Inspection on 24/11/08 for Bridge House

This inspection was carried out on 24th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bridge House 10/01/07

Bridge House 12/01/06

Bridge House 20/06/05

Bridge House 19/01/05

Bridge House 21/06/04

Bridge House 24/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Bridge House Manorside, Market Street Flookburgh Grange over Sands Cumbria LA11 7JS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Marian Whittam     Date: 2 4 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. Copies of the National Minimum Standards – Care Homes for Older People 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Bridge House Manorside, Market Street Flookburgh Grange over Sands Cumbria LA11 7JS 01539558622 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Tony.lyons@cumbriacc.gov.uk Cumbria Care Name of registered manager (if applicable) Mr Anthony Lyons Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The home is registered for a maximum of 39 service users to include: up to 39 service users in the categoey 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) Date of last inspection Brief description of the care home 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 residents bedrooms. There is a passenger lift making all three Care Homes for Older People Page 4 of 32 care home 39 Over 65 10 39 0 0 Brief description of the care home 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. 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. Care Homes for Older People Page 5 of 32 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This site visit to Bridge House forms part of a key inspection. It took place on 24th November 2008 and we (The Commission for Social Care Inspection, CSCI) were in the home for 8 hours. Information about the service was gathered in different ways for the inspection. An Annual Quality Assurance Assessment (AQAA) was completed by the homes relief manager and returned to us before the visit took place. The AQAA is a self assessment that is completed annually by all providers of registered services and is one of the ways the provider tells us how they believe they are meeting outcomes for people using their service. We looked at the service history and any calls or visits we have made to the home and how the manager has dealt with any complaints and safeguarding issues in Care Homes for Older People Page 6 of 32 the last 12 months. Surveys were sent out by us to people living in the home and to staff working there to get their views and experiences of the home. We spent time with people living in the home, observing daily routines and spoke to them about living there. We also spoke with care and supervisory staff and the relief manager. We looked at care planning records and assessments to see if the level of care provided was meeting the assessed needs and preferences of the people living there. We made a tour of the building to look at the facilities and equipment available for people and the general standards of cleanliness and safety. We looked at staff training and personnel records and a selection of the records needed by a registered service. We also assessed the handling of medication through inspecting the relevant records, storage facilities and meeting with the relief manager, residents and staff. What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 32 We made one requirement at this visit to Bridge House. We found that not all of the medicines that were coming into the home for people living there were being checked and this recorded to ensure the medicines and quantities received were correct. Staff checking medicines into the home did record the quantities of some medication but this was not being done consistently to make sure the right tablets and amounts people needed were accepted for administration. From the homes records anyone should be able to see exactly what the service has done and account for all medicines that they have managed for someone living there from when they came into the home to the amounts disposed of. This is called an audit trail. The homes own policies and procedures require that staff check amounts of a medication received and we recommended that the manager did a regular formal medication audit against procedures to ensure all staff were following them. Generally the home was clean and tidy but we found that in an area used for sluicing and cleaning items used in the home some items of linen and staff uniforms and outdoor clothing were being stored. This could be a source of potential cross infection and the clean items should not be stored alongside potential sources of infection. We found that there were several people living in the home with levels of need and dependency that needed the assistance of 2 carers to meet those needs safely and promote independence. However, staff are not always being allocated to units on the basis of individuals needs and levels of dependency and this could limit their choices in daily routines and safety if there are not enough staff available to help them when needed. We strongly recommended to the relief manager that they regularly and frequently monitor the levels of residents dependency to make sure the ratio of carers to residents is always based on meeting individual s needs and lifestyle choices at all times of the day and night. The home has a relief manager running the service at present and ,although the evidence suggests they are running the service well within the resources available to them, this situation needs to have a permanent solution as it was only ever presented as being temporary. The lack of a permanent registered manager and uncertainty over this could affect the service development and focus in the long term the interests of the people living there. The service does have systems to monitor quality and meeting its objectives including satisfaction surveys from people using the service and families. We recommended that when these surveys have been done and collated that the service make them available to all interested parties so the opinions are made known and people who took part get feedback on what is being done as a result. We also recommended that the manager review how care staff are supervised as part of the normal management process on a continuous to make sure that staff get the support they need to put training and procedures into practice and so staff feel listened to and raise their morale. 