We carried out a review of the data available to us about Bridge House Care Centre on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Bridge House Care Centre, you can give feedback on this service.
Bridge House Care Centre is a residential care home that provides personal and nursing care for up to 35 people, mainly older people, some of whom were living with dementia or had other physical or mental health conditions. The service was supporting 35 people at the time of our inspection.
People’s experience of using this service and what we found
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. People’s needs were assessed and monitored and any professional advice was incorporated into care plans with clear guidance for staff to follow. People’s health care needs were met and people were supported to attend appointments with professionals. People received a choice of food and drink and their risk of malnutrition and dehydration was reduced by staff. The premises were adapted for people with dementia to help them orientate around the home.
The registered manager was new in post and had made improvements to the service such as to checks and audits of the quality of care. A range of audits were in place covering all aspects of the service including staff support, medicines management and health and safety. The registered manager communicated well with people, relatives and staff and constantly gathered feedback as part of monitoring and improving the service. The provider worked closely with other health and social care professionals.
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 (report published 5 October 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 we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
This inspection was prompted by a review of the information we held about this service and to follow up on the previous breach of the regulation relating to consent. We inspected 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.
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 requires improvement to good based on the findings of this inspection.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Bridge House Care Centre is a residential care home that was providing personal and nursing care to 31 people, mainly aged 65 and over, at the time of the inspection. The service can support up to 35 people in one adapted building, including people living with dementia and other neurological conditions.
People’s experience of using this service and what we found
Most of the feedback we received from people and their relatives was positive. One person said, “I think it’s lovely here. I like it in here.” Another person’s relative told us, “It’s superb in there, my [family member] is looked after well. We have no concerns.”
People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. This was because the provider did not always have the necessary legal safeguards in place to ensure people’s rights were upheld when they needed to be deprived of their liberty as part of receiving care and treatment.
However, the provider did support people to have maximum choice and control when making other decisions about their care and took all the necessary steps to ensure other decisions made on their behalf were in their best interests. People’s needs were assessed in line with good practice guidance and staff had the knowledge, skills and support they needed to provide effective care. They supported people to access healthcare services when they needed to. People received a variety of food and drink that met their needs. The environment was adapted to meet people’s needs, although one person felt their bedroom was unsuitable. The registered manager agreed to look into this.
Systems to protect people from avoidable harm were mostly robust, although some of the information providers are required to obtain about new staff was missing. However, the registered manager obtained this information promptly after we discussed it. There were thorough health and safety checks and individual risks to people were assessed and managed well. There were systems in place to protect people from the risk of acquiring infections. There were enough staff to care for people safely. Although medicines were managed safely overall, we have made a recommendation about the information that should be recorded for medicines prescribed to be taken only when required.
Although the registered manager was not always fully aware of their statutory requirements as described above, most aspects of management and leadership were robust. The provider effectively operated systems to check and improve the quality of most aspects of service provision. The service had a person-centred, open culture and the provider regularly sought feedback from people, their relatives and staff and used this to help them improve the service. The provider engaged well with other agencies and with the local community.
Staff were kind, caring and empathetic. They made an effort to get to know people well and build up good relationships. The provider promoted equality and supported people to understand what their rights were. People had opportunities to express their views about the care they received. They were involved in planning their care and staff respected their choices. Staff promoted people’s privacy, dignity and independence.
People had detailed care plans to ensure staff had all the information they required to meet their needs. Staff knew about people’s abilities, health conditions and what they needed extra support with. Staff used a variety of communication methods to make sure people understood them. People had opportunities to engage in a variety of activities, go on day trips and engage with the local community, including church services. The provider planned and delivered end of life care to help people have a dignified and comfortable death. We have made a recommendation about considering people’s diverse backgrounds and interests when planning care.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (report published 4 February 2017).
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified a breach of the regulation in relation to the need for consent. 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 for 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.
At our last comprehensive inspection on18 December 2014 the service was rated ‘Requires Improvement’ overall and for two key questions ‘Is the service safe?’ and ‘Is the service caring?’ At a focused inspection on 1 June 2015 the rating for the key question ‘Is the service safe?’ had improved to ‘Good’ which meant the rating for the whole service also changed to ‘Good’.’ The key question ‘Is the service caring’ remained rated ‘Requires Improvement’ due to some staff not consistently treating people with dignity and respect.
