Inspection on 27/06/07 for New Bridge House

This inspection was carried out on 27th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 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 22/06/06

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 Deirdre Nash Key Unannounced Inspection 27th June 2007 1:45 Bridge House DS0000041949.V337324.R02.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.V337324.R02.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.V337324.R02.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.V337324.R02.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. 22nd June 2006 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. Its owned and supported by Dudley Metropolitan Borough Council to provide permanent placements and 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. There is car-parking and 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 en-suite 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.V337324.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. We looked at all of the information that we have received about this home since it was last inspected. The manager returned the annual questionnaire (AQAA) that we sent to bring us up to date with facts, figures and improvements. The Inspector called at the home without notice early afternoon, spoke with three members of staff and met three of the residents. We looked around parts of the home and looked at records. We had sent some comment cards out to residents and received only one back. Those comments are reflected in the report. The care of a sample of two residents was followed in this way to see if the home is providing a service that meets their needs. Residents appear physically healthy and well looked after although some seem under stimulated. They can communicate comfortably with staff and those that we spoke to say that they are comfortable at the home. What the service does well: What has improved since the last inspection? What they could do better: There is no manager, deputy or senior staff and shift leaders are in day-to-day charge of the home and its remaining six residents. They tell us that they do not feel confident to do this although senior managers within Dudley Council believe that they are competent. Bridge House DS0000041949.V337324.R02.S.doc Version 5.2 Page 6 Two residents now living full time at the home do not have both a full assessment of their needs or an adequate care plan to guide staff. Few of the risks involved in their lives and daily care have been assessed although staff are doing their best to manage them and look after them safely. We have asked the Provider to take action to agree how some of these risks should be managed for one particular individual as a matter of urgency. Some residents that we met appeared bored and under stimulated and should have more active lives for people of their age. The staff should have better support and supervision from a manager. We have asked the Provider to show us how they are going to make sure of this until the home closes. The home is making heavy use of agency care staff and there is a sense that things are drifting with no agreed date for closure. We have asked the Responsible Individual for the home within Dudley Council to come and talk to us about the immediate future of 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. The summary of this inspection report can be made available in other formats on request. Bridge House DS0000041949.V337324.R02.S.doc Version 5.2 Page 7 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.V337324.R02.S.doc Version 5.2 Page 8 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 5 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The Provider intends to close this home and many long established residents have moved on. The home has however recently admitted residents without sufficient assessment of their needs and appropriate analysis of staff capacity to look after them properly. Residents live in a home that drifting and may not be able to meet their needs. EVIDENCE: The home is closing and currently has 6 residents. Two of these were admitted for short stay but remain in the home. The long stay residents are being helped to find different accommodation. We looked at the files of two residents, one that was admitted this year in January and one who was admitted on regular short term stay but now remains fulltime since March this year. Both have an ‘individual Care Instruction’ form completed by Dudley Social services. These documents are not signed or dated. For one of these residents the information about his needs is very basic and does not represent a full needs assessment. There is a single sheet of paper completed by the home but this is very basic information. There is a ‘dependency level assessment’ form with scores and totals but no indication of what the totals should mean for care planning and no evidence that they have been used in a service user plan. Bridge House DS0000041949.V337324.R02.S.doc Version 5.2 Page 9 Residents must not be admitted to the home without a full assessment of their needs being obtained or undertaken so he home can be sure it can meet those needs. We have raised this before. The other resident has an individual client care instruction with more detailed information about his very complex condition. The Dudley Council risk assessment form has not been completed. There is some written risk assessment undertaken by the home but nothing to address, among others, the potential dangers of mental ill health referred to in the individual care instruction. The dependency level assessment has no name and no date and no indication that the total score is meaningful for care planning. Senior care assistants that we spoke to who have been left to run the home in the managers absence say that they have no training or experience in mental health care. There is no contract or terms and condition for care and accommodation in either residents file and this means that rights and responsibilities between the parties are not clearly recorded. Bridge House DS0000041949.V337324.R02.