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Inspection carried out on 24 April 2019

During a routine inspection

About the service: St Bridget’s Care Centre is registered to provide accommodation and personal care for up to 12 people. At the time of this inspection there were 8 people living at the home all of whom were over 65.

People’s experience of using this service:

People gave positive feedback about the home and had no concerns about safety. The staff knew people well and knew how they preferred their care and support to be given.

Staff were knowledgeable about the systems and processes in place to safeguard people from potential abuse and knew what action to take if they suspected people were at risk of abuse.

Staff treated people with kindness, respect and dignity, whilst at the same time promoting people’s independence. People received personalised care and, which was planned and delivered to meet their needs.

The home was in good decorative order and people had access to well-maintained gardens.

People were happy with the standards of meals provided.

Staff were supported with regular supervision, annual appraisals and relevant training courses.

The service worked closely with health care professionals to ensure people received the support they needed to manage their health needs.

People were provided with access to activities and to access the community with outings to places of interest.

People’s medicines were being managed safely, stored securely and administered by trained staff.

People and their relatives were involved in assessing and planning the care and support they received.

People and relatives knew how to make a complaint and felt confident they would be listened to if they needed to raise any concerns.

There was a system of audits and spot checks in place to ensure the service received ongoing monitoring to review the quality of the service provided.

People had confidence in the management team and felt the service provided clear leadership.

Rating at last inspection:

The last inspection report was published on 26 October 2016, when the service was rated as good.

Why we inspected:

This was a planned scheduled comprehensive inspection.

Follow up:

We will continue to monitor this service and plan to inspect in line with our inspection schedule for those services rated as Good.

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

Inspection carried out on 6 October 2016

During a routine inspection

This unannounced comprehensive inspection took place on 6 and 7 October 2016.

St Bridgets Care Centre is registered to provide accommodation, care and support for up to 12 people. At the time of the inspection there were nine people living at the home. There was a registered manager employed at the service. 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.’

Our previous inspection of the home, completed in April 2015, identified two breaches of the regulations. These related to; failing to assess, monitor and mitigate the risks relating to the health, safety and welfare of people and a breach relating to people’s privacy in regard to their records.

We told the provider that they must make improvements to protect people from these risks and asked them to send us an action plan stating what improvements they would make. The provider sent us the completed action plan as requested.

At this inspection we found the provider had made the required improvements to meet the regulations that had been breached in the previous inspection. This inspection found the provider was compliant with the regulations.

People were being well cared for and told us they felt safe living at the home. Staff were aware of what constituted abuse and the actions they should take if they suspected abuse. Relevant checks were undertaken before new staff started working at the service which ensured they were safe to work with vulnerable adults.

Staff had the right skills and training to support people appropriately. People told us they felt there were enough staff available on each shift to care for them well. Staff felt well supported by the management team and received regular supervision sessions and appraisals.

Pre-admission assessments were completed prior to people moving into the home. People’s risks were assessed and plans developed to ensure care was provided safely. Accidents and incidents were monitored to ensure any trends were identified to enable action to be taken to safeguard people.

Medicines were managed safely, handled appropriately and stored securely. Medicine Administration Records (MAR) were signed to indicate people’s prescribed medicine had been given. Medicines were stored securely and at the correct temperatures. There was a system of checks in place to ensure any medicine errors were quickly identified.

People were referred to health care professionals as required. Equipment such as hoists, pressure relieving mattresses and cushions were readily available, well maintained and used safely by staff in accordance with people’s risk assessments.

The manager was aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS). These safeguards aim to protect people living in care homes and hospitals from being inappropriately deprived of their liberty. These safeguards can only be used when there is no other way of supporting a person safely.

Staff had an understanding of the Mental Capacity Act 2005 (2005) and how it applied to their work. Records showed appropriate mental capacity assessments had been carried out. Where some people were unable to consent to living in a care home, appropriate applications for a Deprivation of Liberty Safeguard (DoLs) had been made. Staff were able to explain to us how they provided people with choices and how they encouraged people to make their own decisions.

Staff ensured people’s privacy and dignity was protected. People received personalised care from staff who were responsive to their needs and knew them well. Staff created a relaxed atmosphere which resulted in a calm and happy culture in the home.

People knew how to make a complaint and felt confident they would be listene

Inspection carried out on 17 & 20 April 2015

During a routine inspection

This unannounced comprehensive inspection took place on 17 and 20 April 2015.

St Bridgets Care Centre provides accommodation, care and support for up to 12 people. At the time of the inspection there were nine people living at the home. The provider had 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.’

Our previous inspection of the home on 30 April 2014 identified breaches of the regulations relating to; care and welfare of people, assessing and monitoring the quality of service provision and the completion of people’s personal records.

