Inspection on 25/02/09 for Bridge House

This inspection was carried out on 25th February 2009.

CSCI found this care home to be providing an Poor 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 03/09/08

Bridge House 09/10/07

Bridge House 11/07/06

Bridge House 28/11/05

Bridge House 04/07/05

Bridge House 13/10/04

Bridge House 05/05/04

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 19/06/2009.

CARE HOMES FOR OLDER PEOPLE Bridge House Topping Fold Road Bury Lancs BL9 7NQ Lead Inspector Lucy Burgess Unannounced Inspection 25th February 2009 09:30 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 DS0000008412.V374483.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 DS0000008412.V374483.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bridge House Address Topping Fold Road Bury Lancs BL9 7NQ 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) 0161 764 1736 0161 797 5045 bh1europeancare@aol.com www.europeancare.net European Care (UK) Limited Post Vacant Care Home 34 Category(ies) of Dementia (10), Old age, not falling within any registration, with number other category (34) of places Bridge House DS0000008412.V374483.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care home only - Code PC, to service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE (The maximum number of places: 10) The maximum number of people who can be accommodated is: 34 Date of last inspection 3rd September 2008 Brief Description of the Service: Bridge House is owned by European Care (UK) Ltd. The home is registered to provide care and accommodation for up to 34 older people. The range of fees are from £368.89 to £481.57. This is dependent on funding arrangements and room preferences i.e. larger rooms with en-suite facilities. Bridge House is an attractive detached house situated in a residential area approximately 1 mile from Bury. The majority of bedrooms are on the ground floor. There are twenty-eight single bedrooms and three doubles. Twenty of the single rooms are en suite. There are well-maintained spacious gardens, which are easily accessible to the residents and visitors. There is also ample space for car parking. In addition to care staff, the home also employs cooks, kitchen assistants, domestic staff, a maintenance worker and an administrator. Bridge House DS0000008412.V374483.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 0 star. This means the people who use this service experience poor quality outcomes. This was the second key inspection for the service carried out by 3 inspectors, one being a pharmacy inspector. The inspection included a site visit and took place over one day, for a period of 12 hours. The service did not know that the inspectors were going to visit. During the visit care and medication records were looked at as well as information about the staff and health and safety including how the home and equipment were kept safe. We also looked around the building. A full review of the medication was carried out. Time was also spent talking with residents and visitors as well as observing staff practice. Comments have been added to the report. As part of the inspection process the provider’s are asked to complete an annual self-assessment survey information document called an Annual Quality Assurance Assessment (AQAA). This was provided following the last inspection and has been used to inform this report. Following the last key inspection in September 2008 we held a management review due to a number of concerns that were identified. A meeting was also held with the Providers to discuss the improvements needed. A random inspection was carried out in November 2008 to explore what progress had been made. Reviews have also been undertaken by the local authority. At present the authority is not making placements at the home due to concerns about the standard of care provided. Issues identified are being monitored in line with the local authority safeguarding procedure. During this visit we again found that a number of areas where requirements had been made remained outstanding. These potentially leave residents at risk. Due to this we will continue to hold management reviews and consider what further action we need to take as part of our enforcement process. Discussion and feedback was held with the acting manager and programme manager. Bridge House DS0000008412.V374483.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? There have been a number of issues brought to the attention of the management team within the home. Procedure had been followed with issues being referred to the local authority in line with their safeguarding procedure. Suitable arrangements are in place with regards to staff training. The home is part of the local training partnership and has been accessing courses available. Further in-house training has also been provided. The manager is making arrangements for on-going training to be provided throughout the coming year. Staff recruitment files were found to be in order. All relevant checks and information was in place ensuring practice was safe and staff are suitable for work. Supervision sessions have also commenced. The acting manager is aware of the standard in this area and is making arrangements to meet with staff on a regular basis offering the relevant support and guidance. Information about the needs of people had been reviewed and details expanded upon offering further guidance for staff about how to meet the individual needs of residents. The acting manager and programme manager both felt that changes within the team have improved staff morale and that the team were keen to make the improvements needed. Information in line with regulation about the well-being of residents is being provided ensuring we are kept informed of events within the home. Bridge House DS0000008412.V374483.R01.S.doc Version 5.2 Page 7 What they could do better: 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 DS0000008412.V374483.