Inspection on 07/11/05 for Bridgemead

This inspection was carried out on 7th November 2005.

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 05/12/06

Bridgemead 28/02/06

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 Johns Road Bathwick Bath BS2 6PZ Lead Inspector Andrew Pollard Unannounced 7 & 9 November 2005 09:30 th th 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 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 D56_S20299_Bridgemead_V236726_041105_Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Bridgemead Address 81 St Johns Road Bathwick Bath BA2 6PZ 01225 484904 01225 466486 Telephone number Fax number Email 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 OP Old age (32) registration, with number of places Bridgemead D56_S20299_Bridgemead_V236726_041105_Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 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 3-Mar-2005 Brief Description of the Service: Bridge Care is a Christian trust and is a registered charity. It is the founder of Bridgemead. Bridgemead is registered as a care home for a maximum of 32 service users, accommodating up to 24 service users requiring nursing care. The home also provides day care Monday to Thursday for up to 8 service users. Bridgemead D56_S20299_Bridgemead_V236726_041105_Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The following methods of evidence gathering have been used in the production of this report: observation; discussion with residents, staff and relatives a tour of the home; sampling policies, records and care plans. The house was purpose built for disabled people and is generally well designed for the function. It is well furnished and equipped to a high standard. The house is considered a home for life and all physical health care needs would be met, including terminal care. The home is a well-managed and friendly establishment and has a pleasant, relaxed atmosphere. There are a small number of requirements and recommendations set out in this report, which were discussed during the inspection, but the standards overall are high. During the inspection the inspector spoke to residents and relatives, all of who were very complimentary of the home and the quality of staff. What the service does well: What has improved since the last inspection? The overall high standards of the home have been maintained. Residents participation in activities / events are recorded. Pressure relief equipment used is documented in the care plan. Care plans have been updated. Risk assessments have been updated and reviewed. Bridgemead D56_S20299_Bridgemead_V236726_041105_Stage4.doc Version 1.30 Page 6 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. Bridgemead D56_S20299_Bridgemead_V236726_041105_Stage4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Bridgemead D56_S20299_Bridgemead_V236726_041105_Stage4.doc Version 1.30 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 standard(s) 1, 2, 3, 4 Prospective residents or their families have all relevant information to make a decision about the nature of the home. A thorough assessment of prospective residents needs is carried out. Trial visits give prospective residents an opportunity to assess the nature of the home. EVIDENCE: A statement of purpose and resident guide is available, in loose-leaf format and presented as a whole document in a Bridgemead folder. The document is available to prospective residents/families and has been issued to all current residents. Copies are also available from reception. Minor updates have been made. All local authority residents have terms and conditions/contracts issued by the funding authority; privately funded residents have terms and conditions issued by Bridgecare. Bridgemead D56_S20299_Bridgemead_V236726_041105_Stage4.doc Version 1.30 Page 9 The home caters for older people with continuing social, health and nursing needs and has no other speciality. The staff are trained and experienced in providing care for the resident group. Many new residents were formerly in receipt of day care at Bridgemead, so are known to the home. Mrs Bourton, the registered manager, completes a full pre-admission assessment and ensures the individual’s assessed needs can be met by the home before the admission is accepted. It was agreed that in future a formal assessment document will be used for this purpose rather than rough notes. Local Authority and health assessment documentation is requested where appropriate. The manager confirms in writing if the resident’s assessed needs can be met at Bridgemead. The home has equipment to meet needs of people with physical disability, such as a range of pressure relieving and moving and handling equipment. Admissions are taken mostly from local hospitals and the community. The specific admission criteria is that residents must live within a 10–mile radius of Bath applies. Prospective residents, where possible, are encouraged to visit to have a meal along with a family member or social worker. Emergency admissions are not taken, as the home very rarely has a vacancy. Bridgemead D56_S20299_Bridgemead_V236726_041105_Stage4.doc Version 1.30 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 standard(s) 7, 8, 9, 10 The care plans identify needs and give clear directions to staff. Residents or their relatives are consulted with about care matters and decisions about the way the home operates. Risk assessments are clear and detailed. The medication arrangements and records are in good order. EVIDENCE: The residents preferred form of address is established prior to admission and noted in the care file. Staff were observed to be knocking on doors before entering. Privacy and dignity issues are discussed during induction. Staff and resident interactions were seen to be friendly and supportive. Residents can meet visitors in their own rooms or communal areas. Bridgemead D56_S20299_Bridgemead_V236726_041105_Stage4.doc Version 1.30 Page 11 All rooms have a telephone point from which residents can make and receive calls. Private telephone lines can be installed. A portable pay phone is available and can be