Bridge House Care Home

Bridge House is a residential care home providing personal and nursing care to up to 66 older people. At the time of the inspection there were 45 people living at the home. The care home accommodates people across three separate floors, each of which has separate adapted facilities. The first floor supports people who need residential support. The second floor supports people who need nursing care. The third floor supports people who are living with dementia.

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

Some improvements were needed to make sure the management of medicines was safe. The service had systems and processes in place to do this and some improvements were made during the inspection. Staff were recruited safely and there were enough staff to meet people’s needs. Issues around high agency use were being addressed by the appointment of new staff. The service was working with the authorities to address some safeguarding issues and were actively learning from previous issues. Staff received safeguarding training and knew what to do if they thought someone was at risk. All but 1 of the people and relatives we spoke with felt safe at the home. One person said, “I have been happy here from Day 1, I do feel well looked after.” A relative told us when asked if they thought their family member family member was safe, “Yes, I do, (person) is well looked after and has not had any accidents. (Person) is nervous and anxious and is more settled than (person) has ever been.” Risks to people’s health and safety had been assessed and new systems were being introduced to improve risk management. Some people told us staff did not always respond to the nurse call system in a timely way.

We have made a recommendation about the management of some medicines.

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.

Since the last inspection there had been a number of management changes at the service. The current manager had been in post for approximately 4 months. People told us they had seen improvements since the new manager started. One said, “I am much more confident with the new manager.” The manager and nominated individual recognised that auditing of quality and safety was not up to date in all areas. They had introduced a new schedule to address this, but it was not operational at the time of the inspection.

People gave mixed responses about how involved they felt in their relative’s care. Some said they had been involved whilst others had not. Similarly, some people felt they were asked for their opinions of the service whilst others did not. People did appreciate the opportunity to be involved in meetings about the service. Staff were engaging with health and social care professionals to improve the quality of service.

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 good (published 4 March 2022). The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key questions safe and well led.

For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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. Risks associated with infection outbreaks were generally well managed, but some improvement was needed.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Bridge House is a residential care home providing personal and nursing care to up to 66 older people. At the time of the inspection there were 48 people living at the home. The care home accommodates people across three separate floors, each of which has separate adapted facilities. The first floor supports people who need residential support. The second floor supports people who need nursing care. The third floor supports people who are living with dementia.

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

Significant improvements had been made since the last inspection which had resulted in better outcomes for people using the service.

Medicines were managed safely. People received the right medicine at the right time.

People received safe care. Risk assessments were in place to support staff in knowing how to manage any identified risks to people. Staff knew the processes to follow to manage any allegations of abuse.

Systems were in place to manage the risk of spread of infection within the home.

Care records detailed information about people’s needs and preferences and people were involved in making decisions about their care. People’s health care and nutritional needs were well managed.

People were complimentary of the care and support they, or their relatives received.

Recruitment processes ensured staff were suitable to work in the care service. Staffing had been reviewed and new positions had been introduced to make sure people’s needs were met effectively. Staff were trained and said they felt well supported in their roles. They had the required skills to meet people’s needs.

The service was well run. There was a new management team in place who worked together to ensure improvements were made and sustained. They promoted good practice and worked alongside the staff supporting them and making sure the quality of care was maintained.

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 inadequate (published 28 September 2021).

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.

This service has been in Special Measures since September 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced inspection of this service on 18/08/2021 and 06/09/2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve. The breaches were in relation to Safe care and treatment, Safeguarding service users from abuse and improper treatment, Staffing and Good governance

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Caring and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Inadequate to Good. This is based on the findings at this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Bridge House is a residential care home providing personal and nursing care to up to 66 older people. At the time of the inspection there were 65 people living at the home. The care home accommodates people across three separate floors, each of which has separate adapted facilities. The first floor supports people who need residential support. The second floor supports people who need nursing care. The third floor supports people who are living with dementia.

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

People were not safe. They were at risk of harm as the provider had not assessed and mitigated the risks to people. Medicines were not managed safely. There were multiple instances when people had not been given their prescribed medicine.

There were not enough staff to keep people safe. We saw staff were kind and caring but they were rushed, and routines were often task orientated. People were regularly left on their own for long periods of time and there were limited opportunities for meaningful social interactions. Staff were not always able to respond quickly where people needed care, support or comfort. People were not always protected from abuse or neglect.

People had not been protected from the spread of infection because robust systems and processes were not in place.

The home was not well-led. Systems to assess, monitor and improve the service were not effective. Governance systems were ineffective, and the provider did not have oversight of key safety issues.

People and relatives were generally positive about the staff who cared for them and their experiences of the service. Staff were recruited safely.

The home was well maintained. The living environment was attractive and spacious and incorporated open communal spaces and leisure facilities such as a roof top garden, cinema room and hair dressing salon.

