Inspection on 25/04/05 for Bridge House

This inspection was carried out on 25th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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 21/05/08

Bridge House 08/05/07

Bridge House 22/06/06

Bridge House 26/10/05

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE BRIDGE HOUSE 1 Forty Hill Enfield Middlesex EN2 9HT Lead Inspector Jackie Izzard Unannounced 25 April 2005 @ 9:00 am 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 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 Version 1.10 Page 3 SERVICE INFORMATION Name of service Bridge House Address 1 Forty Hill, Enfield Middlesex EN2 9HT Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 02083630045 Steven Tall of London Borough of Enfield Ruby Chung Care Home 41 Category(ies) of DE(E) registration, with number of places BRIDGE HOUSE Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: Bridge House is registered for up to 41 people over the age of 65 who may have dementia Date of last inspection 1 December 2004 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 forty one people who are over the age of 65 and have dementia. The home has five places which are used for respite care (short breaks). The five people staying for respite care have their own kitchen, lounge and laundry facilities on the first floor. The thirty six people who live in the home as long-term residents use two lounges and a dining room on the ground floor. There are nineteen single bedrooms and eight shared bedrooms. There is a safe enclosed garden at the back of the home. BRIDGE HOUSE Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on 25 April 2005 and lasted seven hours. This was an unannounced inspection, which means that the home did not know that the inspector was coming. The inspector looked around the building, including the garden, looked at records in the office, spoke to the manager and assistant manager and talked to most of the people who live at Bridge House. As many of the people in the home have dementia and were not able to tell the inspector much about the home, the inspector spent time sitting with people and watching how staff looked after them. The inspector also watched staff giving out medication and everybody eating their lunch. At the last inspection of Bridge House on 1 December 2004, twenty two requirements were made. These requirements are things that the manager of the home and Enfield Council must do to meet the standards required of all care homes. The inspector spent a large part of the day checking on these requirements. What the service does well: Staff work hard to look after the people who are living at Bridge House. Staff were seen to be caring, kind and patient. Routines are flexible. People can get up when they choose and breakfast is served throughout the morning rather than at a set time. People are offered choices of meals. An organised activity is offered for one hour each day for those who wish to join in. There is a good monthly programme of entertainment and outings which families can also attend. BRIDGE HOUSE Version 1.10 Page 6 What has improved since the last inspection? What they could do better: Enfield Council and the manager of the home did not complete fourteen of the twenty two requirements made at the last inspection of Bridge House. Three of these do not have to be completed until 1/6/05. It is very important that they now complete all these requirements, which are repeated in the back of this report . The inspector gave six immediate requirements. These are things that have to be done straight away as these immediate requirements all relate to health and safety; such as checking the fridges and freezers are working properly, making sure electrical items are safe and having regular fire drills so that staff know what to do if there is a fire. These are also written in the back of this report. If the home does not complete all these requirements by the date they have been asked to do them, the Commission for Social Care Inspection may take further action against the registered persons (the home manager and Enfield Council). The Commission for Social Care Inspection is very concerned that requirements are being repeated because Enfield Council have not done what they are expected to do, nor given reasonable excuse for not having done so or asked for extra time. They have already been told in the last inspection report that enforcement action may be taken against them if they do not meet requirements, some of which have been repeated to them four or five times before. The inspector spent several hours at the inspection checking up on requirements which had not been complied with. As well as repeating the fourteen requirements that have not been completed, the inspector made a further eleven requirements, making a total of twenty five things that the home must improve. The service manager and manager should check whether there are enough staff on duty to spend time with people on activities or just talking with them as well as taking care of their physical needs (going to toilet, getting dressed, eating meals, etc). The inspector will look more closely at the number of staff on duty at the next inspection. BRIDGE HOUSE Version 1.10 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. BRIDGE HOUSE Version 1.10 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 Standards Statutory Requirements Identified During the Inspection BRIDGE HOUSE Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 4. People living in this home are looked after by staff who have some knowledge of their needs. Their needs are assessed and staff are given training on how to meet their needs. This provides some assurance that people’s care needs will be met. EVIDENCE: Enfield Council provide staff with training on looking after people with dementia and an assessment of each persons needs is carried out before and after they move to the home. The inspector looked at three peoples care plans and saw that they had all had their needs assessed