Inspection on 22/06/06 for New Bridge House

This inspection was carried out on 22nd June 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 no outstanding requirements from the previous inspection report, but made 34 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

New Bridge House 12/11/07

New Bridge House 27/06/07

New Bridge House 17/11/05

New Bridge House 04/05/05

New Bridge House 04/11/04

New Bridge House 15/04/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOME ADULTS 18-65 Bridge House Bayer Street Coseley West Midlands WV14 9DS Lead Inspector Mrs Jean Edwards Unannounced Inspection 22 & 23 June 2006 08:10 Bridge House DS0000041949.V298287.R01.S.doc Version 5.2 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 Bridge House DS0000041949.V298287.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 Adults 18-65. 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. Bridge House DS0000041949.V298287.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bridge House Address Bayer Street Coseley West Midlands WV14 9DS 01384 813450 01384 813451 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) N/K Dudley Metropolitan Borough Council Mrs Jannett Telfer Care Home 14 Category(ies) of Physical disability (14) registration, with number of places Bridge House DS0000041949.V298287.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. All requirements contained within the registration report of 11 & 12 December 2002 are met within the timescales contained within the action plan agreed between Dudley Metropolitan Borough Council and the National Care Standards Commission. Service users in the category PD(E) may be accommodated at the home for as long as the home is able to demonstrate that their needs can be met. 2. Date of last inspection Brief Description of the Service: Bridge House is a purpose built Residential Care Home for up to fourteen younger adults with physical disabilities, owned and supported by Dudley Metropolitan Borough Council. The Organisation intends to provide 8 permanent placements and 6 short stay respite beds. The property is located near to Roseville village, Coseley. There are many local amenities nearby and the Home is within walking distance of several good bus services to nearby towns. The Home has ample car-parking facilities; to the rear there are gardens, with shrubs and trees. The majority of the interior of the Home provides corridors, which are spacious and have ease of access for wheelchair users. The Home provides 14 single bedrooms; including one, which has ensuite facilities. There is one bathroom, one shower and five toilets for communal use. Communal areas include a dining room, three seating areas around the Home, one of which is a quiet patio lounge, which doubles as a library. The level of fees for this home are currently £355 per week for places funded by Dudley Local Authority and up to £450 per week for places, which are purchased privately outside Dudley Borough. Bridge House DS0000041949.V298287.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first unannounced key inspection visit for 2006 - 7, undertaken by an Inspector from the Commission for Social Care Inspection (CSCI), over two days on the first day between 8:10 am and 1:40pm and the second day between 12:40 p.m. and 6:40 p.m. All Key National Minimum Standards have been assessed at this visit. The range of inspection methods to make judgements and obtain evidence includes: discussions with the registered manager and staff on duty during the visits, examination of records and documents and discussions with residents, relatives, the NVQ Assessor and the newly appointed occupational therapist. Other information was gathered before this inspection visit from notification of incidents, accidents and events, and an action plan submitted by the home following the unannounced inspection in November 2005. This inspection visit has included a tour of the premises, including the grounds, communal areas of the home, the bathrooms, toilets, laundry, kitchen areas, and a sample of residents’ bedrooms, with their permission. Nine service user surveys were sent to the home by the CSCI and an analysis of the seven survey forms returned is contained throughout this report. Comments have been generally positive, particularly about meals and staff. Nine residents are in residence at the time of this visit, seven people are permanent residents and two people are visiting for short stays. Various people have chosen to stay at Bridge House during the two days of this visit. A number of residents have been eager to be involved in the inspection process and the majority of residents have been involved in discussions in varying degrees. What the service does well: The registered manager continues to respond to inspection reports with an action plan, giving dates for the required improvements to be put into place. The residents are able to treat Bridge House as their own home and to be as independent as possible. Residents make their own choices and are active in running their own residents meetings and staff only attend if they are invited. There are wide ranges of topics discussed, with views freely aired about the running of the home, such as mealtimes and arrangements for outings during the summer months. To the question on the CSCI service user survey: Do you Bridge House DS0000041949.V298287.R01.S.doc Version 5.2 Page 6 have meetings in your home to talk about whats good and what should be changed? All 7 responses state - Yes 7 There are also consultations taking place with residents, relatives and staff about the future of the home, which may change over the next few years. The future may include a more independent style of living, with individual support for each person as needed. To help people plan and develop skills the home now has the support one day each week of an occupational therapist. All residents currently at Bridge House independently manage their own financial affaires and have their own banking arrangements, without any interference from the home. Some residents