Inspection on 08/09/05 for Bridge House

This inspection was carried out on 8th September 2005.

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 found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bridge House 04/12/08

Bridge House 08/01/07

Bridge House 15/02/06

Bridge House 14/03/05

Bridge House 22/09/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Bridge House 2 Bridgwater Road Taunton Somerset TA1 2DS Lead Inspector David Kidner Unannounced 8 September 2005 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 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 Stationary 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 D53_D02 S39957 Bridge House V244122 080905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Bridge House Address 2 Bridgwater Road Taunton Somerset TA1 2DS 01823 331712 01823 353691 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Home First & Foremost Ltd. Miss Sarah Louise Fry Care Home - PC Only 11 Category(ies) of 1. Learning disabilities (LD) - 11. registration, with number of places Bridge House D53_D02 S39957 Bridge House V244122 080905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection 14 March 2005 Brief Description of the Service: Bridge House is a large property located within walking distance of Taunton town centre. Service user accommodation is provided over two floors. All service users bedrooms have an en-suite bathroom. There are two lounges, a dining room and kitchen within the home. The garden, to the rear of the property is an attractive space made secure and accessible for service users. The Registered Manager is Sarah Fry and the Registered Provider is Voyage Ltd. Bridge House is registered with the Commission for Social Care Inspection to care for up to eleven people with a learning disability. Bridge House D53_D02 S39957 Bridge House V244122 080905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Unannounced Inspection took place over one day (5hrs). The Inspector would like to thank the service users and the staff team for making the Inspector welcome at the home. The Inspector viewed most parts of the home, viewed records in relation to care and support plans, health and safety and medicines records. The Inspector did not speak to all the staff team as they were closely supporting the service users. The Inspector observed the staff team interacting with service users in a professional, caring and sensitive manner. As a result of this Inspection the home had three requirements and three recommendations. The three requirements related to one particular standard. What the service does well: What has improved since the last inspection? The home has worked towards meeting the recommendation made at the last Inspection. The Inspector has spoken to the Registered Manager who has acknowledged as to how this recommendation can be further improved. Bridge House D53_D02 S39957 Bridge House V244122 080905 Stage 4.doc Version 1.40 Page 6 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. Bridge House D53_D02 S39957 Bridge House V244122 080905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Bridge House D53_D02 S39957 Bridge House V244122 080905 Stage 4.doc Version 1.40 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 standard(s) These standards were not assessed, as there have not been any new admissions to the home since the last inspection. EVIDENCE: Bridge House D53_D02 S39957 Bridge House V244122 080905 Stage 4.doc Version 1.40 Page 9 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 standard(s) 6 7 9 10 The home has detailed care plans that have been regularly reviewed. The risk assessments are very detailed and are regularly reviewed. Service users are encouraged to make decisions as much as possible. EVIDENCE: The Inspector viewed two care plans. Both care plans were very detailed and comprehensive and had been recently reviewed and signed by the Registered Manager. Annual reviews by the placing authority have also recently taken place. The care plan files included a personal profile, records of health care professionals contacts, management of behaviours and monthly summaries. The care files also contained very detailed risk assessments. Risk assessments have been reviewed. Service users are encouraged to make decisions wherever possible. These include decisions relating to clothing, meals and activities. The behaviours of some service users at Bridge House may at times necessitate restrictions to their liberty. Such issues are detailed in individual care plans. Bridge House D53_D02 S39957 Bridge House V244122 080905 Stage 4.doc Version 1.40 Page 10 The home has a Data Protection policy. All documents relating to service users are stored securely, in accordance with the Data Protection Act 1998. The storage of all documents seen was in keeping with this. Bridge House D53_D02 S39957 Bridge House V244122 080905 Stage 4.doc Version 1.40 Page 11 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 standard(s) 13 14 The home strives to provide appropriate activities for all the service users that live at Bridge House. The home could improve the systems for recording these activities. The home offers service users a holiday or day trips out based on individual need. EVIDENCE: The Inspector had detailed discussion with the Senior Carer in relation to service users being offered appropriate activities, accessing community facilities and accessing leisure activities. Service users all achieve some community-based activities. However, this will vary considerably; examples of service users involved in tennis lessons, rambling and trips to shops and pubs were in evidence. Some “therapists” come into the home to offer music, massage, creative play, or for activities supported by