Inspection on 26/05/06 for Bridge House Nursing Home

This inspection was carried out on 26th May 2006.

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 21/09/07

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 Marie Carvell Unannounced Inspection 10:00 25th May 2006 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.V290024.R01.S.doc Version 5.1 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.V290024.R01.S.doc Version 5.1 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 (41) of places Bridge House Nursing Home DS0000010978.V290024.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th October 2005 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. The current scale of charges as at May 2006 are between £650 and £900 per week. There are additional charges for toiletries, hairdressing, chiropody and newspapers. Bridge House Nursing Home DS0000010978.V290024.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report has been prepared using information provided on the preinspection questionnaire completed by the manager of the home; our inspection records held at the local office of CSCI: fifteen service user surveys; an unannounced site visit on the 25th May 2006 and a short notice visit on the 26th May 2006. During the unannounced site visit, time was spent service users, relatives, staff on duty, manager and the training and operations manager, observation was made of the delivery of care: a tour of the premises and nine service user files were case tracked. During the short notice site visit records concerning the management of the home were reviewed, time was spent with the manager, training and operations manager, staff on duty and service users. The manager and training and operations manager were present during both site visits. The first site visit took place from 10am until 4.45pm and the short notice visit from 11am until 4.45pm. One inspector conducted both site visits. What the service does well: What has improved since the last inspection? Bridge House Nursing Home DS0000010978.V290024.R01.S.doc Version 5.1 Page 6 The manager who was appointed in October 2005 was registered with CSCI in February 2006. All work required by the Berkshire Fire and Rescue has been completed. Work has been completed to provide additional sluicing facilities in the home. The home has commenced a detailed refurbishment of bedrooms, bathrooms and toilets. Staffing levels have been reviewed and increased to meet the needs of the service users. 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 Nursing Home DS0000010978.V290024.R01.S.doc Version 5.1 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 Nursing Home DS0000010978.V290024.R01.S.doc Version 5.1 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): 1,2 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including visits to the service. EVIDENCE: The manager or a senior nurse undertakes a pre-assessment of all prospective service users to ensure that the home is able to meet their needs. The assessment covers health, welfare and social circumstances. Prospective service users and their friends/family are encouraged to visit the home and to move in on a trial period, this was confirmed in discussion with service users and relatives. The fifteen service user surveys also confirmed that information is received in order to decide whether the home was the right place to live in. Comments received included “ Close relatives had to make the decision as illness prevented otherwise. The family was very well informed as well as a visit arranged”,“Visited the home and asked questions before placing my mother on the waiting list”, “Needed accommodation urgently and the home was Bridge House Nursing Home DS0000010978.V290024.R01.S.doc Version 5.1 Page 9 extremely helpful” and “Visited home- few places available in that area that take EMI, so not much choice.” From a sample of service user files it was evidenced that a written contract or terms and conditions are provided to all service users. Relatives and service user surveys confirmed this. Bridge House Nursing Home DS0000010978.V290024.R01.S.doc Version 5.1 Page 10 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 and 10 Quality in this outcome is good. This judgement has been made using available evidence including visits to the service. EVIDENCE: A sample of service user files were case tracked and evidenced that the home is pro-active in meeting the health, personal and social care needs of service users in a caring and dignified manner. Care plans and risk assessments were found to be well documented and up to date. Healthcare needs are provided by a local GP practice and it was evidenced that a wide range of healthcare professionals are involved in service user care as necessary. At least one service user, who should be receiving free chiropody treatment, is in fact paying for this service. Service user surveys stated that care and medical support was “always provided” or “usually provided”. One survey stated, “Doctor called when needed. Not always told of his visit before event, but sometimes afterwards”, “Sometimes bells are not responded to promptly, due to apparent shortage of staff”. Service users and relatives spoken to during the site visits were complementary about the care and support provided. Bridge House Nursing Home DS0000010978.V290024.R01.S.doc Version 5.1 Page 11 A sample of medication administration records seen were well maintained with no obvious gaps in recordings. The home has a contract for pharmacy advice from the supplying pharmacist who visits the home regularly. The CSCI pharmacist inspector carried out an inspection in November 2005 and found storage arrangements, medication records and policies and procedures to be satisfactory. Staff were observed to communicate with service users in a respectful and appropriate manner. The inspector gained the impression that there is a good rapport in the home between service users and all grades of staff. Comments made in service user surveys included “ On the whole, the care is very good and the atmosphere happy. I appreciate what is being done for my relative in what must be very trying circumstances for the staff, and I am grateful for the kindness and patience shown to the patients, some of whom must be difficult to manage”, “ The staff at Bridge House are superb, the care my relative gets is very good. But the support and friendliness I receive makes my job so much easier”, “The management and staff go out of their way to help and understand”, “My sister and I have always found all the staff (not just the nursing staff) to be very helpful and caring and have always treated our relative with dignity and respect”, “Some staff are better than others”. Service