At this inspection we found that people’s safety was maintained. There were sufficient staff deployed to meet people’s needs and they were prompt in responding to people’s requests for assistance. Staff identified risks to people’s safety and developed plans to mitigate those risks. Staff protected people from harm. They were knowledgeable in recognising signs of possible abuse and liaised with the local safeguarding team when required. Safe medicines management was in place and people received their medicines as prescribed.
Staff continued to undertake training relevant to their role, including completion of refresher courses, and they received regular supervision. They adhered to the Mental Capacity Act 2005 code of practice. The manager liaised with the local authority to ensure they only deprived people of their liberty when legally authorised to do so, in order to maintain the person’s safety. Staff supported people with their nutrition, hydration and healthcare. The manager arranged for improvements to be made to the environment during our inspection to ensure a safe and pleasant environment was provided.
Improvements had been made since our previous inspection and we observed that staff treated people with respect, maintained their privacy and dignity. Staff were friendly, kind and patient when supporting people. They supported people to practice their faith and were respectful of people’s religious and cultural backgrounds. Staff discussed with people their end of life preferences and provided support in line with people’s choices.
The provider ensured people’s individual needs were met. Staff assessed people’s needs and for the majority developed clear care plans about how they were to meet those needs. Where we identified that improvements could be made to aid clarity to the care plans these were addressed. Staff maintained accurate records of the support provided. A range of activities were available to engage and stimulate people. People, and their relatives, felt able to raise concerns and complaints as and when they needed to.
A new manager was in post. Staff told us there was an open and honest culture within the team. The manager welcomed feedback about service delivery from people, their relatives and staff. There continued to be processes in place to review the quality of service delivery and where required action was taken to address areas of concern. Staff were aware of their roles and responsibilities and liaised with their management team about any concerns identified. The management team liaised with other health and social care services to review their joint working arrangements.
Further information is in the detailed findings below.
We carried out an unannounced comprehensive inspection of this service on 18 December 2014 and a breach of legal requirements was found. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the management of medicines at the home.
We undertook this focused inspection to check the provider had followed their plan and to confirm they now met legal requirements. This report covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Bridge House Care Centre on our website at www.cqc.org.uk
We undertook this unannounced focused inspection of Bridge House Care Centre on 1 June 2015. Bridge House Care Centre is a care home which provides accommodation for up to 35 people who require personal care and support. At the time of our inspection the home was fully occupied. The home specialises in caring for older people living with dementia.
The service is required to have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The registered manager on our records left the service in October 2014. We were notified at the time by them and the provider. A manager was appointed to replace them but subsequently stepped down from the role. A new manager has been appointed from 26 May 2015 and is in the process of submitting the appropriate registered manager application to CQC.
We found the provider had taken appropriate and timely action to make improvements in relation to the management of medicines at the home. Our checks showed people received their medicines as prescribed and appropriate records in relation to the management of medicines were maintained. We also found medicines in stock were all in date.
People’s records gave guidance for staff on how and when to administer ‘as required' medicines, topical creams and ointments. The provider had updated their medicines policy and procedure so that staff had clear guidance about their responsibilities for when to administer these medicines.
Regular checks of medicines had been undertaken by senior staff to ensure staff were administering and disposing of medicines as required.
The provider had taken steps to ensure staff were aware of how to ensure peoples’ rights to privacy and dignity were upheld. Staff had received dignity training. However we found there were still some inconsistencies in the way information about people was used and discussed in the home which could compromise people’s privacy and dignity.
This inspection took place on 18 December 2014 and was unannounced. At the last inspection on 3 June 2013 we found the service was meeting the regulations we looked at.
Bridge House Care Centre is a care home which provides accommodation for up to 35 people who require personal care and support. At the time of our inspection the home was fully occupied. The home specialises in caring for older people living with dementia. Accommodation is arranged over three floors. There is a lift to assist people to get to the first and second floors. Within the home, each person has their own room some with en-suite facilities.
