Inspection on 05/11/05 for Bridge House

This inspection was carried out on 5th November 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bridge House 07/03/07

Bridge House 06/07/05

Bridge House 02/08/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Bridge House Green Hills Barham Canterbury Kent CT4 6LE Lead Inspector Nicki Dawson Unannounced Inspection 5th November 2005 09:00 Bridge House DS0000023349.V252002.R01.S.doc Version 5.0 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 DS0000023349.V252002.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 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 DS0000023349.V252002.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Bridge House Address Green Hills Barham Canterbury Kent CT4 6LE 01227 831545 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) Family Investment (Four) Limited Vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Bridge House DS0000023349.V252002.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th July 2005 Brief Description of the Service: Bridge House provides residential care for up to six adults with a learning disability. The home has recently been extended to provide accommodation for a further two residents. Once the building work has been completed, the home will then be registered to provide accommodation for eight residents. The home is situated in the rural village of Barham. A shop with a post office, village hall, bowls club and two churches are within walking distance of the home. Buses provide links to Canterbury and Folkestone. The home is on two floors and on each floor there is a bathroom with toilet and shower facilities. Four of the eight single rooms have an en-suite toilet and shower. The communal space consists of a main lounge and a kitchen/diner. Half an acre of gardens surrounds the home. Bridge House is part of a group of homes owned by Family Investment Limited. The families of each resident purchase a share interest in the property prior to admission. Families play an active role in the conduct of and care provided in the home. Family Investment offers a wide range of day services, which form an integral and significant part of the lives of the residents. There is a day centre run by the Fifth Trust in Barham and in the Elham Valley, a vineyard, teashop and pottery. People who attend Family Investment Day Care Services come from Family Investment Homes and from other parts of the community. Bridge House DS0000023349.V252002.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection commenced at 9am and concluded at 3.30pm. About half of this time was spent socialising with residents and the rest of the time was spent talking to the two staff on duty, and looking at records. Since the inspection took place at the weekend, the inspector was able to meet all of the residents. The inspector telephoned the home’s manager after the inspection to gain additional information. What the service does well: 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. Bridge House DS0000023349.V252002.R01.S.doc Version 5.0 Page 6 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Bridge House DS0000023349.V252002.R01.S.doc Version 5.0 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 DS0000023349.V252002.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 and 5 The Service User Guide needs to be finalised and a copy given to each existing and prospective resident to ensure that they are aware of the facilities and services that they can expect when living at Bridge House. Before moving to the home, prospective residents have their needs assessed and have opportunities to visit the home to ensure that it meets their needs and aspirations. EVIDENCE: The home has produced a ‘statement of purpose’ that sets out the aims, objectives and philosophy of the home, together with the services and facilities provided for residents. The statement of purpose is living document that needs constantly up dating to take into account any changes in the home and organisation. In order to be up to date, the document needs to include the name of all staff and their qualifications and to include the new manager. The home is also required to produce a ‘service user’s guide’, which clearly sets out for residents, the services and facilities that they can expect if they move to the home. The home has produced this guide in a draft format and is undergoing consultation before giving each new and existing resident a copy. The homes procedure for admitting new residents is that at the point of first contact the prospective resident is given an information pack about the service. They are then asked to complete an application form. The manager explained that staff at the Family Investment office visits the prospective Bridge House DS0000023349.V252002.R01.S.doc Version 5.0 Page 9 resident and their family to undertake an initial assessment. Additional information is gained from any professionals involved in the prospective residents care. It is the homes policy that the prospective resident is able to meet existing residents and staff and if possible, to stay at the home for a two week period. Current residents confirmed that they had met prospective residents. The manager and staff confirmed that each resident has an individual contract. Individual contracts were not available at the inspection. However, they were viewed at a previous inspection when it was noted that contain information about medical and personal requirements, religious views, complaints, pets, procedures to be taken in event of death and any particular wishes of both the resident and their family. It is recommended that each contract also contains the residents room number. Bridge House DS0000023349.V252002.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 and 10 Resident’s assessed needs and goals are reflected in their individual plan of care and are regularly reviewed by staff with the involvement of the resident concerned. Residents make choices and take informed risks as part of their every day lives. EVIDENCE: The care provided for one resident was viewed in detail, by talking to the resident concerned, through discussion with a member of staff and by looking at their care plan and daily records. Each resident has a current goal and residents are now involved in the monthly review of their care plans. Residents are encouraged to be independent and strategies to take risks are included in individual plans of care. Care plans have been reorganised to ensure that the most up to date is easily accessible to staff on a daily basis. Residents are supported to undertake tasks as independently as possible by the use of discrete prompts and unobtrusive checks. Residents were able to make a range of choices throughout the day, within the limitations of the routines of the home. They chose what time to get up, when exactly to come for lunch, what they wanted to eat for lunch and breakfast, when to spend time in their room and if they wanted to go out or spent time in Bridge House DS0000023349.V252002.R01.S.doc Version 5.0 Page 11 their home. Each time a resident made a decision about their routine, whether it was that they wanted to make a cake or collect money for charity, this decision was supported and encouraged by staff. Staff explained through discussion when it would be appropriate to share information given to them by residents with other staff or professionals. They demonstrated that there is a delicate balance between sharing information and keeping resident’s confidences and hence their trust. Bridge House DS0000023349.V252002.