Bridge House Nursing Home

Bridge House Nursing Home is a care home providing personal and nursing care to up to 54 people. The service provides support to older adults who may also have a physical disability, sensory impairment or dementia. Bridge House Nursing Home accommodates people across two separate buildings, which have separate adapted facilities. One of the buildings specialises in providing respite and rehabilitation to people and external physiotherapists visit the home daily.

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

The registered manager ensured infection prevention and control guidance was followed to keep people and staff safe. People reported they felt safe living at the service.

Care plans were person centred and included the input of the relevant people. The environment in the home had improved from previous inspections including improvement in decoration and signage around the service. However, further development is still required. This was acknowledged by the registered manager and operations director.

People told us they felt staff were caring. The service supported people to be as independent as possible. People felt involved in their care and care plans were reviewed regularly to meet the needs of the person.

People’s communication needs were assessed, and staff were aware if a person required further support with their communication. People and relatives told us they were aware of how to raise a complaint with the service. Staff worked well with people, families and health and social care agencies to support people’s wellbeing.

The service had an open and transparent way of working to ensure the safety of the people living at the service. The provider was able to demonstrate that quality assurance systems ensured the quality of the service improved. There was a positive culture amongst staff at the service. Staff knew people they supported well and cared about their wellbeing. The provider was able to demonstrate their compliance with legal obligations and any learning from incidents or accidents was undertaken effectively.

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.

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 (published 3 November 2021). 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.

At our last inspection we recommended that the provider reviewed their staff training, documentation regarding people’s abilities to make decisions and learning from incidents and accidents. At this inspection we found the provider had acted on the recommendations and they had made improvements.

Why we inspected

We carried out an unannounced focused inspection of this service on 21 and 22 September 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the premises, medicine management, staff recruitment records and governance.

We undertook this comprehensive inspection to check they had followed their action plan and to confirm they now met legal requirements.

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

Follow up

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

Bridge House Nursing Home is a care home providing personal and nursing care to people aged 65 and over who may also live with dementia, a physical disability or a sensory impairment. Bridge House Nursing Home accommodates up to 54 people across two separate buildings, each of which has separate adapted facilities. At the time of inspection, 36 people used the service.

The service is also registered to provide care to people in their own homes. At the time of inspection no one who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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

People told us they felt safe. People and relatives felt there was not always enough staff deployed. Staff training records were reviewed, and we made a recommendation. Staff understood their responsibilities to raise concerns and report incidents or allegations of abuse. The staff team followed procedures and practices to control the spread of infection using personal protective equipment. Medicines were not always managed safely. The registered person did not ensure that all required information was recorded, and appropriate checks were carried out.

People were supported with their nutrition and staff worked well with people, families and health and social care agencies to support people’s wellbeing.

People’s care was individualised in order to best meet their needs and activities were in place to support with stimulation. Care plans were person centred and included the input of the relevant person. We made a recommendation about the building and premises.

Systems were in place for people to raise concerns and they felt they would be listened to. People felt that staff were caring, and regular activities were available for them to take part in if they wished to.

Prior to the inspection, the provider had written their own action plan in August 2021 and identified areas of improvement, however actions were outstanding.

The provider did not ensure systems were embedded to oversee the service and ensure compliance with the fundamental standards. They did not have evidence to support effective governance. The service had an open and transparent way of working to ensure the safety of the people living at the service. Staff knew people they supported well and cared about their wellbeing. 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 did not always support this practice.

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 17th January 2020).

Why we inspected

We received concerns in relation to the management of medicines, people’s nursing care needs, and staffing levels. As a result, we undertook a focused inspection to review the key questions of safe, effective 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 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. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

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

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 discharge our regulatory enforcement functions required 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 good governance, medicines management, safe recruitment of staff and premises. Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Bridge House Nursing Home is a care home providing personal and nursing care for up to 48 people aged 65 and over. At the time of the inspection there were 42 people living at the home in 2 separate wings; some of these people were living with dementia.

