Inspection on 09/08/06 for Bridgewater Park Care Home

This inspection was carried out on 9th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Bridgewater Park Care Home 16/07/07

Bridgewater Park Care Home 12/01/06

Bridgewater Park Care Home 02/06/05

Bridgewater Park Care Home 10/11/04

Bridgewater Park Care Home 12/05/04

Bridgewater Park Care Home 12/02/04

Bridgewater Park Care Home 08/12/03

Similar services:

Snydale Care Home

Abbey The

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Bridgewater Park Care Home Bridgewater Road Scunthorpe North Lincolnshire DN17 1SN Lead Inspector Mrs Kate Emmerson Key Unannounced Inspection 9th August 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 Bridgewater Park Care Home DS0000002775.V308680.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. Bridgewater Park Care Home DS0000002775.V308680.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bridgewater Park Care Home Address Bridgewater Road Scunthorpe North Lincolnshire DN17 1SN 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) 01724 847323 01724 847309 bridgewaterpark@meridiancare.co.uk Meridian Care Limited Mrs Julie Ann Marshall Care Home 53 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (22), Old age, not falling within any other of places category (30), Physical disability (20), Physical disability over 65 years of age (20) Bridgewater Park Care Home DS0000002775.V308680.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The two places registered for DE are age limited to those over 55 years 12th January 2006 Date of last inspection Brief Description of the Service: Bridgewater Park is a 53-bedded purpose built care home. The home is situated on a residential development on the edge of Scunthorpe. The home is close to major transport links. The home provides for a variety of needs including nursing care and care for those with a cognitive impairment. The service users accommodation is all on the ground floor and is separated into two units one of which deals particularly for those with cognitive impairment. The rooms are all single occupancy and all but one have ensuite toilet facilities. The home provides a variety of communal space including a smoking room and sensory room. The home provides a variety of bathing /shower facilities to meet service users needs. The gardens are pleasant, accessible to all service users and secure. The fees as of 9 August 2006 were £327 – £460 per week. Bridgewater Park Care Home DS0000002775.V308680.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over two days in August 2006. The inspection included an investigation three complaints received by the Commission. Mr M Hird, Regulation Manager, assisted the inspector for 3 hours on the second day. To find out how the home was run and if the people who lived there were pleased with the care they got the inspector spoke to the manager and 5 of the staff working in the home at the time of the inspection. The inspector also spoke to 6 service users and 2 visitors. Surveys were sent out to eight service users and thirty-eight staff: visitors were also surveyed. At the time of the inspection only 1 staff member and 1 visitor had returned a survey. Some of the records kept in the home were checked. This was to see how the people who lived in the home were being cared for, that staff were safe to work in the home and that they had been trained to their job safely and to make sure that the home was safe. The home was checked to see if it was kept clean and tidy. There had been a great deal of investment in the home to improve the décor in the home and they had managed, very successfully, to combine a very contemporary look with a homely feeling throughout. What the service does well: Service users were assessed before they moved into the home and where there was care management involvement a copy of their assessment and care plan had been obtained. A relative confirmed that they were provided with information about the home and stated that staff had been very helpful. The home was well maintained and well decorated. There was lots of space and different places to sit. The chairs in the lounges were very comfortable and different types of chairs were available to meet people’s needs. The homes communal areas and some of the bedrooms had been redecorated and improved throughout and new furniture had been provided. The home was organised into two parts to help keep people safe and there were secure garden areas for people to use. The home had different types of baths and showers and equipment to help people to move around the home. Bridgewater Park Care Home DS0000002775.V308680.R01.S.doc Version 5.2 Page 6 Staff were very good at assisting people who needed help when eating and spent time helping one person at once. Training for the staff was given on a regular basis and care staff had had a wide variety of training to help them do their job safely. The people who lived in the home said that generally the staff were good and were kind to them. There was a willingness on behalf of the management to improve care plans and staff training and auditing of care plans had continued since the last inspection. A care plan had been developed for all the service users and there was evidence that the service users had been involved in their development. The home had well developed policies and procedures in place to assist the staff in their work. The home consulted with the service users and the visitors about the quality of care provided and achieved the Investors in People Award and had the Gold Standard in the North Lincolnshire Councils Quality Scheme. What has improved since the last inspection? What they could do better: To make sure that all the service users needs are adequately met they must make sure that the care plans include all the service users needs identified at assessment, and that they are specific in the care required. The care plans must be evaluated monthly to ensure that the care they provide is meeting service users needs. They must consult with the service users about their social and religious needs and