Inspection on 26/10/05 for Bridge House

This inspection was carried out on 26th October 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 25/04/05

Bridge House 01/12/04

Bridge House 23/06/04

Bridge House 12/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Bridge House 1 Forty Hill Enfield Middlesex EN2 9HT Lead Inspector Jackie Izzard Unannounced Inspection 26th October 2005 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bridge House DS0000033427.V252187.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bridge House DS0000033427.V252187.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Bridge House Address 1 Forty Hill Enfield Middlesex EN2 9HT Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8363 0045 020 8245 4246 London Borough of Enfield Ms Ruby Chung Care Home 41 Category(ies) of Dementia - over 65 years of age (41) registration, with number of places Bridge House DS0000033427.V252187.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th April 2005 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 DS0000033427.V252187.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on 26 October 2005 and lasted one day. This was an unannounced inspection, which means that the home did not know that the inspector was coming. Two inspectors carried out the inspection. The inspectors looked around the building, including the garden, looked at records in the office, spoke to the manager, assistant manager, staff and some of the people who live at Bridge House. They also met the service manager from Enfield Council who is responsible for overseeing the home. As many of the people in the home have dementia and were not able to tell the inspectors much about the home, the inspectors spent time sitting with those people and watching how staff looked after them. They spoke to the few people who could tell them what it is like to live at Bridge House. The inspectors also watched staff giving out medication and everybody eating their lunch. The inspectors also received written comments about the home from relatives of people living there, spoke with two relatives by phone and met one. At the last inspection of Bridge House on 25 April 2005, twenty-five requirements were made. These requirements are things that the manager of the home and Enfield Council as the registered providers must do to meet the standards and associated regulations required of all care homes. The inspectors spent a large part of this inspection checking on these requirements. A number of requirements made at the last inspection have not yet been met and have been restated in this report, with a new timescale for compliance. Further information about unmet requirements can be found under the section relating to the standard. Unmet requirements impact upon the welfare and safety of residents. Failure to comply by the revised timescale will lead to the Commission for Social Care Inspection considering enforcement action to secure compliance. What the service does well: Staff are considered to be caring, kind and patient with the residents. They look after people who have a wide range of needs, a number of whom are very frail. Enfield Council provides staff with training on how to work with people who have dementia. Routines are flexible. People can get up when they choose and breakfast is served throughout the morning rather than at a set time. Bridge House DS0000033427.V252187.R01.S.doc Version 5.0 Page 6 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. Relatives of residents believe that people are well cared for at the home. What has improved since the last inspection? What they could do better: At the previous inspection in April 2005, twenty-five requirements were made which included seven immediate requirements. These were things that have to be done straight away as these immediate requirements all relate to health and safety of residents. The inspectors spent several hours at this inspection checking up on requirements which had not been complied with. Fourteen of the twenty-five requirements have been complied. Eleven are still not fully completed. These are repeated in the back of this report. As well as repeating the requirements that have not been completed, the inspectors made a further fifteen requirements, making a total of twenty-six things that the home must improve. The majority of requirements relate to health and safety matters; confirming that the gas, electricity, lift, emergency lighting are all safe for use, producing a fire risk assessment and emergency plan, keeping fire doors closed, repairing the call system, making sure that confused residents cannot leave the home undetected, refurbishing some toilets and the windows, replacing stained carpets, keeping cleaning materials locked away safely, providing hand towels for kitchen staff and checking water supply for legionella. As well as these requirements, other requirements have been made to ensure all staff have regular supervision sessions, training some more staff in protecting residents from abuse, providing more activities for people with Bridge House DS0000033427.V252187.R01.S.doc Version 5.0 Page 7 dementia, providing written guidance for staff on what to do when a resident has lost weight, assessing the risk of getting a pressure sore for residents who do not move around very much and reviewing staffing levels to make sure Enfield are satisfied that enough staff are on duty to meet residents’ needs. If the Registered Person does not complete the requirements within the specified timescale, the Commission for Social Care Inspection shall consider further action against the Registered Persons as a means of achieving compliance. The Commission for Social Care Inspection is very concerned that requirements are being repeated because the London Borough of Enfield have not done what they are expected to do, neither given a reasonable reason for not doing so, nor have requested additional time for compliance. Previous inspection reports have already highlighted that enforcement action may be taken against the Registered Persons if they do not meet requirements within the timescale specified. In view of the lack of progress to achieve compliance with the requirements et, the Commission will be pursuing the matter further with the Registered Persons outside of this inspection. 