Bridgeway Care Home

Bridgeway Care Home is a residential care home providing personal and nursing care to up to 29 people. The service provides support to adults aged between 18 and 65. The service is registered to provide support to adults with a physical disability and adults with a learning disability and or autistic spectrum disorder. At the time of our inspection there were 28 people using the service.

The care home is a large building set across two floors. It has an accessible lift, communal areas and a good-sized garden available to use.

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

Medicines were not always managed safely, although we did not find any harm as a result.

People were supported by staff that knew them well and there were enough staff to keep people safe. A relative said, “The same staff always work with my relative.” Another relative said, “They have the right skills.” People were protected well from the risk of the spread of infection and the home was clean and comfortable.

The registered manager and clinical leads kept people and their relatives involved and up to date. A relative said, “Staff ring you to tell you things.”

We found a positive culture amongst staff, and they told us they loved their jobs. Relatives were positive about the home and said, “It is the perfect place”, another said, “(My relative) loves the home, it is brilliant, and the staff are calm.”

We have made recommendations about audits and recruitment processes.

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.

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.

Based on our review of safe and well-led the service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Care took place within a care home environment making it difficult to have different opportunities to maximise people’s choice, control and independence. However, at times people were supported with their own interests; for example, staff supported people who wanted to do their own shopping. Staff understood the importance of promoting people’s dignity and privacy was respected. Staff used different methods to make sure people could make their own choices, for example using pictorial aids and other communication aids.

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 (published 18 August 2021).

At our last inspection we made recommendations about the incident recording process and audits. At this inspection we found that some improvements had been made in these areas.

Why we inspected

This inspection was prompted by a review of the information we held about this service and we inspected the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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 and will take further action if needed.

We have identified a breach in relation to the safe management of medicines at this inspection.

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 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Bridgeway Care Home is a residential care home providing personal and nursing care up for to 29 people living with dementia, learning disabilities, physical disabilities and/or sensory impairment. At the time of our inspection there were 24 people living there. Accommodation is provided over two floors with several communal areas.

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

Where accidents and incidents had occurred, some records lacked detail in recording what actions were taken or if lessons had been learned to prevent incidents happening again. We have made a recommendation about completing the records in full, detailing any learning and all the actions taken.

The provider, who is also the registered manager, and staff team worked closely with other agencies and healthcare professionals to make sure people had good care. The quality and safety of the service was regularly monitored and areas which could be improved were identified. However, the audit processes and systems for monitoring used were not always utilised effectively in gathering information. For example, trends and themes were difficult to identify. We have made a recommendation about recording more detail in the audit processes.

Safeguarding systems were in place to protect people from the risk of abuse or unsafe care. Staff were aware of the procedures and had received training on it and knew what action to take. Staff had been recruited in a safe way. The provider made sure sufficient numbers of staff were on duty throughout the day and night.

People received their medicines safely and as prescribed. People's needs and risks had been assessed and people received the level of support they required. We looked at infection prevention and control measures under the safe key question. We were assured the infection prevention and control practises were satisfactory.

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 and their families had been fully involved, where relevant, in planning and reviewing the care and support provided.

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 Care Quality Commission (CQC) to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of key questions safe and well-led the service was able to demonstrate how they were meeting some of the underpinning principles of right support, right care, right culture.

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 (published 20 June 2018).

Why we inspected

We received concerns in relation to people’s nursing care needs. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. We found no evidence during this inspection that people were at risk of harm from this concern.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bridgeway Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Following our last inspection we asked the provider to complete an action plan to show us what they would do and by when to improve the key question of effective to at least good. During this inspection, we found the service was meeting the requirements of the current legislation. We made recommendations in relation to individual risk assessments to manage people’s self harm behaviours and to ensure the refurbishment to the property was continued.

Bridgeway care home 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 care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. At the time of our inspection seven people with a learning disability lived in the home.

Bridgeway care home accommodates up to 27 people in one building. The home was in the process of a substantial refurbishment across all areas. It provides accommodation for persons who require nursing or personal care for people living with a dementia, learning disabilities, physical disabilities and sensory impairment. At the time of our inspection there were 23 people in receipt of care.

The service had a registered manager in post at the time of our inspection. 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 was run.

Systems to record and act on allegations of abuse were in place. Staff had undertaken safeguarding training, which provided them with the knowledge and skills to protect people from harm. We saw one person was displaying self-harm behaviours, but the registered manager immediately ensured their risk assessment reflected the measures for staff to take to protect them from unnecessary risk of harm.

