We carried out an unannounced inspection of Bridgemarsh Residential Home on 6 and 7 November 2018 to see if the provider had made the necessary improvements to the monitoring of the quality of the service. At this inspection, improvements had been made to the quality assurance process, medicine administration and supervision of staff. However, we found that the service was not always responsive in the way they discussed and recorded people’s religion, culture, sexual orientation and end of life care wishes.

The service has been rated as Good in safe, effective, caring and responsive and Requires improvement in well led with a breach of the Regulations. The overall rating is Requires improvement.

Bridgemarsh Residential Home 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.

The service provides care and support for up to a maximum of 24 adults with a learning disability and autism. At the time of our inspection 17 people were using the service.

People were not always able to tell us verbally about their experience of using the service. We used observation to gain an understanding of their lives at the service. We saw that people were comfortable and safe with the staff and in their environment.

The service had 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 quality assurance process was not effective or sufficiently robust. Information about people’s needs, preferences and wishes was not fully recorded. Policies and procedures were not in place or reviewed to ensure staff had adequate guidance to follow. We identified a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Good governance.

People were protected from abuse and harm as staff had the knowledge and skills to keep them safe. Staff were able to explain to us what they would do to protect them and how they would report their concerns. Risk assessments had been completed in order that people’s health and wellbeing were monitored and they had the maximum amount of independence and freedom whilst being kept safe.

People were cared for by staff that had been recruited and employed after appropriate checks were completed. There were enough skilled and experienced staff available to support people to live safely at the service. Medicine management had been improved and people were receiving their medicines in a timely way.

Staff had the necessary training, supervision and support in order to assist people in their everyday lives. They were aware of the principles of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) when people did not have capacity to make their own choices and decisions. The service was meeting the Accessible Information Standard by ensuring people’s sensory and communication needs were met.

People had choices about what they had to eat and drink and were involved in shopping, preparing and cooking their meals. Any health issues which people had were closely monitored. The service worked well with other professionals by seeking guidance and support from health, social care and voluntary sector professionals and organisations.

People were provided with the opportunity to choose and participate in activities which interested them. Records were regularly reviewed and updated and staff were provided with the information they needed to meet people’s needs. People’s culture, ethnicity, faith, sexual orientation and end of life care wishes were not discussed or r

At the last inspection on 23 August 2016, we reported that the service required improvement in three areas. These were medicine administration, training and supervision and quality assurance checks.

We carried out an unannounced inspection of Bridgemarsh on 7 September 2017 to see if the provider had made the necessary improvements to the service. We saw that improvements had been made to ensure people were kept safe, had effective care and the service was well led in most areas. However, some improvements were still required in relation to the quality assurance process. The service was rated as Good in Safe, Effective, Caring and Responsive but Requires improvement in Well Led with a breach in the Regulation. The overall rating is Requires Improvement.

Bridgemarsh is a residential care service for up to a maximum of 24 adults with a learning disability. At the time of our inspection eleven people were using the service.

The service had 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.

People were protected from abuse and harm as staff had the knowledge and skills to keep them safe. Staff were able to explain to us what they would do to keep people safe and how they would protect their rights. Risk assessments had been completed in order that people’s health, wellbeing were monitored to ensure they had the maximum amount of independence and autonomy.

People were cared for by staff that had been recruited and employed after appropriate checks were completed. There were enough skilled and experienced staff available to support people to live safely at the service. Medicine management had been improved and people were receiving their medicines in a timely way.

Staff had the necessary training, supervision and support in order to assist people in their everyday lives. They were aware of the principles of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) when people did not have capacity to make their own choices and decisions. The service was meeting the Accessible Information Standard by ensuring people’s sensory and communication needs were met.

People had choices about what they had to eat and drink and were involved in shopping, preparing and cooking their meals. Any health issues people had were closely monitored. The service worked well with other professionals by seeking guidance and support from health, social care and voluntary sector professionals and organisations.

People's support was planned and delivered in an individual and personalised way. People were provided with the opportunity to choose and participate in activities which interested them. Records were regularly reviewed and updated and staff were provided with the information they needed to meet people’s needs. People were relaxed in the company of staff. Staff were able to demonstrate they knew people well and they were attentive to people's needs and treated them with dignity and respect.