choose to attend daytime activities provided by the local authority or pursue their own leisure time activities in the community or at Bridge House. One person continues to do voluntary work at a local day centre for older people and another person attends college for a computer course. Wherever possible residents are encouraged and supported to maintain regular contact with family and friends. To the question on the CSCI service user survey: Can your family and friends visit? All 7 state Yes. Residents spoke of their enjoyment of meals provided and the meal on the second day of this visit looked delicious, with a choice of fish & chips or an appetising salad, followed by apple pie and ice cream. To the question on the CSCI service user survey: Do you choose what to eat? The responses were 7 Yes. Bridge House is generally well adapted to suit the needs of the residents, providing them with easy wheelchair access to most areas. There are some areas, which need to be improved. The home is clean, tidy, homely and comfortable, providing residents with a pleasant place in which to live. The staff are friendly and eager to share their views, answering questions in an open and honest manner. During discussions the permanent staff show a dedicated approach to their work; they clearly know residents’ likes and dislikes and how to meet their needs. To the question on the CSCI service user survey: Do you feel well cared for? All 7 responses were Yes, and to the question: Do the staff treat you well? 6 - Yes and 1 - Sometimes and most residents feel they are listened to. The home has a total ratio of 84 of the staff with an NVQ care qualification, including senior care officers with an NVQ 3 in supervisory skills. There is a ratio of 76 of the care staff with an NVQ 2 care award and the NVQ Assessor, spoken to during this visit, is very complimentary about the willingness and commitment of the staff at this home. The question on the CSCI service user survey asks: Whats good about living at your home? The following are comments from the forms: very few restrictions and rules, feel safe, well cared for, go out when want to, theres Bridge House DS0000041949.V298287.R01.S.doc Version 5.2 Page 7 no hassle, I can be as independent as I want to be and feel safe, I like it, company and everythings alright. This inspection has been conducted with full co-operation of the registered manager, staff and residents. The atmosphere through out the inspection was relaxed and friendly. The Inspector would like to thank staff, and residents for their hospitality during this inspection visit. What has improved since the last inspection? What they could do better: To the question on the CSCI service user survey: Whats not so good? The comments are: could use more storage space, Ive been here 18 years and have run out of space so I will have to consider throwing out or selling some of my things, nothing, a bit scared and unsure about future changes at Bridge House and sometimes we get on top of each other and it gets on your nerves. The organisation still needs to improve policies, procedures and staff awareness particularly relating to the protection of vulnerable people from abuse, to offer more safeguards to protect the residents living at this home. Bridge House DS0000041949.V298287.R01.S.doc Version 5.2 Page 8 The stability of the staff team has deteriorated especially relating to the compromised senior team, with a full time senior care officer away on a secondment to another home. The replacement cover is not satisfactory with the registered manager working excessive shifts and ad hoc arrangements using relief staff and staff from other homes on an acting up basis, just minding the home for a particular shift. The result is a lack of knowledge about the residents and a lack of continuity of care. The organisation has received separate correspondence to resolve the situation with immediate effect. The registered manager must demonstrate improvements to staff training and formal structured supervision. As already indicated some aspects of the premises do not entirely meet the residents needs. For example, the fire exit from the residents’ kitchen is still not independently accessible for people in wheelchairs. The organisation must make sure that the external environment is made safe for people who are wheelchair users and provide financial resources to redecorate the remainder of the interior of the home to a satisfactory standard. These are long outstanding requirements. The home is dependent on Local Authority maintenance staff for the maintenance of the grounds, garden areas and paths and these are badly in need of attention. Some paths are uneven, shrubs and bushes need pruning and the gardens tidying. The registered person must take action to rectify the areas to make them safe and pleasant for residents to use. Urgent action has been required as a result of this inspection, to replace a defective grab rail in a bedroom, rectify excessively hot water temperatures in the en suite shower room, used independently by a resident on a short stay visit, and repair or replace the defective that hoist in the only assisted bathing facilities at the home. 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. Bridge House DS0000041949.V298287.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bridge House DS0000041949.V298287.