Inspection on 05/12/06 for Bridgemead

This inspection was carried out on 5th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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

Bridgemead 21/11/08

Bridgemead 28/02/06

Bridgemead 07/11/05

Bridgemead 03/03/05

Bridgemead 02/11/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Bridgemead 81 St John`s Road Bathwick Bath Bath & N E Somerset BA2 6PZ Lead Inspector Wendy Kirby Key Unannounced Inspection 5th December 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bridgemead DS0000020299.V321622.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. Bridgemead DS0000020299.V321622.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bridgemead Address 81 St John`s Road Bathwick Bath Bath & N E Somerset BA2 6PZ 01225 484904 01225 466486 bridgecare@freeola.com 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) Bridgecare Limited Ms Pamela Vanessa Bourton Care Home with nursing 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places Bridgemead DS0000020299.V321622.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. May accommodate up to 24 Persons over 50 years of age requiring nursing care May accommodate up to 16 persons aged 65 years and over requiring personal care. Manager must be a RN on parts 1 or 12 of the NMC register Staffing notice dated 03/03/2000 applies Date of last inspection 28th February 2006 Brief Description of the Service: Bridgemead is registered as a care home for a maximum of 32 service users, accommodating up to 24 service users requiring nursing care. It is operated by Bridge Care, a Christian trust and registered charity. The home also provides day care, Monday to Thursday, for up to 8 service users. The house is considered a home for life and all physical health care needs would be met, including terminal care. The cost per week to reside at Bridgemead ranges from £490.00 to £725.00. Fees are reviewed annually. This weekly fee does not include provision for items such as hairdressing, chiropody, dental, ophthalmic or aromatherapy services. Prospective residents can be provided with information about the home by accessing the Service Users Guide, which will detail the services and facilities available at the home. Bridgemead DS0000020299.V321622.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection conducted as part of the annual inspection process. The inspection lasted one day. The inspector sent questionnaires “Have your say” to all residents in the home prior to the inspection and twenty were completed and returned. “Comment Cards” were also sent to relatives, visitors and visiting health and social care professionals, thirty-five of these were also completed and returned. Information from these has been collated and is detailed throughout the report. As part of this unannounced inspection the quality of information given to people about the care home was looked at. People who use services were also spoken to, to see if they could understand this information and how it helped them to make choices. The information included the service user’s guide (sometimes called a brochure or prospectus), statement of terms and conditions (also known as contracts of care) and the complaints procedure. These findings will be used as part of a wider study that CSCI are carrying out about the information that people get about care homes for older people. This report will be published in May 2007. Further information on this can be found on our website www.csci.org.uk The inspector spent time throughout the visit in discussions with the manager and staff; a number of records and files relating to the day-to-day running and management of the home were examined. Four residents were case tracked. Their care plans and care files were examined. The inspector had discussions with the residents and observed them going about their daily routines. The inspector toured the premises accompanied by the manager. Feedback was given on the outcome of the inspection. What the service does well: Admission procedures are resident focussed and supportive to residents. Care plans accurately reflect the residents’ needs and how they will be met. Residents and their families are involved in this process wherever possible. Bridgemead DS0000020299.V321622.R01.S.doc Version 5.2 Page 6 Systems are in place to help ensure that there is consistency in assessing, planning, implementing and evaluating the resident’s care at the required times. Staff have a good awareness of individuals’ needs and treat the residents in a warm and respectful manner, which means that they can expect to receive care and support in a sensitive way. There are safe systems of medication. Residents benefit from a varied activities programme, which is both enjoyable, stimulating and meets individual preferences and expectations. Meals were well presented and menus verify a healthy well balanced diet for all residents who benefit from a wide variety of choice. The home is comfortable, tastefully decorated and furnished. It provides a safe, peaceful and well-maintained environment for the residents. Adequate staffing levels help to ensure that resident’s needs are met. Staffing levels are increased should the dependency levels of the residents change. The recruitment procedure is robust and serves to protect vulnerable residents. The home was well organised and managed by an effective, stable management team that promoted the views and interests of the residents. Bridgemead provides a high standard of care to its residents, who appear to be happy with the service they receive and are content with their daily lives. What has improved since the last inspection? What they could do better: All of the National Minimum Standards assessed at this inspection were met. No statutory requirements have been made as a result of this inspection Bridgemead DS0000020299.V321622.R01.S.doc Version 5.2 Page 7 It was recommended and agreed that the manager includes a brief discussion about the homes complaints policies and procedures at future resident and relative meetings as a way of updating and refreshing knowledge and understanding. 