Archived: Bridlington House

Bridlington House is a residential care home providing personal care to 12 adults at the time of the inspection. The service can support up to 22 people with mental health needs. Accommodation is provided within a house and annex.

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

Quality monitoring of the service still required improving in some areas to ensure the home remained a pleasant place for people to live in.

We made recommendations in the well-led section of this report about introducing systems to ensure timely quality monitoring is undertaken and advice provided regarding fire safety is acted upon.

Minor environmental issues found during the inspection were addressed. Medicine management was robust. People were protected from the risk of harm and abuse. Safeguarding procedures guided staff about the action they must take if they suspected abuse was occurring. People’s risk assessments identify hazards to their health or wellbeing. Action was taken to reduce risks whilst maintaining people’s independence and choice. There were enough staff to meet people’s needs. Incidents and accidents were monitored, and corrective action was taken to prevent re-occurrence.

Staff undertook training to maintain their skills. Supervision and appraisal were undertaken by staff to develop their skills.

People had their capacity assessed and 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.

Staff were kind and caring. They provided encouragement, guidance comfort and support to people. Information was provided to people in a format that met their needs in line with the Accessible Information Standards.

Staff supported people to meet their health and nutritional needs. People were supported and encouraged to maintain their independence, where possible. Staff worked with healthcare professionals to maintain people’s wellbeing.

People felt able to raise concerns and were confident they would be addressed. A programme of activities was provided in line with people’s hobbies, preferences and interests. End of life care was provided with support of relevant healthcare professionals where possible.

The registered manger was available, and they listened to and acted on feedback provided about the service. Data security was maintained.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 08 November 2018) and there were multiple breaches of regulation. 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.

Why we inspected

This was a planned inspection based on the previous rating. The inspection was carried out to follow up on action we told the provider to take at the last inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bridlington House 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.

Bridlington House 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.

Bridlington House is registered to accommodate up to 22 adults who have mental health needs in one building over three floors. Some bedrooms are shared.

There is 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.

During the last inspection, the service was rated requires improvement. We had found concerns with person-centred care records. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve person-centred care records so they were compliant with this.

At this inspection, we found the service had made improvements in this area and was compliant with ensuring people had person-centred records in place. Despite this, the service continued to be rated requires improvement. We found concerns in three other areas including the safety of the premises, managing risk and quality assurance systems. This is the third consecutive time the service has been rated requires improvement.

The provider was unable to assure the safety of the building because there was no electrical safety certificate. Due to the problems with the electrical safety this also meant there were issues with the reliability of the fire alarm and emergency lighting. Maintenance work was in the process of being carried out by an electrical contractor to address the issues with the electrical safety.

We observed poor maintenance in some areas of the home during our inspection. This included two damaged radiator protectors and one broken radiator. The provider confirmed these would be rectified as soon as possible.

Risk assessments were in place, but some had not been reviewed. One person’s risk assessment had failed to mitigate risk appropriately. The risk assessment had identified that bed rails were required to prevent the person falling out of bed. Bed rail protectors were required to prevent the person becoming trapped in the bed rails and causing subsequent injury. The bed rail protectors were in place, but did not cover the full length of the bed rail, which meant there was still a risk they could become trapped in the bed rail. We raised this with the registered manager who agreed to seek advice and address as soon as possible.

Some systems were in place to improve the safety and quality of the service, but there were gaps in these systems, so not all shortfalls were identified and addressed. This included the shortfalls in the safety and maintenance of the premises. There was also no system for auditing staff files including recruitment and training and support or accident and incidents, which led to shortfalls. As systems were ineffective this meant any opportunity to drive improvement was lost.

You can see what action we have asked the provider to take in response to the above concerns at the back of the full version of the report.

Staff felt supported in their role, however there were gaps in the frequency of supervision provided to staff and they had not received annual appraisals. We have made a recommendation about this.

Sufficient staffing levels were in place to meet people’s needs. Systems were in place to recruit staff safely. Staff were equipped with the necessary skills to provide effective support. They supported people to manage their medicines safely, as well as supporting them to meet their nutritional and healthcare needs. Staff knew people well and how best to communicate with them.

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. People felt the service was homely and staff were friendly and respected their privacy and promoted their independence.

Staff knew people well and were knowledgeable about their needs, which meant support was provided in a person-centred way. People had care plans in place which reflected their needs.

