Inspection on 21/09/07 for Bridge House Nursing Home

This inspection was carried out on 21st September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Bridge House Nursing Home 26/05/06

Bridge House Nursing Home 24/10/05

Bridge House Nursing Home 26/04/05

Bridge House Nursing Home 30/11/04

Bridge House Nursing Home 05/08/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Bridge House Nursing Home 64 High Street Twyford Berkshire RG10 9AQ Lead Inspector Debbie Calveley Unannounced Inspection 09:00 21 September 2007 st 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 Nursing Home DS0000010978.V348373.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 Nursing Home DS0000010978.V348373.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bridge House Nursing Home Address 64 High Street Twyford Berkshire RG10 9AQ 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) 01189 340777 01189 344173 bridge_care@yahoo.co.uk Bridge House Holdings Limited Mrs Tracey Catherine Muller Care Home 47 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (40), of places Physical disability (1) Bridge House Nursing Home DS0000010978.V348373.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That provision is made for one service user under the age of 65, identified in the `Application to vary a condition` dated 19/04/06, to be accommodated in the home (PD). 26th May 2006 Date of last inspection Brief Description of the Service: Bridge House is a listed Georgian building just off the main Twyford high street and is close to the village shops. The towns of Henley-on-Thames, Wokingham and Reading are a short distance by car or public transport. The home is set in ten acres of grounds with an orchard and a walled garden. In addition to the extensive gardens, there is a sitting room, dining room, library, drawing room and conservatory for residents. The bedroom accommodation available varies in style and size. The Care Home provides 24 hour nursing care for older people and is registered to provide care for six individuals with dementia. There is a range of additional facilities available by arrangement including chiropody, dental care, and physiotherapy. The homes proprietor is Bridge House Holdings Ltd who own other care homes in the UK. Fees charged as from 1 April 2007 range from £750 to £1000, which does not include toiletries. Additional charges are made for hairdressing, chiropody, newspapers and outside activities such as visits to the theatre. Intermediate care is not provided Bridge House Nursing Home DS0000010978.V348373.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term ‘service user’ to describe those living in care home settings. For the purpose of this report those living at Bridge House will be referred to as ‘residents’. This was a key inspection that included an unannounced visit to the home and follow up contact with resident’s representatives and visiting health and social care professionals. This unannounced inspection was carried out over 8.5 hours on the 21 September 2007. There were thirty-three residents living in the home on the day, of which five were case tracked and spoken with. During the tour of the premises eight other residents both male and female were also spoken with. The purpose of the inspection was to check that the requirements of previous inspections had been met and inspect all other key standards. A tour of the premises was undertaken and a range of documentation was viewed including the Service Users Guide, Statement of Purpose, care plans, medication records and recruitment files. Five members of care staff, activity lead and the chef were spoken with in addition to discussion with the Manager. Telephone contact was made with visiting professionals following the visit and three relatives were spoken with during the inspection visit. The information received verbally has been incorporated into this report. An Annual Quality Assurance Assessment was received from the Manager completed in full prior to this key inspection. The inspector would like to thank the residents and staff at Bridge House for their time and hospitality. What the service does well: There is a comprehensive Statement of Purpose and Service Users Guide that gives prospective residents the information required to enable them to make an informed choice about where they live. Residents confirmed that they were visited by the Manager prior to admission to the home and two stated they had been invited to visit the home to see if they liked it enough to live there. There is an open-house policy, which welcomes visitors at all reasonable times. Bridge House Nursing Home DS0000010978.V348373.R01.S.doc Version 5.2 Page 6 The atmosphere at the home was relaxed, with communication between staff, residents and visitors being positive, open and friendly. Comments included ‘ lovely staff, very caring and friendly’ Activities are an important part of life at Bridge House and are provided seven days a week, which is appreciated by the residents. The quality and choice of meals remain good and all residents spoken with were complimentary about the food. The training for staff is good, and covers a wide variety of resident related conditions, which give the staff an understanding of the residents needs. Bridge House provides a clean, safe and well-maintained environment, which is appreciated by the residents and their relatives. Staff provision is well maintained with a robust recruitment practice being followed