Inspection on 14/07/09 for Bridgeway Care Home

This inspection was carried out on 14th July 2009.

CQC found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bridgeway Care Home 18/07/07

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Ruskin Lodge

Dystlegh Grange

The Good Companions

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Cuerden Grange Rest Home

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Sue Ryder Care Birchley Hall

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Bridgeway Care Home Gamull Lane Ribbleton Preston Lancashire PR2 6TQ     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Phil McConnell     Date: 2 2 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: Bridgeway Care Home Gamull Lane Ribbleton Preston Lancashire PR2 6TQ 01772796048 01772705726 bridgeway@craegmoor.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Parkcare Homes (No2) Ltd care home 27 Number of places (if applicable): Under 65 Over 65 0 physical disability Additional conditions: 27 The registered person may provide the following category of service only: Care home with nursing: Code N, to service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Physical disability: Code PD The maximum number of service users who can be accommodated is: 27. Date of last inspection Brief description of the care home Bridgeway Nursing and Residential Home is registered with the Care Quality Commission to provide nursing and residential care for up to 27 younger adults of either sex, who may have a learning disability, sensory impairment, or a physical disability. The home is situated in a residential area on the outskirts of Preston. Shops and local amenities are easily accessible and the home has good links with the local community. The home is owned by Craegmoor Healthcare which is a National Company. A registered manager is employed to manage the home on a day to day basis. Current weekly fees are between £650 and £1000 depending on individuals assessed needs. Care Homes for Adults (18-65 years) Page 4 of 35 Care Homes for Adults (18-65 years) Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: Various information was gathered in order to be able to assess the National Minimum Standards for Care Homes for Adults (18-65) including: The Annual Quality Assurance Assessment, this is a document which the registered manager completes every year and it contains information about the service being provided. We use this information, in part to focus on our inspection activity. An unannounced Key Inspection, which was carried out on the 14th of July 2009 by the Care Quality Commission (CQC), with a follow up visit on the 22nd of July 2009 in order to gather further information. Some questionnaires were returned to CQC from service users and from members of staff. The registered manager ( Pauline Smith) was present for both of the site visits. The business service manager was also present for the majority of the visits and the area Care Homes for Adults (18-65 years) Page 6 of 35 manager was present at the end of the second visit, when feedback was given. There was the opportunity to speak to some of the people who use the service in private. Discussions also took place with some of the staff members. The discussions were constructive, with appropriate information being obtained. Peoples files were examined, with the majority of relevant documentation being in place. A number of the staff files were examined and they contained all of the necessary documentation needed for inspection purposes including, recruitment information and Criminal Record Bureau (CRB) checks. Throughout the visits there was the opportunity to observe the support and care that was being provided to individuals. Some concerns were evident, which have been discussed in the body of the report. The management were informed of the concerns and an assurance was given that they will be addressed. The organisations policies, procedures and the health and safety documentation were examined. A tour of the premises was carried out and it was evident that Bridgeway is in need of full refurbishment. The home in its present state does not meet the needs of the people who live there. It is envisaged that extensive refurbishment work will commence within the next few months. Assurances were given that any disruption to service users, whilst this work is in progress will be immediately and satisfactorily dealt with. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Adults (18-65 years) Page 8 of 35 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 35 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The pre admission assessment process needs to be more thorough, in order to ensure that all relevant and necessary information is obtained and documented. This will help give further assurance that peoples needs are satisfactorily assessed. Evidence: Four service users files were examined, including the last person to go and live at Bridgeway Care Home. Generally the assessment documentation was satisfactory, with evidence that initial pre admission assessments had been carried out. Although it was evident that regular reviews of the assessments have been limited. It was commented by management , we do request annual reviews from the funding authorities, but they dont always take place. The home has a statement of purpose, which is specific to Bridgeway and it is also available in pictorial format. This helps enable people to have an understanding of what the service can provide. Care Homes for Adults (18-65 years) Page 11 of 35 Evidence: There was appropriate and relevant information, with details of peoples care and health needs, next of kin and medication, however two of the files had no record of historical or background information. The manager was informed about the limited information in files, relating to peoples background / history and an assurance was given that this will be addressed and all of the files will be audited to ensure that relevant information is recorded. Care Homes for Adults (18-65 years) Page 12 of 35 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples care plans need to be correctly and accurately documented. There is also a need to amend care plans, when any significant changes have been identified following reviews. Evidence: The care plans of four people were examined and generally they contained sufficient information to give guidance to the nursing and care staff to enable them to provide the care and support that was needed, however as previously mentioned some of the care planning documentation contained blank