Bridlington Lodge

Bridlington Lodge is a residential care home providing personal care for up to 20 young adults or older people some of which may be living with dementia. At the time of our inspection there were 19 people living at the service.

People’s experience of using this service and what we found

The environment did not always support people to remain safe. Communal areas displayed hazards such as trailing electrical wires and broken window seals. People did not always receive their medicines as prescribed. The service was not always clean, and some areas did not always support effective infection control measures.

Systems and process to monitor the quality of the service were not always effective. They did not reflect the concerns we found in relation to the environment or management of people’s medicines.

Quality assurance audits completed around people’s care and wellbeing were detailed and effective in identifying improvements and monitoring these. Staff felt supported by the manager and the manager was keen to address the concerns found during the inspection.

People told us they were happy living at the service. People and their relatives told us there was enough staff and staff were kind and caring.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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

Rating at last inspection

The last rating for this service was requires improvement (12 November 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last 2 consecutive inspections.

Why we inspected

We received concerns in relation to fire safety at the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has remained requires improvement based on the findings of this inspection. 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bridlington Lodge on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to environment, infection control, management of medicines and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

People's experience of using this service and what we found

People were happy and felt safe living at the service. People were relaxed in the company of their care workers. The majority of relatives made positive comments about people's safety and how the service was managed. Care workers understood how to prevent infectious diseases and were proactive in managing infection control.

The registered manager and care workers understood their responsibilities and had received training to enable them to identify and respond appropriately to safeguarding concerns. Risk assessments identified areas of risk and detailed the measures in place to reduce them. Environmental risk assessments were reviewed to maintain people’s safety and equipment serviced in line with legal requirements. We observed care workers were able to meet people’s needs in a timely manner. Incidents had been recorded in detail and managed appropriately.

Within the context of the COVID-19 infection risk, people were supported to have maximum choice and control of their lives and care workers supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported best practice.

Care workers felt the registered manager was approachable and supportive. They were confident about using the whistle blowing processes in place. The registered manager understood their regulatory responsibilities. The provider sought feedback from people and their relatives or advocates to ensure their views were considered. The registered manager engaged regularly with external health professionals to ensure people received the right support when needed. Regular audits were being completed to drive improvements in the service.

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

Rating at last inspection

The last rating for this service was requires improvement (published 16 May 2019) 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 we found improvements had been made and the provider was no longer in breach of regulations.

The criminal investigation (referred to in the report of 16 May 2019) was concluded with no action taken.

Why we inspected

We undertook this targeted inspection due to concerns we had received. The complaint highlighted concerns in relation to the management and recording of safeguarding concerns and other incidents, care worker and service user engagement, checks of equipment, management of infection prevention and control practices around continence care. During the inspection we checked whether the service was compliant in relation to Regulation 12 (Safe Care and Treatment) and Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service: Some people had been exposed to risk within the environment; some areas of the service were unsafe. When safety equipment was required this was not always in working order. Assessments had not always been carried out or followed to ensure people’s safety. Risk management was not always effective and placed people at risk of harm. Lessons were not always learnt following accidents and incidents.

Systems had failed to effectively identify and mitigate risks to people. Auditing systems had failed to identify when required equipment was not in working order such as door sensors.

Staff had been recruited safely and staffing levels were adequate to meet people's needs. Infection control procedures had been followed and the service was clean and tidy.

People and staff were engaged with the running of the service. Staff felt supported by the registered manager.

Rating at last inspection: At the last inspection this service was rated good. (Published on 27 March 2018).

Why we inspected: We were notified about two serious incidents in which two people using the service were seriously injured. We looked at risks associated with this. Further information is in the full report. This was a focused inspection which looked only at the domains of safe and well-led.

Enforcement: The provider was found to be in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, namely Regulation 12, Safe care and treatment and Regulation 17, Good governance. You can see what action we told the provider to take at the back of the full version of the report.