before moving to Bridge House. The home plans to introduce a new care plan format which will better assess peoples needs in all areas of their life. Staff received training in working with people who have dementia and challenging behaviour. In the last year, thirty staff attended this training which is very positive. BRIDGE HOUSE Version 1.10 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 and 9 There has been little progress in meeting previous requirements made to improve care plans. It is difficult to assess whether people’s care and health needs are being fully met due to the insufficient progress made on improving the care records. On the day of this inspection, people were not fully protected by the home’s procedures for dealing with medication, although the recording was generally satisfactory and the manager planned to rectify the errors as soon as possible. EVIDENCE: Requirements were made at the last inspection of the home on 1 December 2004, that peoples needs are recorded on their care plans in more detail, that there is evidence of consultation with people living at the home or their representatives in developing the care plans, that the plans describe how staff will meet peoples needs and support them to achieve their goals and to review the goals on a monthly basis. Only the latter requirement has been met. The home have developed a new format for care plans which is of a very high standard but have yet to introduce it. None of the care plans seen showed any evidence of consultation with the resident or their relatives. BRIDGE HOUSE Version 1.10 Page 11 It is of concern to the CSCI that the requirements about care plans have not been met given that two of them have been restated five times. The inspector advised the manager and service manager from Enfield Council that these requirements must be met. An immediate requirement was issued by the inspector, requiring the manager and Enfield Council to undertake pressure ulcer risk assessments for everybody who is at risk of developing pressure ulcers because of their limited mobility. Again the home had failed to meet the requirement to produce these assessments by the end of March 2005. In practice, the inspector saw some example of good work being carried out to prevent pressure sores, including the use of specialist equipment and regular moving and turning of people who are unable to move themselves during the night. Care plans and the quality of care being offered to individual residents will be looked at in detail at the next inspection of the home once the new care plans have been written. The inspector looked at medication in the home, how it is stored, given to people and recorded. The medication records were generally satisfactory and two requirements made at the last inspection regarding improving medication records have been met. The requirement to monitor the medication fridge temperature could not be assessed as staff had lost the temperature records. This requirement therefore has to be restated in this report. The inspector observed an example of poor practice in giving medicine. A member of staff had placed a small cup with tablets in next to a man who was eating his breakfast. This man did not appear able to take his own tablets and there was also a risk that another person could come and take them. The inspector was reassured by the manager that this practice was not acceptable within the home and that she would be speaking to the member of staff concerned to ensure it did not happen again. None of the people living at Bridge House were able to take responsibility for their own medication at the time of this inspection. BRIDGE HOUSE Version 1.10 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15 People living at Bridge House are offered opportunities to go out to places of interest on a regular basis and take part in activities within the home in order to enrich their social opportunities. Their families are encouraged to visit whenever they wish. They are offered a choice of meals at flexible times. Their opinions on the meals varied so it is recommended that people are regularly consulted for their views on the food cooked for them. EVIDENCE: People living at Bridge House are offered the opportunity to take part in an activity at 4 p.m. each day for one hour. The activities offered are skittles, arts and crafts, games, singalongs, ball games, movies and cooking. Upstairs, the people who are staying at home for respite care also take part in an activity at this time if they want to. Sometimes one or two of the long-term residents joined this group for an activity. The inspector was told that some of the more able people bake cakes or cook a meal with help from a member of staff. This is really positive. This home provides regular outings for people which have included trips to Southend to see the lights and eat fish and chips. The inspector was told that this trip included mince pies and sherry on the coach. People have also been out for meals and to a cabaret, shopping at the Lakeside shopping centre, BRIDGE HOUSE Version 1.10 Page 13 visiting London zoo, a model village and other places of interest. During the summer there are trips out on a monthly basis for which the home hire a minibus and encourage relatives to join in the outings and bring their cars. In the winter outside entertainers are brought in on a monthly basis. Due to the high care needs of people living at Bridge House, staff are very busy helping people with their personal care. During the seven hours of this inspection the inspector noted that staff did not have time to take part in any activities or spend time sitting and talking to people. An activity was planned to take place at 4 p.m. but for the rest of the day most people were sitting in the lounges. During the afternoon the inspector observed that childrens television programmes were on in both lounges. The recommendation is made in this report to review the staffing levels as increased staffing may lead to staff spending more time with the