We told the provider that they must make improvements to protect people from the risks of unsafe care and asked them to send us an action plan stating what improvements they would make. We received the action plan on 30 August 2014.

At this inspection we found the provider had made the required improvements to meet the regulations that we found had been breached in the inspection that took place on 30 April 2014.

However we also found two of breaches 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 this report.

Although overall the service was safe we found some areas where the safety of the people living there could be compromised. The carpet in the communal areas which included, the reception area, corridors and first floor landing had become worn and stretched and was rucked in places. This could pose a trip hazard for people and was a risk to their health and safety. Wardrobes were not secured to the wall which meant they could topple over and compromise the health and safety of people living at St Bridgets.

People told us they felt safe at the home. Staff knew how to identify, prevent and report abuse. People were relaxed with members of staff and told us they found the staff to be kind, friendly and helpful. Support was offered in accordance with people’s wishes and their privacy was protected. People received personal care and support in a personalised way. Staff knew people well and understood their physical and personal care needs and treated them with dignity and respect.

Medicines were handled appropriately, stored securely and managed and disposed of safely.

People’s needs were assessed and care was planned and delivered to meet their needs. Records showed an assessment of need had been carried out to ensure risks to people’s health were managed. Risks of people falling or developing pressure injuries were managed effectively. People and their relatives were involved in assessing and planning the care and support they received. People were referred to health care professionals as required. Equipment such as hoists and pressure relieving mattresses and cushions were readily available, well maintained and used safely by staff in accordance with people’s risk assessments.

There was a system in place to ensure staff received their required training courses and refresher training as required. Staff were knowledgeable about their role and spoke positively regarding the induction and training they received.

There were enough staff to meet people’s needs and the provider had a system in place to ensure staff had the appropriate skills and experience to support people appropriately. Staff felt well supported by the management team and received regular supervision sessions and appraisals. The  manager told us they were in the process of recruiting one additional member of staff.

The manager was aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS). These safeguards aim to protect people living in care homes and hospitals from being inappropriately deprived of their liberty. These safeguards can only be used when there is no other way of supporting a person safely.

Staff sought consent from people before providing care and followed relevant legislation to protect people’s rights and ensure decisions were made in their best interests.

Staff ensured people’s privacy was protected and they were cared for with compassion and kindness. People received personalised care from staff who were responsive to their needs and knew them well. Staff created a relaxed atmosphere which resulted in a calm and happy culture in the home.

People knew how to make a complaint and felt confident they would be listened to if they needed to raise concerns or queries. The provider sought feedback from people and changes were made if required.

People told us they felt the service was well led, with a clear management structure in place. People praised the management team and care staff stating, “It’s been excellent, nothing is too much trouble for the staff, everyone is so helpful and friendly”.

There were systems in place to drive the improvement of the safety and quality of the service. Analysis of accidents or incidents was undertaken so lessons could be learnt in order to minimise the likelihood of them reoccurring.

Inspection carried out on 30 April 2014

During a routine inspection

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

This is a summary of what we found-

Is the service caring?

People were treated with consideration and respect. We spoke with three people and one person’s relative. One person told us, “The staff are very good. The way we are treated is very good.” Another person said, “If you don’t look very happy they question it.” One person’s relative commented, “The staff have always been very friendly.” We saw that people were treated sensitively. For example, we saw staff kneeling down to a person’s eye level and provide reassurance regarding their medicines. The provider may find it useful to note that we observed staff assisting people to eat while wearing disposable gloves. The registered manager told us that this practice was carried out to reduce the risk of infection. However, no specific risks of infection had been identified with helping these people to eat and this practice did not respect the people’s dignity.

People’s privacy was respected. One person told us, “The staff will knock on the door before coming in. They always close the curtains when they are helping me.” Another person said, “The staff knock on the door before they come in. We have enough privacy.” We saw that people were supported with their personal care needs behind closed doors and staff knocked on people’s doors before entering their rooms. The provider may find it useful to note that a list of people and the day they had a shower was publically displayed in the home. This did not respect people’s privacy.

Is the service responsive?

People could access the services of healthcare professionals as necessary. One person told us, “The staff phone the doctor if we need them. The district nurses have also been in before.” Another person said, “They are on the ball here with the doctor. The doctor comes here we never have to go to the surgery. If I ask to see the doctor they get one for me.” A person’s relative commented, “The manager will call the doctor if she needs to. Mum is taken to outpatients appointments by the home.” We found that contacts with healthcare professionals were documented in people’s care records, for example, visits by the chiropodist and GP.

Is the service safe?

