CARE HOME ADULTS 18-65
Bridge House Bayer Street Coseley West Midlands WV14 9DS Lead Inspector
Jean Edeards Unannounced 4 May 2005 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 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 Stationary 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 E55 S41949 Bridge House V221294 040505 Stage 4.doc Version 1.20 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 Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Dudley MBC Mrs Jannett Telfer Care Home 14 Category(ies) of Physical disability (14), Physical disability over registration, with number 65 years of age (1) of places Bridge House E55 S41949 Bridge House V221294 040505 Stage 4.doc Version 1.20 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 MBC and the Commission for Social Care Inspection. 2. Service users in the Category PD(E) may continue to be accomodated at the Home for as long as the Home is able to demonstrate that their needs can be met. Date of last inspection 4/11/04 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 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. There is a stable staff team of twenty-five people, including the Registered Manager, currently supplemented by agency staff. Bridge House E55 S41949 Bridge House V221294 040505 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection visit was undertaken by the inspector from the Commission for Social Care Inspection using the following information: the previous inspection report, the action plan submitted in response by the home and records held at the home. The visit commenced at 8:50 am and lasted until 5.20pm. During the visit the inspector spoke to all 9 residents who are currently living at the home, including one person who was staying at Bridge House on a temporary basis. Longer discussions took place with 2 residents whose care was looked at in depth. One relative who was visiting was asked for his views. He stated that he felt that the care offered could not be better and that he was always made welcome by the staff who were friendly and courteous. Discussions took place with the Catering Manager and Service Manager during their visits to the home on the day of the inspection. Three senior staff took an active part in the inspection process and the majority of members of staff were spoken with during part of a staff meeting, which took place during the visit. The inspector toured the building, looking in particular at the kitchen, communal areas of the home and a sample of residents’ bedrooms, with their permission. What the service does well:
The organisation and registered manager responded to the previous inspection report with a comprehensive action plan, which gave dates for the required improvements to be put into place. The registered manager is committed to making sure that improvements happen, where she has the authority to make decisions. Residents are encouraged by staff to treat Bridge House as their own home and to be as independent as they wish. Residents are able to make their own choices and are active in running their own residents meetings, with staff only attending if invited. There are a range of topics discussed, with views freely aired about the running of the home. All residents are able to go on an annual holiday if they wish. A decision has been reached to take this years holiday in Skegness in July and all permanent residents have chosen to go together, supported by volunteers from the staff group. People are able to attend day time activities provided by the local authority. One person does voluntary work at a local day centre for older people and another person attends college for a computer course, decisions which are fully supported by staff.
Bridge House E55 S41949 Bridge House V221294 040505 Stage 4.doc Version 1.20 Page 6 The meals are thoughtfully and well prepared, members of staff were seen to ask residents what they preferred for each meal, and taking time to sensitively offer people help if they need it, after serving food. The majority of residents say that they are very happy with the meals provided. Two of the residents were going out for a meal to the ‘Bostin Fittle’ pub, accompanied by two members of staff. They said they had been there before and the food was very good. Another person was going shopping in the early evening accompanied by another member of staff and they were going to have their meal during the shopping expedition. Bridge House has a small group of staff who have worked at the home for a long time and know the residents well. They are caring, committed and flexible, often willing to work extra shifts, especially to support residents with outings in trips away from the home. Residents spoken to described the home as ‘happy’, ‘friendly’, ‘ welcoming’ and ‘well run’. These views were reflected in comments made by the staff to describe the home. There was a lot of friendly chatting between staff and residents through out the day. During discussions staff demonstrated a dedicated approach to their work; they clearly know residents’ likes and dislikes and how to meet their needs. They were keen to share their views during a staff meeting and answered questions in an open and honest manner. This inspection was conducted with full co-operation of the Registered Manager, staff and residents. The atmosphere through out the inspection was relaxed and friendly. Bridge House is generally clean, tidy, homely and comfortable. The Inspector would like to thank staff, and residents for their hospitality during this inspection visit. What has improved since the last inspection?
