Inspection on 08/05/07 for Bridge House

This inspection was carried out on 8th May 2007.

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 22/06/06

Bridge House 26/10/05

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 Key Unannounced Inspection 8th May 2007 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.V333395.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bridge House DS0000033427.V333395.R01.S.doc Version 5.2 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 www.enfield.gov.uk London Borough of Enfield Ms Ruby Chung Care Home 39 Category(ies) of Dementia - over 65 years of age (39) registration, with number of places Bridge House DS0000033427.V333395.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28 February 2007 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 thirty-nine people who are over the age of 65 and have dementia. There is a car park at the front of the building and a raised area planted with shrubs. The home comprises of three storeys. There are nineteen single bedrooms and eight shared bedrooms located on the upper floors. These are accessed by lifts. There are three lounges, a kitchen and a dining room on the ground floor. There is a safe enclosed garden at the back of the home. The entrance to the home is protected by an intercom system and closed circuit television. A coded keypad is used to exit the building. The fees for the service are £623 per week. At the time of this inspection there were thirty-four people living at Bridge House with another person expected on the day of the inspection. Following “Inspecting for better lives” the provider must make information available about the service, including inspection reports, to service users and other stakeholders. Inspection reports produced by the Commission of Social Care Inspection (CSCI) are available upon request from the registered manager/provider. Bridge House DS0000033427.V333395.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on 8 May 2007. The inspector did not tell anyone she was coming. She stayed at the home for seven hours. During the day, the inspector: • • • Talked to four staff Talked to the people who live at the home Checked up on all the requirements made at the last inspection to see if they had been completed (these were improvements that Enfield Council and the manager of Bridge House had to do to make sure the home complies with the Care Homes Regulations 2001 and the National Minimum Standards for care homes for older people. used information provided by the manager in a questionnaire to help with the inspection. spent time observing people in the lounges, at mealtimes and their interactions with staff. studied four people’s care plans in detail. Examined medication, with regard to record keeping and the way it was being administered. toured the building including all communal rooms and a random sample of bedrooms. Inspected staff files examined a selection of the home’s records, policies and health and safety records sampled the food served at the home and inspected the menus and discussed the food with four people living there and one staff member. • • • • • • • • Bridge House DS0000033427.V333395.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: At the last inspection of Bridge House on 28 February 2007, eight requirements were made. These were actions that Enfield Council and the manager of the home needed to take in order to provide better care to people at the home and to comply with the Care Homes Regulations 2001. Six of these requirements had been met and two had not been fully met. Bridge House DS0000033427.V333395.R01.S.doc Version 5.2 Page 7 Two 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. A review of staffing levels was carried out after a requirement was made to do so at the last CSCI inspection, but this did not result in increased staffing levels. It was evident to the inspector that staff on duty were busy helping people with basic care such as feeding, washing and using the toilet and there was little time for them to spend more “quality” time with them. This same observation was made at previous inspections. Medication at the home is not being properly monitored and therefore people are at risk of not having their medication needs met. Requirements made at the last inspection regarding improving medication practice have not been properly met. A requirement was made in February to investigate why a resident was not given her prescribed pain relief medication for three days, report the outcome to the CSCI, including what action has been taken to ensure this does not happen again. Although the manager responded that this was investigated, the action taken to prevent this happening again was not being carried out properly (frequent monitoring of medication records by the management team). Although Enfield Council has made positive improvements to the home for the benefit of residents in the past few years, eg wheelchair accessible toilets, improved security and now some new flooring, these have mainly been as a result of requirements made at CSCI inspections. It is important that the Council take responsibility for maintenance and updating the home as needed without CSCI involvement. To this effect, a requirement is made that a maintenance and renewal and decoration plan is made and implemented. The inspector is confident that Enfield Council will meet this requirement. Seven new requirements made as a result of this inspection were; to ensure staff references are authenticated before allowing them to work at the home, to ensure any potential resident’s needs are assessed before s/he moves into the home, to keep a record of all health appointments as evidence that people’s health needs are being met, to investigate why a resident did not receive prompt hospital treatment after an accident, to devise a maintenance plan for the home, to provide evidence that the home has passed an inspection of its electrical installation and to provide information about how the Council safeguards residents’ financial interests. A recommendation is made to assess the food preferences of all residents who are from a different ethnic minority group and ensure their preferences are provided to them. Bridge House DS0000033427.V333395.R01.S.doc Version 5.2 Page 8 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 DS0000033427.V333395.R01.S.doc Version 5.2 Page 9 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.V333395.