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2,3,4,5 The overall outcome for this group of standards is judged to be adequate. The home has a statement of purpose and service user guide, though there are no recent reviews of these documents, they are made available to residents. No further progress has been made to revise and update residents contracts / terms and conditions of occupancy. This has the effect that residents and their advocates do not have sufficient information regarding their rights and entitlements and any agreed restrictions. The home generally uses comprehensive assessment tools, which means that residents’ needs are thoroughly assessed to ensure that care needs will be met. The home actively encourages introductory visits and there is documentary evidence to demonstrate that people have been given the opportunity and time to make decisions, which are right for them. EVIDENCE: Information about proposed changes to the service is displayed in the reception area of Bridge House, which is very positive for residents, families and staff. However no potential changes have been notified to the CSCI. The registered manager states that there is to be a residence and relatives meeting at 4 p.m. on Friday 11 August 2006 regarding the proposed changes for the future of Bridge House. A social worker has been allocated to the home for two Bridge House DS0000041949.V298287.R01.S.doc Version 5.2 Page 11 days each week, together with an occupational therapist allocated for one day each week, to work with the residents and staff to improve levels of independence with daily living activities wherever this is possible. The organisation it is looking at the possibility of re-provision in supported living in purpose-built flats or apartments with care and/or support provided on an individual basis. The home is not aware of a specific timescale for this to happen, however it is indicated during discussion with the service manager that the timescale is likely to be around five years. One resident states she is, very happy with lots to do but a bit worried about the future, another says, was worried about moving out at first but now looking forward to it - hope new flat will have enough space, a third person is not impressed by any ideas. The home is not accepting any new residents on a permanent basis. However a number of residents use the home for short respite stays. Staff at Bridge House make sure that any admissions of new residents take account of the individual needs, concerns and anxieties of the prospective resident and their families or carers. Usually the home receives copies of the individual care instruction (ICI) and assessment summary, and using the information of home carries out separate assessments for most of the residents. However, the home is currently providing short-term care for a resident whilst her bungalow in the community is being adapted to meet her needs. From the examination of this residents case file it is noted that although she has stayed at Bridge House on previous occasions there is no up-to-date individual care management instruction (ICI) or documentary confirmation that there are no changes to her needs during this visit. Assessment of a sample of residents case files indicates that there has been no change to the existing contract / terms and conditions of residence, though staff state that the existing document is being revised by the organisation. Bridge House DS0000041949.V298287.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9, 10 The overall outcome for this group of standards is judged to be adequate. Each resident has a care plan and there is involvement of residents and relatives in the development and review of the plan. The organisation has introduced a new care plan format, which has some strengths but also omissions, which means that staff do not always have sufficient guidance to fully met all care and support needs. EVIDENCE: There is evidence that all residents have a care plan in the new care plan format, as mentioned at the previous visit this format has some strengths and some omissions notably no preferred routines, or medication regimes, or short and long term goals and no plan for short term care needs. An example is that care plans currently do not include information relating to preferred gender of staff to give support and assistance with personal care needs. There is positive evidence, confirmed in discussions with residents that they and where appropriate their family or supporter have agreed and signed care Bridge House DS0000041949.V298287.R01.S.doc Version 5.2 Page 13 plans and reviews. There are also detailed care plans and risk assessments in place for temporary residents. Residents case files sampled show evidence of tissue viability risk assessments, nutritional screening and continence assessments and falls risk assessments for residents who are at high risk. The home makes good efforts to inform residents of advocacy services, with information displayed in the foyer along with very visual information about proposed changes options for future service provision. As the processes advance with the involvement of the designated social worker and occupational therapist individual care plans will need to be expanded to include details of how each person is supported to achieve their potential. Bridge House DS0000041949.V298287.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the 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, 15, 16,17 The overall outcome for this group of standards is judged to be good. Links with the community are generally good and some planned and spontaneous activities take place. Residents are generally able to take advantage of and develop socially stimulating opportunities. The menus are designed to consistently offer residents choices of healthy and good quality meals. EVIDENCE: There are activity programmes for individual residents; these would be enhanced with fuller written evaluation and monitoring of daily activities. There is ample anecdotal evidence that the majority of residents either attend day care provision at Queens Cross or Roseville day centre or choose to pursue individual leisure and social activities at Bridge House. One resident continues to work as a volunteer at Roseville day centre and helps out around Bridge House as and when he feels like it. Assessment of a sample of activity records demonstrates that activities, which are provided, reflect preferences of individual residents. For example one of the older residents has his own copy Bridge House DS0000041949.V298287.R01.S.doc Version 5.2 Page 15 of the weekly TV Guide, which he spends time going through to choose what he wants to watch highlighting the programmes for the whole week. Records show