Inspection on 21/05/08 for Bridge House

This inspection was carried out on 21st May 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Bridge House 08/05/07

Bridge House 22/06/06

Bridge House 26/10/05

Bridge House 25/04/05

Bridge House 01/12/04

Bridge House 23/06/04

Bridge House 12/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Bridge House 1 Forty Hill Enfield Middlesex EN2 9HT Lead Inspector Jackie Izzard Unannounced Inspection 09:30 21 and 30th May 2008 st 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 DS0000033427.V363192.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 DS0000033427.V363192.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bridge House Address 1 Forty Hill Enfield Middlesex EN2 9HT 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) 020 8363 0045 020 8245 4246 ruby.chung@enfield.gov.uk www.enfield.gov.uk London Borough of Enfield Ms Ruby Chung Care Home 39 Category(ies) of Dementia - over 65 years of age (39) registration, with number of places Bridge House DS0000033427.V363192.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th May 2007 Brief Description of the Service: Bridge House is a large purpose-built care home near Forty Hill in Enfield. The home is owned and managed by Enfield Council. The nearest station is Gordon Hill and the amenities of Enfield town are a short bus ride away. The home is registered to provide care for thirty-nine people who are over the age of 65 and have dementia. There is a car park at the front of the building. The home comprises three floors. The first floor is accessed by a lift. There are three lounges, a kitchen and a dining room on the ground floor. There is a safe enclosed garden at the back of the home. A separate respite care unit with a small lounge and dining room is located on the first floor. The entrance to the home is protected by an intercom system and closed circuit television. A coded keypad is used to exit the building for the safety of the residents. The fees for the service are £623 per week. Following Inspecting for Better Lives the provider must make information available about the service, including inspection reports, to people living at Bridge House and other stakeholders. Inspection reports produced by the Commission of Social Care Inspection (CSCI) are available upon request from the registered manager/provider. Bridge House DS0000033427.V363192.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. This inspection took place on 21 May 2008. The home had no prior notice that the inspection would take place. The inspection lasted for seven hours. A further inspection took place on 30 May by a CSCI Pharmacy Inspector due to concerns about the way the home is managing medication. During the inspection, we checked up on the requirements made at the last inspection in May 2007 to see if these had been completed. We spoke with the manager, two senior staff, two relatives of residents, two care staff and a selection of residents. Some of the people living at Bridge House have difficulty speaking for themselves due to their dementia, so periods of time were spent observing them and staff interacting with them, to see what daily life is like for people in the home. A meal time and two medication rounds were observed as well as a period of time in the lounges. The care records for four people living at the home were inspected in detail along with two staff files and a selection of other records, policies and procedures. The manager completed a self-assessment of the home (annual quality assurance assessment) which contributed to the inspection. As well as speaking to a number of residents and the relatives of two residents, we received feedback is from six other relatives of people living at the home in the form of surveys. Their comments and views are included as part of the inspection. At the time of this inspection, there were 32 people living at Bridge House. The home was in the process of reducing the number of places from 39 to 37. There were 27 permanent residents and 5 people staying for respite care. What the service does well: Bridge House offers a good quality of personal care to the residents who have a wide range of needs, a number of whom are very frail. Bridge House DS0000033427.V363192.R01.S.doc Version 5.2 Page 6 Staff are provided with appropriate training and support and their interaction with residents is of an excellent standard. Relatives consider the quality of care to be very good. Those residents who are able to give their views also consider that they are well looked after and happy in the home. Peoples needs are recorded in an individual care plan which they and their family can be involved in writing. Relatives of people living in the home made the following comments; “ I have nothing bad to say,”” the food is beautiful,” the staff at the home do a magnificent job and need to be congratulated,” ” given the resources and funding I think that they do an excellent job and would find it hard to suggest how it could be improved. I am totally confident that my aunt is getting the attention and care that she needs.” These comments reflect the high level of satisfaction that relatives have expressed to CSCI about this home this year. What has improved since the last inspection? What they could do better: Three requirements made at the last inspection