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17 Residents at Bridge House lead active, busy lives and are encouraged to be as independent as possible. The home needs to look at how it can enable residents to have access to a telephone in private. EVIDENCE: Each resident has a weekly programme of activities, which can include employment in the community or at the in-house vineyard, garden or café; learning skills such as pottery, art and craft and cushion making at the inhouse day centre; or leisure activities such as aerobics and swimming. Given such busy lives, it is not surprising that one resident described Bridge House as, “a place of work”. They did agree however, that they also had time to relax. In addition, residents are allocated one day a week called an ‘in-house’ day, when they carry out their own personal tasks, such as cleaning their room and doing their washing. Residents take responsibility for all household tasks and were seen, washing the car, raking the leaves, doing the washing up and getting their own meals. One resident has taken on the responsibilities of looking after a pet. Bridge House DS0000023349.V252002.R01.S.doc Version 5.0 Page 13 Residents said that they could go out at any time as long as they let staff know. For long periods during the day, the absence of a number of residents from the home was noticeable. One went to the bottle bank, another to the village shop, two went to Canterbury and others spent time in their rooms. At the previous inspection it was observed that residents were unable to make telephone calls in private. This is because the resident’s telephone is located in a corridor by the stairs and next to a newly built bedroom. The home have yet to submit a plan of action to the Commission for Social Care Inspection detailing how residents can make telephone calls in private. Residents take turns in choosing and preparing the main meal of the day. If residents do not like something on the main menu, they are able to choose an alternative and this is appropriately recorded. Residents who opt for a healthier diet are supported to do so. The inspector shared lunch with the residents. Lunch was very relaxed with jovial conversation and residents came and went as they pleased to fit in with their own activities. Bridge House DS0000023349.V252002.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Resident’s physical and emotional health is promoted. Not all residents are protected by the home’s policies and procedures for administering medication. EVIDENCE: Staff discretely ensure that the person care needs of residents are met, giving prompts and support only when required. It was observed that times for getting up, meals, and activities are flexible within the routine of the home. Resident’s health needs are monitored and clear records are kept of all medical appointments. Staff communicated with residents positively, giving emotional support. Selected aspects of the recording and administration of medications was inspected. Staff knew the correct procedure for administrating medication i.e. checking that the resident takes the medication that is administered to them and signing the medication administration record (MAR) immediately after the event, but did not follow it on this occasion. There were a number of errors and conflicting information on the MAR sheets, which could seriously put the health of residents at risk. Firstly, two MAR sheets with the same dates were being used simultaneously and staff were recording different outcomes on each. Secondly, gaps were left on the administration records, making it unclear whether the correct medication had been administered. Thirdly, one staff Bridge House DS0000023349.V252002.R01.S.doc Version 5.0 Page 15 recorded that they had administered medication that had been discontinued. Lastly, the frequency of administration had been tippexed out in respect to one medication and another frequency added, without any authorisation. A list of these concerns was left at the home on the day of the inspection and the manager was contacted four days after the inspection. The manager said that she was looking into these errors and it was requested that she write a full report of her findings to the Commission for Social Care Inspection (CSCI). The home’s policy and procedure on the administration of medication was generally good, but needs to include some additional procedures. These details are in the statutory requirements section at the end of this report. Bridge House DS0000023349.V252002.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Residents feel that their points of views are listened to taken seriously. The home is beginning to put systems in place to ensure that residents are protected from abuse. EVIDENCE: Residents said that if they had any concerns that they would talk to a member of staff and that staff listened and acted upon their concerns. Staff said that they would try to resolve any minor complaints. If they could not be resolved or if the complaint was of a serious nature, staff said that they would record the details and pass them onto the manager. The home has a comprehensive complaints policy that is on display in the home. Staff demonstrated that they would challenge and report suspected abuse and are due to attend training on adult protection to widen their knowledge base. The home has written policies on adult protection and the prevention of abuse, including the ‘whistle blowing’ of members of staff. However, the adult protection policy does not make it clear that the social services department is the lead agency in the investigation of suspected abuse or give details of the circumstances in which it may be contacted or it’s contact number. There are additional policies on dealing with aggression and physical intervention and what to do if a resident goes missing. Bridge House DS0000023349.V252002.