CARE HOMES FOR OLDER PEOPLE
Bridge House Care Centre 280-282 London Road Wallington Surrey SM6 7DJ Lead Inspector
Alison Ford Key Unannounced Inspection 7th August 2007 11:30a 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.V347554.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 Care Centre DS0000019079.V347554.R01.S.doc Version 5.2 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.V347554.R01.S.doc Version 5.2 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 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 residents 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, seventeen of which have en-suite facilities. There is a lounge, 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. At the time of this inspection fees ranged from £550 - £725 per week with some additional charges, which would be discussed prior to admission. A copy of the homes Statement of Purpose and their latest inspection report can be obtained from the home. Inspection reports can also be downloaded from the Commission for Social Care Inspection website. Bridge House Care Centre DS0000019079.V347554.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the homes first key inspection visit as part of the inspection process for the year 2007/2008 and was unannounced. When writing the report consideration has also been given to other information gathered throughout the year such as, records of accidents and complaints and other documentation required to be kept by the home. There have also been conversations with residents, their relatives and members of staff. Prior to this visit, the homes acting manager had submitted a pre-inspection questionnaire supplying information about the home. Comment cards routinely sent out, by The Commission, had also been received from residents and relatives. These generally reflected positive outcomes for the people using this service and comments were made regarding how kind and helpful staff were in the home. On the day of the visit there were 30 residents living in the home. In addition to the Registered Manager, two trained nurses were on duty with five care staff, supported by a cook, and domestic staff. During the visit, a partial tour of the premises was undertaken; a sample of care plans were assessed, documentation relating to health and safety was seen and several of the residents and relatives, who were visiting, were spoken with. Menus and kitchen records were 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. Two investigations have been undertaken under the local authority safeguarding procedures however; concerns about the home were unsubstantiated. The management team of the home are currently in the process of applying for a variation to their registration, which will allow them to care for people who have dementia in addition to their other nursing needs. The week before this visit particularly heavy rain had caused flooding to the kitchen area, which is in the basement of the home. This had caused concerns about food hygiene and infection control practices in the home, which are currently being addressed. Bridge House Care Centre DS0000019079.V347554.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection?
Bridge House Care Centre DS0000019079.V347554.R01.S.doc Version 5.2 Page 7 All of the issues of concern that were raised at the last inspection have now been addressed More emphasis is being given to gaining information regarding resident’s social needs during the pre-admission assessment to make sure that the home will suit them. In the event of people with dementia being admitted more “life history “ work will also be needed in order to understand their behaviour patterns. Some work has been done to try and gain the views of the people who use the service. Relatives are always encouraged to be involved in discussions about care issues and questionnaires are now being sent out annually to monitor their satisfaction with services that are provided. Records are also being kept of visits made by the management team. There is an ongoing redecoration and refurbishment programme in place in the home and decorative touches have been added to the dining room with flowers on the table and new glassware and condiments. Welcome cards have been introduced to put in residents bedrooms when they first arrive although it was suggested that these might be further improved by including information about their key worker. In order to improve staff training an in house trainer has been employed by the group of homes who will undertake all mandatory sessions. What they could do better:
During the recent adverse weather conditions, flooding occurred to the kitchen area, which is situated in the basement of the home. Although residents enjoyed the fish and chips that were bought for them as the kitchen was out of action, there were serious concerns raised about risks to their health and safety due to strong odours of sewage. Ideally the kitchen should be re - sited to ensure that this does not happen again however, in the meantime or if this proves not to be feasible, there must be a procedure in place so that staff are aware of the steps that should be taken to minimise the risk to residents. This must include additional staff training in issues concerned with infection control. It has also become apparent that a staff room was also being used to provide kitchen facilities for residents. This is now being addressed and the room being upgraded in line with regulations however, an alternative area must be provided for staff to change and take their breaks. Please contact the provider for advice of actions taken in response to this
Bridge House Care Centre DS0000019079.V347554.R01.S.doc Version 5.2 Page 8 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 Care Centre DS0000019079.V347554.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 Care Centre DS0000019079.V347554.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): Standards 1,3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who use this service consider that they were able to get all of the information that they needed before they moved in to the home to help them make their choice. Pre-admission assessments ensure that the home will be able to meet their healthcare needs. EVIDENCE: The home has a comprehensive Statement of Purpose and Service User Guide so that people who use the service are able to get all of the information that they need to help them decide if the home will suit them. Copies of these are put into all of their bedrooms for future reference. Four care plans were looked at during this inspection and there was evidence that pre-admission assessments had been undertaken in order to ensure that the home would be able to meet the needs of the resident. This assessment
Bridge House Care Centre DS0000019079.V347554.R01.S.doc Version 5.2 Page 11 then forms the basis for subsequent care planning. Regular reviews of any changes in the needs of residents take place throughout the year. Bridge House Care Centre DS0000019079.V347554.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): Standards 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who use this service generally consider that their health care needs are met in a way, which suits them and they have an individualised plan of care, which is reviewed on a regular basis so that any changes are identified. They say that they are treated with respect and kindness and that their dignity and privacy are respected at all times. 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. Four of these were seen at this inspection. The plan 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.
