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Inspection carried out on 7 March 2019

During a routine inspection

About the service:

Bridgewood Mews is a 22-bedded purpose-built property and provides nursing care and support for younger adults with complex physical and mental health needs. At the time of our inspection there were 20 people using the service

People’s experience of using this service:

¿ People felt safe at the home which they said was well-staffed. They had personalised care plans and chose how they wanted staff to meet their individual needs.

¿ Staff supported people with their cultural needs, including those relating to language, ethnicity and religion.

¿ Staff had additional training to ensure they understood the complex needs of some of the people using the service. They met people’s healthcare needs in conjunction with external specialists.

¿ People had plenty to eat and drink. They were offered food from different cultures including Asian, Caribbean, and English and chose what they liked.

¿ The home was purpose built and all areas were accessible to people with limited mobility. It was clean, tidy and fresh throughout. Improvements to the decoration were ongoing.

¿ The staff were kind and respectful. They knew people well and understood what was important to them.

¿ Members of the staff team used Sign Language and people had the support of external communication specialists to ensure their voices were heard.

¿ People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

¿ People led active lives and staff supported them to take part in a wide range of one-to-one and group activities.

¿ The staff worked as a team, supporting each other, and ensuring they were there for people, regardless of their specific roles at the home.

¿ People had the opportunity to provide feedback on the home at one-to-one and group meetings, and through the service users council and the provider’s regular quality surveys.

¿ The provider and managers carried out audits of all aspects of the service to ensure it was running well and providing people with safe, high-quality care and support.

Rating at last inspection

At the last inspection we rated this service Good (report published on 8 September 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Inspection carried out on 30 June 2016

During a routine inspection

Our inspection was unannounced and took place on 30 June 2016.Bridgewood Mews is registered to provide accommodation, nursing and personal care for up to 20 people, who are mainly younger adults with complex physical needs. The service also specialises in the care of people with Huntington’s disease. At the time of our inspection 18 people were using the service.

The service was last inspected on the 20th and 21st April 2015 where we found that the provider was not meeting the regulations we assessed associated with the Health and Social Care Act 2008 and they were deemed to require improvement. The areas requiring improvement were safe, as medicines were not always administered, stored or handled safely. Also people’s health and support needs were not always updated of reviewed in a timely manner. In the area of well-led the manager and providers own quality assurance systems had failed to identify issues that were found during the previous inspection. We found that steps had been taken to rectify these issues.

The manager was not registered with us as is required by law, but was new in post and was in the process of becoming registered. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

A suitable amount of staff were on duty with the skills, experience and training in order to meet people’s needs. People told us that they were kept safe and that staff interacted with them in a positive manner.

People were given their medicine correctly and the recording of medicines administered to people was clear and concise. Medicines were stored and disposed of as they should be. People’s health needs were addressed and GP and hospital appointments were attended.

Systems for updating and reviewing risk assessments and care plans to reflect people’s level of support needs and any potential related risks were effective.

People were asked their consent prior to care being carried out, where people were unable to communicate agreements were in place. Staff had a good understanding of the Mental Capacity Act 2005.

People were supported to take sufficient food and drinks, and choices were encouraged wherever possible. People also felt that staff listened to them and acknowledged their needs and preferences.

Staff maintained people’s privacy and dignity, and people were encouraged to be as independent as possible.

People were able to raise any concerns they had and felt confident they would be acted upon.

People, their relatives and staff spoke positively about the approachable nature and leadership skills of the registered manager. Structures for supervision, allowing staff to understand their roles, and responsibilities were in place. The provider gave the registered manager support and visited the home regularly. Audits were carried out regularly in order for any trends to be identified and acted upon if required.

Notifications were sent to us as required, so we were able to see how incidents had been responded to.

Inspection carried out on 20 & 21 April 2015

During a routine inspection

Bridgewood Mews is registered to accommodate and provide nursing and personal care to a maximum 20 people. People who live there may have a variety of complex physical health needs, including Huntingdon’s disease. At the time of our inspection 18 people were using the service.

Our inspection was unannounced and took place on the 20 and 21 April 2015. At our last inspection in July 2014 the provider was meeting all the requirements of the regulations and was given a ‘Good’ overall rating.