Appropriate levels of staffing were in place to ensure people’s needs were met. The registered manager told us they were implementing a staffing analysis following our inspection. Safe recruitment practices were followed.

Medicines were managed safely. We observed staff providing people with their medicines with dignity, offering support and time for them to take.

There was an ongoing detailed refurbishment programme taking place. Improvements since our last inspection were noted, however work was still required to make the necessary improvements to all areas of the home.

Staff told us and records confirmed they had undertaken a wide variety of training that supported the delivery of care to people. We saw evidence of the use of advocacy services when people required support with important decisions.

Consent had been recorded in most people’s care files. We observed most staff knocking on people’s doors and waiting to be invited into their bedrooms. Relevant DoLS applications had been submitted to the assessing authority. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Most people we spoke with were happy with the care they received in the home. We discussed some concerns raised by one person with the registered manager, who was aware of these.

On the whole people were treated with privacy, dignity and respect. Staff were seen speaking kindly to people engaging in light-hearted conversations and banter with them. On two occasions we observed staff to interrupt people during our discussions with them.

Care files were detailed and provided appropriate information about how to meet people’s individual needs. There was evidence of an activities programme in place at the home. We saw people engaging in activities during our inspection.

Systems to record, investigate and act on complaints were seen. We saw some positive feedback had been received.

Assistive technology was supported and promoted in the home. Communication boards were used to support people, where verbal communication was limited. The new lift supported people who had sensory impairments.

We received positive feedback about the registered manager. All members of the staff team were supportive, open and transparent throughout our inspection.

Audits and monitoring was taking place that demonstrated the home was monitored and safe for people to live in.

Feedback about the service was obtained. Team and resident meetings were undertaken regularly and discussions had been recorded. This enable people’s view to be acted upon and included them in decisions about the home.

Bridgeway provides nursing and personal care for up to 27 adults living with dementia, learning disabilities, physical disabilities and sensory impairment. The home offers short and long term care. The home is situated in a residential area on the outskirts of Preston. Shops and local amenities are easily accessible and the home has its own transport.

The home did not have a registered manager in post at the time of our inspection. The manager who is registered with CQC left employment over 12 months previously and had not submitted an application to de-register. 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. There was however, a manager in post who was responsible for the day to day running of the service but they had not yet submitted an application to register with CQC.

The provider had a plan in place for refurbishment and extension of the premises, in order to improve the premises for the people who used the service. However, they were not able to give us a date for when work was likely to start. We looked at all areas of the home and found the home was in need of redecoration and refurbishment, with the exception of the recently decorated lounge and two bedrooms, which were decorated to a good standard. In addition, the passenger lift, used by people to access the first floor, had been assessed as not meeting suitability requirements for access by disabled persons. The above matters constituted a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, because the premises were not properly maintained and the passenger lift was not suitable for the purpose for which it was being used.

People who used the service told us they felt safe. Staff were trained to keep people safe and had a range of policies and procedures to guide them in doing so. There were sufficient numbers of suitably qualified, skilled and experienced staff deployed at all times. The service had appropriate processes in place and staff were trained to make sure people received their medicines safely. The service ensured risks to people's health and well-being were assessed and managed effectively.

People were supported by staff who had the skills and knowledge to meet their needs effectively. The home carried out assessments of people's capacity to make decisions and acted in accordance with the Mental Capacity Act 2005. The service provided a good standard of food and people were satisfied with the quality and choice of food available. People were able to and supported to access outside healthcare services if they required them.

Staff knew people well, including their preferences and social histories, however, these details were not always well recorded in people's written plans of care. Staff took a kind, caring and compassionate approach to the delivery of care and respected people's privacy and dignity. People were able to receive visitors without restriction.

The service responded well to people's needs. Assessments of people's needs and their involvement in the care planning and review processes helped to ensure people received care that met their needs which was delivered in accordance with their preferences. People's needs were kept under regular review so that the service could continue to deliver suitable care in line with changes in people's circumstances. A range of activities were provided at the home and people were able to access the community.

People we spoke with, staff and visiting professionals all gave positive feedback about the leadership at the service and described an open and transparent culture. Regular meetings took place between management, staff and people who used the service so that their views and opinions could be sought and explored. People we spoke with during our inspection, including staff and visiting professionals told us that the manager and provider, along with senior staff provided good leadership. A suite of checks were available to the manager which helped to assess and monitor the quality of the service.