Bridge Haven

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question Good. At this assessment, the rating has remained Good. This meant people were safe and protected from avoidable harm. Potential risks to people’s health and welfare had been assessed, when accidents and incidents happened, these had been used as learning opportunities. People were protected from abuse and discrimination. People received their medicines as prescribed. There were enough staff to meet people’s needs. Staff understood their role in reducing the risk of infection and the environment had been maintained to keep people safe.

This service scored 75 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Relatives told us staff acted and made changes to people’s support when they had fallen. A relative told us, “(Relative) had a spell where they had a few falls, but they cannot walk too well now so they got occupational therapist in to assess them.” A positive culture had been developed whereby staff were given regular opportunities to raise safety concerns and felt confident to do so. People’s safety was discussed at daily meetings with staff and a member of the management team and any lessons learned shared. The management team acted on concerns raised to them to ensure they did not occur again. For example, when it was identified that some staff had not been using correct moving and handling processes this was discussed with the staff and checks on the staff members practice were increased. All staff were reminded about safe moving and handling techniques to reduce the risk of this happening again. There were systems to record, investigate and respond to accidents, incidents, and significant events. The management team had undertaken lessons learned training and this was cascaded to the staff team. This was to ensure these processes were being used effectively to record events in detail and to help identify any patterns, trends or follow up actions required.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. An assessment of people’s needs was undertaken before they moved to the service to help ensure the continuity of care. This was a comprehensive assessment of people’s health and personal care needs identifying the level of support the person needed. Nationally recognised screening tools for people’s nutritional and skin care needs were used. People were supported to access the health care support they needed relevant to their physical or medical needs. Guidance given by health care professionals was recorded and available to staff so they could act on it. A visiting professional told us, staff referred people quickly to ensure any changes in their care were assessed as soon as possible. Relatives told us, when people needed to go to hospital, such as after a fall, staff had made sure people’s needs and preferences were handed over to paramedics and hospital staff.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm, and neglect. The provider shared concerns quickly and appropriately. Relatives told us they thought their loved ones were safe living at the service. Relatives had observed staff following correct moving and handling procedure to keep their loved ones safe. One relative told us, “They always have two staff whilst hoisting them. ”There were processes to monitor, report and escalate concerns about people’s safety. Staff had undertaken safeguarding training and understood how to recognise the signs of abuse or neglect. They understood their responsibilities to challenge a staff members poor practice and report their safeguarding concerns to a member of the management team. Staff said when they had raised safeguarding concerns the management team had listened to them and taken prompt and appropriate action to address them. The management team had contacted the local authority on any safeguarding issues and acted on their advice. Health care professionals told us they had not observed any safeguarding concerns on their regular visits to the service. We observed staff supporting people with safe practice. Staff were vigilant with regards to people’s mobility and helped where necessary to allow people to walk freely around their home. Applications had been made under the Mental Capacity Act to ensure that any deprivations of a person’s liberty (DoLs) to receive care was in their best interests and legally authorised. The provider had identified further oversight was needed to ensure that any conditions set out in people’s DoLs were being met.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive, and enabled people to do the things that mattered to them. There were processes to assess and monitor potential risks to people’s safety in their everyday lives. Risk assessments contained guidance for staff to support people in the way they preferred and mitigate risks. When people were at risk of skin deterioration, care plans guided staff when to reposition people, equipment they needed to move, and about their diet. A health professional told us staff alerted them to changes in people’s skin integrity in a timely manner. Regular monitoring was in place for people with specific health care needs such as diabetes. There was information about how to recognise when people’s sugar levels were too low or high and what actions to take to keep them healthy. People were supported to do things that mattered to them such as walking around the service. Staff supported people who used equipment such as a walking frame to do so safely. Specific risks for each person were communicated between the staff team at daily handover meetings. The service specialised in providing support for people who may become anxious which could affect themselves and other people. Care plans guided staff to recognise any potential triggers for their anxieties and the best way to support them. We observed staff knew how to follow this guidance to keep people and themselves safe. Staff described potential risks to people and how they were mitigated. Such as encouraging people to wear supportive shoes, and monitoring where they were in the building. Staff described how they engaged people in activities to reduce the risk of them walking around and falling.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Regular checks were made on the environment and equipment to make sure it was safe and fit for purpose. A maintenance person was employed whose responsibility was to ensure all equipment such as wheelchairs, hoists and specialist beds were checked and maintained regularly. Electrical and gas appliances were serviced and maintained. When any shortfalls were found, these were logged and remained as an outstanding action until the necessary repairs were completed. Visual checks and servicing were undertaken on all fire equipment. Staff were trained and their competency checked to make sure they knew what to do in the event of a fire. People had individual plans about the support they needed to evacuate the building if there was a fire. There was signage to guide people safely around their home. People had photos or pictures that were meaningful to them by their bedroom door to help people recognise which door lead to their bedroom.

The provider made sure there were enough qualified, skilled, and experienced staff, who received effective support, supervision, and development. They worked together well to provide safe care that met people’s individual needs. Relatives told us there was generally enough staff, there had been times when staff or people were sick, they had been short staffed or used agency staff. People were protected by safe staff recruitment processes. Checks were completed on staff’s performance in previous roles and on their character. Candidates right to work in the UK had been checked and staff were supported to work within any visa restrictions. There were enough staff deployed to meet people’s needs. The management team told us they completed a monthly assessment of people’s needs to ensure enough staff were always on duty. They also explained staffing levels were increased to support admissions, training courses, appointments, end of life care and people who required one to one support to keep them safe. We observed there were enough staff and people did not have to wait for the care they needed.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Relatives told us the environment was clean, “It is very, very clean! I have not seen anything left on the floor, no food under the tables, nothing. (Relative’s) room is very clean.” The provider had effective processes to assess and manage the risk of infection. Housekeepers understood how they managed laundry processes and a cleaning regime to help control the risk of any infection present at the home spreading. Staff followed a programme of cleaning which ensured all areas of the home remained clean and hygienic. This included regular deep cleaning of people’s bedrooms and of high use areas of the home. The home was clean with no unpleasant odours on the day of our visit. There were handwashing facilities throughout to promote regular hand washing. Staff told us personal protective equipment (PPE) such as gloves and aprons were always available when they needed it. This was used to make sure staff and people were kept free form the risk of infection. We saw staff using PPE appropriately during our visit.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities, and preferences. Staff involved people in planning, including when changes happened. Relatives told us they knew which medicines their loved one were prescribed and if there were any changes. One relative told us, “I have been told what medication they are on. If they change anything they tell me straight away.” People were protected by effective medicines management processes. Safe systems were in operation to order, store and dispose of medicines. Staff used electronic medicines administration records, and this supported safe medicine administration. For example, the system highlighted if staff planned to administer medicines at the wrong time or outside of the prescribed amount. We observed staff administer medicines in the way people preferred. They explained what the medicines were for and took time to chat with people while they administered them. Some people were prescribed pain relief patches. Records of where patches had been placed and when they had been changed were maintained to ensure they were applied in accordance with manufactures guidance. People received their medicines at the correct times and staff had set alarms to remind themselves when people required medicines outside of the usual medicine rounds. Some people were prescribed medicines ‘when required', detailed guidance was in place for staff to follow about when and how much to administer and why. We observed staff who administered medicines wearing a red tabard to alert other staff members they should not be distracted to reduce to potential of any medication errors.