There was a complaints procedure in place, although none had been received. People told us they would know how to raise one if required. People and staff told us the registered manager was approachable and communication was good.

At the last inspection on 19 and 20 December 2016 we had concerns about how medicines were managed, the cleanliness of the service and the timeliness of replacing damaged furniture. We issued a warning notice for governance and the provider had to be compliant by April 2017. We received an action plan which told us how the provider was to make improvements and we checked out the progress with it during the inspection.

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.

We found the registered manager had started a quality assurance system of checks and audits. Whilst a lot of improvements have been made in the overall governance of the service, there are still some issues to address and we have asked these to be completed straight away.

We found improvements had been made in the management of medicines, which at the last inspection was mainly with counter-signing controlled drugs [those medicines that required more secure storage]. We saw these medicines were signed appropriately by two staff at the time of administration. We did find that there were some minor recording issues such as an inconsistent use of codes when medicines were omitted and there could be clearer guidance for staff when administering ‘when required’ medicines and those with a variable dose. We have made a recommendation about this in the text of the report.

We found the cleanliness of the service had improved and staff were more aware of managing infection prevention and control. Furniture and bedding had been replaced.

We saw people had assessments of their needs prior to admission to the service and staff completed risk assessments and care plans. Whilst some of these were person-centred and tailored to people’s individual needs, others lacked important information. This meant staff may not have full and up to date information about people’s needs. You can see what action we have asked the provider to take at the back of the full version of the report.

Staff confirmed they received supervision, support and training in order for them to feel confident and skilled when supporting people. The training record showed which staff had completed essential training, however, there was no record staff had completed training in the specific needs of people who used the service such as mental health conditions, and substance and alcohol misuse. The registered manager told us staff had completed some of this training but the records could not be located. We have made a recommendation that this training be re-visited or an attempt made to obtain the certificates from the original trainer.

Staff were observed as kind and caring during their interactions with people and privacy and dignity were respected. However, we observed two practices that were institutional and limited choice, although carried out by staff with good intentions. We spoke with staff and the registered manager about these and they confirmed the practices were to cease straight away.

There were sufficient staff on duty to meet people’s needs and although not assessed at this inspection, recruitment practices were safe at the last inspection.

Staff had received training in how to safeguard people from the risk of harm and abuse. They could recognise the different types of abuse and knew who to contact if they had any concerns.

We found people’s health and nutritional needs were met. People who used the service were supported to attend appointments with community health professionals. Menus provided people with choices and alternatives. Those people with nutritional concerns were referred to dieticians for advice and treatment.

There was a complaints policy and procedure on display and people felt able to raise concerns with staff or the registered manager.

There are six single and eight shared rooms; four single rooms and two shared rooms have en-suite facilities. The home has communal sitting rooms and four bathrooms. There is a rear garden and a parking area. At the time of the inspection 16 people were living at the service.

This inspection took place on 19 and 20 December 2016 and was unannounced. The service was last inspected 19 January 2016 and was found to be compliant with the regulations inspected at that time.

The service had a registered manager. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The infection control practises at the service put people at potential risk of cross contamination. The staff were not following the guidance given in the Health and Social Care Act 2008 Code of Practice on the prevention and control of infections and related guidance (“the Code”). The Code sets out basic steps that are required to ensure that the essential criteria for compliance with the cleanliness and infection control requirements under the Health and Social Care Act 2008 and its associated regulations are being met.

The registered provider had no means of monitoring the infection control practises and made no reference to the above guidance. We found that the bedrooms were dirty and in need of cleaning, and personal items, for example sponges, combs and hair brushes, were not clean and posed a risk of cross infection to the people who used the service. Bedroom furniture was damaged and needed replacing. Mattresses, beds and bed linen were found to be dirty and stained and in need needed replacing. The bathrooms and toilets were dirty and again contained personal items such as sponges, hair brushes and tooth brushes that had not been cleaned.

The laundry was not handled safely and soiled linen came into contact with clean items. The laundry area also posed a risk of cross infection due to the wall covering and flooring needing repair, making it difficult to clean. We have made a referral to the Clinical Commission Group (CCG) for those who are qualified in assessing the extent of the infection control risk to undertake an inspection of the premises. They will share their findings with us.

We found some items in the basement which we thought posed a potential fire hazard, for example cardboard boxes, old beds and mattresses. We informed the fire department who undertook a visit and agreed, and also asked the registered provider to undertake remedial work in the laundry area to make it fire proof. This meant people were exposed to potential risk of cross infection and they lived in an environment which not was clean and well maintained or safe.

