CARE HOMES FOR OLDER PEOPLE
Bridge House Care Centre 280-282 London Road Wallington Surrey SM6 7DJ Lead Inspector
Alison Ford Unannounced Inspection 22nd December 2005 12:30 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 Care Centre DS0000019079.V269768.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bridge House Care Centre DS0000019079.V269768.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Bridge House Care Centre Address 280-282 London Road Wallington Surrey SM6 7DJ 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 8647 8419 020 8773 9392 Ryedowns Ltd Mrs Patricia Wynne Reid Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (0), Physical disability (0) of places Bridge House Care Centre DS0000019079.V269768.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users in the Physical Disability category to be aged 55 or over. Date of last inspection 20th July 2005 Brief Description of the Service: Bridge House Care Centre is a home registered to provide nursing care for up to thirty-five elderly people although service users with physical disabilities may be aged from fifty-five. Six beds are also registered to provide care for terminally ill residents. The home has twenty-nine single and three double bedrooms nineteen of which have en-suite facilities. There are two lounges, a dining room and a conservatory overlooking the river, plus the usual toilet, bathroom and shower facilities. The home is on a bus route and opposite a large public park. Since the last inspection the redecoration programme has been completed and the home is now attractively presented. Bridge House Care Centre DS0000019079.V269768.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was the homes second unannounced inspection of the year 2005/2006 and took place over three hours. A partial tour of the premises was undertaken, a sample of care plans and staff files were seen, several residents and one visitor were spoken with. The complaints book was seen and the lunchtime meal was served during the visit. No additional visits have been made since the last inspection; there have been no complaints made to The Commission. Over the course of the two inspections all of those standards considered by The Commission to be key to the inspection process have been assessed and this report should be read in conjunction with the one produced following the last inspection on 20thy July 2005. What the service does well:
This home provides a good standard of nursing care in a well presented, well maintained and homely environment. This appears to suit the needs of its residents who describe it as “being a lovely place to live” with “first class staff” and “beautiful food.” Staff were seen to be interacting well with residents and treating them kindly and respectfully; one resident commented that “they were diamonds” and another that “ they always talk to you nicely”. On the day of the inspection, all of the residents looked clean and well cared for and several were sitting in the lounge, which looks out over the garden and the river. The home had been beautifully decorated for the Christmas festivities and pictures were seen of the recent party that was held and all of the residents agreed how much they had enjoyed it. Assessment of care plans show that all aspects of resident’s health care needs are considered and the plans generally reflect the care and support that is currently being given. Aids and adaptations are in place to meet the needs of the residents and allow them to move freely throughout the home and activities are in place, which they enjoy. The lunchtime meal was observed during the visit, it looked appetising and well presented. Special diets are catered for and choices are always available. Bridge House Care Centre DS0000019079.V269768.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Bridge House Care Centre DS0000019079.V269768.R01.S.doc Version 5.0 Page 7 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 Care Centre DS0000019079.V269768.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 A pre admission assessment ensures that residents in this home are confident that the home will meet their assessed needs This home does not offer intermediate care: this standard does not apply. EVIDENCE: Four care plans were seen and these showed that a pre- admission assessment had been undertaken by the home. Those residents that are funded by the local authority also have a care manager’s assessment. Together these` provide evidence that the home can meet the healthcare needs of the resident. They then form the basis for subsequent care planning. Bridge House Care Centre DS0000019079.V269768.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Residents, in this home, have an individualised plan of care, which is reviewed on a regular basis so that staff can be sure that their healthcare needs remain met. Residents are confident that they will be treated with respect and kindness to ensure that their dignity and privacy are respected at all times and procedures concerned with medication are in place to protect them. EVIDENCE: All residents have an individualised plan of care; a commercially produced document is in use “The Standex “ system. It is generated from an initial assessment of the resident’s psychosocial needs. One of the senior nurses is allocated to review the care plans on a regular basis to ensure that they remain up to date however it was noted that one resident had a wound for which no care plan was available. Care must be taken to identify the treatment and support required for all identified problems. Residents are registered with one of four GP practices and have access to other members of the multidisciplinary healthcare team as necessary. Risk
Bridge House Care Centre DS0000019079.V269768.R01.S.doc Version 5.0 Page 10 assessments are undertaken to identify those residents whose health may predispose them to pressure sores and evidence was seen to illustrate that wounds had improved since admission. Hoists and pressure relieving equipment were seen to be in use throughout the home and visits are made by other members of the multidisciplinary healthcare team as required. All personal care is administered in resident’s own bedrooms and staff were observed treating residents with sensitivity. Those residents spoken to agreed that the staff were helpful and kind, one resident said “staff in the home are first class” and another that “they talk to you nicely” Medication stores and records were seen and were generally in order although some errors were noted in the administration records and highlighted to the nurse in charge. Care must be taken to audit these records regularly and identify those staff making the omissions. Bridge House Care Centre DS0000019079.V269768.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 Residents live in a home, which allows them choice in their routines in order that they can retain their independence EVIDENCE: Residents, spoken to, confirmed that there was an element of choice within their daily lives such as when they got up, went to bed and the clothes that they wore and that there was always a choice of meals. They have been encouraged to bring possessions from home to personalise and individualise their rooms. Bridge House Care Centre DS0000019079.V269768.R01.S.doc Version 5.0 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Residents in this home can be confident that there are procedures in place to ensure that their complaints will be taken seriously and acted upon and that they are protected from abuse. EVIDENCE: The complaints book was seen and the few issues raised had been dealt with appropriately and in a timely manner. Residents confirmed that they would be able to raise any concerns with the homes manager. The home has policies in place to recognise and deal with abuse and all staff are given copies of these as a part of their induction. All staff have received satisfactory clearance from the Criminal Records Bureau and Protection Of Vulnerable Adults Register. Bridge House Care Centre DS0000019079.V269768.R01.S.doc Version 5.0 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 Residents live in a home, which is safe, accessible and well maintained and so suits their needs in a comfortable homely way, although there are still some concerns about their safety in the event of a fire. EVIDENCE: All parts of this home are safe, well -maintained, and accessible to residents. It is close to local amenities and to a bus route. There is a pleasant garden overlooking a river and several residents choose to sit by the windows here. Furnishings and lighting are domestic in style and bedrooms have been personalised by their occupants and are clean and bright. There was an element of concern that, despite previous requirements and a recent recommendation from the Fire Safety Officer, bedroom doors are still being wedged open. If residents wish their bedroom doors to be held open, a device, which operates automatically in the event of a fire, must be fitted. This issue must now be attended to without delay in order to avoid possible enforcement action.