We looked at four people’s care records and found that their needs were not always accurately assessed. For example, people’s risk of malnutrition was assessed using a nationally recognised tool. This tool requires the assessor to consider weight loss in comparison to the person’s usual weight over a period of three to six months to calculate the degree of risk. None of the assessments we looked at had considered any weight loss over this period and there was no recording of the person’s usual or pre illness weight. One person had lost a significant amount of weight in the previous month, however, the assessment concluded that they were at a medium risk of malnutrition rather than a high risk as the assessment had not been accurately completed. This meant that there was a risk that people at risk of malnutrition were not identified.

People’s moving and handling needs were not adequately assessed. We looked at people’s care records in relation to moving and handling. These records did not demonstrate a sufficient assessment, such as consideration of the type and size of equipment required to assist the person to move safely. The registered manager told us that the hoist slings allocated to people did not have any identifying markings on them as staff could visually recognise each person’s equipment. We found that the hoist sling in one person’s bedroom was marked with a name of a person who did not occupy the room. Another person had a large sized hoist sling which the registered manager said was due to their epilepsy rather than their size. However, there was no assessment which detailed that this was recommended by a healthcare professional.

People told us that there were sufficient staff to meet their needs. We spoke with three people and one person’s relative. One person told us, “Normally they are very quick when I press the bell.” Another person said, “I think there are enough staff. They have got short now and again, but they just get on and do extra.” A person’s relative commented, “I’ve never noticed there being a shortage of staff. As far as I know, when mum presses her buzzer there is no unnecessary delay.”

People’s care records did not always contain sufficient information to protect people from the risks of unsafe or inappropriate care.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The provider had made a number of applications under these safeguards.

Is the service effective?

People’s risk of skin damage was assessed and care was planned to reduce this risk. We found that an assessment of people’s risk of skin damage had been carried out. We found that where people were assessed as being at risk of skin damage a plan was in place to reduce this risk. For example, one person had a pressure-relieving mattress which was set at a level which was consistent with their weight and was regularly checked.

People told us that care was delivered to meet their needs. We spoke with three people and one person’s relative. One person told us, “They always look after me. The staff are brilliant.” Another person said, “The staff are very nice and very good. They are there to help us and they do help us. You will have to go a long way to beat this place.” A person’s relative commented, “They are meeting mum’s needs.” We spoke with three staff who were aware of people’s needs.

Is the service well led?

People’s views of the service were sought. We spoke with three people and one person’s relative. One person told us, “The manager is very attentive. I see her quite a bit. She is always there if I want her.” Another person said, “We asked for our supper later, so they now bring it at 9pm rather than 8pm.” We looked at the minutes of two recent ‘residents meetings’. We found that people’s views were sought during these meetings on a range of topics such as activities and the menu. The registered manager told us that they were preparing a survey for people to complete.

The provider did not have an effective system to monitor the quality and accuracy of people’s care records. The registered manager told us that they monitored the quality of people’s care records by completing monthly evaluations. However, this monitoring had not identified issues such as the lack of adequate assessment of people’s moving and handling needs or the absence of detail in people’s repositioning charts.

Audits of practice were not always effective. For example, we looked at records relating to a health and safety audit. The audit looked at moving and handling, among other health and safety topics. The audit stated that the correct size of hoist slings were used and detailed in people’s care records. However, we found that this was not the case in all of the people’s care records we looked at.

Trends in accidents and incidents were considered on a three monthly basis. We found that the provider had a system to review all accidents and incidents on a three monthly basis in order to identify any trends. We looked at records for the previous six months. No trends had been identified during this period.

Inspection carried out on 9 July 2013

During an inspection to make sure that the improvements required had been made

The name of a registered manager that appears in this report was not in post or managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

At the time of our inspection there were nine people living at St Bridget’s Care Centre. We spoke with four of them in order to obtain their views about the service the home provided.

We also spoke with five visiting relatives and five members of staff in order to obtain their views about the home.

People we spoke with who lived at the home all expressed satisfaction with the support they received. They told us their needs were met, food provided for them was good and the home was kept clean They said the home’s manager asked them for their opinions about the service they received.

Nationally recognised assessment methods or tools were not always used to identify risks to people’s health and welfare and care plans had not always been put in place to ensure people’s needs were met.

There were appropriate arrangements in place for people who lacked capacity to make decisions for themselves. Arrangements were also in place that ensured people’s nutrition and hydration needs were met; they were protected from the risk of infections; medication prescribed for them was managed safely; individuals recruited to work in the home were suitable; and the quality of the service was monitored.

Inspection carried out on 7 March 2013

During a routine inspection

At the time of our visit there were 7 people living at the home. We spoke with staff, three people living at the home and two people’s relatives. The owner told us that they no longer provide nursing care.

The senior care coordinator told us that some people living at the home had been assessed as not having capacity to make choices and decisions which affected their lives.

During our observation we saw that staff interacted well with people when they were supporting them. We saw that staff were knowledgeable about people's needs and preferences. We found staff were respectful and maintained people's dignity, privacy and independence. For example staff knocked on people's door before entering and they checked on how they wanted their care to be provided before doing so.