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 DS0000008412.V374483.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): 1 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Placements are not currently being made at the home due to concerns about the standard of care provided in meeting resident’s needs safely. EVIDENCE: Following concerns raised about the management and conduct of the home we carried out a random inspection in August 2008. Further issues were again found at the key inspection in September 2008. These issues were referred to the local authority in line with the safeguarding procedure. Following an initial strategy meeting the local authority made the decision to suspend placements at the home until such time they were satisfied that people would receive a good standard of care and were kept safe. Bridge House DS0000008412.V374483.R01.S.doc Version 5.2 Page 10 Due to this no new people have moved into the home and therefore we were unable to review the assessment information gathered prior to people coming to live at the home. Following our last visit the providers sent us an improvement plan, which detailed the process of assessment the service was to follow when assessing prospective new residents. Through discussion with the acting manager and programme manager they were able to explain the process they would follow and an audit system would be implemented to ensure that all relevant information was in place. This would ensure that only those people whose needs can be met would be admitted to the home. Standard 6 is not applicable to this service, as they do not provide intermediate care services. Bridge House DS0000008412.V374483.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 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents are at risk due to poor medication practice and the lack of some information and guidance for staff ensuring people are cared for properly. EVIDENCE: Care plans were looked at for people where specific needs had been identified. Information examined included the care plans, risk assessments, professional visits, weight records and daily records. We looked at the care plan for one of the residents who had a lot of care needs. We saw that it had been previously identified that this resident had a pressure sore on both heels and elsewhere on the body. We asked the staff if these pressure sores were still present and we were told that they were. We saw however that there was no evidence of a care plan for two of the pressure sores. There was no evidence to show if there had been an improvement or otherwise and no evidence to show how they were being cared for. Bridge House DS0000008412.V374483.R01.S.doc Version 5.2 Page 12 Several of this resident’s care documents were neither signed nor dated by the staff. It is important to date documents so that a clear record is in place showing the condition of the resident at any specific time. Over a period of two months this resident had also lost a lot of weight. The district nurses who were involved in this resident’s care informed the staff that they needed to record daily what the resident ate and drank. There was no evidence to show that this had been done. This resident was referred to a dietician who advised the prescription of supplement drinks and fortnightly weighing. There was no care plan in place in relation to this advice. The second file looked at showed that the person had a good diet and was able to manage alone when eating, however whilst observing this person during lunch we found that they did not have a good appetite and required assistance to cut up their food as well as encouragement when eating. Information about the resident’s weight and diet showed the resident was underweight however this had not been reflected on the nutritional assessment. Further details about this resident’s mobility and continence care were also conflicting. In some parts of the plan the resident was described as needing to use a zimmer frame to move around the home whilst another record stated that they forget to use it or abandon it. During our observation of this person no aids were used and at times they were seen to be wandering. This has resulted in two falls over the last few months, which have required hospital treatment and stitches. With regards to continence needs information on the plan stated that the resident uses aids throughout the day to offer protection however the continence assessment only identifies what is needed throughout the night. Without clear and accurate information about the current and changing needs of people there is no assurance that their needs will be met, potentially placing them at risk. During the inspection the pharmacist inspector looked at how well medicines were handled to make sure that residents were being given their medicines properly. This was because at the previous inspection medicines had not been handled safely. We also checked to see if the requirements made at the previous inspection regarding medicines had been met. Medication records belonging to a number of residents were looked at together with their medicines. We spoke to two senior care assistants who were responsible for administering medicines on the day of our visit. At the last inspection we found that although residents were given most of their medicines as prescribed, there were some areas of medicines handling Bridge House DS0000008412.V374483.R01.S.doc Version 5.2 Page 13 which needed to be improved so that residents received all their medicines safely. We made five requirements to make sure that residents health would not be at risk. At this inspection we found that none of the requirements had been complied with and residents health was at risk. Since our last inspection staff had received additional training in safe handling of