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get Care Homes for Older People Page 9 of 32 printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 32 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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. There are admission and assessment procedures in place to help ensure that the care needs of people can be met when they come to live in the home. Evidence: The service has a Statement of Purpose and service user guide and these are kept in the foyer with the signing in book for visitors. Since the last inspection these documents have been made available in large print as well. A copy of the last inspection and annual service review is also available for people to look at if they wish. People we spoke with during the visit,and their returned surveys, indicated that people felt they had information about the service before coming there to live. The service offers some respite accommodation and people may be introduced to the service using this. One person told us they had originally Just come in for a break , but then decided to stay. The person told us that they were Glad I came in, Im absolutely sure I made the right decision. Prospective residents and their families may visit the home Care Homes for Older People Page 12 of 32 Evidence: and look around if they want to. We looked at the pre admission assessments of four people in detail to see if their individual needs had been assessed before admission to help ensure that the home would be able to met their needs when they came in. The records on file indicated that the manager or senior staff do an assessment before people come to live there. The information was in sufficient detail and covered relevant areas of assessment to begin developing a plan of care with someone. There were also social services care management plans from assessing social workers on file for these people. The service develops its initial care plans from this information before and at admission and also has an introductory period followed by a review with the individual to help make sure they are satisfied and that the service is meeting their needs. We saw that residents files contained copies of terms and condition of residence and the homes contracts with the purchasing agencies. The terms and conditions outlined peoples rights and responsibilities. The service does not provide intermediate care. Care Homes for Older People Page 13 of 32 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are being met by staff that respect their privacy and dignity. Evidence: The service has individual care plans for people living there based on initial needs assessments and risk assessments. The plans set out assessed health, personal and social care needs and have been reviewed and updated where needed. Supervisory staff have been transferring care plans onto a new more person centered care planning system that should help staff to work with people in a way that focuses more on the individuals perspective and expectations. This is being achieved in a planned way so that other areas of care do not slip during the transition. The new care plans have a section called all about me and this gave information on what people wanted and how they preferred to be cared for. In this some people had chosen not to take part in the work being done on developing life stories and their wishes were being respected. Referrals to doctors and other health care and specialised services are good and Care Homes for Older People Page 14 of 32 Evidence: records are kept of what is to be done. This was evident for one person with particular needs and visits and management advice from the speech and language therapist was incorporated into written guidance for staff. We asked people living there about their care and the support they received from staff. People we talked with made positive comments about their care, including, I am happy with things as they are and Staff do as I ask, I am content, I have no worries. One new resident told us The staff are very kind, I get on well with them and I am getting used to living here now. From what we saw of positive staff interaction during the day and what people told us about living there the indication is that people feel generally well cared for and supported by staff. We looked at four peoples care plans in detail and found their plans covered information for staff on moving and handling needs, skin condition, mobility, nutrition, personal care, continence, communication and information on specific conditions and needs. Appropriate equipment to prevent pressure sores is in use and effective nutritional screening with weights recorded and monitored. We examined medication policies and procedures, the storage, recording and handling of medicines kept for people in the home. We found that not all the medicines coming into the home for people had the quantities of the medicines being received checked and recorded on the Medication Administration Record (MAR) or elsewhere. The service had recorded the quantities of some medicines coming into the home but this was not done consistently. As a result for a number of medicines there was not a clear audit trail to follow to account for medicines from entry to the home until disposed of. It is important to check and agree the quantities of each medicine that the service keeps and manages for people. Medicines received from whatever source much be verified as correct as to quantity, what they are and when received and any errors dealt with quickly. The manager should make sure they do regular formal medication audits to monitor that staff are consistently following procedures. We found that storage of medication was safe including that for controlled drugs. Staff have been given training on medication and there is a system in place for 2 people to check at medicine administration to try to minimise the risk of error. We found that the handling of high risk medication for thinning the blood was satisfactory to promote residents safety. As an additional safeguard we recommended that where changes have been made to dosages by hand then this should be checked and verified as correct by another person. This double check helps identify any mistakes in writing the new dosage. The home observed good practice in the use of protocols for medicines taken as required that stated the reasons for use, the administration procedure and maximum Care Homes for Older People Page 15 of 32 Evidence: doses people could have. Care Homes for Older People Page 16 of 32 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. 