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Bridge House Care Home Inadequate

Reports


Inspection carried out on 18 January 2021

During an inspection looking at part of the service

About the service

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

Inspection carried out on 8 October 2020

During an inspection looking at part of the service

About the service

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 specif

Inspection carried out on 21 November 2019

During a routine inspection

About the service

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.

Inspection carried out on 8 March 2017

During a routine inspection

This inspection took place on the 8 March 2017 and was unannounced.

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 state

Inspection carried out on 15 and 20 April 2015

During a routine inspection

This inspection took place on the 15 April and 20 April 2015 and was unannounced on both days.

Bridge House Care Home is owned by the Maria Mallaband Care Group. The service is registered to provide accommodation with personal care for up to 30 people. At the time of our inspection there were 22 people living at the service, some of whom are living with dementia. The majority of people were mobile and able live their lives independently. The accommodation is over two floors that are accessible by stairs and a passenger lift. There is an annexe that can accommodate three people who are very independent.

At the time of our visit a new manager was in post and had begun the process of submitting an application to register with the Care Quality Commission (CQC). The previous registered manager had been transferred to another service owned by the provider and was in the process of de-registering as the manager for Bridge House Care Home. 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 were at risk because there were inconsistencies in the systems and arrangements to protect people from the spread of infection. Appropriate standards of cleanliness were not being maintained. Infection control policies and procedures were in place; however, these had not always been followed. There were malodours in four bedrooms and a communal bathroom. The bedding and mattresses in two bedrooms were stained.

During this inspection we found that the provider had not always recruited staff safely. This put people at risk of receiving care from staff who may not be suitable to work with people in a caring environment. Documents required to ensure people are safe to work with vulnerable people had not been obtained in respect of prospective employees.

People could be at risk because of how staff were deployed. Some people and relatives remarked on how busy the staff were and told us staff really tried to do their best in often challenging situations. Some people told us they had to wait for a member of staff to be available if they wanted to have a bath or a shower, others told us they did not have to wait. Staff were satisfied that there were enough staff on duty to meet the needs of people. We have made a recommendation about this in our report.

The environment did not support the independence of people who had dementia as parts were poorly lit and there was a lack of signage in the key areas of the building including people’s bedroom doors.

People told us they felt safe living at the service. Staff had received training in relation to safeguarding adults and were able to describe the types of abuse and processes to be followed when reporting suspect or actual abuse.

Staff had received training and regular supervisions that helped them to perform their duties. They told us that they had completed induction prior to commencing their duties at the service.

Medicines were administered safely by staff and systems were in place for the recording and storage of medicines. People received their medicines as prescribed by their GP

People we spoke with were positive about the care they received and their consent was sought. People were positive about the caring nature of the home and all the people we spoke to consistently said that they would be happy to recommend the home. People told us that staff treated them with respect and attended to their personal care needs in private.

People’s care and health needs were assessed and they were able access to all healthcare professionals as and when they required.

People’s nutritional needs had been assessed and people were supported by staff to eat and drink as and when required. Not all the people we spoke with were complimentary about the way the food was always cooked. Some people told us that the meals were a set menu and the vegetables could do with more cooking time. They were not aware of the choices available to them. The menus we looked at provided a choice of meals and people were asked each morning to choose their preferred meal.

Documentation that enabled staff to support people and to record the care and treatment they had received was up to date and regularly reviewed. People had signed their care plans that signified they had been involved in writing and reviewing their plans of care. Peoples’ preferences, likes and dislikes were recorded and staff were knowledgeable about the care needs of people.

People and relatives told us they thought the service was well run and they were able to have open discussions with staff. People told us they were able to raise concerns and make complaints if they needed to.

We identified two breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

During a check to make sure that the improvements required had been made

We found that the provider had taken action to ensure that people�s care plans had been updated when their care needs changed. There was clear information about people�s medicines and pain assessment tools had been implemented. The provider had ensured that one type of care plan was used to record people�s needs in relation to incontinence. The home evacuation plan had been updated.

Inspection carried out on 29 October 2013

During a routine inspection

We spoke with two relatives who told us they were very happy with the care provided at the home. They said the staff knew people as individuals and knew what their preferences were. One relative told us �the staff here are wonderful and treat my relative kindly, they take care to make sure people get the things they like�. This meant staff knew about people�s preferences and were able to ensure their needs were met.

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.

Inspection carried out on 30 January 2013

During an inspection looking at part of the service

We spoke with people who used the service who told us they felt there had been improvements in the management of the service. All the people we spoke with said they felt well looked after. Comments included �I cannot tell you how wonderful and kind the staff are.� and �The girls are lovely. I could not manage without them.� One person told us the night staff were �very helpful and prompt in helping me.�

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.

Inspection carried out on 19 October 2012

During a routine inspection

We spoke with at least seven people using the service and without exception they all said that staff were kind, caring and did their best.

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.

During an inspection looking at part of the service

We did not, on this occasion, speak to people about this outcome.

Inspection carried out on 8 July 2011

During an inspection in response to concerns

People said they had opportunity for choice and autonomy in their daily lives. They were satisfied with arrangements for healthcare. They told us the home was always clean and hygienic. The majority were happy with their rooms though one person felt their room was too small. The same person said their bed was too high and this created difficulties when getting in and out of bed at night to use their en-suite facility. They told us they couldn't always wait for staff assistance as some were slow in responding to their call bell.

People were overall complimentary about staff, describing them as kind and caring. Some felt staff were overstretched, reporting long delays before receiving assistance with personal care at peak times. One person said they would like to have more baths but couldn't because staff were too busy.

People overall enjoyed the meals, stating the menu was varied with plenty of choice. One person said they would like to have suitable aids to support them in retaining as much independence as possible at mealtimes.

Reports under our old system of regulation (including those from before CQC was created)