have not been fully complied with and have been restated in this report, with a new timescale for compliance. Further information about unmet requirements can be found under the section relating to the standard. Unmet requirements impact upon the welfare and safety of residents. Failure to comply by the revised timescale will lead to the Commission for Social Care Inspection considering enforcement action to secure compliance. Bridge House DS0000033427.V363192.R01.S.doc Version 5.2 Page 7 These requirements were to provide written confirmation that the electrical installation is safe and satisfactory, to provide information regarding residents whose finances are managed by Enfield Council and to improve vetting of staff to ensure they are suitable to work in the home by checking that their references are authentic. Four new requirements have been made as a result of this inspection. These all relate to the recording and management of medication. This is the area where the home needs to make most improvements to ensure the health and safety of residents. The Pharmacist Inspector has also made further recommendations for improvement in the area of medication. The Pharmacist Inspector’s findings are written in bold type in this report. 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 DS0000033427.V363192.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 DS0000033427.V363192.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): 3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Potential residents can feel assured that they will be assessed before moving into the home so that their needs can be identified and met. EVIDENCE: In order to assess these standards, we inspected the assessment records for four residents. These were one new resident, one resident who was at the home on a temporary basis for respite care, one who had had a recent fall and one who was from a minority ethnic group. Examination of these four residents’ files showed that their needs had been fully assessed before they had moved to the home. This also included a form which their families had completed giving information on their needs and preferences. Each resident had an interim care plan giving staff guidance on Bridge House DS0000033427.V363192.R01.S.doc Version 5.2 Page 10 their care needs as soon as they moved into the home. This care plan was updated and amended as the home got to know the residents better and as their needs changed. The written information reflected the residents needs. The home does not provide intermediate care. Respite care is provided within a separate unit in the building for those people who need assistance for a temporary period, for example when their permanent carer is ill or away on holiday. People using this service have a separate lounge and dining room from the permanent residents of the home and are looked after by dedicated staff. Bridge House DS0000033427.V363192.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): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s needs are reflected in comprehensive care plans and the standard of personal care and health care they receive is good. People are treated with dignity and respect. There continues to be insufficient monitoring of medication records and this is of concern as it leaves people at risk of their medication needs not being met. EVIDENCE: To assess these standards we looked at the personal files of four people living at the home. These were a new resident, a person with high dependency care needs, a person from a minority ethnic group and somebody who was at the home for a temporary period. The files had an assessment of their needs and a person-centred care plan advising staff on how to meet their identified needs. The care plans were Bridge House DS0000033427.V363192.R01.S.doc Version 5.2 Page 12 comprehensive. This means that staff have good information about each resident so that they can meet their needs. Cultural, dietary, religious and language needs were recorded where appropriate for that individual. The care plans were all reviewed on a monthly basis. to see if they still reflected the person’s needs. Relatives have the opportunity to be involved in a monthly review of the care plan and to say if changes are needed. Relatives had signed a form stating whether or not they wanted to be involved. This is positive as some residents cannot speak for themselves and to rely on their relatives to tell staff their wishes. Six surveys were completed by relatives of residents and sent to CSCI about Bridge House. All six said the they felt the home always or usually met their relative’s needs. Two said the agency staff were not as dedicated as the permanent staff. One said the care was excellent. We spoke with two relatives in person who also thought the care was good. Three residents were asked for their views and all three said they thought they were looked after very well and that their needs and wishes were catered for. “I have never had any concerns and neither has my aunt.” “These girls are lovely. They look after me so well.” “I am totally confident that my aunt is getting the care and attention that she needs.” One of the home’s GPs also completed a survey and commented that staff were very caring. We looked at a sample of health records and saw that health care appointments have been