Archived: The Bridgings Limited (Eston)

At the last inspection in January 2017 the service was rated Requires Improvement. We also identified a breach of regulation in relation to the safety of the premises and equipment. This was because tests of the fire alarm, emergency lighting and electrical installation had not been carried out by someone qualified to do so. We took action by requiring the provider to send us plans setting out how they would address this. When we returned for this latest inspection we found that action had been taken and the service was no longer in breach of regulation.

The Bridgings (Eston) is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our inspection 11 people with learning disabilities or autism were using the service.

The care service had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager in place. 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. The registered manager was also one of the owners and registered providers of the service.

Risks to people using the service – including from the premises and equipment – were assessed and monitored. Plans were in place to support people in emergency situations. The provider had systems in place to promote effective infection control. People’s medicines were managed safely. Policies and procedures were in place to safeguard people from abuse. The registered manager and provider monitored staffing levels to ensure they were sufficient to keep people safe. The provider’s recruitment processes reduced the risk of unsuitable staff being employed.

Staff received a wide range of mandatory training in order to support people effectively. Newly recruited staff were required to complete induction training before they could work with people unsupervised. Staff received regular supervisions and appraisals. Staff applied the principles of the Mental Capacity Act 2005 (MCA). People were supported to maintain a healthy diet and to take control of their own food and drink. People were supported to access external professionals to monitor and promote their health. The premises had been adapted to make them suitable for the people living there.

People spoke positively about staff at the service, describing them as kind and caring. People were treated with dignity and respect and promoted their independence. The registered manager was able to describe how advocacy services would be arranged should they be needed.

People told us staff provided them with the support they needed and wanted. Care plans were personalised and based on people’s support needs and preferences. People at the service were supported to access a wide range of activities and interests in the local community. The provider had a complaints policy in place, setting out how people could raise issues and explaining how they would be investigated. Staff received end of life care training, and policies and procedures were in place to support this should it be needed.

Staff spoke positively about the culture and values of the service. The registered manager told us about links they, people and staff had forged with the local community. The registered manager and provider carried out a number of quality assurance checks to monitor and improve standards at the service. Feedback was sought from people, relatives and external professionals. The registered manager had informed CQC of significant events in a timely way by submitting the required notifications. This meant we could check that appropriate action had been taken.

When we last inspected the service in January 2015 we found two breaches of regulations. Checks on water temperatures and fire alarms were not taking place as often as they should be and effective systems were not in place to ensure that regular auditing was undertaken. The registered provider wrote to us telling us what action they would be taking in relation to the breaches of regulation.

At this inspection on 19 January 2017 we found that the registered provider had followed their plan and legal requirements had been met.

The home had a registered manager. 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.

The service is registered to provide care and support for up to 12 adults with a learning disability. The service is a two-storey building close to local shops and amenities and on a main bus route into Middlesbrough. At the time of the inspection there were 10 people who used the service.

We found that checks of the fire alarm, electrical installation and emergency lighting had not been tested by someone who was competent to do so. This posed as a significant risk to people who used the service and others. The registered provider contacted us after the inspection and informed they were to take swift action to address this.

People were protected by the services approach to safeguarding and whistle blowing. People who used the service told us they felt safe and could tell staff if they were unhappy. People who used the service told us staff treated them well and they were happy with the care and service received. Staff were aware of safeguarding procedures, could describe what they would do if they thought somebody was being mistreated and said that management acted appropriately to any concerns brought to their attention.

There were sufficient staff on duty to meet the needs of people who used the service. We found staff had been recruited safely following the completion of appropriate checks.

Appropriate systems were in place for the management of medicines so that people received their medicines safely.

The registered manager told us if they employed any staff who didn’t have a care background then they would undertake The Care Certificate induction or alternatively commence an NVQ qualification in care. The Care Certificate is a set of standards that social care and health workers stick to in their daily working life. Staff were aware of their roles and responsibilities and had the skills, knowledge and experience to support people who used the service. We saw that staff had undertaken training considered to be mandatory by the service. This included: safeguarding, fire, health and safety, mental capacity and deprivation of liberty safeguards, nutrition awareness, medicines administration, infection control, people movement and first aid.

Staff had an understanding of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards and acted in the best interest of people they supported.

We saw that people were provided with a choice of healthy food and drinks, which helped to ensure that their nutritional needs were met.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks.

We saw positive interactions between people and staff and saw that staff treated people with dignity and respect. Staff were kind, caring, respectful, and interacted well with people. Observation of the staff showed that they knew the people very well and could anticipate their needs. People told us that they were happy and felt very well cared for.

People were encouraged and supported to engage in daily activities they enjoyed. Staff understood what was important to people, their personal histories and social networks so that they could support them in the way they preferred.

People’s needs were assessed and their care needs planned in a person centred way. We saw that risks identified with care and support had been identified and included within the care and support plans.

The registered provider had a system in place for responding to people’s concerns and complaints. People told us they knew how to complain and felt confident that staff would respond and take action to support them. People we spoke with did not raise any complaints or concerns about the service.

Systems in place to monitor the quality of the service provided. However, it was concerning that the registered provider had not ensured that a qualified and experienced tradesperson had undertaken the electrical testing and testing of the fire alarm.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we took at the back of the full version of this report.

We looked at three care records (27%). We saw that people were included in the assessment and management of their own care. We saw care plans were reviewed regularly. People's needs, wishes and preferences had been taken into account.

The home had a relaxed atmosphere and we could see that people were happy and well cared for.

We saw that people were involved with various health professionals appropriate to their needs and were supported to attend appointments.

Staff told us that that there was always enough staff on duty to care and support people who used the service. One person we spoke with told us, 'We have good staffing levels.' Another staff member told us, 'It's absolutely brilliant here. We have a really good staff team.'

Records were stored safely and securely, yet still accessible to staff when needed.

We observed staff interacting well with people and saw there was a warm and friendly atmosphere between people living and working at the home. We found that, where possible, people were encouraged to be independent. A number of people who used the service were out on placements on the day of the visit. We spoke to people as they returned to the home from their placements and they talked enthusiastically about their day. This contributed to maintaining people's welfare and promoting their wellbeing.

We found the premises that people, staff and visitors used were safe and suitable and that people were cared for by staff who were supported to deliver care safely and to an appropriate standard.

We found there was an effective complaints system in place.