People who used the service and their relatives were involved in developing the service. They knew how to raise a concern or make a complaint if they needed to. We saw that any complaints were dealt with and resolved quickly.

The service followed its vision and values and had clear leadership and a consistent staff team. It was developing new ways of providing accommodation and support to people in line with current good practice known as ‘Registering the right support.'

A system for monitoring the quality of the service was in place although some minor improvements were needed.

We identified a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Good Governance. You

Bridgemarsh is a residential care home service for up to a maximum of 24 adults with a learning disability. At the time of our inspection nine people were using the service.

One person using the service was in an interim care bed for older people, this service had been provided by Bridgemarsh to support older people following a hospital admission to enable them to return home. The registered home manager told us that following this person’s discharge they would not be continuing with this service.

This unannounced inspection took place on 23 August 2016.

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 and associated Regulations about how the service is run. The registered manager assisted us with our inspection on the day.

There were sufficient staff available to actively support people to engage in activities of their choice that were important to them, whilst kept them safe. Staff were seen to gain consent and involve people in discussions and decisions about their care and support.

Improvements were needed in how people’s medicines were managed to ensure they received them safely.

People were cared for by staff who were extremely kind and attentive. Staff encouraged people to participate in tasks in the home during the day. People were able to make their own choices. Relatives were involved and consulted all the time in relation to their family members care.

Staff were not always provided with the training and development they needed to care for and support people's individual needs through regular supervision, meetings and updating their training. Despite this people received good quality care.

Where people had specific dietary requirements staff were aware of these and made sure people were provided with appropriate food or support. Staff helped people access external healthcare professionals when they needed to.

Accidents and incidents that occurred were recorded and monitored by staff. There were very few incidents at the service.

People were kept safe by staff who recognised the signs of potential abuse and knew what to do when safeguarding concerns arose.

Recruitment procedures were robust and ensured that only suitable staff were employed to look after people using this service.

The correct procedures were being followed by staff in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS).

Quality assurance checks had not identified the issues we found at the service.

People were encouraged to offer feedback on the quality of the service and knew how to complain if they needed to. They felt that the registered manager was responsive to feedback and staff reported the registered manager to be a positive role model who was dedicated to providing a high quality service.

We inspected Bridgemarsh Residential Home. We spoke with three people who used the service. Many people using the service had communication difficulties which meant we were unable to speak with more people and therefore we used observation to look at interaction between people and staff. We also spoke with management staff and three members of care staff. They helped answer our five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the staff supporting them and from looking at records.

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

Is the service safe?

People’s health and care needs were assessed fully with them and their representatives, and they were involved in planning how their care should be provided. Specialist health, mobility and behavioural issues had been identified in care plans when this featured as part of the person’s needs, for example if a person had fluctuating moods this was noted in the records. People said that they took part in making decisions about their care, their health and any changes. We saw that care records reflected people’s current needs.

Policies and procedures were in place which were robust and regularly updated. This meant that staff had a safe structure to work within and that all staff knew what was expected of them.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications have needed to be submitted at the time of the inspection, consideration was required for one person using the service. Detailed policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

The building in which the service was run from was safe and appropriate for the needs of those people who lived there. Daily checks and regular audits were in place. Contracts were in place for maintenance and annual checks such as fire safety checks. People’s needs were taken into account which enabled people to move around freely and safely. The premises were suitable for people’s needs and aids had been provided to meet the needs of people with physical and visual impairments.

Daily checks are required for fridge temperatures which held medication, to help ensure that medication is held at the correct temperature, meaning it is safe to be administered.

Is the service effective?

We saw that the staff employed had relevant experience and qualifications to enable them to complete their role. Training was encouraged and undertaken regularly. Support was given to staff through supervision, appraisal and training to help ensure they had the knowledge and skills required to effectively complete their work.

People using the service and their representatives were able to give feedback on the service. Staff and management analysed the information given to ensure that the service remained appropriate and effective in meeting the needs of those using the service.

Is the service caring?

People are treated with respect and dignity by the staff. People told us that the staff were kind and helpful. One person told us, “I get all the help I need.”

People were supported by caring staff. We saw that staff showed patience and gave encouragement when supporting people. One person commented, “I have everything I need, the staff are good and I love it here.”