that he loves anything to do with cars and planes. There are also examples from discussions with residents and staff that some residents enjoy going to the church of their choice, sometimes twice on Sundays, and on the day of this visit two residents were returning to Queens Cross Centre for an evening club. There is an activities committee of residents and staff responsible for coordinating group activities. It is noted that the residents are not going away on a group holiday this year. It is stated that this is mainly due to insufficient staffing for us all to go together but the manager and seniors are looking at a separate holidays as a possibility. Some people are saving to go somewhere special and the minutes of the residents meeting show that people have expressed preferences to go on day trips to Blackpool, the Trafford Centre, the new bullring shopping centre, Sea life Centre, Dr FAQ racing at Hall Green, Cadbury World, and the Emmerdale set. There is a visiting policy, which is displayed in the home. Visitors can be received in private in residents’ bedrooms and in the library (though this area is still used as a designated smoking area) or in the patio lounge. Discussions with the residents and examination of a sample of records indicate that every effort is made to promote positive relationships with family members, friendships in the wider community and within the home. Staff have given details of how residents are supported to maintain contact. It is noted that one resident maintains contact with relatives and friends using the telephone and another using his personal computer. It would be beneficial to the number of residents if the home had an appropriate communal computer to stimulate independence and help maintain contact with family and friends. Residents are able to develop personal and intimate relationships if they wish. People are encouraged to seek specialist advice and support in these circumstances. One person has a new friendship with a girlfriend in the community and the visits her in her own flat, using the Ring and Ride service independently. He has indicated that he will be having a meeting to seek specialist advice and support regarding this relationship. Bridge house has planned menus, however there is ample evidence from observations and discussions with residents and for catering staff that people exercise individual choices at each mealtime, especially at breakfast. The home is also making great efforts to promote independence by encouraging people wherever it is deemed safe to make their own meals and snacks. These efforts are being supported by the social worker and will have future input from the occupational therapist. During discussions it is evident that staff recognise that the route to independence will take a long time for some people for some people and the outcome of their efforts must be sufficiently attractive to encourage them to eat. For example if someone attempts to butter their Bridge House DS0000041949.V298287.R01.S.doc Version 5.2 Page 16 own bread it must look edible in order for them not to be discouraged. During individual and group discussions residents have been very complimentary about meals provided and the meals during the two days of the visit looked and smelled appetising. Bridge House DS0000041949.V298287.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 The overall outcome for this group of standards is judged to be good. Personal support in this home is offered in such a way as to promote and protect residents’ privacy, dignity and independence. The health needs of residents are generally well met with good evidence of multi disciplinary working taking place on a regular basis. The systems for the administration of medication are generally good with clear and comprehensive arrangements being in place to ensure residents medication needs are met. EVIDENCE: From the sample of case files examined and from discussions with residents and staff there is good evidence of annual health checks, dental, optical, auditory, chiropody, and well person screening for breast, cervical or testicular cancer as appropriate with refusals noted. One of the younger residents who has had several short stays at Bridge House states that when she came to Bridge house she could not walk and with the help and support she has received she can now walk with minimal aid of a walking stick. She goes on to say that Bridge house and its staff are wonderful Bridge House DS0000041949.V298287.R01.S.doc Version 5.2 Page 18 and feels that she would not have improved without them. She would not go elsewhere for the help and support she needs whilst she is waiting for adaptations to be made to a bungalow in the community. It noted from her file that she was not weighed on admission and has not had her weight regularly monitored. However she was weighed before the end of this inspection visit and was surprised at her weight level, as she had put on weight, which she attributes to the good and plentiful meals, together with contentment with the laughter and banter around and about at Bridge House. Examination of the homes medication system, demonstrates that Generally medication is well managed by senior staff, with accredited training and a good working knowledge of residents medication needs. It has been established the majority of the previous minor deficits have been rectified. However a small number of additional improvements are needed as a result of this visit. The most important omission is to rectify the lack of a written risk assessment for the resident administering her own medication. The Home must devise and implement a written risk assessment for any resident who self-administers any part of their medication and introduce meaningful monitoring systems, with the residents consent. It is strongly recommended that the home introduce periodic documented internal audits of the homes medication system, identifying and resolving any issues, which may arise. Bridge House DS0000041949.V298287.