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. Bridgemead DS0000020299.V321622.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 Bridgemead DS0000020299.V321622.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): 1,2,3,4,5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents or their families have all relevant information to make a decision about the nature of the home. Residents receive a contract and written terms and conditions on admission to the home Prospective residents needs are assessed prior to admission to determine the suitability of placement to ensure that their needs can be met. Trial visits give prospective residents an opportunity to assess the nature of the home. Bridgemead DS0000020299.V321622.R01.S.doc Version 5.2 Page 10 EVIDENCE: A statement of purpose and resident guide is available, in loose-leaf format and presented as a whole document in a folder. This document is made available to prospective residents/families and has been issued to all current residents. Copies are also available from reception. Through discussions with residents in the home and residents surveys it was confirmed that they and their families had received adequate information about the home prior to admission. Several residents stated in their surveys that they use to attend the day care centre at Bridgemead, which gave them the opportunity to get to know fellow residents, staff and routines prior to moving in on a permanent basis.” Residents’ files contained contracts and terms and conditions, which are signed on admission. Sixteen residents confirmed in their surveys that they had received a contract and four residents who didn’t know said that they thought their families had signed contracts on their behalf. The residents’ records and discussions with the manager confirmed that a letter is sent to the residents notifying them of any changes in the fees. The prospective resident, family and carers are involved in the pre-admission and all information is used to determine the suitability of the placement. Where possible the manager had also obtained comprehensive assessments and care plans from other professionals involved for example, social workers and hospital staff. Prospective residents are encouraged to visit the home either for the day or perhaps for lunch dependent on their wishes. A month’s trial period on both sides is usually undertaken to ensure that everyone is happy with the arrangements and to ensure that the placement is suitable. One resident informed the inspector, “It was a hard decision for me to make with regards to remaining a permanent resident at Bridgemead. The home was very understanding and I was given the opportunity to extend my trial period”. Bridgemead DS0000020299.V321622.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): 7,8,10,11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service had good systems for meeting and monitoring residents’ health and personal care needs in consultation with residents. There are safe systems of practice in receiving, storing, administering, and disposing of drugs. Staff have a good awareness of individuals needs and treat the residents in a warm a respectful manner, which means that they can expect to receive care and support in a sensitive way. Plans have been developed with regards to resident’s wishes when dealing with acute illness and making plans for end of life. Bridgemead DS0000020299.V321622.R01.S.doc Version 5.2 Page 12 EVIDENCE: From the pre admission assessments the staff are able to develop an initial long-term plan, which includes, past medical history, personal social history, likes and dislikes and dependency levels for activities of daily living. During the first months trial period the plan is regularly reviewed and developed accordingly. Any identified needs are then transferred to individual care plans and contain details of how these needs will be met by the home. The home uses the Standex system of documentation for assessing, planning and evaluating care. The documentation available was comprehensive and overall completed to a satisfactory standard. It was evident that the care plans had been developed and reviewed with the resident and or their families’ involvement and that they had signed them. Risk assessments were in place with detailed information to ensure safe procedures for example, manual handling, the correct use of bed rails and pressure sore assessments. The pilot scheme continues whereby care staff receive training in basic nursing skills under the direction and supervision of the trained nurses. Assessment of the training is carried out by staff from Bath and North East Somerset Council Training Department. The manager stated that the home was motivated and spoke positively about the new skills they are acquiring and how through learning these skills they will be able to implement them effectively within the home to the residents. Through this training the care staff will be able to meet basic health needs including venepuncture, taking observations and specialist feeding. This holistic approach to care will enable the staff to provide consistency in delivering care to the residents without involving resources within the community e.g. district nurses and GP. Subsequently this may avoid possible hospital admissions. One resident told the inspector, “The staff manage to control my