Archived: Bridges Healthcare

The service was inspected on August 2016, where we found the service was in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) 2010. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Bridges Healthcare Limited’ on our website at www.cqc.org.uk.

We undertook a focused inspection in February 2017 in relation to the breaches of regulation we identified at our previous inspection of September 2016. We found that the service had followed their action plan and had made improvements. We could not however change the overall rating of the service because to do so required a record of consistent good practice.

We undertook an announced comprehensive inspection on 14 September 2017. We gave the registered manager 24 hours’ notice as we needed to be sure they would be available for the inspection. At this inspection we found that the service had sustained the improvements put in place following our previous inspections of September 2016 and February 2017 and met the legal requirements.

The service had a registered manager. 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.

Staff handled and administered people’s medicines to them in a safe way. Staff had been trained and assessed in the safe administration of medicines and they understood and followed the organisation’s medicines policy.

Risks to people were assessed and detailed risk management plans put in place for staff to follow to keep people safe from avoidable harm. Staff understood risks associated with people and knew what the actions to take to reduce such risks.

Thorough recruitment checks took place before staff were allowed to work with vulnerable people. Staff understood how to recognise signs of abuse and how to protect people from the risk of abuse. Staff also knew and were encouraged to whistle blow if necessary to keep people safe.

Sufficient staff were deployed that ensured people needs were met in a timely way. People told us staff had sufficient time to safely support them. Staff confirmed time allocated to them to support people was sufficient. People also told us and the call monitoring system confirmed people received their care visits as planned.

The registered manager and staff understood their responsibilities within the Mental Capacity Act 2005. Staff were supported through effective induction, supervision, appraisal and training to provide effective service to people. People were supported to eat and drink appropriately and to meet their dietary and nutritional requirements. People were supported to arrange appointments to ensure their health needs were met. Relevant professionals were involved to ensure people received appropriate support and care that met their needs.

People were treated with kindness and their dignity respected by staff. People told us staff were caring and considerate towards them. Staff understood people’s needs, preferences and cared for as they wanted. People and their relatives were involved in planning their care and in day-to-day decisions about their care. Care plans were reviewed and updated regularly to reflect people’s changing needs. Staff told us they were updated with changes in people’s care.

People received care tailored to meet their individual needs. Staff encouraged and enabled people to do what they can do for themselves to keep them active and maintain their independence.

People and their relatives were given opportunity to share their views about the service. People knew how to complain. The registered manager investigated and responded to complaints and concerns appropriately.

Regular spot checks and audits took place to assess and monitor the quality of the service provided. Where required, action plan developed to improve on areas of shortfall. The service ensured that lessons were learnt from incidents.

We carried out an unannounced comprehensive inspection of this service on 03, 04, 08 and 09 August 2016. Breaches of legal requirements were found in respect of staff recruitment and record keeping.

After the comprehensive inspection, the provider sent us an action plan to say what they would do to meet legal requirements in relation to these breaches. We undertook this unannounced focused inspection on 02 and 06 February 2017 to check that they had followed their action plan and to confirm that they now met legal requirements.

At this focused inspection we looked at aspects of the key questions Safe and Responsive. This report only covers our findings in relation to the focused inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Bridges Healthcare Limited’ on our website at www.cqc.org.uk.

Bridges Healthcare Limited provides personal care and support to people in their own homes in the boroughs of Bromley and Bexley. At the time of this inspection approximately 50 people were using the service.

There was a registered manager in place. 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 staff recruitment records had been checked and missing documentation regarding staff employment history was now available. The job application form had been amended to request applicants’ full employment history in line with the requirements of the regulations.

People’s care records were now accurate and people told us they reflected their current health and care and support needs. The care plans in people’s homes matched the records at the office to ensure staff had up to date information about people’s needs at all times. However we found there was still some improvement needed to ensure people’s care plans were personalised to their individual needs and preferences rather than task focused.

We have not changed the rating of the key question Safe in line with the characteristics for each rating, because, although improvements had been made, there were other aspects of that key question that needed improvement from the comprehensive inspection in August 2016. We have not changed the rating of Responsive to Good in line with the characteristics for each rating because although improvements had been made further improvements, in other aspects of this key question, were required to meet the characteristics for Good.