moved from room to room. A payphone is available on each floor. The home uses the Standex system of documentation for assessing, planning and evaluating care based on the activities of living. The documentation available was comprehensive and overall completed to a satisfactory standard. The standard of information recorded was appropriate for both nursing and residents. There are resident risk assessments where necessary. The risks identified are formulated into the care plan and actioned to reduce the risks. Nutritional and pressure sore risk assessments are undertaken. Weight, and blood pressure monitoring are recorded as required. All residents can remain registered with their own GP if the GP consents to visit them at Bridgemead. GPs visit the home upon request. Arrangements are made when requested for residents to attend their own or a local dentist/optician. Domiciliary optical services are provided annually and dental on request. Records are kept of visiting dental and optical checks. All other specialist services are accessed by referral from the GP. Currently no residents require District Nursing services. An aroma therapist visits the home weekly. On the day of inspection the supplying pharmacist was carrying out a review of medication and procedures and provided a copy of her report, which indicated all was in order. Proper arrangements have been made with a waste contractor to dispose of unwanted medication. Bridgemead D56_S20299_Bridgemead_V236726_041105_Stage4.doc Version 1.30 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 standard(s) 12, 13, 15 The range of social and occupational activities taking place enhances the quality of life for the residents. Residents’ families are involved and informed of issues related to their relatives. The food is of a high standard and provides a healthy diet. EVIDENCE: From discussion with Manager and the residents it was clear that the home has a flexible approach to resident wishes about the pattern of their day. An activity organiser works for 20hrs a week. In addition, there are about 20 volunteers taking an active part in the home including trolley shop, library, drinks trolley and helping in day care activities to which all are invited. A programme of events is produced each week and each resident receives a copy. Activities are targeted to individuals who require one to one work as well as group activities. Residents are involved in activities such as gentle exercise to music, visiting entertainers, theme evenings, and celebration of topical events - e.g. a planned Christmas events includes a party, panto, carols and bell ringers. A record of resident participation is made along with recorded comments of the residents. Bridgemead D56_S20299_Bridgemead_V236726_041105_Stage4.doc Version 1.30 Page 13 Some residents make regular visits to local shops, restaurant and pubs. Community transport and or disabled taxi are used for transportation. The home operates an open visiting policy. There are meetings for the residents, arranged and chaired by the manager, which are quite well attended, minutes of the meetings are made. The home produces a monthly newsletter for residents and families. Sunday services are held and a daily quiet time Monday to Friday. Monthly communion services are held. There are no people of other faiths in the home at present. There is a dining area on the lower ground floor, which is spacious and the tables were neatly presented with individual place settings. Residents are encouraged to have their meals in the dining area, but can choose to stay in their rooms. The main meal times are set; however, staff can provide beverages and snacks 24hrs a day for the residents. There is a full time cook and deputy who provide cover over 7 days. There was an extensive menu plan, which was varied and offered a daily choice. Residents make their choice the previous day. The cook would also prepare alternatives on a daily basis to meet resident requests. The cooks regularly spend time with the residents both on a group and individual basis taking feedback and identifying likes and dislikes. There are records of foods served. Residents’ special needs are catered for. All bar two of the residents spoken with enjoy their meals and felt they received a balanced diet. The criticism seemed to relate to agency cooks where some meals lacked flavour. Bridgemead D56_S20299_Bridgemead_V236726_041105_Stage4.doc Version 1.30 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 standard(s) 16, 18 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: The home has not received any complaints since the last inspection. The complaints policy and procedure is detailed and contains all the required information. The home has written procedures for adult protection, whistle blowing, management of aggression, abuse, bullying and management of residents’ money/valuables. The Local Authority ‘No Secrets’ document is available. The home actively promotes staff training and education in issues related to the protection of vulnerable adults. The home’s policies, previously viewed, were found to be detailed and comprehensive. Each resident who has money in safekeeping has an envelope and ledger entries are made detailing transactions. Only two administrators and the manager have access to the safe. When the petty cash records were seen it was noted they were sometimes overdrawn and collection money was temporally used to makeup the shortfall. This is poor practice and should cease. The records for the collection money lacked adequate detail and did not show these transactions. There was a large package of apparent jewellery in the safe but no record of what it contained and other items of property of unknown ownership. Bridgemead D56_S20299_Bridgemead_V236726_041105_Stage4.doc Version 1.30 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 standard(s) 19, 21, 23, 24, 26 The home is clean, comfortable, well decorated and furnished. It provides a safe 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 was purpose-built to care for elderly people. The gardens were attractive and designed to the