Bridge House Care Centre is currently registered to provide accommodation and nursing care to up to 35 older people. At the time of our inspection 29 people were using the service. The provider had increased their bedrooms from 35 to 36. This included 15 beds for people requiring end of life care, 11 beds for people living with dementia and 10 beds providing an intermediate care service with support from the local NHS trusts’ community healthcare professionals. This additional bed was not in use and the provider was aware of the legal requirement to apply to the Care Quality Commission to increase their bed numbers.

At our last comprehensive inspection on18 December 2014 the service was rated ‘Requires Improvement’ overall and for two key questions ‘Is the service safe?’ and ‘Is the service caring?’ At a focused inspection on 1 June 2015 the rating for the key question ‘Is the service safe?’ had improved to ‘Good’ which meant the rating for the whole service also changed to ‘Good’.’ The key question ‘Is the service caring’ remained rated ‘Requires Improvement’ due to some staff not consistently treating people with dignity and respect.

At this inspection we found that people’s safety was maintained. There were sufficient staff deployed to meet people’s needs and they were prompt in responding to people’s requests for assistance. Staff identified risks to people’s safety and developed plans to mitigate those risks. Staff protected people from harm. They were knowledgeable in recognising signs of possible abuse and liaised with the local safeguarding team when required. Safe medicines management was in place and people received their medicines as prescribed.

Staff continued to undertake training relevant to their role, including completion of refresher courses, and they received regular supervision. They adhered to the Mental Capacity Act 2005 code of practice. The manager liaised with the local authority to ensure they only deprived people of their liberty when legally authorised to do so, in order to maintain the person’s safety. Staff supported people with their nutrition, hydration and healthcare. The manager arranged for improvements to be made to the environment during our inspection to ensure a safe and pleasant environment was provided.

Improvements had been made since our previous inspection and we observed that staff treated people with respect, maintained their privacy and dignity. Staff were friendly, kind and patient when supporting people. They supported people to practice their faith and were respectful of people’s religious and cultural backgrounds. Staff discussed with people their end of life preferences and provided support in line with people’s choices.

The provider ensured people’s individual needs were met. Staff assessed people’s needs and for the majority developed clear care plans about how they were to meet those needs. Where we identified that improvements could be made to aid clarity to the care plans these were addressed. Staff maintained accurate records of the support provided. A range of activities were available to engage and stimulate people. People, and their relatives, felt able to raise concerns and complaints as and when they needed to.

A new manager was in post. Staff told us there was an open and honest culture within the team. The manager welcomed feedback about service delivery from people, their relatives and staff. There continued to be processes in place to review the quality of service delivery and where required action was taken to address areas of concern. Staff were aware of their roles and responsibilities and liaised with their management team about any concerns identified. The management team liaised with other health and social care services to review their joint working arrangements.

Further information is in the detailed findings below.

We carried out an unannounced comprehensive inspection of this service on 18 December 2014 and a breach of legal requirements was found. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the management of medicines at the home.

We undertook this focused inspection to check the provider had followed their plan and to confirm they now met legal requirements. This report covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Bridge House Care Centre on our website at www.cqc.org.uk

We undertook this unannounced focused inspection of Bridge House Care Centre on 1 June 2015. Bridge House Care Centre is a care home which provides accommodation for up to 35 people who require personal care and support. At the time of our inspection the home was fully occupied. The home specialises in caring for older people living with dementia.

The service is required to have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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 and associated Regulations about how the service is run. The registered manager on our records left the service in October 2014. We were notified at the time by them and the provider. A manager was appointed to replace them but subsequently stepped down from the role. A new manager has been appointed from 26 May 2015 and is in the process of submitting the appropriate registered manager application to CQC.

We found the provider had taken appropriate and timely action to make improvements in relation to the management of medicines at the home. Our checks showed people received their medicines as prescribed and appropriate records in relation to the management of medicines were maintained. We also found medicines in stock were all in date.

People’s records gave guidance for staff on how and when to administer ‘as required' medicines, topical creams and ointments. The provider had updated their medicines policy and procedure so that staff had clear guidance about their responsibilities for when to administer these medicines.

Regular checks of medicines had been undertaken by senior staff to ensure staff were administering and disposing of medicines as required.

The provider had taken steps to ensure staff were aware of how to ensure peoples’ rights to privacy and dignity were upheld. Staff had received dignity training. However we found there were still some inconsistencies in the way information about people was used and discussed in the home which could compromise people’s privacy and dignity.

We were able to speak with two people using the service and a visiting relative of another person during our inspection. We also gathered evidence of people's experiences of the service by speaking with staff, reviewing people's care records and other records

People we spoke with were positive about their experiences of care and support received. One person said, “It’s nice here. I like the atmosphere and they’re all friendly and staff do activities with you. Yesterday we did drawing”. Another person said, “It’s ok here. Staff are nice, look after me and treat me with dignity”. A relative told us “Staff will always check if you’re worried about anything or tell you if they’re worried about anything”.

