Archived: The Bridgings Limited (Middlesbrough)

At the last inspection in January and February 2017 the service was rated Requires Improvement.

We also identified a breach of regulation in relation to the safety and condition of the premises and equipment. This was because tests of the fire alarm, emergency lighting and electrical installation had not been carried out by someone qualified to do so. In addition, the premises and furniture was not properly maintained. We took action by requiring the provider to send us plans setting out how they would address this. When we returned for this latest inspection we found that action had been taken and the service was no longer in breach of regulation.

The Bridgings (Middlesbrough) 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. At the time of our inspection 10 people with learning disabilities or autism were using the service.

The care service had 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.

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. The registered manager was also one of the owners and registered providers of the service.

The registered manager carried out a range of checks of the premises and equipment to ensure they were safe to use. Plans were in place to support people in emergency situations. Risks to people were assessed and steps taken to address them. Measures were in place to ensure appropriate standards of infection control. Policies and procedures were in place to safeguard people from abuse. People’s medicines were managed safely. The provider and registered manager monitored staffing levels to ensure enough staff were deployed to support people safely. The provider’s recruitment policies minimised the risk of unsuitable staff being employed.

The premises had been redecorated since our last inspection. Staff were supported with regular training, supervision and 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 in the service supported this. People were supported to maintain a healthy diet. People were supported to access external professionals to monitor and promote their health.

People and their relatives spoke positively about the support provided by staff at the service. Throughout the inspection we saw numerous examples of kind and caring interactions between people and staff. People told us they were treated with dignity and respect. People were supported and encourage to maintain their independence. People were supported to maintain interests and relationships they had enjoyed before moving into the service. The service had received a number of written compliments from relatives of people using the service. We found the service had listened to family members as natural advocates for people to learn about people who used the service.

People received person-centred support that responded to their needs and preferences. People were supported to maintain their hobbies and interests and access activities they enjoyed. Policies and procedures were in place to investigate and respond to complaints and to arrange End of Life care if needed.

Staff spoke positively about the culture and values of the service and said they were supported in their role by the registered manager. The registered manager and provider carried out a number of quality assurance audits to monitor and improve standards at the service. Feedback was sought from people, relatives and external professionals who worked with the service. The registered manager and staff worked to create and sustain links with a number of community organisations to help improve the health and wellbeing of people at the service. The registered manager had informed CQC of significant events in a timely way by submitting the required notifications. This meant we could check that appropriate action had been taken.

When we last inspected the service in December 2015 we found one breach of the regulations. People were not protected against the risks of ineffective monitoring as the service did not have any formal auditing tools. The registered provider wrote to us telling us what action they would be taking in relation to the breach of regulation.

At this inspection we found that the registered provider had followed their plan and legal requirements had been met.

The home 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.

The service is registered to provide care and support for up to 10 adults with a learning disability. Accommodation is provided in 10 single occupancy rooms. The service is a two-storey building, close to the centre of Middlesbrough and on a main bus route. At the time of the inspection 10 people were using the service.

We found that checks of the fire alarm, electrical installation and emergency lighting had not been tested by someone who was competent to do so. This posed a significant risk to people who used the service and others. The registered provider contacted us after the inspection and informed they were to take swift action to address this.

Systems were now in place to monitor the quality of the service provided. However, it was concerning that the registered provider had not ensured that a qualified and experienced tradesperson had undertaken the electrical testing and testing of the fire alarm.

People were protected by the service's approach to safeguarding and whistle blowing. People told us staff treated them well and they were happy with the care and service received. Staff were aware of safeguarding procedures, could describe what they would do if they thought somebody was being mistreated and said that management acted appropriately to any concerns brought to their attention.

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. This enabled staff to have the guidance they needed to help people to remain safe.

There were sufficient staff on duty to meet the needs of people who used the service. We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

Appropriate systems were in place for the management of medicines so that people received their medicines safely.

Any staff who didn’t have a care background would undertake the Care Certificate induction or alternatively commence an NVQ qualification in care. The Care Certificate is a set of standards that social care and health workers adhere to and promote within their roles. Staff were aware of their roles and responsibilities and had the skills, knowledge and experience to support people who used the service. We saw that staff had undertaken training considered to be mandatory by the service. This included: safeguarding, fire, health and safety, mental capacity and deprivation of liberty safeguards, nutrition awareness, medicines administration, infection control, people movement and first aid.