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9, 10 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Although daily records are maintained care planning is poor and risks are not sufficiently evaluated and managed. Residents are not safely supported to take control of their lives and their care. EVIDENCE: Referred to above two residents have been admitted this year without comprehensive assessments from which to generate a service user plan for their care at the home. One has a basic ‘staff instruction Sheet’ that covers personal care and a monthly checklist for personal care that has only one entry. The basic staff instruction shows some amendments dated in June. This resident was admitted on short stay but remains at the home. The other resident with complex physical and mental health needs that are outlined in his social services assessment has no service user plan. There is a brief handwritten instruction of daily routine undated and unsigned. Risk assessments do not address all of the potential dangers to health that appear on this record, his social services assessment and his daily records. Staff have Bridge House DS0000041949.V337324.R02.S.doc Version 5.2 Page 11 no clear and accountable guidance for looking after him safely. This must be put right immediately. One resident who is physically disabled and uses a wheel chair permanently has a ‘handling staff instruction sheet’ signed off by a senior carer as ‘needing a Manual Handling Team Assessment because of epilepsy’. There is no evidence in his file that this has happened. There are no other risk assessments on file for him. This could put him at risk of injury. We have already commented on the need for full assessment. This resident told us that he likes the home but that he is there temporarily. There is no indication in his file if or how he has been involved in the decisions made about him only copies of e-mail from his social worker confirming on two occasions to the home that his stay could be extended. Residents files are kept in locked cabinets but we had to prompt a shift leader to stop the conversation that we were having about an individual resident when a visitor came into the room. Residents personal information must be treated as confidential. Bridge House DS0000041949.V337324.R02.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home does not sufficiently help residents to enjoy a reasonable range of activity and leisure although family relationships are supported. Residents do not have a lifestyle suited to their age and that promotes psychological wellbeing. EVIDENCE: We met two residents sitting in the main lounge doing nothing when we arrived. Their response to our presence and greeting was initially slow and unfocussed. There were no staff with them at the time. One shift leader was sitting in the other lounge alone without residents and the other was in a review meeting. It became clear to us that both residents are able to hold a conversation once they get going and they then spoke to us and answered our questions happily. This suggests that they had been under stimulated before we approached them and had ‘drifted off’ into their own internal world taking a little time to respond to contact. They did not have sufficient occupation or attention. Later an Bridge House DS0000041949.V337324.R02.S.doc Version 5.2 Page 13 agency staff member put the TV on to show the tennis at Wimbledon and sat with them actively following a match. This made a visible difference to their level of alertness. The care file for one of these residents shows a monthly checklist including ‘activities’ under which is only 3 entries in six months, all for March 2007 including ‘8th asleep in lounge’. Daily notes shows that he had some family visits during February. There are no records at all on a number of days. There is no record of his interests or hobbies or whether he has any regular day time occupation. This resident may be at risk from emotional and intellectual deterioration through boredom and under stimulation. Staff report that the other resident in our sample, who was attending a review of his future placement while we were there does take himself out and about locally. His basic social services assessment says that ‘low mood’ can be improved with stimulation. There is nothing on file to show how staff should go about this. Daily records show potential for self-harm. There is no risk assessment or management plan for this. This must be put right immediately so that the home is keeping him as safe as he can be. We asked another resident about daily routines and she confirmed that she could get up and go to bed when she wants. There is a small residents kitchen/pantry where they can get themselves hot drinks and small snacks. Both residents that we asked say that the food in the home is good. The main kitchen is untidy but properly run and clean. Fridge and food temperatures are recorded and the food stocks are high. There was fresh vegetable and fruit. There is no indication however of how the weight and nutrition of one resident in our sample has been managed during his 6 month stay. He is a very slim man and appears to be very limited in his ability to help himself to food. This must improve. We have made requirements above about needs assessment, including risk and care planning. We have raised this before. There are brief notes on file about a resident choking on some foods and drinks. Staff that we spoke to say this is not a real issue but there is no written and agreed assessment of this risk and how it should be managed. We asked the home to put this right immediately. Bridge House DS0000041949.V337324.R02.