Bridge House Care Centre DS0000019079.V347554.R01.S.doc Version 5.2 Page 13 Residents are registered with one of four GP practices and have access to other members of the multidisciplinary healthcare team as necessary. Risk 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. Some visitors that were spoken with commented that they had seen great improvements in the health of their relatives since they had come to live in the home and several thank you cards were seen acknowledging the expertise of the staff. All personal care is administered in resident’s own bedrooms and staff were observed treating residents kindly. Those residents spoken to agree that the staff are helpful and kind, resident said, “staff in the home are lovely and marvellous ” and another that “they talk to you kindly ” Medication stores and records were seen and were in order. Bridge House Care Centre DS0000019079.V347554.R01.S.doc Version 5.2 Page 14 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): Standards 12,13,14,15 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. The people who use this service are encouraged to exercise choice over their daily lives as much as they are able and their relatives and friends are always welcome to visit. They enjoy a limited range of activities that are arranged for them and meals that are nutritious varied and attractively presented. EVIDENCE: Residents confirmed that care staff encourage them to maintain their independence and make choices within their daily lives. During the visit it was noted that people were able to stay in their rooms to eat their meals if they liked and they agreed that they could always do what ever they wanted to. Several visitors were in the home and they said that they are always made welcome. The majority of them praised the home and the care that was given to residents there. Bridge House Care Centre DS0000019079.V347554.R01.S.doc Version 5.2 Page 15 Many of the residents appear to appreciate a quiet and peaceful life and the pleasant surroundings, which the home provides, enables them to do so. A limited range of structured activities is provided and this has been increased since the last inspection. Some relatives said that they would like to see more organised outings however, residents seem to be happy with the present arrangements. Reminiscence, and craft sessions are held weekly, an aromatherapist visits fortnightly and there are church services monthly. Recently students on a work experience scheme had been in the home and they had written letters explaining how, despite their initial concerns, the time had developed their insight into the problems experienced by older people and how much they had enjoyed the visits. One has asked for permission to continue to visit even though the placement has finished. The lunchtime meal was served during the inspection and looked appetising and was obviously enjoyed by the residents. There is always a choice available and special diets can be catered for. Staff have time to sit with residents who need help at mealtimes and this is done with sensitivity. A new chef has recently been employed and will be revising menus in the near future. Bridge House Care Centre DS0000019079.V347554.R01.S.doc Version 5.2 Page 16 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): Standards 16,18 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. The people who use this service know that any complaints that they might have would be dealt with promptly and appropriately and that measures are in place to ensure that they are protected from abuse. EVIDENCE: Two complaints have been dealt with under the local authority Protection Of Vulnerable Adults procedures since the last inspection. In both cases claims against the home were unsubstantiated. The complaints book showed that any issues are resolved promptly and people that were spoken with during the course of the visit said that should they have any concerns they would be dealt with quickly. The Registered Managers door is always left open and residents and relatives are encouraged to “pop in”. 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.V347554.R01.S.doc Version 5.2 Page 17 Bridge House Care Centre DS0000019079.V347554.R01.S.doc Version 5.2 Page 18 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): Standards 19,26 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People who use this service say that they are living in comfortable clean surroundings, which suit them. However, a recent untoward incident put them at some risk and procedures will need to be improved to prevent similar issues occurring in the future. EVIDENCE: The home is in a pleasant residential area in keeping with surrounding properties and close to public transport links. There are various different seating areas in the home so that residents can either choose to watch television or sit quietly. The lounge with its views over the river is particularly pleasant. A tour of the premises was undertaken. Both communal areas and resident’s bedrooms are clean and well maintained; the latter have been personalised by their occupants with items from home. A continual programme of redecoration