unstable diabetes very skilfully”. All staff were able to demonstrate good relationships with individuals and were knowledgeable about the care needs of the residents living in the home. One relative told the inspector, “I cannot praise enough the love and care my relative has received at Bridgemead and also the concern expressed relating to my welfare”. Records of the General Practitioner visits/contact with residents and the outcomes were also available. The home had access to pressure relieving equipment and this was documented in the plan of care. Specialist referrals and visits from other professionals were evidenced in care files including Community, Chiropodists, opticians and Dentists. Bridgemead DS0000020299.V321622.R01.S.doc Version 5.2 Page 13 Visiting health professionals comment cards stated, “Consistently impressed with the high standards of care both nursing and personal”, “Staff are always helpful and communicate well with us” and “Bridgemead provides a high standard of care and I always feel confident that my patients are well cared for”. The Inspector was informed that each resident was referred to a GP of his or her choice on admission to the home and an initial first visit was then set up. Although only one local GP conducts a fortnightly visit to the home, good working relationships with other GP’s and District Nursing teams have been formed and will visit on request. All residents’ surveys stated that they always felt that they received the medical support they needed. Policies and procedures for receiving, storing, administering and disposing of medications were examined and discussed with the manager; all systems in place are effective and well managed. The home operates a monitored dosage system for the administration of medication, which is supplied at regular intervals by the local pharmacist. The GP’s conduct a medication review for all residents every six months. The home also keeps an accurate stock check of medicines given on an as required basis. Fridge temperatures are recorded daily. The administration charts were legible and continuity of administration was shown with a signature from the person dispensing. Staff were witnessed knocking on residents doors before entering confirming respect for the residents individual privacy and dignity at all times. One relative stated, “My parent is well cared for treated respectfully”. All rooms have a telephone point from which residents can make and receive calls. Private telephone lines can be installed. At the previous inspection the manager was developing care plans for resident’s wishes for end of life and was also taking part in a survey organised with a local Consultant Geriatrician with regards to dealing with acute illness in nursing homes. As a result of this the home now completes a plan with the resident and their families entitled an advanced care plan. The manager and staff are continuing to make every effort to establish resident’s wishes concerning palliative care and any provision residents and their families would wish for by developing end of life care plans. The manager explained that the plans are sensitively completed with residents and their families/significant others preferably during the initial four week trial period. Bridgemead DS0000020299.V321622.R01.S.doc Version 5.2 Page 14 Plans were personalised and signed by the residents and a member of staff. The information sought was well thought out and should help ensure that residents’ choices are respected. One question asks “What would you not like to happen in the event of ill health” and one resident had replied, “I do not want to be admitted to hospital”. Bridgemead DS0000020299.V321622.R01.S.doc Version 5.2 Page 15 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): 12,13,14,15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents benefit from a varied activities programme, which is both enjoyable, stimulating and meets individual preferences and expectations. Residents maintain family contact and staff encourage family and friends to join in with activities and any outings. Residents receive a varied and wholesome diet that they are able to influence. EVIDENCE: From discussion with manager and the residents it was clear that the home has a flexible approach to residents wishes about the pattern of their day. Residents stated in their surveys that activities were provided in the home and comments included, “There is a good programme of activities arranged and I choose which ones I wish to attend” and they always have a great variety especially musical entertainment and outings, first rate!” Bridgemead DS0000020299.V321622.R01.S.doc Version 5.2 Page 16 The home has recruited an activities coordinator since the last inspection and is also fortunate to have approximately twenty volunteers taking an active part in the home including the “trolley shop” where residents can buy a range of useful day-to-day items, including toiletries, sweets and a selection of greeting cards. The volunteers also assist with the mobile library, tea and coffee mornings, help with the day-to-day activities, and provide quiet time for fellowship, fifteen minutes daily. A programme of events is produced each week and each resident receives a copy. Activities are targeted to individuals who require one to one stimulation as well as group activities. Residents are involved in activities such as gentle exercise to music, story telling, arts and crafts and poetry. Visiting entertainers include a pianist, classical guitar, harpist and magician. A record of resident participation is made along with recorded comments from the residents. The “Friends of Bridgemead” are a small voluntary committee, which was formed six years ago. They specifically organise