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Inspection carried out on 4 February 2021

During an inspection looking at part of the service

Bridgwater Court provides accommodation with nursing and personal care for people in individual self-contained flats. The service is registered for up to nine people. At the time of this inspection there were nine people living at the home.

We found the following examples of good practice.

The provider had not had an outbreak of coronavirus within in the service. At the time of the inspection all residents and staff had tested negative. Seven of the nine residents had received their first coronavirus vaccination.

When staff came on shift, they checked their temperature and sanitised their hands on entering the building. At the time of our inspection staff were able to maintain social distance because people living at the service didn’t need close support with their personal care needs.

Staff had received training in infection control, including how to safely put on and take off personal protective equipment (PPE) such as face coverings, gloves and aprons (if needed). The registered manager carried out regular observations to check on good practice. We saw staff wearing masks and they described how they would change their PPE if supporting anyone who had coronavirus.

Due to the recent increase in coronavirus infections the provider had stopped all visitors coming into the home to reduce the risk of the virus entering the home. People were supported to go out safely by staff. One person chose to visit a friend for a walk.

People living in the home were deemed to have capacity and understood the importance of maintaining social distance in public and wearing masks. People had agreed to limit their usual activities in the community to remain safe. The provider had a policy and procedure in place to check visitors’ temperatures, ensure they sanitised their hands, wore PPE and maintained social distancing.

The registered manager told us they would isolate individuals in their flats should there be an outbreak of coronavirus. Regular testing was carried out, weekly PCR testing for staff and monthly testing for people living in the home, this was in line with coronavirus testing guidance. Two people living at the service refused to be tested. Staff also undertook a lateral flow test twice weekly.

One person had recently been admitted. They were tested on admission and supported to isolate in their flat for.

Inspection carried out on 11 October 2017

During a routine inspection

This inspection was unannounced and took place on 11 and 16 October 2017.

Bridgwater Court is a two storey modern property. It offers individual accommodation and care in single occupancy flats. The home is registered for up to 12 people who may have a Learning Disability and Mental Health difficulties. All of the flats are furnished to meet individual choices. There is a communal hallway which provides access to all the flats. The ground floor flats are accessible to those people who have mobility and access problems.

At the last inspection in March 2016 the service was rated Good. However two domains had been rated requires improvement and the service should have been rated as Requires Improvement overall. This inspection had been brought forward to check on the progress of the service. .

At this inspection we found the service remained Good.

At the last inspection people told us they did not feel safe, relatives said they felt staff were young and lacked experience. There was a high staff turnover and people lacked consistency of care. At this inspection everybody spoken with told us they felt safe living at Bridgwater Court both with other people living there and the staff team. We saw a successful recruitment programme had been carried out. This meant people were supported by a consistent staff team who knew them, well.

At the last inspection we found that although there were systems in place to monitor the quality of the service provided these were not being used effectively to drive improvement. People and relatives did not feel listened to. At this inspection we found people felt staff and management listened to them. The systems in place to monitor the quality of the service provided were being used to identify shortfalls and drive improvement.

There was not a registered manager in post, however an application for the manager to be registered with the Care Quality Commission had been submitted and was being processed. 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 felt safe at the home. They told us they trusted staff and knew other people living in the home well. One person said, “This is the place I feel safe and I don’t want to go anywhere else.”

There were systems and processes in place to minimise risks to people. These included a robust recruitment process and making sure staff knew how to recognise and report abuse. There were adequate numbers of staff available to meet people’s needs in a timely manner.

Staff supported people to manage risk through education and discussing risk with them. They agreed ways with people to enable them to manage their own risk enabling them to access the community safely.

People received effective support from staff who had the skills and knowledge to meet their needs. People told us they thought staff knew them well and understood their individual needs.

Staff received an in-depth induction before they worked with people. The induction included training in identifying behaviours that might challenge and how to recognise individual triggers.

Staff were passionate about ensuring people’s human rights were upheld and ensured their choices, decisions and goals were respected.

People received support from caring and kind staff. Staff were openly proud of the achievements people had made and clearly had a very good relationship with the people they supported.

The service was responsive and people were supported to make progress and achieve goals set by them so they could lead the life they aspired to. Staff looked at creative and innovative ways to ensure the support people received was responsive to their individual needs.

The service was well led. There were systems in

Inspection carried out on 8 March 2016

During a routine inspection

This inspection was unannounced and took place on 8 March 2016.

Bridgwater Court is a three storey modern property. It offers individual accommodation in single occupancy flats. Bridgewater Court is part of Community Therapeutic Services (CTS).