The service is required to have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The registered manager on our records left the service in October 2014. We were notified at the time by them and the provider. A new manager had since been appointed and has submitted the appropriate registered manager application to CQC.
During this inspection we found the provider in breach of their legal requirement to ensure medicines in the home were effectively managed. We found a medicine had not been properly administered and a medicine that was no longer safe to use. There was no written guidance for staff as to how some medicines should be administered. However, medicines were stored safely and people received their medicines as prescribed. You can see what action we told the provider to take at the back of the full version of the report.
People and their relatives told us people were safe at Bridge House Care Centre. Staff knew what action to take to ensure people were protected if they suspected they were at risk of abuse or harm. Risks to people’s health, safety and wellbeing had been assessed by staff. There were plans in place which instructed staff on how to minimise identified risks to keep people safe from harm or injury in the home. The home, and the equipment within it, was checked and maintained to ensure they safe. Staff kept the home free from clutter and obstacles to enable people to move around safely. There were enough suitable staff to care for and support people.
People’s needs were met by staff who received appropriate training and support. The manager monitored training to ensure staff skills and knowledge were kept up to date. Staff felt well supported by the manager and other senior staff. They had a good understanding of people’s needs and how these should be met.
Staff encouraged and supported people to stay healthy. People were supported to eat and drink sufficient amounts to reduce the risk to them of malnutrition and dehydration. Staff regularly monitored people’s general health and wellbeing. Where there were any issues or concerns about a person’s health staff ensured they received prompt care and attention from appropriate healthcare professionals such as the GP. They also ensured relatives were kept regularly informed and updated about any changes to people's health and wellbeing.
Care plans had been developed which reflected people’s needs and their individual choices and beliefs for how they lived their lives. People’s relatives and other healthcare professionals were involved in supporting them to make decisions about their care and support needs. Where people were unable to make complex decisions about their care and support, staff ensured appropriate procedures were followed to ensure decisions were made in their best interests.
The provider had procedures in place in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). DoLS provides a process to make sure that
people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them. The manager had sufficient training to understand when an application should be made and in how to submit one. This helped to ensure people were safeguarded as required by the legislation.
The home was welcoming to relatives who told us there were no restrictions on them visiting their family members. People were encouraged and supported to maintain relationships that were important to them. People and their relatives felt comfortable raising any concerns they had with staff and knew how to make a complaint if needed. People said concerns raised in the past had been listened to and dealt with responsively.
People and their relatives told us staff looked after people in a way which was kind, caring and respectful. However staff did not always ensure that people’s privacy and dignity was maintained when they received personal care.
A new manager had been appointed to the home and had taken appropriate steps to inform people, their relatives and staff of important changes within the home.
There were systems in place to monitor the safety and quality of the service which the provider used to identify changes and improvements that were needed. When improvements were needed, people and their relatives were informed and involved and their views were taken account of in how these could be made.
The home used learning from investigations and best practice to improve the quality of care people experienced.
People we spoke with were positive about their experiences of care and support received. One person said, 'It's nice here. I like the atmosphere and they're all friendly and staff do activities with you. Yesterday we did drawing'. Another person said, 'It's ok here. Staff are nice, look after me and treat me with dignity'. A relative told us 'Staff will always check if you're worried about anything or tell you if they're worried about anything'.
We observed from people's records their individual care and support needs had been assessed and plans were in place to meet these needs. Where people lacked capacity to make decisions their representatives had been involved in planning and developing their plan of care. From the records we looked at, information was reviewed and updated regularly so that staff had up to date information about people's current care and support needs.
The home was clean and free from odours. Staff carried out audits to check the cleanliness of the home. From staff training records we saw all staff who worked in the home had access to training to keep their skills and knowledge up to date. The provider had systems in place to assess and monitor the quality of service that people receive.
Some relatives told us they didn't think there were enough staff working in some parts of the home. The registered manager told us staffing levels had been, and would continue to be reviewed to reflect the changing needs of people using the service.
The provider used surveys to assess the quality of service being provided. They also carried out audits and checks within the home to ensure risks to people's health and wellbeing were identified managed and mitigated.