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Personal and health care is not detailed in individual care files. Residents do not get planned healthcare and are not involved in decisions about how their personal care is provided. EVIDENCE: The staff instruction sheet that we saw in the file of one of our sample residents gives very basic information to staff about personal care. Daily notes don’t indicate the extent of his involvement in his own care. Monthly checklist charts contain one entry in 6 months, ‘shave’. There is a monthly health appointment checklist with no entries. He and another resident that we met and spoke to looked physically well and well cared for. They said that staff look after them well, treat them with respect and handle them gently when they bath, shower and dress and shave them. There are no health care records on file for the resident with complex mental health needs and the shift leaders that we spoke to who are now left in charge Bridge House DS0000041949.V337324.R02.S.doc Version 5.2 Page 15 of the home say that they do not have the training or experience to look after some one with complex mental health needs. There is a list of medication in the files of both residents but no assessment for staff or self-administration of medication in the file of one. There is a consent form for staff to administer and a PRN (as and when necessary) guide but this is not very useful, as it doesn’t say exactly what signs, symptoms and circumstances can prompt its administration. This means that staff have no clear direction and this could be unsafe. Although there is an ‘observation of self medication record chart’ for the other resident comments from staff and daily notes show that staff are carefully watching the self purchase of any further medication that they believe to be dangerous. There is no risk assessment on file for over - medication or overdose. This risk identified by staff is not been managed in an agreed and accountable way there is too much room for error and this could leave the resident exposed to harm. As we did not have access to any staff files we could not verify staff training in the safe administration of medication but the two shift leaders say that only they administer it. Medication is kept in an office in a locked cupboard. MAR sheets are kept for each resident but the file is cluttered and tatty with records of residents that have moved on and this unnecessary mess could lead to errors. The home keeps controlled drugs register and we saw that administration of controlled drugs is countersigned. Bridge House DS0000041949.V337324.R02.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Although residents no longer have contact with many long serving staff the home has a complaint procedure and the Provider organisation acts to investigate complaints received. Residents are protected by policy and procedures. EVIDENCE: We have received no complaint about the home since the last inspection or been informed of any adult safeguarding referrals. We have received a letter from the Responsible Individual for the home within Dudley Council a few days after this visit to say that he has received a complaint from a ex resident about poor care practices in the home and they are investigating this. The outcome of this should show the level of confidence felt about making a complaint while still living at the home. The AQAA tells us that there is a complaint procedure and the home has received one complaint. We asked one resident who she would go to if she wanted to complain about something. She said ‘there is no one left to go to. Manager and senior staff have left’. We asked her if she knows about an official complaint procedure and she said ‘no’. This is the resident that told us that the home always meets her needs however. Shift leaders who are now responsible for staffing the roster say that agency staff that they use regularly know the residents. They are being used to staff Bridge House DS0000041949.V337324.R02.S.doc Version 5.2 Page 17 the home as longstanding staff leave for other substantive posts. This situation is not ideal. We were unable to see any staff files to find evidence of safeguarding vulnerable adults training. Referred to above there is no written and agreed care plan or risk assessment for a resident who, according to staff makes comments about self-harm. Staff that we spoke to however say they do monitor his comings and goings and his purchases carefully. Bridge House DS0000041949.V337324.R02.