Bridge House Care Centre DS0000019079.V269768.R01.S.doc Version 5.0 Page 14 Bridge House Care Centre DS0000019079.V269768.R01.S.doc Version 5.0 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30 Residents can be confident that there is training in place for staff, which will ensure that they are competent to do their jobs. EVIDENCE: Since the last inspection, the ongoing staff training programme has continued. 50 of staff members are now trained in first aid, and 50 have attended manual handling and risk assessment training this year. The remaining staff will undertake these sessions in the New Year. These should be yearly training sessions and The Registered Manager is reminded of her responsibilities in these issues. Medication training is also planned for the qualified nurses. It is recommended that some of the senior nurses should undertake training in assessment and supervision in order to complete with standard 36. Bridge House Care Centre DS0000019079.V269768.R01.S.doc Version 5.0 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,36,38 Resident’s views are not monitored in this home so there is no evidence of their satisfaction with the standard of care that is given and some working practices pose a risk to their safety. Although care staff are supervised in their daily work there is no formal supervision programme in place to determine their training needs and ensure that they are compliant with the philosophy of the home. EVIDENCE: The Registered Manager has been in post for some time and is supported by a team of trained nurses. She is currently overseeing work in another of the company’s homes and there are plans to employ a relief manager to cover the times that she is not available.
Bridge House Care Centre DS0000019079.V269768.R01.S.doc Version 5.0 Page 17 Despite previous requirements there is still no quality assurance-monitoring tool in use in the home. It is understood that there is a plan to introduce a similar procedure in all of the homes in this group this must now be attended to as a matter of importance. There is still no formal supervision for care staff in place although their daily work is monitored. This would provide the opportunity to identify their training needs and ensure that the homes philosophy of care is being maintained. In order that this can take place it is recommended that some of the senior nurses undertake training in supervision and assessment. Certificates of worthiness were viewed and not all were available. Copies of those relating to Legionella testing, emergency lighting, call bell testing, PAT and smoke detectors must be sent to the office of the Commission for Social Care Inspection. Kitchen records were in order and the area was very clean however, lidded boxes must be purchased in which to store opened packets of foods and dry goods. Bridge House Care Centre DS0000019079.V269768.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X X STAFFING Standard No Score 27 X 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X 2 X 2 Bridge House Care Centre DS0000019079.V269768.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1) Requirement Timescale for action 30/03/06 2 OP9 13(2) 3 OP19 13(4) 4 OP33 24(1) The Registered Manager must ensure that all residents identified healthcare problems have an appropriate care plan. The Registered Manager must 30/03/06 ensure that medication administration sheets are audited regularly and any errors identified. The Registered Manager must 30/03/06 ensure that where residents wish their bedroom doors to remain open they are fitted with a device, which allows it to close automatically in the event of a fire. (Previous timescale 30/10/05 not met) The Registered Manager must 30/03/06 ensure that a quality assurance is put into place to regularly seek the views of residents on the care that they receive. (Previous timescales 30/9/04 and 30/10/05 not met) The Registered Manager must ensure that all care staff receive documented supervision at least
DS0000019079.V269768.R01.S.doc 5 OP36 18(2) 30/03/06 Bridge House Care Centre Version 5.0 Page 20 6 OP38 13(4)(c) 7 OP38 13(4)(c) 6six times a year. (Previous timescales 30/9/04 and 30/10/05 not met.) The Registered Manager must 30/03/06 ensure that copies of all of the certificates of worthiness required to provide evidence of compliance with standard 38 are sent to The Commission for Social Care Inspection office. The Registered Manager must 30/03/06 ensure that all opened packets of food are stored in lidded boxes. 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 OP30 Good Practice Recommendations The Registered Manager should consider sending some senior nurses on training courses in order to provide supervision to care staff as detailed in standard 36. Bridge House Care Centre DS0000019079.V269768.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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