CARE HOMES FOR OLDER PEOPLE
Bridge House Manorside, Market Street Flookburgh Grange over Sands Cumbria LA11 7JS Lead Inspector
Marian Whittam Unannounced Inspection 10:00 10 January 2007
th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bridge House DS0000036506.V316312.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bridge House DS0000036506.V316312.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Bridge House Address Manorside, Market Street Flookburgh Grange over Sands Cumbria LA11 7JS 015395 58622 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.cumbriacare.org.uk Cumbria Care Mr Anthony Lyons Care Home 39 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (39) of places Bridge House DS0000036506.V316312.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The service must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The home is registered for a maximum of 39 service users to include: up to 39 service users in the category of OP (Old age, not falling within any other category) up to 10 service users in the category of DE(E) (Dementia over 65 years of age) The staffing levels for the home must meet the residential forum care staffing formula for older adults. When single rooms of less than 12 sqm usable floor space become available they must not be used to accommodate wheelchair users, and where Existing wheelchair users are in bedrooms of less than 12 sqm they must be given the opportunity to move to a larger room when one becomes available. 12th January 2006 3. 4. Date of last inspection Brief Description of the Service: Bridge House is a purpose built residential care home owned by Cumbria County Council and operated by Cumbria Care, an independent business unit of the County Council. Bridge House is registered to provide residential care for up to thirty nine older people. The home is divided into three distinct units, Sandgate, which specialises in Dementia Care for up to 10 people, and Applebury and Humphrey Head. Each unit contains a dining room with kitchenette, two communal lounges, accessible toilets and bathrooms and the resident’s bedrooms. There is a passenger lift making all three floors fully accessible. There are well kept gardens to the front and rear of the home. The home is situated in the centre of the village of Flookburgh, within walking distance of the local amenities and close to the town of Grange-over-Sands. Fees payable at the home are £317.00 to £422.00 a week as at 10.01.07. There are additional charges made for personal newspapers, magazines and hairdressing. The home makes information about its services available through its Service User Guide and Statement of Purpose that are available on the foyer of the home. Bridge House DS0000036506.V316312.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key unannounced inspection took place on 10th January 2007. The inspector looked around the home and spoke with the manager, residents and with staff members. Staff recruitment records, training records, medication handling records and care plans were examined and a selection of records required by regulation. Information about the home and its services, asked for by the Commission for Social Care Inspection (CSCI), before the inspection took place was completed and returned to CSCI in good time by the home manager. Before the visit information was also gathered on the service from records of previous visits, notifications and other regulatory activity. Questionnaires from residents and relatives about the service, provided by CSCI, were returned before the inspection took place and also provided information about their experiences of the home. What the service does well: What has improved since the last inspection?
Bridge House DS0000036506.V316312.R01.S.doc Version 5.2 Page 6 It is evident that care plans are now being reviewed at least once a month to improve monitoring, although they are still not always being fully updated after the review. The home has had a problem maintaining satisfactory levels of staff at times. In the kitchen this meant using agency staff so the recruitment of a permanent second cook means better continuity in the provision of resident’s meals. Work has recently been done on radiators with the aim of improving resident’s access to controlling heating in their bedrooms, this gives them more control over their environment in their daily lives. The service has worked hard and shown commitment to continuing to try and improve areas of the service where requirements have been made in the past and to try and improve the service for residents. What they could do better:
The home has a statement of purpose and service user guide, including resident views on display in the entrance hall. However these important sources of information are not available in alternate formats, such as audio or large print for those with sight problems. To improve the provision of this information the home should make its statement of purpose/service user guide, including the information contained on making complaints, available in different formats to suit the different needs of residents. The home is doing regular reviews of residents care plans now but needs to take care and make sure that any changes found at review are updated in the care plans and so improve consistency. Changes identified at review should always be recorded in an updated care or management plan to improve monitoring of changes. Although staff have a good knowledge of resident’s needs they should not rely too heavily on verbal communication to pass on information about changes. The home should undertake more detailed and individual nutritional screening on admission and keep a record of any actions taken. Information on nutrition is being taken but this is on a basic level and does not lend itself to easy monitoring. The home could improve its care planning methods by using person centred approaches to developing care plans with residents, reflecting their perspectives and individual goals. The home has had to use significant numbers of agency, relief and extra permanent staff shifts to cover staff shortages recently. Unexpected staff absences have meant that at times staffing levels have been particularly stretched, when this happens staff cannot give as much time and attention to residents notably social and recreational needs. The home should consider how it monitors and demonstrates, in the long term, that staff levels are always
