Archived: Bridgewater House

Updated 21 January 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we could understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

There was one inspector.

Service and service type

Bridgewater House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager, but they were not registered with the Care Quality Commission. This means the provider alone is legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

The inspection was unannounced.

What we did before the inspection

We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.

We reviewed the information we held about the service and the service provider, including the previous inspection report. We looked at notifications we had received for this service. We sought feedback from the local authority and professionals who work with the service. Notifications are information about important events the service is required to send us by law. We used all of this information to plan our inspection.

During the inspection

People were not able to share their views of the service due to their complex communication and support needs. Therefore, we observed their experiences living at Bridgewater House and staff interactions with them. We spoke with the manager, the regional manager and with five staff members.

We reviewed a range of records. This included one person’s care plan, some health and safety records, daily records and medication records for everyone. We looked at two staff files in relation to recruitment.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at two people’s care plans, staff rotas, training records and a wide range of quality assurance records. We received feedback from five people’s relatives and four health and social care professionals.

Updated 21 January 2022

About the service

Bridgewater House is a care home providing accommodation and personal care for up to nine people with profound and multiple learning disabilities. At the time of our inspection, five people were living there. Accommodation was provided over three floors.

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

A new manager was appointed at the end of August 2021. They told us they would be applying for their registration with CQC shortly. The manager was aware there was a lot of work required to improve the service. There were several staff vacancies and a high use of bank and agency staff. The manager tried to ensure there were regular agency staff who knew people well, but this was not always the case. There was, however, always someone on duty who was trained to give emergency medicines.

The organisation had systems to monitor the service and the regional manager monitored progress with their action plan. Although we were told most areas of the action plan had been signed off as having been addressed, we found that this was not the case and further work was required.

Systems to ensure greater analysis was carried out in relation to daily records, people’s welfare and activities were needed. There was limited oversight of some people’s mealtime experience to ensure support was always person centred. We found an incident of potential abuse had not been reported to the Commission as is required.

All staff had received mandatory training. However, whilst permanent staff had received specific training to meet people’s complex needs, agency staff had not always received this, and the manager told us that some agency staff declined this training. People needed staff who knew them well and understood their needs so, particularly in the evenings and at night, people’s care had the potential to be compromised. In addition to ongoing recruitment, the home had increased the number of agencies used to secure more agency staff who would be willing to undertake appropriate training.

People’s relatives had confidence in the manager and the permanent staff. They were keen to see the home develop and move forward and recognised the potential to improve in all areas.

People were not always supported to have maximum choice and control of their lives. However, staff supported people 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.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

• Model of care and setting maximises people’s choice, control and independence.

Permanent and regular agency staff knew people well and understood how to support people safely. Staff wore their own clothes which did not identify them as support workers. Although there were enough staff on duty, staff who knew people well needed to stay on the premises, as these were also the designated drivers, people did not go out regularly. When health appointments were carried out, staff tried to include a café trip too. Due to staff vacancies, some things such as meal choices, activities and goal planning were not as actively promoted as they would have been if there was a full staff compliment.

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights.

Staff respected people’s dignity and privacy and when people requested/indicated they were uncomfortable or wanted a change of environment this was respected. There was always a staff presence in the lounge area, but the atmosphere was much livelier when there was staff who knew people well. People responded to banter with smiles. We saw that when people were supported by staff who knew them well, they were encouraged to make simple choices.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

Despite the size of the staff team, staff remained positive and felt supported. They knew what they wanted to achieve with people and felt motivated to do the best they could for them. They were positive the manager was doing all she could to increase the staff team so they could meet people’s needs appropriately.

Since our inspection additional managerial support was agreed to ensure that new staff received a thorough induction to the home and got to know people well, before working with them independently.

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

Rating at last inspection

The service was previously registered with CQC but became dormant whilst the building was extensively refurbished. During this time the organisation was part of a merger. The service reopened in April 2021 and this is the first inspection. The last rating for the service under the previous provider Aitch Care Homes (London) Limited, was good (published 4 November 2016).

Why we inspected

This was a planned inspection as the home has not been inspected for some time. It was also prompted by our data insight that assesses potential risks at services and concerns in relation to aspects of care provision.

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.

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 monitor the service 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 safeguarding people from the risk of abuse, good governance and reporting of notifications at this inspection.

You can see what action we have asked the provider to take at the end of this report.

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.