interests and develop an activities programme, which takes these into account. One service user said they were bored with the activities being offered and others thought the activities were poor. To ensure that service users receive the care they prefer at the end of their life they must record service users wishes regarding end of life care and their wishes on death. Bridgewater Park Care Home DS0000002775.V308680.R01.S.doc Version 5.2 Page 7 They must record GP visits and details of why the GP visited and the outcome of the visit. They must ensure that drugs are stored safely in the refrigerator by making sure that it is kept at the proper temperature. They must ensure that service users and staff are not put at risk by making sure that the oxygen cylinders are safely secured. They must protect service users dignity and ensure comfort by not leaving service users in wheel chairs unnecessarily. They must make sure that dining rooms are kept at a comfortable temperature. They must make that service users get a good quality nutritious meals and that sufficient is prepared to allow everyone a choice. Records must be kept to show what food is served. They must make sure that all staff record any complaints they may get and they should remind service users and visitors where they can record complaints if they wish. Cleaning must be improved to ensure that the kitchen must be kept clean and records must be kept to show that the cleaning was done. The cleaning in the general environment must also be improved to keep the home clean and free from offensive odours. They must keep the home safe in the event of a fire by not wedging fire doors and ensuring fire exits are kept clear. The minimum guide lines for staffing levels must be adherred to. It is recommended that service users dependancy is rewiewed to ensure that these staff levels are adequate to meet needs. The home must keep accurate records of who is on duty. Checks must be completed to make sure that staff are safe to work in the home before they start. They must ensure that new staff complete their induction to the home and carers role within six weeks of starting. They must make sure that people who need special chairs are properly assessed to ensure safety. Although there were adequate systems in place to monitor the quality of the service these were not always completed consistently, for example kitchen records and cleaning records and deficiencies in standards were noted in these areas. Bridgewater Park Care Home DS0000002775.V308680.R01.S.doc Version 5.2 Page 8 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. Bridgewater Park Care Home DS0000002775.V308680.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bridgewater Park Care Home DS0000002775.V308680.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a site visit to this service. All service users had had their needs assessed before moving into the home although assessments could be more detailed in some areas to assist in providing a more individualised service. EVIDENCE: There was evidence that service users had had their needs assessed prior to admission to the home and care management assessments and care plans had also been obtained. A relative stated that they had been provided with information about the home including the complaints procedure and the key worker had been very helpful on admission and even stitched name labels into the service users clothing for them. There was some improvement in the risk assessments that had been completed for new admissions and more consistent use of risk assessment Bridgewater Park Care Home DS0000002775.V308680.R01.S.doc Version 5.2 Page 11 documentation although care plans had not always been developed where risks were identified in areas such as tissue viability. In one case the service user had not signed the care plan or agreed to the measures to reduce risks. There were some gaps in the assessments, which if completed, would assist the management to tailor the services more closely to service users needs and wishes. For example there was little evidence that areas relating to needs/wishes regarding end of life care and on death had been discussed as part of the assessment in care files examined. The format for creating a pen picture of the service users life had not always been completed and the service users social and religious interests/needs were not recorded in all the care files. Bridgewater Park Care Home DS0000002775.V308680.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected 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 area is good. This judgement has been made using available evidence including a site visit to this service. The majority of health and personal needs of the service users were set out in detailed care plans but these would benefit from more detailed assessment, consistency regarding specific care instructions and regular detailed evaluation. There was improvement in medication records. The safety of medications requiring refrigeration may be compromised, as drug fridge temperatures were not adequately controlled. Service users stated that their privacy and dignity was respected but there was one area of practise which did compromise service users dignity and comfort and this needs addressing. EVIDENCE: A random selection of 13 care plans was examined. Bridgewater Park Care Home DS0000002775.V308680.R01.S.doc Version 5.2 Page 13 To improve care plans and address the issues raised at the last inspection the manager had continued to provide training in care planning and there was evidence that care plans were being audited. Each service user had an individual plan of care. The format was well developed with basic individual risk assessments in place. Not all the care needs identified at assessment had care plans developed to advise staff how the needs should be met. One service user who had a sensory impairment identified at assessment had not had a care plan developed to ensure communication needs would be met. Care requirements in areas such as death and dying and social activities were not identified due to deficiencies in