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. Bridge House DS0000033427.V252187.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bridge House DS0000033427.V252187.R01.S.doc Version 5.0 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 the following standard(s): 3, 6 People living in this home are looked after by staff that have knowledge of their needs. Their needs are assessed and staff are given training on how to meet their needs. EVIDENCE: The home does not provide intermediate care. The inspector looked at three peoples care plans and saw that they had all had their needs assessed before moving to Bridge House. Staff have been trained to meet the needs of older people who have dementia. Bridge House DS0000033427.V252187.R01.S.doc Version 5.0 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 the following standard(s): 7, 8, 9, 10 Residents’ needs are met through a comprehensive care plan format being in place and by their relatives being involved in reviewing their care needs with staff. While residents are protected by the home’s policies and procedures for dealing with medication, their health needs are not fully met, as the home needs to make immediate improvements in the prevention of pressure sores. EVIDENCE: Inspectors looked in detail at three residents’ care pans. The home has made good improvements in care planning since the last inspection and the new format used is easy to understand for staff. The manager said that staff find the new care plans more meaningful. There was evidence that relatives have been consulted and involved in devising new care plans. Relatives are also given the opportunity to be involved in monthly reviews of the care plan to see if the resident’s needs have changed. This was confirmed by reading the files and by talking to a relative. The manager and senior staff have worked very hard to complete the new care plans. Bridge House DS0000033427.V252187.R01.S.doc Version 5.0 Page 11 Residents’ relatives say that the residents are treated with dignity, that their privacy is respected and that they are generally satisfied with the care given at this home. In assessing heath care, inspectors looked at how the home assess who is at risk of developing pressure sores and how staff try to prevent this. It was very concerning to find that some people who are at risk of developing a pressure sore through having limited mobility had no recent risk assessment undertaken. An immediate requirement was issued at the last inspection in April 2005 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 by 25/5/05. This was because the registered persons have failed to meet the requirement to produce these assessments by the end of March 2005. Enfield Council returned an action plan to the CSCI stating that these assessments had been completed. One resident had a risk assessment regarding pressure sores on the home computer (though not in her file) which had not been reviewed for five months despite this resident being unable to walk and four mentions of red marks or blisters in her daily records in recent weeks. It was confirmed during the inspection that this person did not in fact have a pressure sore. It is however of serious concern that a risk assessment had not been placed with her care plan and reviewed monthly and a plan of action recorded to address this risk. In practice, inspectors saw that some people had specialist equipment to prevent pressure sores and that some people were turned during the night as part of their care plan. Inspectors were told that only two residents had a pressure sore at the time of the inspection so the concerns are about prevention rather than a high number of people with pressure sores. Also, in the area of health care, inspectors checked a random selection of three residents’ weight records. All three had lost weight in the last seven months (ranging from seven pounds to over three stone). Senior staff were able to offer explanations but there was no record that action had been taken to address this weight loss. It was explained to senior staff that to meet standard 8.9 of the National Minimum standards for care homes for older people, they would need to record what action they have taken to address any weight loss and to ensure they know at what point medical attention is needed. The care needs of one resident were discussed in detail with the manager, assistant manager, a relative and the service manager. The relative was very satisfied with the care provided at Bridge House, which is very positive. However, a requirement is made to review the care of this person at night and update the risk assessment. The risk assessment said the resident was at medium risk of falling. When speaking to staff it indicated that this resident was at high risk of falling and sat in a reclining chair to discourage him/her from trying to stand up because of this high risk. Bridge House DS0000033427.V252187.R01.S.doc Version 5.0 Page 12 The decision to use such a chair, which effectively restrains a person, should only be made if other health care professionals have agreed that this is the most appropriate way to protect the person from risks to their safety. The home had not consulted any professional so a requirement is made to do so. The service manager agreed that this practice would be immediately reviewed. A chiropodist working at the home during the inspection commended staff for “exceptional “ care of residents’ feet, which is very positive. Medication records and the storage of medicines were checked at this inspection. All records were completed correctly and there