The home is registered for up to 12 people who have a Learning Disability and/or Mental Health difficulties difficulties and who may present behaviours which challenge the service being provided. There is a communal hallway which provides access to all the flats. The ground floor flats are accessible to people who may have mobility or access problems. At the time of the inspection there were nine people living there. We last inspected this service in February 2015.No concerns were raised at that inspection.

There is 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.

Although staff knew how to recognise and report abuse they felt they were not always able to keep people safe. People told us they did not always feel safe. Where allegations or concerns were brought to the providers attention they ensured issues were investigated

Staff told us and records confirmed all staff received training in how to recognise and report abuse. Staff we spoke with had a clear understanding of what may constitute abuse and to report it. Staff discussed how they had raised concerns regarding behaviours in the service. Measures were in place to address concerns raised by staff.

Staff had received training in aspects of safeguarding and they knew how to identify and report any concerns. Staff had received training, to enable them to effectively support each person’s mental and physical health needs. New staff received induction training before they began working with people. All staff received ongoing training including daily “bite sized” training at handovers.

Care plans contained risk assessments which outlined measures in place to enable people to maintain their independence with minimum risk to themselves and others. Behaviour support plans were in place for people who needed additional support when they were anxious or upset.

Staff knew how to protect the legal rights of people who did not have the capacity to make decisions for themselves. DoLS applications had been submitted where relevant. Staff understood the importance of seeking consent before carrying out care tasks. We observed staff seeking consent from people before carrying out any tasks for them.

People’s medicines were administered safely by staff who had received specific training and supervision to carry out the task. Medicines were stored and administered safely. We observed medicines being administered and found safe procedures were followed. People who managed their own medicines had the appropriate risk assessments in place.

People received the support they required to purchase food and drink of their choice and were encouraged to make healthy choices in nutrition and diets. People that needed additional support were supported to maintain good health. Food was seen to be prepared with the support of the staff members were needed other people were more independent. One person told us “I like to make really hot food. I will always add more spices as that is how I like to cook”.

People were able to take part in a range of activities according to their interests. During our inspection people went out to the shops or for walks or to see health professionals, they discussed their chosen activities. One person discussed how they are getting known in the community by people in coffee shops and how they were also getting to know people, and would now stop to say hello.Each person had a personal key to their flat.

Inspection carried out on 2, 11 and 12 February 2015

During a routine inspection

Bridgwater Court is a three storey modern property. It offers individual accommodation in single occupancy flats. The home is registered for up to 12 people who have a Learning Disability and/or Mental Health difficulties and who may present behaviours which challenge the service being provided. There is a communal hallway which provides access to all the flats. The ground floor flats are accessible to people who may have mobility or access problems.

This inspection took place on 2, 11 and 12 February 2015 and was unannounced.

There is a registered manager who is responsible for the home. 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 last inspected this service on 24 June 2014 and 3 July 2014. Following this inspection we asked the provider to make improvements in how they protected people from the risk of abuse and how they assessed the needs of people prior to them moving to the home to ensure they could be met.

Following the inspection in June and July 2014 the provider sent us an action plan to tell us the improvements they were going to make, which they would complete by December 2014. During this latest inspection we looked to see if these improvements had been made.

The service had made the required improvements since our last inspection. People’s safety had been improved; the provider now gave greater consideration to the impact of people’s behaviours on others living in the home. We saw comprehensive and detailed preparations had been made for one person who might come to live at the home. People who had already moved to the home had a detailed assessment which identified their background, wishes, preferences and support needs.

People said they felt the home was a safe place for them. They were able to take risks as part of their day to day lives. People said staff understood their needs and provided the care and support they needed. One person said “I like living in my flat; I’m happy here. It’s good fun sometimes.”

The service supported people with diverse lifestyles and care needs. People used many community facilities and were encouraged to be as independent as they could be. People said they were happy with the care they received. One person said “I wouldn’t want to move from here.”

People had one to one staffing and also received high levels of support from health and social care professionals, both from the provider’s own clinical team and externally. Staff provided care to people whose behaviour challenged the service provided in a supportive and planned way. One person said “When I’m like that staff give me time and space to calm down.”

People were involved in planning and reviewing their care and support; they spoke with staff if they had any problems or concerns. People knew how to make a formal complaint if they needed to but felt that issues could usually be resolved informally.

Staff had good knowledge of people including their needs and preferences. Communication throughout the staff team was good. Staff were well supported and well trained; there were good opportunities for on-going training and for obtaining additional qualifications. All staff spoken with said the training and support they received was “very good.”