medicines, however staff had not been formally assessed as competent in this task and the concerns we found highlighted their lack of competence. The manager had audited, made checks, to ensure medicines were being given to residents properly. She told us that these checks highlighted medicines had not always been given properly, however did not tell us of any actions she had taken to improve residents safety. At the last inspection we found that creams were stored in peoples bedrooms and made a requirement that all medicines should be stored securely. At this inspection once again we found creams stored in bedrooms we also found them stored in communal bathrooms. One resident had cream in her bedroom that was over 12 months old, which was not currently, prescribed for her and a cream that belonged to another resident. Other residents also had creams, which were not currently prescribed for them in their rooms. No records were made to tell us if checks had been done to make sure it was safe for these residents to have any medicines stored in their rooms. It is neither safe nor hygienic to store creams in such a manner. Some eye drops, which must be stored in a fridge, had not been. When medicines are not stored at the correct temperatures they may not work properly. If medicines do not work properly residents health could be placed at risk. Eye drops and some liquid medicines have a limited life once opened. It is important that that when such medicines are opened they are dated so that staff know that they are safe to use. We found that such items of prescribed medicines were not dated on opening, so staff could not be sure that they were safe to use. We observed medicines being given to residents at lunchtime and noticed that the trolley was left open and unattended whilst the senior care assistant administered medicines to people. It is not safe to leave the medicines trolley open during medicines rounds. The trolley must be locked so that medicines cannot be mishandled or lost. One lady was given her medicines by having her tablets pushed against her lips in an attempt to make her take them. We noticed that one of the tablets fell to the floor and although the carer looked for it failed to find it and signed that the lady had taken both her tablets. This was inaccurate record keeping as we later found the tablet on the floor. Bridge House DS0000008412.V374483.R01.S.doc Version 5.2 Page 14 Other records about medicines were also inaccurate. The records could not show that medicines, including creams, had been given properly nor could they show that all medication could be fully be accounted for. Staff signed for medication, which they had not given, and for doses, which were different to the actual doses administered. One resident was collected, by his family, to go out for the afternoon. Staff gave the family his medication and falsely signed the records to indicate they had administered it to him. Staff failed to follow the proper procedures for medicines, which are taken out of the home. After the last inspection we made a requirement that accurate records must be kept about medication because if records do not show exactly what medicines residents have taken their health could be at risk of harm. We looked at medicines together with records about medicines for twelve people and found that there were examples of poor record keeping for some medicines for all twelve residents. We also found that six residents had not been given at least one of their medicines properly because they had run out of their medication. If medicines are not available to be given then residents health could be placed at significant risk of harm. Some residents were not given their medicines properly because the staff failed to follow the prescribers directions carefully. After the last inspection we made requirements that every one must be given their medications prescribed and that medicines should not run out. Neither of these requirements had been met and residents health was placed at risk. Bridge House DS0000008412.V374483.R01.S.doc Version 5.2 Page 15 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 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Suitable arrangements are in place with regards to daily routines however this could be enhanced further by providing a more flexible approach, which caters for people with vary needs. EVIDENCE: Since our last visit there has been a change in the activity worker. The new co-ordinator had been in post a few weeks and is currently working Tuesday through to Friday each week. A timetable of activities has been developed and is displayed in the hallway. This includes 1-2-1 with people, board games and cards, memory lane reminiscence, arts and crafts, sing-a-long and quizzes. During our visit we observed a small group of people taking part in activities throughout the day. Residents sat chatting and relaxing and appeared to enjoy the interaction with each other. Bridge House DS0000008412.V374483.R01.S.doc Version 5.2 Page 16 Further consideration is to be given to the choice of activities made available particularly for those people who have some level of confusion and do not easily settle in a group. The acting manager said that other opportunities will be explored as the co-ordinator settles into and develops her role. We also spent sometime observing lunch. This was so we could see what food was provided and how people were supported with their meals. The dining room had recently been repainted and new curtains were on order. Tables had been nicely set. The main meal is served at lunchtime with a lighter meal in the evening. A menu card is placed on each table so that people can see the choice available. The meal served was shepards pie and vegetables or cauliflower cheese followed by syrup sponge and custard. During our observations we found that whilst some residents were able to manage