Staff had an understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. The registered manager told us all people who used the service had capacity.

We saw that people were provided with a choice of healthy food and drinks, which helped to ensure that their nutritional needs were met.

People were supported to maintain good health and had access to healthcare professionals and services. They were encouraged to have regular health checks.

There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. Staff were kind, caring, respectful, and interacted well with people. Observation of the staff showed that they knew the people very well and could anticipate their needs. People told us that they were happy and felt very well cared for.

People were encouraged and supported to engage in daily activities they enjoyed. Staff understood what was important to people, their personal histories and social networks so that they could support them in the way they preferred.

People’s needs were assessed and their care needs planned in a person centred way, however some care plans were first written many years ago and although reviewed still contained some out of date information.

The registered provider had a system in place for responding to people’s concerns and complaints. People told us they knew how to complain and felt confident that staff would respond and take action to support them. People we spoke with did not raise any complaints or concerns about the service.

Staff told us they enjoyed working at the service and felt supported by the registered manager. Feedback was sought from people who used the service through regular meetings. This information was analysed and action plans produced when needed.

The Bridgings is located in the centre of Middlesbrough and provides a home for up to ten people who have a learning disability. Accommodation is provided in ten single occupancy bedrooms. Communal areas include a kitchen, lounge, dining room and yard to the rear of the property. At the time of the inspection there were ten people who used the service.

The service has 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.

We looked at the arrangements in place for quality assurance and governance. Quality assurance and governance processes are systems that help providers to assess the safety and quality of their services, ensuring they provide people with a good service and meet appropriate quality standards and legal obligations. The service did not have audit tools for checking care plans, medication or infection control. This meant that we could not determine what checks were made to make sure the service was run in the best interest of people.

This was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we took at the back of the full version of this report.

Appropriate systems were in place for the management of medicines so that people received their medicines safely. However the registered manager did not keep a record of competency checks undertaken on staff.

People’s needs were assessed and their care needs planned in a person centred way. Staff were aware of action to take should a person have an epileptic seizure; however, there wasn’t a care plan in place for this. We saw that risks identified with care and support had been included within the care and support plans.

People were protected by the service's approach to safeguarding and whistle blowing. People who used the service told us they felt safe and could tell staff if they were unhappy. People who used the service told us that staff treated them well and they were happy with the care and service received. Staff were aware of safeguarding procedures, could describe what they would do if they thought somebody was being mistreated and said that management acted appropriately to any concerns brought to their attention.

Staff told us that they felt supported. There was a regular programme of staff supervision and appraisal in place. Supervision is a process, usually a meeting, by which an organisation provides guidance and support to staff.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).

The registered manager was in the process of completing decision specific capacity assessments for one person who used the service. At the time of the inspection the registered manager had assessed one person as being deprived of their liberty and was to make an application to the local authority in respect of this.

The service did not have a high turnover of staff. The registered manager and staff that worked at the service had done so for some time. We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

People who used the service and relatives we spoke with told us that staff were caring and treated people well, respected their privacy and encouraged their independence. Our observations showed staff and people who used the service were comfortable together and interacting in a friendly and caring way.

People’s nutritional needs were met, with people being involved in shopping and decisions about meals. People who used the service told us that they got enough to eat and drink and that staff asked what people wanted.

People were supported to maintain their health, including access to specialist health and social care practitioners when needed.

People’s independence was encouraged and their hobbies and leisure interests were individually assessed. There was a plentiful supply of activities both in and out of the home for people to take part in. Staff encouraged and supported people to access activities within the community. People had holidays.

The registered provider had a system in place for responding to people’s concerns and complaints. People and relatives told us they knew how to complain and felt confident that staff would respond and take action to support them. People and relatives we spoke with did not raise any complaints or concerns about the service.

Previously we obtained answer our five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

We found that action was needed to ensure the service was safe and well-led.

At our inspections in January 2014 we found that many areas of the home had not been adequately maintained. During the June 2014 inspections we found that the provider had taken some action to address our concerns but on-going concerns remained. The building was not adequately maintained.

Also in June 2014 we found that some records were not available for inspection or had not been completed. People did not have health action plans or hospital passports. Care records were not always written in a way that ensured the confidentiality of people who used the service. People were not protected from the risks of unsafe or inappropriate care and treatment because appropriate records had not been maintained.