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26 and 30 Bridge House continues to provide a comfortable, clean and homely environment for the residents who live there. EVIDENCE: Bridge House provides a comfortable environment for residents and the furnishings and fittings of the home are of good quality. The home is situated with good access to the local community. One resident’s room was viewed and it was furnished and decorated according to the resident’s needs and preferences. Two of the current residents plan to move to the newly extended rooms. They were proud to show their new rooms and look forward to day when they can move in. The home was clean throughout on the day of inspection. Staff were knowledgeable about how to minimise the spread of infection and stated that all staff have recently undertaken training in infection control. Bridge House DS0000023349.V252002.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 and 33 Residents’ benefit from being supported by competent staff who have good communication skills. EVIDENCE: The staff team consists of a newly appointed manger (who manages another residential care home in the locality) a senior carer and care support staff. There is a minimum of one member of staff in the home at all times, rising to two members of staff at some periods. One person is on call at all times. Staff demonstrated throughout the day that they were good listeners, understood residents motivations and behaviours and that they promoted residents independence and boasted their confidence. One resident’s face glowed when they received high praise and another resident admitted, “I know you only care about me”, when they were encouraged to take part in an activity to their benefit, that they were reluctant to undertake. Bridge House DS0000023349.V252002.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39, 40, 41 and 42 Residents’ views about the home are actively sought and acted upon. Systems are in place to ensure as far as reasonably practicable, the safety and welfare of residents and staff. EVIDENCE: Bridge House DS0000023349.V252002.R01.S.doc Version 5.0 Page 20 The home uses various methods to gain the views of residents, staff and stakeholders about the quality of care provided at Bridge House. The home receives monthly visits from the registered provider. These are recorded and provide comprehensive information about staffing and residents’ issues, the buildings, maintenance work and health and safety. Staff meetings are held and the home’s policy states that there are shareholders meetings and an annual general meeting. Residents said that their views were sought and listened to during regular meetings and in addition they had recently completed a quality service questionnaire. A plan of action had been made for each suggestion made by a residents in the quality service questionnaire. A selection of policies and procedures were sampled and some statutory requirements were made in respect of the policy on the administration of medication and adult protection. Staff said that the homes policies and procedures were accessible and that they dipped into them from time to time and when necessary. Records that staff used on a daily basis were available to staff and those records that were confidential were appropriately locked in the absence of the home’s manager. Before a resident is admitted to the home the resident’s relative signs a consent form that information about a resident may be disclosed to other staff members. It is recommended that this consent be extended to cover other relevant professionals in line with the Data Protection Act. At the last inspection the home’s maintenance records were checked and were up to date. On this occasion the record of fire checks was inspected and had been appropriately completed. The home has a valid insurance certificate, keeps monthly accounts and produces an annual report of accounts. Bridge House DS0000023349.V252002.R01.S.doc Version 5.0 Page 21 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 x 3 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 x 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x 3 x x x 3 LIFESTYLES Standard No Score 11 3 12 4 13 3 14 4 15 2 16 3 17 Standard No 31 32 33 34 35 36 Score x 3 3 x x x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Bridge House Score 3 3 1 x Standard No 37 38 39 40 41 42 43 Score x x 3 3 3 3 3 DS0000023349.V252002.R01.S.doc Version 5.0 Page 22 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 4 schedule 1 (3) 16 (2) (b) Requirement Timescale for action 05/03/06 2 YA15 2 3 YA15 YA20 16 (2) (b) 13 (2) The registered person should ensure that the Statement of Purpose is up dated to include the number and qualifications of all staff employed in the home The registered person must write a plan of action and send this to 06/09/06 the Commission for Social Care Inspection (CSCI) detailing how residents can access a telephone in private Revised to: 05/01/06 The registered manager must 30/11/06 investigate the errors made in the administration of medication and detail the action taken to ensure that all staff are competent in the administration and recording of medication; and send a copy of the outcome to the CSCI The registered person should 05/01/06 ensure that the policy on the administration of medication includes the procedure when: There is an error in the administration of medication; A resident is absent from the home at the time when medication needs to be DS0000023349.V252002.R01.S.doc Version 5.0 4 YA20 13 (2) Bridge House Page 23 5 YA23 13 (6) administered; A GP changes a resident’s medication verbally The registered manager must ensure that the home’s policy on the protection of vulnerable adults sets out the circumstances and procedure for contacting the local social services department 05/02/06 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 YA5 YA35 YA41 Good Practice Recommendations The registered person should ensure that the room number for each resident is included in their statement of terms and conditions. The registered person should ensure that all staff induction training is accredited by the Learning Disability Award Framework The registered person should gain written consent from each resident or their representative before they enter the home that sensitive personal data will be accessed by relevant professionals Bridge House DS0000023349.V252002.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU 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. 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