recorded properly so that staff know what happened at the appointment and what further treatment the resident might need. Appropriate pressure care equipment such as cushions and pressure relief mattresses were in place where identified in the care plan as needed. Pressure care records were made where a resident needs support to prevent a pressure sore developing. This all helps to avoid residents developing pressure sores. The four people had a risk assessment relating to their individual needs addressing risks such as falling. To assess medication standards, the inspector observed part of the breakfast and lunchtime medication rounds, discussed medication with the manager and the worker who was administering medication and inspected a sample of five people’s medication records. Bridge House DS0000033427.V363192.R01.S.doc Version 5.2 Page 13 Staff giving out medication were observed to be giving it to the correct person, observing them take it and signing the medication chart immediately which is safe practice and protects residents. One temazepam tablet was unaccounted for through an audit trail. The tablet was issued from controlled drugs cupboard, not administered according to MAR chart but not accounted for in any records. A requirement was made that the manager investigate this and report the outcome to CSCI which she did shortly after the inspection and had located the tablet. The manager said that she had reminded the management team to be more vigilant in monitoring medication records. One person’s prescribed medication had not been given for four days and we were told that the stock of medication had run out for four days. An example of this was also found at the last inspection. This is a very serious matter and may have put this person at risk. It is the home’s responsibility to ensure they have the prescribed medication in stock to give it to the resident. For another resident staff had stopped giving a medicine every day and the senior said that the GP had changed the dosage two weeks ago to “as and when necessary.” There was no written evidence in the home that the GP had done so. It is important to have authorisation for changing a resident’s medication as proof that staff had understood the GP’s instructions properly. Staff have been informed that they must write the reason why a medicine was not given. Managers monitor medication records in order to check these were completed accurately. However this monitoring did not always find or address where errors had been made in recording. Therefore there was inadequate monitoring of medication records to ensure people were receiving their medication as prescribed. The service manager who inspects the home monthly on behalf of Enfield Council has also identified in her monthly reports that the management team must ensure this is carried out. However this monitoring has failed to improve the problem. On 30 May 2008 at 10:30 I conducted an unannounced pharmacists specialist inspection of the home when I was accompanied by Ruby Chung, the home’s manager. The medicines were stored in an air-conditioned room that also occasionally served as a sewing room. Medicines were administered to residents from two medicines trolleys, one for each of the two floors of the home. Both trolleys were free standing and require tethering to the wall for security when not in use. When the keys to medicines storage were not in use they were hung within the home’s office and Bridge House DS0000033427.V363192.R01.S.doc Version 5.2 Page 14 require improved security to restrict access by either keeping on the person with responsibility for medicines or in a locked key press. A lockable fridge dedicated for medicines storage was available in the medicines storage room. The daily record of the fridge temperatures required the maximum and minimum temperatures to be recorded, in addition to the current temperature, to indicate medicines were kept at the right temperature to maintain the therapeutic effect. When the expiry of medicines is limited by their time in use, the date of first opening is to be entered on the label as indication of the period in use e.g. eyes drops and some creams. Hand-written entries by authorised care staff on the residents’ medicine administration record (MAR) charts required endorsement with the signature/signed initials and date by the person making the entry for accountability. Recording was required on the MAR chart for the receipt of medicines for persons using the service for respite care. All codes entered to indicate the dose omission of medicines are required to be defined with the reason for omission to provide accountability and information on the progress of treatment. Any recording errors on MAR charts must be clearly indicated and not hidden by the application of ink eradicating fluid. Where a dose range is prescribed, for example, painkillers - 1 or 2 tablets, then it is required to indicate the dose given to provide for audit of the medication and to provide feedback on the progress of treatment. When a medicine for external use, such as a cream or ointment, and a duplicated MAR chart are kept in the resident’s room for the convenience of application by trained care staff, reference to recording on a secondary chart is to be made on the primary MAR chart. Any medicines kept in residents’ rooms are to be kept