This inspection took place on 5th, 6th and 7th September 2017 and was unannounced.

Bridgeside Lodge Care Centre is a residential care home that provides long-term specialist nursing care for up to 64 adults. The home supports elderly people, some of whom have dementia, and younger people, aged 18-65, who have acquired neurological conditions including spinal injuries. On the day of our inspection there were 58 people living in the home.

At the last inspection on 14 May 2015, the service was rated Outstanding in the Caring and Responsive domains. At this inspection we found the service remained Outstanding.

There was a registered manager in place at the time of the inspection. 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.

Bridgeside Lodge Care Centre provides outstanding care and support to people who live there. The registered manager, with proactive support from the provider’s management team, had worked towards ensuring exceptional and continuously improving standards of care at the home. Together, they had thought about all aspects of the service provided and since the last inspection they had introduced new progressive ideas and initiatives to create a high quality of life for the people who used the service.

These initiatives included the introduction of innovative work aids, such as, an instant IPad care planning and recording system, adopting the FISH philosophy, a technique promoting fun at work to make staff alert and active in the workplace and embedding “People Like Me”, an initiative in which staff and people who used the service were encouraged to make positive connections based on shared interests. The effect of these innovations was that staff had spent less time on completing their daily care notes and had more time and opportunities for building meaningful and positive relationships with people. Consequently, people told us they were feeling happy and safe at the home as staff always had time for them.

External professionals gave us consistently positive feedback about the support provided at the home, its management team and the staff who worked there. They said they had enjoyed working in partnership with the home as it always provided exceptional care to all people who used the service and the staff went the extra mile to ensure people’s care needs had been met

The care and support provided at the home was holistic and enabled staff to meet even the most complex needs of people who used the service. There was a clear strategic vision from the management team that enabled the home to continuously improve and build significant links with the local community and external health and social care professionals. For example, there was an “end of life” project that aimed at ensuring that people received the right and chosen end of life care. Another example was the ReSpect project, which aimed at formulating individualised and personalised recommendations for a person’s clinical care in a future emergency in which they would be unable to make or express choices. Staff were well trained and they continuously worked towards improving their knowledge and skills to care for people effectively.

Other partnership initiatives promoted by the home supported people in creating and sustaining positive links with the local community. These included a partnership between Bridgeside Lodge and local nursery schools and the celebration of a recent event, the Regents Canal Festival, where other members of the community were invited and participated.

The registered manager was highly regarded by people using the service, their relatives, the staff and external health and social care professionals. They all gave exceptionally positive

We carried out an unannounced inspection on the 14 May 2015. Our previous inspection took place on 22 April 2104 and we found the provider met the regulations inspected. Bridgeside Lodge Care Centre provides nursing care primarily for people with cognitive impairment, including dementia and other neurological conditions including spinal injuries. The service provides care and support for 64 adults of all ages.

There was a registered manager in place at the time of the inspection. 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.

We found that the registered manager and staff worked in partnership with local health and social care teams to provide a person-centred service that encouraged independence. There were strong links with the local community and an emphasis on creating opportunities for people to maintain interests and build friendships.

Activity programmes were detailed on a weekly activity board and arranged by the activity co-ordinator. We saw activities planned for the week that included poetry, movies, memory box, exercise to movement, card games, yoga, cinema and massage. People had designated one to one time with staff in order to pursue their interests; one example was a monthly cinema visit and shopping trips which people told us they looked forward to and enjoyed.

We saw innovative projects and initiatives in place to promote connectivity between people who use the service, relatives, friends and the local community. This included a new project called; ‘People like Me’ that had brought together people, staff, relatives and friends through their experiences, beliefs and interest. Outcomes were good and we saw that a number of people had developed friendships and rekindled the interests they had before coming to the home.

A volunteering project and partnership had been set up between Bridgeside Lodge and local university students. The aim of this initiative was to reduce isolation in the community by offering activities like gardening, baking and games. People were positive about the initiative and the opportunities that they had been given to interact again with the local community. They told us they missed the connections with the community and were happy to be once again doing the activities that they loved. This was another excellent demonstration of the emphasis the service put on creating opportunities for meaningful activities to take place and this ethos was at the heart of promoting and enhancing wellbeing for people, relatives and staff at the home.

Another positive development was the appointment of a dementia specialist. This person is the lead person for the company on setting up the “Who am I” document which is a passport to ensure people’s unique information and life stories are written down in one place, including choices and preferences and how they wished to be supported.