permanent staff in the home. At the previous inspection conducted on the 14th March 2005 the Inspector strongly recommended that a weekly programme of activity is formulated for Bridge House D53_D02 S39957 Bridge House V244122 080905 Stage 4.doc Version 1.40 Page 12 each service user and recording systems develop which can report and analyse the extent to which this has been delivered. It appears that the home have introduced a recording system for activities on the “day-to-day” records. The Inspector sampled a variety of day-to-day records with the Senior Carer. It appeared that activities are not being fully recorded in the designated place. This can provide misleading information and not demonstrate good care practices. It was also unclear what constituted an activity. From records viewed it was not clear if all service users have had a weekly activity programme developed. It is again strongly recommended that a weekly programme of activities be developed for each individual service user with clear recording systems and analysis undertaken. Four service users were on holiday in Brittany at the time of the inspection, five care staff accompanied them. The Inspector was advised that some service users would only benefit from short breaks or day trips. The home ensures that all service users are offered holiday opportunities. Bridge House D53_D02 S39957 Bridge House V244122 080905 Stage 4.doc Version 1.40 Page 13 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 standard(s) 18 19 20 The home offers a high degree of privacy and care plans reflect the manner in the way service users prefer to be supported. The home ensures that service users have access to appropriate healthcare professionals. EVIDENCE: The home is able to ensure very high levels of privacy to service users as direct personal care is only given in the privacy of their bedrooms, which are all en-suite. Service users are enabled to voice preferences, or indicate preferences in whatever manner they choose and this is respected. The Inspector witnessed care staff responding in a professional and discreet manner when service users needed support with their personal care. All service users have an allocated key worker. There was evidence that staff are proactive in involving multi-disciplinary healthcare professionals, including appointments with physiotherapists, GPs, Speech and Language therapists, Dentist, Optician and Consultant Psychiatrist and Psychology Services. Records are kept of all consultations. The Inspector discussed the administration of medicines with the Senior Care Assistant. The home operates a Monitored Dosage System. A Community Pharmacist advice visit was conducted on the 09/03/05. All service users require support in keeping and administering their medication. The Inspector Bridge House D53_D02 S39957 Bridge House V244122 080905 Stage 4.doc Version 1.40 Page 14 viewed the MAR sheets. These records were very well maintained. The variable dose for a medication was not clearly recorded due to the MAR sheet format. It is recommended that this be addressed. Bridge House D53_D02 S39957 Bridge House V244122 080905 Stage 4.doc Version 1.40 Page 15 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 standard(s) 22 23 The home has a robust Complaints Policy. The home must ensure that behaviour intervention plans are developed to address challenging behaviours and to ensure that staff receive training in physical intervention. This will promote health and safety for service users and the staff team and ensure that service users are protected. EVIDENCE: Voyage has a Complaints Policy and Complaints record. However, the Inspector did not view the complaints record at this visit. The home has a Whistle Blowing Policy and a policy relating to the Protection of Vulnerable Adults. The Inspector noted when viewing one service users’ behavioural management guidelines that as a last resort the individual might need to be restrained. It appears that staff have not received formal training in the use of breakaway techniques and physical intervention. The behaviour management guidelines care plan did not identify the specific breakaway/physical intervention technique to be used and it appeared that this has not been reviewed since March 2003. The Registered Manger must ensure that the staff team have received training in this area and that the care plan is reviewed on a regular basis to confirm the agreed plan of intervention. Another care plan viewed stated that one service user might become very challenging and display behaviour that may become a threat to the individual, other service users and care staff. It was noted that there were no behaviour management guidelines to guide staff in how to manage the situation. The Bridge House D53_D02 S39957 Bridge House V244122 080905 Stage 4.doc Version 1.40 Page 16 risk assessment stated that at times of such extreme behaviour PRN medication might be required. The Registered Manager must ensure that an agreed behaviour management protocol is implemented with review dates set. Records are maintained of all transactions involving service users finances. The Inspector did not view any individual financial records at this inspection. For the protection of vulnerable service users, the home operates a robust recruitment procedure and ensures that a POVA first is applied and a CRB disclosure is received for each staff member. Bridge House D53_D02 S39957 Bridge House V244122 080905 Stage 4.doc Version 1.40 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 standard(s) 24 30 Bridge House appears to be very homely and at the time of the inspection the home was very clean and hygienic. EVIDENCE: Bridge House is located on a main road within walking distance of Taunton town