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Inspection carried out on 25 August 2017

During a routine inspection

Bourne Bridge House is a residential home which provides care for people living with profound learning disabilities and/or autism. Some of the people cared for at the home also have physical disabilities. The home is situated in a rural setting about four miles from the village of Witheridge in mid Devon. The home is a converted three-sided farmhouse which surrounds a fully enclosed courtyard garden. The original property has been split into four accommodation units, three of which are two storeys. Office accommodation is provided within the main building.

At the last inspection, carried out in August and September 2015, the service was rated good overall, although we found that the home needed to make some improvement to ensure people were kept safe. We found a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because some risk assessments and care plans were not fully up to date.

At this inspection we found the service remained good. The service had made improvements to their care records and these now reflected people’s risks, needs and preferences. Care plans described how staff should support people to meet their needs. There were detailed personal descriptions of people and the care they required. Staff were very knowledgeable about people and were able to communicate with them in a number of different ways. This included using sign language as well as recognising each person’s body language. Daily notes in care records showed that staff followed the care plans, which were reviewed regularly.

People were relaxed and happy with staff, laughing and chatting with them. Staff knew people’s histories and families well. Staff showed real care and compassion to support people maintain relationships with their relatives. This included accompanying them to other parts of the country to go to family events as well as supporting people at times of bereavement.

People experienced effective care that promoted their health and wellbeing. Medicines were administered safely. Staff worked with health professionals to ensure people received the care and treatment they needed in a timely manner. People were kept safe by staff who understood their responsibilities to safeguard vulnerable adults.

The home had been adapted to ensure people with different support needs were provided with private spaces and independence. Food was freshly prepared and people were encouraged to have meals of their choice. People were also supported to have sufficient drinks to keep them hydrated. People were involved in activities both in the home and in the community. People’s preferences and abilities were taken into account when supporting them to enjoy their daily lives.

The service has 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 registered manager was supported by a deputy manager. Both of them worked closely with staff and people in the service. There were sufficient staff who had been recruited safely. Staff were supported with training, as well as supervision whilst working at Bourne Bridge House.

There were policies and procedures in place which ensured the smooth running of the service. The service worked within the requirements of the Mental Capacity Act 2005.

Inspection carried out on 28 July and 12 August 2015

During a routine inspection

The inspection took place on 28 July and 12 August 2015 and was unannounced. The service had been previously inspected in November 2013 and found compliant.

Bourne Bridge House provides accommodation with personal care for up to eight people over the age of 18 who have a diagnosis of a learning disability and/or autistic spectrum disorder. The home is located in a rural setting with four self-contained accommodation buildings, called Hazel, Beech, Bramble and Bourne Bridge set around a large grassed courtyard. Another building contained administration offices and a staff room. At the time of the inspection, six people lived at the home and one other person had respite care which was provided by the home on a regular basis.

The home had a manager who had been registered in the role with the Care Quality Commission since 2010. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers and nominated individuals, 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.

Prior to the inspection we had received information of concern about the care provided to one person. We found no evidence to substantiate the concern. However, we had not received a statutory notification about an incident which had occurred some months previously where the police had been involved. Subsequent to a discussion with the registered manager about this, we did receive a statutory notification.

People’s needs and risks were assessed and care plans were developed to support them to be as independent as possible. Daily notes reflected the care described in the care plan. Staff signed to say they had read the care plans. However, not all risk assessments and care plans were up to date, although the manager agreed to ensure that actions were taken to address this.

The service provided to people living at Bourne Bridge was delivered by a team of staff, who had been trained to support people with learning disabilities and who had in-depth knowledge of people’s needs and aspirations. Staff were supported to undertake training to help them in their role and received regular supervision.

Staff were recruited safely with disclosure barring service (DBS) checks and references taken up before a new member of staff started working at the home. Staff undertook an induction, including training and work shadowing, until they were assessed as able and confident enough to work with people on their own.

People said they liked living at Bourne Bridge House and found the staff kind. Relatives were very complimentary about the home and the staff who worked there. People were offered a wide choice of activities both in the home and in the community and chose what they wanted to do each day. These activities included swimming, creative arts, visits to places of interest as well as helping staff to prepare meals. Where needed, two staff would support people when they went out on trips. Staff communicated with people using a range of methods including the use of simple sign language and pictures to aid understanding.

Staff were aware of the Mental Capacity Act (2005) and the associated Deprivation of Liberty Safeguard (DoLS) requirements and took them into account when working with people. Applications for DoLS authorisations for each person living at the home had been submitted to the relevant local authority.

Medicines were stored, administered and recorded safely by staff who had received training in medicine administration. Audits of medicines were undertaken internally and also by the dispensing pharmacy who had not found any significant issues.