Bridge House DS0000036506.V316312.R01.S.doc Version 5.2 Page 7 sufficient to consistently meet the varied needs of residents day and night and how these are adjusted as needs change. Work has recently been done on radiators to improve resident’s access to controlling heating in their bedrooms. In order to maintain the overall homely appearance of the home the home needs to make sure that any re plastering and finishing off work is done to maintain a cared for environment. Similarly general repairs to the porch, and the re touching of paintwork and wallpaper in some places would improve and maintain an attractive home for residents. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Bridge House DS0000036506.V316312.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bridge House DS0000036506.V316312.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 1, 2, 3 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Pre admission assessments are done by the home to ensure individual needs will be met on admission. EVIDENCE: The home has a statement of purpose and service user guide, including resident views and the most recent inspection report, on display in the entrance hall. These are not available in alternate formats, such as audio or large print for those with sight problems. Individual care plans show that the residents have their personal health and social needs assessed before and following admission to the home and their individual care plans have been developed from this. The home manager or senior staff do an individual assessment of needs in addition to social services care management plans to try to ensure that the home will be able meet their needs before residents come to live there. The home has an introductory
Bridge House DS0000036506.V316312.R01.S.doc Version 5.2 Page 10 period followed by a review to make sure needs are being met and that the home suits the resident. Residents are provided with terms and conditions of residency so they are aware of their rights and responsibilities. Bridge House DS0000036506.V316312.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 7, 8, 9 and 10 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. A care planning and review system is in place and the personal, social and health needs of residents are being met and privacy respected. EVIDENCE: Overall the home has clear individual care plans for residents, based on initial care assessments and risk assessments. These are informative and cover a range of needs, although not obviously person centred in all approaches to care planning. However residents said that they are asked about their care and involved when changes are made in their care and some have signed their care plans. The care plans set out assessed individual health, social and personal care needs and these are being reviewed, but have not always been fully updated. This was evident for one resident where the daily records showed changes in skin condition, but no updated plan or body chart was in place to effectively monitor and record this observed change. Staff spoken with are however aware of the resident’s needs and changes through verbal communication,
Bridge House DS0000036506.V316312.R01.S.doc Version 5.2 Page 12 although this should not be relied upon as changes may not always get passed on. Residents spoken with felt they were well cared for and one said “the staff are wonderful, I can’t fault them” and another praised the time and care taken by night staff when they have a “bad night”. Staff were seen to have a good rapport with residents and offer support on an appropriate way. Staff were seen to treat residents with respect and remained calm and reassuring even in difficult situations when residents were distressed or felt unwell. Information on nutrition is being taken but this is on a basic level and does not lend itself to easy monitoring. There is evidence in care plan records and from resident comments of consistently prompt referral to health care and support services. Healthcare needs are being identified and met and there is evidence of advice and support from specialist and community nursing services to assess and help manage individual problems. Medication practices, the storage of medicines and their handling is of a consistently good standard with evidence of good practice in record keeping. The home keeps records of medicines it receives from and returns to the pharmacy and the manager undertakes regular audits to monitor quality. Management of as required medication states the indications for use, the administration procedure and maximum dosages, which is good practice. Bridge House DS0000036506.V316312.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides some social activities within the home, supports resident choice and there is variety and choice in the food on offer to residents. EVIDENCE: Care plans record resident’s social interests and preferences including some informative personal profiles and background information. Residents spoken with confirmed that they are supported in their interests and do not feel they have to join in with any activities going on in the home if they do not want to. Residents spoke of trips out to local places of interests, which they had enjoyed, and musical entertainments that the home held. One resident said, “We do well for entertainment with trips and concerts”. Activities files are kept on units and recorded what residents had enjoyed or found beneficial this included Tai Chi, board games, reminiscence sessions and singing. Some residents spoken with preferred to follow their own interests, reading, watching television, listening to their music and going out with family and friends. Most residents have attractive views over the surrounding countryside from their bedroom windows and one said they liked to “just sit in my chair and look at my view”.