People who used the service and their representatives had been asked for their views on the service. During these reviews people confirmed that they felt well cared for and this view was shared by relatives.

People’s preferences, interests and needs had been recorded and care and support had been provided in accordance with people’s wishes. Encouragement was given to people to live as independently as possible within safe parameters.

Is the service responsive?

People completed a range of activities in and outside the service regularly. People told us, “I like to go bowling,” and, “I attend a meeting in Essex where we get together to talk about services and what needs to be done everywhere.”

People told us that they felt listened to and they felt able to talk to all staff if they wanted to do anything. Staff confirmed that they felt people were able to make choices, which were then responded to.

When people’s needs changed, we found that care records had been updated to reflect this. We saw that health professionals were involved in a timely manner when people needed them and that advocacy services were available to people who used the service.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a seamless way. We saw evidence that the management team had focused on managing the service and ensured that care provided was relevant and that people who used the service were the central focus when planning their care.

The service had a quality assurance system; we saw positive feedback had been received from people and their representatives. Development of this system was underway to ensure that as much feedback was obtained from people as possible. The management team completed analysis of feedback and information received.

We saw that staff were supported by management and encouraged to undertaken relevant training courses and qualifications to enhance their knowledge.

We gathered evidence of people’s experiences by talking with them and observing how they spent their time and how they interacted with the staff. We spoke generally with some people who told us they liked living at the home.

During our inspection we saw that people received good care and support. We saw that people were comfortable with staff and others living in the home and there was a relaxed atmosphere.

Improvements had been made in people’s care records and their care plans and risk assessments had been reviewed and completed appropriately. Medicines were administered correctly and there were sufficient staff available to meet the needs of people living at Bridgemarsh and to offer them a good quality of life.

The people we spoke to who were living at Bridgemarsh told us that they were happy living at the home and spoke positively about their lives and the staff team. People said that they had choice in their day to day lives and that staff helped them to be as independent as possible. One person told us "I go out a lot and I do my own shopping."

We found that in some cases people did not always have their needs fully assessed and that up to date information and guidance was not always available for staff on how to care for and support people.

We found that the staff team had received training and although there were gaps in the training the manager had a plan in place to address this. The provider and manager had systems in place to enable them to monitor and assess the quality of the service provided. The people living at the home were regularly able to comment and provide feedback.

During our visit we spoke with some people who use the service and two visitors. One of the people using the service told us that they were happy living at Bridgemarsh, and felt comfortable there. They said that they were involved in their care, for example in reviews, and knew who their keyworker was. The two visitors we spoke with were also positive about the support provided to people living at Bridgemarsh.

People we spoke with were positive about the recent changes to the building aimed at increasing independence. It was evident, in our discussion with people, that those using the service were increasingly enabled to develop their independent living skills. One person we spoke with said that they felt staff knew the needs of the person using the service who they were visiting as well as knowing what the person liked to do as part of their daily routine.

One person we spoke with said that they were able to cook their own meals and were able to choose where they wanted to eat. Another person said that they were involved in cooking meals.

One visitor we spoke with said they did not have any concerns about the arrangements for the administration of medication in the home. One visitor to the service said they were concerned about staffing numbers, and the availability of staff to support people on individual activities in the wider community. They also expressed concern that when agency staff were used in the home they may not know the people living their and the routine.

One visitor to the home said they had not been asked their views about the service. One person living at Bridgemarsh told us about ‘unit’ meetings that are held, and that the last one had been in December 2011. They said that these were to talk about general things and anything of concern. Everybody we spoke with said that they would feel comfortable raising any concerns and knew who to speak to. One person visiting the service said that they found the staff were open and the home operated in a transparent way.

People told us that they had received good informnation about the service. They said that they felt well treated and that the staff team respected and involvced them in all areas of their care and support. People told us that they had regular health check ups and that they were happy with the care they received at Bridgemarsh.

People told us that they liked the food at Bridgemarsh and that they were able to choose what they wanted to eat. People said that they felt safe whilst living at Bridgemarsh. They said that they would tell the manager or staff if they did not. People told us that the staff helped them with their medication. People said that they liked the staff and that they were always busy, they told us that they liked living at Bridgemarsh and that staff asked them how they wanted to spend their time.