The manager was registered with us as is required by law. 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.

We found that medicines management within the service were unsafe. The provider had failed to handle, store and administer prescribed medicines in such a way as to maintain and promote peoples good health. You can see what action we told the provider to take at the back of the full version of the report.

There were systems in place to protect people from abuse and harm. Staff had a clear knowledge of how to protect people and understood their responsibilities for reporting any incidents, accidents or issues of concern.

The provider ensured that there were suitable number of staff on duty with the skills, experience and training in order to meet people’s needs at all times.

Staff had access to a range of training to provide them with the level of skills and knowledge to deliver care safely and efficiently. Staff were encouraged by the provider to undertake training in addition to the standard level of training they were routinely provided with.

The provider supported the rights of people subject to a Deprivation of Liberties Safeguard (DoLS). Staff were able to give an account of what this meant when supporting the person and how they complied with the terms of the authorisation.

People were supported to take food and drinks in sufficient quantities to prevent malnutrition and dehydration.

People’s cultural and spiritual needs had been considered and we saw that people were supported to fulfil these.

Staff interacted with people in a positive manner and used a variety of communication methods to establish their consent and/or understanding. Staff maintained people’s privacy and dignity whilst encouraging them to remain as independent as possible.

Care plans contained information about people’s abilities, preferences and support needs. However, we saw in some records they had not been updated and reviewed in a manner that gave the reader absolute clarity about the persons current needs.

People were involved in a range of activities, both within the service and in the community, centred on people’s individual abilities and interests.

Systems were in place for people and their relatives to raise their concerns or complaints.

Structures for supervision allowing staff to understand their roles and responsibilities were in place.

Staff told us the registered manager actively promoted an open culture amongst them and made information available to them to raise concerns or whistle blow.

The registered manager and the provider undertook regular checks on the quality and safety of the service. However, the issues we found during our inspection had not been identified through the providers own quality assurance systems.

Inspection carried out on 8 and 10 July 2014

During a routine inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This was an unannounced inspection when the provider did not know we were visiting.

Bridgewood Mews Nursing Home provides accommodation for up to 20 younger people who have complex health needs and or physical disability. There were 20 people living at the home when we visited. The home had a registered manager and a recently appointed deputy manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

We spoke to people who lived at the home and their relatives. They told us that they were happy with the care provided and the staff who delivered support. It was apparent to us during our inspection that staff were attentive, polite and sought consent before providing care and support. Staff knocked on people’s doors before entering their rooms and asked for permission before providing any personal care to people; using curtains or blinds and offering space for people to talk in private.

We found that people’s health and care needs were assessed, and care planned and delivered in a consistent way. From the three people’s plans of care we looked at, we found that the information and guidance provided to staff was detailed and clear, and in formats that people could understand. People had regular access to a range of health and social care professionals which included general practitioners, dentists, chiropodists and opticians. We saw that people had individualised social plans on their care file which recorded their interests, hobbies and preferences. 

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We saw that the provider had proper policies and procedures in relation to the MCA and DoLS. We saw from the records we looked at that where people lacked the capacity to make decisions for themselves, that ‘best interest’ meetings were held. These were for topics such as; finances, medicines and other issues which affected people’s safety. This ensured that the provider protected people’s rights to express how they wanted their care to be delivered and receive care which met their needs.

We found that the home followed safe recruitment practices. We checked records and saw that all new employees were appropriately checked through robust recruitment processes to ensure that they were suitable to work with vulnerable people. We found that the staff at this nursing home were well trained, knowledgeable and had a good knowledge of the people they were caring for, including their preferences and personal histories.

The home’s safeguarding procedures were robust and there were arrangements in place to deal with foreseeable emergencies. People were safe and their health and welfare needs were being met because there were sufficient numbers of staff on duty who had appropriate skills and experience.

People were encouraged to make their views known about the care, treatment and support they received at the home. This was achieved by holding group meetings, sending out survey questionnaire forms and seeking ‘one to one’ feedback (via key workers) on a variety of topics that were important to people who lived at the home.

A check of records showed that the provider had an effective system to regularly assess and monitor the quality of service that people received at the home and a system to manage and report accidents and incidents. Findings from these systems were analysed and used to make improvements.

