Bridge House Residential Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

People’s needs were assessed and included consideration of their physical and mental health. We received a mixed response from people and their relatives about their involvement in the development and on-going review of their plan.The relative of one person told us, “No one spoke to us and we were not involved in any assessments.”

The provider independently recognised that some care plans lacked detail around people’s preferences and social history. They had appointed a ‘care plan champion’ to gather the information required and input the person-centred element in people’s care plans.

The local authority was in the process of re-assessing people’s needs and also providing additional information for care plans. Those people who needed or wished to move to alternative placements were assisted to do so.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Care plans outlined people’s physical and healthcare needs. Appropriate referrals were made where further advice and support was needed to help meet people’s dietary needs.

The provider worked closely with the Speech and Language Team (SALT) and Dieticians. Upon speaking with kitchen staff, it was evident they had a good understanding of people’s dietary needs. There was a clear system in place to update the kitchen staff of changes. The kitchen also provided people with a range of alternative meals when they did not like the menu choices.

If there were concerns for people’s weight, they were monitored weekly. There were few instances in which people had been weighed twice on the same day, however results varied, therefore the accuracy of the record keeping is unknown. In addition, further weight decreases were noted for some people, however, it was unclear from care plans if further action had been taken to address this.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

At present the local authority were not making placements at the home. Managers were working with the local authority to address the areas of improvement required.

When discussing how care and domestic staff work together a staff member explained they were “A perfect team, everyone steps in to help each other". Daily handover records were helping to improve communication across the team and co-ordinate support needs and appointments planned each day. Some staff said at times they felt under pressure from senior managers and guidance provided was sometimes inconsistent. One staff member told us, “We need a manager who is going to stay and help us and improve things”.

There was consistent input from external professionals who worked with provider. The GP visited once a week to monitor people’s health. Care files evidenced the GP had made onward referrals to Dieticans and Speech and Language Therapists where there were concerns. There were also weekly visits from a Physiotherapist, who supported people to engage in tailored exercises to improve their mobility. Upon speaking to families most reported they were kept well informed of any changes to their loved one’s health. One stating “They keep in touch with me if there are any changes in medication or if [relative] is poorly, they stay in touch. [Relative] has fallen out of bed twice and so now they have an hospital bed and sensor mat to reduce the risk."

The provider did not always support people to manage their health and well-being, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

People were supported to maintain a varied and healthy diet. Some of the meal choices, particularly for those people who required a modified diet, needed improving. At the time of our visit managers told us they were in the process of reviewing the menus with the lead cook, to further improve this. Further training and development was also to be provided for the kitchen team. We saw a picture menu board was being introduced in the dining room, to assist people in making meal choices and fresh fruit has been added to the tea trolly as an optional snack.

Upon inspecting the building, it was noted that people did not have access to call bells and sensor mats were used in each room. This meant people able to make use of a call bell were not enabled to maximise their independence.

At the time of the inspection people were often left for long periods without meaningful stimulation and activity. The provider was in the process of recruiting an activities co-ordinator to improve this and add enrichment to people’s lives. In the interim a carer was offering their support 2 days a week. One staff member report, “[Staff] is doing 2 days as activities co-ordinator. Bingo, craft work, painting and 1-1 for those who do not like to join in groups or prefer their own company. Christmas and Easter we have performers. Nursery children come. Physio visits every Tuesday.”

Daily flash meetings were undertaken, during these meetings person’s physical and emotional well-being was discussed. Upon reviewing the minutes of these meetings, it was noted that actions taken to address concerns with people’s emotional well-being was not always recorded, as it was with physical health concerns.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive andconsistent, or that they met both clinical expectations and the expectations of people themselves.

We witnessed people were supported to remain hydrated throughout the day. We observed a regular tea trolley which offered a good selection of beverages and snacks. This was reflected in people’s fluid charts.

One family member reported “Since being there, 14 months, [Relative] has gone from a size 16 to a size 10. Staff help people to eat but others just encourage and that’s not enough for some of them”. When reviewing care plans, we found that people at risk of weight loss were weighed weekly. Some people weight had continued to decrease despite increased monitoring and input from dieticians. Care plans offered some guidance but did not state when reassessments from SALT or the dietician should be requested, if concerns continued.

Observations were completed over lunch time. People who were being supported with eating their meals had positive interactions and were given the time they required to enjoy their food. However, others needing encouragement were not always offered the prompts they required to finish their meal.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

Where people were being deprived of the liberty, lawful authorisations were in place. Where necessary people were supported by independent advocates so their rights were protected. Staff told us they had completed Mental Capacity Act and Deprivation of Liberty Safeguards training. There had also been a more recent drive for staff to attend more comprehensive face to face training.

People’s care records included mental capacity assessment relating to their ability to give informed consent about specific decisions, such as day-to-day care and administration of medication. Where people lacked capacity, care plans contained details of family members holding Deputyship or Lasting Power of Attorney. This served as a prompt for staff to involve people’s family in decision making in line with the Best Interest process.