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Generally, the home ensures an assessment of a potential resident’s needs is carried out before they move into the home. A recent failure to do this for one resident means this person cannot be satisfied that his/her needs can be met. The home therefore needs to improve the current system to ensure all potential residents are assessed before admission. EVIDENCE: To assess this area, the inspector requested the assessment for one person who had moved into Bridge House recently, in March 2007, and three other residents’ assessments. The manager had recorded some information on the new person’s needs supplied by her relative but no formal assessment had been carried out Bridge House DS0000033427.V333395.R01.S.doc Version 5.2 Page 11 including no risk assessment. This person had transferred from another Enfield council home yet no written information had been passed over. This was of concern. A full assessment is expected to be in place and a requirement is made that the home undertake this without further delay. The other three people had a full assessment of their needs in place on their files. The home does not, and is not equipped to , provide intermediate care. Bridge House DS0000033427.V333395.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s needs are reflected in comprehensive care plans and the standard of personal care they receive is good. People are treated with dignity and respect. Health records need to be improved as evidence that everybody’s health needs are being met. There continues to be insufficient monitoring of medication records and this is of concern as it leaves people at risk of their medication needs not being met. EVIDENCE: To assess these standards the inspector looked at the personal file of four people living at the home These were a new resident, a person with high dependency care needs, a person from a minority ethnic group and somebody who had lived in the home for two years. Bridge House DS0000033427.V333395.R01.S.doc Version 5.2 Page 13 The new resident had no care plan. A requirement is made to ensure this is carried out without further delay. The other three files had an assessment of their needs and a care plan advising staff on how to meet their identified needs. The care plans were comprehensive. Cultural, dietary, religious and language needs were recorded where appropriate for that individual. The care plans are reviewed on a monthly basis. The last review in the files was carried out in March 2007 and the senior on duty said that the reviewed for Aril 2007 had also been carried out and were waiting to be filed. Relatives have the opportunity to be involved in a monthly review of the care plan and to say if changes are needed. In three of the four files seen, a relative had signed a form stating whether or not they wanted to be involved. This is positive. The inspector looked at the health records for each of the four people she had chosen to study plus for one other person who had high care needs. Appropriate pressure care equipment such as cushions and pressure relief mattresses were in place where identified in the care plan as needed. Pressure care records had improved as a result of a requirement made at the last CSCI inspection. One person was being turned at night to reduce the risk of him/her developing pressure ulcers and the inspector saw that night staff were recording on a chart when the person had been turned during the night. Three of the four people whose files were examined had detailed risk assessment relating to their individual needs addressing risks such as falling, depression and financial abuse. Health appointment records are kept in the home office rather than personal files. This is so that managers can keep an overview of people’s health needs and appointments. The chart in use for recording health appointments was not up to date in all files and although it was possible to see from records that people had been to hospital appointments and been visited by the GP and or district nurse, some health appointments could not easily be located. The senior on duty told the inspector that a dentist visits the home twice yearly and optician on request. These appointments need also to be recorded on the health appointments sheet as a record of evidence that people’s health needs are being met and a requirement is made to ensure all health appointments are recorded and then transferred to personal files. On person’s toenails were observed to be very long and it was not possible from the records available to easily check when they had last been attended to. Staff agreed to attend to this person without delay. • To assess medication standards, the inspector observed part of the breakfast and lunchtime medication round, discussed medication with the senior on duty and the worker who was administering medication DS0000033427.V333395.R01.S.doc Version 5.2 Page 14 Bridge House • • • • and inspected a sample of medication records. At the