assessment. The care plans were generally evaluated monthly and updated where appropriate but one had not been evaluated between November 2005 and June 2006 and another had only been evaluated 3 times between January 2006 and July 2006. The evaluations were not always cross-referenced to other monitoring tools such as weight charts and daily diary records. There was some conflict in instructions between nutritional assessments, care plans and weight records. Some indicated that service users required weighing weekly but they were only being weighed monthly and some were not weighed for long periods of time with no explanation as to why. One service user had lost sixteen pounds in the period between March and July 2006 but had not been weighed in the intervening period so preventative measures if appropriate were not identified. This may have put the service users health and welfare at risk. In all but one case, care plans to prevent pressure sores were in place where this had been identified as a risk. However two were not specific as to the frequency with which the care must be provided or conflicted with information in the evaluation. Staff were aware of the care required in this area and were now completing turn monitoring charts on a more consistent basis evidencing that adequate care had been provided. There was evidence that even where care plans were not completed staff were aware that the service users needed assistance to relive pressure and this assistance had been provided. Plans for wound care and records of wound care provided had been developed as required although instructions on the circumstances/frequency for dressing changes were not included and the manager stated that this was completed on an as required basis. In one case it was noted that a dressing had been changed six times in nine weeks, it could not be determined from the information in the evaluation whether this was sufficient or whether the wound had healed. This service user had also sustained a further wound and although there was information relating to the dressing and when this was changed the reasons for the dressing changes were not recorded and there was no individual care plan. Bridgewater Park Care Home DS0000002775.V308680.R01.S.doc Version 5.2 Page 14 Daily diary records were very detailed although there was evidence that significant events were not always recorded. For example, in one case a GP had visited a service user and prescribed medication with no indication of why and no previous mention of ill health or record of when the GP was requested or who had requested the GP. There was no information recorded as to whether the service user had improved or deteriorated following the visit. There was evidence that in all but one case the service user or their representative had been consulted on and agreed the care plan. One of the inspectors examined medication records and spoke to staff regarding practises in the home in relation to medication. The home had a contract for disposal of medication in the home to meet new government requirements and the systems for the disposal of controlled medication had now been implemented. The drug storage fridge on the nursing unit was running above the recommended temperature for storage of drugs requiring refrigeration, which may compromise the safety of medication. An oxygen cylinder in a bedroom was not secured to prevent it falling and the oxygen cylinders in the treatment room were only loosely secured. All oxygen cylinders must safely secure. There were no issues raised in relation to medication records at this inspection. Accredited training in the safe administration of medication was provided to all staff administering medication including the nurses. One of the staff members assisting the inspector, when questioned, did not know the side effects of one of the medications they were administering. Staff must ensure that they are aware of these so that they can respond appropriately to any adverse effects. Service users stated that the staff respected their privacy and dignity and were polite and pleasant. The home provided single room accommodation and all but one had ensuite facilities. Staff recorded service users preferred term of address on the care plans were observed to use this appropriately. Service users had access to facilities for private phone calls. Medical examination and personal care was provided in private. During the inspection the service users were seen to be dressed appropriately for the season in clean and wellmaintained clothing. There was one area where service users dignity and comfort were being compromised. The meal times on the nursing unit were arranged in two sittings due to there being insufficient space in the dining room. It was noted that all service users were put into wheelchairs, where required, prior to the Bridgewater Park Care Home DS0000002775.V308680.R01.S.doc Version 5.2 Page 15 first sitting and those on second sitting were placed near the nurse’s station to wait, being effectively parked up. These service users were then waiting at least an hour before going for their lunch, one service user looked very uncomfortable and was leaning heavily to one side and the nurse who was supervising had to be asked by the inspector to make the service user comfortable. Bridgewater Park Care Home DS0000002775.V308680.R01.S.doc Version 5.2 Page 16 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 adequate. This judgement has been made using available evidence including a site visit to this service. The service users had access to limited activities and their needs in this area were not recorded. There were good systems in place to promote good communication and support in the home for service users and their visitors. Service users were able to have choice in daily routines. The meals in the home sometimes lacked variety and were not always provided in sufficient quantity to ensure all service users had a choice. EVIDENCE: Bridgewater Park Care Home DS0000002775.V308680.R01.S.doc Version 5.2 Page 17 Service users social interests/needs were not assessed and although