in locked storage. When medicines are carried forward to a new MAR chart the details of quantity, date and signature/signed initials are required for accountability. The use of a cover sheet to precede the MAR chart(s) for each resident is recommended. This sheet should include the resident’s photograph and reference details such as allergies, including an entry if none is known. Although residents’ medicines were prescribed at 4-weekly intervals, the monitored dosage system (MDS) required replenishing weekly. The change to an alternative MDS with 4-weekly replenishing was discussed which should reduce the time given to checking-in medication and allow more time for monitoring the usage. Documentary guidance available from the CSCI and the Pharmaceutical Society was not available in the home but accessed online during the inspection and should prove invaluable as reference for the home’s control of medicines. Bridge House DS0000033427.V363192.R01.S.doc Version 5.2 Page 15 The home’s Controlled Drug (CD) cupboard was used to store medicines other than CDs as well as CDs and did not fully meet with the construction requirements of the Misuse of Drugs Regulations recently required for non-nursing care homes. The design, fixing and provision of a suitable cupboard were discussed. The homes policies & procedures on medication could provide more robust guidance in 6.14, dealing with medication errors by including direction to NHS Direct when unable to contact a resident’s GP. For quick reference to the action to be taken, the section on medication errors should be clearly referenced in the contents of the policies & procedures. To avoid the risk of cross-contamination of blood-borne infections e.g. Hepatitis, the home requires disinfection facilities and a documented procedure that includes granules containing sodium dichloroisocyanurate (Presept or equivalent) to deal effectively with any blood spillage. Further information is available from the Department of Health or from the local PCT. The tables at the end of this report include some of the above issues arising from this inspection by a pharmacist inspector in requirements 1 to 4 and recommendations 1 to 7. We observed some people having breakfast in respite unit and permanent dining room and lunch (two sittings) and observed staff resident interaction in the lounges, office and corridors. We noted that staff addressed people with dignity and respect at all times. Some people were addressed by their first name or a chosen nickname and some as Mr X according to their preferences. We asked two people what they preferred to be called and they confirmed that staff call them by their chosen name. It was noticed that staff explained what they were doing at all times and were caring. Staff supporting people with eating also showed respect and considered their dignity when assisting them. Bridge House DS0000033427.V363192.R01.S.doc Version 5.2 Page 16 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): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home are offered opportunities to take part in activities and to follow their interests. They are provided with food they enjoy and are encouraged to maintain contact with friends and relatives outside the home. They and their relatives are satisfied that that they are well looked after and are happy in the home. EVIDENCE: There has been improvement in the amount and choice of activities offered to residents in the last year. This is due to more effort being made, more guidance given to staff on suitable activities and increased staffing levels to allow staff the time to interact more with residents. This is very positive for residents. Three relatives told us that staff stimulate the residents and offer them activities. There is a list of activities in the staffroom with names of residents who enjoy those activities to guide staff. Activities are planned on a daily basis. We looked at records of activities which had taken place over a Bridge House DS0000033427.V363192.R01.S.doc Version 5.2 Page 17 week before this inspection and saw that these included; reminiscence, reading, use of garden, colouring, sensory room, dominoes, jigsaws and dancing. On the day of this inspection, seven residents were going on a trip to London zoo. This is very positive and residents were looking forward to it. Other trips are planned to Southend, a river cruise and a garden show. Residents’ visitors are encouraged and the eight that we had contact with said that staff were welcoming and helpful to them. Observations of interaction between staff and residents was very positive at all times, staff were friendly, kind and respectful. There is a four week menu in the home. We looked at week four of the menu. This comprised of mainly English food. We asked six residents if they liked the food and observed whether people were enjoying it. The conclusion was that the residents do enjoy the meals. Two people said they didn’t like the food, but on further discussion it was evident that they did not want to eat anything rather than that they did not like the meal. We observed one resident being offered two different snacks as she had rejected both the main meals on offer at lunchtime. Staff were patient and the resident asked for ice-cream which she was given and enjoyed. Staff then planned to give a food