We undertook an unannounced inspection of Bridgemead on 17 April 2018. At the last comprehensive inspection of the service in January 2017 six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. These were in relation to fit and proper person employed, safe care and treatment, need for consent, staffing, person centred care and good governance. The service was rated as Requires Improvement.

During this inspection we checked that the provider was meeting the legal requirements of the regulations they had breached. You can read the report from our last comprehensive inspections, by selecting the 'All reports' link for Bridgemead, on our website at www.cqc.org.uk

Bridgemead is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Bridgemead can provide care and nursing support for up to 32 older people, some whom are living with dementia. At the time of our inspection there were 31 people living at the service.

The service provides accommodation in purpose built premises. The building had a unique and interesting design. A large communal dining and seated area was available to people with big windows, a conservatory and rooftop garden. People enjoyed the location of the service and the views to the river. People told us how the light, space and scenery from the building enhanced their well-being.

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.

At this inspection we found that the service had made improvements. The previous breaches in regulations had been met. Recruitment checks were in place which ensured the provider’s recruitment policy was followed. People’s care plans had been enriched. Care plans contained details around people’s preferences, backgrounds and routines. Where people had specific needs care plans were in place to support these. Supervision and training to support staff in their roles was up to date and occurring regularly. Quality assurance systems were now in place but needed further development in the details provided in order to drive quality improvement. This had already been identified by the provider.

We received mixed feedback about the staffing levels at the service. People said sometimes they had to wait for staff to be available. We made a recommendation in regards to recording best interest decisions in accordance with the Mental Capacity Act Code of Practice.

People said they could retain their independence by moving around the service, helping themselves to drinks and snacks and coming and going as they pleased. However, a few people commented that their independence could be further promoted by the service. Details about people’s end of life wishes were limited in care records. Care records had been reviewed monthly.

Staff had developed good relationships with people. People told us that staff were kind, caring and polite. People’s privacy and choices were respected by staff. Visiting was unrestricted. Friends and family were welcomed at the service. There were different areas for people to spend time with their loved ones in private and communal areas.

People spoke positively about the range of activities facilitated by the service and the regular outings available to them. The service had a Christian ethos, but people from any faith group were welcomed. The service had links with local religious establishments, a weekly service and a daily ‘quiet time’ where prayers and hymns were observed. ‘Friends of Bridgemead’ arrange

The last inspection of this service took place in July 2015 and at that time, two breaches of the Health and Social Care (Regulated Activities) Regulations 2014 were found in relation to fit and proper persons employed and safe care and treatment.

At this inspection we found six breaches of regulations. The two previous breaches from the last comprehensive inspection in July 2015 had been repeated. The four new breaches were in relation to good governance, need for consent, person centred care and staffing.

Bridgemead provides accommodation and care, including nursing care, for up to 32 older people who have dementia and other associated needs in relation to their mental health. On the day of our inspection, there were 31 people living at the home and one person receiving respite care.

There was a registered manager in place at the time of our inspection; 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.

Overall we found that quality and safety monitoring systems were not fully effective in identifying and directing the service to act upon risks to people and ensuring the quality of service provision.

The registered manager had not made appropriate statutory notifications. Notifications tell us about significant events that happen in the service. We use this information to monitor the service and to check how events have been managed.

The administration of people's medicines was not in line with best practice.

Recruitment procedures were not followed appropriately.

Care plans were not person centred. Peoples' risk assessments and the associated parts of the care plan did not provide adequate detail to enable safe and effective care.

Staff we spoke with had a variable understanding of the Mental Capacity Act 2005 and DoLS. These safeguards aim to protect people living in care homes from being inappropriately deprived of their liberty. These safeguards can only be used when a person lacks the mental capacity to make certain decisions and there is no other way of supporting the person safely. There were no examples of best interest decision making on behalf of people who lacked capacity to agree to the delivery of their care.

The registered manager had made applications for Deprivation of Liberty Safeguards (DoLS) where they had been assessed as being required.

Staff had not received regular supervision and training.

People had access to healthcare professionals however records did not always demonstrate that the service had made appropriate referrals when there were concerns.

The staff had received training regarding how to keep people safe and they were aware of the services’ safeguarding procedures.

There were enough staff to meet peoples' needs. We received positive feedback about the care staff and their approach with people using the service.

The provider had a complaints procedure and people told us they could approach staff if they had concerns.

We found six breaches of regulations at this inspection and will be asking the provider to send us a report of the improvements they will make.

This inspection took place on 21 July 2015 and was unannounced. The previous inspection of Bridgemead was on 24 October 2013. There were no breaches of the legal requirements at that time.