users were seen to be well groomed and appropriately dressed. Bridge House Nursing Home DS0000010978.V290024.R01.S.doc Version 5.1 Page 12 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): 12,13,14 and 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including visits to the service. EVIDENCE: Two very enthusiastic activity organisers are employed full time in the home; these hours are flexible to meet the needs of the service users. A wide range of activities are organised and are age appropriate. All service users have an activities/social care plan, which is detailed and up to date. Service users are encouraged to maintain their individual interests. The activity organisers also provided one to one activities for those service users who are frailer or do not wish to join in group activities. Service users and relatives expressed their satisfaction of the activities and day trips arranged. Comments made in service user surveys included “ Recent flurry of events arranged for residents”, “We are lead to believe that this aspect is being improved”, “ Management has recently changed and there now seems to be more effort to arrange outings. This is most welcome” and “Most impressive programme of events available throughout the year”. Visitors to the home are made welcome, relatives confirmed that refreshments are always offered and a meal can be requested. The majority of service users have family or friends who visit the home on a regular basis. Bridge House Nursing Home DS0000010978.V290024.R01.S.doc Version 5.1 Page 13 Service users are assisted to exercise choice and control over their lives, this was confirmed by service users, evidenced in service user records and observed during the site visits. Service users were complementary about the food offered. Menus demonstrated that a varied, appealing, wholesome and nutritious diet is provided. Service users with specific dietary needs are well catered for. The inspector joined service users for the midday meal on both site visits. Service users had a choice of three main dishes and wide selection of desserts. Salads are always available. Food choices are recorded to ensure that a varied diet is being eaten. Catering staff seek the views of service users daily and any special requests are introduced into the menu. Cakes are provided to celebrate birthdays. The meals were tasty and attractively served. All service users asked, confirmed that they had enjoyed their meal. Staff were observed to be attentive and assisted service users in a dignified and responsive manner. It is the home’s policy that all staff are available, including the manager to assist at mealtimes. Comments made in service user surveys included “Do not like processed salty soup or jellies, otherwise food is adequate if uninspiring. More fruit would be welcome”, “No problem when my mother needed pureed food”, “A greater choice of pudding would be welcome, but must be low fat”, “fresh fruit seldom offered” and “All the meals that the family have seen look to be extremely appetising and very well presented”. Bridge House Nursing Home DS0000010978.V290024.R01.S.doc Version 5.1 Page 14 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 and 18 Quality in this outcome is adequate. This judgement has been made using available evidence including visits to the service. EVIDENCE: Service user surveys stated that all knew how to make a complaint “always” or “usually”. Comments included “Never anything to complain about, staff always seem OK”, “ I am able to speak to the manager or head office”. In discussion with service users and relatives the majority were satisfied with how their complaints had been addressed and felt confident that the manager would act immediately. One relative expressed some reservations about complaints being acted upon; this was referred to the manager with the relative’s permission. The pre-inspection document completed prior to the inspection stated that the home had not received any complaints. The home has a minor grumbles book; this was examined by the inspector and found to contain several complaints regarding poor care practices and staff attitude problems. Most entries did evidence action taken and outcomes for service users, but not all. The home’s complaints procedure had been updated by the following days site visit and all staff are to be made aware of the new procedure. All staff are provided with training in the protection of vulnerable adults from abuse, this was confirmed by staff and evidenced by training records. Bridge House Nursing Home DS0000010978.V290024.R01.S.doc Version 5.1 Page 15 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): 19,21, 22, 24 and 26 Quality in this outcome is good. This judgement has been made using available evidence including visits to the service. Standards 19,21 and 26 were subject to requirement at the last inspection. EVIDENCE: The service users live in a safe and well maintained environment. The home has addressed all requirements made by the Berkshire Fire Authority. A planned refurbishment of the home is underway with new sluicing facilities and laundry facilities installed, bathrooms are being upgraded and redecorated. Additional toilets are to be installed. Many bedrooms have been redecorated and updated. Service users are encouraged to personalise their bedrooms and this is appreciated. Appropriate aids and adaptations are provided throughout the home and an additional hoist is to be purchased, this was welcomed by nursing and care staff. Bridge House Nursing Home DS0000010978.V290024.R01.S.doc Version 5.1 Page 16 All areas of the home were found to be clean and free from unpleasant odours. It was evidenced that housekeeping staff work hard to keep the home clean, pleasant and hygienic. One service user survey stated, “ The home always smells sweet and clean, this is very noticeable in comparison with other homes visited”. Bridge House Nursing Home DS0000010978.V290024.R01.S.doc Version 5.1 Page 17 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): 27,28,29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including visits to the service. Standard 27 was subject to requirement at the last inspection. EVIDENCE: Since the last inspection staffing levels have been increased in order to more effectively meet the needs of the service users. This has been welcomed by all staff, and has had a positive impact on staff morale and service user care. When necessary the manager is able to provide additional staff, if the dependency levels of the service users indicate the need. From discussion with staff on duty and from observation it appears that there are adequate staff rostered on duty to meet the needs of service users. The home’s recruitment