This announced inspection took place on 3, 4, 8 and 9 August 2016. At our last inspection of the service on 22 July 2014 we found a breach in legal requirements; as it was not clear that the service sought the views of people it supported to identify any learning to improve the quality of the service.

Bridges Healthcare provides personal care and support to people in their own homes in the boroughs of Bromley, Bexley, Lewisham and Greenwich. At the time of this inspection approximately 64 people were using the service. There was no registered manager in post but the scheme manager had applied to become a registered manager with the Care Quality Commission and their application was being considered. 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 people’s views were taken into account at the service through a number of means. However we found two breaches of regulations as although an assessment of people’s needs was completed before they started with the service and individual support plans were completed and reviewed regularly, people’s care records were not always sufficiently detailed to provide an up to date and accurate picture of their care and support needs for new or unfamiliar care workers. While recruitment checks were carried out for new employees people’s full employment history had not been requested as required under the regulations. The provider took immediate action to remedy the issues we found, however we were not able to verify these actions were fully completed at the time of our inspection. You can see the action we told the provider to take at the back of the full version of this report.

The service had recently introduced an improved system to record medicines administration but this required some improvement to ensure good practice was consistent. While there were effective quality assurance mechanisms to monitor and improve the quality of the service such as spot checks, telephone monitoring and a daily meeting to ensure effective communication about people’s needs, there was some room for improvement. The service had not identified the issues we found with recruitment or people’s care plans.

People told us they felt safe and well looked after. They said they had the same group of regular care workers who knew them well. There were enough care workers to meet people’s needs. Staff received regular training and supervision. Care workers understood their responsibilities under the Mental Capacity Act 2005. People told us they were asked for their consent before care was provided. They were involved in making decisions about their care wherever possible and were supported to be as independent as they could be. They said care workers were caring and kind and that their dignity and individuality were respected. Where people were supported to eat and drink they were asked about their food and drink choices. People were supported to have access to a range of health professionals if needed. People knew how to make a complaint if they needed to and these were investigated in line with the provider’s policy.

Below is a summary of what we found. The summary describes what people who used the service and the staff told us and the records we looked at.

Is the service safe?

The staff employed were suitably trained and experienced. All staff had been trained in first aid and had attended safeguarding vulnerable adults training in the past year. Staff were observed by care managers whilst caring for people who used the service every three months in order to assess their attention to safety and care delivery.

Is the service effective?

There were up to date care plans in place for each person; however, four care plans did not contain any evidence that potential or actual risks had been assessed and plans put in place to manage such risks. Care plans included details of health professionals involved in the delivery of each person's care and they had been audited. Written and verbal consent was obtained from people who used the service before care and support was delivered.

Is the service caring?

People who used the service were involved in decisions about their care and support. Staff supported people and advised them, but allowed the person who used the service to make the final decision. A member of staff told us, "We always ask [people who used the service] what they would like." They went on to say they never forced people to do anything.

Is the service responsive?

People's individual needs had been assessed by suitably experienced staff. The staff we spoke with were aware of the needs of people who used the service. The people we spoke with and their relatives told us they were aware of how to make a complaint and a system was in place to investigate any complaints that arose.

Is the service well-led?

Staff told us they were able to raise concerns during spot checks held every three months and they felt able to speak to care managers over the phone if they had a concern. People who used the service had not been consulted recently for their feedback.

We found that people's needs had been assessed and appropriate risk management plans were implemented to guide staff in the delivery of care and protect people against the risks of unsafe care. The provider had effective recruitment processes in place to ensure that all employment checks had been completed before staff began work. This ensured that people using the service were safe and their social care needs were met by staff of good conduct, qualified and fit to do their job.

We found that people were involved in making decisions about their care and they were supported by staff to maintain their independence. However, we saw that some care plans and risks assessments were not updated to reflect people's current care needs and to ensure their welfare and safety was maintained. Staff we spoke with showed a good understanding of safeguarding vulnerable adults from abuse, and had been supported with relevant training and guidance. However, we found that the provider had not carried out relevant checks to ensure staff were of good character, and physically and mentally fit before they began work. We found that the provider had appropriate systems in place to assess and monitor the quality of care provided to people.