CQC report explained · a nursing home
What the CQC found at Bridgemead
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, June 2018
Rated Good overall, but safe care Requires Improvement because staffing feedback and pressure-care records were not consistently strong.
Inspectors made an unannounced visit on 17 April 2018. They spoke with people living at the home, day visitors, relatives, staff and health professionals. They also observed care and reviewed care records, staff files, medicines, complaints, incidents, training and management checks.
The home had improved since its January 2017 inspection. All six previous breaches had been met. Recruitment checks, staff training, care plans, medicines management and consent arrangements had improved. The home was clean and well maintained, and people generally described staff as kind, respectful and caring.
The overall rating was Good. Effective, caring, responsive and well-led were rated Good. Safe was rated Requires Improvement because some people experienced delays when they needed help, and records did not always show that people at risk of pressure ulcers were repositioned as required. The home's quality checks were in place but still needed more detail.
Kind and respectful care
People and professionals described staff as caring and polite. Inspectors observed patient and calm support, with people's privacy and choices respected.
“People told us that staff were kind, caring and polite.” from the report
Improved care planning
Care plans had been expanded to include people's histories, preferences, routines and specific health needs.
“The details around people's background and preferences had been developed.” from the report
Food and daily life
People spoke highly of the food and could choose where and how to eat. They could also help themselves to drinks and snacks.
“People were given individual choices about the different foods on offer, the portion size and the condiments that accompanied their meal.” from the report
Improved medicines safety
Inspectors found medicines were stored, administered and disposed of safely. Records reviewed showed no gaps in the main medicines administration records.
“Medicines were stored, administered and disposed of safely.” from the report
Staffing and waiting times
seriousFeedback about staffing was mixed. Some people and relatives said they waited for help, and the home was using a large proportion of agency staff.
“There aren't enough staff and I have to wait to get up or be moved at night when I'm uncomfortable.” from the report
Pressure-care records
seriousRecords did not always show that people at risk of pressure ulcers were repositioned as often as their care plans required. There were also gaps and one record had been completed in advance.
“Positional change records for the week prior to the inspection showed that the frequency was around four hourly and that there were gaps in recording” from the report
Quality checks lacked detail
needs fixingThe home had introduced audits, but some relied mainly on yes or no answers. Inspectors said this limited the home's ability to identify and sustain improvements.
“However, the detail in the audits was sometimes limited as often yes or no answers were provided.” from the report
End-of-life planning
needs fixingCare records did not contain enough detail about some people's wishes for end-of-life care.
“Details around people's end of life wishes were limited in the care plans we reviewed.” from the report
Promoting independence
minorSome people felt the home could do more to support their independence and mobility. Risk concerns sometimes led to people being discouraged from taking part in tasks.
“However, a few other people commented they felt they could be more independent.” from the report
- 01How many permanent staff and agency staff are usually on duty on each shift, including at night?
- 02What has changed to prevent people waiting for help with moving, getting up or using the toilet?
- 03How are repositioning schedules now recorded, and how are missed entries checked and followed up?
- 04How will you record each person's end-of-life wishes in enough detail?
- 05How are the quality audits being improved so that they identify problems and track whether changes work?
This was an unannounced follow-up inspection that checked earlier breaches and reviewed the overall service; the visit covered the home, care and nursing support, with all five ratings updated. This explanation was written from the published report of 9 June 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, February 2017
Rated Requires Improvement; inspectors found kind care and enough staff, but six legal breaches and ongoing safety, care planning and management problems.
Inspectors made an unannounced visit on 10 January 2017. They spoke with people, a visitor, staff and the manager. They observed care, reviewed six care plans and checked medicines, staffing, training, complaints and other records.
The home was caring, with positive relationships and respect for privacy and dignity. There were enough staff to meet people's needs, and people could take part in activities. However, medicines records were poor, risk assessments did not always explain how to keep people safe, and recruitment checks were incomplete.