supplement drink to this person to ensure adequate nutrition was given to her. Staff showed residents both the meals on offer and allowed them to choose. A new improved dining room has been set up in the respite care unit and this was seen to be a pleasant room with flowers on the tables. The main dining room has also improved and has new furniture and is a more attractive place to eat than before. An alcove in that room has been transformed into a comfortable seating area and we observed one resident choose to go there to eat her dessert in peace. Staff assisting residents with eating did so in a sensitive unrushed manner which met the needs of the individual. We observed residents being asked if they wanted their mashed or pureed food mixed together or kept separately and staff sat down with them individually and talked to them while helping them to eat. All residents were fully involved in choosing their meal and the way they wanted to eat. Bridge House DS0000033427.V363192.R01.S.doc Version 5.2 Page 18 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): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their families feel confident that their concerns are listened to and taken seriously. Residents are protected by staff trained in recognising and reporting abuse. EVIDENCE: The manager reported that staff have attended training in the protection of vulnerable adults so that they know what to do if a resident is abused or makes an allegation of abuse. There have been no safeguarding investigations in the last year regarding any Bridge House resident. The manager demonstrated a good knowledge of the procedures she is required to follow. There had been one complaint in the last year which the outcome had not been recorded. The manager was reminded to ensure the outcome of this complaint is recorded in the complaints file. Six relatives and four residents were asked if they knew how to complain. All either knew how to complain or said they were happy to report any concerns to staff on duty. The majority said they did not have concerns. Two said their concerns were always addressed. One relative of eight who were either seen Bridge House DS0000033427.V363192.R01.S.doc Version 5.2 Page 19 in person on the day or provided written feedback to CSCI, had one concern. It was evident that this person had felt able to voice this concern to staff and all the management team were aware of it. The inspector advised the manager to speak to this person again regarding their concern and saw that they did so. Bridge House DS0000033427.V363192.R01.S.doc Version 5.2 Page 20 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): 19, 20, 26, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable environment which has improved over recent years to meet residents’ needs and is homely and attractive in the communal areas. The home is kept clean and hygienic for the benefit of residents. EVIDENCE: All communal areas were inspected. This included the kitchen, bathrooms, four lounges, two dining rooms, lift, corridors and other seating areas. A sample of bedrooms were also seen. All rooms seen were clean, and decorated to a satisfactory standard so as to provide a homely environment for residents. The lounge and dining room in the first floor respite unit were homely and tidy. The ground floor dining room Bridge House DS0000033427.V363192.R01.S.doc Version 5.2 Page 21 has been redecorated and new furniture provided which has greatly improved the appearance of this room. Small alcoves have been furnished and turned into attractive seating areas where people can sit quietly or in a small group if they prefer this to the main lounges. There are three lounges to choose from depending on whether people prefer company or a peaceful room. Attractive cushions and blankets are provided in all chairs for residents’ comfort. A new bathroom is clean, functional and attractive for residents. There is a safe garden for residents to use. The level of hygiene in the home was very good. All areas seen were cleaned to a high standard. Staff follow infection control procedures and wear protective aprons and gloves when needed. There are suitable laundry facilities for washing residents’ clothes. Bridge House DS0000033427.V363192.R01.S.doc Version 5.2 Page 22 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): 27, 28, 29, 30 This judgement has been made using available evidence including a visit to this service. Quality in this outcome area is good. People living in this home benefit from trained and supervised staff. The recruitment of staff generally protects residents but improved practice regarding staff references would further protect people. EVIDENCE: The home had a number of vacancies and was using agency staff to cover the posts. Three relatives commented that they thought the agency staff were not always as dedicated to the residents as the permanent staff. The manager said that Enfield Council were in the process of recruiting new staff as there were nine vacant posts at the home and that a number of applications had been received. Two of the agency staff on duty were observed during this inspection. Both had worked at the home for a long period of time and were competent and experienced. Both were seen to be treating residents with courtesy and showed that they were aware of individual needs. Bridge