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

People’s needs were assessed, and care plans were in place. People were cared for by staff who had been trained to carry out their roles and who were knowledgeable about the support people needed. People’s nutritional needs were assessed. People enjoyed their food, and always had a choice of what to eat and where to eat it. People’s health needs were met. 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 have made a recommendation about the environment in relation to dementia. Not all areas of the building were dementia friendly. There was a lack of dementia friendly signage for example, and some areas of the building were difficult for people to access.

People we spoke with told us they felt safe living at Bridge House Nursing Home. People were cared for by staff who knew how to keep them safe and protect them from avoidable harm. There were enough staff available to meet people's needs and people told us when they needed assistance, staff responded promptly and never rushed them. People received their medicines regularly and systems were in place for the safe management and supply of medicines. Incidents and accidents were reported, investigated and actions taken to prevent recurrence. The environment was clean, and staff followed infection prevention and control procedures.

People were cared for by kind and compassionate staff. The atmosphere was relaxed and welcoming. We saw that staff regularly engaged people in conversation. People told us they felt involved in making decisions about their care and that staff respected their privacy and dignity.

Staff were knowledgeable about people’s support needs as well as people’s preferences for how they were cared for. There was a range of activities for people to participate in if they wanted to; including one to one support for those people who preferred not to take part in group events. People’s feedback was sought. Complaints were reported, investigated and resolved appropriately.

The service was well led. Systems were in place to monitor the quality of care provided and continuously improve the service.

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 28 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Bridge House Nursing Home is a care home with nursing. It is comprised of two units, one known as Bridge House and the other as Bridge Court. It is registered to accommodate 54 people across both units. At the time of the inspection 20 people were resident in Bridge House and 13 in Bridge Court. Some of the people living at the service may require either nursing or specialist care associated with dementia and other conditions.

At our last inspection in November 2016 the provider was not meeting four Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the service was rated requires improvement. Requirement notices were issued with respect to the breaches of Regulation 12 (safe care and treatment), Regulation 9 (Person centred care), 17 (Good governance) and 19 (Fit and proper persons employed).

The provider sent us an action plan in January 2017 outlining the improvements they were going to make in order to meet the requirements of the regulations.

This inspection was a comprehensive inspection to follow up and ensure the requirements of the previously identified breaches of regulations had been met and to make a judgement about the overall compliance of the service. At this inspection we found significant improvements had been made and there were plans in place to maintain and further improve the quality of the service. The requirements of the regulations had been met.

The service is required to have a registered manager. 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the time of the inspection there was no registered manager. Two managers had been appointed since the previous registered manager deregistered. Both had submitted applications to become registered with the care quality commission to manage the service however, both left the service prior to the registration process being completed. Following discussions with the provider the operations manager who had worked with and supported the service for a significant amount of time had begun the process to become the registered manager.

People were safe and told us they felt so. Risk assessments had been completed and plans were in place to manage and limit any identified risks. Incidents and accidents were reviewed, investigated and monitored to identify emerging trends and enable action to be taken to reduce their occurrence. Recruitment procedures were thorough and established so far as possible the suitability of staff to work with people. There were sufficient numbers of staff to care and support people safely. Staffing levels were calculated according to the needs of people using the service and were reviewed regularly. People were protected from abuse by staff who had been trained in safeguarding people and understood how to report concerns. Medicines were ordered, stored and administered safely. The provider had a business continuity plan which provided guidance for staff on the actions to take in a foreseeable emergency.

People were supported by staff who had received training to perform their role effectively. Induction was provided to new staff who also shadowed experienced staff until they were confident and competent to work unsupervised. Staff were supported by the manager and other senior staff who we were told listened and took action when necessary. Further support was provided through one to one meetings, staff meetings and annual appraisals. 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 supported this practice. People were given encouragement to eat and drink sufficient quantities. They told us they enjoyed their meals and there was plenty to eat. Menu choices were presented to people and alternatives were available if people preferred something different. When concerns arose with a person’s nutrition or weight, referrals were made to relevant health professionals. People’s health and well-being were monitored and they were able to access a range of professionals to support them with new or on-going health matters.

