Inspection on 29/06/07 for Bridge House

This inspection was carried out on 29th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Bridge House 02/02/06

Bridge House 04/10/05

Bridge House 22/03/05

Bridge House 13/05/04

Bridge House 29/01/04

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

CARE HOME ADULTS 18-65 Bridge House Bridge House 115 Grovehurst Road Kemsley Sittingbourne Kent ME10 2TA Lead Inspector Debbie Calveley Key Unannounced Inspection 29thJune 2007 11:30 Bridge House DS0000023825.V339578.R01.S.doc Version 5.2 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 DS0000023825.V339578.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 Adults 18-65. 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 DS0000023825.V339578.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bridge House Address 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) Bridge House 115 Grovehurst Road Kemsley Sittingbourne Kent ME10 2TA 01795 478157 01795 410877 care@cartrefhomes.co.uk Cartref Homes UK Limited Mrs Brenda Joyce Tyler Stuart John Byrne Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Bridge House DS0000023825.V339578.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd February 2006 Brief Description of the Service: Bridge House is a registered care home offering 24-hour support to 5 service users. It is a detached property with accommodation on two floors. Accommodation is provided in 5 single bedrooms, all of which have TV points. The home employs a manager; a team leader and 10 care staff, all of whom work a rota, which includes one person working at night on waking duty. A further senior staff member is available on call if needed. The home offers services for young adults with learning disabilities who aspire towards more independent living. The home provides a supportive ‘house share’ environment with clear boundaries enabling service users to take risks and to take responsibility for their own lives and behaviour with the aim towards independent living. Services are tailored to meet the needs of the individual offering opportunities and choice, to facilitate experience, enhancement of self esteem, and to enable service users to manage their lives with minimal support and assistance. Bridge House DS0000023825.V339578.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulations 2001, uses the term ‘service user’ to describe those living in care home settings. Those living at Bridge House were consulted about what term they felt was suitable and they wish to be known as residents, so for the purpose of this report they will be known as residents. This report reflects a key inspection based on the collation of information received since the last inspection, feedback from a range of representatives and an unannounced site visit, which commenced on Friday 29 June 2007 and lasted for lasted four hours. Follow-up information was sought from health professionals. The site visit included discussion with all parties present, a tour of the premises and an examination of medication and care records. There were five residents living at Bridge House at the time of this inspection. During the visit, the Inspector met with four residents and spoke privately with each of them. The Inspector spoke individually with the staff team on duty. Surveys were sent to the home following the visit. What the service does well: Bridge House is a relaxed and friendly environment where residents are supported by a team of staff who are committed to meeting their needs. Residents have access to a wide range of activities, which meet both their social and educational needs. Care plans are person centred and the residents are fully involved in all aspects of their care and personal goals. Bridge House provides residents with choice and control over all aspects of their lives and support to achieve maximum independence within a risk assessed framework. Two residents told the Inspector “staff help us a lot so we can do the things we like and have control over our lives”. Residents are supported to maintain and develop existing and new relationships. The feedback provided by three relatives expressed satisfaction with the general level of care provided at Bridge House. Bridge House DS0000023825.V339578.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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 DS0000023825.V339578.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bridge House DS0000023825.V339578.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2, 3, 4 and 5. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Information about the services offered at Bridge House is available for all prospective residents. Pre admission assessments are completed to ensure the home can meet the identified needs of prospective residents, and they are encouraged to visit the home prior to admission. EVIDENCE: The statement of purpose and Service User Guide is in place, but the format of the Service User Guide is formal, it would be beneficial if it was more user friendly- involving the residents in the document could be very rewarding for the residents. The pre –admission assessment documentation for two residents were reviewed. The documentation evidenced that the pre – admission assessment process was detailed and thorough. It also concentrated on the strengths and needs of the prospective resident, and clearly identified the care and support required. All the information is gathered from a variety of sources, and always includes the residents. Initial care plans and risk assessments are developed from this pre-admission assessment and reviewed as necessary but within a six-week period. Bridge House DS0000023825.V339578.R01.S.doc Version 5.2 Page 9 Two residents talked of the process of their admission to the home; they confirmed that they had visited the home before moving in to meet the other residents and the staff. They told of their aspirations and of what they hoped to achieve, and referred to their care plan and to the work they do with their assigned key worker to meet their goals. The residents were unsure of the contract but were clear about the terms and conditions of residency. The contracts were seen and were clear and comprehensive. Bridge House DS0000023825.V339578.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 and 10. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The changing needs of residents are reflected in their individual plans and are supported and enabled to take risks as part of an independent lifestyle. EVIDENCE: Two residents were happy to share their care plans and to explain how they worked to the inspector. The care plans evidenced a simple and person centred system entirely based on the needs of the residents. They are working documents, which respond to changing needs. Included in the care planning process is a task book for key workers in which tasks are set at the beginning of the week and expected to be completed by Friday; a discussion section within each care plan, detailing discussion with the resident about how the care plan is going, and a conclusion sheet attached to each care plan detailing how the care plan has been achieved. All residents sign to agree the care plan. Bridge House DS0000023825.V339578.R01.S.doc Version 5.2 Page 11 Meetings between the resident and the key worker to discuss the care plan take place weekly, where issues are raised and discussed and any views and ideas are listened to and where appropriate implemented. A new development is an x file which has personal goals and the residents receive points and accumulated points result in a bead. This has proven to be successful and all the residents discussed how they achieved points, who was leading and what they had to do to get the points. The residents all have a week of assigned jobs and this is rotated a resident proudly showed a notice board that displayed all residents involvement. The residents are very involved in their care plan plans and the risk assessments that enable them to live their lives to the full. From direct observation of the interaction between the staff and residents evidence positive relationships and residents stated that they felt supported and even on a bad day, that staff understand them. The residents said that their care plans are important as it gives them a purpose and a goal, one resident said it helped him focus, and when he reaches a goal and another is set. The goals set were seen to be achievable. The staff document all discussions with residents either on the relevant care plan or on a separate sheet. Bridge House DS0000023825.V339578.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents have opportunities for personal development and they are encouraged and enabled to be part of the local community. Residents have their rights respected and responsibilities recognised, and benefit from a healthy diet. EVIDENCE: There are five residents living in the home, all of them have an individual care plan based on their strengths and depicting their needs in areas of personal development. At Bridge House the staff focus on enabling and supporting residents to work towards refining and obtaining the daily living skills required to live a more independent and personally fulfilling life. One resident proudly showed his teaching plan that helps him with money. From talking to staff and residents it is clear that the personal goals are discussed in full when set and the resident only moves on to the next goal when the resident is confident that he has reached it. Bridge House DS0000023825.V339578.R01.S.doc Version 5.2 Page 13 Throughout the day of the inspection residents were noted going in to town on local transport, attending the gym with a care worker and one was out working. The residents attend local football games and they feel that they are part of the local community. They regularly go out and dependant on the risk assessment either in the company of staff or independently. The risk assessments identify the level of support required. Residents are supported to promote contact with their families and form relationships with friends. The residents spoke of weekends away with their families. The lifestyle experienced in the home promotes and encourages independence, all the residents take part in cooking, every evening a resident cooks for the home, they follow a rota so everyone has the responsibility of preparing a nutritious, balanced and tasty meal. Menus are discussed with all the residents. The care plan for each resident contains information regarding their personal development and community opportunities; this includes educational, social and job opportunities. Nearly all the residents are working for some hours a week, either working in a restaurant, gardening or in a charity shop. One resident is assisting the maintenance person at other home in the organisation. Bridge House DS0000023825.V339578.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents benefit from the provision of flexible and respectful personal and healthcare support and are protected by the systems in place to manage medication. EVIDENCE: Residents are encouraged and supported to manage their own personal care. The role of staff is primarily to prompt residents as necessary. There is evidence in the care plans that staff support is offered in a sensitive and respectful manner. Risk assessments are in place to ensure the safety of residents at all times. Staff also support residents to ensure their health needs are met. Communication sheets contain a record of any visits or contact with healthcare Bridge House DS0000023825.V339578.R01.S.doc Version 5.2 Page 15 professionals. This is then linked to the care plan if it impacts on the health or safety of the resident. The storage and administration of medication were found to be satisfactory. Records are accurate and current. Each resident has their own medication file, which contains information of their medication and the criteria for when each medicine should be administered. One resident was seen to be consulted about changing his medication and was advised and supported by a care worker. Staff receive appropriate training in the management of medication. Residents are supported to self-administer their own medication within a risk assessment framework. They each have a lockable tin box that they keep in their bedroom, which also has a lock. All residents are aware of how they need to look after their medications Bridge House DS0000023825.V339578.