About the service:

Bridge Medical Solutions is a small family run domiciliary care service. Bridge Medical Solutions also provide care staff to other providers via their staffing agency. This inspection looked only at the regulated activity carried out by domiciliary care service which was personal care. At the time of the inspection the service was supporting five people with personal care.

People’s experience of using this service:

The service has 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.

People we spoke with told us they felt safe and secure in their accommodation. They said staff were very good. Described as outstanding by one person. Relatives told us they thought staff were professional in their approach but remained friendly and caring.

There was a recruitment system in place that helped the employer make safer recruitment decisions when employing new staff. Support workers we spoke with had a clear understanding of safeguarding people and would act appropriately to safeguard people from abuse.

There was a programme of training, supervision and appraisal for staff to support people using the service with their assessed needs.

The care plans we looked at included risk assessments, which identified any risks, associated with people’s care and had been devised to help minimise and monitor the risks without placing undue restrictions on people.

Medications procedures were in place including protocols for the use of ‘as and when required’ (PRN) medications. Staff had received training in medication management and medication was audited in line with the provider’s procedures.

We observed good interactions between support workers and people who used the service. People were encouraged to make decisions about their activities and meals.

Although there had been no complaints received, there was a clear complaints process in place and copies of this were available in people’s homes.

The service was very well run. People spoke fondly of the registered manager. There were effective systems in place to monitor and improve the quality of the service provided.

Feedback received from healthcare professionals was extremely positive.

Rating at last inspection:

Good (published 16 September 2016)

Why we inspected:

This was a planned inspection based on the rating awarded at the last inspection. The service remains good.

Follow up:

We will continue to monitor this service. We plan to complete a further inspection in line with our re-inspection schedule for those services rated good.

The inspection took place on 16 August 2016. The inspection was announced as the service is very small and we needed to be sure someone would be in the office.

The last inspection took place in May 2014, at which time the service was found to be meeting all the requirements of the regulations we looked at.

Bridge Medical Solutions is a very small family run domiciliary care service, who were providing personal care to one older person at the time of our inspection. Bridge Medical Solutions also provide care staff to other providers via their staffing agency. This inspection looked only at the regulated activity carried out by domiciliary care service which was personal care.

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.

The service was providing care and support to people in their own homes, at the time of our inspection however there were no people who were receiving the regulated activity (personal care).

The service was run by the registered manager who was also a director. The service was very small and also comprised of a care staff agency which supplied care staff to other services.

The standard of records which were kept was very good, the registered manager was able to complete all care assessments and care plans personally due to the size of the service.

People we spoke with told us the service was ‘second to none’ and they expressed no concerns about any aspect of the support they received.

Staff had undertaken training in safeguarding vulnerable adults and were able to demonstrate their understanding of their role and responsibility in keeping people safe.

There were robust, detailed risk assessments in place which identified individual risks and showed the measures which were in place to minimise those risks.

Staff recruitment procedures were thorough and all relevant pre-employment checks were carried out to help the provider make safer recruitment decisions.

Staff had received an induction prior to commencing their roles and had undertaken all required training.

Staff received regular supervision and appraisals and were well supported.

People were asked for and gave their consent to the care they received in line with the Mental Capacity Act 2005.

We were told staff were kind, caring and patient when supporting people.

There was clear evidence that people were involved in all aspects of their care and care planning.

People were encouraged to be as independent as they were able.

Care plans were written in partnership with people who used the service and their relatives if this was what they wished.

Care plans were reviewed regularly with the person who used the service, everyone who was involved in the care and support of the person was asked for their feedback.

Although there had been no complaints received, there was a clear complaints process in place and copies of this were available in people’s homes.

The registered manager was involved in all aspects of the service including working alongside the care staff on a regular basis, which allowed them to closely monitor the day to day practice of care staff.

Records were detailed and well maintained. There were processes in place to regularly audit and assess the quality and safety of the service.

The provider was meeting all the requirements of their registration. All the policies and procedures which were in place were up to date and reflected current legislation.

We gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

We visited the services office and spoke with the registered manager, nominated individual and two support staff. We checked records and we spoke with relatives of people who used the service.

Below is a summary of what we found.

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

Is the service safe?

Relatives of people who used the service told us they thought the agency and the staff provided a safe service. Safeguarding procedures were robust and staff understood how to safeguard people they supported.

The service had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made and how to submit one. This meant that people would be safeguarded as required.

Relatives of people who used the service said they felt their loved ones privacy was respected when staff assisted them with care and support .They said, “staff are brilliant with them (relative), they treat them with respect.”

We found that risk assessments had been undertaken to identify any potential risk and the actions required to manage the risk. This meant that people were not put at unnecessary risk but also had access to choice and remained in control of decisions about their care and lives.

Staff were aware of potential environmental risks and said documentation to reflect any changing risks was always updated and communicated to all staff.

Recruitment practices were safe, thorough and effective. There were procedures in place to ensure staff were suitable for their role.

Is the service effective?

Relatives told us they were actively involved in making decisions about their family member. People’s health and care needs were assessed with them and their representatives, and they were involved in writing the support plans. Relatives of people supported said their loved ones support plans were up to date and reflected their current needs.

Staff were provided with training to ensure they had the skills to meet people’s needs. Managers’ were accessible to staff for advice and support.

Is the service caring?

We asked relatives of people who used the service for their opinions about the support provided. Feedback and comments were very positive, for example; “excellent care”, “this is more than an excellent service, absolutely brilliant” and “they know the staff, we can see they are happy when they are with staff.”

When speaking with staff it was clear that they genuinely cared for the people they supported and had a detailed knowledge of the person’s interests, personality and support needs.

Relatives of people who used the service said their loved ones preferences, interests and diverse needs had been recorded and staff provided support in accordance with their wishes.

Is the service responsive?

Relatives spoken with said they had never had to make a complaint but knew how to make a complaint if they were unhappy. We found that appropriate procedures were in place to respond to and record any complaints received. People could be assured that systems were in place to investigate complaints and take action as necessary.

Relatives said they felt listened too and the agency would respond to their views. They told us the staff and the managers were flexible and accommodating with visit times. A relative told us, “I see the managers all the time; any issues are sorted straight away.”

Is the service well-led?

The service had a comprehensive quality assurance system. The manager confirmed that audits were regularly conducted and they worked alongside support staff very regularly. The manager said they monitored staff at these times but said they didn’t always record these observations. We saw evidence that staff performance was discussed at their supervision sessions which were held every two to three months.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the agency and showed a commitment to their work with Bridge Medical Solutions. This helped to ensure that people received a good quality service at all times.