Inspection on 28/10/09 for Bridge Reach

This is the latest available inspection report for this service, carried out on 28th October 2009.

CQC found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Bridge Reach 17/01/07

Bridge Reach 26/09/05

Bridge Reach 30/06/05

Bridge Reach 14/03/05

Bridge Reach 08/02/05

Bridge Reach 04/04/03

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Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Bridge Reach 3 Tern Crescent Rochester Kent ME2 2RE     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Elizabeth Baker     Date: 2 8 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Bridge Reach 3 Tern Crescent Rochester Kent ME2 2RE 01634318283 01634328140 bridgereach@blueyonder.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Herbert James Smith ScottTelford,Mrs Kim Scott-Telford care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 3 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category:Learning disability(LD) Date of last inspection Brief description of the care home Bridge Reach is a small care home providing personal care support to three people with learning difficulties. The aims of the service are to support people with learning disabilities to live as independently as they can and to achieve their goals in life. The home is a three bedded semi-detached house situated in a residential area on the outskirts of Strood. It has three single bedrooms, bathroom and one toilet upstairs and a lounge, kitchen and conservatory, used as a dining room, on the ground floor. The home has front and rear gardens as well as off road parking. Buses and shops are in walking distance. Strood and Rochester have good bus and rail links. Current fees range from £527.01 to £922.17 per week. Additional charges are payable for toiletries, outings, holidays and some meals outs. Activities include bowling, cooking, retail Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 3 Brief description of the care home shopping, pub and restaurant meals, discos, social clubs and holidays. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: On the 28 October 2009 we the Commission carried out a key unannounced visit to the service. The visit lasted about four hours. At the time of the visit three service users requiring personal care were living at the home. We walked around the home and talked with the two residents and member of staff who were at the home. We looked at care records, staff files, policies and procedures and maintenance records. At the time of compiling the report, in support of the visit, we received surveys about the service from the three residents, one health professional and one member of staff. An up to date Annual Quality Assurance Assessment was not available to support this inspection because the visit was brought forward in line with our revised programme for excellent rated homes. Verbal feedback was provided to the deputy manager throughout the visit. Feedback Care Homes for Adults (18-65 years) Page 6 of 28 was also provided to the manager at the end of the visit. The last site visit to the service took place on 17 January 2007. Annual Service Reviews (ASR) were undertaken on the service on 18 June 2008 and 25 June 2009. We have not received any complaints about the service since the last site visit. Care Homes for Adults (18-65 years) Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 28 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes service user handbook provides prospective service users with the information they need to know to make a decision about moving into the home. Evidence: There have been no new admissions into the home since 2002. Indeed all three service users have lived at 3 Tern Crescent for a long time and intend to do so for the foreseeable future. All three returned survey forms from the service users indicate they were asked if they wanted to move into the home and that they had enough information about the home before moving in. The providers regularly review and update the service user handbook which all the service users are provided with. The handbook has been put together in an easy to read and understandable format. We spoke with two service users and they both said they are happy living at the home. Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: A survey from a healthcare professional indicated the service users healthcare needs are properly monitored, reviewed and met by the care service. Service users care records include an assessment of their needs which are regularly reviewed. Care Homes for Adults (18-65 years) Page 11 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are enabled and supported in living an independent life as is possible. Evidence: Each service user has a support plan that outlines their individual needs, risks and the action to be taken. The plans are supported by risk assessments and cover daily living activities such as personal care needs, relationships, behaviour, medications, social, travel, domestic duties, shopping and night care. Service users are involved in the development of their service user plans. And staff assist service users in meeting their goals. Indeed one service user has recently achieved their goal of giving up smoking by attending the stop smoking clinic. The two service users we met with at the visit looked happy and relaxed. Staff spoke to them in a respectful manner and supported them in making choices. During our visit it was clear that staff have a good understanding of service users individual needs. Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: The home seeks specialist input from professionals when there is a need. This included involving the local learning disability team when two service users expressed a desire to have a relationship. All three returned surveys from service users indicated they always make decisions about what they do each day. Care Homes for Adults (18-65 years) Page 13 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Links with the community are good and support and enrich service users social, occupation and development opportunities. Service users benefit from a variety of lifestyle choices with support from care staff where this is needed. Evidence: On our arrival one service user was at work and the other two service users were getting ready to go into town to do some banking and have lunch. The service users were busy getting ready, laughing and talking to each other and to staff. The two service users showed us around the home and let us go into their bedrooms. The two service users spoken with said they like living at the home. All three service users have a plan of weekly activities and routines. This includes going to work, house duties, attending clubs, day centres, going shopping and taking trips out to pubs and discos. Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: The service users described their recent holiday in Hastings and said how much they had enjoyed this. There are no service users who currently attend regular church services. However a priest was involved as part of the professional support provided to two of the service users who had expressed a desire to have a relationship. So that service users can keep their bedrooms private, all bedroom doors are lockable and the service users hold the keys. In order to decide on the weekly menus, the service users get together to state their suggestions for the forthcoming week. The service users do the weekly shop with support from staff. A menu diary is maintained by staff to make sure that the menu choices are balanced and healthy. And service users weights are regularly checked and recorded. Service users help prepare certain meals if they wish to. The three returned surveys from service users indicated they all do what they want during the day, evening and weekends. Care Homes for Adults (18-65 years) Page 15 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users receive personal support in accordance with their assessed needs, wishes and preferences and can feel confident they are fully supported with their healthcare needs. Evidence: Because the service users have lived in the home for some years, staff know each service user very well and know how they like to be supported with their daily routines, care and activities. Each service user has a service user plan. We looked at all three. The plan includes details of service users health needs. Where hospital treatments are needed, staff support service users in attending appointments. This includes London hospitals. One of the service users recently had specialist input from Moorfields Hospital, after much badgering by staff to the service users GP for a specialist referral to be made. The result is that the service user can now see much better and has grown in confidence. This is an excellent achievement. Service users go to bed and get up when they want to and choose what to wear. Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: Indeed the service users seen were appropriately dressed for the time of day and with attention to detail where this is important to them. Support plans inspected also showed that the service users are supported in attending GP appointments, dental services, opticians, and speech and language services when needed. Medication is stored in a locked cupboard. At present only one service user is taking prescribed medications. Staff administer these to the service user. A risk assessment to see whether the service user would be able to self administer these medications had been carried out. The result was that it would not be safe for the service user to do so. To track that the service user has been given their medicines, staff complete a medication administration record chart. Whilst acknowledging controlled drugs have not been needed for the current residents, since the home was registered there has been a change in legislation which requires all types of care homes to have an approved type of controlled drug cupboard. The homes current medicine cupboard would not comply. In 2008 our legacy organisation published Professional Advice re the safe management of controlled drugs in care homes. This is still available from our website and may prove useful to the providers. Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users can be sure their concerns and worries are listened to and acted upon Evidence: The complaints procedure is included in the service user hand book. The providers have also put together an easy to read complaints guide which has pictorial information. Contact numbers for the local social services and us are included. The guide also advises service users that members of Medway learning disability team are also available to support them. The three returned surveys from service users indicated they all knew who to speak to if they were not happy and know how to make a complaint. Information obtained at the site visit indicates there have been no formal complaints in the last 12 months. And that there have been no safeguarding vulnerable adult referrals or investigations made. We have not received any complaints about the service. One service user living in the home needs some support to manage and spend their money. A specific book is kept to record monies received and that spent. And the service user signs the book against each entry. There is an open culture in the home and service users discuss any problems with Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: staff as and when they occur. The home has safeguarding vulnerable adults policies and procedures in place, including those published by the local authority. The home has also acquired the version specifically published for people with a learning disability. This is good practice. Care Homes for Adults (18-65 years) Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users live in a homely and comfortable environment Evidence: 3 Tern Crescent provides a home for three service users with a learning disability. All the service users have a single room, located on the first floor and which are accessed by a flight of stairs. Two service users showed us their bedrooms and we talked to them in there. Both rooms had been personalised to reflect each service users individual preferences and style. Bedrooms are kept locked and the service users hold the keys. There is a bathroom with a bath and shower upstairs and a separate toilet. The service users share these facilities. There is a small fitted kitchen, a lounge and a conservatory which is also used as a dining room. The rear garden provides an area for residents to enjoy activities in good weather. For security purposes, the fencing has recently been replaced. Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: There have been no major changes to the homes environment since the last visit, although some equipment has been replaced. This is includes the washing machine and tumble dryer. The providers have informed us that they intend to renew the floor covering in the hall, kitchen and staff room shortly. This is good news as the hall carpet looked worn and frayed and the staff room carpet was stained. There are no staff employed specifically for cleaning. Service users are involved in the household chores and know what is expected of them. All three surveys returned from service users indicated the home is always fresh and clean. Care Homes for Adults (18-65 years) Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users care, social and emotional needs are promoted by a stable workforce in such numbers that meet current service users needs. Evidence: The three service users who live at the home have low dependency needs. There is always one member of staff on duty in the day, and occasionally two. Nights are covered by one sleep in member of staff. Cooking and household duties are done by staff with some help from service users. Administration support is provided by the providers. The home has a low staff turnover. Since the last visit two new members of staff have been appointed. One has yet to commence working at the home. The staff files for the two staff members indicated they had completed application forms and had been interviewed. Criminal Record Bureau checks had been undertaken and references taken up. This is for service users protection. New staff initially work at the home working along side trained staff for about two weeks as part of their induction. New staff who are not NVQ trained in care are then expected to undergo NVQ training. The one returned staff survey indicated there are always enough staff to meet the individual needs of all the people who use the service. Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: Over 70 of staff have NVQ level 2 or above in care. And another member of staff is currently undertaking the course. Details provided at the visit indicate some staff have received training within the last 12 months in subjects including safeguarding vulnerable adults, Mental Capacity Act, first aid, food hygiene, fire, infection control and administration of medicines. All three returned surveys from service users indicated staff always treat them well and they listen and act on what they say. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from living in a well run home Evidence: Since the last visit the manager and deputy manager have successfully completed the NVQ 4 care qualification. They both now intend to do a relevant management course. The manager has many years experience of working with people with a learning disability and showed a clear understanding of the service users needs. The home has acquired off the shelf policies and procedures and individualises them to reflect the needs of the home. These are reviewed on an annual basis. The home has developed its own quality assurance programme which includes surveying service users and stakeholders. Service users have regular meetings with staff to discuss their views and opinions on the service. The home is an active member of the Medway Workforce Development Partnership and attends service provider forum meetings. This helps it keep up to date with Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: market changes. The providers access our website to obtain details of forthcoming registration changes. This is good practice. One of the providers has just completed Deprivation of Liberty Safeguarding training and this knowledge will be passed down to all members of staff. This is important as the recent changes may affect the homes current and future service users. For service users safety hot water temperatures are controlled. The temperatures are tested monthly to make sure they do not exceed the recommended levels. The homes fire precautions are serviced and tested by external contractors as required. The homes alarm system is connected to the three emergency services, for service users safety. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!