the home employed an activities coordinator there was little evidence that activities were arranged in consultation with the service users. Service users stated that there was little choice in activities in the home at the time of the inspection and activities had dwindled over the last few weeks. One service user stated that they were bored and would like something a bit more active to do than just bingo twice a week. The staff confirmed that the activities provided in the home were poor. The manager stated that this had been identified and an additional activities organiser was to commence employment the week following the inspection The service users stated that they were usually able to exercise choice in their daily routines such as getting up/going to bed. There were no restrictions on visiting unless requested by the service users. Visitors stated that they were made to feel welcome and said that staff communicated well with them. The key worker system in place at the home was well-organised and assisted in promoting good relations and communication between the home and relatives and ensured service users had individual attention. Those visitors spoken with knew their relative’s key worker. Information regarding service users rights and choices including access to records was provided in the service users guide. The dining rooms in the home were well decorated and seating was appropriate to service users. The service users, visitors and staff stated that the dining rooms had become very uncomfortable during the recent very hot weather. (The rooms are like conservatories in design.) Ceiling fans had been removed during the recent refurbishment adding to the problem. There was evidence that some small fans had been provided but staff and service users said these had been insufficient. Alternative means of ensuring the rooms are kept at a comfortable temperature at all times must be provided. The staff were extremely busy over the lunch and teatime period but staff were seen to offer individual assistance with meals discreetly and sensitively. There was a relaxed and unhurried approach to meal times. Service users were offered a choice at the time of the meal being served and could take their meal where they wished. Some of the comments from service users about the food were – ‘very good’, ‘not bad’; ‘puddings always ground rice’ ‘don’t really get a choice’. The home had, as part of its QA processes, completed a service users survey in March in which the service users were positive about the food provided in the home. Bridgewater Park Care Home DS0000002775.V308680.R01.S.doc Version 5.2 Page 18 The lunchtime meals were observed on both days and teatime was observed on the second day. There were 2 choices of main meal offered at lunchtime with a choice of vegetables. There was insufficient vegetables provided on the second day and they ran out before all were served even with very small portions given. The staff stated that this was a regular occurrence but they had only informed the cook. The manager had not been made aware of the issue by the care staff. There was evidence that menus were not being followed and therefore variety and a balanced diet was not assured. It was noted that one day service users were offered spaghetti Bolognese with meatballs as an alternative and 3 days later were offered shepherds pie with meatballs as an alternative. Staff stated that service users were offered mince or corned beef hash on a regular basis. Records of alternatives to the main two choices were not recorded when served and food served at teatime was not always recorded. When questioned the cook was not able to state if she had a budget for the provision of food, she showed little knowledge of service users dietary needs and did not know how many the meal she had prepared would serve. Staff stated that fluids were offered on a regular basis with drinks available in lounges and bedrooms. Service users stated that drinks were freely available if requested and at regular periods in the day. The service users stated that during the hot weather staff had been very vigilant at offering regular drinks. They stated that during the hot weather they had had jugs of cold drinks available in the lounges and bedrooms but this was not a regular occurrence. There was some evidence of jugs/cups of juice/water in bedrooms but not in the lounges on the day of inspection. Bridgewater Park Care Home DS0000002775.V308680.R01.S.doc Version 5.2 Page 19 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 area is good. This judgement has been made using available evidence including a site visit to this service. The home had a well developed and widely distributed complaints procedure however there was a lack of recording of complaints by staff which does not allow management to formally manage and monitor activity in the home which may lead to continued poor practise and complaints. The service users were protected from abuse. EVIDENCE: The home had a well-developed complaints procedure and information regarding this was provided to service users and a copy was posted on each bedroom door and at reception although this one needed updating with the Commissions new address. A visitor stated that they had been given a copy of the complaints procedure. Forms to record complaints with the title ‘your opinion matters’ were kept by the visitor’s book. Records of complaints from 16.3.06 were examined and 5 complaints had been recorded. The complaints covered various issues and had all been addressed appropriately. Bridgewater Park Care Home DS0000002775.V308680.R01.S.doc Version 5.2 Page 20 The Commission had received five complaints since April 2006, one of which was investigated by the provider, one was referred to social services for investigation and three were investigated as part of this inspection. Of the three complaints investigated, one related to issues regarding staffing levels, quality of the food, inadequate fluids offered and cleanliness of the home. The second related to service users wearing other people’s clothes, inadequate wound dressing