We observed from people’s records their individual care and support needs had been assessed and plans were in place to meet these needs. Where people lacked capacity to make decisions their representatives had been involved in planning and developing their plan of care. From the records we looked at, information was reviewed and updated regularly so that staff had up to date information about people’s current care and support needs.

The home was clean and free from odours. Staff carried out audits to check the cleanliness of the home. From staff training records we saw all staff who worked in the home had access to training to keep their skills and knowledge up to date. The provider had systems in place to assess and monitor the quality of service that people receive.

The majority of people using the service were not able to share their views about living in Bridge House Care Centre due to their complex needs. We were able to speak with one person using the service who described their care as ‘very good for me’. We were also able to speak with four relatives who were visiting the home during our inspection. All the relatives spoke positively about the care and support provided to people using the service. They told us staff were kind and respectful and they felt comfortable approaching them with any issues or concerns they had.

Some relatives told us they didn’t think there were enough staff working in some parts of the home. The registered manager told us staffing levels had been, and would continue to be reviewed to reflect the changing needs of people using the service.

The provider used surveys to assess the quality of service being provided. They also carried out audits and checks within the home to ensure risks to people’s health and wellbeing were identified managed and mitigated.

This inspection took place on 18 December 2014 and was unannounced. At the last inspection on 3 June 2013 we found the service was meeting the regulations we looked at.

Bridge House Care Centre is a care home which provides accommodation for up to 35 people who require personal care and support. At the time of our inspection the home was fully occupied. The home specialises in caring for older people living with dementia. Accommodation is arranged over three floors. There is a lift to assist people to get to the first and second floors. Within the home, each person has their own room some with en-suite facilities.

The service is required to have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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 and associated Regulations about how the service is run. The registered manager on our records left the service in October 2014. We were notified at the time by them and the provider. A new manager had since been appointed and has submitted the appropriate registered manager application to CQC.

During this inspection we found the provider in breach of their legal requirement to ensure medicines in the home were effectively managed. We found a medicine had not been properly administered and a medicine that was no longer safe to use. There was no written guidance for staff as to how some medicines should be administered. However, medicines were stored safely and people received their medicines as prescribed. You can see what action we told the provider to take at the back of the full version of the report.

People and their relatives told us people were safe at Bridge House Care Centre. Staff knew what action to take to ensure people were protected if they suspected they were at risk of abuse or harm. Risks to people’s health, safety and wellbeing had been assessed by staff. There were plans in place which instructed staff on how to minimise identified risks to keep people safe from harm or injury in the home. The home, and the equipment within it, was checked and maintained to ensure they safe. Staff kept the home free from clutter and obstacles to enable people to move around safely. There were enough suitable staff to care for and support people.

People’s needs were met by staff who received appropriate training and support. The manager monitored training to ensure staff skills and knowledge were kept up to date. Staff felt well supported by the manager and other senior staff. They had a good understanding of people’s needs and how these should be met.

Staff encouraged and supported people to stay healthy. People were supported to eat and drink sufficient amounts to reduce the risk to them of malnutrition and dehydration. Staff regularly monitored people’s general health and wellbeing. Where there were any issues or concerns about a person’s health staff ensured they received prompt care and attention from appropriate healthcare professionals such as the GP. They also ensured relatives were kept regularly informed and updated about any changes to people's health and wellbeing.

Care plans had been developed which reflected people’s needs and their individual choices and beliefs for how they lived their lives. People’s relatives and other healthcare professionals were involved in supporting them to make decisions about their care and support needs. Where people were unable to make complex decisions about their care and support, staff ensured appropriate procedures were followed to ensure decisions were made in their best interests.

The provider had procedures in place in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). DoLS provides a process to make sure that

people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them. The manager had sufficient training to understand when an application should be made and in how to submit one. This helped to ensure people were safeguarded as required by the legislation.

The home was welcoming to relatives who told us there were no restrictions on them visiting their family members. People were encouraged and supported to maintain relationships that were important to them. People and their relatives felt comfortable raising any concerns they had with staff and knew how to make a complaint if needed. People said concerns raised in the past had been listened to and dealt with responsively.

People and their relatives told us staff looked after people in a way which was kind, caring and respectful. However staff did not always ensure that people’s privacy and dignity was maintained when they received personal care.

A new manager had been appointed to the home and had taken appropriate steps to inform people, their relatives and staff of important changes within the home.

There were systems in place to monitor the safety and quality of the service which the provider used to identify changes and improvements that were needed. When improvements were needed, people and their relatives were informed and involved and their views were taken account of in how these could be made.

The home used learning from investigations and best practice to improve the quality of care people experienced.