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27, 28, 29, 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Although kept clean and fresh the home remains in poor internal structural and decorative condition and is only half occupied. Residents live in a home that is suited to their abilities but is deteriorating. EVIDENCE: The premises, purpose built for people with physical disability are environmentally suitable for the needs of residents including those in our sample. However it was designed for large group living. Modern technological innovation in aids to independence have not been installed. The Provider organisation has recognised this and is gradually closing the home and making other provision for individuals. The home is clean but cluttered in places. The small lounge off the entrance foyer is used for smoking but there is no signage for this. The home needs to consult the local environmental health officer now in light of new legislation about smoking. Bridge House DS0000041949.V337324.R02.S.doc Version 5.2 Page 19 Most of the bedrooms are empty although no date for closure has yet been agreed. The telephone is on a corridor and offers no privacy for conversation. One resident that we spoke to confirmed this. She showed us her bedroom and it was clean and has a bed suited to her particular needs but one ceiling light was not working. There are some personal effects and a TV. She told us that she likes her room and the home. She uses the shower rather than the assisted bath as she says she prefers it. She told us ‘this home has always met my needs’. Only one bedroom has en suite bathroom facilities. Door frames around the home remain knocked about from wheel chairs. We raised this at previous inspections. The patio garden has no seasonal interest and is not an inviting area for residents. Two resident told us that they do not go out. There is a laundry and sluice room and we saw protective clothing stocks and dissolvable bags for transporting soiled linen around the home safely. There are hand towels and soap in the toilets. Bridge House DS0000041949.V337324.R02.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 35, 36 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Although resident’s personal care needs are being met the home is being staffed by mostly agency workers as the regular staff team have been redeployed with reducing resident numbers. Residents are not being looked after by a well supported and supervised staff team. EVIDENCE: Shift leaders who have been ‘made up’ from care assistants now run the home. They tell us that they don’t feel equipped for what they are doing. The services manager for Dudley Council says they are competent to run the home day to day and that he has taken an office on the first floor of the home to be available to them. We were told that the home relies heavily on agency staff but that they use staff that the service users already know, regular agency workers. Referred to above we have doubts about how much time is actually spent with residents other than with their personal care tasks. There is a cook and an assistant cook and the council catering department deal with staffing the kitchen, there was a temporary cook from a local school there when we visited covering leave. Bridge House DS0000041949.V337324.R02.S.doc Version 5.2 Page 21 The AQAA shows a good percentage of staff with NVQ Level 2 Awards but so many staff have been redeployed or found other posts as residents numbers decrease that these figures are no longer accurate. The roster shows two care staff plus a shift leader on duty for each shift and two waking night staff. This is sufficient for six residents while they are at home. Only three were at home when we arrived. There is no evidence that staff take any residents out and this ratio may not be enough to do so. We could not get access to staff files when we arrived as shift leaders left in charge of the home do not hold keys to those cupboards. We could not check recruitment practices therefore. There have been no staff except agency staff employed since the last inspection. The AQAA tells us that staff get regular one to one supervision from a manager but the shift leaders say that they don’t. There is no manager, deputy or seniors working at the home any more to do it. It is important that these shift leaders get some regular formal guidance and support from someone as they have been left to run the home. The shift leaders that we spoke to seem to know the residents well and all residents that we spoke to say they are treated well by all the staff. Bridge House DS0000041949.V337324.R02.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41, 42, 43 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The home has no manager or senior staff on site and is drifting towards a slow closure with no clear plan. Remaining residents are not living in a home that is run in their best interests. EVIDENCE: The AQAA was returned to us handwritten, poorly and scantily filled in with the most common response being ‘the home is closing’. This did not give us a clear picture of how things are running meanwhile. There is no manager, deputy or seniors there anymore. The manager went on long term sickness leave the week before this inspection and the provider organisation are not intending to replace her. A social services team/care manager is overseeing the running of the home. Bridge House DS0000041949.V337324.R02.S.doc Version 5.2 Page 23 He told us that he has based himself at the home and is on call for the staff when he has to go elsewhere. They called him when we arrived but his ‘phone was turned off because he was in a meeting. There is no evidence of how often or how long this manager is on the premises. We have referred above to the new arrangements for staffing the home in light of senior care assistants and deputies moving on or being re deployed. The ‘shift leaders’ left in charge of the home are not confident about their ability to meet the challenging needs of at least one current resident. We have asked the Provider to demonstrate that these staff are receiving appropriate and regular supervision regularly from the Team Manager. The home has only 6 residents now and the services manager tells us that they are actively seeking appropriate places or tenancies for them elsewhere and consulting the individuals and their families. The home looks run down and although the residents look well cared for physically we saw evidence of institutional boredom, staff morale is poor, and there is heavy use of agency