Bridgemead

During this inspection we checked that the provider was meeting the legal requirements of the regulations they had breached. You can read the report from our last comprehensive inspections, by selecting the 'All reports' link for Bridgemead, on our website at www.cqc.org.uk

Bridgemead is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Bridgemead can provide care and nursing support for up to 32 older people, some whom are living with dementia. At the time of our inspection there were 31 people living at the service.

The service provides accommodation in purpose built premises. The building had a unique and interesting design. A large communal dining and seated area was available to people with big windows, a conservatory and rooftop garden. People enjoyed the location of the service and the views to the river. People told us how the light, space and scenery from the building enhanced their well-being.

There was a registered manager in post. 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.

At this inspection we found that the service had made improvements. The previous breaches in regulations had been met. Recruitment checks were in place which ensured the provider’s recruitment policy was followed. People’s care plans had been enriched. Care plans contained details around people’s preferences, backgrounds and routines. Where people had specific needs care plans were in place to support these. Supervision and training to support staff in their roles was up to date and occurring regularly. Quality assurance systems were now in place but needed further development in the details provided in order to drive quality improvement. This had already been identified by the provider.

We received mixed feedback about the staffing levels at the service. People said sometimes they had to wait for staff to be available. We made a recommendation in regards to recording best interest decisions in accordance with the Mental Capacity Act Code of Practice.

People said they could retain their independence by moving around the service, helping themselves to drinks and snacks and coming and going as they pleased. However, a few people commented that their independence could be further promoted by the service. Details about people’s end of life wishes were limited in care records. Care records had been reviewed monthly.

Staff had developed good relationships with people. People told us that staff were kind, caring and polite. People’s privacy and choices were respected by staff. Visiting was unrestricted. Friends and family were welcomed at the service. There were different areas for people to spend time with their loved ones in private and communal areas.

People spoke positively about the range of activities facilitated by the service and the regular outings available to them. The service had a Christian ethos, but people from any faith group were welcomed. The service had links with local religious establishments, a weekly service and a daily ‘quiet time’ where prayers and hymns were observed. ‘Friends of Bridgemead’ arranged social events and fundraising activities. Coffee mornings were held with the manager and people said they could express their views and opinions.

The food provided by the service was spoken highly of. Mealtimes were relaxed and sociable. People had individual choices about where they ate their meal, the portion size and how their meal was served. The building and environment was clean and well maintained. Regular health and safety and fire checks were undertaken.

Staff, people and relatives spoke positively about the registered manager. The registered manager was approachable and responded to feedback. Systems were in place to communicate effectively. For example, through staff handovers and newsletters to people. Feedback was sought through meetings and questionnaires. Actions were taken in response to suggestions made.

At this inspection we found six breaches of regulations. The two previous breaches from the last comprehensive inspection in July 2015 had been repeated. The four new breaches were in relation to good governance, need for consent, person centred care and staffing.

Bridgemead provides accommodation and care, including nursing care, for up to 32 older people who have dementia and other associated needs in relation to their mental health. On the day of our inspection, there were 31 people living at the home and one person receiving respite care.

There was a registered manager in place 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 is run.

Overall we found that quality and safety monitoring systems were not fully effective in identifying and directing the service to act upon risks to people and ensuring the quality of service provision.

The registered manager had not made appropriate statutory notifications. Notifications tell us about significant events that happen in the service. We use this information to monitor the service and to check how events have been managed.

The administration of people's medicines was not in line with best practice.

Recruitment procedures were not followed appropriately.

Care plans were not person centred. Peoples' risk assessments and the associated parts of the care plan did not provide adequate detail to enable safe and effective care.

Staff we spoke with had a variable understanding of the Mental Capacity Act 2005 and DoLS. These safeguards aim to protect people living in care homes from being inappropriately deprived of their liberty. These safeguards can only be used when a person lacks the mental capacity to make certain decisions and there is no other way of supporting the person safely. There were no examples of best interest decision making on behalf of people who lacked capacity to agree to the delivery of their care.

The registered manager had made applications for Deprivation of Liberty Safeguards (DoLS) where they had been assessed as being required.

Staff had not received regular supervision and training.

People had access to healthcare professionals however records did not always demonstrate that the service had made appropriate referrals when there were concerns.

The staff had received training regarding how to keep people safe and they were aware of the services’ safeguarding procedures.

There were enough staff to meet peoples' needs. We received positive feedback about the care staff and their approach with people using the service.

The provider had a complaints procedure and people told us they could approach staff if they had concerns.

We found six breaches of regulations at this inspection and will be asking the provider to send us a report of the improvements they will make.

We spoke to people and staff about nutrition. All the people we spoke with were complimentary about meals. For example, one person said 'I have nothing bad to say about the food, it's all lovely.' Staff demonstrated a good understanding of a balanced diet. We observed fresh fruit, snacks and hot and cold drink were available at all times to all people and their friends and family. We saw there were processes in place to ensure people received adequate nutrition and hydration to meet individual needs.

People told us they felt safe living at Bridgemead. One person said 'I feel very safe, and I know I could say something if I was worried about my care.' We spoke with staff who were able to demonstrate an understanding of safeguarding adults from abuse policies and procedures. We observed risks had been assessed and documented in people's care records and the provider worked with other professionals and agencies of reduce risks of abuse for people.

We spoke with staff and the manager about recruitment when we visited. We looked at records which showed there were effective recruitment and selection processes in place.

We looked at care and other records to see how people were protected against the risks of unsafe or inappropriate care. We saw people's care had been assessed and planned to meet individual needs. We saw the provider maintained other records relating to the safety of equipment and services in the home. We saw records were stored securely but accessibly for staff.

We asked people about the staff that cared for them. One person said 'yes staff are trained for this job and they are ok.' Another person said the staff were respectful and they were well cared for, but were not aware of the training staff undertook. A relative visiting the home said the staff were good and they were welcome at the home and were offered refreshments when they arrived.