pages, where history and background information was requested. There were recorded dates indicating, that the care plans had been reviewed, however significant changes had not always been amended in peoples plans, for example one persons plan indicated that the person attended a day centre, although the centre had been closed for some time. The care plans have been developed in a way that they ask for a lot of information, which is not always specific to the individual. Therefore the care plans appear to be too generic and not sufficiently Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: person centered. This was discussed with the management and it was commented that care plans will be looked at, with the intention of them being more person centered. Each person has an allocated key worker, which helps give the assurance that each persons changing needs are more quickly observed and satisfactorily addressed. Up to date daily records were observed, which gave relevant and appropriate information, regarding a persons care and support that had been received. There were risk assessments in place, which helped to show that people are encouraged and empowered to be as independent as possible. This was evident in the way that individuals are enabled to access the wider community and with support when necessary. Care Homes for Adults (18-65 years) Page 14 of 35 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Varied activities, events and outings are provided. This helps to give the assurance that community participation and presence is promoted. Evidence: A varied programme of activities is available throughout the week and it was commented by the activities coordinator, Every Monday a meeting is held with the residents to discuss and decide what to do during the week, we have a brilliant response to the meeting, they are brilliant and activities are planned weekly because things can change week to week. Some of the activities and events that people get involved in are, Bright Futures, which is an Art & Crafts class held at a local centre, some people go to a Monday club, which is for people who have learning disabilities, a weekly outing, this week we are going to Chorley market and having lunch out. If its raining people like to go bowling or to the cinema and on the day of the visit some Care Homes for Adults (18-65 years) Page 15 of 35 Evidence: people had been involved in tile painting, others were going for walks and four people were going to a local pub to play prize bingo. This demonstrates that community participation is actively promoted, with people being empowered and encouraged to be involved. The activities coordinator said, everybody gets involved in something during the week. We have a nice little routine going and can involve everybody. Some of the feedback from people using the service was, The staff work really hard and do their jobs very well I attend the Voice meetings (which is a meeting for service users) and I have also been involved in interviewing new staff Its like a big family and I like to think we are a community and we get on, most of the time. It was apparent that people, when possible take part in meaningful activities and leisure pursuits, that provide motivation and stimulation. It was evident that people are encouraged and enabled to maintain links with family and friends and visitors to the home are made welcome. People using the service also commented that they can meet family and friends in the privacy of their own rooms. During the visit to the home it was observed that some people do keep their rooms locked and members of staff were seen knocking at peoples bedroom doors before entering, helping to show that peoples rights and privacy are respected. Records of meals being provided was observed and it was evident that consideration is given to ensuring that varied, nutritional and appetising meals are provided. It was also apparent that individuals specific dietary need are catered for. This could include, liquidising food or being aware of a persons dietary needs, for example if a person has diabetes. Care Homes for Adults (18-65 years) Page 16 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal care support is not always satisfactorily provided. There is a need to ensure that clean bed linen is provided at all times. Evidence: As already mentioned some peoples care planning documentation lacked certain information however, it was evident that there was sufficient information in place to enable the care staff to provide personal care to the people they support. During a tour of the premises on the first visit, seven of the beds were found to be either soiled, stained, dirty and one persons bed had pillows that had no pillowcases, with the pillows being quite badly stained. The manager was present during this time and fully accepted that this lack of care and support was totally unacceptable. A catheter bag was also discovered in a shared bathroom draining into the toilet. It was later discovered that this had been left from the night staff. Another item of concern was that peoples clothing had their names written on the collar or the top part of the item of clothing with an indelible marker. One person was observed to be wearing a shirt with his name written in big black letters across the collar,which was easily visible to any bystander. The majority of clothing in the laundry was also inappropriately marked Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: in this way, with some peoples names even being visible from the outside of the garment. It was concerning to find this obvious lack of dignity and respect. This was discussed with the registered manager at the time and later with the area manager and the business service manager. Before the second site visit two sets of new bedding had been purchased for all of the bedrooms. An assurance was given that an alternative way of identifying clothing would be sought and bed changing routines would be more closely supervised. During the second visit one person was observed to need to have his catheter bag emptied. This was quickly addressed when the manager was informed. There appears to be a lack of monitoring and supervision of everyday tasks, which are needed to provide a satisfactory level of care and support to vulnerable people. There was evidence to show that health action plans are in place for each person using the service and it was evident that individuals health needs are monitored and satisfactory procedures are in place, in order to ensure that that all health needs are appropriately provided. The medication