House DS0000033427.V363192.R01.S.doc Version 5.2 Page 23 Staffing levels have increased since the last inspection. There are currently eight care staff on duty in the morning, six in the afternoon and evening and three awake at night. There is at least one of the management team in the building twenty-four hours a day. This ensures staff have a manager to ask for advice so that good care practice is maintained at all times. The increased staffing in the mornings has meant that staff are not so rushed and have more time to talk to residents and engage them in activities. Relatives said that staff spend time interacting with residents and stimulating them. The manager also said that residents have benefited from staff having more time to spend with them. From the week after this inspection, there will be eight people in the respite unit and staffing levels will increase to nine staff in the mornings. This is very positive as residents will benefit from closer supervision and a maintained good standard of care. Inspection of the recruitment records relating to a sample of two night staff showed staff have a CRB check, health and identity checks and two references in place before starting work. This is to protect residents from unsuitable people being employed. Both staff files showed Enfield had not received two verified references before employing them. There was no record on one file as to why a last employer reference had not been received nor evidence that the references on file had been verified as authentic as they were not from the actual employer. The other staff member who was more recently employed had a reference from the previous employer but the other reference has not been checked to ensure it was authentic. A requirement is made on this issue as it is essential to be vigilant in order to protect residents. This was identified at the previous inspection. One of these staff had been employed in 2005 but the other was employed within the last year and therefore the requirement made at the last inspection should have been complied with. Information provided about staff training showed that the Council has a commitment to training staff to do the job well. Staff receive the training they need, including training on working with people with dementia and NVQ training. Bridge House DS0000033427.V363192.R01.S.doc Version 5.2 Page 24 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): 31, 33, 35, 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is competent and experienced at running a care home. The home is monitored by the provider, Enfield Council , to ensure a good standard of care is maintained and the home is run in the best interests of residents. Health and safety of residents and staff is promoted. EVIDENCE: The manager of the home was present for this inspection along with another member of the management team who was recently relocated from another home. Both assisted with the inspection throughout the day, along with the Bridge House DS0000033427.V363192.R01.S.doc Version 5.2 Page 25 homes administrator. The service manager from Enfield Council attended the home at the end of the inspection to receive feedback. Two other members of the management team were present at the beginning of the inspection, then went out to accompany residents on a trip to London zoo. The manager, Ruby Chung, has managed this home for a number of years and is suitably qualified and experienced to do so. She is supported by an experienced management team. There is always at least one of the management team on duty to oversee the running of the home and ensure residents are receiving care they need. The manager informed us that she was in the process of completing a summary of a quality assurance audit for the home and would send a copy of this to the CSCI once completed. She reported that questionnaires had been received back from people giving views on the service provided which was in the process of being collated. Residents are also consulted for their views on the service at residents’ meetings and we were informed that a relatives’ meeting is planned for the near future, to obtain the views of relatives on the care provided. The home is inspected in accordance with Regulation 26 of the Care Homes Regulations 2001 each month by a service manager from Enfield Council to ensure that the home is being run properly. Her reports are comprehensive and include interviews with both staff and residents to ask for their views on the home. There is an open approach in the home and all four members of the management team play an active role in caring for the residents as well as supervising staff. Residents’ finances were discussed during the inspection with the home’s administrator and the service manager. The majority of residents have their money managed by family members. We were informed that Enfield Council look after the money of a small number of residents at Bridge House. These arrangements were inspected by looking at a sample of records but it was not clear whether or not the arrangements complied with the Care Homes Regulations and National minimum standards so a requirement is restated to provide CSCI with further information on this issue. This is so we can make sure residents’ money is being managed to their benefit. Health and safety records were inspected and a tour of