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 The overall outcome for this group of standards is judged to be adequate. The home has a generally satisfactory complaints system with some evidence that residents feel that their views are listened to and acted upon. Policies, procedures, guidance and staff training have not yet been fully implemented in order to provide residents with satisfactory safeguards from abuse. EVIDENCE: There have been no complaints recorded in the home’s complaints log since the last inspection visit in May 2005. The residents say they feel that they can raise any general concerns through their meetings or individually with the manager or staff at the home. The manager and staff are aware of the multidisciplinary procedure Safeguard and Protect for the protection of vulnerable adults; and there is a copy readily available in the office. In discussions staff are able to describe processes to report allegations of abuse. The home does not currently have documentary evidence that all staff have read the policy guidance. It is strongly recommended that staff signatures be obtained to demonstrate awareness and understanding of their responsibilities. Progress is continuing slowly to ensure all staff are provided with appropriate levels of training so that they are aware of and are able to respond appropriately situations, which require them to take action to protect vulnerable people. Bridge House DS0000041949.V298287.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 29, 30 The overall outcome for this group of standards is judged to be adequate. The home presents as a homely and comfortable environment for residents. The manager has a good understanding of the areas where the home needs to improve and though there is some proactive planning improvement are not currently resourced and managed in a timely way to benefit residents. EVIDENCE: Bridge House, which was purpose build for younger adults with physical disabilities, is clean, bright and cheerful. There is a rolling programme for the interior of the home and residents are able to contribute their ideas. The premises do not entirely meet the needs of the residents or demonstrate compliance with the National Minimum Standards for younger adults to the fullest extent. A sample of residents bedrooms have been viewed with their consent and are organised and decorated to each persons taste. Corridors are spacious and allow good access for people who are wheelchair mobile. Bridge House DS0000041949.V298287.R01.S.doc Version 5.2 Page 21 During the tour of the premises it was noted that the only assisted bath was out of use because of a defective Arjo bath hoist. Due to the age of the appliance there is currently no date for a part for repair or replacement. The result is that currently none of the residents is able to have a bath and they are limited to having to use showering facilities. The following also need attention: Maintenance of the grounds and gardens to acceptable standards to provide a pleasant and safe environment for residents to enjoy Replacement of all damaged radiator and pipe covers, mainly in the toilets and bathing facilities, ensuring that they are fit for purpose Replacement of the broken desk drawers in bedroom 4 with items of furniture more suited to the residents needs, for example shelving Removal of the broken bedside table, with defective drawers and handles in bedroom 9 Repair of the handle on the built-in unit in bedroom 9 Replacement of the commode in bedroom 1 along with any others, which are not in a good state of repair Replacement of the defective grab rail beside the bed in bedroom 12 and ensure all aids are maintained in a safe condition or replaced (this had been action by the second day of the visit) The laundry and kitchen are well organised, and there is a varied range of fresh, frozen, dried and canned food available. There are minor areas in the kitchen needing improvement, identified as a result of this visit, which can be seen at the requirements section of this report. Bridge House DS0000041949.V298287.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 The overall outcome for this group of standards is judged to be poor. Substantive staffing levels have deteriorated and the risks that residents may not always receive consistent care have increased. Staff training and supervision are compromised by the current instability in the senior team. EVIDENCE: There continues to be a stable core group of long serving staff at Bridge House, who demonstrate a strong commitment to the residents. There is warm and empathetic rapport between the residents and staff. There are currently unsatisfactory arrangements to provide the necessary trained, experienced and a consistent senior team and supernumerary managerial hours for residents at Bridge House. At this visit it is noted that one full time senior care officer is covering a secondment at another home and one full time senior officer has commenced two weeks annual leave. This means that availability is currently one full time senior care officer and the registered manager, with limited support from a relief senior carer shared with Wallbrook House, another acting senior carer available for one weekend in the next month and other ad hoc arrangements. Bridge House DS0000041949.V298287.R01.S.doc Version 5.2 Page 23 Since April 2006 more than eight staff from other homes, mainly Wallbrook House, which also has compromised staffing levels, have been used to provide senior cover. The rotas and salaries book show that the registered manager has also worked as the senior on shift, working long stretches, including 15hour shifts on some weekends. This situation poses unacceptable potential risks for residents using the service. Staff files examined at this visit, demonstrates that the home follows corporate recruitment and selection policies and procedures, with the majority of documentation in compliance with legislation available. However three staff files sampled do not have satisfactory evidence of PoVA / CRB clearances. Although it is stated that this is held centrally, the practice does