This inspection took place on 12 and 14 September 2018 and was unannounced. The previous inspection was carried out on 10 and 13 May 2016. We rated the service good overall. Since the last inspection a new provider had taken over the service. There had been no change in legal entity.

Bridge House is registered to provide accommodation for up to 16 people who require help with personal care. The service specialises in the care of older people but does not provide nursing care. At the time of our visit there were 16 people living at the service.

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 of the Health and Social Care Act 2008.

People using the service said they felt safe and that staff and the registered manager treated them well. Staff understood how to safeguard the people they supported from abuse. There was a whistle-blowing procedure available for staff and they told us they would use it if they needed to.

Systems and processes were in place to keep people safe and risks associated with people's care needs had been assessed.

There were processes in place to ensure the premises and equipment were regularly checked and to manage the prevention and control of infection. The registered manager reviewed accidents and falls to ensure people had the right support to keep them safe. People were receiving their medicines as prescribed by health care professionals, medicines were securely stored, and the administration of medicines was recorded appropriately.

Recruitment of employees was robust with good record keeping and checks including DBS and ID procedures. These checks ensure that staff are not barred from working with vulnerable people and have a right to work in the UK. Sufficient numbers of staff were employed who had the knowledge and skills to meet people's needs.

Staff had received training to meet the needs of people using the service. They had also received regular supervision and an appraisal of their work performance. The registered manager and staff demonstrated a clear understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People were supported with maintaining a balanced diet and the people who used the service chose their meals and these were provided in line with their preferences. People were encouraged to attend appointments with other health care professionals to maintain their health and well-being.

Staff treated people with dignity and respect and helped to maintain people's independence by encouraging them to care for themselves where possible. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People were supported to maintain relationships with relatives and friends.

Visitors were made to feel welcome. People were supported to practice their faith.

People had personalised care plans, which detailed how they wanted staff to meet their individual needs. Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs, in the service and within the local community.

The provider had an effective complaints procedure in place and people who used the service and their relatives were aware of how to make a complaint. The provider had a quality assurance process in place. People who used the service, relatives and staff were regularly consulted about the quality of the service through meetings and surveys.

There were effective processes in place to monitor the quality and safety of the service.

The inspection took place on 10 and 13 May 2016. Bridge House provides accommodation and personal care and support for up to 16 older people. This was an unannounced inspection, which meant the staff and provider did not know we would be visiting. The previous inspection was completed in April 2013 there were no breaches of regulation at that time.

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.

Bridge House is a family run business. The provider and the registered manager were very visible in the service and operated an open door policy.

This inspection was brought forward because we had received concerns about how people we being supported especially at night when there was only one member of staff providing sleep in cover. The provider and registered manager had developed a robust plan to change the sleeping to a waking night before we completed the inspection. Waking night cover was being introduced from the 31 May 2016. In the interim the sleep in staff were supporting a person throughout the night in a consistent way ensuring their safety.

People were receiving care that was responsive and effective and tailored to their needs. Care plans were in place that described how each person would like to be supported. There were some areas that required more information to guide staff. However, it was clear the staff were consistent in their approach and knew how people liked to be supported. Other health and social professionals were involved in the care of the people. Safe systems were in place to ensure that people received their medicines as prescribed.

People were protected from the risk of abuse because there were clear procedures in place to recognise and respond to abuse and staff had been trained in how to follow the procedures. Systems were in place to ensure people were safe including risk management. There were suitable recruitment processes to ensure only suitable staff were employed to support people.

Staff were caring and supportive and demonstrated a good understanding of their roles in supporting people. Staff received training and support that was relevant to their roles. Training was planned for staff on supporting people living with dementia. Systems were in place to ensure open communication including team meetings and one to one meetings with their manager.

People’s rights were upheld, consent was always sought before any support was given. Staff were aware of the legislation that ensured people were protected in respect of decision making and any restrictions and how this impacted on their day to day roles.

People’s views were sought through care reviews, meetings and acted upon. Regular activities were organised for people. People’s cultural and religious were being met in an individualised way. Systems were in place to ensure that complaints were responded to and, learnt from to improve the service provided.

The service was committed to involve relatives in aspects of running the service. Relatives told us they were made to feel welcome and there were no restrictions on visiting times.

People were provided with a safe, effective, caring and responsive service that was well led. The values and philosophy were clearly explained to staff. Systems were in place to review the quality of the service identifying areas for improvement.

People told us about what it was like to live at the home and how they felt they were cared for by the staff. One person said "The home encourages me to maintain my independence".

People living at the home told us "The thing I like about the meals here are they are very traditional, served warm and fresh” and “I have no complaints about the food, we all eat very well” and “We have lots of choice here, the meals are lovely”.

People were given support by the provider to make a comment or complaint where they needed assistance. People living in the home told us "If I had a complaint I would tell my family and the staff here” and “I would talk to the manager if I was unhappy”.

We spoke with three staff, they told us they felt supported by senior staff in the home. Staff told us "We have a lovely staff team here and all work together” and “The manager is very supportive and offers us regular training opportunities”.

People were cared for in a clean, hygienic environment. We found very good standards of cleaning. Bedrooms were checked and were found to be clean, tidy and odour free.

People told us about what it was like to live at Bridge House and how they felt they were cared for by the staff. Comments included "It is a nice place and we are happy, the staff work hard and are always cleaning", "The food is lovely here” and “I am very happy with the way I am looked after".

We were able to speak with a visitor to the home. They told us “I’m very happy with my relatives care here, their mobility has improved 100% and their now socialising with others and happy” and “Staff are so friendly and welcoming here”.

People confirmed that staff listened to them and acted appropriately to their requests. One person said "The home and staff are lovely here and they cannot do enough for me”. Another person said, “I am able to make choices about what i'd like to wear, and what food I'd like to eat from the menu”.

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The provider did not have effective systems in place to assess, plan and deliver care to meet people's individual needs and to ensure their welfare and safety. We have asked them to make improvements to ensure people are safe.

The provider did not maintain appropriate standards of hygiene and cleanliness with the home and did not follow infection control guidelines.