A ‘Carers Network’ had also been established to support families and friends as a result of feedback from families saying they sometimes feel alone. Relatives reported feeling less isolated and more connected to others in a similar position since the setting up of the network.

Staff had a good understanding of safeguarding adult’s procedures and keeping people safe. They knew how to recognise and report concerns appropriately and understood how to ‘whistle blow’.

Medicines were stored and administered correctly and staff had completed the appropriate training to ensure they were competent to administer medicines safely.

Risk assessments and care plans for people using the service were effective. They were person centred and recorded all the required information. People and their relatives were involved in the care planning process.

Staff had the knowledge and skills to enable them to support people effectively. They had undertaken induction training and currently thirteen staff had completed the new care certificate training, which are a set of standards which aim to give confidence that workers have the introductory skills, knowledge and behaviours to provide compassionate, safe and high quality care and support.

People consented to their care and treatment and staff had a good understating of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). DoLS exist to protect the rights of people who lack the mental capacity to make certain decisions about their own wellbeing. Services should only deprive someone of their liberty when it is in the best interests of the person and there is no other way to look after them, and it should be done in a safe and correct way.

The staff team were caring and promoted positive caring relationships. People’s dignity and privacy was maintained. They were supported with personal care and other tasks and were encouraged to do as much for themselves as possible in order to maintain and increase their independence.

The provider had invested in a training package devised by a renowned actress to support staff awareness in the area of dignity and compassion. DVD's from the package were also used during staff induction to ensure dignity and compassion were embedded at the start of the employment process. 

Three were excellent practices in place to support people and their relatives around end of life care which was described by people and their relatives as being sensitive and supportive. Policies and procedures were in- depth and included information on cultural and religious customs.

There were innovative systems in place involving the robust and timely sharing of information between health and social professionals to support people achieve a dignified pain-free death.

There was a clear management structure in place and people, who used the service and staff, were fully aware of the roles and responsibilities of managers and the lines of accountability. Improvements were seen at the home and this was attributed to the extensive activity programme as well as the excellent management of the service.

People were given a service guide on how to make a complaint and other information about the service. Complaints were logged and addressed appropriately.

The registered manager conducted a number of regular audits at the service to ensure the service was delivering high quality care. Actions were carried through and discussed with the staff team for learning and improvements.

Bridgeside Lodge is a purpose built care home, near the Angel Islington. The home provides long term care for people with physical disabilities, learning disabilities and dementia. It also offers four beds for respite and those who are ready to leave hospital but require some rehabilitation before going home. The service has four floors and can accommodate up to 64 people, all rooms are single with en suite facilities. The home had three vacant beds on the day we inspected.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the regulations associated with the Health and Social Care Act 2008, to pilot a new inspection process under Wave 1 and to check whether improvements had been made since our last inspection of the service. At our inspection in October 2013 we found people were at risk of receiving inappropriate care and treatment as the provider was not completing and maintaining accurate and up to date care records. At that inspection we saw care plans for people were not updated, and staff had an inconsistent approach in recording of important information such as wound assessments.

At our inspection of the service on the 22 April 2014 we found some improvements had been made since our last inspection. We saw care plans for people were being updated, recording of important information such as wound assessments were being completed and staff understood the importance of keeping records up to date. However in three people’s records it was difficult to find the most recent information as information was not regularly archived. Therefore there was a risk that visiting professionals and staff may not have the most up to date information on the person when treating or caring for them.

We reviewed people’s care records and saw important documents were not fully completed such as, Do Not Attempt Resuscitate (DNAR) forms. However people and relatives we spoke with were confident that their end of life wishes were recorded in their care plans and understood by the staff.

Most of the people we spoke with said they felt safe living at the service. The service kept medicines safely and followed its own policy and procedures in storage, dispensing and disposal of medicines. Relatives and people commented on how clean the service was and we saw staff were knowledgeable in infection control.

Some people we spoke with were involved in planning their care. However others told us they would like to be more involved in planning their care. We saw a GP visited the service regularly and people told us the GP “listened.” Referrals to other professionals such as district nurses and physiotherapy were completed promptly.

Staff were receiving regular supervision and felt supported by the management. However the provider had not ensured staff had received an appraisal in 2013. We reviewed records that showed the provider had started to give staff appraisals in 2014, and some staff we spoke with confirmed this.

We observed lunch on all floors of the service on the day we inspected. We saw that the food was hot and well presented. Some people told us they were offered choice and that the food was “ok.” However others told us they did not like the food.