was a written agreement for a resident who is given medicine covertly. Recording was of a good standard. Medication was safely stored and carefully administered when inspectors observed staff during this inspection. This is an area, which had improved since the last inspection. A number of the relatives of people living at the home gave feedback to the inspector in writing or verbally that they were satisfied with the care provided at the home and that residents were treated with dignity and afforded their rights to privacy. The inspector observed staff treating residents kindly and respectfully and dealing with their personal care discreetly. Bridge House DS0000033427.V252187.R01.S.doc Version 5.0 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 15 Resident’s recreational interests and needs are achieved through regular trips out and daily activities on offer at the home. However, a review of staffing levels could result in staff having more time to devote to activities and stimulation of residents and therefore assist in improving their lifestyle. While the diet offered provides a satisfactory diet and a flexible approach for residents, the limited space for everyone to eat together limits mealtimes from being as sociable as they could be. EVIDENCE: The diet in the home is satisfactory and residents are helped with eating in a kind and sensitive way. All the above standards were assessed and found to be met at the last inspection. Recommendations were made to include more suitable activities for people with dementia in the programme of activities. There was insufficient evidence to support that this had been carried out so has now been made a requirement in this report. A daily activity takes place at 4pm and anyone who is able is invited to take part. However, during the rest of the day there is little stimulation for residents. Staff were seen to be very busy helping people with their physical care needs such as using the toilet, feeding and getting dressed, taking residents to hospital appointments and talking and reassuring Bridge House DS0000033427.V252187.R01.S.doc Version 5.0 Page 14 residents but did not have enough time to spend on any activity. This is not a criticism of staff that were providing a very good standard of care. A requirement is made to review staffing levels. There is a programme of outings for those who are more able, which is very positive. Two outings planned for November are shopping at Lakeside shopping Centre and lunch out and a trip to Southend to see the Christmas lights then a fish and chip supper. Families are invited to go with residents on those trips if they wish to. The cook told the inspectors that there is a two-week rolling menu. It is recommended that this be extended to offer a more varied selection of meals. Lunch on the day of this inspection was liver or sausages, mashed potato and cabbage with gravy. This was not on the menu but the cook said that the liver needed to be used. Residents did not indicate any signs of minding the chance in menu and all were seen to enjoy the meal. Residents are shown both meals to make their choice, which is a positive and an appropriate way for people with dementia to be offered choices. Lunch is served in two sittings, as there is not enough room in the dining room or enough staff for everybody to eat at once. Inspectors were told the second lunch sitting is at 1.30 or 2pm, which is late, but were assured that those in the second sitting were people who got up late and liked a later breakfast. There were seven staff on duty at lunchtime but two had to take their own lucnhbreak during this period. At one point there were five staff on duty at lunchtime. One gave out medication, two were assisting those people who needed to be fed and two were serving the others and generally supervising them. Residents started eating after 1pm. Two staff had to feed two residents each. It was observed that they did so with kindness and sensitivity. A recommendation is made to review staffing levels so as to ensure that there are satisfactory staffing levels to meet the needs of residents. A recommendation is made to review the mealtime arrangements. If this review, which should include the views of all residents who are able to give their views, their relatives, staff and the service manager, suggests that current arrangements need to be changed, the CSCI must be informed of any planned action. This may be that some people eat their meals in one of the lounges if preferred. Bridge House DS0000033427.V252187.R01.S.doc Version 5.0 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 the following standard(s): 18 While residents are protected through the process of adult protection training for staff, further work is needed to ensure that those staff that have not received such training to date do so. EVIDENCE: A requirement was made at the previous two inspections to ensure all staff receive training in adult protection and an adult protection strategy meeting also highlighted a need for this training last year. Although the London Borough of Enfield has failed to train all the staff within the timescale given, good progress has been made. At the time of this inspection twelve staff had not been trained. Seven of them were booked on training within the next three months and five were yet to be trained. The requirement is restated for those five staff. Complaints were not addressed at this inspection as this standard was assessed and there had been no complaints for a year at the last inspection. The manager had recorded a complaint satisfactorily. It is planned that complaints will be addressed in detail at the next inspection. Bridge House DS0000033427.V252187.R01.S.doc Version 5.0 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 the following standard(s): 19, 20, 21, 23, 24, 25, 26 Bridge House is spacious and comfortable and kept clean by staff so that residents can live in clean and comfortable