centre. Service user accommodation is provided over two floors. The home appeared very homely and contained many photographs of the service users who live at the home. There were many soft furnishings that promoted a homely environment. All service users bedrooms have an en suite bathroom, some of which include a Jacuzzi. There are two lounges, a large dining room that leads onto a patio area and the rear garden and a main kitchen. The home is decorated and furnished to a high standard. The Inspector noted that some kitchen units and worktops mighty need minor repairs to promote health and safety. At the time of the Inspection representatives of the company (Voyage) were viewing the kitchen area. This may be as a view to upgrading the kitchen. This will be followed up at the next inspection. On the day of the inspection the home was very clean and hygienic. There are adequate laundry facilities at the home. The laundry room appeared well Bridge House D53_D02 S39957 Bridge House V244122 080905 Stage 4.doc Version 1.40 Page 18 managed. All cleaning equipment is kept locked in this area. Service users only access the laundry area with staff support. There are Policies and Procedures in relation to Infection Control and COSSH regulations. Bridge House D53_D02 S39957 Bridge House V244122 080905 Stage 4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 33 At the time of the Inspection the home appeared adequately staffed. EVIDENCE: Staff are provided with clearly defined job descriptions. The Senior Carer advised that there have not been any new staff appointments since the last inspection. The senior carer advised that there is a minimum of six staff on duty up to 6pm and then there is usually three staff on duty till 8.30pm. The home has two wake over staff and one sleep over staff. The duty rota is amended to ensure adequate staff are on duty if any activities/outings are arranged. Bridge House D53_D02 S39957 Bridge House V244122 080905 Stage 4.doc Version 1.40 Page 20 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 40 41 42 As the Registered Manager was on a service users’ holiday and staff were busy supporting service users the inspector did not assess standards 37, 38 and 39. The home has comprehensive policies and procedures. The home strives to promote health and safety in the home. EVIDENCE: The Inspector viewed the document files for policies and procedures. Voyage has very comprehensive policies and procedures that are accessible to all interested stakeholders. The Inspector viewed the documentation in relation to health and safety. The heath and safety file was very well maintained and easily accessible. All fire records were up to date and from records viewed it appeared that all staff have received regular fire training. Comprehensive environmental risk assessments had been regularly reviewed. The Gas Safety certificate was dated 13/05/05 Bridge House D53_D02 S39957 Bridge House V244122 080905 Stage 4.doc Version 1.40 Page 21 and the Electrical Installation certificate was dated 20/12/02. The Arjo AquaTec bath was last serviced on 11.03.05. A visit by the Environmental Health (kitchen and stores) took place on 14/02/05. There were no recommendations. The Inspector was advised that the temperature of the hot water is tested on a regular basis. However, the inspector recommends that records be kept of the hot water temperatures. The Inspector tested some hot water outlets. They were within acceptable ranges. The Inspector noted that one wardrobe was not secured to the wall in one bedroom. However, this has now been rectified. Bridge House D53_D02 S39957 Bridge House V244122 080905 Stage 4.doc Version 1.40 Page 22 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 x x x x x Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 4 x x x x x 3 Standard No 11 12 13 14 15 16 17 x x 3 3 x x x Standard No 31 32 33 34 35 36 Score 3 x 3 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Bridge House Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score x x x 3 3 3 x D53_D02 S39957 Bridge House V244122 080905 Stage 4.doc Version 1.40 Page 23 Are there any outstanding requirements from the last inspection? NO 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 YA23 Regulation 13 (8) 15 Requirement The Registered Manager must ensure that if any service users require physical intervention that the agreed plan of care includes the agreed intervention technique and that is reviewed on a regular basis. All staff must receive training in breakaway and physical intervention with refresher training as needed. The Registered Manager must ensure that an agreed behaviour management protocol is implemented for one identified service user, with review dates set. Timescale for action 30/09/05 2. YA23 13 (6) 31/12/05 3. YA23 15 30/09/05 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 YA13 Good Practice Recommendations It is strongly recommended that a weekly programme of activity is formulated for each service user and recording systems develop which can report and analyse the extent to which this has been delivered. D53_D02 S39957 Bridge House V244122 080905 Stage 4.doc Version 1.40 Page 24 Bridge House 2. 3. YA20 YA42 The Registered Manager should ensure that all variable doses are recorded correctly on the MAR sheets. The Registered Manager should ensure that records are kept of the temperature of the hot water outlets. Bridge House D53_D02 S39957 Bridge House V244122 080905 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier, Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bridge House D53_D02 S39957 Bridge House V244122 080905 Stage 4.doc Version 1.40 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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