changes, inadequate fluids being given, cleanliness of the home, wheelchairs not being cleaned and failure to contact the GP when required. The third was relating to staffing levels, dining room being too hot and managers failure to act on concerns when raised. Details of the findings are within the body of the report and required actions are stated in Statutory Requirements or Recommendations to back of this report. Staff were aware of the complaints procedure and took a positive view. Commendably all stated they dealt with complaints as they were made, four staff separately stated they had recently dealt with a complaint but none of them had recorded the complaint. One stated they had passed it on to senior staff but there was no record made. Some staff stated that they did not know where they should record complaints. This does not assist the manager to monitor the service provided and deal with complaints formally. This may give the impression that complaints are not taken seriously by the home. The management must ensure that all staff are recording complaints and any actions taken. It is also recommended that service users and visitors are reminded that the forms are available for them to record concerns and complaints and advise them to whom these should be given. Bridgewater Park Care Home DS0000002775.V308680.R01.S.doc Version 5.2 Page 21 There was evidence that the company had made a commitment in all aspects of the protection of vulnerable adults in terms of developing policies and procedures and provision of staff training. The manager and one senior staff had completed a train the trainer course in the protection of vulnerable adults through Action on Elder Abuse. The training was provided to the staff by way of induction and a rolling programme of training providing annual updates. In depth policies and procedures for the protection of vulnerable adults including whistle blowing, restraint and managing aggression were in place and staff training had been provided in the management of challenging behaviour and care of those with Dementia. The company had also developed its own information booklet in relation to abuse and how to report suspicions of abuse. This was displayed in the reception area. They had included a company confidential helpline number. The information booklet included space to put the Local Authorities and the Commissions telephone numbers but this had not been completed and this is recommended. Bridgewater Park Care Home DS0000002775.V308680.R01.S.doc Version 5.2 Page 22 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, 20, 22, 24, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a site visit to this service. The home provided accessible, safe and comfortable facilities. The garden areas were accessible and secure. The company had invested in an extensive refurbishment programme to improve the environment for the service users. The company should be commended for the improvements made and the contemporary but homely feel created in the home. Service users had access to a variety of aids to assist them in activities of daily living and keep them safe. However service users health and safety may be at risk due to provision of specialist seating without appropriate professional assessment. Some areas of the home were not cleaned to a satisfactory standard and cleaning records were not adequately maintained. Wedging of fire doors and blocking a fire escape may compromise fire safety. Bridgewater Park Care Home DS0000002775.V308680.R01.S.doc Version 5.2 Page 23 EVIDENCE: The home was purpose built and has all single rooms. All but one of the rooms has ensuite facilities. There were a variety of bathroom and shower facilities in the home with good quality fittings. The service users have access to a variety of communal rooms including a smoke room, a quiet/reading room and a sensory room. A partial tour of the building was conducted. All the communal areas in the home had been completely refurbished to a very high standard. New carpets and furniture had been provided and a variety of comfortable seating was available. Some bedrooms had been redecorated and new furniture, soft furnishings and fully adjustable beds had also been provided. The service users were very pleased with the work already completed. Some of the new seating was badly stained and may not be suitable for the purpose as staff stated that they had difficulty cleaning these satisfactorily. The service users were able to take their own possessions and furniture into the home with prior agreement and where they met fire safety regulations. Some the rooms were very well personalised and lists of possessions brought in had been completed in the majority of care files seen. It was a pity that previous recommendations that the registered person should consider the provision of communication aids and signs for those with sensory impairment and dementia had not been included in the programme of refurbishment. There was no evidence that to show individual risk assessments had been completed where service users had been provided with chairs that limit their mobility. An occupational therapist assessment must be completed to ensure that an appropriate chair in the correct size has been provided to ensure tissue viability and personal safety when using this type of restraint. Bridgewater Park Care Home DS0000002775.V308680.R01.S.doc Version 5.2 Page 24 The cleaning records in the kitchen were still not consistently maintained and had often not been completed for two to three days at a time. Although the overall cleanliness in the kitchen had improved, the Bain-Marie, walls behind the cooker and shelving required cleaning. The cook had signed to say she had cleaned the Bain-Marie at breakfast but on examination, just before lunchtime, toast from breakfast was still in one of the pans. The standards of cleanliness of the home on the nursing and residential unit was fair, two bedrooms had dirty/stained carpets and one bedroom was odorous. On the Emi unit the cleaner had not commenced her work at the time of the inspection but the unit was odorous