not demonstrate compliance with the Care Homes Regulations 2001. There is an organisational framework to ensure that all care staff receive structured, formal supervision at prescribed frequencies. However discussions and records confirm that the frequency of supervision sessions currently does not demonstrate compliance with the National Minimum Standards or the organisational policy. Examples are no recorded supervisions for one person, 3 recorded supervisions in 12 months for a second person and 4 recorded supervisions in 12 months for a third member of staff. There is a designated senior care officer to take responsibility for staff training and it is stated that efforts are continuing, albeit slowly, to access training and development for each member of staff. Training records could not be assessed at this visit. The registered manager has agreed to forward the homes training plan and individual staff training profiles to the CSCI office, Halesowen for consideration. Bridge House DS0000041949.V298287.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41, 42 The overall outcome for this group of standards is judged to be poor. The management of the home continues to provide generally clear leadership and communication systems are generally effective, though there is a lack of clarity with relief about their roles and responsibilities. There are systems in place to consult residents about the way forward for their home. The compliance with all aspects of records and health and safety is currently not satisfactory, which poses potential of risks residents safety and well-being. EVIDENCE: The registered manager, Jannett Telfer has worked at Bridge House for more than twenty years, she has achieved NVQ level 4 in care management and the Registered Managers Award (RMA). She demonstrates a willingness to update her professional training but feels hampered at present by the shortages in the senior team. Bridge House DS0000041949.V298287.R01.S.doc Version 5.2 Page 25 The registered manager has made progress to implement residents surveys, with results forwarded to the CSCI office, Halesowen following this inspection visit. The results and any actions as a response need to be included in the next review of the homes Service User Guide and be made available to all interested parties. Residents organise their own meetings, with minutes produced and displayed. During the visit the registered manager states that there is business plan / an annual development plan relating to Bridge House and although not readily available a copy has subsequently been forwarded to the CSCI Office, Halesowen. Although the senior management generally make visits to the home there are no reports of monthly unannounced visits relating to the conduct of the home. It is particularly important for the home to receive monitoring, feedback and support for its continued improvement to achieve satisfactory compliance with required standards and for the CSCI to be kept informed between inspections visits. The registered manager states that she and the designated senior care officer try to ensure all staff receive all mandatory training commensurate with their roles, such as fire training, drills twice each year, and moving and handling, hoist, first aid, food hygiene, and health and safety. There is evidence of training booked in supervision notes, however the training course is then sometimes cancelled, leaving staff in need of refresher training in various areas. A sample of fire safety and maintenance service records have been examined, and whilst these are generally satisfactory, assessment of the water temperature records shows excessive hot water temperatures in the en-suite shower in bedroom 14. This was recorded as 46 C in May and 47.3 C in June 06, presenting a high risk of scalding to the resident using the room for a short stay, recovering from a stroke, and currently using the shower unsupervised. Accident records show that there have been 12 recorded accidents involving residents the inspection visit in November 2005, and as good practice there is now evidence that the registered manager conducts regular accident analysis. No further progress has been made to provide the manager and senior staff with training to effectively promote the management of risks and health and safety. Bridge House DS0000041949.V298287.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 2 3 2 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 1 28 X 29 1 30 2 STAFFING Standard No Score 31 X 32 4 33 1 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 2 2 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 2 15 2 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 2 2 2 1 X Bridge House DS0000041949.V298287.R01.S.doc Version 5.2 Page 27 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 YA1 Regulation 39 Requirement The registered provider is required to notify the CSCI of potential changes to the provision of the service, together with information relating to ongoing consultations with residents, relatives and other interested parties To ensure that the home receives up to date individual care instructions (ICI) or written confirmation from the referral agency that there are no changes to residents needs when admitted for the short stay/respite visit To ensure that any restrictions of choice or personal freedoms are recorded as part of the contract /terms and conditions, as well as the individual plan (Timescale of 31/01/05 and 30/06/05 and 01/02/06 Not Fully Met) To ensure that agreed limitations on choice, freedom or decision-making are clearly DS0000041949.V298287.R01.S.doc Timescale for action 01/09/06 2 YA2 14(1) 01/08/06 3 YA5 5(1)(b) 15(1) 01/09/06 4 YA6 15(1) 17(1)(2) 01/09/06 Bridge House Version 5.2 Page 28 documented as part of the service user plan, examples: going out, bathing, smoking un-chaperoned (Progress but Timescale of 31/01/05 and 30/06/05 and 01/02/06 Not Fully Met) 5 YA6 15(1) 17(1)(2) The new care plans must 01/09/06 include all relevant information transferred from the existing care plans, for example