There are ten people currently living at the home with another person moving in soon. The people living at Bridge House have a learning disability and many are unable to communicate verbally. Some people have complex needs that often challenge the service and sometimes cause aggressive outbursts. The home has a high ratio of staff to ensure people's needs are supported safely.During our visit to the home, some people, who were able to verbally communicate, told us that they were happy living in the home, some said "they liked staff and staff took them out". Some people talked about the activities they did, naming, swimming, shopping, art classes and going to the pub. Some people talked about how they were involved in the information in their care plans and confirmed that staff supported them to make decisions about their lives. Some people talked about house meetings where they are supported to express their views about how the home is run.
During our visit we observed staff providing care and support. We saw staff communicating appropriately and respectfully, and offering choices to people. Staff had a good rapport and people responded well to them.
On the day of the visit the home had 4 staff on duty in the morning instead of the 6 staff that they had identified were required to meet people's needs. We were told this was due to some shift changes that had meant there was a shortage on this morning but the next day the rota showed there would be 9 staff on duty. The manager explained that this was because there had been staff sickness at the weekend and the rota had to be swapped around. On this day the shift leader felt that the 4 staff on duty were experienced members of staff and said that the manager was due in at 11am and another member of staff was due in at 12 noon so thought they could manage until then.
The home uses a care hour assessment to establish the care hours required to meet the needs of the people currently living in the home. We were told that the hours have been increased 3 times in the past year and will be increased again when a further person moves into the home. The home now has enough hours to provide 6 staff between 8am and 6pm and 4 staff from 6pm to 8.30pm when the night staff come on duty.
During the visit staff said they were flexible with their hours to ensure people are able to go out in the evening for planned activities but add hoc activities in the evenings are more difficult.
The manager explained that all homes operated by the provider recruit over and above their allocated hours by 12% to 15%. This enables homes to have excess staff at times so that they can cover shortages in their own homes or support others within the organisation. We were told there is currently no bank system for obtaining additional staff to cover shortages but at a recent meeting the provider has instructed managers to recruit bank staff for their homes. We were told that agency staff can be used as a last resort but often this can cause more difficulties in the home because of the complex and challenging needs of some of the people living there.
Staff on duty had a good knowledge of people's needs and risks. Staff said they were involved in care planning and were key workers to people. Staff were observed being respectful and caring towards everyone, but it was clear that having less staff than normal was causing difficulties to plan effective care and support. For example, activities were cancelled for two people and some people were constantly asking if and when they could go out. For those people whose activities had to be cancelled, staff explained why and said they would be able to arrange for them to go out later that day when more staff came in. For those asking when and if they could go out, staff were very patient and spent time reassuring people that they would get out and when.
Staff were observed being busy providing personal care but also spending time observing and talking to people. Much of this was spent diffusing situations to prevent some people becoming aggressive. We were told that it is not unusual having to diffuse situations, staff were very good at managing to communicate effectively with people and prevent situations escalating.
We read some support plans and found them to contain detailed information about a persons needs and how to care for them safely. Some plans also contained detailed information about how the home has involved other professionals and relatives in making decisions that effect people's lives, particularly decisions that may restrict someone's freedom. Examples were read of the home involving Independent Mental Capacity Advocates, Deprivation of Liberty Safeguards and Good Practice Committees. The information showed that these are under constant review.