This inspection took place on 26 and 27 March, 2018 and was announced.

Bridgewell House is owned and managed by Bright Futures Care Limited.

Bridgewell House is a ‘care home’. People in ‘care homes’ receive accommodation and nursing or personal care as single package under one contractual agreement. Bridgewell House is registered to provide care and support to young adults who are living with learning conditions, a disability, Mental Health Conditions or Sensory Impairment. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Bridgewell House can support up to six people, at the time of the inspection there was five people living at the home.

The home is situated in a residential area of Stockton Heath, Warrington. Bridgewell House is a large detached property which provides accommodation over two floors. Each bedroom comes with en-suite facilities; there are two large communal rooms, two large kitchen areas and a large garden area at the back of the house.

At the previous inspection which was conducted in February 2015, Bridgewell House was rated ‘Good’ in the safe, effective, responsive and well-led domains. The ‘caring’ domain was rated ‘outstanding’.

At this inspection we found the service remained 'Good', with the caring domain continuing to be rated as ‘outstanding’.

At the time of the inspection there was 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The registered manager had a number of different systems in place to assess, monitor and continually improve the standard and quality of care being provided. This meant that people who were being supported were receiving safe, compassionate and effective care.

‘Accidents and Incidents’ processes were reviewed during the inspection. Each person had an ‘incident’ reporting book and the relevant care records were updated as and when an accident/incident occurred. All staff were aware of the incident reporting procedure and the importance of completing and updating records. We identified that an analysis of accidents/incidents was not been carried out to establish trends and patterns.

We have made a recommendation regarding the analysis of accidents and incidents within the home.

Medication was administered by staff who had received appropriate training. Medication that needed to be given ‘as and when’ (PRN) was being prescribed however, protocols were not in place. Medication protocols outline to staff the circumstances in which this should be given. We discussed this with the registered manager so these could be put in place.

Care plans and risk assessments were in place. They contained up to date and relevant information for each person who was being supported. Each person had a designated key worker who was familiar with the varying levels of support needs and risks which needed to be managed.

Recruitment was safely managed. Staff personnel files demonstrated that safe recruitment practices were in place. All staff who were working for the registered provider had submitted an application form, sufficient references had been obtained and disclosure and barring system checks (DBS) were in place.

The registered provider operated within the principles of the Mental Capacity Act 2005 (MCA). People had been appropriately assessed and the relevant Deprivation of Liberty Safeguards (DoLS) had been submitted to the relevant local authority.

Staff expressed that they were fully supported in their roles. Staff had received the necessary induction training, regular supervision and appraisals were taking place and extra training was provided to further equip staff with specialist skills and abi

We undertook an inspection of Bridgewell House on the 14th May 2014. We spoke with four of the young people using the service, one family member and eight staff members including the manager and deputy during our visit. Bridgewell House is owned and managed by Cornerstones which is an organisation who provide care, support and education to children and young people. We were also able to visit Cornerstones school during our inspection and speak with staff and observe the young people in an educational setting. We used a number of different methods to help us understand the experiences of people using the service, because some of the young adults who lived at Bridgewell House had complex needs which meant they were not able to tell us about their experiences. These methods included observational practices and verbal and non-verbal communication.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask.

• 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 using the service, their relatives, 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?

Training records highlighted that staff were up to date with all mandatory training needed to support people living at Bridgewell House. Staff said they felt they were appropriately supervised and appraised within a performance management framework, in accordance with their role and identified development needs. Staff told us that they understood their tasks and boundaries in relation to their work with young people and felt competent and appropriately qualified to carry out their work in a safe non-threatening environment.

The manager advised us that appropriate procedures, including reviews were in place should anyone need to be subject to a Deprivation of Liberty Safeguard (DoLS) application or plan. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests.

Is the service effective?

Feedback from the young people who used the service was most positive. They told us that they were happy living in Bridgewell House and enjoyed attending Cornerstones School and doing work experience. We also used observational practices which identified that the young people interacted well with each other and the staff and presented as being very comfortable within their surroundings.

Staff told us that the service provided designated keyworkers for each young person. They said that the allocated key worker would be suitably equipped, experienced and trained to understand the persons individual needs, inclusive of communication, behaviour and development. We asked staff to tell us about the needs of some of the people using the service. Staff gave responses which indicated that they knew people well and were providing support based on the person's individual needs and choices. Care staff told us that they had read care plans and they had been regularly updated when people's needs changed. They also told us that the company director, service manager and home manager were always available to provide advice and support when people's needs had changed.

Is the service caring?