practices do not protect service users. A sample of seven personnel records evidenced that although all staff had completed an application form, these did not include a full employment history. Gaps in employment were not explored at interview. Not all personnel files contained two written references. Staff had been recruited and employed in the home before Criminal Records Bureau and the Protection of Vulnerable Adults checks had been completed and returned. Two members of staff in post since 2004, did not complete a CRB check, but provided evidence of a check having been carried out by a previous employer prior to the POVA list checks becoming a legal requirement. This has since been addressed for one member of staff in May 2006. Five personnel records were for members of staff who have been recruited since January 2006, a CRB application was submitted for four as part Bridge House Nursing Home DS0000010978.V290024.R01.S.doc Version 5.1 Page 18 of the recruitment process, however, all four were working in the home for approximately four to eight weeks before these checks had been completed. One member of staff was appointed with a CRB check undertaken in February 2004 and therefore does not include checking the POVA list. The manager and training and operations manager have now revised the home’s recruitment policies and procedures, all staff must complete a CRB application, as is current policy, a POVA first check will then be requested. Only when this check as been completed and it is confirmed that the member of staff is not on the list of persons not suitable to work with vulnerable adults, will a start date be agreed. Until the CRB check has been returned, the new member of staff will be supervised by a named individual at all times. This information will be documented. There are currently sixteen care staff in post, mostly employed full time. Six care staff have achieved NVQ level II and three have achieved NVQ level III, two care staff are currently working towards level II and level III and five are to commence NVQ level II later this year. Each member of staff has a training and development programme. All staff have completed or are working towards completing mandatory training, other training courses are on going. The training and operations manager is present in the home for two to three days per week. Training is actively promoted and staff spoken to stated that there are good training opportunities available, including English lessons for staff for whom English is not their first language. Training records are well maintained. Bridge House Nursing Home DS0000010978.V290024.R01.S.doc Version 5.1 Page 19 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): 31,32,33,35,36 and 38 Quality in this outcome is good. This judgement has been made using available evidence including visits to the service. EVIDENCE: The manager was appointed in October 2005 and registered with the CSCI in February 2006. She is a registered nurse, an experienced care home manager and has completed the Registered Managers Award. This appointment has had a positive effect in improving care practices and staff morale in the home. Service users, relatives and staff were complementary about the manager, her leadership and her management approach. Comments made included the manager leading by example, being approachable, fair and being supportive. The manager spends time each day monitoring care practices and seeking the views of service users, relatives and staff on duty. Regular audits take place including care plans, risk assessments, accidents, medication and food. The Bridge House Nursing Home DS0000010978.V290024.R01.S.doc Version 5.1 Page 20 home has an annual development plan. In discussion the manager, informed the inspector that since her appointment, the priority has been service user focussed. Communication systems are well evidenced, with staff handovers taking place at the start of each shift. Regular staff meetings take place and are well attended. The home has a system for the safekeeping of service users money. Records are adequately maintained but could be improved to assist with auditing of accounts. Since the unannounced site visit, the recording of income, expenditure and balance has been developed including the signatures of two members of staff for each transaction. Formal supervision for nursing and care staff has not yet commenced. It was evidenced from staff meeting minutes that this is being addressed within the next few weeks. Supervisory training is planned for all staff with supervisory responsibility. Annual appraisals have recently commenced. A sample of records relating to fire, health and safety were examined. These were found to be up to date and maintained to a high standard. Bridge House Nursing Home DS0000010978.V290024.R01.S.doc Version 5.1 Page 21 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 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 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 3 x 3 3 x 3 x 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 2 1 x 3 Bridge House Nursing Home DS0000010978.V290024.R01.S.doc Version 5.1 Page 22 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 OP16 Regulation 22 Requirement That the manager advises the CSCI that the complaints policy and procedure has been updated to include the recording of complaints received by the home and that all staff are now familiar with the new policy and procedure. That the manager advises the CSCI of what action has been taken to ensure that recruitment practices in the home are robust. That the manager carries out an audit of staff files to ensure that all staff employed in the home since July 2004, have had a POVA check completed. The CSCI are to be advised of the outcome and any action taken. That the manager advises the CSCI of action taken to improve the recording of service users monies held in safekeeping by the home. That the manager advises the CSCI of action taken to ensure that all nursing and care staff receive formal supervision at least six times per year, by an DS0000010978.V290024.R01.S.doc Timescale for action 29/06/06 2. OP29 19 29/06/06 3. OP29 19 29/06/06 4. OP35 17 Sch 4 29/06/06 5. OP36 18 29/06/06 Bridge House Nursing Home Version 5.1 Page 23 individual who has received supervisory training. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Bridge House Nursing Home DS0000010978.V290024.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Berkshire Office 2nd Floor 1015 Arlington Business Park Theale, Berks RG7 4SA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bridge House Nursing Home DS0000010978.V290024.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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