Inspectors also found problems with consent decisions, staff training and supervision, nutrition records and person-centred care plans. The home's checks on quality and records had not led to lasting improvements. Six regulations were breached, including two breaches repeated from the July 2015 inspection.
Kind and respectful care
People were treated with kindness and compassion. Inspectors saw staff protect people's privacy and dignity during personal care.
“People's privacy and dignity was respected. People and staff got on well together and the atmosphere in the service was caring, warm and friendly.” from the report
Enough staff
Inspectors found enough staff on duty to meet people's needs. The rota allowed for extra support when needed, although one visitor gave a different view.
“There was enough staff on duty to meet the needs of people using the service.” from the report
Activities available
People could choose to join activities or spend time quietly. The programme included exercise, singing, arts and crafts, poetry and church services.
“Activities included arts and crafts, singing, entertainers, poetry and church services.” from the report
Access to health professionals
People were seen by a range of health professionals, including GPs, district nurses, specialist nurses, occupational therapists and dentists.
“Records showed that people were seen by the GP, the district nurse, specialist nurses, occupational therapists and the dentist.” from the report
Medicines were not safely recorded
seriousMedicine administration records had gaps and handwritten changes were not always signed. Advice had not been sought before some medicines were crushed, and cream application records were inaccurate.
“Record keeping in relation to medicines administration was poor.” from the report
Risk assessments lacked instructions
seriousCare plans did not always explain how staff should reduce known risks. Three of four air mattresses checked were set incorrectly, and repositioning records had significant gaps.
“Risk assessments did not always reflect actions required to reduce risks to people.” from the report
Recruitment checks were incomplete
seriousSome staff records did not include references from previous employers. Two staff had provided references for each other, without a recorded assessment of their suitability.
“However there were no previous employer references for all staff employed.” from the report
Consent decisions were not properly recorded
seriousThe home did not record best-interest decisions for people who lacked capacity to consent. Staff also showed limited understanding of the Mental Capacity Act.
“There was no documentation in place to evidence the best interest process for people who did not have the capacity to consent.” from the report
Training and supervision were not up to date
needs fixingSome training, including infection control, diabetes and dementia training, was missing or overdue. Records showed that staff did not receive supervision as often as the manager said they should.
“The provider had not ensured that staff training was up to date and monitored effectively.” from the report
Poor quality monitoring
seriousThe home's audits did not reliably identify or resolve problems. Care, maintenance, complaint, training and supervision records were incomplete or out of date.
“The 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.” from the report
- 01How are medicines now checked, especially handwritten MAR entries, crushed medicines, creams and as-required medicines?
- 02How do you make sure pressure-relieving mattresses are set correctly and that repositioning is recorded?
- 03How are best-interest decisions and consent recorded for people who cannot make particular decisions?
- 04What training and supervision have staff completed since this inspection, and how are overdue items monitored?
- 05How do you check that care plans contain each person's preferences, health risks and clear instructions for staff?
This was an unannounced inspection covering all five key questions and the overall rating, with records, care and management systems reviewed. This explanation was written from the published report of 14 February 2017 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Bridgemead
3 rated inspections over 3 years: the service has held its Good rating throughout.
- June 2018Goodcurrent ratingup from Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- February 2017Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- September 2015GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- November 2013
Report published without a new overall rating.
- January 2013
Report published without a new overall rating.
- May 2012
Report published without a new overall rating.
- January 2011
Report published without a new overall rating.
- November 2010
Registered with the Care Quality Commission on 24 November 2010.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
Weigh the report against the rest
Fees, photos and reviews from families
How to read CQC ratings and reports
What to check when you visit
25 live-in carers within about an hour of Bath and North East Somerset
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £1,030 to £1,320 a week. 20 can care for a couple. 12 years' experience on average.
“She enabled mum to lead a high quality life in her own home until the very end and Lena and her family became close personal friends to me and my family.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.