residents, either talking or helping them to take part in some meaningful activity. One resident still attends a social club that he attended before moving to Bridge House which is very positive. Visitors are welcomed in the home and families are encouraged to visit when they want to. The home plans to begin consulting families about their relative’s care plan in the near future which will help them to feel more involved. One family has produced a photographic life story to for their relative and the manager said staff are encouraging other families to do the same. Church services are held in the home for those who wish to attend. Lunch is served in two sittings. The inspector observed both sittings and saw that each service user was offered a choice of two meals. The ways that this home offers a choice of meals is very good, in that each person is shown both meals and they take which plate they prefer. This practice is far better than in expecting people to choose their meal from a menu before the meal time when it is difficult for them to remember what they have chosen. Staff should be commended for this good practice. The inspector saw the food served at breakfast and lunch on the day of this inspection. Breakfast was tinned grapefruit segments or prunes followed by cereals or porridge with tea and coffee. Two residents told the inspector that they enjoyed their breakfast. Lunch was Shepherds pie with frozen mixed vegetables, or cold meats, pickle, mashed potato and frozen mixed vegetables. At the first lunch sitting the cold meat was corned beef and/or spam. At the second sitting, there was a selection of three or four cold meats. Dessert was chocolate pudding with chocolate custard. The inspector spoke with a number of service users to ask them what they thought of their meal and the meals served at the home in general. Those people who were able to make comments said:“ not my choice but quite good”, “never cooked to my liking”, BRIDGE HOUSE Version 1.10 Page 14 “I dont like mash” (three people said this), “ its disgusting”, “I dont like this lunch but usually its not so bad” “its very good”. One person told the inspector that she didnt like the lunch offered today but that she had thoroughly enjoyed a roast dinner which had been cooked on the previous day. Their feedback was passed on to the manager and service manager by the inspector. They agreed to monitor whether people were enjoying the food. The inspector observed that the majority of people did eat their lunch. People did seem to enjoy the chocolate pudding and chocolate custard. The inspector also observed that hot drinks and biscuits were offered in between meals. BRIDGE HOUSE Version 1.10 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Staff have not received adequate training in the protection of vulnerable people from abuse, which needs to take place in order to ensure that residents are properly protected from the risk of abuse. EVIDENCE: There have been no complaints about Bridge House in the last year. One adult protection investigation took place in the last year.This concern has been satisfactorily resolved. A requirement was made at the last inspection that all staff receive adult protection training by 31 March 2005. The adult protection strategy meeting also highlighted that staff needed this training. This requirement has not been met. The manager said that twenty eight staff will be attending a course called Alerters training within the next year. The managers will be attending further training. It is essential although all staff are trained in the awareness and protection of vulnerable adults from abuse. It is important that the manager attends this training as a priority. BRIDGE HOUSE Version 1.10 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 23, 25 and 26 The home is spacious, clean and comfortable for the people who live there and their bedrooms are homely. There appears to be a lack of coordination and planning about maintenance of Bridge House. EVIDENCE: People have a choice of lounges in which to spend their day. There are two lounges on the ground floor plus small sitting areas in an alcove, the dining room and in the front lobby. There is a separate lounge for people staying at the home for respite care on the first floor. The home is spacious and there is a large secure garden which people may spend time in. Staff in the home have tried to make the building as homely as possible. Since the last inspection the entrance hall and ground floor corridor has been redecorated and posters designed for people of this age group are displayed on the walls. Enfield Council have begun work on a third assisted bathroom. The inspector’s tour of the building showed that the home was generally clean and comfortable. BRIDGE HOUSE Version 1.10 Page 17 The inspector looked at a random sample of bedrooms and found all the bedrooms to be clean, personalised with peoples own belongings and comfortable. Some windows do not have window restrictors fitted and a requirement is made that these are fitted to ensure safety of the person in that bedroom. The inspector looked at all toilets and bathrooms in the home. There are two sets of three toilets which should be refurbished. There is a lack of privacy as the walls do not reach the floor and two of the three toilets are not fully wheelchair accessible. Requirements to refurbish the windows, replace corridor carpets, complete an extra assisted bathroom and produce a proper plan for maintenance and renewal are restated in this report. BRIDGE HOUSE Version 1.10 Page 18 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 28 and 30 People are looked after by caring trained staff who understand their needs. Staffing levels need regular review to ensure staff are able to spend quality time with people as well as attending to their physical care needs. EVIDENCE: The inspector spoke informally with some of the staff on duty and observed interactions between staff members and residents of the home. At all times staff were observed to be caring and