceptable standard.

Controlled drugs were securely stored, and self-administration arrangements were in place for 2 people, supported by suitable risk assessments.

People who required specialised arrangements such as insulin or liquid formulations were known to staff and their medicine needs were managed appropriately.

Medicines audits were carried out each month and a broader audit every six months. We saw evidence of staff receiving annual medicines training supported by a competency assessment.