previous inspection of this home on 28 February 2007, four requirements were made regarding medication practice as the following concerns were found by the inspector. A requirement to keep accurate records was repeated as there were instances of medication not being given and no explanation recorded. One person’s prescribed pain relief medication had not been given for three days and the senior on duty said that the stock of medication had run out. This is a very serious matter and may have caused this person unnecessary pain/discomfort and had not been reported to the CSCI. Inspection of one service user’s medication showed two tablets from a course of antibiotics missing. This could have had serious consequences for her health should the course not be completed. One tablet was later satisfactorily accounted for but the other remained missing with no explanation. It took one staff over three hours to complete the morning medication round. Each medication sheet stated that medication is given at 8.30am when some did not receive theirs until 11.30am. This practice should be reviewed and a risk assessment carried out. The manager reported to the inspector after that inspection that managers had introduced more regular monitoring in order to check the medication records up to four times a day to ensure these were completed accurately. Insufficient information was supplied to the inspector to account for why two people had not received their prescribed medication. It was also reported to the inspector during this inspection that the medication round now begins earlier at 8am for those people who need their medication at this time and that the trolley is taken around to people in their bedrooms which also means people receive their medication quicker. The inspector followed up all the above reported actions during this inspection. The medication records for four residents were inspected and checked against information from their care plans. One person’s medication had not been signed for the day before this inspection,. It was found that although the monitoring forms had been introduced, the managers were not using them properly. Six days of monitoring forms were inspected. On three days, the medication records had been checked once and on the other three, not at all. Therefore there was inadequate monitoring of medication records to ensure people were receiving their medication as prescribed. On the day of the inspection, the medication round again took three hours. The home’s assessment of staffing needs does not address this. The inspector did observe good practice by the staff member giving medication in that they always offered a drink with the medicine and explained to each person what they were doing and how to take the tablets where appropriate. Bridge House DS0000033427.V333395.R01.S.doc Version 5.2 Page 15 The inspector observed some people having breakfast and lunch (two sittings) and observed staff resident interaction in the lounges, office and corridors. She noted that staff addressed people with dignity and respect at all times. Some people were addressed by their first name or a chosen alternative name and some as Mr X according to their preferences. It was noticed that staff explained what they were doing at all times and were caring. The person and their relatives’ prefences for arrangements in the event of illness or death were clearly specified in four care plans. Bridge House DS0000033427.V333395.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 People using the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. There are some examples of good practice in meeting individual social needs but the majority of residents have limited opportunities for taking part in activities in or outside the home. People are encouraged to maintain contact with their families who are welcomed into the home. EVIDENCE: To assess these standards the inspector looked at four people’s care plans and daily records, activity records and menus. She also spoke with two care staff, one manager, three residents of the home and the cook. Two mealtimes were observed along with short periods of observation of four residents plus periods of observation of two of the four lounges to see what activities and interaction were taking place. Bridge House DS0000033427.V333395.R01.S.doc Version 5.2 Page 17 Although there have been no planned outings for a few months, the home has planned trips out starting in June. These were displayed on the wall in the entrance hallway. The planned trips are to Southend (two trips), Lakeside shopping centre with lunch out and dinner at Whitewebbs pub. These trips are once a month. There is no trip in July. One person told the inspector that he had enjoyed trips in previous years to Southend, Lakeside and a boat trip on the River Lea. The home is holding a fete in July. In the home there is one staff member allocated to undertake activities for one hour in the morning and another hour in the afternoon. This person may plan a group or individual activity. In practice, there is little stimulation or activity offered. The inspector is of the view that this is not due to staff not being willing, but due to the high care needs of residents which means staff spend their time helping people with using the toilet, dressing, eating, etc and have no time to sit and talk with residents or engage in activities with them. This was also noted at the last two inspections of Bridge House and a requirement was made at the last inspection to review staffing levels. Unfortunately this review did not result in increased staffing. People’s hobbies and interest were recorded in their care plans but the more dependent people received little stimulation or quality