independently others required support and encouragement. It did appear that a couple of residents who needed time to have their meal had it taken away before they had finished as desert was ready to be served. One resident was heard to say ‘I wish they would hurry up with desert, I’ve been sat here a long time. This was discussed with the acting manager and programme manager who agreed that residents should be supported to have their meal at a pace which suits them and where necessary staff should spend the time needed offering encouragement and assistance for them to eat their meal properly. Bridge House DS0000008412.V374483.R01.S.doc Version 5.2 Page 17 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 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. On-going concerns have been identified in relation to adult protection. Action has been taken by the providers and other relevant parties to ensure that residents are not at risk of harm. EVIDENCE: Following some concerns, disciplinary action has been taken by the providers, which has resulted in the registered manager being dismissed. Where necessary further disciplinary action has and continues to be taken by them where bad practice has been identified. Information has been shared with us and the local authority. Where necessary referrals to the Protection of Vulnerable Adults register have also been made. Due to some of the concerns regular visits have been made by us as well as health and social care professionals to monitor and review the standard of care provided. Since our last visit to the home no complaints have been received. The acting manager and programme manager stated that feedback has been received from relatives and visitors that had been positive about the changes taking place. Bridge House DS0000008412.V374483.R01.S.doc Version 5.2 Page 18 Those involved with the strategy team are continuing to meet to discuss if progress is being made. Previously we have identified that training was needed for staff so that they are aware of their responsibilities with regards to the local authority safeguarding procedure. In-house training has now been provided covering adult abuse and whistle-blowing as well as safeguarding awareness training, which is provided by Bury Training Partnership. This has now been completed by most of the staff team. The acting manager is making the necessary arrangements to ensure the remaining staff complete the course. This will ensure that staff are aware of the procedure to follow should an allegation be made. Bridge House DS0000008412.V374483.R01.S.doc Version 5.2 Page 19 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 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements still need to be made to enhance the appearance as well as improve the overall standard within the home so that people live in a pleasant, comfortable and well maintained home. EVIDENCE: Bridge House is a large home with several communal lounges and a large dining room providing residents with plenty of space to sit and relax. All but three of the bedrooms are single and allow for privacy when they have visitors. The home also has a large well maintained garden to the front as well as an enclosed garden which has easy access to and from the lounges. During the summer months this allows people to move around freely and safely Bridge House DS0000008412.V374483.R01.S.doc Version 5.2 Page 20 Following our visit in September 2008 we identified a number of areas that required attention to improve the standard and physical appearance of the home. A redecoration and refurbishment plan was requested. At the random inspection a further request was made. However a plan has yet to be received. During this visit we found that redecoration had been completed in two of the lounges and the dining room, however improvements have been slow. During this visit we spent time looking round the communal areas and a random number of bedrooms. The following areas were still found to need attention: • Carpeting in the hallway near the staff office taped down in several areas • Carpeting in the dining room. We were advised at our last visit that this had been identified for change by the homes dementia co-ordinator providing something more suitable for those people with dementia needs however has yet to be addressed • Chairs in the lounges were tired and worn • Lockable spaces not provided in bedrooms • Bedrooms in need of painting, old/broken furniture needs to be replaced • Some bedroom carpets were worn • Some fire doors not closing to the rebate on the 1st floor. The acting manager and programme manager explained that requests had been made for funding so that work could be carried out however they had been waiting for this to be agreed. We also found that bedroom windows had not been fitted with restrictors. The acting manager agreed to address this straight away paying particular attention to the first floor rooms and then ground floor rooms ensuring people were kept safe. With regards to bathroom facilities, there are 2 ground floor bathrooms (one full bath and one with a medi-bath) and one on the first floor. In the main people are supported to use the medi bath as the other baths are unassisted and therefore are generally not used as they do not meet the physical needs or residents. We also found that toilets are not signed and therefore not distinguishable to people should they need to find them unassisted. Suitable bins are not provided for the disposal of clinical waste and hand washing is not provided in all areas where residents are supported with their personal care needs, which does not promote good hygiene standards and minimise the risk of cross infection. Bridge House DS0000008412.V374483.R01.S.doc Version 5.2 Page 21 The home has a full time handy man that carries out relevant health and safety checks as well as general maintenance within the home. Records are completed to show what work has been carried out. Bridge House DS0000008412.V374483.