Bridge House DS0000036506.V316312.R01.S.doc Version 5.2 Page 14 Residents meetings and one to one support means residents are able to exercise a degree of choice and control over their lives. The menus and records of food served show a varied and nutritious diet that catered for special dietary needs. Menus have been discussed at the resident’s meetings and resident’s surveys and comments during the visit confirmed the overall good standard of food provided. The menus within the home have been revised and changes made following resident consultation. The menu offers a good variety of meat, fish, vegetarian and any special diets residents’ need. One resident said, “ I can’t fault the food either, we have a very good cook”. The lunchtime meal offered a choice and residents confirmed they took their meals where they wanted with some preferring to stay in their bedrooms. The kitchen was clean and tidy and the home now has a second permanent cook so the home does not need to use so many agency staff anymore. Bridge House DS0000036506.V316312.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s policies procedures and practice safeguard residents and staff and ensure concerns and complaints are responded to appropriately. EVIDENCE: Since the last inspection the home has completed one adult protection investigation following an allegation of abuse. The correct procedure was followed using multi agency guidance and it has been appropriately and fully addressed by the home with other relevant agencies. The home has a complaints procedure and a system for logging complaints for investigation and the procedure is available to residents on the units and in the service user guide, although not in different formats. Residents spoken to said that they know who to speak to if they want to complain or are not happy, usually their carers, or the supervisor. Those spoken with felt confident staff would listen and act if they were unhappy. Residents also said that they saw the manager most days and would see him if they were unhappy. There are procedures in place to protect vulnerable adults from abuse and whistle blowing procedures. The home also has procedures in place for staff guidance on gifts and preventing involvement in service user’s wills. Current multi agency adult protection guidance and the “No Secrets” Department of Health guidance are available for all staff in the home. Staff
Bridge House DS0000036506.V316312.R01.S.doc Version 5.2 Page 16 have been given training on adult protection and this topic is included in the NVQ course. The home holds only small amounts of daily spending money on resident’s behalf. All personal monies are recorded, receipts kept and totals checked are correct. Residents are supported to handle their own financial affairs or with help from their families and legal representatives. Bridge House DS0000036506.V316312.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 19, 20, 21, 22, 24, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean, tidy, homely and adequately maintained for residents and has the equipment they need to promote mobility and independence EVIDENCE: On the whole Bridge House is decorated and maintained to a consistently good standard. An annual condition survey of the premises is done and a programme of maintenance and improvement for the home planned from that. Timescales are placed on this work, although not always met. Residents spoken with say that their rooms are cleaned regularly and kept clean. The lounge and dining areas on the three units are warm, comfortable and well furnished with good lighting and natural ventilation. There are call bells in areas used by the residents to summon assistance if needed. Resident’s bedrooms seen by the inspector were attractively decorated and
Bridge House DS0000036506.V316312.R01.S.doc Version 5.2 Page 18 appropriately furnished. Many residents have brought into the home personal possessions and items of importance to them. This helps make their bedrooms more personal and homely. Work has recently been done on radiators to improve resident’s access to controlling heating in their bedrooms. As a result there are areas in the home that need re plastering and making good to maintain a homely and cared for environment. Similarly general repairs to the porch, re touching of paintwork and wallpaper is needed in some places to maintain an attractive home for residents. The home has policies and procedures for infection control in place supported by staff training. Staff were seen to be following good practice using gloves and aprons and appropriate waste bags. The laundry facilities are satisfactory and away from resident areas. There are systems are in place to minimise risks from Legionella and test water temperatures to minimise risks from scalds. Bathrooms are equipped with suitable aids and adaptations to support residents. Moving and handling equipment is also in place and is being maintained and serviced. Overall the home was found to be clean and hygienic and, where a problem with unpleasant smells has been identified, the manager is acting to rectify this by having more appropriate flooring installed. Bridge House DS0000036506.V316312.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The numbers of care staff on the rota are satisfactory to meet resident’s needs and provide continuity of care. There are recruitment procedures in place to promote residents safety. EVIDENCE: Staff files were examined and confirmed the home was following good practice guidelines with regard to the recruitment of staff. Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks and references are being done before staff start work in the home. Staff spoken with enjoyed their work and had a good understanding of their role and meeting resident’s needs. Staff say they are given regular supervision and they feel supported to undertake training. Individual records of staff training are kept and record all training activity, including induction and foundation training. NVQ level 2 training in care is well established for care staff and this is continuing towards reaching the 50 asked for by the National Minimum Standards. Residents spoken with felt they were well cared for by staff and one said,“the staff are very helpful, they help me to dress and to get everything I want ready when I am going out”. Another resident said that even when they are busy staff “pop in to have a chat when they can.”