time other then that spent on their personal care. Between meals the inspector noted that the majority of people had contact with staff only for care tasks such as medication or going to toilet. One person told the inspector that he visits his club regularly and that the home supports him to take part in his chosen hobbies. Also, this person has a friend to visit every week and they eat lunch together in his room. This is a positive example of how the home supports individual needs. This person said that the manager always responds to any requests he makes. The majority of people are much less able to ask for their social and leisure needs to be met. Newspapers and magazines were available and those who could read them were seen to do so. People are allowed to walk freely around the home and garden if they are able. There is a sensory room available. One person had recently been escorted to an appointment by staff who then took her to a café which was apparently very much enjoyed. A large number of people have had not had the opportunity to leave the building for some months. This was discussed with one of the senior staff who said that once the weather was warm staff would be encouraged to take people for a walk in the local park. Those who are able to go out with family or friends re encouraged to so. The home supports the residents in maintaining contact with their families and friends which is very positive and families are included in care plan reviews if they would like to be. The inspector saw that relatives are listened to and respected. Only one person manages their own finances but people are encouraged to make their own decisions where they re able for example on what to wear and Bridge House DS0000033427.V333395.R01.S.doc Version 5.2 Page 18 what to eat, etc. The inspector noted that for two people their clothing preferences as recorded in their care plans matched the clothes they were wearing. Staff allow people to walk around as they wish and were seen to be always listening to people and respecting what they were saying. Two weeks of the four week menu was examined and the inspector observed breakfast and lunch. The inspector spoke with the cook and three residents about the food. The majority of people were not easily able to discuss their food preferences due to communication difficulties associated with their dementia. The inspector tried to speak with three people from different ethnic groups to ask about their food preferences but they were able to give limited information. One of their care plans did include that they did not eat pork for religious reasons and staff were aware of this. A recommendation is made to serve food appropriate to the cultural backgrounds of these people to assess their preferences if this assessment has not been done prior to their admission to the home. On the day of the inspection the menu stated that lunch was beef casserole or vegetable lasagne. The lunch served was beef casserole and tinned ravioli. This was served with mashed potato and fresh vegetables. Apple pie and custard was served for dessert. The cook said that all desserts were suitable for diabetic people as no sugar was put in. The majority of people appeared to enjoy their lunch. Eight people had liquidised meals and need to be fed. Breakfast is served throughout the morning and some were eating breakfast at 11.15am. Lunch is served at 1pm in two sittings. The inspector was informed that tea is served at 6pm then snacks are available throughout the evening so that there is not a long interval between supper and breakfast. The senior on duty said that night staff also made hot drinks and sandwiches for people as requested. Tea on the day of the inspection was to be beef burgers and spaghetti hoops. It was not clear whether any fruit or vegetables would be offered. Four people were asked for their views on the food. One said “beautiful” another said “it’s alright” and the other two said they sometimes liked the meals. Bridge House DS0000033427.V333395.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home listens to its’ residents and responds to complaints made. Staff are trained in safeguarding vulnerable adults which helps to protect residents from abuse. It is of concern that a resident was recently injured and did not receive the appropriate care promptly. This needs to be investigated and remedial action taken in order to safeguard other residents from risk of neglect of their medical needs. EVIDENCE: A pre-inspection questionnaire completed by the manager reported that there were two complaints in the last year. The records of these complaints were inspected. The complaints were both minor and had been resolved. One resident told the inspector that the manager always takes complaints seriously however minor they may seem and always listened to any suggestions for improvements. There has been one safeguarding adults investigation where concern had been raised about the standard of care given to a former resident of Bridge House. The investigation concluded that Bridge House had offered a good standard of care to this person. Bridge House DS0000033427.V333395.R01.S.doc Version 5.2 Page 20 Staff have attended training in the protection of vulnerable adults so that they know what to do if they suspect a resident had been abused. The inspector saw that one person living at the home had sustained a fracture and looked at the records pertaining to this accident. It was evident from the records that this person was injured in a fall but had not received hospital treatment until two days later. This is not acceptable. A requirement is therefore made that the registered persons must investigate why this resident injured in fall did not receive hospital treatment promptly and report the outcome to CSCI. Bridge House DS0000033427.V333395.