The registered manager and senior team have put together a ‘welcome pack’ of information about Bridge House in an easy to read format, which is to be given to all residents. A member of senior care staff, was able to talk knowledgeably about how residents’ medication is managed and administered by the home, and was able to demonstrate that minor improvements have been put in place since the last inspection visit to make the medication system as safe as possible. The manager is trying to make sure that all residents’ medication is reviewed by their GP on a regular basis. A member of staff has attended a disability awareness training course and as a result has talked to the people living at Bridge House to seek their views about how people should be referred to. The result is that people living at Bridge
Bridge House E55 S41949 Bridge House V221294 040505 Stage 4.doc Version 1.20 Page 7 house would like to be referred to as residents and they would prefer a staff to have the title of support worker rather than care assistant, as they feel this more accurately reflects how they would wish to be helped. During a recent discussion a decision has been made to allocate a senior care officer to be responsible for monitoring the kitchen, which it is hoped will maintain the good standards and make sure that any minor improvements required are put in place. The registered manager and the staff team are very committed to be involved in further training and personal development in order to provide an improved service for the people living at Bridge house. The registered manager has recently achieved The Registered Managers Award. What they could do better:
The home must make minor improvements to the records it keeps to demonstrate the care given to the residents. There must be fuller details in daily records and records of appointments and reviews with other healthcare professionals, such as dentists, chiropodists and opticians. The manager must continue contact with each resident’s GP to make sure that their medication is reviewed regularly. Staffing levels at the home are being maintained to provide the correct number of hours required to provide a satisfactory service. However this is being achieved with existing staff working longer than their contracted hours, the use of supplementary agency staff and members of senior staff from another home. This has the potential to adversely affect residents’ care needs being met consistently. The organisation must come to an agreement with the Commission for Social Care Inspection for a consistent staff team, which has the capacity to meet the needs of people permanently living at Bridge House and any people visiting for a short stay. Accelerated progress must be made for all staff to receive the training that they require to meet the needs of the residents. The organisation needs to improve policies, procedures and staff awareness particularly relating to the protection of vulnerable people from abuse, offering more safeguards to protect the residents living at this home. The premises do not entirely meet the needs of residents. For example, the fire exit from the residents’ kitchen is 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. Bridge House E55 S41949 Bridge House V221294 040505 Stage 4.doc Version 1.20 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Bridge House E55 S41949 Bridge House V221294 040505 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Bridge House E55 S41949 Bridge House V221294 040505 Stage 4.doc Version 1.20 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 standard(s) 1,2,3,4,5 Information about the running and performance of the home is made proactively available and residents are encouraged to make their views known. Limited progress has been made to update contracts/terms and conditions of occupancy, especially relating to residents accommodated for respite stays. 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 uses comprehensive assessment tools, which means that residents’ needs are thoroughly assessed to ensure that care needs will be met. Introductory visits and trial stays are encouraged by the home, ensuring that people have time to make decisions which are right for them. EVIDENCE: In discussions with residents they were able to talk knowledgeably about the service offered by the home and about the results of previous inspection visits. One person commented that the visits were an opportunity to ask for improvements to the decor and equipment in the home. During a tour of the home information leaflets were seen attached to the inside of the door in residents’ bedrooms. On examination of a sample of residents’ files the Home has comprehensive assessment information and there is evidence of periodic reassessment as is good practice. Bridge House E55 S41949 Bridge House V221294 040505 Stage 4.doc Version 1.20 Page 11 Discussions with staff and examination of documentation offer some that specialist services are accessed. Throughout this visit staff were seen to be communicating effectively with residents. The Home has a contract/statement of terms and conditions although on examination this does not contain details of any agreed restrictions such as not going out unaccompanied or not smoking except in permitted areas. Contracts/terms and conditions issued to the permanent residents have been signed and dated. There was no contract/terms and conditions in place for the person who is living at the home on an extended short stay basis. Contracts / terms and conditions need to be put in place for people visiting the home on a temporary basis. Bridge House E55 S41949 Bridge House V221294 040505 Stage 4.doc Version 1.20 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 standard(s) 6,8,9,10 There is a clear and consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet service users needs. This could be further enhanced with more detailed daily records. EVIDENCE: Each resident has a care plan in place, however not all of the sample of plans examined had been signed by the resident and / or their family or supporter. However during discussions with one of the residents whose care was tracked during this visit; and with a visiting family confirmed that there is an active involvement in developing and implementing their care plans. All residents spoken to were aware of their key workers name. They were aware that information relating to them is held securely by the home and treated in confidence. Though the home has not yet produced documentary evidence that all residents are aware of their rights to access their own information held by the home. Of the care plans examined there was some variance in content. For example one older resident has reduced mobility, however there was no falls risk assessment and additional control measures in place. Not all daily records are
Bridge House E55 S41949 Bridge House V221294 040505 Stage 4.doc Version 1.20 Page 13 completed daily and in one persons file the entries were very sporadic, some more than a month apart. Staff commented that this person had very limited interests and his needs did not change very much. However the entries gave little information as to the way this persons care needs were being met. The home must demonstrate the good practice in the way it meets the residents’ needs with more detailed daily records. Some elements of care plans had not been reviewed on a six monthly basis. The Home must demonstrate that all care plans are reviewed on a six monthly basis and provide evidence that service users, relatives, advocates and other professionals have been invited to participate in this process. Bridge House E55 S41949 Bridge House V221294 040505 Stage 4.doc Version 1.20 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 standard(s) 12,13,14,15,16,17 Links with the community are good, these support and enrich residents social and educational opportunities. The meals at Bridge House are good, offering both choice and variety and catering for any special dietary needs. EVIDENCE: All residents were at home at some times during this inspection visit. Some people were observed in making their own drinks and taking responsibility for house hold tasks with some support from staff. There were care plans in place relating to daily living skills. During a conversation one person commented that staff were very helpful but were also very good about prompting him to do those tasks that he could, to preserve and improve his level of independence. This is particularly important to him because he intends to return to live in his own home in the community, when adaptations to his property have been completed. Another person who has good information technology skills has been encouraged and supported to enrol on a computer course at a local college, which he clearly enjoys.
Bridge House E55 S41949 Bridge House V221294 040505 Stage 4.doc Version 1.20 Page 15 A resident who does volunteer work at a local day care centre for older people also enjoys making drinks and helping the less able people who live at Bridge House. This person and his friend who also lives at the home had planned on the evening of this inspection visit, to eat out at a local hostelry ‘The Bostin Fittle’, stating that they had been before and enjoyed the food there. They left the home in high spirits in a taxi, which could accommodate wheelchair users; accompanied by two members of staff. New menus have recently been compiled in consultation with the residents. Catering arrangements for the home are supplied from a Direct Service Organisation (Dudley Catering DSO) from within the local authority. The catering manager was visiting the home on the day of this visit to monitor standards and give support and advice to the young cook on duty. A discussion was held about minor improvements to food safety, such has the need for a new food temperature probe, records for the existing one indicated an unacceptable variance in its calibration; and best practice recommendations such as labelling dried foods stored in sealed containers with ‘best before date’. Following the residents meeting, the main meal of the day is going to be changed to the evening, as most people are out during the day on weekdays. The exception will be at weekends when everyone prefers to have the main cooked meal at midday. The new arrangements are due to be put in place in the near future. The residents spoken to were very complimentary about the meals, one person stating that it was always possible to have something different from everyone else and on occasions staff including the manager would prepare an individual alternative. There was evidence during the visit of planning activity for the forthcoming annual holiday, which this year is due to take place at Skegness in July. All eight people living permanently at Bridge House have decided to go together. They will be accompanied by sufficient numbers of staff, who have volunteered to go on the holiday, to ensure that each person can pursue their individual activities and spend time as they wish. The holiday is currently partly funded from the residents fund, partly from the budget at Bridge House and partly by the residents themselves. The organisation must agree the contribution it will make to ensure that everyone is offered the opportunity of a seven-day annual holiday outside the home, on a consistent basis. Bridge House E55 S41949 Bridge House V221294 040505 Stage 4.doc Version 1.20 Page 16 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 standard(s) 18,19,20,21 Personal support in this home is offered in such a way as to promote and protect service