The staff we spoke with were aware of people’s personal histories before they came to the service and ‘life history’ documents were completed. However staff had not used this information to ensure that activities available at the home were personalised to people’s interests.

We saw the service had conducted a resident and relative’s survey in August 2013. The results showed that people were unhappy with the standard of their rooms, quality and choice of food. We could see the provider had acted to attempt to address these concerns.

Staff we spoke with understood the importance for people to be able to make their own choices and if they were unable to do this, the staff were aware of how to get support from relatives and the local authority to assess a person’s capacity to ensure any decisions were made in the person’s best interests.

Audits were completed by the registered manager, in areas such as health and safety and medicines management. We saw evidence that when problems had been identified, the service was quick to resolve these.

People and relatives knew how to complain and who to contact, and staff were also aware of their role in helping and supporting people and relatives if they wanted to complain. The provider had a whistle blowing policy and staff we spoke with fully understood how to use it.

We visited this service overnight on 26 July 2013 and found that the service was compliant with the areas we inspected against. This time, two months later, we visited during the day time with a specialist nurse advisor to track and observe the care being given to people who use the service.

We tracked the care for eight people who use the service and looked at the care plan records of 12 people who use the service.

We spoke with a relative about the care their mother was receiving. They said they were happy with the care. They told us that staff usually answer the call bells promptly and meals were good. They also told us that their mother had arrived at the home with pressure sores acquired at her family home. We were told that these were "1000 times better". We observed that this person's mother had been provided with a pressure relieving cushion to sit on.

We found that people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

We found that people were at risk of receiving inappropriate care and treatment as the provider did not complete and maintain accurate and up to date records.

We arrived at the service at 8:30pm and most people were in their bedrooms throughout our visit. We were told by the registered manager that due to the nature of people's disabilities, many of the people who use the service spent the majority of their time in their rooms during the day and night. We found that this was reflected in most people’s care plans. Care plan records showed that staff had considered the risk of isolation and had identified a few group activities which corresponded to individuals’ interests which people were encouraged to attend.

We found that people's rooms had been personalised and that people's preferences of whether they wanted to sleep with the light on or off, door open or closed were supported and reflected in their care plan records.

We accompanied staff during their routine checks. Some people's welfare was checked on hourly and other people were seen more frequently. We found that staff demonstrated a good knowledge of people’s individual needs and spoke about them in a very caring way.

We found that the provider submitted notifications of allegations of abuse and informed us of what steps they had taken in each instance. We also found that the provider routinely informed the Local Authority of any safeguarding concerns.

We found that there were enough staff to meet people’s needs.

We used statistical information and analysis to inform our inspection and we followed-up with the service and others where we identified issues.

We spoke with seven people using the service, four relatives of the people, a social worker, and four care staff. All of these people felt that the home provided a safe and caring environment for people who use the service. People using the service told us that they were happy living at the home. Two of the people we spoke with said: "This is like a home from home". They told us that they were involved in their care and staff always asked them their preferences how they wanted to be supported. People told us that their privacy and dignity was respected. A person using the service told us staff always knocked on the bedroom door "even when the door was open".

We saw that many of the people were engaged with reading books and newspapers or watching television while some others were taking part in an entertainment activity. We saw that some people were sitting on the wheelchairs while having their meals. We discussed this with the people and the manager. Some of these people told us that they wanted to use their wheelchairs but we did not get a response from the others. The manager told us risk assessment had been completed for all the people but this was not always the case in the files we checked.

All the people we spoke with felt that they were safe in the home. People using the service and their relatives told us that staff were polite and friendly.

We spent time talking to people and observing the care that people received.

People and their relatives were generally pleased with the home and praised the staff and the quality of care. People were also positive about the food and said there was enough choice. People were able to personalise their own rooms but some areas of the home appeared worn and in need of redecoration. The manager has told us that the company intends to refurbish these areas of the home this year.

We observed some people enjoying group activities on the day we visited and saw that the activities coordinator spent time talking to people individually. Staff confirmed that they took people out if they wanted to go out shopping or for a walk. However some of the home's facilities were not being used for the benefit of people using the service, for example some of the toilets were being used as storage areas for the staff.

One relative wanted their family member moved to a room with a better view and the manager told us this person would move as soon as a suitable room became available.

People using the service felt safe and able to raise any concerns with the staff. Relatives felt that communication was generally very good.