CARE HOMES FOR OLDER PEOPLE
Bridgeside Lodge Bridgeside Lodge 61 Wharf Road Islington London N1 7RY Lead Inspector
Ms Pippa Treadwell-Smith Unannounced Inspection 13th September 2005 10:00 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 Bridgeside Lodge DS0000061535.V249540.R02.S.doc Version 5.0 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. Bridgeside Lodge DS0000061535.V249540.R02.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Bridgeside Lodge Address Bridgeside Lodge 61 Wharf Road Islington London N1 7RY 020 7250 0156 020 7490 8027 carmen.warner@foresthc.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Blackberry Hill Ltd Carmen Arlithia Warner Care Home 52 Category(ies) of Dementia (18), Old age, not falling within any registration, with number other category (52) of places Bridgeside Lodge DS0000061535.V249540.R02.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 4th May 2005 Brief Description of the Service: Bridegside Lodge is owned and operated by Blackberry Hill Ltd, which is a subsidiary of Forest Health Care. Although the home is registered to admit service users over the age of 65 years, in the category of general nursing care, some of the service users can be aged 60 years. The home was purpose built five years ago. It occupies a site overlooking the canal. The nearest underground station is The Angel and the home is within reach of many bus routes. Bridgeside Lodge is a care home with nursing for 52 people. This large property stands in its’ own grounds and vehicle as well as pedestrian access is through large gates. Car parking is available at the front of the building. The ground floor houses the main kitchen, laundry, hairdressing room and a large lounge overlooking the canal. This area is being redeveloped to accommodate service users with physical disabilities. Accommodation for the older service users is located on the first, second and third floors. Each floor is self-contained and staffed separately. A shaft lift gives access to all floors. Terraces are available on the third floor to enable service users to have access to outside space and there are opportunities to view the canal from the patio at ground level. All bedrooms have ensuite facilities, which include a toilet, shower and walk-in shower. Each floor has a nurses’ station, two lounges and a separate dining room. There are two assisted bathrooms on each floor and single toilets. Each floor provides a pantry/kitchenette, which can also be used by visitors to make drinks. The home and grounds offer disabled access. Bridgeside Lodge DS0000061535.V249540.R02.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day in September 2005 and lasted about 5 hours. A tour of the premises was made and the inspector had the opportunity to speak to ten of the service users. There was a general discussion with staff on each floor and feedback was given to the manager. A variety of records were looked at but close attention was paid to the care plans and underpinning assessments. Another visit had been made by a CSCI Pharmacist in response to an anonymous complaint about drug administration. A letter sent to the manager following this visit can be obtained from the CSCI office. What the service does well: What has improved since the last inspection?
There is major alterations being carried out to the ground floor, which previously was under utilised and presented a potential security risk. When completed the ground floor will accommodate service users with a physical disability. Some of whom will be in a younger age group. This will be the final stage of change and development in the home and bring about a new focus. One area in which the home needs to improve is recorded in this report. The management team of the home has always emphasised that they are keen to work closely with CSCI in order to give a high quality of care in the home.
Bridgeside Lodge DS0000061535.V249540.R02.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Bridgeside Lodge DS0000061535.V249540.R02.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bridgeside Lodge DS0000061535.V249540.R02.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 When people move into the home their needs are being appropriately assessed so that the staff can provide the necessary care they require. EVIDENCE: About 10 of the service users were spoken to during the inspection. They all said that they liked living in the home and felt that their needs are being met. One service users who recently moved into the home said “ I like it here because the staff are very good. They understand my condition and that makes me feel safe.” An inspection of a sample of care records showed that they contained assessments of service users’ needs and wishes. These had been completed by care managers. Following admission the staff had put together a plan of care setting out how this person’s needs and wishes would be met by the home. All service users are assessed in elation to continence promotion , nutritional screening, tissue viability and manual handling. The care plans
Bridgeside Lodge DS0000061535.V249540.R02.S.doc Version 5.0 Page 9 reflect the outcome of these assessments. Risk assessments are also completed to ensure that any risks identified could be managed by the home. Bridgeside Lodge DS0000061535.V249540.R02.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8 & 9 Service users benefit from the attention paid by staff at the home to meeting their health needs. The home continues to have a good working relationship with the General Practitioner. The policy and procedures relating to the administration of medication are judged as sound following a pharmacy inspection. EVIDENCE: Feedback form the service users and discussions with staff was positive about the commitment to keep service users as well as possible. The GP makes attends the home on a weekly basis for a surgery and is available for advice or visits at other times. A service user said that “The staff are lovely and always concerned for your health and comfort”. The records showed that service users are seen by dentists, opticians, chiropodists and other health care professionals. Records show that referrals are made to dieticians and service users are using pressure relieving equipment. Six care plans were looked and one did not contain sufficient detail however the service user was receiving appropriate care. Service users said that they appreciated the visits by the hairdresser.