surroundings. Notwithstanding this, some refurbishment works are required so as to ensure a safe environment for both staff and residents. EVIDENCE: Inspectors carried out an inspection of all toilets, bathrooms, communal rooms and corridors and a sample of bedrooms on both the ground and first floors of the home. Some refurbishment is needed and requirements to complete this work are restated in this report, as the London Borough of Enfield has as yet carried out this work. There are some concerns about residents’ safety in the environment, which are detailed in standard 38 of this report. Requirements are restated to carry out the following works; refurbish windows, replace corridor carpets. A requirement is made to provide a date for the Bridge House DS0000033427.V252187.R01.S.doc Version 5.0 Page 17 refurbishment of toilets, which do not meet the needs of residents, and for which the registered providers have made a plan to refurbish. The London Borough of Enfield have informed the CSCI that requirements regarding the building will be complied with before the end of March 2006 except for windows which will be completed in Summer 2006. The CSCI have also been provided with a plan of maintenance and renewal work for 2005/6. However, no definite dates for these works have been provided to either the CSCI or the service manager or home manager and so, given the history of slow compliance with requirements about maintenance of the building, it is difficult to verify at this stage whether this work will be completed by March 2006. Carpets in at least two bedrooms are worn down to the concrete underneath and these are included in the Council’s plan of work, though again with no specified date. Carpets in the ground floor lounges are stained. The manager said that these are regularly cleaned and the stains cannot be removed. These carpets therefore must be replaced along with those already identified. The lounge carpets must be replaced by 30 April 2006. Staff try to make the building as homely as possible. The ground floor corridor is attractively decorated and interesting pictures have been hung there for the residents. The majority of bedrooms are homely and reflect the interests of the resident and include photographs of family members and personal memorabilia. While the dining room is too small to seat all residents at the same time but the home has been registered with this room seen as acceptable. There are concerns about health and safety of residents at Bridge House, which are detailed in standard 38 of this report. Bridge House DS0000033427.V252187.R01.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29, 30 Residents are looked after by staff who are trained to meet their needs and who are competent. While residents are protected by the council’s practices in recruiting staff, a review of the number of staff on duty at any time is needed to ensure there are enough staff to meet residents’ needs at all times. EVIDENCE: Inspectors observed interactions between staff members and residents. Staff were observed to be caring and sensitive to the residents’ needs. While staff were very busy attending to peoples personal care needs, they spent time talking to them during this and demonstrated a caring attitude towards residents. 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 attending to other personal care tasks. This left people without any interaction from staff for periods of time. At lunchtime, two staff had to feed two residents each and the other staff had limited opportunity to sit with any resident who may need extra encouragement. Staff worked hard interacting really positively with the residents. Bridge House DS0000033427.V252187.R01.S.doc Version 5.0 Page 19 Similar observations were made at the last inspection of the home six months ago, so a requirement is made for staffing levels to be reviewed as a matter of priority and for the CSCI to be informed of the outcome. A selection of six staff files were inspected for evidence that the Council had undertaken a Criminal Records Bureau check before employing them. All six had this check on file. Other required information was also present in their files. It was not possible to check the manager or assistant managers’ files as their files were kept at Enfield Council Human Resources department. A requirement is made for a file for all staff who work in the home to be present in the home and contain all the information required by the Care Homes Regulations 2001. The manager provided details of staff training and the training planned for the next year, which was positive. The Service Manager said that the training section of Enfield Council do not provide staff with certificates of attendance at training courses and agreed to pass on inspectors’ concerns that this should be done in order to evidence their attendance. Inspectors saw records to confirm that the home has complied with the requirement to ensure that all staff handling food have received training in food hygiene and handling. The cook and kitchen assistant both received this training in July 2005. Staff are provided with training in working with people who have dementia and other training necessary to carry out their duties. A number of staff are undertaking NVQ level 2 training as required. Bridge House DS0000033427.V252187.R01.S.doc Version 5.0 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36, 38 An experienced manager who is supported by a team of assistant managers runs the home. In order to ensure that staff are appropriately supported and supervised, the frequency of staff supervision needs to improve in accordance with the National Minimum Standards. In order to fully safeguard residents, the Registered Providers need to urgently review the arrangements for ensuring the home is run safely with due regard to residents’ safety. This is to include clearly defining who is taking responsibility for each area of health and safety. EVIDENCE: The registered manager