and appropriate numbers of suitably qualified staff working in the home. Quality assurance systems are in place, which enables the service to monitor and improve their service and involve the residents in decisions concerning their home. All residents, relatives, visitors and visiting professionals contacted as part of the inspection process confirmed a satisfaction with the home and its services one resident saying ‘I am very well cared for the staff are nice it’s a lovely home and has good food’ What has improved since the last inspection? What they could do better: The home needs to confirm in writing to the prospective resident or their representative that with regard to the needs assessment completed the home can meet the needs of the prospective resident. This ensures that decisions around admission to the home are informed. Bridge House Nursing Home DS0000010978.V348373.R01.S.doc Version 5.2 Page 7 The care documentation including individualised care plans and risk assessments need to be improved to ensure residents receive appropriate and person centred care that meets their assessed needs and to minimise any risks. Care plans need to provide guidance for staff to ensure residents receive continuity of care. The procedure for investigating complaints needs to be improved to ensure records demonstrate a thorough investigation process and outcome. 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 Nursing Home DS0000010978.V348373.R01.S.doc Version 5.2 Page 8 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 Nursing Home DS0000010978.V348373.R01.S.doc Version 5.2 Page 9 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): 1, 2, 3, 4 and 5. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides prospective residents and relatives, with a good level of information about the home, its facilities, services and the costs involved. The admission procedures allow for the needs of prospective residents to be assessed by a competent person before admission although people are not assured in writing that their needs will be met. EVIDENCE: There is a range of well-documented information about the home and the services it provides. The home has a combined Statement of Purpose and Service Users Guide and a copy of this is available along with the last inspection report and a copy of the homes terms and conditions of residency in the front reception area. The documents clearly state that they can meet the needs of a multi-cultural society in respect of religion, meals and individual Bridge House Nursing Home DS0000010978.V348373.R01.S.doc Version 5.2 Page 10 preferences. Relatives and relatives spoken to were clear on the service provided by the home and costs involved. It was confirmed that all residents receive a contract on admission to the home along with the terms and conditions of residency. The registration certificate is clearly displayed and was found to be accurate. Five pre-admissions documents, which included the last admission to the home, were selected and the records relating to the admission procedures followed were reviewed. This confirmed that pre admission assessments are completed and provide a clear assessment of prospective residents care needs. These are completed by the Manager or the Head of Care and discussion with the Manager confirmed that these are used to ensure new admissions to the home are appropriate and that the home have the staff, equipment and environment to meet their care needs. Prospective residents’ are seen either in their home or hospital before admission and the input from relatives and other professionals is used whenever possible. This approach should be more clearly recorded on the assessment documentation to demonstrate the procedure followed. It was however noted that the home does not confirm in writing with regard to the assessment that the home can meet the assessed needs of the prospective resident. This was discussed with the Manager who was advised that this should be completed in writing in accordance with the required documentation. The Manager was able to verbally demonstrate her knowledge and awareness of the different specialities required in the home and ensures that the Registered Nurses and carers employed have attended relevant courses to deal with the needs of the elderly and also specialised courses for certain diseases. Trial visits to the home can be arranged. The Manager confirmed that selffunding residents are invited to a trial period to ensure suitability of the home; this is clearly stated in the Statement of Purpose and in the statement of terms and conditions. Intermediate or rehabilitative care is not provided at Bridge House. Bridge House Nursing Home DS0000010978.V348373.R01.S.doc Version 5.2 Page 11 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 and 10. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Although care documentation provides a framework for the delivery of care it needs to be developed to provide clear guidance to care staff on all the care needs of the residents, along with robust systems for risk assessment to ensure individual person centred care is delivered. The homes practice ensure resident’s medicines are stored and administered safely and residents are treated with respect and have their privacy and dignity maintained. EVIDENCE: The care documentation pertaining to five residents were reviewed as part of the inspection process. These were found to include plans of care, nutritional assessments, personal histories and risk assessments. On the whole the care documentation demonstrated that the care was reviewed and evaluated, however it was noted that whilst the care plans have goals they do not include guidance for the staff in meeting the needs of the residents consistently. Bridge House Nursing Home DS0000010978.V348373.R01.S.doc Version 5.2 Page 12 There is guidance for staff in the additional needs such as catheter care and wound care. However as discussed further information regarding prevention of further tissue breakdown is needed for certain residents, and details of specialist equipment involved. The residents would benefit from a more person centred approach to care planning. There was little evidence that the plans of care and reviews are written in consultation with residents or their representatives. Risk assessments for health needs are included in the care planning format used by the home, and all risk assessments were found to be completed, but not all followed through with an appropriate plan of action when identified as required. Fluid charts and turn charts were not all correctly completed specifically between the hours of 1730 pm and 0900 am, this gives a period of 16 hours without fluids. This was discussed in full with the Manager. The staff also need to ensure that any changes in the residents condition are clearly reflected in the plans of care. An internal audit is performed on the care plans monthly and the Manager and Head of Care are aware that there are areas of the care plan documentation that needs to improve. The Manager confirmed that they have close links with the local hospice and Mc Millan nurses for end of life care and are aware of the different specialist advice sources to access if required. These include chiropodists, audiologists, dentists and opticians. Staff spoken with confirmed that they received a full report on each resident daily and read the care documentation that is kept in a cupboard on each floor by the nurse’s station. They felt that their views were taken into account when planning resident’s care. Relatives and residents spoken with were satisfied with the care provided at the home one saying that the home ‘should be congratulated for its care’ ‘my relative receives good nursing care and care workers are kind, considerate and supportive of his every need’ ‘ I give them 9/10’ ‘Staff are efficient, courteous and very kind’. Residents spoken to were also satisfied, comments included ‘they look after me very well’ ‘I have my own room and the staff are kind ’ ‘ It’s my home’. There are two clinical rooms, which are compact, and they are kept locked at all times. There is a small fridge and temperatures of the room and fridge are recorded daily. There are policies and procedures in place for staff to refer to regarding the safe administration, storage, disposal and recording of medication. The systems for recording and checking controlled drugs were found to be thorough. Medication Administration Charts (MAR) were found to be on the whole competently completed with minor shortfalls noted. Bridge House Nursing Home DS0000010978.V348373.R01.S.doc Version 5.2 Page 13 Some areas of good practice re medication were discussed with the Manager during the inspection and include: all verbal changes to medication and handwritten transfers are to be signed and dated to provide an audit trail, resident photographs to be dated and updated regularly as some residents were not recognisable, and if a gap is noted on the MAR, staff need to track and find out the reason. Staff were seen to be respectful and considerate to all residents and visitors, whilst attending to their needs. Each of the residents were addressed by their preferred term and dressed appropriately in well-laundered clothing. However staff were seen entering bedrooms without knocking during the inspection. The home have implemented the Gold Standards Framework for End of Life, which promotes the dignity and choice for residents at this important stage of their life. The Manager has developed a bereavement booklet to inform and support relatives and this would also benefit staff. The home are pro- active in advanced care planning which include open discussion if possible with residents and their families on admission regarding their wishes and thoughts regarding death and dying. Bridge House Nursing Home DS0000010978.V348373.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): 12, 13, 14 and 15. People who use this service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Social activities and meals continue to be creative and provide daily variation and interest for people living in the home. Residents are able to make a range of choices about their lives as well as maintaining links with friends and relatives EVIDENCE: There are three activity co-ordinators that cover the whole week to optimise mental and social interaction. The lead activity co-ordinator is enthusiastic and demonstrated awareness and knowledge of the resident’s social and mental needs. The care plans and documentation was seen to be of an excellent standard. There is a wide variety of activities that are both structured to individual preferences, and organised for group sessions and visits from musicians. Discussions with residents confirmed that they joined in activities only if they chose to do so; some residents prefer their own company and often spent their time in their own rooms. Bridge House Nursing Home