daily routines and medication regimes (Timescale of 01/02/06 Not Fully Met) To ensure that a care plans include information relating to preferred gender of staff to give support and assistance with personal care needs To ensure that all residents are weighed on admission and that there are documented regular monthly weight checks 1) To record carried forward medication stocks on MAR sheets (Timescale of 01/12/05 Not Met) 2) To expand the medication policy to ensure that all medication errors and corrective actions are notified to the CSCI office, Halesowen, as a Regulation 37 matter (Timescale of 01/02/06 Not Met) 9 YA20 13(2) 1) To devise and implement a written risk assessment for any resident who self administers any part of their medication, especially CB 2) To introduce meaningful monitoring systems, with the Bridge House DS0000041949.V298287.R01.S.doc Version 5.2 Page 29 6 YA6 15(1) 17(1)(2) 01/09/06 7 YA19 13(1) 01/08/06 8 YA20 13(2) 01/09/06 01/08/06 residents consent for any person who self administers their own medication 3) To introduce periodic documented internal audits of the homes medication system, identifying and resolving any issues To ensure that the Organisation reviews and updates the policy, procedure and useful flowchart, dating from 1994. (Timescale of 31/01/05 and 31/07/05 and 01/02/06 Not Fully Met) To update the corporate complaints procedure to include a 28 day timescale of response and details of the CSCI. (Timescale of 31/01/05 and 31/07/05 and 01/02/06 Not Fully Met) 1) To progress training for all staff relating to the areas of responding to allegations of suspected abuse and protection of vulnerable adults, dealing with aggression/challenging behaviour, and use of physical or non-physical intervention (Timescale of 31/01/05 and 31/07/05 and 01/02/06 Not Fully Met) 2) To devise and implement step-by-step procedures relating to dealing with allegations of abuse, use of restraint etc., for staff guidance (Timescale of 31/01/05 and 31/07/05 and 01/02/06 Not Fully Bridge House DS0000041949.V298287.R01.S.doc Version 5.2 Page 30 10 YA21 17 (1) 01/09/06 11 YA22 22 01/09/06 12 YA23 13(6) 01/09/06 Met) 13 YA23 13(6) 18(1)(c) 1) To expand the safeguard & protect policy with a simple to use flowchart, with contacts and telephone numbers for staff guidance (Timescale of 01/02/06 Not Fully Met) 2) To obtain staff signatures to provide evidence that all staff have read and have an awareness of policies to protect vulnerable adults (Timescale of 01/02/06 Not Fully Met) 14 YA24 23(2)(b) 1) To renovate / replace the 01/09/06 floor covering in the Residents kitchen, lounge, dining room, corridor areas and bedrooms identified in the maintenance programme (Timescale of 31/01/05 and 31/07/05 and 01/02/06 Not Met) 2) To continue the ongoing renovation of all doors, doorways and communal areas, which have damage caused by wheelchairs or other equipment; and seek advice for more robust protection for these areas (original timescale completed they now needs new and continuing renovation) (Improved but Timescale of 31/07/05 and 01/02/06 Not Fully Met) 3) To repair and make safe the cracked car port roof (Timescale of 31/01/05 and 31/07/05 and 01/02/06 Not Met) 4) To undertake work required Bridge House DS0000041949.V298287.R01.S.doc Version 5.2 Page 31 01/09/06 to make the exit from the residents kitchen accessible for wheelchairs (Timescale of 31/01/05 and 31/07/05 and 01/02/06 Not Met, though it is on the homes maintenance programme) 15 YA24 23(2)(o) To ensure the gardens and garden furniture are maintained in conditions which are safe and pleasant for residents to use 1) To replace the broken desk drawers in bedroom 4 with items of furniture more suited to the residents needs, for example shelving 2) To remove the broken bedside table, with defective drawers and handles in bedroom 9 3) To repair the handle on the built-in unit in bedroom 9 4) To replace the commode in bedroom 1 along with any others, which are not in a good state of repair 5) To replace the defective grab rail beside the bed in bedroom 12 and ensure all aids are maintained in a safe condition or replaced (this had been action by the second day of the visit) 6) To ensure that inventories and bedroom audits are signed by the resident and / or representative as well as the member of staff To renovate / replace the 01/09/06 flooring in the shower room (Timescale of 31/01/05 DS0000041949.V298287.R01.S.doc Version 5.2 Page 32 01/09/06 16 YA26 16(2) 23(2) 01/09/06 17 YA27 23(2)(b) Bridge House and 31/07/05 and 01/02/06 Not Fully Met) 18 YA27 23(2)(j) The registered persons are required to ensure work is undertaken to repair or replace the defective Arjo bath hoist within a reasonable identified timescale. Documentary evidence of compliance must be submitted to the CSCI office, Halesowen by 1700 hours on Friday 30 June 2006. 19 YA27 13(4) 1) The registered persons are required to ensure work is undertaken to rectify the excessively hot water temperature in the en suite shower in bedroom 14 and as an immediate interim measure a written risk assessment must be implemented, which demonstrates the awareness and consent of the resident. Documentary evidence of compliance must be submitted to the CSCI office, Halesowen by 1700 hours on Friday 30 June 2006. 20 YA27 23(2)(b) To replace all damaged radiator and pipe covers, mainly in the toilets and bathing facilities, ensure that they are fit for purpose 1) To provide appropriate and consistent senior staff cover for duties on weekends, where the previous practice of a senior member of staff working long days (14 hours) has ceased. (Timescale of 31/01/05 and 30/06/05 and 01/02/06 Not Met) DS0000041949.V298287.R01.S.doc 30/06/06 30/06/06 01/09/06 21 YA33 18(1)(a) 01/09/06 Bridge House Version 5.2 Page 33 2) To provide a revised staffing proposal to ensure that there are sufficient numbers of adequately trained staff available to meet the needs of existing residents and any additional people using the service for respite / short stay visits (Timescale of 30/06/05 Not Met) 22 YA33 18(1)(a), 13(4)(6) The registered persons are required to submit written proposals to the CSCI office, Halesowen to demonstrate consistent, planned senior cover for Bridge House for the remainder of the full time senior care officers secondment. Documentary evidence of compliance must be submitted to the CSCI office, Halesowen by 1700 hours on Friday 30 June 2006. The registered persons are required to ensure staffing rotas are submitted to the CSCI office, Halesowen until further notice. 