We found that meaningful activities were lacking due to the reduction in staff and people who used the service had limited opportunity to access the community. The registered provider has agreed to look at this and make improvements.

We saw that staff did not always follow good practise guidelines and legislation when handling people’s medicines; this was particularly with regard to those medicines which came under the controlled drugs guidance. This put people at risk of not receiving medicines as prescribed by their GP.

We found the monitoring and auditing of the service had not been undertaken effectively and no systems were in place to identify those areas of concern we found during the inspection. We also found there had been no formal consultation with the people who used the service or those who had an interest in their welfare such as relatives, GPs or nurses to gain their views about the service and how it was run. This would have also afforded people the opportunity to suggest changes and improvement which would keep the service improving and moving forward.

The above demonstrated that the cleanliness, infection control and medication were not well managed and are a breach of regulation. You can see what actions we have told the registered provider to take at the end of this report.

We found the registered provider was not always sending in the required information to the CQC about events which happened in the service, which affected the wellbeing of the people who used the service and the smooth running of the service. In this instance we have sent a letter reminding them of their responsibilities; this will be closely monitored and used a part of the ongoing assessment of the compliance of the service with the regulations.

As part of the inspection we found staffing levels had been reduced therefore not providing enough staff to ensure the full range of people’s needs were met and to ensure care was delivered safely. This was discussed during the inspection and the registered provider who increased the staffing levels and sent us evidence in the form of rotas to confirm this had been done. There was also an issue with one person’s care file which did not describe the person’s needs and had not been updated. However, in this instance we found staff were aware of what the person needed and were providing this despite the care plan not being up to date. This has been discussed with the registered provider and they have agreed to update the care plans as a priority. Again due to the lack of monitoring systems this had not been identified by the registered provider.

We also found the same person is now cared for in bed and certain elements of their care are restrictive, for example, the use of bed rails and covert medicines. We could not see that an application had been made to the local authorising authority for a deprivation of liberty safeguard (DoLS) or that a best interest meeting had been held to make sure the care the person received was in their best interest and least restrictive. Since the inspection the registered provider has made the application for the DoLS and the decision will be shared with us as part of the regulatory notifications they have to send us.

Staff had received training that was appropriate to their role and equipped them to meet the needs of the people who used the service. However, there had been a lack of support for staff in relation to supervision.

People who used the service were cared for by staff who were kind and caring. They enjoyed good relationships with the staff and the staff understood their needs. The registered provider had recruitment systems in place which ensured people were not exposed to staff who had been barred from working with vulnerable adults. Staff knew they had a duty to keep people safe and knew how to recognise and report abuse. People were provided with wholesome and nutritional diet which was of their choosing.

The service is registered with the Care Quality Commission [CQC] to provide care and accommodation for up to 22 adults who have mental health needs.

There are six single and eight shared rooms; four of the single rooms and two shared rooms have en-suite facilities. The home has communal sitting rooms, bathrooms and a shower room. There is a garden at the rear which is accessible and a parking area at the front of the building.

This inspection took place on 19 January 2016 and was unannounced. At the time of the inspection 17 people were living at the service.

The service was last inspected in March 2015 and was found to be compliant with the regulations inspected at that time.

There was a registered manager in post. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff were trained in how to recognise and report abuse; this training was updated regularly. They knew the importance of protecting people and upholding their rights. Staff had been recruited safely, and were provided in enough numbers to meet the needs of the people who used the service. People’s medicines were handled safely and they received these as prescribed by their doctor. Staff had received training in how to safely handle medicines and this was also updated regularly.

People received food which was wholesome, nutritious and of their choosing. People were able to choose where they ate their meals and their dietary needs were monitored by the staff who involved other health care professionals when needed. People were supported by the staff to lead a healthy lifestyle and were enabled to access health care professionals when needed.

Staff had received training in how to ensure people’s human rights were protected so they could make informed decisions about their chosen lifestyle. People were supported to make informed choices and decisions which were in their best interest. Systems were in place to make sure people were protected and did not take any unnecessary risks. Staff had a good understanding of the principles of the Mental Capacity Act 2005 and the use of Deprivation of Liberty Safeguards. Staff had received training which equipped them to meet the needs of the people who used the service. We saw the training was updated when required and staff were supported to gain further experience and qualifications.