events throughout the year to raise money for the home and its residents. Events so far this year included a barn dance and a racing evening; the money raised this year has assisted in purchasing new lounge furniture. Relatives comment cards stated “Staff make a tremendous effort to make special occasions really special for residents” and “A varied programme of activities are arranged”. Each year the home produces a “Christmas Programme”, which contains information on forthcoming events, stories, poems and prayers. All residents, relatives, visitors and staff are encouraged to participate with the collation of information. Some of the events arranged over this festive period include, a nativity play performed by local children, a visit from a bell ringing group, a production of Jack and the beanstalk and a trip to Bath to see the Christmas lights. The home has also participated in the “Christmas Child Appeal” whereby fifteen boxes were decorated and filled with presents for children in need. The charity that organised the appeal sent a DVD to the residents showing them a film of the children receiving the gifts they had supplied. Sunday services are conducted weekly and a monthly communion is held. The home has a monthly residents meeting which are well attended and minutes are taken. A monthly newsletter called “Bridgemedia” is also produced and circulated to residents and families. Information includes “News and Views”, sharing interesting facts, dates for your diary, mottos and anecdotes. Bridgemead DS0000020299.V321622.R01.S.doc Version 5.2 Page 17 The home operates an open door policy for visitors. Residents are able to see visitors in the privacy of their rooms and there are several semi-private seating areas around the home and in the gardens. One visiting family stated, “We travel quite a distance to see our relative and the family rooms are very useful”. The size and layout of the dining room makes it possible for all residents to enjoy the social advantages of dining together. Staff had used their expertise and knowledge of the residents, personalities, preferences and ability to eat independently, when seating them for lunch. The dining room is light, spacious and the tables were attractively laid with tablecloths. Staff members supported residents that required assistance with eating their meals in a respectful, sensitive way. Staff sat at the same level as the resident and assisted without rushing. They were also seen to be polite and helpful when serving the meals. Residents surveys were generally positive about the meals provided and included comments, “I have a good assortment of food and when there is something I don’t like I am always found an alternative” and “I always enjoy the food and portions are just right”. The inspector who had met with the cooks during previous inspections who continue to demonstrate an awareness of individual requirements and needs of the residents, including special dietary requirements and personal preferences. The 4-week menu rota displayed traditional meals and with a choice available at each sitting. The menus are reviewed to reflect seasonal trends and availability of produce. Extras are ordered on request for birthdays and special occasions. When residents have a birthday, to celebrate the day they are asked to choose the menu for the whole day to include all of their favourites. The kitchen was very clean and spacious. Stores exhibited a good range of foods. Food hygiene training was up to date for staff. Documentation was provided to show the inspector that required temperature checks were being carried out on fridges and freezers and that food was also being probed after being cooked before serving. Risk assessments were in place and up to date. Bridgemead DS0000020299.V321622.R01.S.doc Version 5.2 Page 18 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): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are robust and comprehensive policies in place to manage complaints or allegations of abuse. There are good arrangements in place for staff training and awareness of protection of vulnerable adults. EVIDENCE: A copy of the complaints procedure is on display in a well-frequented part of the home, which means people should know how to obtain the required information if they want to make a complaint. The complaints policy and procedure is detailed and contains all the required information, a copy of this is in the information pack provided on admission. There had been no complaints received since the last inspection. Only three comment cards indicated that they were unaware of the complaints procedure and some residents’ surveys stated that they were “unsure”. The surveys were anonymous so unfortunately the inspector was unable to identify those residents who were “unsure”. Bridgemead DS0000020299.V321622.R01.S.doc Version 5.2 Page 19 The inspector asked residents during her visit about how they would complain and who would they speak to if they were unhappy. Despite the comments in the surveys it was evident that residents were confident and comfortable to speak to the manager, staff and their relatives should they have any concerns. The manager was surprised about people’s awareness and it was suggested that it could be possible that long-standing residents and visitors to the home may have forgotten the information they had received on admission. It was agreed that it would beneficial for the manager to include a brief discussion about the homes complaints policies and procedures at future resident and relative meetings as a way of updating and refreshing peoples knowledge and understanding. There are procedures as well as a range of guidance information on the topic of protection of vulnerable adults from abuse’ including the Local Authority “No Secrets” document. The staff handbook and induction training provides education on topics for whistle blowing, management of aggression and bullying. The availability of this information should increase staff awareness and understanding of their role in protecting vulnerable adults who live at the home. The inspector was informed that the home actively promotes staff training and education in the protection of vulnerable adults on induction and by attending training on the Protection of Vulnerable Adults through Bath and North East Somerset Council. Staff training records evidenced this commitment. A number of staff are also undertaking the National Vocational Qualification in care award, and a component of the award addresses issues around the topic of the protection of vulnerable adults from abuse. Bridgemead DS0000020299.V321622.R01.S.doc Version 5.2 Page 20 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): 19,20,21,22,24,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean, comfortable, well decorated and furnished. It provides a safe, peaceful and well-maintained environment for the residents. The bedrooms and communal rooms and facilities are suitable and well presented for their purpose and meet the resident’s needs. EVIDENCE: The home is purpose-built to care for elderly people. The gardens are attractive and designed to meet the needs of the residents. The residents spoken with were very complimentary about the home and the garden areas. Bridgemead DS0000020299.V321622.R01.S.doc Version 5.2 Page 21 The home is on three floors, with level access to all via a passenger lift. The inspector walked around the inside of the home and viewed, some of the bedrooms, and the communal living areas including the dining room, several lounges and a large conservatory. Room sizes are adequate for their stated purposes, particularly the lounges and conservatory and the bedrooms. Rooms have en suite facilities provided and communal bathing areas; showers and toilet facilities are located throughout the home. All areas of the home were tastefully decorated, clean and well maintained. Great attention has been given to ensure that all areas are homely. Residents had been supported to personalise their bedrooms with pictures and ornaments and residents are able to bring items of furniture should they wish. The conservatory adds a pleasing space for residents to use and overlooks a large mature garden where the river Avon is running at the bottom of it. The gardens have well-stocked flowerbeds, established trees and shrubs, and a patio area. There are various semi-private seating areas with plenty of sun screening. The gardens provide peace, tranquillity and enjoyment for the residents and visitors throughout the year. Residents were making full use of these areas and their bedrooms on the day of the inspection. A number of residents said how much they liked the views of the river, trees and wildlife from their bedroom windows. All residents stated in their surveys and in discussion with the inspector that the home was always clean and smelled fresh and pleasant throughout. The home employs domestic staff on a daily basis. Residents’ surveys confirmed that the home is always fresh and clean and comments included, “There are very high standards of cleaning in all rooms and fresh flowers in reception” and “The home is spotless all the time”. Bridgemead DS0000020299.V321622.R01.S.doc Version 5.2 Page 22 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): 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. Adequate staffing levels help to ensure that resident’s needs are met. Residents are supported and protected by the homes recruitment policy. The residents are cared for by caring staff that are trained and supported by management. EVIDENCE: The manager ensures that staffing levels are indicative of the needs and levels of care required by the residents twenty-four hours a day and confirmed that levels of staff would rise should dependency levels increase. As mentioned previously in the report the home also has a steadfast group of volunteers on a daily basis. Sixteen residents’ surveys agreed that staff were usually always available when they needed them comments included, “There are many residents in the home so I understand why sometimes the staff are not able to give me immediate attention when called”, “One doesn’t know where the staff are at times and sometimes they seem slow in responding” and “I find that most of the time staff response is extremely good”. Bridgemead DS0000020299.V321622.R01.S.doc Version 5.2 Page 23 A robust recruitment policy and procedure is in place and the files inspected showed all the appropriate documents and checks were in evidence. CRB (in full) disclosures are being retained until the inspector has examined them. Nurse PIN’s (in full) are validated annually. On recruitment staff are given a handbook, which contains, many of the homes policies and procedures including manual handling, health and safety and first aid. There is an induction programme, which covers all mandatory training, including Fire, Manual Handling, Health and Safety and the Protection of Vulnerable Adults. The home has a mentor system where all new staff are linked with and shadow a senior staff member during each shift to enable continuity and continued training throughout the induction process. The manager and staff are conscientious in attending training relevant to the care needs of the residents, this year courses have included, “Wound care management”, “Catheter Care and managing bowel movements” and “Dementia Awareness”. Staff confirmed in discussions that they had valued the training they had received particularly in dementia care. The