30/06/06 23 YA33 18(1)(a), 13(4)(6) 17(2) Schedules 2 and 4 30/06/06 24 YA34 19(1) 25 YA35 18(1)(c) Documentary evidence of compliance must be submitted to the CSCI office, Halesowen by 1700 hours on Friday 30 June 2006. The organisation must provide 01/09/06 documentary evidence of satisfactory PoVA and CRB clearances, such as certificates with numbers, dates etc 1) To ensure that all staff have 01/10/06 awareness training and appropriate skills to appropriately deal with specialist needs such as DS0000041949.V298287.R01.S.doc Version 5.2 Page 34 Bridge House epilepsy, strokes etc. (Timescale of 31/01/05 and 31/07/05 and 01/02/06 Not Fully Met) 2) To ensure that all staff receive appropriate awareness training in Equal opportunities, Racism and Disability awareness (Timescale of 31/01/05 and 31/07/05 and 01/02/06 Not Fully Met) 3) To ensure that every member of staff has an individual training and development assessment and profile (by 2004) and produce documentary evidence that all staff receive at least five paid training / development days (pro rata) each year (Timescale of 31/01/05 and 31/07/05 and 01/02/06 Not Fully Met) 26 YA35 17(1)(2) 18(1)(c) 1) To forward copies to the CSCI office, Halesowen of Mandatory training records Annual training plan Individual training plans / profiles 2) To obtain and hold on file copies of NVQ certificates 27 YA36 18(1)(c) 1) To ensure that all care staff receive a minimum 6 documented formal supervision sessions in each 12 months 2) To devise and display an annual schedule of supervision meetings The registered persons are DS0000041949.V298287.R01.S.doc 01/09/06 01/09/06 28 YA37 17(2), 30/06/06 Page 35 Bridge House Version 5.2 18(1)(a), 24 required to ensure that the registered manager has sufficient supernumerary managerial hours, which are to be demonstrated on staffing rotas. Documentary evidence of compliance must be submitted to the CSCI office, Halesowen by 1700 hours on Friday 30 June 2006. 29 YA39 24 30 YA39 24 31 YA40 17, 24 To devise and implement relatives and stakeholder surveys, with collated results used as part of the homes quality assurance system to identify strengths and weaknesses The responsible individual must ensure that reports of monthly unannounced visits relating to the conduct of the home are made available to the home and the CSCI on a consistent basis To make progress to ensure that all applicable policies and procedures relating to topics set out in Appendix 2 of the National Minimum Standards for Younger Adults are put in place and reviewed on a regular basis. (Timescale of 31/01/05 and 31/07/05 and 01/02/06 Not Fully Met) 1) To ensure all staff receive mandatory training commensurate with their roles; fire training, drills twice each year, moving and handling, hoist, first aid, food hygiene, health and safety (Timescale of 31/01/05 and 31/07/05 and DS0000041949.V298287.R01.S.doc 01/10/06 01/09/06 01/09/06 32 YA42 18(1)(c) 01/09/06 Bridge House Version 5.2 Page 36 01/02/06 remains partly met, with progress continuing) 2) To provide documentary evidence that approved risk assessment awareness training has been arranged for all staff to be delivered within an identified timescale. (Timescale of 31/03/05 and 31/07/05 and 01/02/06 Not Met) 33 YA42 18(1)(c) The registered manager is required to raise issues of cancelled training courses with appropriate managers within the organisation to ensure all staff receive mandatory training in compliance with legislative timescales 1) To ensure that Dudley Catering DSO provides refresher food safety training for the cooks and kitchen staff 2) To provide fly screens in the main kitchen 01/09/06 34 YA42 13(4) 18(1)(c) 01/10/06 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 YA5 Good Practice Recommendations That where service users have additional needs, the Manager should develop and agree a revised, written and costed contract / terms and conditions - NOT MET That serious consideration is give to providing IT equipment for residents use to improve and maintain contact with friends and family and stimulate independence DS0000041949.V298287.R01.S.doc Version 5.2 Page 37 2 YA16 Bridge House 3 YA17 That consideration is given to the introduction of fruit and vegetable smoothies in addition to meals as a means of increasing healthy food options That staff have access to awareness / training relating to new equipment / developments relating to service user needs - NOT MET That the organisation gives serious consideration to implementing a standard form to be used for allegations and referrals relating to abuse of vulnerable adults That the overhanging hedges at the rear of the Home are trimmed to an acceptable standard and garden maintenance is generally carried to the Homes satisfaction - NOT FULLY MET That staff signatures are obtained to demonstrate their awareness of the food hazard analysis -In Progress That the Manager undertakes a regular documented analysis of accidents relating to Service Users. - PARTLY MET That the Organisation should be mindful that all records including accidents records, need to be compliant with the Data Protection Act 1998 and the Care Homes Regulations 2001, i.e. that all records containing personal / sensitive information are held securely and must be retained at the Home for 3 years from the date of the last entry - Partly Met 4 YA22 5 YA23 6 YA24 7 8 YA42 YA42 9 YA42 Bridge House DS0000041949.V298287.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA 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. 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