People were supported to have their health needs met by health and social care professionals including their GP and dentist. People were involved in how the home was run, including what activities were offered and what meals were prepared. People were supported to have a healthy balanced diet.

We found one breach of 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.

Inspection carried out on 8 November 2013

During a routine inspection

Bourne Bridge House provided a home for up to eight people. On the day of the inspection, there were six people living at the home and one person on a respite stay at weekends. People lived in either the main house or in adjoining cottages in the grounds. The home provided a home for life arrangement for people which gave them security that they could live at Bourne Bridge for as long as they chose.

Two people were out on the day of the inspection at a community skittles session and were then going out for lunch. We met with the other three people who were at home. One of these were about to go out to a swimming session. We spoke with another person who had chosen to stay at home. They showed us around their cottage, which included a kitchen, living room, bathroom and bedroom. Their bedroom had been personalised and we were told that it had been decorated to take account of the person’s chosen wall paper and individual preference of decoration.

Although people’s capacity to consent to their care and treatment was limited, we observed staff who gave people choice about what they did or what they chose to eat. People without verbal skills were able to make their wishes clear to staff and staff understood their needs. Best interest meetings were held regularly with people who knew the person well. Local advocates were used by people at the home to represent their views. People at the home had high and challenging behavioural needs. Staff were observed to know the people well. Staff worked on a ratio of one or two staff members to each person, which ensured individual needs were met and any risk reduced. People recognised and responded to staff in a comfortable manner.

We spoke with the acting manager who assisted us with the inspection and also spoke with four other members of staff. Staff said they enjoyed their work with people at the home and told us that ‘everyone was very supportive’ and that ‘we all work as a close team to support people living here’. New staff followed a full induction programme at the start of their employment. Staff told us that received ‘good’ training on a regular basis.

People who use the service, their family and advocates can be confident that personal records were accurate, up to date and confidential. We were told that the provider visited the home each month to conduct a monthly quality audit to ensure high standards were maintained throughout the home.

Inspection carried out on 26 March 2013

During a routine inspection

We looked at the care plans for all six people and other documentation. We observed people being supported by staff. We saw that people's privacy, dignity and independence was respected and that people's views and experiences were taken into account.

People supported told us they liked living at Bourne Bridge House. We found that people's needs had been assessed with plans developed to meet their needs. People experienced care, treatment and support that met their needs and protected their rights.

Staff were trained in safeguarding people and knew how to respond in the event of any abuse being suspected, witnessed or alleged. We found that people were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

Staff rotas, training records and observing staff supporting people demonstrated that there were enough qualified, skilled and experienced staff to meet people's needs. Staff told us "there's a lovely atmosphere here" and that the provider was "really supportive". We were also told by staff that "it's great knowing you're making a difference" and "I like seeing people enjoying doing things".

The provider had in place systems that sought people's views, took account of complaints and comments and learnt from investigations into accidents and incidents. This meant the provider had an effective system to assess and monitor the quality of service.

Inspection carried out on 20 March 2012

During a routine inspection

We carried out an inspection of this service on 20 March 2012 as part of our planned inspection programme. We spent time talking with two of the people who currently live at the service and had lunch with one other. We observed care for a small amount of time during this inspection. We spoke with five staff members and with the registered manager. We also looked at some key documents. These included care plans, risk assessments, records relating to accidents and incidents and audit of handling of personal monies. This helped us to better understand how well the home was run.

Two people we spoke with were able to tell us the sorts of things they had been doing or had plans to do in the future. These included trips out, regular art sessions, holidays and activities in and around the home. Both appeared relaxed comfortable and interacted well with the staff on duty. We met another person at lunchtime, who is newer to the service. They did not communicate with words, but their non verbal communication was relaxed and they appeared at ease in their dinning area and lounge. Two other people on site did not want to meet us as they find new people in their surroundings difficult to cope with. One other person was away at a hospital appointment.

We saw most of the houses, communal areas and some of the bedrooms. Each cottage is maintained to a high standard. There are some restrictions to where people could go without staff support, such as the kitchen. There were risk assessments in place to support this decision to protect people from possible dangers.

Staff that we spoke with were able to show they had a good understanding of people’s needs, ways of communicating and triggers that may cause them to feel more distressed and present with challenges. Staff told us they were well trained and supported to do their job.

Effective and comprehensive systems were in place to monitor the quality of care and support provided, including listening and acting upon the views of people living at Bourne Bridge House.

Outcome 1

What people told us

During this inspection we were able to talk with two people in some detail about their experiences of living at Bourne Bridge House. Both were able to tell us what sorts of things they enjoyed doing and what support they needed from staff.

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