is experienced and is supported by assistant managers. All attend training to update their knowledge. The manager was able to provide this information to inspectors. The manager and assistant managers have clear lines of accountability and are each responsible for Bridge House DS0000033427.V252187.R01.S.doc Version 5.0 Page 21 specific areas of work as well as sharing general management duties and supervision of staff. The management team are all experienced in working with people with dementia and showed a good understanding of residents’ needs. There is a manager on duty in the home twenty-four hours a day. There is a low staff turnover and staff showed that they are committed to the residents. Residents and relatives are informed about CSCI inspections and gave their views to the inspectors by questionnaire. The home’s annual development plan and results of stakeholder surveys were not requested on this occasion. A requirement for staff to be provided with supervision, which meets national minimum standards, is restated as records of supervision seen at this inspection show that some staff are still not receiving supervision on a regular basis. Two staff’s records showed a gap between June and October 2005. Two others had no supervision sessions recorded since May 2005. Supervision needs to be carried out approximately two monthly in order to meet the required frequency of six times a year. It is of concern that this requirement is unmet and therefore restated again. There were a number of concerns regarding health and safety at Bridge House. The following requirements were restated as they were made at the last inspection but the registered persons have failed to ensure that they have been completed in the required timescale. These are as follows: • • • • • Current risk assessment for legionella Ensuring that all cleaning materials are locked away at all times (inspectors saw toilet cleaner and air freshener stored on a high shelf in the ground floor ladies toilet). Ensuring constant supply of hand towels in the kitchen Refurbishing the windows Taking action to reduce risk of confused residents leaving the building undetected Three relatives informed the inspectors that they were concerned about their family member resident in the home walking out of the building as they did not know where they were going and could not find their way back again. After a requirement was made at the last inspection to take action to reduce this risk, CSCI were informed that action was being taken as the Council’s property services had been to the home to assess what measures were needed. The manager informed inspectors that Enfield Council plan to fit keypads to the main doors, which deactivate when the fire alarm goes off. However, as yet this has not been done. In the meantime, staff have to be vigilant and cannot be expected to watch all exits at all times. There was no written risk assessment or management plan stating what action is being taken on this issue pending the keypads being fitted. The safety of some residents is therefore of concern. Bridge House DS0000033427.V252187.R01.S.doc Version 5.0 Page 22 Inspectors also saw the kitchen door wedged open. As well as being a fire risk, this enables residents to walk into the kitchen and through a fire exit if they wished to thus putting themselves at risk. The service manager told inspectors that she had been advised that the front door could be locked with a key, as it was not a designated fire exit. Inspectors advised that no external door could be locked with a key unless the home has written agreement from the fire brigade (LFEPA). The following health and safety concerns were noted and requirements made at the back of this report: • • • • • • • • • Staff reported that the call system is not working properly Inspection of gas installation unsatisfactory at last inspection Inspection of electrical installation unsatisfactory at last inspection Further clarification needed regarding lift Fire doors wedged open Action needed regarding emergency lighting according to report by engineers Monthly inspections needed of emergency lighting No fire risk assessment for the home No emergency fire plan for the home despite being asked to produce one by LFEPA six months ago. Inspectors considered that there was a lack of attention to some areas of health and safety and lack of clarity within the organisation about who was responsible. There have been some improvements since the last inspection but it is of concern that inspectors had to make requirements at the last inspection for basic health and safety issues to be attended to such as carrying out quarterly fire drills and testing electrical appliances for safety. Although these have been complied with, there were further health and safety concerns uncovered at this inspection as detailed above. Bridge House DS0000033427.V252187.R01.S.doc Version 5.0 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 1 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 2 3 2 X 3 3 3 3 STAFFING Standard No Score 27 2 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 2 X 1 Bridge House DS0000033427.V252187.R01.S.doc Version 5.0 Page 24 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 OP8 Regulation 13(4)(c) 14 Requirement 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 and 25/5/05 not met). The assessments must be reviewed on at least a monthly basis, and more frequently if a resident develops a pressure sore. The registered persons must ensure written guidance is made available to inform staff when and what action to take if a resident is losing weight. A written record must be made of what action is taken on the resident’s weight record. The registered persons must ensure a review is carried out of the care of a specified resident. This review must include a review of the risk assessment, nighttime care plan and use of a reclining chair. DS0000033427.V252187.R01.S.doc Timescale for action 10/01/06 