Bridgeside Lodge DS0000061535.V249540.R02.S.doc Version 5.0 Page 11 Each floor had a copy of “A Guide To Looking After Yourself and Others In Hot Weather”. Discussions with staff highlighted that they understood the importance of promoting fluid intake during spells of hot weather but also to promote continence. There is a water dispenser in each lounge. Staff were seen to use it for the benefit of service users. All the services who preferred to stay in their rooms all had jugs of either water or juice within reach. Drinks are served at regular intervals throughout the day as well as at meal times. One service user who has an indwelling catheter confirmed that staff are always encouraging fluids. The home had an inspection by a CSCI Pharmacist on 19th August 2005. This had been in response to an anonymous complaint. The outcome of the inspection was that Bridgeside Lodge is managing medication well. The systems for the administration of medication are good with clear and comprehensive arrangements in place to ensure service users’ medication needs are met. The Pharmacist recorded one requirement and two recommendations. Action taken to remedy the requirement must be included in the action plan for this inspection report. Bridgeside Lodge DS0000061535.V249540.R02.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected. EVIDENCE: Bridgeside Lodge DS0000061535.V249540.R02.S.doc Version 5.0 Page 13 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): Standards 16 & 18 There is a satisfactory complaint’s procedure available and the manager works hard to investigate concerns that have arisen. Policies and procedures are in place to protect service users from abuse. EVIDENCE: The home has policies and procedures in place in relation to reporting and investigating complaints. Service users said that they felt able to approach staff if they had any concerns or worries. A thank you card from a relative carried the following message “ You made her time here a comfortable and pleasant experience, showed great patience and understanding in the way you looked after her”. Another card records “Thank you for all your kindness to my mother”. The home has an in-house policy and procedure in responding to allegations of abuse and these are linked to the Islington’s Council’s Adult Protection policy. Staff have also attended training. The manager has access to the disciplinary process and professional support in respect of employment legislation. Bridgeside Lodge DS0000061535.V249540.R02.S.doc Version 5.0 Page 14 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): These standards were not inspected EVIDENCE: Bridgeside Lodge DS0000061535.V249540.R02.S.doc Version 5.0 Page 15 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): Standard 30 Service users are looked after by a team of staff who have the skills and training to meet their needs. EVIDENCE: Staff said that they have access to relevant training and records show that staff have done courses in essential areas. A training programme is in place. Staff were observed being proactive about service user’s care and ensuring that they were treated as individuals. The manager is organising training workshops in the home. The organisation is keen to invest in staff training and the organisation has a clear development plan for the home. At least 90 of the care team are trained to NVQ Level 2 standard and some staff are engaged in NVQ Level 3. Arrangements are in place for each nurse to take a lead on various subjects ie tissue viability, diabetes, stroke, infection control and health and incontinence. Bridgeside Lodge DS0000061535.V249540.R02.S.doc Version 5.0 Page 16 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): Standard 31 The manager has a good understanding of the areas in which the home needs to develop. EVIDENCE: The manager has successfully completed the fit person process to become registered. She has nearly completed the Registered Manager’s Award. The home has been going through a period of change and there is evidence that some staff are unsettled. The organisation has put in support mechanism both for the manager and the staff group. Those staff spoken to said that the manager was approachable and ready to listen. There is clear evidence that efforts have been made to communicate the changes to the staff, service users and the relatives. The organisation and the manager are keen to set high standards for the home.
Bridgeside Lodge DS0000061535.V249540.R02.S.doc Version 5.0 Page 17 Bridgeside Lodge DS0000061535.V249540.R02.S.doc Version 5.0 Page 18 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 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X X Bridgeside Lodge DS0000061535.V249540.R02.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard 7 Regulation 15(1) Requirement Care plans must contain all relevant information to ensure that a service user’s needs, in respect of his health and welfare are to be met. The registered person must forward an action plan to CSCI Camden in response to the deficiency recorded on the pharmacy report. Timescale for action 31/12/05 2 9 13(2) 31/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Bridgeside Lodge DS0000061535.V249540.R02.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Camden Local Office Centro 4 20-23 Mandela Street London NW1 0DU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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