Bridge House Care Centre DS0000019079.V347554.R01.S.doc Version 5.2 Page 19 and refurbishment is in place, which ensures that the home is always pleasant. Two of the bathrooms have been converted to shower rooms to help residents who may be less mobile. Locks are on residents doors so that they can maintain their privacy if they wish, and door closers, operating in the event of a fire, have also been fitted to them. This will help to protect them in the event of a fire. The home was clean on the day of inspection and free from malodour. However, recent severe weather conditions had lead to flooding in the kitchen, which is in the basement. Concerns had been raised during a visit by an environmental health inspector about sewage deposits still being present several days later. The issues are now being addressed, alternative storage has been found for food and intensive cleaning is taking place. Ideally the kitchen should be resisted in an area, which is at less risk however; in the meantime a strategy must be put in place to reduce any risks to residents in the event of this problem happening again. This must include training to improve staff knowledge around issues relating to infection control. The situation will continue to be monitored closely. It has recently become apparent that the staff room was also being used as a kitchen facility for residents. This is now being refurbished in line with kitchen regulations however an alternative facility must now be provided for staff to change in and to have their breaks. Bridge House Care Centre DS0000019079.V347554.R01.S.doc Version 5.2 Page 20 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): Standards 27,28,29,30 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. The people who use this service know that there are usually enough appropriately trained staff on duty in the home in the home to meet their needs and that recruitment policies and procedures are in place to protect them EVIDENCE: The home is staffed by trained nurses and care staff in accordance with previous staffing notices although some people say that they sometimes have to wait a while for help, especially at night. This situation will need to be monitored closely. All of the care staff are trained to at least NVQ level 2 and some have also undertaken level 3. In addition all of the staff are encouraged to undertake training appropriate to the work that they undertake and this is ongoing throughout the year. It is planned that future training will include dementia awareness training in preparation for the proposed variation to registration and
Bridge House Care Centre DS0000019079.V347554.R01.S.doc Version 5.2 Page 21 as previously noted there must be additional training in issues around infection control for all staff. There is a robust recruitment policy and all staff have received necessary clearance from The Criminal Records Bureau. Four staff files were seen and all were complete, providing evidence that appropriate pre-employment checks are undertaken to maintain the safety of residents. Bridge House Care Centre DS0000019079.V347554.R01.S.doc Version 5.2 Page 22 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): Standards 31,33,35,38 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The people who use this service consider that the home is managed by a person who is fit to be in charge and that it is run in their best interests. Policies and procedures are generally in place to show that health and safety of staff and residents is protected. EVIDENCE: The Registered Manager has been in post for some time and displays an understanding of the needs of this client group. Several people commented positively on her kindness. Bridge House Care Centre DS0000019079.V347554.R01.S.doc Version 5.2 Page 23 A quality assurance programme is in place and questionnaires are distributed annually to residents and their relatives to enable them to comment on the running of the home. Relatives are always encouraged to be involved in the running of the home and the care provided to the residents. Staff meetings are held regularly to ensure that staff are aware of any developments in the home and able to contribute their views. The Registered Provider and other members of the management team frequently visit the home to monitor its running, in line with regulation 26. Residents are generally not able to manage their own finances and all have relatives or representatives who do this on their behalf. The pre-inspection questionnaire showed that maintenance and safety checks have all been done in order to ensure that safety and wellbeing of staff and residents. As has been previously noted, procedures must be developed that will maintain the health and safety of staff and residents in the event of further flooding to the kitchen. Bridge House Care Centre DS0000019079.V347554.R01.S.doc Version 5.2 Page 24 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Bridge House Care Centre DS0000019079.V347554.R01.S.doc Version 5.2 Page 25 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 OP26 Regulation 13(4)(c) Requirement Policies and procedures must be developed so that risks to the health and safety of residents are minimised in the event of further flooding in the kitchen Alternative arrangements must be made to provide an area for staff to change in and to take their breaks. There must always be enough staff on duty to enable residents call bells to be answered promptly. There must be evidence that all staff have received recent training in issues concerned with infection control. Timescale for action 30/11/07 2. OP26 23(3)(i) 30/11/07 3. OP27 18(1)(a) 30/11/07 4. OP30 18(10(c) (i) 30/11/07 Bridge House Care Centre DS0000019079.V347554.R01.S.doc Version 5.2 Page 26 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 OP33 Good Practice Recommendations It is recommended that the format of questionnaires designed to gain the views of relatives are made more suited to the abilities of the residents. Bridge House Care Centre DS0000019079.V347554.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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
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