About the service: Bridgewood House is a residential care home providing personal care to 18 people with learning disabilities and physical disabilities. People living at the home had varying abilities with some people living more independently in four bungalows on the site. People with complex health and social care needs lived in the main building. This service is larger than current best practice guidance. However. the size of the service was not having an impact on people and this was mitigated by people having their own personalised areas and small communal lounges.

People’s experience of using this service:

¿There were areas of care which needed to improve to ensure they met the fundamental standards of care and we found breaches of the regulations in safe care and treatment and good governance. This included how the service recorded their assessment of risk, care records, and robust auditing systems.

¿ Recorded risk assessment and risk management plans in some areas of support needed to improve to demonstrate all risks had been fully explored. The registered manager could tell us how they minimised the risk of harm to people, but the records did not reflect this. The service was not using an evidence-based tool to assess the risk of developing pressure ulcers. We have made a recommendation about this and seek advice from a reputable source.

¿There were enough staff to meet people’s and staff had been recruited safely to ensure they were appropriate to work with people at the home. We found the service was clean and tidy and people were protected from the risk of infection.

¿ We observed medicines to be administered safely, although there were issues with the medicines audit and storage. We have made a recommendation the service refers to current guidance.

¿People who were able to communicate verbally and their relatives told us they were safe in the home; systems were in place to manage any allegations of abuse.

¿Our observations during this inspection confirmed staff were friendly, kind and compassionate. They ensured people were comfortable, safe and provided a homely environment, so people enjoyed living there.

¿The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways; promotion of choice and control, independence and inclusion. Where relevant people's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

¿People were supported by staff who were motivated, enjoyed their job and felt well supported through regular supervision, feedback, appraisal and training.

¿Staff were kind and caring, treating people with respect and maintaining their dignity.

¿People received adequate nutrition and hydration which supported a healthy and balanced diet. People's likes and dislikes were accommodated within menu planning. The provider ensured that people were referred to healthcare professionals as required.

¿People were able to make choices and were involved in decisions about their care. Staff asked people for consent before providing care. Some best interest decisions were specific and considered all the available options. Others did not and were not in line with the MCA Code of Practice.

¿Care records were difficult to navigate and contained out of date information. The registered manager recognised improvements were needed to make sure all the care records were accurate. The provider was planning to imminently introduce computers at this service which would help rectify this issue.

¿People, relatives and staff praised the management of the home and spoke highly of the registered manager who they said was approachable and always available.

¿People and relatives knew how to raise any concerns and had confidence in the complaints process.

¿Regular checks were undertaken to ensure the environment and equipment was safe. However, audits were not robust or detailed whi

The inspection of Bridgewood House took place on 7 June 2016 and was unannounced. We previously inspected the service on 27 August 2013. The service was not in breach of the Health and Social Care Act 2008 regulations at that time.

Bridgewood House is a care home currently providing care for up to a maximum of 23 adults. The home main building has19 bedrooms with a further four bungalows in the grounds where people who require a lower level of day to day support live. On the day of our inspection 18 people were living at Bridgewood House.

The service had a registered manager in place. 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 we spoke with told us they felt safe. Staff received training in safeguarding vulnerable people, and were aware of how to keep people safe.

Equipment was provided within the home but risk assessments did not address all areas of identified risk.

There were systems in place to reduce the risk of recruiting staff who may be unsuitable to work with vulnerable people. there were enough staff to meet people’s needs.

The storage of medicines needed to be improved to reduce the risk of staff and people who lived at the home having unauthorised access to them. When this was brought to the attention of the registered manager they took immediate action to rectify this matter. Medicines were administered safely to people.

New employees were inducted into their role. Staff received an on-going programme of training and management supervision.

Our discussions with the registered manager and staff evidenced they understood the principles of the Mental Capacity Act 2005 and how they would act in people’s best interests where people lacked capacity to make decisions.

People were supported to eat and drink and were enabled to choose what meal they would like to eat. We observed the lunch time meal on the day of our inspection, people enjoyed their meal and the atmosphere while people were eating was relaxed.

People told us staff were caring and kind. When we spoke with staff they were knowledgeable about people’s individual needs, likes and preferences. Staff demonstrated how they maintained people’s privacy and dignity and they gave us examples of how they supported people to make choices about their daily lives.

People were supported to participate in a range of activities; these were planned around people’s likes, preferences and abilities. Care plans recorded a level of detail which enabled staff to provide person centred care and support.

Staff understood their role and spoke positively about the registered manager and the people they supported. The registered provider had a system in place to audit the service provided to people. the views and opinions of both staff and people who lived at Bridgewood House were gained through meetings and surveys.

We spent time observing the lunchtime meal being served and saw people were supported to eat a healthy diet. The atmosphere was relaxed and people could chose from two options what they wanted to eat. However, if people did not want either option we saw they were offered something else. We saw that people who required support from staff to eat their meal were given personal support.

We looked at the care records of four people and saw their needs had been assessed and care was delivered in relation to their needs. We saw when people required support from other healthcare professionals such as district nurses or GP's, this was actioned and clear records of treatment and actions were kept.

Due to the complex needs of the people living at Bridgewood House, it was difficult to ascertain their views. However, we did speak to three people who live at the home and they told us they were happy. We also spoke to one visitor and two visiting health professionals.

The people we spoke with told us they were involved in making decisions about their care and staff respected their views and beliefs.

One visitor told us that they were happy with the standard of care provided for their relative. The two visiting health professionals told us that care standards were high.

We were unable to communicate with some of the people living at Bridgewood house however, through our observations we saw that people seemed confident in their surroundings and in their interactions with staff. Those people we did speak to spoke highly of the support they received from staff. They said that staff treated them with respect and that they were helped to make decisions about how they wanted to spend their time, what they ate for meals and how they decorated their bedrooms. One person said they thought that there were too many rules and regulations which staff had to keep to.