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 People using the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable environment which has improved over recent years to the benefit of residents. The home is kept clean and hygienic. A maintenance and redecoration programme would benefit residents even further. EVIDENCE: The home has twenty-five single bedrooms and seven shared rooms. Currently four people are sharing by choice and the other shared rooms are used as single rooms which is positive. Bridge House DS0000033427.V333395.R01.S.doc Version 5.2 Page 22 As result of a requirement made at the last inspection in February 2007, Enfield Council had replaced the flooring in the ground floor lounges and alcoves. The new laminated type flooring greatly improves the appearance and the hygiene of these rooms. Staff have purchased new cushions and blankets which help to improve these lounges even further. The rooms now appear homely and pleasant to sit in. These residents who were able to communicate an opinion, indicated that they liked the new flooring. The dining room is in need of redecorating due to stained and in places torn wallpaper. The manager has requested money to carry out this decoration. It is of concern that he majority of the improvements made to the building in the last few years have been as a result of requirements made by the Commission of Social Care Inspection. It is important that Enfield meet the requirement to devise a maintenance and refurbishment plan for the home rather than respond to requirements made from CSCI. The level of hygiene in the home was very good. All areas seen was cleaned to a high standard. Staff follow infection control procedures and wear protective aprons and gloves when needed. There are suitable laundry facilities. Bridge House DS0000033427.V333395.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 People using the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in this home benefit from trained well supervised staff. They would benefit from a better quality of life if staffing levels increased to enable staff to spend time talking with residents and engaging them in activities. The supervision and recruitment of staff generally protects residents but improved practice regarding staff references would further protect people. EVIDENCE: The inspector looked at staffing levels and at the reviews of staffing levels recently carried out by the manager. The staffing review does not take into account the general supervision requirements of the residents, the time taken each shift in giving out medication and need for time spent with people on activities or conversation. Observation were made at the previous inspection about staffing level allowing insufficient time to spend with people other than on care tasks and no improvement has been made since then. Bridge House DS0000033427.V333395.R01.S.doc Version 5.2 Page 24 There are seven care staff on duty in the morning and five in the afternoon. One of the four managers is always on duty to supervise and assist as necessary. A requirement is made to review staffing levels again. Staff training records were inspected for three staff. It was evident that staff were provided with the required training in moving and handling people, dementia, protection of vulnerable adults, fire safety awareness and medication. All three had an induction and probationary period and it was noted that two of the three had their probation extended due to concerns about their practice. This is evidence that the management team are monitoring staff performance carefully. Staff supervision had taken place recently for the three staff whose records were inspected and had taken place on a regular basis. The service manager monitors staff supervision records regularly and reminds the management team to ensure all staff receive supervision on a regular basis. On the day of the inspection, two new agency staff were working. The home had a number of vacancies and the use of agency staff puts extra pressure on other staff. Both staff said they were following he guidance of the experienced staff on duty and were observed to be treating residents with courtesy. It was also noted by the inspector that the management team were asking the agencies by telephone to provide staff known to this home rather than new staff. Inspection of the recruitment records relating to a sample of staff showed staff have a CRB check and two references in place before starting work. Two staff files showed Enfield had not received a reference from their last employer before employing them. There was no record on their file as to why a last employer reference had not been received nor evidence that the references on file had been verified as authentic. A requirement is made on this issue. Bridge House DS0000033427.V333395.