Follow up: The rating of this service has deteriorated to requires improvement. We have asked the provider to send us an action plan to indicate how they are going to address the shortfalls in regulation that we have identified at this inspection. We will review this action plan and continue to monitor all intelligence received about the service to ensure the next planned inspection is scheduled accordingly. We will also work with partner agencies to monitor the service.

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

During our previous inspection in January 2016, we found improvements were required to provide safe access to the outside garden areas. At this inspection we checked and found the provider had implemented improvements to ensure the outside garden areas were safe to access.

People were protected from avoidable harm and abuse. Systems and processes were maintained to record, evaluate and action any outcomes where safeguarding concerns had been raised.

Assessments of risks associated with people’s care and support and for their environment had been completed and associated support plans implemented to ensure people received safe care and support without undue restrictions in place.

The provider maintained safe staffing levels and recruitment included pre-employment checks to ensure people were of suitable character to provide people with personal care and support.

Systems and processes ensured safe management of medicines and infection control.

People received appropriate care and support to meet their individual needs because staff were supported to have the skills, knowledge and supervision they needed to carry out their roles.

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.

Staff understood the importance of building caring relationships with people, paying attention to people’s well-being, privacy, dignity and independence.

The provider equipped staff with the skills and knowledge to appreciate and respond to the principles of equality and diversity. The provider ensured everybody received care and support that reflected their wishes and preferences.

People’s support plans continued to be person-centred. Staff supported people to live as they choose and to enjoy individual activities and trips out to the sea front.

Systems and processes were in place to support people should they need to raise a complaint.

The provider sought feedback and input to improve the service and lives of people living at the home and to encourage participation in the running of their care provision.

A quality assurance system remained effective with oversight at provider level. Further evaluation of the service was discussed with the registered manager to provide transparency and to celebrate successes and identify areas for improvement.

Further information is in the detailed findings below.

Bridlington Lodge is registered to provide accommodation and personal care to up to 20 people. The service supports people over the age of 18, older people and people living with dementia.

The registered provider is required to have a registered manager and the manager in post was registered with the Care Quality Commission (CQC) in December 2015. 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 told us that they felt safe living at the home. We found that staff had a good knowledge of how to keep people safe from harm and there were enough staff to meet people’s needs. Staff had been employed following appropriate recruitment and selection processes and we found that the recording and administration of medicines was being managed appropriately in the service.

Some people who used the service were subject to a level of supervision and control that amounted to a deprivation of their liberty; the registered manager had completed a standard authorisation application for each person and these being reviewed by the supervisory body of the local authority. This meant there were adequate systems in place to keep people safe and protect them from unlawful control or restraint.

People told us that they, and their families, had been included in planning and agreeing to the care provided. We saw that people had an individual plan, detailing the support they needed and how they wanted this to be provided. People had risk assessments in their care files to help minimise risks whilst still supporting people to make choices and decisions.

We saw that staff were knowledgeable about supporting people with anxiety and distressed behaviours and they were able to tell us about the techniques they used to reassure people when these behaviours occurred. However, we found the management plans in people’s care files did not always reflect the individualised support being given. Therefore, new staff members might find the lack of information meant they could not deliver appropriate support, to meet the person’s needs.

People had access to external gardens, but we identified that uneven paving slabs and a low garden wall could present trip hazards to people using the service.

People were supported to maintain their independence and control over their lives. All of the people we spoke with said they were well cared for. They told us staff went out of their way to care for them and all said that it was a lovely place to live. People spoken with said staff were caring and they were happy with the care they received. They had access to community facilities and most participated in the activities provided in the service.

Staff received a range of training opportunities and told us they were supported so they could deliver effective care; this included staff supervision, appraisals and staff meetings.

There was a manager in post who was registered with the Care Quality Commission. People felt the home was well run and they were happy there.

The registered manager monitored the quality of the service, supported the staff team and ensured that people who used the service were able to make suggestions and raise concerns. We saw that the registered provider had introduced a new management system for the service, which included more robust health and safety and quality assurance documentation including audits and risk assessments.