users’ privacy dignity and independence. The health needs of service users are well met with generally good evidence of multi disciplinary working taking place on a regular basis. The systems for the administration of medication are good with clear and comprehensive arrangements being in place to ensure service users medication needs are met. EVIDENCE: During discussions staff gave very thoughtful examples of how residents’ privacy, dignity and independence is maintained. The home has a key worker system, which enhances this aspect of care, ensuring each persons choice of how and when their personal care is met. There is documentary evidence of each persons preference as to the gender of staff to assist with personal care. There was some evidence that residents continue to be encouraged and assisted to attend health care screening programmes such as well person checks. The checks are undertaken by the practice nurse where people have agreed to the process. The Manager ensures that all service users are offered, as a minimum, an annual health check by the Primary Care Team. Each person is able to exercise preferences regarding dentists, opticians and
Bridge House E55 S41949 Bridge House V221294 040505 Stage 4.doc Version 1.20 Page 17 chiropody services. There was evidence that staff have been allocated to work extra hours to their usual care rota, to act as escorts for residents to attend appointments. There are completed tissue viability scores, nutritional assessments and dependency levels on each person’s file. However documentation relating to the health care checks provided for one of the older residents were inadequate to demonstrate that all regular checks had been offered, whether or not they had been attended or what the outcome had been. The Home also needs to establish a procedure and plan, with the assistance of other healthcare professionals for monitoring potential complications such as breast, cervical or testicular cancer, as applicable. The home has comprehensive medication policies and procedures and all staff administering medication have received accredited medication training. Though there was no documentary evidence of training received by relief seniors used from other Homes. There is a robust and rigorous medication system, which safeguards the residents with minor improvements identified at the last visit implemented. Bridge House E55 S41949 Bridge House V221294 040505 Stage 4.doc Version 1.20 Page 18 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 standard(s) 22, 23 The home has a satisfactory complaints system with some evidence that residents feel that their views are listened to and acted upon. Policies, procedures, guidance and staff training need to be implemented in order to provide residents with more safeguards from abuse. EVIDENCE: There have been no complaints recorded in the home’s complaints log since the last inspection visit in November 2004. Residents spoken to stated that they felt that they could voice any concerns either through their meetings or directly with the manager or staff at the home. One person did take the opportunity of the inspection visit to raise a matter which had been bothering him. The visitor who was present during the discussion was also aware of the concern, however the resident wished to raise the matter without assistance. The registered manager must explore these concerns more fully, taking whatever action is required and notifying the CSCI office, Halesowen of any outcomes. The manager and staff were aware of the local authority multidisciplinary procedure for the protection of vulnerable adults. All staff must be provided with appropriate levels of training to ensure that they are aware of and are able to respond appropriately situations which require them to take action with the protection of vulnerable people. Bridge House E55 S41949 Bridge House V221294 040505 Stage 4.doc Version 1.20 Page 19 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 standard(s) 24,25,28,30 The manager has a good understanding of the areas where the home needs to improve and proactive planning is now in place indicating how this improvement is going to be resourced and managed. The standard of the décor within this home is generally good with evidence of improvement through maintenance and future planning. The home presents as a homely and comfortable environment for residents. People living at the home are protected by the good infection control measures which are in place. EVIDENCE: The residents of Bridge House, the majority of whom are wheelchair users have ample personal and communal space, with wide corridors and generally spacious bedrooms. The internal decor is generally bright and cheerful. The Home provides a range of adapted equipment, suitable for the needs of people who have physical disabilities and has access to the local authority physical disability team for additional advice. For example a specially adapted shower chair/hoist has been provided for one person. Two of the residents were pleased to show their individual bedrooms, confirming that they were able to have furniture and possessions arranged to their own preference. One person had a large display of model aircraft, vintage cars and other vehicles displayed in specially made cabinets and