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 service provides some organised activities and people living there are supported to make choices in their their daily lives. Evidence: Individuals care plans recorded peoples social and recreational interests and preferences so staff had information about peoples interests and what had meaning for them. The All about Me section of the new care plans gave useful information on peoples lives and backgrounds and what they considered important. This information is useful in supporting people in making choices in their daily lives and in achieving what mattered to them. The home does not have its own activities coordinator and care staff organise and oversee activities and support people, where staff resources allow, to follow their interests. Staff have been doing some work on helping people with life stories. Some people had decided they did not want to participate in this work and their decision was respected. The service has an activities programme in place and this is in the Statement of purpose/service users guide. Board games, dominoes and cards are available for people to play and exercise sessions as well as newer ideas such as Tai Care Homes for Older People Page 17 of 32 Evidence: Chi and hand massage. These new activities have been introduced to try and improve the range of recreational opportunities. The hairdresser visits regularly and their are regular visits from the local churches and peoples own ministers if wanted. Some people said they had attended the day centre attached to the home and one said they knew about activities but they are not for me. Any additional planned events such as musical entertainments, any trips and the planned Christmas Fair are advertised in the home. Satisfaction surveys done by the home and by us indicated that people would like more trips out. We spoke with several people in their bedrooms and they had televisions and some had DVD players and musical equipment so they could play and listen to what they wanted. One person said they used the garden quite a bit,when the weather allowed, and other residents were seen going out for walks around the area near the home and in the village. Others had their books and puzzles and one person told us I am quite content watching my own television and seeing my visitors. The home encourages relatives and friends to visit and people said there was no restriction on this or if they wanted to go out with them. On the day of the visit the regular cook was off and there was an cook from an agency doing the cooking. We looked at the menus of food offered to people and spent time with people on the Sandgate (EMI) unit at lunchtime. One person having their lunch gave us a thumbs up sign and said very good, referring to their meal. The menus offer a choice at each meal and the mealtime was relaxed and the 2 care staff on duty supported those people who needed prompting with their meal or assistance with eating it in a friendly and discreet way. Meals are one of the items often discussed at the residents meetings as well as activities. One person on another unit told us that the food varies, sometimes very good, sometimes not so good and others that it was generally good and there was always a choice. Resident surveys supported that usually they enjoyed the food. The service received 4 stars at its inspection by The Environmental Health Department. Care Homes for Older People Page 18 of 32 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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. People using the service were protected by the complaints and safeguarding procedures, which were understood by staff. Evidence: The home has a complaints procedure and a system for logging and responding to complaints made. The procedure is in the homes Statement of Purpose and service user guide and can be made available in large print if needed and is available on audio tapes if requested. Records indicated that the home has received three complaints in the last year and all of these were resolved within the 28 days stated in the procedure. People we spoke to knew who to talk to if they were unhappy or wanted to make a complaint. One person told us that, So far I have nothing to complain about but I know how to. I think if I ask they will help. Another person told us that the manager walks round to say hello most days and they could talk with them about anything that bothered them. Staff we spoke with knew about safeguarding procedures and what to do if they suspected abuse or bad practice. There are policies and procedures in place to protect vulnerable people from abuse and whistle blowing procedures for staff to report any suspicions or bad practice. There are also policies and procedures on gifts to staff and handling peoples monies to Care Homes for Older People Page 19 of 32 Evidence: safeguard their interests. The service uses the local authority multi agency guidance on safeguarding and staff receive training on safeguarding in the home, during induction and cover this topic in their NVQ course. Care staff have also had training on maintaining peoples dignity and respecting the individuals beliefs and faiths. The service has made 2 referrals to social services under Safeguarding procedures to protect the interests of people who use the service. These were reported promptly by the manager and investigated by the appropriate agencies to promote peoples safety and interests. The home does not manage any residents finances but holds small amounts of spending money on their behalf. Residents are supported to maintain control over their own finances where possible or with the help and support of family and representatives. All the homes financial processes are audited annually by the Local Authority. Care Homes for Older People Page 20 of 32 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, 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. 