We observed that staff interacted well with the young people who lived at Bridgewell House. They took time to ensure that they were fully engaged with the individual and checked that they had understood. Before carrying out interventions with the people using the service they explained what they needed or intended to do and asked if that was alright rather than assume consent. All staff said that they felt supported to do their job and had received regular formal supervision. (These are regular meetings between an employee and their line manager to discuss any issues that may affect the staff member; this would include a discussion of ongoing training needs).

Records showed that young people and their parents/carers were actively involved and engaged in the assessment and planning of care and support. They also showed that comprehensive risk assessments were in place and updated as and when required. This ensured that the young people were in receipt of the care and support of their choice.

Is the service responsive?

The care plans had been written in a person centred manner. This means that the individualised care plans focused on the person's individual assessed needs and on how they could be met. The care plans focused on providing support to an individual in different aspects of their daily life, for example how the person was to be supported with promoting their independence and any issues regarding their health so that they were kept as healthy as possible. Staff told us that the service provided designated keyworkers for each young person. They said that the allocated key worker would be suitably equipped, experienced and trained to understand the person's individual needs, inclusive of communication, behaviour and development. We asked staff to tell us about the needs of some of the people using the service. Staff gave responses which indicated that they knew people well and were providing support based on the person's individual needs and choices. This enabled staff to provide responsive needs led services to the people living in the home.

Is the service well-led?

The staff members we spoke to said that the home was well managed and they enjoyed working there. We saw that the provider had a range of checks completed by the manager and staff on a regular basis. This showed that the provider ensured that there was an effective system to regularly assess and monitor the quality of service that people received. The staff members had regular staff meetings. These enabled managers and staff to share information and / or raise concerns. Comments from staff were positive and included "Managers celebrate and reward good outcomes and share best practice. Its a wonderful place to work".

We used a number of different methods to help us understand the experiences of people using the service, because some of them had complex needs which meant they were not able to tell us their experiences.

During our visit, discussions we had with members of the staff team showed they had a clear understanding of the need to respect and value the people they supported. We spoke with one person who used the service who told us that the care they had received was delivered in a way which respected their privacy and dignity. They told us, "They are always making sure I am alright."

Staff told us that young people benefited from individualised support in all aspects of their care. They said that effective planning during the transition period from children's services to a young adult placement enabled young people to have an understanding of the home and services provided prior to them moving into the home.

A visiting social worker told us they and the people living in the home had been consulted on matters such as social activities, access to healthcare, choice and variety of meals, access to information and complaints or comments about the service. They told us that the staff worked very hard to ensure people were well looked after and the young people experienced quality care which was individualised and creative.

Staff told us they felt supported by the management team who motivated and encouraged them to develop their skills.

This inspection took place on 23 February 2015 and was unannounced. This location was last inspected in May 2014 when it was found to be compliant with all the regulations which apply to a service of this type.

Bridgewell House is owned and managed by Bright Futures Care Limited. They are registered to provide care and support to young adults who experience Learning Disability, Mental Health Condition or Sensory Impairment. The home is situated in a quiet residential area of Stockton Heath, Warrington. The accommodation is provided in a large detached property which is equipped to provide residential care and support for five young adults to assist them to develop their decision making and independent living skills.

Bridgewell House has a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. 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.

People living at the home and their relatives and other representatives were very positive about all aspects of Bridgewell House.

We observed how staff spoke and interacted with people and found that they were very knowledgeable about each person and supported them with dignity and respect.

Each young adult living at Bridgewell House was provided with designated key workers who were suitably equipped, experienced and trained to understand the person’s individual needs, inclusive of communication, behaviour and development. We found the staff had an excellent understanding of people’s care and support needs and we found care plans to be detailed and focused on the individual person.

Staff also understood how to support people if they lacked capacity to include the requirements of the Deprivation of Liberty Safeguards. We found that Bridgewell House had a policy in place with regard to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). None of the five young adults living in the home are subject to a DoLS although some restrictions such as managing sleep patterns, medication management and nutritional issues were being used to minimise the risk of harm.

We noted the service had a complaints procedure, details of which were included in the service user’s guide. People living at the home and their relatives said they were confident that they could raise their opinions and discuss any issues with the registered manager or any other staff member who was on duty.

Bridgewell House had robust recruitment policies and procedures in place to ensure staff were suitable to work with vulnerable people. This included standardised application forms, the provision of written references and a structured interview process being undertaken to enable the management of the home to have adequate information before employing staff.

Staff were provided with monthly structured supervision sessions and regular updated training and development courses to assist them to build on their knowledge and skills.

The provider had robust systems in place to monitor and review the standards of the services provided at Bridgewell House. These included reviews with external professionals, daily staff meetings and handovers and the use of self -assessment tools that looked at the safety, management, residents life skills, education and well -being, environment and nutrition.