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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems have improved with regards to the recruitment procedures, training and support of staff ensuring staff are suitable to work at the home and are equipped with the necessary skills needed to meet people’s needs. EVIDENCE: At present the team comprises of the acting manager, deputy manager who is currently on long term sick, senior carers, carers, 2 cooks, 2 kitchen assistants, laundry and domestic staff, an activities co-ordinator and a handyman. Due to recent changes staff have been utilised from other services within the group to ensure that sufficient staff are available. We were told that one member of staff who had been offering regular support to the acting manager was no longer available due to the travelling and personal commitments. At present there are 24 people living at the home. Information on the rotas showed that staffing levels comprise of 4 carers covering the morning and afternoon in addition to the manager and ancillary staff, with 3 staff in the evenings. There were also 3 wake-in night staff identified for each night. Bridge House DS0000008412.V374483.R01.S.doc Version 5.2 Page 23 From observations made staff were more visible in communal areas interacting and supervising residents. However we noted the following the evening meal 2 staff had taken their break together leaving one staff member alone supervising residents in the 3 lounge areas. This was raised with the acting manager and programme manager who said they would address this. In relation to staff recruitment information, two files were looked at. Information was found to be orderly and included an application form, written references, interview information and POVA first check. The administrator confirmed that those staff requiring an up to date CRB had now been received. These are held separately. During previous visits major shortfalls had been found with regards to staff training and supervision. The acting manager has now joined the local training partnership group accessing relevant staff training. A training matrix and plan was looked at. This identified training completed by staff and courses planned for the following month. The acting manager stated that as training for the forthcoming year becomes available through the partnership, arrangements will be made for staff to attend the relevant courses ensuring their continuous development. Progress has also been made with regards to dementia training. Staff have been completing the Yesterday, Today and Tomorrow training which is now near completion. This will be verified by the Alzheimer’s society. Further training has also been provided with regards to NVQ’s. Within the current team, 3 staff have achieved level 3 and a further 4 staff have now progressed to level 3 having completed the level 2. Three further staff are working towards level 2. Information also showed that ancillary staff were also completing NVQ training in areas specific to their role i.e. hospitality, housekeeping and catering. The providers must however satisfy themselves that staff are competent in carrying out their duties and are able to apply their learning to practice in order to ensure no further issues arise and residents are kept safe. Bridge House DS0000008412.V374483.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, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service now needs a period of stability so that the necessary improvements can be made with clear leadership and management ensuring the service is ran in the best interests of people living at the home. EVIDENCE: Following a number of concerns raised in 2008 an investigation was undertaken by European Care into the conduct of the registered manager. This has now concluded and the manager has been dismissed. An acting manager has been working at the home since September 2008. We have been advised that she has shown an interest in becoming the permanent Bridge House DS0000008412.V374483.R01.S.doc Version 5.2 Page 25 manager. Once appointed as the permanent manager she is aware that application must be made to us to register as the manager and steps have already been taken to address this. Feedback in relation to our visit was provided to the acting manager and programme manager. Whilst improvements have been identified in a number of areas we were concerned that issues specifically in relation to medication had not been addressed. The managers were made aware that these concerns would be discussed as part of our enforcement pathway to agree what action would be taken. In relation to quality assurance this area was not explored in detail. We were aware that the service has been subject to review by internal members of European Care and that the regulation 26 monthly reviews are carried out. Information in relation to quality monitoring is held within the home and further supporting evidence was provided following our visit. The providers are working hard to address issues which have been identified to ensure that a good quality service is provided. Arrangements in relation to resident’s finances has now been resolved. At present money is not held for anyone with the money being managed by relatives or appropriate representative. Should this be necessary suitable arrangements could be made available with the bank in relation to a specific residents account. Secure storage is also available at the home. Staff supervision has also commenced. Evidence was seen on the staff files of session held with the new staff. The acting manager feels that positive relationships are being developed with staff creating more openness. She is aware of the standard required in this area ensuring staff are clearly directed and supported in carrying out