We spoke to staff and reviewed records which showed us that people were protected from abuse and that their care was planned and delivered in a respectful and safe way. One individual told us they were “quite satisfied with there care”.

People told us the food was good and people could choose what they wanted to eat, when they went to bed and time they got up in the morning.

People told us they felt safe and knew who to speak to if they had any complaints. They told us there were organised activities once a week they could join in with if they wanted.

We found evidence of unsafe arrangements that were in place in relation to the recording and administration of medicine.

During an inspection to make sure that the improvements required had been made

This report is a review and summary of all what we found on the four inspection visits made to the home during 2011. It shows what improvements the service had made over that period of time.

We did not speak to people using the services provided by St Bridget’s Nursing Home in order to carry out this review. We looked at all the information we held about the service arising from our inspection visits to the home.

The first of our four inspection visits made to the home occurred on 26 April 2011. A further two inspection visits took place on 21 and 24 October 2011. The last inspection visit was on 29 December 2011.

Inspection carried out on 29 December 2011

During an inspection to make sure that the improvements required had been made

We carried out an inspection visit at St Bridget’s Nursing Home on 29 December 2011. We did this in order to follow up a warning notice that we had issued to the registered provider (home owner) on 5 December 2011.

The warning notice had been issued because of our findings during our inspection of the home on 21 October 2011 and 24 October 2011. On that occasion we found that records about the care and treatment people living in the home needed were not being kept according to the law.

Following that inspection we sent the registered provider a warning notice. This told them that we would take legal action if the records about the care provided to people living in the home were not kept properly. We told the registered provider that such records were to be kept up to date. We also said that they had to contain sufficient information to enable staff working in the home to provide the help people needed, safely and appropriately.

At our inspection on 21 and 24 October 2011 we also looked at the management of the home and concluded that it was not being managed by a person with the necessary skills and experience. As we were only following up the warning notice on this occasion we did not review the home's management arrangements. Consequently our report states (above) that the home is not meeting one or more essential standards and improvements are needed.

At the time of our inspection on 29 December 2011 there were eight people living in the home. We looked at the records for three people. This was to check whether the records were now being kept in accordance with the law.

We spoke with the person who was managing the home at the time and with a registered nurse and two care assistants who were on duty. We also spoke with some people who were living in the home.

The majority of the people living at St Bridget’s were too physically or mentally frail to talk with us about the service the home provided. We were however able to speak with two people who could tell us what they thought about the care and treatment they received. They told us that they were well looked after. They said they had particularly enjoyed the Christmas celebrations that had been organised in the home. They told us that they received all the help and support they required from the home’s staff. They said they were involved in planning the care that they received. They also said the home looked after medication that had been prescribed for them and they were given it when they needed it.

Inspection carried out on 21 October 2011

During an inspection to make sure that the improvements required had been made

We carried out inspection visits at St Bridget’s Nursing Home on 21 and 24 October 2011. We did this in order to see what action had been taken by the registered provider to address concerns that found when we inspected the home on 26 April 2011.

We were able to speak with two people about their experiences of living at St Bridget’s Nursing Home. At the time of our visit there were ten people living at the home but most were too physically or mentally frail to express opinions about the care and treatment that they received.

We were also able to speak with a visiting GP and two visiting relatives to obtain their views about the service provided by St Bridget’s Nursing Home.

The two people living in the home who we spoke with told us that they received all the help from the home’s staff that they needed. They said that they were given their prescribed medicines when they needed them. They told us that minor repairs, redecoration and improvement to the premises were “going on all the time” and that the building and their bedrooms were kept clean. They said that in their opinion the acting manager made sure that everyone was happy, was doing a good job and that everything seemed to run smoothly.

Visitors told us that they were involved in important decisions about the care that their relatives received. They also said that the premises were well maintained and that hygiene standards were “good”. They told us that the home’s acting manager organised it “well” and that they were “great”.

A visiting GP who spoke with us said that the home had done really well looking after their patient who had very complex needs.

Inspection carried out on 26 April 2011

During a routine inspection

St Bridget’s Nursing Home is registered to accommodate up to 12 people, but at the time of our visit which was part of a planned review of compliance 10 people were living there. We spoke to most of the people living in the home and also some of their visiting relatives and friends to obtain their views about the service provided by St Bridget’s Nursing Home.

People told us that, the staff and food were “good”, the accommodation was “comfortable”. They said that arrangements were made for healthcare professionals to visit when they were required. They also told us that there were no rigid routines and that they could exercise choice about a range of everyday matters, such as getting up and going to bed. They said that they felt safe and knew who to speak to if they had any complaints. They told us that the premises were kept clean and that that there were organised activities that they could join in if they wanted to.