communal areas was undertaken to look at health and safety matters. A number of people living in this home need a hoist to help them move from wheelchair to armchair, chair to bed,etc. Staff have been trained to use the hoists and the hoists have been serviced regularly. The records of safety inspections for the electrical wiring, gas appliances, hoists, lift, portable electrical appliances, fire alarm and emergency lighting were all checked by the inspector. With the exception of the electrical wiring, all these had been assessed as safe and were not yet due for the next inspection. The electrical wiring inspection certificate stated that the result of the last two inspections were unsatisfactory and remedial work Bridge House DS0000033427.V363192.R01.S.doc Version 5.2 Page 26 was to be carried out. There was no written evidence of another inspection being undertaken to assess the electricity as satisfactory so a requirement was made to do this at the inspection in 2007. During this inspection we spoke with a representative of Enfield Council on this matter who said that the electrical wiring was in a safe condition. The necessity of the home having documentation that the electrical wiring is safe was emphasised and the requirement restated. A tour of the ground floor was carried out and no health and safety hazards were observed. Information provided regarding staff training showed that staff are given the necessary training in food safety, fire safety, infection control and first aid as well as moving and handling people. Bridge House DS0000033427.V363192.R01.S.doc Version 5.2 Page 27 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 X X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 3 3 X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 3 Bridge House DS0000033427.V363192.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? yes 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. 1 Standard OP9 Regulation 13(2) Requirement Medication records are required to be complete and accurate to account for the administration of medicines to users of the service in accordance with prescribed directions. The details of what is required to improve medication records for residents’ safety is written in the health and personal care section of this report. In the interest of security and to meet legal requirements the medicines trolleys require tethering to a fixed point when not in use. Medicines in residents rooms are required to be kept in locked storage. To meet recent change in legislation a Controlled Drugs cupboard meeting the Misuse of Drugs Regulations is required. The registered persons must ensure that all staff are thoroughly vetted before commencing work in the home, this must include confirming that DS0000033427.V363192.R01.S.doc Timescale for action 27/06/08 2 OP9 13(2) 30/06/08 3 OP9 13(2) 30/06/08 4 OP9 13(2) 30/08/08 5 OP29 19(1)(c) schedule 2 30/06/08 Bridge House Version 5.2 Page 29 references are authentic. This is to ensure they are not unsuitable people. This requirement is restated. Previous timescale of 30/06/07 not met. The registered persons must inform the CSCI of how they are meeting national minimum standard 35 and safeguarding residents’ financial interests for those residents whose finances are managed by Enfield council. This requirement is restated. Previous timescale of 30/06/07 not fully met. The registered persons must obtain written confirmation from the company who inspect the home’s electrical installation/appliances that any necessary remedial work has been undertaken and the electrical installation is safe and satisfactory. A copy of this written confirmation must be sent to CSCI. This requirement is restated. Previous timescale of 30/06/07 not met. 6 OP35 20 30/08/08 7 OP38 23 30/07/08 Bridge House DS0000033427.V363192.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP26 Good Practice Recommendations To avoid the risk of cross-contamination of blood-borne infections, disinfection facilities and a documented procedure that includes granules containing sodium dichloroisocyanurate should be provided for dealing effectively with any blood spillage. To limit access to the keys to medicines storage by either keeping them on the person or in a locked facility such as a key-press. To keep a record of the maximum/minimum temperatures available using the medicine fridge thermometer to provide accountability of meeting the medicines licensed storage conditions. To improve the home’s medicines policies & procedures with respect to dealing with medication errors. To make reference to the documentary guidance on medicines provided by the CSCI and the Royal Pharmaceutical Society of GB as an aid to the safe usage and control of medicines. To record the date of first use of medicines where expiry is limited by the period of usage. The use of a cover sheet to precede the MAR chart(s) for each resident is recommended. This sheet should include the resident’s photograph and reference details such as allergies, including an entry if none is known. 2 3 OP9 OP9 4 5 OP9 OP9 6 7 OP9 OP9 Bridge House DS0000033427.V363192.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 © 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 Bridge House DS0000033427.V363192.R01.S.doc Version 5.2 Page 32 - 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!