Bridgemead is a care home with nursing for up to 32 older people. 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.

People told us they received a service that was caring and which met their needs. They spoke very positively about their relationship with staff and how they were treated. People were well supported to maintain links with the community and to have contact with relatives. One person commented “It is not just a place to live, it is my home”.

People felt the service was safe and they had confidence in the registered manager and staff team. However, there were shortcomings in the home’s procedures for recruiting staff and managing people’s medicines.

People enjoyed the meals and were given a choice of courses. One person told us “The meals are good and I’m very choosy about food.” When people needed support, staff showed they were competent and worked in a way which promoted people’s independence. Staff received training and support which helped to ensure they did their jobs well.

People appreciated the ethos of the home. The registered manager and staff team worked in a way that was consistent with the provider’s aims and values.

We found two breaches of the regulations during our inspection. You can see what action we told the provider to take at the back of the full version of the report.

We spoke with seven people and three friends and relatives of people who lived at Bridgemead to find out how care was delivered and experienced. All these people spoke positively about care and staff. People told us “this is the best care service in town” and “I couldn’t find anywhere better. There just wouldn’t be anywhere better.” One friend of a person told us “I cannot speak highly enough about the place and that’s how she feels too, she’s told me many times she feels very lucky to be here.”

We spoke to people and staff about nutrition. All the people we spoke with were complimentary about meals. For example, one person said “I have nothing bad to say about the food, it’s all lovely.” Staff demonstrated a good understanding of a balanced diet. We observed fresh fruit, snacks and hot and cold drink were available at all times to all people and their friends and family. We saw there were processes in place to ensure people received adequate nutrition and hydration to meet individual needs.

People told us they felt safe living at Bridgemead. One person said “I feel very safe, and I know I could say something if I was worried about my care.” We spoke with staff who were able to demonstrate an understanding of safeguarding adults from abuse policies and procedures. We observed risks had been assessed and documented in people’s care records and the provider worked with other professionals and agencies of reduce risks of abuse for people.

We spoke with staff and the manager about recruitment when we visited. We looked at records which showed there were effective recruitment and selection processes in place.

We looked at care and other records to see how people were protected against the risks of unsafe or inappropriate care. We saw people’s care had been assessed and planned to meet individual needs. We saw the provider maintained other records relating to the safety of equipment and services in the home. We saw records were stored securely but accessibly for staff.

The purpose of this visit was to follow up the compliance actions set at our previous inspection. At an earlier inspection visit we had found that although staff undertook training, there were not effective systems in place for their supervision and appraisal. At this visit we found improvements had been made and the service was now meeting the required standard for supporting workers.

We asked people about the staff that cared for them. One person said “yes staff are trained for this job and they are ok.” Another person said the staff were respectful and they were well cared for, but were not aware of the training staff undertook. A relative visiting the home said the staff were good and they were welcome at the home and were offered refreshments when they arrived.

We spoke to 14 people about the care and service they received at Bridgemead.

We were told “It’s a really happy home with a Christian base”. “I think that everybody here is caring, somebody is looking after us here”. “The home has a friendly atmosphere”. “I have had Christian love care and kindness show to me since I’ve been here”.

We saw people were supported by staff in an attentive and caring manner with their range of nursing and personal care needs. We saw that care plans supported care practises with information to guide staff to give people the care they needed.

People felt safe and properly treated living at Bridgemead. There were effective systems in place to ensure staff had the right information available to guide them, so that people received the care they needed. The majority of the staff team had not been on recent training on the subject of how to safeguard people from abuse. This could impact on people who used the service, as staff may not know what actions to take to keep people safe from the risk of abuse.

We saw that three staff had recent one-to-one supervision sessions with the manager. However the rest of the staff team had not had recent or regular supervision meetings to review their work and the way they care for people who used the service.

We saw that people were asked what they thought of the care and support they received at Bridgemead. There were methods being used to check monitor and improve the quality of the service people received. There were systems to review and learn from all critical incidents and occurrences that may have impacted on people's health and wellbeing.

The people that we met who live at the home told us how very happy they were there. One person told us that to live at the home was, ‘excellent,’ another person said ‘we are all very happy here’.

We observed people who use the service sitting together in different parts of the home looking relaxed and comfortable in their surroundings.

We observed warm and friendly relationships between the people who use the service and the staff caring for them.

We found that the environment is suitable for the needs of the people who live there. There are small lounges known as ‘family rooms’ on each floor of the home. We noticed how relaxed and comfortable people looked in their surroundings.

Bridgemead care home supports the people who use the service to ensure that their care needs are properly met and people feel happy and settled living at the home.