This inspection took place on 8 and 10 August 2018. The first day of the inspection was unannounced, which meant that the staff and registered provider did not know we would be visiting. The second day was announced.

The Bridge Care Centre 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 for people affected by neurological disorders. The home is a detached 40 bedroom purpose built care home in Middlehaven, Middlesbrough. Accommodation is within four separate units each with ten ensuite bedrooms. At the time of our inspection three people were living at the service.

When we inspected the service the manager was going through the process of becoming a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered person’s'. 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.

This was our first inspection of the service since it registered with the Care Quality Commission (CQC) in August 2017.

We identified a range of discrepancies in medicine records. We found risk assessments were not always available to give guidance to staff as to how to help keep people safe.

We found that the service did not have clear governance systems in place. The issues we found during this inspection with record keeping, risk assessments and medication had not always been identified and addressed.

We found that some staff did not always have the required up to date training they needed to meet the needs of the people supported by the service. Nurses did not always have the regular training they needed or their competency checked.

We saw that where some people were unable to make some decisions for themselves some decisions made in their best interest were not recorded. We noted that one person’s family member had signed their care plan without having the legal authority to do so.

Policies and procedures were in place to protect people from harm such as safeguarding and whistleblowing polices. Staff knew how to identify and report suspected abuse.

Safe recruitment practices were in place. Pre-employment checks were made to reduce the likelihood of employing staff who were unsuitable to work with vulnerable people.

Staff told us that they were supported through supervision. Most staff said felt they could approach the management team if they had any issues.

The premises were spacious and tidy however the furniture available to people did not help enable them to become more independent.

Learning took place following reviews of accidents and incidents where themes and trends were addressed.

People had access to a range of healthcare such as GPs, hospital departments and dentists.

We observed that staff members were kind and caring towards people in their interactions with them however we also saw that people were left in front of a television with minimal staff intervention from staff for long periods of time. We received mixed feedback on care staff from relatives.

Staff told us that activities were very limited due to the complex needs of people supported. We have made a recommendation about activity provision within the service.

People’s privacy, dignity and independence were respected. The policies and practices of the home helped to ensure that everyone was treated equally. End of life care procedures were in place.

Meetings for staff took place. The manager told us that the people supported were unable to engage with team meetings. People supported were unable to express their views about the service provision and management.

Relatives told us they had had difficulty in develo