procedures were examined and it was clear that only qualified nurses administer medication. The medication administration records (MAR) were correctly maintained, with the storage of medicines being observed to be safe and secure. At the time of the inspection visit one person was receiving controlled drugs and the controlled drugs register was seen to be accurately recorded, with two signatures for each time medication was dispensed. Care Homes for Adults (18-65 years) Page 18 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are clear policies and procedures in place, helping to demonstrate that vulnerable people are protected as much as possible from abuse. Evidence: There is an easy read copy of the complaints procedure in the service users guide and a copy is appropriately placed in the main entrance to Bridgeway. Also displayed throughout the home in unobtrusive places, were copies of the whistleblowing procedure and the complaints procedure. There was a suggestion box, which was also placed in a convenient area. The AQAA says, All staff are aware of the complaints policy and the Voice meetings for service users, provide a forum to allow complaints and concerns to be aired. Some of the people using the service were asked if they had any complaints or had they ever complained? Some the answers were, If I had a problem, I would be able to say so I have had to complain a couple of times, but it was soon sorted and there are some things I cant do for myself and at times I need to remind people and say, that certain things need doing and they are always done. In the last twelve months the home has received three complaints, with all three being resolved within the twenty eight day required period. One of the complaints was Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: upheld, however it was satisfactorily addressed. It is evident that up to date and appropriate safeguarding adults training is being provided to staff. In observation of the training programme and in discussion with some of the staff it was clear that people are fully aware of safeguarding issues and would know what to do in the event of a suspicion or of an allegation of abuse being made. The AQAA states, there is a whistle blowing policy in place and a robust contact chart for responding to any suspicion or evidence of abuse. During the second site visit a service user made an allegation, regarding alleged verbal and emotional abuse that he had encountered. With the persons agreement this was reported to the management and a safeguarding adults referral was made to the safeguarding team at Lancashire County Council. It is the responsibility of the Local Authority to carry out an investigation, in order to determine if a person has been subject to any form of abuse. It was evident that people using the service do have the confidence to raise any concerns or complaints and the management do follow the correct procedures if any allegation has been made. Care Homes for Adults (18-65 years) Page 20 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall the environmental standards within the home are poor. The home is in need of full refurbishment. Evidence: At the start of the inspection visit the manager stated that a full refurbishment programme is planned to take place in the near future. A full tour of the premises was carried out and it was observed that peoples bedrooms contained their own personal belongings and items of furniture, however it was apparent that some bedrooms were not very clean and were in need of being redecorated, in order to bring them up to an acceptable standard. As previously mentioned a number of peoples bedrooms contained bedding, that was observed to be soiled, dirty and in some cases it was apparent that the bed linen had not been changed for some time. There is a need to ensure that bed linen and the cleaning of peoples bedrooms is regularly and routinely carried out. This will help ensure that cleanliness and hygiene is promoted and help demonstrate that dignity and respect is positively promoted. The dining room is a good size, giving sufficient room for people using wheelchairs, however the floor is very uneven and could potentially be the cause of an accident. The decor is also in need of being updated. The ceilings throughout the home are low Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: level false ceilings and in a number of places they are stained, with what looks like flood damage. It is envisaged that the ceilings will be restored to the original height in the building refurbishment. The homes corridors are also in need of full redecoration, especially one corridor that has a number of large cracks in the walls and plaster. The kitchen also had a low false ceiling and it was commented, the kitchen can get very hot. An Environmental Health inspection that was carried out in June 2009, raised some concerns regarding the kitchen. The Inspectors report stated, The level of ventilation in the kitchen was insufficent. All food preparation and storage areas must have adequate ventilation either by natural or mechanical means. This is to reduce high humidity, room temperatures, cooking odours and airborne particles. Five legal requirements and six recommendations were issued as a result of the Environmental Health inspection, which included the need to replace some equipment, some equipment was observed to be dirty, some areas of the kitchen and store room were also observed to be unclean. Although the kitchen looked clean during the inspection carried out by the Care Quality Commission, it was clear that the kitchen as well as the rest of the home is in need of a full refurbishment. During the first site visit, it was also observed that all of the pans being used in the kitchen, were either badly worn or the handles were very loose, which potentially could cause a serious accident. The business service manager was informed of the poor quality pans and an assurance was given that a full new set of pans would be bought. During the second visit the homes cook stated that new pans had been ordered. The previous report mentioned that the lift was inadequate for the needs of some of the people living at Bridgeway. The same lift is still in use and it was apparent that it is still unsuitable. It is much too small to accommodate some of the wheelchairs used by some of the people living at Bridgeway. It is envisaged that this will also be satisfactorily addressed during the refurbishment, with a larger lift being installed. The previous report also mentioned that the downstairs bathroom needed some attention regarding