home continues to support their staff with their NVQ training. Staff records and the homes training matrix confirmed that training was up to date and future courses had been arranged. One volunteer told the inspector “There is a warm and loving atmosphere at the home”; staff were respectful, good humoured and sensitive towards the residents within a relaxed, calm environment. They demonstrated a very caring, committed attitude to their roles and responsibilities in ensuring they provide quality of care to the residents. Relatives comment cards expressed how pleased they were with the all aspects of the home, the staff and services provided. Comments included, “I am impressed by the professional and caring way staff treat my relative”, “Very pleasant approachable senior staff” and “My relative receives the best treatment from dedicated staff”. Bridgemead DS0000020299.V321622.R01.S.doc Version 5.2 Page 24 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): 31,33,35,38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ needs and best interests are central to the management approach in the home. Good accounting methods are adopted and policies and procedures are followed correctly when handling residents’ personal money. The health and safety of residents, staff, and visitors is protected. Bridgemead DS0000020299.V321622.R01.S.doc Version 5.2 Page 25 EVIDENCE: The home continues to consistently demonstrate good, effective leadership and management that relates to the aims and purpose of the home. The home’s registered manager Mrs Bourton has over five years managerial experience working at Bridgemead and is well qualified both in management and training. It was evident from discussions with the manager and staff that the home has a stable team that supports a commitment to providing quality care for the benefit of the residents. As detailed throughout the report there was a high degree of satisfaction expressed by all of the residents, relatives and visitors who stated, “I could not be more pleased with the way Bridgemead is run” and “Bridgemead is a caring well run home and place where I would happily be a resident if it were necessary”. Based on the comments made and through the inspectors observation it is evident that the home is run in residents best interests and to ensure that their needs are being met. The home continues to develop formal quality assurance system and has completed its annual audit to assess the satisfaction of residents with regards to the service that the home provides. Residents and relatives are asked to complete surveys. Information from the surveys is collated and documented effectively. The results have enabled the home to identify all strengths and any weaknesses within the service they provide, and to produce an action plan where necessary. In June this year the activity coordinator also conducted an audit to ascertain what activities residents would most enjoy. The results were valuable in that residents had identified activities that they would like removed from the programme and initiated other activities that were of particular interest to them for example flower arranging classes and a classical music hour once a week. Thirteen residents said they would like reminiscence sessions individually. It is planned that a reminiscence book for each resident who wishes to participate will develop this with his or her key worker. The manager also personally sends out invites to all residents and their families on alternate months to join her for a coffee morning. Although the manager is available on a full time basis, this opportunity is greatly received and allows people the option to share information and discuss any concerns/ issues they may have. The policy and procedure for holding residents personal money was examined and four individual accounts were looked at. It was evident that good accounting methods are adopted which account for all transactions documented and receipts for sundries were available to see. Residents’ accounts are audited on a weekly basis. Bridgemead DS0000020299.V321622.R01.S.doc Version 5.2 Page 26 Some of the Health and Safety records in the home were examined. Documentation showed that relevant checks were maintained correctly and at the required intervals including all fire alarms and equipment and emergency lighting. The homes records showed all necessary service contracts were up to date including, gas and electrical services and the passenger lift. The fire logbook evidenced compliance to the weekly, monthly and annual checks alongside records of staff training and drills completed, records clearly identified that all members of staff have been present during fire drills as recommended by the Fire Prevention Officer. All night staff undertake this on a three-monthly basis, and day staff six-monthly. Bridgemead DS0000020299.V321622.R01.S.doc Version 5.2 Page 27 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 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 X 3 X 3 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 4 X 3 X X 3 Bridgemead DS0000020299.V321622.R01.S.doc Version 5.2 Page 28 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. Standard Regulation Requirement Timescale for action 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 OP16 Good Practice Recommendations Ensure that people who use the service have all the information they need to make a complaint. Bridgemead DS0000020299.V321622.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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. Extracts may not be used or reproduced without the express permission of CSCI Bridgemead DS0000020299.V321622.R01.S.doc Version 5.2 Page 30 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!