At this inspection we found that the provider had taken action to ensure the service was compliant and the building and records were appropriately maintained.

The inspection team was made up of one adult social care inspector. The inspector spoke with four people who used the service, a senior support worker, two support workers, a care assistant and a visiting professional. The manager was on holiday at the time of the inspection visit.

We set out to answer our five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Care plans and risk assessments were in place and were updated as people's needs changed. Care records detailed the support people required and encouraged people to be independent where possible. People we spoke with during the inspection told us that they felt safe.

Staff we spoke with during the inspection were knowledgeable about the people they cared for. Staff we spoke with were aware of risk management plans that had been written for people with particular needs.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The home had flow charts that had been provided by the local authority in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards; however there was limited information contained within the homes policies and procedures. During discussion staff demonstrated a clear understanding of DoLS and the Mental Capacity Act. Staff had received training in relations to these topics along with the safeguarding of vulnerable adults and had an understanding of the actions to take. This meant that people were safeguarded as required.

At out last inspection in January 2014 we found that many areas of the home had not been adequately maintained. The provider had taken some action to address our concerns; however at this inspection in June 2014 we found ongoing concerns. The building was not adequately maintained.

We asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the safety and suitability of the premises.

Is the service effective?

People's health and care needs were assessed and people had been involved in writing the plan of care. Care and support plans were reviewed and updated on a regular basis.

We saw that people's needs were regularly reviewed. There was evidence of people being involved in assessments of their needs and planning of care.

Is the service caring?

People were supported by kind and attentive staff. We saw that care staff showed patience and gave encouragement when supporting people.

We saw that both people who used the service and staff were affectionate whilst ensuring that professional boundaries were maintained. This helped to ensure wellbeing.

People who used the service, their relatives and friends were asked for their views on the care and service provided. Where shortfalls or concerns were raised, however small, these were taken on board and dealt with.

Is the service responsive?

People knew how to make a complaint if they were unhappy. Discussion with the senior support worker during the inspection confirmed that any concerns or complaints were taken seriously. There had not been any complaints made in the last 12 months.

People took part in a range of activities both in and out of the home. This helped to keep people involved in their local community.

Is the service well led?

Staff told us that they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and all senior staff understood and shared the responsibility of quality assurance processes. This helped to ensure that people received a good quality service at all times.

Some records were not available for inspection or had not been completed. People did not have health action plans or hospital passports. Some information on people who used the service was not written in a way that ensured the confidentiality of people who used the service. People were not protected from the risks of unsafe or inappropriate care and treatment because appropriate records had not been maintained.

We asked the provider to tell us what they are going to do to meet the requirements of the law in relation to records.

What people told us.

During the inspection we spoke with four people who used the service, a senior support worker, two support workers, a care assistant and a visiting professional.

People who used the service told us that they were very happy with the care and service received. One person said, "I like it here."

People told us that they went out on a regular basis and that they went on regular holidays. One person said, 'I like to go out on my own and with staff.' Another person said, 'We went to Spain and I liked it.'

People who used the service told us that they helped with the tidying of their bedrooms, washing up and other cleaning duties. One person said, 'I like to hoover.'

One person told us how they had personalised their bedroom. They showed us the posters they had put on their wall and the pictures of their family.

People told us that if they had any concerns they would feel comfortable in speaking with staff who worked at the home.

All the people we spoke with were satisfied with the service they received. We found that people had their needs assessed and that care plans were in place. Staff responded quickly when people needed support and people were provided with the care they needed.

We saw that staff worked in collaboration with other health and social care professionals.

People who used the service were protected from the risk of abuse and told us they felt comfortable and safe with staff.

We found the home had systems in place to ensure maintenance and improvements were carried out. However there were areas of the home in need of repair and this had not been undertaken.

We found there was a recruitment procedure in place and appropriate checks were carried out on staff before they started work.

The quality of the service was monitored and reviewed on a regular basis.

We found that people were treated with dignity and respect. We saw there was a friendly and relaxed atmosphere between people living and working at the home. We observed staff interacting well with people and involving them in activities which we saw had a positive impact on their wellbeing.

We found the premises that people, staff and visitors used were safe and suitable. We found that staff were appropriately supported in relation to their responsibilities which enabled them to deliver care and support safely and to appropriate standards.

We found there was an effective complaints system in place.