DS0000010978.V348373.R01.S.doc Version 5.2 Page 15 Resident’s religious requests are asked on admission to home and Holy Communion is held regularly, visits from local churches are arranged and residents are supported to attend the local services if they should choose to go. At present one resident goes to a church service every Sunday. Residents are asked their preferences regarding the gender of the staff attending to their personal needs, so as to preserve their dignity and respect. The work force is multi cultural and receive training in meeting the diverse needs of the residents and ensuring that the social aspect of care is person centred. Resident’s rooms were found to be individual and personalised and each resident has their preferred term of address recorded in their care documentation and this preference was respected. From discussion with residents and relatives it was confirmed that residents are offered choices daily regarding how they spend their time from getting up, to meals and to going to bed. Residents were seen to have their choices respected through out the day with decisions being responded to. Visitors spoken to were all happy with the visiting arrangements and how staff who were said to be ‘very welcoming’ received them. During the inspection visit it was noted that the reception area was always manned during the day and visitors were greeted with assistance being provided if needed. The mid day meal and evening meal was observed and was seen to be organised and well managed ensuring that those residents needing assistance were given time and able to have the assistance that they needed in an unrushed manner. It was confirmed that residents had a choice at lunchtime, which included a vegetarian choice. Those residents saying they did not like the main choice were seen to have alternatives provided that they did want. Menus are used and circulated the day prior to or on the day the meals are provided, however records are not kept on what food is eaten by each resident and it would benefit the residents if this was introduced and help staff identify appetite traits early. All feedback about the food was complimentary and comments included ‘good food’ ‘I have choices in the meals and the meals are good’. The Quality Assurance Audit performed by the home identified that the new menus are not as popular with the residents, but the Manager has allowed 6 months to see if the new system is working. The dining areas used are pleasant and well furnished with natural light. A full time chef is in post and when the kitchen was inspected by Environmental Bridge House Nursing Home DS0000010978.V348373.R01.S.doc Version 5.2 Page 16 Health April 2007, there were some requirements made to fridge shelves and new fridges were brought. Staff were seen to be following good practice when serving and distributing the meals. Residents needing assistance were being offered support discretely. The meals provided looked appetising and were served in a manner that ensured it looked attractive. Bridge House Nursing Home DS0000010978.V348373.R01.S.doc Version 5.2 Page 17 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): 16 and 18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Practice in the home ensures that complaints are responded to, with residents and representatives being confident that they are listened to. However systems for recording complaints need to be improved to demonstrate a robust procedure is followed. Practice in the home ensures that adult protection issues are responded to when identified. EVIDENCE: The home has a written complaints procedure and this is displayed in the home and provided within the service users guide. The procedure followed on receipt of a complaint however does not clearly record the process and does not provide an audit trail of how the home has responded to the complaint. All records need to be clear and kept in a way that promotes peoples confidentiality. A formal complaint has been dealt with by the home and although this complaint has been resolved the records held did not clearly record what and how the complaint was received how it was investigated and responded to. Relatives and visiting professionals said that they were confident that the management of the home would respond positively to any concern raised. Bridge House Nursing Home DS0000010978.V348373.R01.S.doc Version 5.2 Page 18 Everyone spoken to confirmed that if they had any concerns or complaints they would not hesitate in talking to either the Manager a member of the staff team. The home has relevant guidelines on the protection of vulnerable adults and staff have received appropriate training. There are policies and procedures in place for staff to follow if there are residents that evidence agitation/aggression and behavioural problems. The management team has a clear understanding of adult protection guidelines and are aware of how to initiate an investigation if required Bridge House Nursing Home DS0000010978.V348373.R01.S.doc Version 5.2 Page 19 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, 20, 21, 22, 23, 24, 25 and 26. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Bridge House provides a comfortable, clean and safe environment for those living there and visiting. Residents and their families are enabled and encouraged to personalise their room, and rooms are homely and reflect the resident’s personalities and interests. EVIDENCE: Bridge House is a listed Georgian building set in well-kept large gardens. A tour of the home confirmed that the home is well maintained. There is a large attractive garden which is used for fetes and fairs. The communal areas are also attractive and allow for different uses ensuring residents have choice and how they spend their time. The home continues to follow an improvement and refurbishment programme that has benefited the residents and visitors to the home and provided a welcoming and comfortable environment. Bridge House Nursing Home DS0000010978.V348373.R01.S.doc Version 5.2 Page 20 The tour of the home evidenced that a considerable amount of work has been done and the Manager discussed the on-going areas of refurbishment. Residents who expressed an opinion spoke positively about the home, many have decorated their rooms with their own possessions, pictures and ornaments. There are adequate communal bathrooms and shower rooms in the home with specialist equipment, which enables frail residents and those with a physical disability to enjoy the facilities available. However not all the bathrooms are attractive and inviting and are in need of redecorating. They are also used as storage areas for equipment. This was discussed in full and part of the refurbishment is to review the bathrooms and provide further wet rooms, which are preferred by residents. Specialised equipment to encourage independence is provided e.g. handrails in bathrooms, hoists, wheelchairs and lifts to all areas of the home. Call bells are provided in all areas. The lighting in the home is of domestic quality and there are above bed lights as well as the main ceiling lights. Water temperatures are controlled and monitored monthly and a record kept. Random temperatures were taken and were of the recommended level. Polices and procedures for infection control are in place and are updated regularly. The home was clean and free from offensive odours on the day of the inspection. Some areas of the kitchen were discussed as possible sources of infection e.g the floor needs to be repaired and a fan leading to outside needs an appropriate cover. All bins in use need to have a suitable lid and some commode pots need replacing. Staff are to be reminded of the policy and procedure regarding appropriate use of gloves and aprons whilst giving personal care. The laundry is equipped with suitable equipment and was found well organised. Bridge House Nursing Home DS0000010978.V348373.R01.S.doc Version 5.2 Page 21 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): 26, 27, 28, 29 and 30. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Robust recruitment procedures are in place to protect residents, and staff training ensures they are aware of their roles and are able to provide the support and care the resident’s need. EVIDENCE: At the time of the inspection visit 33 residents were living at Bridge House. The staffing rota was viewed and the staffing levels were seen to be sufficient to meet the needs of the residents at this time. The Manager confirmed that the staffing arrangements are flexible and respond to resident’s dependency. Staff spoken to said that there was enough staff to look after the residents to a good standard. Feedback from residents and family included ‘ never have to wait if I ring for assistance’ ‘always plenty of staff’ ‘ have never noticed staff rushing around and staff always visible’. Call bells were responded to quickly during the inspection. Staff spoken with said that training opportunities at the home are good and they are well supported by the senior staff and the Manager. Staff are supported and encouraged to undertake National Qualification Training (NVQ) at level 2 currently 60 of staff have an NVQ and 30 are on the training programme. Staff training is well established and records indicated that this is well organised with new staff starting their ‘skills for care’ induction. There was evidence that core areas of training are addressed regularly with a Bridge House Nursing Home DS0000010978.V348373.R01.S.doc Version 5.2 Page 22 rolling programme. Staff and the training list seen confirmed that compulsory training such as manual handling, adult protection, first aid and fire safety are being undertaken. A selection of staff recruitment files were viewed and demonstrate that a robust recruitment process has been maintained to protect residents and contained all the relevant information required. There was evidence of health questionnaires, Criminal Record Bureau checks, two references, a resume of previous employment and work permits where necessary. All the paperwork is kept within a locked room. Bridge House Nursing Home DS0000010978.V348373.R01.S.doc Version 5.2 Page 23 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, 32, 33, 35, 36, 37 and 38. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is managed in an open and friendly manner with suitable quality monitoring systems. Resident’s financial interests are safeguarded, and the health, safety and welfare of residents and staff are generally well promoted and protected. EVIDENCE: The Registered Manager was registered with the CSCI in February 2006 and has been in post for 2 years. She is a Registered General Nurse, and has experience as a care home Manager. She is in the process of completing the Registered Managers Award. The management team in house consists of the Manager and Head of Care, supported by the administrator. The comments received from residents, relatives and staff regarding the Manager include ‘ very approachable and Bridge House Nursing Home DS0000010978.V348373.R01.S.doc Version 5.2 Page 24 supportive’ ‘ Is always available if I need to chat’ ‘ seems very competent, the home has improved considerably since she came’ The Manager maintains a visible profile and was seen talking to residents assisting with the meal service for frail residents. Evidence was seen of the regular audits for care plans, risk assessments, accidents, medication and food quality. The home continues to work to an annual development plan. Communication systems are well evidenced, with staff handovers taking place at the start of each shift. Resident meetings are held twice a year formally, but the Manager meets with residents regularly and informally, which has proven beneficial in ensuring that the home is run in the best interests of the residents. Regular staff meetings take place and are well attended. Bridge House produces a house newspaper, which is produced every few months and shares news of birthdays, trips out, forthcoming events and introducing new staff accompanied by photos. There are systems in place to monitor the quality in the home and this includes the use of monthly questionnaires, these are audited, reported on and responded to. It was recommended that the use of questionnaires is expanded to staff and visiting professionals. The home has a computerised system for the safekeeping of service users money and all transitions are signed by two members of staff. This safeguards resident’s property and those staff dealing with it. There are polices in place for staff to refer to in dealing with residents’ finances. Formal supervision for nursing, care and ancillary staff has been commenced and links to the annual appraisals. Staff spoken with confirmed they receive supervision and find them beneficial. All staff have received the mandatory training in moving and handling, health and safety and fire safety and there is evidence of a rolling plan of training. The Manager confirmed that all staff are appropriately supervised until they have received the necessary training and induction. Bridge House looked well maintained and systems are in place to report any problems to the maintenance team that need attention. There are systems in place for monitoring safety issues such as fire checks, fire drills, PAT testing, electrical tests and gas and boiler checks and all the rooms are routinely checked for safety and maintenance issues. The records in the home confirmed they were up to date. The tour of the home confirmed that staff are aware of the fire safety policies, no doors were found inappropriately wedged open. Bridge House Nursing Home DS0000010978.V348373.R01.S.doc Version 5.2 Page 25 The Manager confirmed that the homes policies and procedures are reviewed 3 monthly to ensure best practice and the health and safety of staff and residents. Good practice was observed throughout the inspection in respect of promoting the safety and well being of the residents. Bridge House Nursing Home DS0000010978.V348373.R01.S.doc Version 5.2 Page 26 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 3 2 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 3 3 3 3 3 3 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 3 3 3 3 3 3 3 Bridge House Nursing Home DS0000010978.V348373.R01.S.doc Version 5.2 Page 27 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 OP3 Regulation 14 (1) Requirement That registered person confirms in writing that having regard to the assessment made on any prospective service user that the home can meet those needs. That service users and/or their representatives are consulted regarding the formation of the care plans. That the care plans accurately reflect the changing needs of the service users in respect of their health, social and behavioural needs. That the care plans provide guidance for staff in meeting the individual needs of the service users. That moving and handling assessments are updated and reviewed to reflect the changes in the service users health. That nutritional risk assessments are reviewed and accurate and that fluid records are completed in full and food records are kept. Bridge House Nursing Home DS0000010978.V348373.R01.S.doc Version 5.2 Page 28 Timescale for action 01/12/07 2. OP7 15(1)(2) 12 01/12/07 3. OP8 12 (1) (a) 01/12/07 4. OP16 22 5. OP26 13 (3) That the registered person 01/12/07 ensures that a full complaints procedure is used and that complaints are dealt with effectively and appropriate and that records are maintained to demonstrate a thorough and robust investigation. That good infection control 01/12/07 measures are followed. • Gloves and aprons used for personal care are removed before leaving the residents room. • That the floor in the kitchen is repaired. • That the external/internal fan in the kitchen is fitted with an appropriate cover. • That all bins have the necessary lids • That soiled commode pots are replaced. 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 OP9 Good Practice Recommendations That any gaps on the medication administration charts are identified and investigated. That photographs used for identification purposes are dated and updated regularly. That any verbal changes to medication are signed and dated. Bridge House Nursing Home DS0000010978.V348373.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU 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. 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