needs of the residents. The residents spoken with were very complimentary about the home and the garden areas. The home is on three floors, with level access to all via a passenger lift. The majority of the residents use their own en-suite toilet facility. However communal bathing areas, showers and toilet facilities are located within easy access to lounge and dining areas. All baths are fitted with thermometric regulator valves. The water temperatures are checked and recorded. Bridgemead D56_S20299_Bridgemead_V236726_041105_Stage4.doc Version 1.30 Page 16 Resident areas are fitted with appropriate aids such as grab rails, fixed and mobile hoists. Residents are able to bring items of their own furniture. Individual residents, with their families, have personalised rooms with photographs, plants, TV, Hi-fi equipment, etc. All rooms were generally in good decorative order with appropriate furnishings and fittings. Bedroom carpets in rooms 303,306 and 402 were very faded and discoloured. A lockable storage space is provided in each room. Bedroom doors are also lockable; a number of residents use this facility at present. The standard of cleanliness was good and the home had a pleasant odour throughout. There is a system for monitoring the risk of legionella disease. Sluice areas on each floor have a disinfector. The laundry had two washing machines and two tumble dryers. The home has appropriate infection control and COSHH information and policies. There are appropriate arrangements in place for the service and maintenance of plant and equipment. A handyman works part time at the home. Bridgemead D56_S20299_Bridgemead_V236726_041105_Stage4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, 30 The home is well staffed with appropriately trained and experienced staff. The recruitment procedures and records are in good order. Proper training arrangements and clinical updating for RNs are in place. Good progress is being made with NVQ training for care staff. EVIDENCE: In general there are 1 RN and 6 CAs on duty AM,1 RN and 5 CAs PM and 1 RN and 2 CAs at night. The manager is supernumerary. The staffing levels accorded with the staffing notice previously issued by Avon Health Authority. The nurse team has a low rate of turnover and are well experienced caring for older people. There are current vacancies for night care staff and house keeping staff. The use of agency staff is low. Training records of Registered Nurses show their individual and collective skills and experience were appropriate to the residents needs. The home has two NVQ assessors and ten care staff are on programmes. A number of people have completed NVQ level 2 or 3 already. A robust recruitment policy and procedure is in place and the files inspected showed all the appropriate documents and checks were in evidence. Enhanced disclosures are sought for all staff but only the top portion of the documents were kept; the remainder being destroyed before being seen by a CSCI inspector. Nurse PINs are validated annually and the monthly NMC bulletins checked. The residents considered the staff to be friendly, courteous and caring. Bridgemead D56_S20299_Bridgemead_V236726_041105_Stage4.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 37, 38 The home is effectively managed, taking into account the views of the residents. There are good arrangements in place to maintain and service the equipment and facilities in the home. The home has good Health and Safety arrangements. EVIDENCE: The manager has been in post for approaching four years and has had previous management experience. Mrs Bourton has completed her Registered Manager’s award and attended updating and relevant training. Mrs Bourton is accountable to the Board of Trustees who provide management supervision and has felt supported by the organisation. Bridgemead D56_S20299_Bridgemead_V236726_041105_Stage4.doc Version 1.30 Page 19 The residents and staff spoken with felt that they were supported and that Mrs Bourton was approachable. The manager has delegated responsibility for health and safety matters. Ms Bleathman is the load handling assessor and trainer. Load handling, first aid, food hygiene and H&S training for staff had been regularly updated. Out of house training organisations facilitate most of such training. Generic risk and COSHH assessments were up to date and in order. All wheelchairs are subject to a monthly safety check. The fire logbook was up to date and in order. Training and drills have taken place. The gas safety certificate, lift servicing and hoist load test certificates for hoists were in date. Window restrictors were fitted throughout. Bridgemead D56_S20299_Bridgemead_V236726_041105_Stage4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 x 3 x 3 3 x 3 STAFFING Standard No Score 27 3 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x x x x x 3 3 Bridgemead D56_S20299_Bridgemead_V236726_041105_Stage4.doc Version 1.30 Page 21 No Are there any outstanding requirements from the last inspection? 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 23 Regulation 16. Schedule 4.9 Requirement Timescale for action 10/11/05 2. 19 16.2.c Keep full records of all financial transactions relating to residents money Ensure all valuables are properly recorded when held in safekeeping. Replace faded and discoloured 10/01/06 carpets in rooms 303,306 &402 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 23 Good Practice Recommendations Create a policy to properly dispose of items of lost property or items of unknown ownership. Ensure sufficient petty cash funds are available without drawing on other cash floats. All CRB disclosures should be checked by a CSCI inspector prior to their destruction. 2. 29 Bridgemead D56_S20299_Bridgemead_V236726_041105_Stage4.doc Version 1.30 Page 22 Commission for Social Care Inspection 300 Aztec West Almondsbury South Glos BS32 4RG 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 Bridgemead D56_S20299_Bridgemead_V236726_041105_Stage4.doc Version 1.30 Page 23 - 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. 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