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The manager is competent and experienced and is regarded as approachable. The home is monitored by the provider, Enfield Council and is run in the best interests of residents. Health and safety of residents and staff is promoted. EVIDENCE: The manager of the home was not present for this inspection but the inspector was able to talk with her on the phone during the day. She has managed this home for a number of years and is suitably qualified and experienced to do so. Bridge House DS0000033427.V333395.R01.S.doc Version 5.2 Page 26 One of the residents told the inspector how approachable he found the manager and that she was very responsive to any requests he makes. The manager informed the inspector that she was in the process of completing a quality assurance audit for the home and would send a copy of this to the CSCI once completed. She reported that twenty-three questionnaires had been received back from people giving views on the service provided which is very positive. The home is inspected in accordance with Regulation 26 of the Care Homes Regulations 2001 each month by a service manager from Enfield Council. Her reports are comprehensive and include interviews with both staff and residents to ask for their views on the home. There is an open approach and all four members of the management team play an active role in caring for the residents as well as supervising staff. Only one of the current residents is able to manage their own financial affairs. The manager reported that two are subject to power of attorney and two are under a guardianship, though this was not verified by the inspector. The majority of residents have their money managed by family members. The inspector was informed that Enfield Council look after the money of a small number of residents at Bridge House. These arrangements were not inspected in detail but from information given verbally it was not clear whether or not the arrangements complied with the Care Homes Regulations and National minimum standards so a requirement is made to provide CSCI with further information on this issue. Residents’ financial records were not inspected on this occasion. Health and safety records were inspected and a tour of communal areas was undertaken to look at health and safety matters. A number of people living in this home need a hoist to help them move from wheelchair to armchair, chair to bed,e tc. Staff have been trained to use the hoists and the hoists have been serviced regularly. The inspector observed care staff using the hoist and saw that they used it safely. The call system in the home was replaced on September 2006. The records of safety inspections for the electrical wiring, gas appliances, hoists, lift, portable electrical appliances, fire alarm and emergency lighting were all checked by the inspector. With the exception of the electrical wiring, all these had been assessed as safe and were not yet due for the next inspection. . The electrical wiring inspection certificate stated that the result of the last inspection in 2005 was unsatisfactory and remedial work was to be carried out. There was no written evidence that the work was carried out and another inspection undertaken to assess the electricity as satisfactory so a requirement is made to do so. Bridge House DS0000033427.V333395.R01.S.doc Version 5.2 Page 27 A tour of the ground floor was carried out and no health and safety hazards were observed. Bridge House DS0000033427.V333395.R01.S.doc Version 5.2 Page 28 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 2 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 2 Bridge House DS0000033427.V333395.R01.S.doc Version 5.2 Page 29 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 OP3 Standard Regulation 14 Requirement Timescale for action 30/06/07 2 OP8 13(1)(b) 3 OP9 13(2) The registered persons must ensure that an assessment is made of potential residents’ needs and confirm that the home can meet their needs before they move in. Any current resident without an assessment of their needs must have this carried out with them and a copy placed on their file and read by all staff. The registered persons must 30/06/07 keep a record of all health appointments as evidence that people’s health needs are being met. 14/06/07 The registered persons must ensure that the administration of medicines is accurately recorded. This requirement is restated. Previous timescales of 31/07/06 and 30/03/07 not met . An action plan stating how the home will ensure people receive their prescribed medication must be sent to CSCI. Bridge House DS0000033427.V333395.R01.S.doc Version 5.2 Page 30 4 OP27 18(1)(a) The registered persons must undertake a review of the current staffing levels in this home, using a recognised formula, and send a copy of the review to the CSCI. The review must consider the need for general supervision of service users, activities, the time needed to administer medication and night care needs. This requirement is restated. Previous timescale of 30/04/07 not met. The registered persons must investigate why a resident injured in a fall did not receive hospital treatment promptly and report the outcome to CSCI. The registered persons must devise and implement a written programme of routine maintenance, renewal and decoration and send a copy to the CSCI. The registered persons must ensure that all staff are thoroughly vetted before commencing work in the home, this must include confirming that references are authentic. The registered persons must inform the CSCI of how they are meeting national minimum standard 35 and safeguarding residents’ financial interests for those residents whose finances are managed by Enfield council. 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 DS0000033427.V333395.R01.S.doc 30/06/07 5 OP18 13(1)(b) 37 30/06/07 6 OP19 23 30/08/07 7 OP29 19(1)(c) schedule 2 30/06/07 8 OP35 20 30/07/07 9 OP38 23 30/06/07 Bridge House Version 5.2 Page 31 electrical installation is safe and satisfactory. A copy of this written confirmation must be sent to CSCI. 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 The food preferences of all residents from different ethnic communities should be assessed and the home should ensure these preferences for different cultural food are provided. Bridge House DS0000033427.V333395.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bridge House DS0000033427.V333395.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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