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 home is generally clean and homely and is being maintained to promote safety and independence. Evidence: Overall Bridge House is decorated and maintained to a consistently good standard. An annual survey of the premises is done and any work identified as required is planned and budgeted for. Outside the garden areas were tidy and are being maintained under service contracts. Over the last 12 months a number bedrooms have been refurbished, items of furniture have been replaced and also some carpets and soft furnishings. Residents we spoke to were pleased with the improvements to their rooms and agreed that generally the home was kept clean and fresh. We found lingering odours in one area only, as we made a tour of the premises and checked bathrooms, toilets and communal areas. The reason for this was known to the manager and is being addressed. There are suitable bathrooms with assisted bathing aids, showers and toilets on each floor so people have easy access. There is a passenger lift so people can move around easily and hand rails in corridors help people with mobility problems. Moving and handling equipment is provided and this has been serviced to ensure it is in good working order. Care Homes for Older People Page 21 of 32 Evidence: The different units each have a lounge and dining area that are well decorated and suitably furnished and there are some quiet areas where people can sit as well. We saw that there were call bells in the areas used by residents so they could call for assistance if they wanted or needed it. One person told us If I need help I ring my bell and staff come quickly but I like to be independent if I can. Some people were happy to show us their bedrooms and we spoke with some people in their own rooms. We saw that many people had chosen to bring in their own personal things, photographs and items of importance to them to make their rooms more personal and homely. Bedrooms were warm and suitably furnished and lit for peoples comfort. The home has policies and procedures in place for infection control. Staff are given training on infection control and a training session was booked for this in December to update staff. We saw that there were gloves and aprons provided for staff and these were seen being used by staff providing personal care. The home has a satisfactory laundry on site and care staff attend to laundry. There are small sluice facilities with a hand held spray for cleaning. Some linen was stored in this area and staff uniforms and their outdoor clothing hung in there. Infection could be transferred between dirty and clean items when stored in such an environment and to promote good infection control the manager should make sure that such things are not kept where contaminated items are being cleaned or waste kept. Care Homes for Older People Page 22 of 32 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment and training help ensure that people are cared for and supported but staffing deployment needs to reflect individuals needs and levels of dependency to ensure a person centered approach to care in practice. Evidence: We looked at staff rotas and spoke with residents and staff about staffing levels in the home. The rotas indicate that usually the home has sufficient supervisory and care staff to make sure peoples personal needs can be met. Looking at rotas, observing staffing during the day and speaking to people living and working in the home it was clear that staff are running at capacity with no room for sudden sickness or holiday cover. The manager and supervisors spend a lot of time trying to make sure there is adequate staff cover to meet peoples personal care needs. This has resulted in having to use agency staff on many occasions over the last 3 months and permanent staff doing extra duties. The rotas also indicate that there are, at times of the day, periods when there may be only 1 carer on a unit due to staff starting and finishing work at different times. Care plans and the information provided by the service indicate that there are several people living there who need 2 carers for safe moving and handling and over half the people need help with dressing and going to the bathroom. This indicated a level of Care Homes for Older People Page 23 of 32 Evidence: dependency not always being reflected in staff levels across all times of the day. Given this and the layout of the home there are times when staff work alone and units are left unattended whilst staff assist other colleagues or in the periods before the next staff member comes on shift. This could result in people having their choices limited in daily life, not always getting prompt assistance to meet their needs and preferences and also affect their welfare if there are not enough people to carry out aspects of care needing 2 carers. This needs to be reviewed by the manager addressed to minimise any potential risks. From observation and speaking with residents and staff it was clear that staff work hard to make sure peoples needs are met and support each other and that the manager and supervisors make best use of the staff resources available to them to try and maintain outcomes that are acceptable to residents. The service does however need to look at the ratio of carers to residents according to their needs, preferred routines and levels of dependency rather than what staff resources are made available to them. This would also uphold the person centered approach to care they have been working on in the care plans and provide consistent staff levels. This would help make sure that individualised care can be put into effective practice focusing on people living there as individuals not focusing as much on the tasks to be done and what staff are available at different times of the day. We strongly recommended that the manager monitor levels of dependency frequently and adjusts staffing levels on day and night duty in accordance with individuals needs, expectations, preferred routines and welfare. People we spoke to were, overall, satisfied with the care they received. and appreciated the efforts staff made on their behalf. One person told us that Its wonderful, staff are around when I want them and do as I ask. Another new resident told us, The carers are nice and staff have been very kind. This person praised the staff for their kindness when they suffered a recent bereavement. We looked at staff personnel and training records and spoke with staff about their training and recruitment experiences. Records indicated that the service followed robust and effective recruitment procedures to safeguard people living there and made all required checks. Individual records of training are kept in staff professional development files and the service has a programme of training staff need. Staff told us about their 5 day induction before they started work and records show NVQ Level 2 training is well established and