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents and visitors to the home benefit from and are protected by, the open culture at Bridge House; residents can be assured that their views are listened to and acted upon. EVIDENCE: The home has a standard complaints procedure, which has been produced in a user-friendly format. The CSCI has not received any complaints about this service in the past twelve months. The residents all said if they had a problem or a complaint they would talk to the staff. They trust and respect the staff and feel comfortable talking to them. A copy of the complaints procedure should be kept in the residents’ communal file so it is accessible if a resident required it. The home has a number of systems in place to protect residents from abuse. The policy and procedure for protecting vulnerable adults is in need of updating and reviewing. Residents are supported to manage their finances and the records are maintained. The receipts and logging records for two residents were viewed with the residents and found to be accurately maintained. Bridge House DS0000023825.V339578.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 and 30. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The residents benefit from a comfortable, homely and well maintained environment. EVIDENCE: Bridge House is a two-storey property situated in a quiet residential area of Kemsley on the outskirts of Sittingbourne. The location of the home offers easy access to local shops and other local amenities. There are regular buses and a train station within easy distances of the home. Resident accommodation is provided by five single rooms, which have been individually decorated and furnished. Communal areas comprise of a lounge, games room, poolroom and kitchen/dining room. An adequate garden is situated to the rear of the home. Bridge House DS0000023825.V339578.R01.S.doc Version 5.2 Page 18 One of the residents provided the Inspector with a tour of the home and showed the Inspector his bedroom. There are two bathrooms, one providing a bath and one a shower. Which was a great help a resident said when some one spends ages in the bath. The home is attractively decorated and the furniture is of good quality and comfortable. The maintenance of the home is good and all the necessary maintenance checks are performed regularly. The home was clean and tidy, but also homely and comfortable. There is a garden to the rear of the home with a small vegetable patch, that has not been utilised this year. Bridge House DS0000023825.V339578.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 321, 32, 33, 34, 35 and 36. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from a robust recruitment process and a dedicated and competent team of staff. EVIDENCE: The staff on duty confirmed that staffing levels were currently adequate. The rota indicated that staffing levels reflected those outlined in the Statement of Purpose. The rota allows flexibility for staffing levels to be increased or reduced according to activities and the number of residents living in the home. The home was calm and relaxed on the day of the inspection and there were sufficient staff to meet the needs of the residents. Staff training is ongoing at Bridge House and staff were positive regarding the training they received to perform their jobs. Residents are supported by staff who are competent and qualified. Staff are encouraged and supported to complete their National Vocational Qualifications. Bridge House DS0000023825.V339578.R01.S.doc Version 5.2 Page 20 Residents spoke highly of the staff team, indicating that they felt supported and understood by all staff, and were particularly satisfied with the individual support received from key workers. The Organisation have three homes and the recruitment process is the same for all three homes. The Staff recruitment files are not stored at Bridge House. As it was not possible to view the files in detail information was gained from other sources. The recruitment processes followed by the Organisation are robust. The staff confirmed that residents are involved in the staff selection process. A recent new staff member was able to discuss her introduction to the home in depth. The staff on duty informed the Inspector that they have good support from the management team and they can always get the advice or support they require. All staff receive regular formal supervisions and annual appraisals. Bridge House DS0000023825.V339578.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41, 42 and 43. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from living in home that is effectively managed and monitored. EVIDENCE: The Manager was registered by CSCI in August 2006 and has successfully completed the Registered Manager’s Award. Both staff and residents’ spoke highly of the Manager and the support he provides. The home has a number of informal systems in place to gain feedback about the service and this consists of regular resident and relative meetings, surveys sent out from the head office and the six monthly reviews of the residents. Discussion took place regarding developing a satisfaction questionnaire to be Bridge House DS0000023825.V339578.R01.S.doc Version 5.2 Page 22 carried out on an annual basis with each resident and then the results could be published for all interested parties. The home has a comprehensive range of policies and procedures in place to safeguard the residents living in the home, however not all have been subject to review and updating. This was discussed and brought to the Managers’ attention and will be attended to. Bridge House has effective systems in place for ensuring the health and fire safety of the home is maintained. The home has weekly management meetings and monthly staff meetings to ensure that there is a consistency of approach to the residents. The homes records were of a good quality and standard. Conversations with the staff, residents and the inspection of key documents indicated a management approach that is committed to positive outcomes for residents. Bridge House DS0000023825.V339578.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 4 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 3 3 3 LIFESTYLES Standard No Score 11 4 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 3 3 3 3 3 Bridge House DS0000023825.V339578.R01.S.doc Version 5.2 Page 24 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 2 3 Refer to Standard YA1 YA39 YA40 Good Practice Recommendations That the service users guide is written in a format that is suitable for the service users living in the home. That the Quality Assurance systems are further developed to include a resident satisfaction questionnaire on an annual basis. That all policies and procedures are reviewed and are upto date with current legislation. 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