There was a management structure in the home which provided clear lines of responsibility and accountability. The management team strived to provide the best level of care possible to people with complex needs. Staff had adopted the same ethos and this showed in the way they supported people.

There were effective quality assurance processes in place to monitor care and plan ongoing improvements. There were systems in place to share information and seek people’s views about the running of the home. One person’s relative confirmed communication was “two way.” They said the deputy manager and key workers kept them well informed.

Inspection carried out on 24 June and 3 July 2014

During an inspection in response to concerns

We had received information of concern about this service in relation to the behaviour of some people in the home and the risks posed to staff and other people in the home. Two adult social care inspectors and a specialist advisor carried out the inspection over two days. 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 safe?

� Is the service effective?

� Is the service caring?

� Is the service responsive?

� Is the service well led?

This is a summary of what we found:

Is the service safe?

Most people living in the home were safe and were supported by sufficient competent staff. The provider had installed systems to ensure the safety of the building and to improve the security of people living in the home.

Staff we spoke with were aware of the Mental Capacity Act 2005 and how to support people who were unable to make decisions for themselves. We saw examples of how they had involved other agencies in making decisions when someone lacked the capacity to make a decision for themselves. We saw examples of good practice for example when assisting someone to access healthcare.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. We found the location to be meeting the requirements of the Deprivation of Liberty Safeguards. People's rights were therefore properly recognised, respected and promoted.

The decision to offer a placement to a person was taken by the provider after a thorough assessment process. The process resulted in places being offered to people of different ages and with very different needs. We found the criteria for admission was not specific enough to consider the potential risks of service users to other people living in the home.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to carrying out an assessment of the needs of the service user and establishing any risks to themselves or others.

Is the service effective?

Most people received effective care and support. We saw the care plans and daily living notes for one person who had complex social and health needs. The positive actions of the manager and staff had prevented deterioration in the person�s health and improved their lifestyle.

Whilst most people flourished in the setting of Bridgwater Court for some it had not been a successful placement. At the time of the visit one person was preparing to be transferred to another service due to the breakdown of the placement. Another person had been assessed in preparation for a move to another service. One person�s behaviour had been affected by social interaction with others. Another person had been disturbed at night by the disruptive behaviour of others.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to planning and delivering care that meets people�s individual needs.

Is the service caring?

We talked with the manager and deputy manager and heard of the ways the managers and staff supported and cared for the individuals in the home. Each person was well known to the manager and deputy and they understood people�s needs. We found staff to be kind and caring. One person told us they were happy with the care they received and how much they �liked� the staff. This person told us they were able to make choices for themselves and were helped by staff to �do what I like�.

We heard and saw staff treating people with respect. A member of staff told us this was "a good place to work" and felt people's best interests, care and welfare were considered to be the main focus of the service.

Is the service responsive?

People received care that was responsive to their individual needs. The home had systems in place to plan and monitor people's individual care and support. For example one person needed to be active and participate in sporting activities. We met the member of staff who had recently been on two 22 mile bike rides with the person. Another person liked to go on long walks and these were arranged. Other people enjoyed more leisurely pursuits such as the opportunity to visit a cafe and have coffee and cake.

The service had acknowledged it was unable to meet the needs of two people in the home. They had arranged for them to have re-assessments of their needs and had supported them on their transfer to new placements.

Is the service well led?

There was a registered manager in place who had many years' experience of caring for people and managing a service. They were very knowledgeable about the needs of people in the home and led the staff in providing good standards of care.

There was a staffing structure in the home which gave clear lines of accountability and responsibility. There was always a senior member of staff on duty to offer advice and support to less experienced staff. During the period of time when there had been some disruptions in the home the manager and the deputy manager had worked additional hours to support staff and the people in the home.

The manager listened to people's views and action was taken to make sure suggestions were put in place where appropriate.

Inspection carried out on 30 May 2013

During a routine inspection

This was the first inspection of the service which was registered in April 2013. During our visit we spoke with two people who used the service, the provider and management and two members of staff.

We were told that people were happy living at Bridgwater Court. We saw there were interactions between people and staff, often sharing banter and jokes. We observed that staff were skilled in recognising and responding to people's needs whilst maintaining peoples� dignity.

The atmosphere in the home was relaxed and inclusive; we saw that people were making choices about their daily life. We were told �I am able to make choices about what I do and how I access the local community.�

We read the care records for four people which described the care and support they required and how staff should provide it. Staff spoken with had a very clear understanding of the support needs of people who lived in the home.

The care records showed that risk assessments were carried out and reviewed to protect people using the service and staff delivering the care and support.

We saw that the environment was comfortably furnished to individual tastes and the communal areas were well maintained.