This inspection took place on 24 January 2018 and was unannounced. This meant the provider and staff did not know we would be visiting.

At the last inspection in January 2017 the service was rated Requires Improvement. We also identified a breach of regulation in relation to the safety of the premises and equipment. This was because tests of the fire alarm, emergency lighting and electrical installation had not been carried out by someone qualified to do so. We took action by requiring the provider to send us plans setting out how they would address this. When we returned for this latest inspection we found that action had been taken and the service was no longer in breach of regulation.

The Bridgings (Eston) 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. At the time of our inspection 11 people with learning disabilities or autism were using the service.

The care service had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was 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. The registered manager was also one of the owners and registered providers of the service.

Risks to people using the service – including from the premises and equipment – were assessed and monitored. Plans were in place to support people in emergency situations. The provider had systems in place to promote effective infection control. People’s medicines were managed safely. Policies and procedures were in place to safeguard people from abuse. The registered manager and provider monitored staffing levels to ensure they were sufficient to keep people safe. The provider’s recruitment processes reduced the risk of unsuitable staff being employed.

Staff received a wide range of mandatory training in order to support people effectively. Newly recruited staff were required to complete induction training before they could work with people unsupervised. Staff received regular supervisions and appraisals. Staff applied the principles of the Mental Capacity Act 2005 (MCA). People were supported to maintain a healthy diet and to take control of their own food and drink. People were supported to access external professionals to monitor and promote their health. The premises had been adapted to make them suitable for the people living there.

People spoke positively about staff at the service, describing them as kind and caring. People were treated with dignity and respect and promoted their independence. The registered manager was able to describe how advocacy services would be arranged should they be needed.

People told us staff provided them with the support they needed and wanted. Care plans were personalised and based on people’s support needs and preferences. People at the service were supported to access a wide range of activities and interests in the local community. The provider had a complaints policy in place, setting out how people could raise issues and explaining how they would be investigated. Staff received end of life care training, and policies and procedures were in place to support this should it be needed.

Staff spoke positively about the culture and values of the service. The registered manager told us about links they, people and staff had forged with the local

We inspected The Bridgings Limited (Eston) on 19 January 2017. This was an unannounced inspection, which meant that the staff and registered provider did not know that we would be visiting.

When we last inspected the service in January 2015 we found two breaches of regulations. Checks on water temperatures and fire alarms were not taking place as often as they should be and effective systems were not in place to ensure that regular auditing was undertaken. The registered provider wrote to us telling us what action they would be taking in relation to the breaches of regulation.

At this inspection on 19 January 2017 we found that the registered provider had followed their plan and legal requirements had been met.

The home had 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 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 service is registered to provide care and support for up to 12 adults with a learning disability. The service is a two-storey building close to local shops and amenities and on a main bus route into Middlesbrough. At the time of the inspection there were 10 people who used the service.

We found that checks of the fire alarm, electrical installation and emergency lighting had not been tested by someone who was competent to do so. This posed as a significant risk to people who used the service and others. The registered provider contacted us after the inspection and informed they were to take swift action to address this.

People were protected by the services approach to safeguarding and whistle blowing. People who used the service told us they felt safe and could tell staff if they were unhappy. People who used the service told us staff treated them well and they were happy with the care and service received. Staff were aware of safeguarding procedures, could describe what they would do if they thought somebody was being mistreated and said that management acted appropriately to any concerns brought to their attention.

There were sufficient staff on duty to meet the needs of people who used the service. We found staff had been recruited safely following the completion of appropriate checks.

Appropriate systems were in place for the management of medicines so that people received their medicines safely.

The registered manager told us if they employed any staff who didn’t have a care background then they would undertake The Care Certificate induction or alternatively commence an NVQ qualification in care. The Care Certificate is a set of standards that social care and health workers stick to in their daily working life. Staff were aware of their roles and responsibilities and had the skills, knowledge and experience to support people who used the service. We saw that staff had undertaken training considered to be mandatory by the service. This included: safeguarding, fire, health and safety, mental capacity and deprivation of liberty safeguards, nutrition awareness, medicines administration, infection control, people movement and first aid.

Staff had an understanding of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards and acted in the best interest of people they supported.