decoration and no natural light. Renovation to the bathroom has been carried out satisfactorily, having been fully redecorated with a new window installed, giving some natural light and ventilation. The homes laundry had sufficient equipment and machines to cater for the needs of the people living there. Although as previously mentioned the practice of writing peoples names on their clothing is seen to be disrespectful and undignified. Feedback received from surveys, in observation and in discussions with members of staff, service users and management, clearly demonstrated that the home is in need of a full refurbishment. This will help ensure that people live and work in a safe, Care Homes for Adults (18-65 years) Page 22 of 35 Evidence: comfortable, pleasant, hygienic and clean environment. The refurbishment plans were observed and it is anticipated that the work will commence within the next couple of months. It is also anticipated that the refurbishment work will be carried out, whilst the service users are still living at the home. It was explained that this will happen with different sections of the home being screened off to help ensure that people will not be adversely affected. A discussion took place with the management about the potential possibility of high levels of noise, disruption and inconvenience and an assurance was given that this will be very closely monitored by the manager, with her taking the day to day lead on the situation. There was a consensus of opinion with the management following the inspection that the environmental standards within the home are in need of being improved and an assurance was given that the issues raised will be addressed either immediately or during the refurbishment work. Care Homes for Adults (18-65 years) Page 23 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is limited evidence of the clarity of roles, responsibilities and guidelines for staff. This is required to help ensure that people using the service are receiving the best possible care and support. Evidence: Four staff files were examined, including the last person to be employed at Bridgeway and they contained all of the necessary information that is needed for inspection purposes. There were sufficient numbers of staff on duty including a qualified nurse and it was commented by the manager , there is always at least one qualified nurse on duty and I am also a qualified nurse. At the time of the inspection there was a vacancy for a deputy manager and it was stated by the manager that, we need to increase our staffing levels, I believe we need one more person to help with activities. It was evident that some interviews had already taken place, with one person using the service saying, I was involved in three interviews last week. Some of the feedback received regarding the staff was, The staff work hard and do Care Homes for Adults (18-65 years) Page 24 of 35 Evidence: their jobs very well everyday I stay here, I am grateful to all the staff, especially to the manager the activities coordinator is really good with the residents and sometimes in the afternoons and nights we are short of staff. Some of the staff commented, I dont know who my line manager is, I think it is the nurse on duty I didnt think I could do this kind of work, but I like it there is a need for more structure, especially with the daily routines of cleaning and maintenance. One visiting nurse commented on the wheelchairs being dirty There are no clear guidelines of duties and responsibilities for staff and We all love working here, but it could be so much better. There is a robust and thorough recruitment system in place, with staff files containing relevant and satisfactory evidence that the necessary information and checks have been obtained including, Criminal Records Bureau (CRB), application forms and two written references. It was apparent that correct procedures are carried out, which helps ensure that only suitable people are employed to support and care for vulnerable people. There was available evidence to show that members of staff have received appropriate, relevant and satisfactory training. However, in observation and in discussion with some of the staff it was apparent that there is limited understanding of what each others roles are. This was evident in the afore mentioned issues regarding, the changing of bed linen and the management of individuals catheters. This apparent lack of structure, the inadequate cleaning arrangements, the limited understanding of who supervises who? and what exactly are people employed to do? were discussed with the management following the inspection and an assurance was given that all of the issues raised would be addressed and that staff members would be made exactly clear of what their roles are. Overall with the feedback received and in observation, it was apparent that there is a need for clearer guidelines regarding peoples roles, line management, monitoring of daily routines and individual responsibilities. Care Homes for Adults (18-65 years) Page 25 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a lack of structure and organisation, with the general running and management of Bridgeway. This fails to give the assurance that people are receiving a quality service. Evidence: The registered manager for Bridgeway Care Home has over thirty years of experience in nursing and social care. In discussion with some of the people using the service and the staff it was generally felt that the management is approachable, with some of the comments being, the manager is fair, if you have a problem she will help you the manager is great, if not for her I wouldnt be living here and the manager has been really helpful. However, as previously mentioned it is evident that there is a lack of structure, guidance and leadership from the management team. This is demonstrated in the way that daily routines and necessary tasks are being neglected by some of the staff, which potentially affects the welfare, safety and health of the people using the service. Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: It was evident that the home is not sufficiently well managed, which fails to give the assurance that people are receiving a good quality service. Copies of the last three months provider visit reports were provided. These monthly visits are carried out by the area manager, with the acquired information used to determine the necessary actions that are needed to be taken/implemented. The report format requests information regarding, service users views, interviews with staff are carried out, an inspection of the premises is completed and if any complaints have been received. These reports clearly demonstrated that different issues had been identified, for example the April report mentions about the need for some carpets to be replaced, the dining room and lounge needing to be refurbished and a potential full refurbishment of the home was being requested. It was apparent in the report for June that some of the identified areas for action had been addressed, however it is clear that some of the concerns raised in this Care Quality Commission report have not been identified in the monthly visit reports, for example the poor practice of marking peoples clothing with indelible pens, the apparent lack of structure and guidance given to staff, especially regarding the personal care of people and the apparent failure to carry out daily tasks and routines that are needed to ensure and promote the welfare, respect, dignity and health of people using the service. These concerns have been mentioned in other sections of this report. There is a monthly Your Voice meeting, which is for the people using the service. The previous three months minutes from these meetings were observed and it was clear that people are given the opportunity to voice any concerns, raise any issues and make decisions about the delivery of service. Every two months an area meeting is held in different homes and one of the service users accompanies the manager to these meetings. At the present time four of the service users, individually participate in the meetings and are involved in the interview process for new staff. All inspection certificates were in place including, electric inspection certificate, gas, fire alarm and emergency lighting system,on call system, portable appliance testing (PAT) and a lift safety certificate. Health and safety checks are regularly carried out for example, fire alarms, emergency lighting and water temperature checks. However, during the second visit an engineer was carrying out an inspection for legionella testing and he said, a water tank was found to be corroded and contained sediment and that it could potentially leak and cause extensive flooding. This was brought to the attention of the management and an assurance was given that it will be immediately addressed. As already mentioned there are a number of concerns regarding the health,safety and welfare of people using the service, including the overall poor maintenance of the Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: premises, the evident lack of dignity and respect afforded to people, regarding the soiled bedding and catheter care. Potentially the poor practice of bed changing and catheter care could cause infections and does not promote the good management of cross infection. Care Homes for Adults (18-65 years) Page 28 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 18 12 The registered person shall 30/08/2009 make suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of service users. The marking of peoples clothing should be more discreet, to promote dignity and respect. 2 18 16 The registered manager should arrange for the regular laundering of linen and clothing. Bedding should be regularly changed, helping to ensure that people have clean and fresh bed linen at all times. 31/07/2009 3 19 12 The registered person shall 31/07/2009 ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. Care Homes for Adults (18-65 years) Page 30 of 35 Catheter care including, monitoring, emptying and maintenance should be carried out that promotes dignity and respect for the person. 4 31 18 The registered person ensures that staff have clearly defined job descriptions and understand their own and others roles and responsibility. To ensure that a satisfactory monitoring and supervisory structure is in place. This will help give the assurance that people are receiving a good service. 5 32 18 The registered person shall, 30/09/2009 having regard to the size of the care home, the statement of purpose and the number of and needs of service users ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. Staff should respect service users and have attitudes and characteristics that are important to them. They should be interested, motivated and committed to the work they are employed to perform. 30/09/2009 Care Homes for Adults (18-65 years) Page 31 of 35 6 37 10 The registered provider and the registered manager shall, having regard to the size of the care home, the statement of purpose, and the number and needs of the service users, carry on or manage the care home (as the case may be) with sufficient care, competence and skill. The home is not sufficiently well managed. It is apparent that there is a lack of structure, planning, supervision and monitoring of the service being delivered. 30/09/2009 7 38 12 The registered person shall 30/09/2009 ensure that the care home is conducted so far as to promote and make proper provision for the health and welfare of service users. There is no clear sense of direction or leadership, which gives the staff the guidance and instruction that is needed to provide a satisfactory service. 8 38 12 The registered person shall 30/08/2009 make suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of service users. The daily running and management of the home, should ensure that the Care Homes for Adults (18-65 years) Page 32 of 35 dignity and respect of indiividuals is promoted. This could be demonstrated in the daily tasks and responsibilities that were identified as being neglected. 9 42 13 The registered person shall 31/12/2009 ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. The overall maintenance of the home is poor. 10 42 13 The registered person shall ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. There is insufficient evidence to show that the health and welfare of people is being promoted. Catheter care, bed changing and general cleanliness and hygiene needs to improve, in order to promote the management of cross infection. 30/09/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 In order to further enhance the assessment process, it is recommended that as much information as possible is obtained including, individuals background history. This will give a broader picture of the person using the service and Care Homes for Adults (18-65 years) Page 33 of 35 promote person centered planning. 2 42 Consideration should be given to ensuring that all water tanks and water systems are safe and adequately maintained. Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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