supported and over half the staff have already done this training. Care Homes for Older People Page 24 of 32 Care Homes for Older People Page 25 of 32 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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. Bridge House is being well run by the relief manager in the best interests and safety of the people who live there but the lack of the permanent registered manager may have a negative effect on the development of the service for the people living there in the long term. Evidence: The home has regular staff and residents meetings and monitors its performance using satisfaction surveys, internal and external audits including financial audits and audits of policies and procedures. There is an overall organisational development plan that the service is part of with its own annual objectives to achieve. The homes satisfaction surveys, done in October this year, indicated a good level of satisfaction amongst people using the service and their families with several positive comments. Areas that people wanted improving were being addressed as quickly as resources allowed. We recommended that the survey results be collated so those Care Homes for Older People Page 26 of 32 Evidence: taking part and prospective users of the service, could see the results and what was being done as a result. People living there told us that they see the relief manager often so can speak to her about anything that concerns them. There was a supervisors meeting taking place during the visit and we attended for some of the meeting. The relief manager and supervisors discussed issues with staffing, cleaning, care planning and staff morale with a view to addressing these where they could. A full staff meeting was due later in the week. Staff comments to us and in surveys and speaking with staff and residents indicated that care staff tried to work together as a care team and help each other but that sometimes they were thrown in the deep end and did have to work alone at times. These and other comments in surveys and in conversation about supervisory support and communication suggested to us that the manager should look at how staff are being supervised and supported as part of the normal management process on a continuous basis not just at formal supervision sessions. To consider how on a daily basis staff are being appropriately supervised, supported and enabled to put training and procedures into practice to give the best care they can. This would help improve staff involvement and morale so they feel valued by the service and also ensure that staff can put their training and induction into practice. The homes registered manager is presently on sick leave and a relief manager from another home has been covering the post on a part time basis since March. This was to be a temporary interim arrangement but a permanent solution has not been put in place after 8 months. We spoke with staff as we went around the home who told us that not having their registered manager was having an effect upon staff although the relief was doing a good job. We strongly recommended that a permanent solution be found to the long term absence of the registered manager so there was management continuity and accountability for people using the service. The standard of record keeping was satisfactory overall and showed that staff were receiving regular formal supervision, which the staff we talked to also confirmed was the case. Financial records are kept and the service has systems in place to protect peoples money. Transactions are receipted and the service does not act on anyones behalf financially. The home has adequate insurance cover in place. Records indicated that the home has systems, training and practices to promote the welfare and safety of people living there. Records show that the testing and servicing of equipment including emergency equipment is being done as required and that staff have been given fire training. Care Homes for Older People Page 27 of 32 Care Homes for Older People Page 28 of 32 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 Older People Page 29 of 32 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 1 9 13 On receipt of peoples 30/12/2008 medicines the service must check , verify and record the medication and quantity received is correct, and the date received. This will ensure an audit trail can be followed so all medication managed for residents can be accounted for. 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 1 9 As an additional good practice safeguard we recommend that where staff alter medications or dosages by hand on medication charts this is checked and verified correct by a second person to minimise the risk of any errors. The manager should carry out and record regular formal audits of the medication systems to monitor for quality and compliance with the services procedures. Linen, clothing and uniforms should be removed from the sluice room where contaminated items are cleaned to Page 30 of 32 2 9 3 26 Care Homes for Older People promote good infection control and reduce the risk of transferring infection in such an environment. 4 27 The manager should be regularly, and frequently, monitoring levels of resident dependency on day and night duty and individual care needs and making sure that the ratios of care staff to residents is based on meeting individuals assessed needs and dependency as they change at all times during the day and night. A permanent solution should be found to the need to having a relief manager from another home running the home during the registered managers protracted absence. The lack of consistent management can have a negative effect on service development and staff morale. The results of resident and relatives surveys should be collated and available to current and prospective users of the service so they can see the opinions expressed and what actions are taken if changes are needed. The relief manager should review how care staff are supervised as part of the normal management process on a continuous basis to ensure that staff are supported and enabled to put into practice their induction, training and the homes procedures for residents benefit and feel valued and listened to by the organisation. 5 31 6 33 7 36 Care Homes for Older People Page 31 of 32 Helpline: 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 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 32 of 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!