People told us the staff were kind, compassionate and caring. We observed positive interactions between people and staff and noted people appeared comfortable with the staff team. People were calm when approached by staff and enjoyed chatting and making jokes with them. People’s privacy was respected and staff supported them to maintain their dignity. Staff knew people well and understood their needs. People were made to feel special and valued, they were supported to celebrate significant occasions in their lives. Visitors to the service were encouraged. Relatives told us they visited at various times and were always made to feel welcome. Meetings for residents and relatives encouraged people to share their views on the service. Whenever possible suggestions were acted on to improve things for people. People were provided with the opportunity to discuss and plan the care they would like to receive at the end of their lives.

Care plans were individualised and reflected the needs and wishes of each person. Good and sufficient detail was included to ensure staff knew how to provide responsive, person-centred care to people. Evidence based practice was used to ensure care plans directed staff to follow national guidance when appropriate. A varied and full programme of activities was planned to include people’s personal hobbies and interests. People chose if they wished to join in activities or not. People’s right to spend time alone or to do things of their choice was fully respected. People knew how to make a complaint or raise a concern.

Systems were in place and used effectively to monitor and improve the quality of the service. Deficits were identified and measures taken to address them. The service sought the views of people and their relatives. They used the responses to look for areas of improvement. Records relating to people’s care were accurate and completed in a timely manner. We found an honest and open culture in the service. Staff spoke positively about the leadership they received and how they worked well together for the benefit of the people they care for.

Bridge House Nursing Home is a care home with nursing. It has recently been extended to create an additional unit and is now registered to accommodate 54 people. At the time of the inspection 35 people we resident and receiving care. Some of the people living at the service may require either nursing or specialist care associated with dementia.

At our last inspection in June 2015 the provider was meeting the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the service was rated good overall. However, the Care Quality Commission received concerns regarding the service from the local authority which prompted this inspection.

The service is required to have a registered manager. 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. At the time of the inspection there was no registered manager. A manager had been appointed and had begun the process of applying to CQC to become the registered manager. However, since the inspection the provider has informed us this manager has resigned. Satisfactory, interim arrangements have been made to manage the service until a new manager is appointed.

Risk assessments did not always have sufficient information or detail to mitigate identified risks. Duplication of documents in relation to managing risks had the potential to confuse staff and increase the risk for people. The service was addressing this by reviewing all care plans and risk assessments to provide clarity.

People at risk of developing pressure sores were not always protected from this risk. People’s pressure mattresses were not always set to the correct pressure.

Care plans did not contain sufficient detail of people’s preferred routines to enable staff to provide personalised care to people.

Records were difficult to read and sometimes illegible. They were not always completed promptly after delivery of care, leaving a potential for them to be inaccurate.

Recruitment procedures were not followed robustly to ensure appropriate people were employed at the service.

The provider had systems in place to monitor the effectiveness of the service. However, these did not always identify all concerns. Where they did identify concerns the resulting action plans had not been completed to improve the service.

Notifications required by law were not always submitted to the CQC.

People’s needs were attended to promptly and there was a staff presence in all areas of the service during the inspection. However, we were told that at times staff felt rushed and stretched. We found a dependency tool used to calculate staffing levels was not always completed accurately.

Staff did not feel fully supported by all members of the management team. Staff support mechanisms were in place. However, until recently one to one supervision meetings had not been held for all staff, although group meetings had been provided as support. The manager had planned dates for all staff to have a one to one meeting on a regular basis going forward. Further support was available in the form of staff and team meetings and annual appraisals.

Training was provided for staff but we found staff had not always refreshed their training in accordance with the provider’s policy.

People told us they felt safe and staff had a clear understanding of how to safeguard people and protect their well-being. They were aware of how to report concerns.

Medicines were managed and administered safely. The storage areas for medicines were found to be warmer than the optimum temperature recommended. This was addressed after it was raised during the inspection.