on entry and two bedrooms had dirty/stained carpets, one room had a stained/dirty chair, one ensuite toilet was dirty, and one was odorous. The shower room was very odorous and staff commented this might be from the drains. In one bedroom, bed linen had been left on the floor, which may compromise infection control. The chairs and sofas provided as part of the recent refurbishment were very badly stained. It was noted that a wheel chair was dirty; the inspector was informed that the night staff cleaned wheelchairs but the cleaning rota had not been completed since 17 July 2006. The domestic staff rota showed that there was one or two staff on duty to complete the cleaning of the home between 9am and 4pm, 7 days per week. This should be reviewed to ensure that the cleanliness of the home could be improved. During the tour of the building it was noted that several of the beds had bed rails attached these had been covered with bumpers to prevent injury to service users but in some cases the wrong size had been used on the bedrails which may cause an additional risk. The management had dealt with the situation by the end of the inspection but more care must be taken when fitting this equipment. A variety of moving and handling equipment was in place in the home. The manager provided service certificates for equipment and one hoist had failed the testing and was not being used until a new part had been provided. Staff interviewed stated that all the equipment in the home was working and moving and handling equipment was maintained in working order and all slings were also in good order. Bridgewater Park Care Home DS0000002775.V308680.R01.S.doc Version 5.2 Page 25 The laundry was clean and tidy; staff confirmed that they do not assist in the laundry other than collecting service users clothes. There were systems in place to ensure service users received the correct items of clothing back from the laundry. For example, as all clothing must be named on admission and key workers assist in this. All service users have their clothes individually put on marked shelves in the laundry and all unnamed clothing is retained in a separate box for service users or relatives to look through if items go missing. The laundry assistant spoken with had worked in this area for a number of years, she stated that no complaints had been received where service users had been wearing another person’s clothes and none were recorded. The gardens were well maintained and secure accessible areas were provided for service users. All staff did not adhere to fire safety procedures. A chair obstructed the fire door in the EMI unit lounge and two bedroom doors on the nursing unit were wedged open even though they had working door guards. The wedges were removed on the day of inspection but more vigilance is required to prevent this reoccurring. The fire officer had visited the home in September 2005 and noted that the fire escape to the nursing unit leading to a ramp was adjacent to the smoking lounge window that was too low and did not have fire retardant glass. There was evidence that some work had been completed to the window and the manager stated that this had been passed by the fire officer although there was no written evidence of this. The manager was asked to provide this to the Commission. Call bells were provide in each room and were regularly serviced. One of the service users in nursing/residential unit stated they would like an individual call bell when seated in the lounge to be able to summon assistance as they were unable to reach the call bell and the person sat closest to the bell was unable to understand or communicate with others. Bridgewater Park Care Home DS0000002775.V308680.R01.S.doc Version 5.2 Page 26 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 adequate. This judgement has been made using available evidence including a site visit to this service. Minimum staffing levels were not always met although staff and management were proactive in trying to cover shifts and provide systems to improve attendance. Staff recruitment procedures were not always adequately applied to ensure protection for service users. Staff training was varied and applicable to role and service users needs. EVIDENCE: The manager provided information prior to the inspection, which indicated that the home was accommodating 17 service users who required nursing care and 9 service users who required residential care and 21 service users who required care in the residential unit for those with dementia. The minimum guidelines for these numbers are 1 nurse plus 5 carers morning shift and 1 nurse and 4 carers afternoon/evening shift. On the Dementia unit staffing levels are four staff on duty during the day. Evidence from discussion with staff, observation of the staff rotas and surveys showed that staffing levels for the numbers above had not been maintained at all times. Service users stated that their needs were met but added that when Bridgewater Park Care Home DS0000002775.V308680.R01.S.doc Version 5.2 Page 27 there very few staff ‘it makes a difference to how you are cared for.’ One service user stated that the staff aren’t ‘always pleasant and the older staff are nicer.’ Another said that the staff were ‘quite nice’. A visitor noted that there is sometimes a lack of supervision when there was only 3 staff on duty. Staff rotas for the fortnight commencing 17th July 2006 showed that staffing levels had been below minimum guidelines on the nursing /residential unit on 8 occasions between 8pm and 9pm when numbers of carers was reduced to 1 or 2 and on one occasion there were only 2 staff on duty between 7pm and 9pm and 3 staff on duty between 5pm and 9pm on another occasion. On the Dementia unit there were 8 days in this period when staffing was below minimum guidelines. Staffing reduced to 3 for most of the shifts or down to 1or 2 between 8pm and 9pm. On Wednesday 26th July there were only 2 carers and one nurse in the home between 8pm and 9pm. This may put the service users at significant risk of care needs not being adequately met and health and safety being compromised due to lack of supervision or for example in the event of a fire. There was evidence from the rotas and staff that staff rotas were arranged to ensure adequate cover and that above minimum staffing was usually planned in the nursing/residential unit. Staff stated that reduced staffing levels were usually due to staff ringing in sick at the last minute. They confirmed that the management were proactive at getting cover and staff would usually come in to cover or stay on to work extra hours until cover arrived. They could also use agency staff if available. The staff rotas showed little evidence of staff coming in or staying on to cover and this must be addressed to ensure an accurate record is maintained. The providers had put processes in place to try and improve staff attendance including paying a monthly full attendance bonus. The minimum guidelines were produced when the home first opened and since this time the home has seen increased dependency of service users admitted to the home who require a more intensive care package and increased supervision to ensure safety. The management must ensure that staffing levels take into account service users dependency in the provision of staff in order that service users needs are met. It is recommended that staffing provision be reviewed. The company and the staff had made a commitment to the provision of NVQ training and of the thirty eight care assistants thirteen had completed NVQ level 2 or above and nineteen were registered for NVQ level 2 training with eight due to complete in August 2006. Bridgewater Park Care Home DS0000002775.V308680.R01.S.doc Version 5.2 Page 28 There was evidence of deficiencies the recruitment practises, which may put service users at risk. Five files were checked of staff that had commenced employment since the last inspection. In one case although two written references had been received, there was no evidence that a reference had been sought from the previous employer despite a gap in employment and the person having been employed in a senior position. There were no records of interview to explore this and the staff member had commenced employment prior to a POVA first check or CRB having been completed. In another case the references had been brought in by the staff member and had not been sent for from the two nominated referee’s on the application form. There was no evidence that authenticity of these references had been checked. In another case there were no records of interview to explore why a conviction had not been declared on the application form that then was identified on a CRB check. There was evidence of a structured induction training, which incorporated shadowing other staff for a number of shifts. However there was evidence in two cases that induction had commenced in March/April 2006 but had not been completed. Staff files showed that a variety of training had been provided in the home over the last 12 months. A training overview was available for 2006 and this showed that the majority of staff had completed fire training and POVA training and twelve staff had completed dementia awareness. Moving and handling was provided on a rolling programme by a senior member of staff who had completed a train the trainer course in this area. There was evidence that staff received training commensurate to their role and responsibilities and the area in which they worked. Bridgewater Park Care Home DS0000002775.V308680.R01.S.doc Version 5.2 Page 29 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, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a site visit to this service. The home has a qualified and experienced Registered Manager who consults regularly with the service users, visitors, staff and other agencies about the quality of care provided. The home has procedures in place that safeguards the service users finances. Staff and service users health and safety are promoted and protected through policies and procedures and provision of staff training. However there were some deficiencies with regard storage of oxygen cylinders and to fire doors and exits, which may compromise safety. EVIDENCE: Bridgewater Park Care Home DS0000002775.V308680.R01.S.doc Version 5.2 Page 30 The Registered Manager for the home, Julie Marshall (also known as Julie Moult), is a qualified first level nurse with qualifications in management and teaching. Julie has sixteen years experience in care home management. There was evidence that Julie continues to maintain her knowledge and skills through a variety of training. (A formal written request to the Commission is required to change the manager’s name on a registration certificate.) The home continually monitors the quality of the care provided in the home through the use of questionnaires, quality meetings including informal coffee mornings involving staff, service users and relatives. The home has a quality team, which includes staff and relatives. Results of questionnaires/surveys were displayed in the home and an action plan had been developed. The home had been awarded the Investors in People Award and had the Gold Standard in the North Lincolnshire Councils Quality Scheme. Although there were adequate systems in place to monitor the service these were not always completed consistently for example kitchen records and cleaning records and deficiencies in standards were noted in these areas. The area manager completed visits to the home and Regulation 26 visits reports were completed and sent to the Commission on a regular basis. The home assists service users with their finances by keeping their personal allowances safe and making purchases or paying bills on their behalf. A random sample of the records of these transactions was examined. The records were well maintained and transactions were witnessed. Receipts were maintained appropriately. Cash held balanced with the records in the three cases checked. The home has detailed policies and procedures and provides training to support safe working practises. The home was well maintained and there was evidence that equipment was regularly serviced and maintained in good working order. There was evidence that fire alarms and emergency lighting was regularly checked and staff attended fire drills and fire training. See environmental standards regarding issues relating to fire doors and fire escapes. Accidents were recorded and there was a system for monitoring accidents. See standards relating to health and personal care regarding issues about safe storage of oxygen cylinders. Bridgewater Park Care Home DS0000002775.V308680.R01.S.doc Version 5.2 Page 31 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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 3 3 2 3 3 2 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Bridgewater Park Care Home DS0000002775.V308680.