Archived: Bridgewood House

Bridgewood House is a residential care home providing personal and nursing care to people aged 65 and over, some of whom may be living with dementia. The home is registered to provide care to 70 people. At the time of the inspection there were 53 people using the service.

The home is a modern purpose-built building covering three floors. There are six units, two on each floor, named after local parks and the home refers to each unit as a 'park'. One park provided nursing care and the other five parks provided residential care with no nursing. We have referred to the units as ‘parks’ throughout this report.

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

Records relating to people’s care was inconsistent across the home. Some people’s risks assessments provided staff with clear guidance on how to minimise the risks. However other risk assessments failed to document risks. Accidents and incidents were not adequately recorded. Medicines were not well-managed and we could not be assured that people were receiving their medicines safely.

Complaints were not well documented and often failed to note outcomes. Relatives told us they did not have faith in the complaints’ procedure.

Management oversight, including auditing processes did not identify the issues found at this inspection. There was a failure to address the issues found at the last inspection around managing risk, medicines management and good governance, and a failure to implement changes to improve the quality of care.

People told us that they felt safe living at Bridgewood House. They said that staff were kind and caring and treated them with dignity and respect. Whilst we observed some caring interactions between staff and people, we also observed some interactions which indicated that people were not always treated with dignity and respect.

There were a wide range of activities for people and people were actively encouraged to go out on day trips or to day centres. People told us that they were happy with the activities that were offered at the home.

People had a choice of food and were consulted about what they wanted to eat each day. People were provided with food that was culturally relevant to them.

Staff told us they felt supported in their role and received regular supervision. However, there had been no annual staff appraisals completed.

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.

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 3 August 2018). The service remains rated as requires improvement.

This service has now been rated requires improvement for the last two consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve the quality of care. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified three breaches of regulation around safe care and treatment, complaints and good governance. The failings found are detailed in the main body of the report.

With regards to the breaches for regulations 12 (safe care and treatment) and 16 (complaints), please see the action we have told the provider to take at the end of this report.

We are taking enforcement action and will report on this when it is completed. Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

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

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This was the first inspection of this service since they registered with the Care Quality Commission (CQC) in March 2017. This inspection took place on 24, 25 and 26 April and 8 May 2018.

There was a registered manager in post. 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 received their medicines on time. However, arrangements for covert and ‘as needed medicines’ were not consistently in place. Staff that administered medicines had not received medicines competency assessments since the home opened. Equipment used for medicines administration was not always cleaned after use.

Risk assessments were inconsistent and did not always identify people’s personal risks and there was a lack of guidance for staff on how to mitigate known risks. However, there were also examples of good risk assessments.

Staff did not have easy access to people’s Personal Evacuation Plans (PEEP) as these had not been printed.

Staff were not receiving regular supervision to support them in their role and assess their working practice. However, staff told us that they felt supported. Training was not always provided in a timely manner.

Staff knew people well and understood their needs. However, care plans were not person centred and failed to contain enough information about people to reflect their needs.

People were given prompt and empathetic care at the end of their lives. Arrangements were in place to ensure people were as comfortable as possible.

The home understood that activities and stimulation were important for people. A wide range of activities was in place and the home had two activities coordinators. However, the management team understood that this was an area that required further development.

People told us that they felt safe within the service and were well supported by staff. We saw positive and friendly interactions between staff and people. People were treated with dignity and respect.

Procedures relating to safeguarding people from harm were in place and staff understood what to do and who to report it to if people were at risk of harm. Staff had received safeguarding training.

The home was aware of infection control procedures when working with people. Staff were supplied with gloves and aprons to ensure that people were safe.

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 were well supported when moving between services. Appropriate assessments and support for both people and relatives were in place.

People were encouraged to have a healthy diet. People were given choice around what food they wanted to eat and staff knew what each person enjoyed. Snacks and drinks were readily available. People and relatives were complimentary about the food.

People and relatives were involved in planning their care. Relatives were positive about the input they were able to have.

People were able to personalise their rooms and the home was working towards making the environment more homely as care staff had recognised this area requiring further improvement.

People and relatives knew how to make a complaint or raise concerns. Where complaints had been received, these had been dealt with appropriately.

There were systems in place to identify maintenance issues. Staff were aware of how to report and follow up maintenance.

Relatives felt that there was good communication between the home and themselves.

There were auditing systems in place to monitor the quality of care. However, these did not always pick up issues identified during the inspection.

We identified breaches of regulations 12 and 17 and 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.