Bridge House DS0000036506.V316312.R01.S.doc Version 5.2 Page 20 Staff rotas indicate that the home has sufficient care and supervisory staff to meet resident’s physical needs and there is only 1 permanent staff vacancy. However, observation during the day and rotas also indicate that staff levels are at capacity with little room for any sickness or holiday cover. The home has had to use significant numbers of agency, relief and extra permanent staff shifts to cover staff shortages. Staff absences have meant that at times staffing levels have been particularly stretched. The rotas show and staff confirmed this had happened on more than one occasion the preceding week resulting in only one carer on each floor for a period one day. Given the lay out of the building this is not satisfactory. Staff were able to confirm this difficulty and commented that the staff levels were “fine just so long as no one goes off sick”. This problem was evident on the day of the inspection when due to sickness there was only one carer on the unit providing dementia care during the afternoon. As a result the carer was unable to spend time on any one to one activities but concentrate on meeting basic care needs including dealing with laundry. The manager and supervisor spend a lot of time finding cover and handle the problem as well as they can in the short term, within the resources available to them. The home has recruited more relief staff and the situation should ease. The home should consider how it monitors and demonstrates, in the long term, that staff levels are always sufficient to consistently meet the varied needs of residents day and night as those needs change. Residents have noted that at times the staff levels are low but felt that staff worked hard to meet their needs and did not feel they were not getting the help they wanted. One resident said, “ The manager and supervisor get their sleeves rolled up when they need to” and this was seen to be the case with the supervisor assisting with residents on the dementia unit. Bridge House DS0000036506.V316312.R01.S.doc Version 5.2 Page 21 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 31, 32, 33, 35, 36, 37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Procedures are in place to safeguard resident’s financial interests and promote their health, welfare and safety. EVIDENCE: The home has regular residents meetings and staff meetings and does annual stakeholder surveys to gather wider opinions on the service. Residents comment that they see and speak to the Manager on a daily basis and can raise any matters they want to discuss any time. The manager is experienced and knowledgeable and in the process of completing the NVQ 4 /Registered Managers Award (RMA). The manager has a good awareness of the needs of the residents and the management of the home. Staff spoken with found the manager was approachable and felt supported in their role.
Bridge House DS0000036506.V316312.R01.S.doc Version 5.2 Page 22 Formal staff supervision is being done and records kept. The standard of record keeping and organisation of information is generally good. The home had systems in place to safeguard resident’s monies and a check showed transactions are recorded. All transactions are receipted and the home does not act on behalf of any residents financially. Records and servicing contracts indicate that the home has systems, training and practices to promote resident health and safety. Records show that servicing and maintenance of equipment is being done as needed. Staff have been given appropriate training on first aid, infection control, moving and handling and fire training to promote safe working practices. Bridge House DS0000036506.V316312.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 3 X 3 3 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 3 Bridge House DS0000036506.V316312.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard OP1 Good Practice Recommendations 1. 2. 3. 4. 5. 6. OP7 OP7 OP7 OP8 OP19 The home should consider making its statement of purpose/service user guide, including the information contained on making complaints, available in different formats to suit resident’s needs. All resident’s care plans should be fully updated following the review to record and monitor any observed changes. The home should consider developing a more consistently person centred care planning approach. Staff should not rely too heavily on verbal communication to pass on information about changes. The home should undertake more detailed and individual nutritional screening on admission and keep a record of any actions taken. General maintenance and repairs of internal decoration and the front entrance should be done as part of the home’s maintenance plan.
DS0000036506.V316312.R01.S.doc Version 5.2 Page 25 Bridge House 7. OP27 The home should consider how it monitors and demonstrates, in the long term, that staff levels are always sufficient to consistently meet the varied needs of residents day and night as those needs change. Bridge House DS0000036506.V316312.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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