We saw that people were provided with a choice of healthy food and drinks, which helped to ensure that their nutritional needs were met.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks.

We saw positive interactions between people and staff and saw that staff treated people with dignity and respect. Staff were kind, caring, respectful, and interacted well with people. Observation of the staff showed that

We inspected The Bridgings on 19 January 2015. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

The service provides care and support for up to 12 adults with a learning disability. The service is a two-storey building close to local shops and amenities and on a main bus route into Middlesbrough.

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 told us they felt safe in the service; however we found that checks on water temperatures and fire alarms were not taking place as often as they should be. This meant that people were not totally protected from the risk of harm.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.

We found that people were encouraged and supported to take responsible risks. Those people who were able were encouraged and supported to go out independently.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. People and staff told us that there were enough staff on duty to meet people’s needs. They understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions.

The service had a stable work force and as such had not needed to recruit new staff in the last four years.

Systems were in place for the management of medicines so that people received their medicines safely. However written guidance for those medicines to be given ‘as required’ (PRN) was not in place for medicines prescribed for pain relief. Lack of PRN protocols meant that people might not always receive their medicines in a consistent way.

There were positive interactions between people and staff. We saw that staff were kind and respectful. Staff were aware of how to respect people’s privacy and dignity. People told us that they were able to make their own choices and decisions and that staff respected these.

People told us they were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met. We saw ineffective monitoring of nutritional needs as nutritional assessments had not been undertaken in over four months, since September 2014.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments. People had health passports, however these contained limited information about the person and how they wanted to be supported.

Assessments were undertaken to identify people’s health and support needs as well as any risks to people who used the service and others. Plans were in place to reduce the risks identified. Care and support plans were developed with people who used the service to identify how they wished to be supported.

The majority of people who used the service attended day services and some people did voluntary work. People were encouraged and supported by staff to access the local community. People had their own hobbies and leisure interests.

The provider had a system in place for responding to people’s concerns and complaints. People told us they knew how to complain and felt confident that staff would respond and take action to support them. People we spoke with did not raise any complaints or concerns about the service.

The provider had systems in place in which to seek the views of people who used the service and their relatives. However regular auditing was not undertaken.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we took at the back of the full version of this report.

We met with people living at The Bridgings. We spoke with two staff members, the manager and the director.

We looked at three care records (27%). We saw that people were included in the assessment and management of their own care. We saw care plans were reviewed regularly. People’s needs, wishes and preferences had been taken into account.

The home had a relaxed atmosphere and we could see that people were happy and well cared for.

We saw that people were involved with various health professionals appropriate to their needs and were supported to attend appointments.

Staff told us that that there was always enough staff on duty to care and support people who used the service. One person we spoke with told us, “We have good staffing levels.” Another staff member told us, “It’s absolutely brilliant here. We have a really good staff team.”

Records were stored safely and securely, yet still accessible to staff when needed.

We spoke with four people who used the service. They told us they were treated well and the staff were good. One person said, “I like living here”, another person said, “I am out a lot, I get to choose what I want to do” and “They treat me well here, I get on with everyone.”

We observed staff interacting well with people and saw there was a warm and friendly atmosphere between people living and working at the home. We found that, where possible, people were encouraged to be independent. A number of people who used the service were out on placements on the day of the visit. We spoke to people as they returned to the home from their placements and they talked enthusiastically about their day. This contributed to maintaining people's welfare and promoting their wellbeing.

We found the premises that people, staff and visitors used were safe and suitable and that people were cared for by staff who were supported to deliver care safely and to an appropriate standard.

We found there was an effective complaints system in place.

We spoke to three people living at The Bridgings (Eston). All of the people we spoke to said they enjoyed living at the home. “The homes lovely”, “it’s quite pleasant here actually” and “I have my own DVD player, and have put my own stamp on my room”. “I can go out by myself, and I am encouraged to keep in touch with my family and friends.” “I have a lot of freedom; I can go out to the shops and go on holidays.” “I feel safe here”. They also said they got on well with the staff in the home. “The staff are very kind, if I ask them they will do it”. “I am able to talk to the staff if I have any concerns or complaints”. “The staff can’t do any more than they do”.