sensitive to the service users needs. Staff were very busy attending to peoples personal care needs but were cheerful and friendly. The needs of people living at Bridge House change from time to time and at the time of this inspection the majority of residents had high care needs. The inspector saw how busy staff were and how this meant they could not spend time sitting in the lounges talking to people. Staff spent the majority of their day helping people to eat, drink, use the toilet, get dressed and other personal care tasks. This left people without any interaction from staff for periods of time. The inspector also observed that a staff member left a vulnerable person with a cup of tea in her hand which she was unable to put down. She fell asleep and spilled the tea over herself. Fortunately the tea was not too hot but this indicated how busy staff were. The inspector had no criticism to make of the attitude or approach of any of the staff members on duty, who all appeared to be working hard and interacting really positively with the residents. BRIDGE HOUSE Version 1.10 Page 19 Staff training has been planned for the year ahead which is positive. All the assistant managers have received first aid training following requirements made at previous inspections. A requirement has been made at the last inspection of the home that all staff who handle or serve food or snacks receive food hygiene training. This has still not been fully complied with and is repeated in this report. A requirement to provide supervision for staff which meets National Minimum Standards is restated as the supervision provided is not sufficiently regular. It is of concern that an immediate requirement was issued on this in December 2004 but there has been limited improvement since that date. Appraisals are taking place which is positive. The home is progressing well with training staff to NVQ level 2 in care. BRIDGE HOUSE Version 1.10 Page 20 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 The registered persons are not properly promoting the health and safety of residents and staff at this home as some health and safety requirements have not been complied with. Compliance with health and safety requirements needs to be monitored by representatives of Enfield Council to ensure health and safety of staff and residents is better promoted. EVIDENCE: Ten requirements are made at the back of this report to improve health and safety. An immediate requirement was issued to ensure that all cleaning materials are locked away for the safety of the residents. Three chemical cleaning fluids were present in the sluice room which was not locked. An immediate requirement was also issued to monitor the temperatures of the fridge, freezer and medication fridge. At the time of this inspection the fridge and freezer temperatures had not been recorded for over two weeks and the freezer was not working at the correct temperature. The manager acted quickly by organising for the freezer to be serviced on the day of this inspection. BRIDGE HOUSE Version 1.10 Page 21 Another immediate requirement was issued to ensure that all portable electrical appliances are tested for safety as Enfield council have failed to comply with the requirement to ensure this was done by the end of March 2005. There was no record of a fire drill being carried out in home since August 2004 so another immediate requirement was issued to carry out a fire drill and then ensure that fire drills are undertaken quarterly from now on. A requirement made at the last inspection to ensure that fire drills were carried out quarterly has not been acted on. The inspector saw that there had been an inspection of the gas appliances in the home. The inspection highlighted some minor faults but there was no record to confirm that these have been attended to. The manager was not aware that these faults have been identified. A requirement is made for the manager to seek confirmation that there are no concerns about any of the gas appliances in the home. The manager showed the inspector that the garden was safe and secure but said that on occasions people have left the home through two fire exit doors. One of these doors is alarmed and the inspector found that staff responded quickly to the alarm when the door was opened. The other door was not alarmed. A requirement is made to address this to reduce the risk of a confused person leaving the building without staff knowledge. The monthly monitoring reports on the conduct of the home had not identified that health and safety requirements were not being complied with. The service manager was also advised that the content of the reports must comply with Regulation 26 of the Care Homes Regulations 2001. BRIDGE HOUSE Version 1.10 Page 22 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 2 3 2 x 3 x 2 3 STAFFING Standard No Score 27 x 28 3 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 1 x x x x x x 2 BRIDGE HOUSE Version 1.10 Page 23 yes Are there any outstanding requirements from the last inspection? 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 7 Regulation 15(1) Requirement Timescale for action 1/8/05 2. 7 15(1)(2) 3. 7 15 (1) The registered persons must ensure that service users needs are recorded on their care plans accurately and in sufficient detail to ensure that their needs are appropriately met. This requirement is restated. (Timescales of 30/9/04 and 28/2/05 not met.) The registered persons must 1/8/05 ensure that care plan reviews show consultation with service users or their representative where appropriate and that records are maintained of service user decisions and choices. This requirement is restated from the previous five inspections. (Timescale of 28/2/05 not met.) The registered persons must 1/8/05 ensure that in the service users care plan there is a description of how staff will meet their needs and how they will support service users to achieve the stated goals. This requirement is restated from the previous five inspections. (Timescale of 28/2/05 not met). Version 1.10 BRIDGE HOUSE Page 24 4. 