2 OP8 12(1)(a) 01/01/06 3 OP8 12(1)(a) 01/01/06 Bridge House Version 5.0 Page 25 4 OP12 16(2)(n) 5 OP18 13(6) 6 OP36 18(2) 7 OP27 18(1)(a) 8 OP19 23(2,b&d) 13(4)(c) 9 OP19 23(2) (d) The registered persons must ensure that more suitable activities for service users with dementia, such as life history and reminiscence, be included in the programme of activities. This is a requirement as a result of a recommendation restated from the last two inspections. The registered persons must ensure that all staff working in the home receive adult protection training. This requirement is restated as arrangements must be made for five staff that have not been booked on this training. (Timescales of 31/3/05 and 1/8/05not met). The registered persons must ensure that all staff working in the home receives regular supervision which meets National Minimum Standards and that records of this are placed in their staff files. This requirement is restated from previous inspections. (Timescales of 31/12/04 and 31/8/05not met). The registered persons must undertake a review of the staffing levels in the home and inform the CSCI of the outcome. 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 met. This was an immediate requirement at the previous inspection. The registered persons must ensure that the carpets in the DS0000033427.V252187.R01.S.doc 31/03/06 31/03/06 30/01/06 01/01/06 01/09/06 31/03/06 Page 26 Bridge House Version 5.0 10 OP19 23(2)(d) 11 OP29 19(5)(d) Sch 2 12 OP38 13(4) (c) 13 OP38 13(4) (a) 14 OP38 13(4)c) 13 (3) 15 OP21 16 ground and first floor hallways are replaced. This requirement is restated. (Timescale of 1/6/05 not met). The registered persons must ensure that the carpets in the ground floor lounges are replaced. The registered persons must ensure that all staff have a file in the home containing all the information detailed in Regulation 19 of the Care Homes Regulations 2001. 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. (Timescales of 31/3/05 and 1/7/05 not met). The registered persons must ensure that all cleaning materials are locked away at all times. This requirement is restated. (Timescales of 25/4/05 and from then on not met.) The registered persons must ensure that hand towels are available in the kitchen at all times. This requirement is restated. Previous timescale of 1/5/05 and from then on not met. The registered persons must inform the CSCI of the date when the refurbishment of the toilets is to be carried out to better meet residents’ needs. The registered person must ensure that action is taken to reduce the risk of confused people leaving the home undetected. This requirement is restated. (Timescale of 30/6/05 DS0000033427.V252187.R01.S.doc 30/04/06 30/04/06 10/01/06 01/11/05 01/11/05 28/02/06 16 OP38 13 10/01/06 Bridge House Version 5.0 Page 27 17 OP38 23(2)(n) 18 OP38 13(4)(a) 19 OP38 13(4)(a) 20 OP38 23(2)(c) 21 OP38 23(4)(c) (i) 23(4)(c) (v) 22 OP38 23 OP38 23(4)(c) (v) not met.) The registered persons must ensure the call system in the home is serviced and repaired or replaced. The registered persons must obtain written confirmation from the company who inspect the home’s gas installation/appliances that any necessary remedial work has been undertaken and the gas appliances are safe and satisfactory. A copy of this written confirmation must be sent to CSCI. The registered persons must obtain written confirmation from the company who inspect the home’s electrical installation/appliances that any necessary remedial work has been undertaken and the electrical installation is safe and satisfactory. A copy of this written confirmation must be sent to CSCI. The registered persons must obtain written confirmation from the company who inspect the home’s lift that any necessary remedial work has been undertaken and the lift is inspected as satisfactory. A copy of this written confirmation must be sent to CSCI The registered persons must ensure that fire doors are not blocked open and are able to self-close at all times. The registered persons must ensure that the emergency lighting in the home is tested on a monthly basis and records kept of these tests. The registered persons must obtain written confirmation from the company who inspect the DS0000033427.V252187.R01.S.doc 30/01/06 10/01/06 10/01/06 10/01/06 01/11/05 01/11/05 10/01/06 Bridge House Version 5.0 Page 28 24 OP38 23(4)(a) 25 OP38 23(4)(c) (iii) 26 OP38 23(4)(c) (iii) home’s emergency lighting that any necessary remedial work has been undertaken and the emergency lighting is satisfactory. A copy of this written confirmation must be sent to CSCI The registered persons must 29/12/05 send a copy of a fire risk assessment for Bridge House to the CSCI. The risk assessment must also address the fact that bedroom doors are not fireresistant. The registered persons must 29/12/05 send to the CSCI a copy of an emergency plan for fire, which has been seen and agreed by the LFEPA. The registered persons must 29/12/05 confirm to the CSCI in writing that all staff working in the home have been provided with training on the home’s emergency plan. 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 OP15 Good Practice Recommendations It is recommended that the current two-week menu be extended so that residents are afforded a wider variety of meals. They should be consulted about the menu for their preferences to be taken into account. The registered persons should review the mealtime arrangements in the home. This review should include the views of residents who are able to give their views, their relatives, staff and the service manager. The CSCI should be informed of the outcome of this review. 2 OP15 Bridge House DS0000033427.V252187.R01.S.doc Version 5.0 Page 29 Commission for Social Care Inspection Southgate 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 DS0000033427.V252187.R01.S.doc Version 5.0 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. 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