Inspection carried out on 22 May 2013

During a routine inspection

On the day of our inspection 18 people were living at the home. People had various levels of verbal communication skills due to their health condition. We observed their experiences to support our inspection.

We spoke with four members of staff and the manager about the service. We looked at the care records for six people who lived at the home. We spoke with two people and four relatives. People said they were happy with the care provided.

People were involved in decisions about their care and were asked for their consent before care was given. Where people did not have full mental capacity to consent, care and treatment was provided in their best interests.

Records were person centred. Staff had information to support people with their needs in the way they preferred.

People were involved in a variety of interesting activities. One person said, “I go to the church and the shops. We are going to Blackpool on holiday. The staff are nice.”

People had a choice of meals and the support they needed to ensure that they had sufficient food and drink to keep them healthy.

Staff received training and support so they could safely care for people in the way that they chose. Systems were in place so that people were safeguarded from the risk of harm.

At our last inspection, recommendations were made for improvements in the assessment and monitoring of the quality of the service. Actions had been taken to address these issues. Robust audit systems were in place.

Inspection carried out on 3 January 2013

During a routine inspection

There were 18 people living in the home on the day of our inspection. We spoke with two people living at the home and observed what life was like living at the home for another four people on the day of our inspection. We also spoke with four relatives, the manager and regional manager and five members of staff to find out their views about the service provided.

People, wherever possible, were involved in their care. Where people were unable to be involved in decisions about their care, we saw that multi-disciplinary teams were involved and the person’s relatives and / or representative. One relative told us, “I feel I have a good relationship with the staff team and they keep me informed of my relative’s well being”.

People were given opportunities to take part in activities so that they had a meaningful lifestyle. One person told us, “I did some painting yesterday which I enjoyed”.

We saw that the organisation had provided staff with a safeguarding policy and had provided staff training. This meant that staff had the information they needed and they knew what action to take if they had any concerns or there was an allegation of abuse.

We saw that there were sufficient staff employed to support people and to meet their needs.

We saw that questionaires were given to people, their relatives and / or representatives but saw there was no analysis of the findings to measure people’s satisfaction with the service provided.

Inspection carried out on 3 January 2012

During a routine inspection

We spoke with five people who used the service, two relatives and four members of staff.

A number of people who lived at Bridgewood Mews have difficulty expressing their wishes clearly. We therefore spent time observing what life was like for people who lived at the home.

From our observations we saw numerous staff actively engage with people. They instigated conversations and discussed things that were of interest to individual people. None of the staff we observed waited for people to speak to them; instead they sought to engage in conversation, and continued if there was limited response from the person they were speaking to. The way staff spoke to people encouraged a positive response. Staff treated people respectfully and in a dignified manner. Through discussion with staff we heard that they had good understanding of what was important for people living at Bridgewood Mews.

We spoke with relatives of some people who lived at the home and they told us that they have had involvement in care planning. This involvement was on behalf of the people they represented, as they were not always able to express their views independently.

Our observations, discussions with people who lived at the home, their relatives and staff indicated that overall care plans reflected people’s needs, wishes and preferences. We saw that records showed regular and appropriate access to community health services. Relatives we spoke with also confirmed that this was the case.

Staff had a good understanding of people’s individual preferences and what their likes and dislikes were in respect of daily activity. They also told us how certain individual activities promoted people’s spiritual and cultural needs.

The two relatives we spoke with told us they are aware of who to contact if they had concerns. They were aware they could contact social services. Both told us that there has been improvement in the standard of care due to their raising issues with management in the past. A recent safeguarding alert that was reported to us and the local social services demonstrated that staff had whistle blown on poor practice. The management took quick action to protect people on this occasion and as a result promoted staff confidence and their expectation that people should be kept safe.

We spoke with staff about the arrangements in place to support them to do their job well. Without exception the staff told us that they were well supported, that training was good and the management were approachable.

One staff member said that “Training is spot on”. They said that they have received all the basic training to help they do their job safely and if they required specific training they could ask, and usually receive this.

We did identify that some staff could benefit from guidance related to cerebral shunts (specific health conditions that people had), this as some people who lived at the home have these fitted.

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