staff. The services manager tells us that it is taking a disproportionate amount of money to keep the building open. We agree with him that as remaining residents are experiencing a reduction in the quality of the service it is probably time now to formulate a contingency plan for re provisioning. The home has by default got two residents now who were admitted for short stay and have remained. It is not properly able to meet the needs of one of them and the other looks under stimulated and under occupied with no systems in place to improve this. Referred to above, neither resident has an adequate care plan or assessment of risk. There is no longer the continuous operation presence of a manager in this home. The Responsible Individual within Dudley Council has responded to the requirements that we made for urgent action above as a result of this visit and we have said that we need to meet with him at our office and hear the Councils plans for this home over the coming months as it cannot continue to drift. Safety practice may be patchy. We saw the emergency lighting test log entries and fire alarm inspection and service records by a contractor but weekly check records, including water temperatures were not in the working office and not available for us to inspect. Fire extinguishers did show stickers for recent service. We saw the registration certificate for the home on a wall but the insurance certificate on display is 18 months out of date. Bridge House DS0000041949.V337324.R02.S.doc Version 5.2 Page 24 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 x 2 2 3 2 4 x 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 x ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 2 28 3 29 2 30 3 STAFFING Standard No Score 31 x 32 2 33 2 34 x 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 1 x 2 LIFESTYLES Standard No Score 11 2 12 2 13 2 14 1 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 x 1 x 2 x 2 2 2 Bridge House DS0000041949.V337324.R02.S.doc Version 5.2 Page 25 YES 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 YA2 Regulation 14 Requirement Individuals admitted to the home must be confident that the home can meet their needs. Make admissions to the home only on the basis of a full needs assessment that includes risk. So that residents and their families are clear about the rights and responsibilities of all parties, contract /terms and conditions, must be agreed and provided and restrictions of choice or personal freedoms must be recorded. (Timescale of 31/01/05 and 30/06/05 and 01/02/06 and 01/09/06 Not Fully Met.) Residents must be confident that staff know how to look after them on a daily basis including how to support their need for occupation, leisure and mental stimulation. Produce from needs assessment written plans of care that guide staff DS0000041949.V337324.R02.S.doc Timescale for action 01/09/07 2. YA5 5 01/09/07 3. YA6 12 15/09/07 Bridge House Version 5.2 Page 26 4. YA9 13 Take action to safeguard the identified resident from selfharm and from choking on food and drink on the basis of risk assessment. Immediate Requirement 29/06/07 5. YA19 13 Residents must be protected 15/09/07 from ill health and inadequate nutrition. Ensure that all residents are weighed on admission and that there are documented regular monthly weight checks. Requirement made at last inspection compliance date of 01/08/06 not met Residents must be confident that only safe quantities and frequencies of medication are given to them by staff. Agree and write full and clear individual protocols for PRN medication. Residents must be confident that they are looked after by staff who are suitable to do so. Provide documentary evidence of satisfactory POVA and CRB clearances, such as certificates with numbers, dates etc Requirement made at last inspection compliance date of 01/09/06 not inspected on this occasion. A staff group that is properly supported and supervised must protect residents. Record the amount of professional contact shift leaders have with the officer overseeing the management DS0000041949.V337324.R02.S.doc 6. YA20 13 15/09/07 7. YA34 19 01/09/07 8. YA37 12 01/09/07 Bridge House Version 5.2 Page 27 of the home. 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 YA16 Good Practice Recommendations Give serious consideration to providing IT equipment for residents use to improve and maintain contact with friends and family and stimulate independence. That consideration is given to the introduction of fruit and vegetable smoothies in addition to meals as a means of increasing healthy food options. To ensure the gardens and garden furniture are maintained in conditions which are safe and pleasant for residents to use. To replace all damaged radiator and pipe covers, mainly in the toilets and bathing facilities, ensure that they are fit for purpose and contribute to a comfortable home for residents. To avoid errors reduce the clutter in the medication folder by removing records of residents that have moved on. To ensure residents continuing health and safety request that Dudley Catering DSO provides refresher food safety training for the cooks and kitchen staff. For the comfort safety and preferences of all residents, staff and visitors consult the local environmental health officer in light of new legislation about smoking. 2. YA17 3. YA24 4. YA24 5. 6. YA41 YA42 7. YA42 Bridge House DS0000041949.V337324.R02.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Halesowen LO West Point Mucklow Office Park Mucklow Hill Halesowen B62 8DA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bridge House DS0000041949.V337324.R02.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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