7 15 (1) 5. 8 13(4) (c), 14 6. 9 13(2) 7. 18 13(6) 8. 9 13(2) 9. 36 18(2) In order to meet the above requirements, the registered person must ensure that the homes new proposed care plan format is completed for every service user in the home and that these are available for inspection. The registered persons must ensure a pressure ulcer risk assessment is undertaken for all residents who are at risk through their limited mobility of developing a pressure sore.This requirement is restated. (Timescale of 31/3/05 not met). This is an immediate requirement. The registered persons must ensure that the temperature of the medication fridge is monitored and recorded daily and the temperature is maintained between 2 and 8 C. This requirement is restated. This is an immediate requirement. (Timescale of 31/3/05 not met). The registered persons must ensure that all staff working in the home receive adult protection training. This requirement is restated. (Timescale of 31/3/05 not met). The registered persons must ensure that staff adhere to the homes correct procedures for giving and recording medication at all times. The registered persons must ensure that all staff working in the home receive regular supervision which meets National Minimum Standards and that records are placed in their staff files. This requirement is restated from previous inspections. Version 1.10 1/8/05 25/5/05 2/5/05 and from then on 1/8/05 30/5/05 and from then on 31/8/05 BRIDGE HOUSE Page 25 10. 19 23(2) (b) (d) 11. 19 23(2) (b) (d) 13(4) (c) 12. 19 23(2) (d) 13. 21 23(2) (j) (n) 14. 38 13(4) (c) (Timescale of 31/12/04 not met). The registered persons must ensure that the homes maintenance and renewal plan contains dates and timescales of work to be undertaken. This requirement is restated. (Timescale of 28/2/05 not met) . A copy of this plan must be sent to the home and to the CSCI. The registered persons must carry out extensive refurbishment to the windows including the repair/replacement of the timber window surrounds and repainting the frames. This requirement is restated from previous inspections. Timescale of 1/6/05 not yet reached. This was an immediate requirement at the previous inspection. The registered persons must ensure that the carpets in the ground and first floor hallways are replaced. This requirement is restated. (Timescale of 1/6/05 not yet reached). The registered persons must complete one additional assisted bathroom. This requirement is restated from previous inspections. The work has begun and the timescale of 1/6/05 has not yet been reached). The registered persons must obtain documentation confirming whether tests for legionella have been carried out and the current assessed level of risk. This requirement is restated as current documentation is out of date. (Timescale of 31/3/05 not met). Version 1.10 1/7/05 1/6/05 1/6/05 1/6/05 1/7/05 BRIDGE HOUSE Page 26 15. 38 18(1) (c) 13(4) (c) 16. 38 13(4) (a) (c) 23(4)(c) (iii) 17. 38 13(4)(c) 18. 38 13(2)(4) (c) 19. 38 13(4)(c) 20. 38 13(4)(a) 21. 38 13(4) (a) The registered person must ensure that all staff who handle, prepare or serve food or snacks, receive food hygiene training and a record of this training is placed on the staff file. This requirement is restated from the previous five inspections. (Timescale of 31/3/05 not met). The registered persons must ensure that a fire drill is carried out by 28/4/05 and at least quarterly from then on, with a record kept. This requirement is restated. (Timescale of 31/3/05 not met). This Is an Immediate Requirement. The registered persons must ensure that all electrical appliances have been tested for safety and a copy of the certificate sent to the CSCI by 9/5/05. This requirement is restated. (Timescale of 31/3/05 not met). This Is an Immediate Requirement. The registered persons must ensure a daily monitoring of the temperature of food fridges, medication fridge and freezer are recorded. This Is an Immediate Requirement. The registered person must arrange a service of the homes freezer. This Is an Immediate Requirement. The registered persons must ensure that all cleaning materials are locked away at all times. This Is an Immediate Requirement. The registered persons must ensure that window restrictors Version 1.10 1/9/05 28/4/05 9/5/05 2/5/05 and from then on 2/5/05 25/4/05 and from then on 1/7/05 Page 27 BRIDGE HOUSE 22. 38 13(4)c) 13 (3) 16 23. 21 24. 38 13 25. 33 26 are fitted on all windows which do not have them to prevent anybody climbing in or out. The registered persons must ensure that soap, nailbrush and hand towels are available in the kitchen at all times. The registered persons must review the current toilet facilities in the home and plan any refurbishment of the toilets if this is considered necessary to meet peoples needs. The CSCI must be informed of the outcome of this review The registered person must ensure that action is taken to reduce the risk of confused people leaving the home undetected. The registered person must ensure that the monthly inspections of the home by Enfield Council fully comply with regulation 26 of the care homes regulations 2001, including being unannounced, and the resulting reports sent to the CSCI every month. 1/5/05 and from then on 1/9/05 30/6/05 1/6/05 and from then on 26. 27. 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 12 Good Practice Recommendations It is recommended that more suitable activities for service users with dementia, such as the life history and reminiscence, be included in the programme of activities. This recommendation is restated from the last inspection. 2. 3. BRIDGE HOUSE Version 1.10 Page 28 4. BRIDGE HOUSE Version 1.10 Page 29 Commission for Social Care Inspection North London Area Office Solar House, 1st Floor 282 Chase Road, Southgate London N14 6HA National Enquiry Line: 0845 015 0120 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 Version 1.10 Page 30 - 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. 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