Applications for Deprivation of Liberty Safeguards were made appropriately. However, the system used to track applications and authorisations was not kept up to date. Therefore we could not be sure appropriate reviews took place or outstanding applications were chased up with the supervisory bodies.

Staff understood their responsibilities with regard to the Mental Capacity Act 2005 and best interest meetings were held when people lacked capacity to make decisions for themselves. However, those meetings were not always recorded in line with the principles of the act.

Moving and positioning people was seen to be carried out safely with the correct equipment. People were given explanations and assurances throughout the moving and positioning activities. Staff had received training in moving and positioning people.

People’s nutritional needs were met. They were provided with appropriate support during meal times in accordance with their care plan.

People were supported to maintain their health and well-being. They were able to see healthcare professionals when necessary.

People spoke positively about the staff who cared for them. Staff were warm and friendly in their approach to people and they delivered compassionate care. People were offered dignity and respect by staff who were polite and sought consent before providing support.

A programme of activities was available. People could choose to join in activities if they wished. Visitors were welcomed at any time and could stay as long as they wanted. There were a number of areas where people could receive visitors in private.

We identified several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we have required the provider to take at the end of this report.

At this inspection we found the provider had taken some positive actions to demonstrate that lawful consent to care and treatment was obtained from the appropriate person. Training had improved staff awareness of mental capacity assessments, when it was appropriate to consider best interest decision-making, and who could lawfully consent to a person's care and treatment on their behalf. Meetings had been arranged for relatives to explain the scope of holding a Lasting Power of Attorney, and when this could lawfully be used to provide consent on behalf of others.

However, we found records did not always demonstrate evidence of mental capacity assessments, which would indicate when best interest decision-making would be appropriate. We saw records indicated relatives consented to care or treatment on people's behalf without evidence of a lawful right to do so. This meant the provider had not established suitable arrangements to lawfully obtain, and act in accordance with, the consent of people who use the service.

At our inspection on 22 July 2013 we found the provider did not have sufficient qualified, experienced and skilled staff to meet the needs of people who use the service at all times. At this inspection we found staffing was sufficient to meet the needs of people throughout the day and night. Staff told us staffing levels had improved. We observed meal times had been staggered to ensure sufficient staffing was available to support people to eat their lunch. Staff rotas demonstrated the manager considered people's dependency and support needs when deciding staff cover for shifts.

Since our last inspection the provider had employed a new manager for the home, who took up her position at the beginning of April 2013. The new manager is aware of the steps needed to become registered as the manager for Bridge House Nursing Home.

People were protected from the risks of inadequate nutrition and dehydration. The manager was aware of the NHS England heat wave guidelines and had implemented government guidelines to protect people from heat wave related risks.

The provider had introduced changes aimed at ensuring sufficient staff were on duty at all times to meet the needs of people living at the home. Other steps were underway to ensure further improvements could be implemented and maintained. However, the provider had not fully ensured there were enough qualified, skilled and experienced staff, at all times, to meet people's needs.

People told us staff took time to explain what was happening before doing things. One person commented "They ask me before doing anything." Another person commented "They tell me what is happening." During our visit we saw, before they received any care, people were asked their consent and staff acted in accordance with their wishes. However, in relation to care and treatment, the provider did not have suitable arrangements in place for obtaining the consent of people living at the home.

Care plans and other records related to the management of the service were up to date and accurate. They were kept securely and could be located promptly when needed.

There were arrangements in place to support workers. Staff received appropriate training and supervision. However there were not always sufficient numbers of appropriate staff to ensure that the health and welfare needs of people living in the home were met at all times. There were processes in place for recording, investigating and resolving complaints from people who use the service and their relatives. The people we spoke with were aware of who they would speak to if they had any complaints.

In this report the name of a registered manager appears who was not in post and not managing the regulated activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time of this inspection. We have advised the provider of what they need to do to remove the individual's name from our register. We have advised the provider of the requirement to register a new manager in respect of all regulated activities offered by this service.