The provider was responsive to inspection findings and responded and acted during and after the inspection and shared detailed plans to improve their systems and processes. The registered manager left the service before the inspection was concluded. The provider kept us up to date with interim management arrangements for the home.

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 31 December 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding concerns and complaints from relatives about the quality of the management and care provided at Bridge House. As a result, we undertook a focused inspection to review the key questions of safe, caring and well-led.

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.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report. We met with the provider after the first day of the inspection. We discussed our concerns about the risk to people due to inadequate medicines and risk management. The provider sent us an action plan and assured us they would take action to mitigate the urgent risks.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to medicines management, the assessment and management of risk, infection prevention and control, safeguarding, staffing and good governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Special Measures: The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Bridge House is a residential care home providing personal and nursing care for up to 66 older people, some of who are living with dementia. At the time of the inspection there were 44 people using the service.

Accommodation is provided in single ensuite rooms on three separate floors each of which have communal areas. Nursing care is provided to people on the second floor. Additional communal space is provided on the ground floor and outside space includes a roof garden.

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

At this inspection we found improvements had been made in many areas. However, we remained concerned about medicines management which was not always safe. For example, some people had not received their medicines as they had run out. Following the inspection the provider told us they had taken action to address the issues we identified.

People were happy with the care and support they received and told us they felt safe. When we asked one person what made them feel safe they replied, “I’ve just bedded in! Never in my life have I slept well but here I just get into bed and I’m off in 5 minutes. I sleep so well. That tells you.”

Staff were aware of risks to people and knew how to keep them safe. There were enough staff to meet people’s needs without rushing and the use of agency staff had reduced which people felt was positive. Staff knew people’s needs and how to meet them, although people’s care needs and preferences were not always fully reflected in their care records.

Staff were recruited safely, well trained and had the required skills to meet people’s needs. Staff told us they felt well supported.

The home was clean and well maintained. The environment was decorated and furnished to a high standard with adaptations made to help people find their way around. There were ongoing improvements to make the environment more dementia friendly.

People and relatives praised the staff for their kindness and compassion. One person said, “The staff are good, they do their best to help you. They don’t come in and preach to you.” We saw staff treated people with respect and maintained their privacy and dignity. People enjoyed a range of activities and events, including going out on trips. People had access to healthcare services. Most people were happy with the choice and quality of the food and said they received plenty to eat and drink.

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.

A new registered manager had been appointed since the last inspection and everyone spoke highly of this individual. Leadership and management had improved, which resulted in better outcomes for people and an increase in staff morale. More thorough quality assurance systems had been implemented and issues were actioned, although the auditing of medicines needed to improve. The provider recognised the improvements made need to be sustained and developed further to ensure the service is consistently well-led.

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 inadequate (published 7 May 2019). There were multiple breaches of regulation and we took enforcement action. At this inspection we found improvements had been made, although one breach remained in relation to medicines.

This service has been in Special Measures since 7 May 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We have found evidence that the provider needs to make improvements in relation to medicine management. Please see the safe section of this full report.

Enforcement

We have identified a breach in relation to medicines management at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

People’s experience of using this service:

People were not safe and did not receive support when they requested it. The call bell system had not worked for a long time so when people tried to use their buzzer staff did not respond. Risks to individuals were not assessed and appropriately managed. Medicines were not managed safely. Recruitment practices were not robust and did not ensure staff were suitable to work at Bridge House Care Home. Lessons were not learned when things went wrong.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice. Training and supervision was variable which meant staff were not equipped with the relevant knowledge and skills. People’s experience of the meals varied. Everyone enjoyed breakfast and most enjoyed lunch; tea-time meals were repetitive. Staff did not understand how to meet people’s specialist dietary requirements. Systems were in place to support people with their health needs. People lived in a very pleasant environment. All areas were maintained and decorated to a very high standard.

Most people felt well cared for. However, some people experienced poor care and staff did not always respect people’s privacy, dignity and confidentiality. People were supported to maintain relationships with family and friends; visitors were welcomed.

People’s care needs were not identified, recorded, and highlighted in support plans. Some staff did not know how to use the electronic care recording systems and information about people was recorded incorrectly. The provider had a procedure for investigating complaints but this was not always followed in practice.

The provider's quality management systems were not effective and did not identify areas where the service had to improve. The provider and registered manager did not demonstrate they understood their responsibilities and accountability. People who used the service, relatives and staff had opportunity to share their views and put forward ideas. However, these were not always acted upon.

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

Rating at last inspection: This is the first inspection.

Why we inspected: This was a planned inspection based on the recommended inspection timescales.

Follow up: We referred our concerns to the local safeguarding authority and asked the provider to send us evidence of improvements and action points. They voluntarily suspended admissions to the service. This was used when decisions were made about our regulatory response.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, it will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.”

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.