their duties. Records were also looked at with regards to health and safety. In house checks are carried out with regards to fire safety, water temperatures and general maintenance. Servicing certificates were seen for the fire equipment, small appliances and call bells. We were advised that a recent gas safety check had been carried out and that they were waiting for the certificate. Confirmation of receipt of this should be provided. We also noted that the electric circuit inspection, which had been carried out in 2004 was due a further inspection within 3 years. This was overdue. The acting manager is to make the necessary arrangement to address this. Bridge House DS0000008412.V374483.R01.S.doc Version 5.2 Page 26 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 2 Bridge House DS0000008412.V374483.R01.S.doc Version 5.2 Page 27 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 OP3 Regulation 12 Requirement A comprehensive assessment must be carried out to ensure that the home has all relevant information about the needs of prospective residents prior to moving in ensuring placement is suitable. (Previous timescale of 1.9.08 not met) Due to there being no new admissions this was not reviewed. Area will be examined at the next key inspection. 2. OP7 15 Care plans must be completed in 30/05/09 sufficient detail so that they clearly identify how each resident’s needs are to be met as outlined within the report. Document should be dated and signed by the person completing the form. (Previous timescales of 1.9.08 and 30.11.08 not met). Timescale for action 30/06/09 Bridge House DS0000008412.V374483.R01.S.doc Version 5.2 Page 28 3. OP7 15 Risk assessments must be completed in full and accurately reflect the needs of residents ensuring the appropriate level of support is provided. (Previous timescale of 1.9.08 and 30.11.08 not met) 30/05/09 4. OP9 13(2) The provider must put in place 31/05/09 effective arrangements to ensure that all medicines are stored securely at all times to ensure that medicines are not mishandled. (Previous timescale of 18.9.08 and 14.11.08 not met) The provider must put in place 31/05/09 effective arrangements to ensure that all records regarding medicines are clear and accurate in order to show that medicines are given properly and can be accounted for. (Previous timescale of 18.9.08 and 14.11.08 not met) The provider must put in place effective arrangements in the home to ensure that medications are administered in exact accordance with the prescribers’ directions in order that residents’ health is not placed at risk. (Previous timescale of 18.9.08 and 14.11.08 not met) 20/04/09 5. OP9 13(2) 6. OP9 13(2) 7. OP9 13(2) 31/05/09 The provider must put in place effective arrangements to make sure that people have an adequate supply of medication to ensure that their treatment is continuous. (Previous timescale of 4.9.08 and 14.11.08 not met) Bridge House DS0000008412.V374483.R01.S.doc Version 5.2 Page 29 8. OP9 13(2) The provider must ensure that staff administering medication have been trained and are competent to do so safely. (Previous timescale of 30.9.08 and 14.12.08 not met) The providers must ensure that work identified within the report to improve the standard and safety of accommodation is addressed so that residents live in comfortable, well maintained accommodation. The provider must ensure that suitable facilities are in place for the disposal of clinical waste as well as suitable hand washing so that issues in relation cross infection are minimised. 31/05/09 9. OP19 23 30/06/09 10 OP26 13(3) 30/05/09 11. OP30 18(1) The providers must however 30/05/09 satisfy themselves that staff are competent in carrying out their duties and are able to apply their learning to practice in order to ensure no further issues arise and residents are kept safe. The provider must ensure that the conduct of the home ensures good relationships are maintained and that proper provisions are made to ensure the health and well-being of people. The provider must ensure that once a suitable manager is appointed an application to register with us is forwarded without delay. The provider must ensure that arrangements are made for a full electric circuit check is carried ensuring the premises is safe. DS0000008412.V374483.R01.S.doc 12. OP31 12 30/06/09 13. OP31 9 30/06/09 14. OP38 23 30/05/09 Bridge House 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 OP7 Good Practice Recommendations More attention needs to be paid to ensure that documents have the residents’ name on so that information does not get lost or mixed up. Further opportunities needs to be provided with regards to day-to-day activities particularly considering the varying needs and abilities of people living at the home. Consideration should be given at mealtimes ensuring people are able to have their meal at a pace and with the necessary support need with their meal. The provider is asked to forward a copy of the homes refurbishment plan to us outlining work and timescales for completion. Suitable arrangements in relation to staff breaks should be implemented ensuring sufficient staff are available should residents need assistance or supervision. The manager should ensure that all staff receives supervision in line with the standard or more frequently if necessary ensuring they have the support and guidance to carry out their duties appropriately. The manager is to confirm that a satisfactory gas safety certificate has bee received at the home. 2. OP12 3. OP15 4. OP19 5. OP27 6. OP36 7. OP38 Bridge House DS0000008412.V374483.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Central Registration 9th Floor Oakland House Talbot Road, Old Trafford Manchester M16 0PQ 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 DS0000008412.V374483.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. 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