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 16(2)(m)( n) and 12 Requirement The registered person must ensure that social and religious needs and needs/wishes regarding end of life care and death are recorded. The registered person must ensure that care plans reflect all the assessed needs and are evaluated monthly and updated as required. The registered person must ensure that specific instructions as to measuring of weight, pressure relief and dressing changes are recorded consistently in care plan documentation and that these instructions are followed by care staff. The registered person must evidence that the service users have received where necessary treatment, advice and other services from any health care professional and the circumstances relating to this. The registered person must ensure safe storage for DS0000002775.V308680.R01.S.doc Timescale for action 01/10/06 2 OP7 15 01/10/06 3 OP8 15(1)13(1 )(b) 01/10/06 4 OP8 13(1) 09/08/06 5 OP9 13(2) 09/08/06 Bridgewater Park Care Home Version 5.2 Page 33 6 OP9 7 8 OP10 OP12 9 OP15 10 OP15 11 OP15 12 13 OP16 OP19 medications that require refrigeration and for oxygen cylinders. 13(4) The registered person must ensure that the staff are made aware of the side effects of the medications they administering. 12(1) and The registered person must (4) ensure that service users are not left in wheelchairs unnecessarily. 16(20(m)( The registered person must n) ensure that service users are consulted about their social interests and develop a programme of activities that meets their needs and wishes. 23(2)(p) The registered person must ensure that the dining rooms can be maintained at comfortable temperature for the service users. 16(2)(i) The registered person must ensure that varied, suitable, nutritious and wholesome food is provided in adequate quantities. 17(2) The registered person must Schedule ensure that records of all food 4 served are maintained including any special diets and alternatives to the main menu. 17(2) The registered person must ensure that all complaints and actions taken are recorded. 23(4) The registered person must ensure that fire doors are not wedged open and fire exits are kept clear. 23(4) The registered person must ensure that written evidence is provided to the Commission that the fire officer’s requirements have been met from the letter dated 30/09/06. The registered person must ensure that the home, furnishings and equipment such as wheel chairs are clean and DS0000002775.V308680.R01.S.doc 01/09/06 01/09/06 01/10/06 09/08/06 09/08/06 09/08/06 09/08/06 09/08/06 14 OP19 01/10/06 14 OP26 16(2)(j) and (k) 09/08/06 Bridgewater Park Care Home Version 5.2 Page 34 15. OP22 13(4) 16. OP26 16(2)(j) 17. OP27 17(2) 18 OP27 18(1) 19 OP29 19 20 OP30 18(1) free from offensive odours The registered person must ensure that a suitable qualified person individually assesses all service users who require specialist seating. (The previous timescale 01/03/06 was not met) The registered person must ensure that the kitchen and all the equipment in the kitchen is kept clean and maintained. The kitchen cleaning schedule records must be maintained. (The previous timescale 13/01/06 was not met) The registered person must ensure that an accurate record of who is on duty is maintained. (The previous timescale 13/01/06 was not met) The registered person must ensure that staff are provided in adequate numbers to meet minimum guidelines at all times. The registered provider must ensure that recruitment practises are robust and include ensuring that staff do not work in the home prior to a POVA first check being obtained and that they do not work unsupervised before a CRB is obtained, seeking references from previous employers, ensuring authenticity of references, ensuring gaps in employment and previous convictions are explored and interview records are maintained. The registered person must ensure that induction is completed within 6 weeks and foundation training within 6 months. 01/10/06 09/08/06 09/08/06 09/08/06 09/08/06 09/08/06 Bridgewater Park Care Home DS0000002775.V308680.R01.S.doc Version 5.2 Page 35 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 OP15 Good Practice Recommendations The registered person should ensure that service users have free access to drinks through out the day in communal areas, for example by providing jugs of cold drinks in lounges at all times. The registered person should ensure that service users and visitors are reminded to put complaints in writing to management. The registered person should ensure that contact numbers for the Local Authorities and the Commission are included in the company’s information booklet regarding abuse. The registered person should consider the provision of communication aids and signs for those with sensory impairment and dementia. The registered person should provide service users with the means of calling for assistance when seated in communal areas. The registered person should review minimum staffing levels taking into account dependency of the service users accommodated. 2 3 4 OP16 OP18 OP22 5 6 OP25 OP27 Bridgewater Park Care Home DS0000002775.V308680.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 Bridgewater Park Care Home DS0000002775.V308680.R01.S.doc Version 5.2 Page 37 - 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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