People who used the service had good relationships with staff who were kind and caring. The interaction was relaxed and informal with lots of laughter and general friendly banter. They had been involved with planning their care and reviews were held on a regular basis to discuss this. Staff understood the importance of respecting people’s fundamental human rights and knew how to uphold people’s dignity. They also understood the importance of respecting people’s wishes and not to judge people’s chosen lifestyles.

Staff had access to information which described the person and their preferences. People who used the service could raise concerns and complaints and these were investigated where possible to the complainant’s satisfaction. Activities were provided for people to participate in if they wished and they were supported by staff to access the local community and to keep in contact with family and friends. People were also enabled to access local facilities independently.

Systems were in place which gathered the views of the people who used the service and others who had an interest in their wellbeing. Staff were also consulted about the running of the service. Regular audits were undertaken to ensure people lived in a well-run, safe and well-maintained environment.

The provider sent us an action plan setting out the steps they would take to become compliant. We followed this up during our visit.

We checked the cleanliness of the home. This included communal areas and people's bedrooms. We also looked at equipment to see if infection control measures had been implemented and how effective these were.

People we spoke with who used the service told us they thought the overall cleanliness of the building had improved since our last visit. One person told us how their carpet and bed had been replaced recently. They also commented on how extra cleaning took place at weekends.

We spoke with the member of staff with responsibility for the extra cleaning at weekends; they told us, 'The extra hours are to make sure we deep clean all areas of the home regularly. I make sure that I clean this place as I would do my own home; it's made a real difference to the home.' One person who lived at the home told us, 'They are very keen to get it [the home] as clean as possible and keep it that way; we're all trying really hard.'

We found the provider had made some improvements in decoration and by the purchase of items such as beds, furniture, stair carpet and the installation of a new toilet. However, the cleanliness of the service was not maintained and we found areas of the home in need of a deep clean.

People we spoke with told us they were happy with their home. Comments included, 'I've been here for 18 months and I think it's the best place I've lived', 'Yes, I think it's clean, my room is anyway', 'The place is quite clean and tidy but people stink of smoke' and 'I've got a lot of things in my room but I like it. I try to keep it clean myself.'

During this visit we saw that the environment had improved particularly in the communal areas and a new manager had been appointed, who has initiated some changes with immediate effect.

We spoke with the majority of people who used the service and they told us about the positive changes that had been made since our last visit. People said, "It is lovely now, very homely", "I think it's much better", "We all like it a lot better" and "Since the new manager has been here we have had lots of changes and this has been good."

People also told us they received support from health care professionals such as their GP, psychiatrist and community mental health team. They also confirmed that they felt safe in the home and that activities had improved over the past couple of months.

People who used the service spoke highly of the new manager and staff and commented, "The staff are very nice", "The new manager is wonderful and he gets things sorted."

However, some people did tell us there was no where for them to smoke and that they needed a shelter outside as the home was non-smoking. We also saw that some areas were not clean and hygienic and may pose a risk of infection.

We spoke with several people who used the service and they told us they were happy with the care and support they received. They also told us that the staff were supportive. Comments included; 'The staff are great', 'They are all nice' and 'I get on with them all'. However, people also told us that they were unable to have a bath as the bath seat was not working.

People also told us that overall they were satisfied with the environment. Comments included; 'I love my room and I have made it my own' and 'Yes I am happy I have everything I need.' However, some people did tell us there was no where for them to smoke and that they needed a shelter outside as the home was non-smoking. We were also told that some furniture was in poor condition and fixtures needed replacing.

People also told us that choice was offered and they had agreed to restrictions in relation to smoking and one person commented, "I hand my cigarettes in at night, but that is my choice as I know I would smoke in my room." They told us that choice was offered and consultation took place particularly regarding the menu, 'The food is always nice", "We get a good choice and the cook is very good, but I don't like the meals much at weekends when she's not here."

People who used the service understood the care and treatment choices available to them and people's diversity, values and human rights were respected. Other people who used the service told us they had signed and understood their care plan and comments included, "I worked with my key worker on my care plan and I enjoyed doing this" and "Yes I know what's in my care plan."

People who used the service told us they felt safe within the home and commented, 'I do feel safe here", "I have a key to my door so I know my stuff is safe" and 'I have my buzzer if I need help.'

People told us their views and concerns were listened to and commented, 'If I had a complaint I would see the manager, she always sorts things out."