Bridge House E55 S41949 Bridge House V221294 040505 Stage 4.doc Version 1.20 Page 20 shelves. The other person had chosen not to have any chairs in his room to give him more space to manoeuvre his electric wheelchair. His visitor confirmed that staff always bring in a chair for the use of visitors, removing it when they leave. The residents decisions about facilities provided in their own rooms is supported by a documented room audit on each persons file, as is good practice. There are a number of outstanding requirements from previous inspections which have yet to receive action particularly the replacement of the floor covering in the communal areas; and the work needed to the exterior of the home to make all areas safe for wheelchair users. A programme of refurbishment and redecoration has been established by the registered manager, however funding is awaited from corporate sources. The Service Manager who was present for part of the visit, indicated that meetings had taken place at corporate level and that there were plans to complete the work within this financial year. The level of cleanliness in individual bedrooms, communal areas and kitchen were of a very good standard. Bridge House E55 S41949 Bridge House V221294 040505 Stage 4.doc Version 1.20 Page 21 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,34,35 Limited progress has been made in addressing substantive staffing levels and though residents generally receive consistent care, there is a risk that this may not always be maintained. EVIDENCE: There is a stable core group of long serving staff, there have been no resignations since the last inspection visit in November 2004. Although there is only one vacant post for a relief care assistant, staffing proposals from the organisation have yet to be agreed with the CSCI. The organisation must provide revised staffing proposals to demonstrate that there will be sufficient numbers of staff to meet the needs of the people permanently living at Bridge House and any people who may be at the home for respite or short stays. The home is managing to meet the staffing requirements issued at the previous inspection visits to provide a minimum of 4 care staff plus a senior care officer at peak activity times. This has been achieved by the use of agency staff, albeit that this is a reasonably consistent arrangement; and by ‘borrowing’ staff, particularly seniors from other homes within the organisation. There were records for all staff working at the Home. These were well organised and contained an improved level of the information needed to make recruitment and retention processes robust. However the file of the newest
Bridge House E55 S41949 Bridge House V221294 040505 Stage 4.doc Version 1.20 Page 22 member of staff did not have a recent photograph. The manager has made her own arrangements with staff to provide a copy of their own POVA/CRB clearance as an interim measure, until the situation within the local authority to retain POVA /CRB clearances centrally is resolved. Residents and visitors consulted during the visit spoke warmly about the staff, their helpfulness and kindness. They were pleased that there were more staff about, though at least two residents stated that staff were still very busy at times. Staff were knowledgeable about residents needs and demonstrated a friendly rapport with both residents and visitors. The home is making good progress to meet requirements issued at previous inspection visits relating to staff training. The organisation of training has been delegated to one of the senior team, who was able to speak enthusiastically about sourcing different types of training, which would best equip the staff to meet the needs of the residents living at Bridge house. Bridge House E55 S41949 Bridge House V221294 040505 Stage 4.doc Version 1.20 Page 23 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,39,40,41,42 The registered manager is supported well by her senior staff in providing clear leadership throughout the home with staff demonstrating an awareness of their roles and responsibilities. The systems for resident consultation at Bridge House are good with a variety of evidence that indicates that residents’ views are both sought and acted upon. EVIDENCE: The Registered Manager, who has worked at Bridge house for more than 20 years, has achieved the Registered Managers Award (RMA) since the last inspection visit. In addition the Registered Manager and one of the senior staff have attended an approved risk management training course to effectively promote the management of risks and health and safety within Bridge House. There are plans to cascade risk assessment awareness and training for the whole staff group, though there is no date as yet for this to take place.
Bridge House E55 S41949 Bridge House V221294 040505 Stage 4.doc Version 1.20 Page 24 There are good arrangements in place to ensure that residents are consulted about the day to day running of the home. For example, there are regular (and recorded) residents meetings, organised and run by the residents themselves, with a wide range of topics discussed. Any requests made by residents are recorded with details of action taken to address items raised. These arrangements will be further enhanced when the residents feedback questionnaires are regularly used and collated. The home has yet to implement a comprehensive quality assurance system and must meet previous requirement to provide the CSCI with evidence of its annual development plan. However there are a number of monitoring arrangements in place including unannounced monthly visits from the service manager, with reports which are given to the home and copied to the CSCI. The service manager was undertaking such a visit on the day of this inspection. The majority of staff have received fire safety training and attended a fire drill within the last six months, with other mandatory training in progress for all staff, arranged and monitored by the allocated senior. A sample of fire safety and maintenance service records were examined, these were generally satisfactory, with minor improvements required. For example the home’s fire risk assessment was two-three weeks overdue for review and that was no indication that defects identified by hoist’s service in February 2005 had been rectified. There were a number of issues identified at the previous inspection visit, which have subsequently been improved in relation to health and safety. Although there were just 10 recorded accidents involving residents since the visit in November 2004, there was no evidence available at this visit that a regular accident analysis has taken place. Bridge House E55 S41949 Bridge House V221294 040505 Stage 4.doc Version 1.20 Page 25 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. Where there is no score against a standard it has not been looked at during this inspection. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 2 3 2 Standard No 22 23
ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 x 3 2 3
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 3 3 x x x 3 Standard No 11 12 13 14 15 16 17 3 3 4 3 x 2 3 Standard No 31 32 33 34 35 36 Score 3 4 2 2 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Bridge House Score 3 2 2 x Standard No 37 38 39 40 41 42 43 Score 3 3 2 2 2 2 x E55 S41949 Bridge House V221294 040505 Stage 4.doc Version 1.20 Page 26 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 5 Regulation 5(1)(b) 15(1) Timescale for action To ensure that any restrictions of 30/06/05 choice or personal freedoms are recorded as part of the contract /terms and conditions, as well as the individual plan 30/06/05 To ensure that there are comprehensive service user plans in place for people visiting for short respite stays, identifying all assessed needs, which are signed, dated and reviewed at appropriate intervals To ensure that there is a photograph on file of service users visiting for respite stays To ensure that agreed limitations on choice, freedom or decisionmaking are clearly documented as part of the service user plan, examples: going out, bathing, smoking un-chaperoned (Timescale of 31/01/05 partly met) The residents daily notes must be expanded to reflect fuller details of the care offered, as identified in the care plan A documented falls risk assessment must be undertaken Requirement 2. 6 15 (1) 17 (1)(2) 3. 6 15(1) 17(1)(2) 13(4) 30/06/05 4. 9 30/06/05
Page 27 Bridge House E55 S41949 Bridge House V221294 040505 Stage 4.doc Version 1.20 5. 19 13(1) 6. 20 13 (2) 7. 21 17 (1) 8. 22 22 9. 23 13 (6) and regularly reviewed for the resident discussed during the visit (N) and for any other person identified to be at risk of falls To maintain more detailed records of healthcare checks, annual health check, dental, optical, auditory, chiropody, well person (for breast /cervical/ testicular cancer), with refusals noted To pursue medication reviews for all residents with their GP, taking further action with Primary Care Trust and/or Pharmacist if necessary To ensure that the Organisation reviews and updates the policy, procedure and useful flowchart, dating from 1994. (Timescale of 31/01/05 partly 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 partly met) 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 To devise and implement stepby-step procedures relating to dealing with allegations of abuse, use of restraint etc., for staff guidance (Timescale of 31/01/05 partly met) The Registered Manager must explore further the issue of concern raised by one resident, and take action according to the 30/06/05 30/06/05 31/07/05 31/07/05 31/07/05 Bridge House E55 S41949 Bridge House V221294 040505 Stage 4.doc Version 1.20 Page 28 information obtained, with the outcome notified to the CSCI Office, Halesowen 10. 24 23(2)(b) To renovate / replace the floor covering in the Resident’s kitchen, lounge, dining room, corridor areas and bedrooms identified in the maintenance programme (Timescale of 31/01/05 not met) 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 the now needs new renovation) To repair and make safe the cracked car port roof (Timescale of 31/01/05 not met) To undertake work required to make the exit from the resident’s kitchen accessible for wheelchairs (Timescale of 31/01/05 not met, but is on the home’s maintenance programme) To renovate / replace the 31/07/05 flooring in the shower room (Timescale of 31/01/05 not met) 30/06/05 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 partly met) To provide a revised staffing proposal to ensure that there are sufficient numbers of adequately
Bridge House E55 S41949 Bridge House V221294 040505 Stage 4.doc Version 1.20 Page 29 31/07/05 11. 12. 27 33 23(2)(b) 18(1)(a) trained staff available to meet the needs of existing residents and any additional people using the service for respite / short stay visits 13. 34 19 (1), Schedule 2 (2) 18(1) (c) To provide a recent photograph of the member of staff most recently recruited, to be held on and personnel file To ensure that all staff have awareness training and appropriate skills to appropriately deal with specialist needs such as epilepsy, strokes etc. (Timescale of 31/01/05 partly met) To demonstrate commitment to undertaking training to meet the assessed needs of Service Users accommodated; providing a training plan, dedicated training budget, designated person and a development plan (Timescale of 31/01/05 partly met) To ensure that all staff receive appropriate awareness training in Equal opportunities, Racism and Disability awareness (Timescale of 31/01/05 partly met) 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 partly met) To devise and forward a copy of the annual development plan relating to Bridge House to the CSCI Satellite Office – Halesowen (Timescale of
E55 S41949 Bridge House V221294 040505 Stage 4.doc 31/05/05 14. 35 31/07/05 15. 39 24 31/07/05 Bridge House Version 1.20 Page 30 31/01/05 partly met) To progress the implementation of residents surveys, with results published, included in the Service User Guide and made available to all interested parties including the CSCI satellite office (Timescale of 31/01/05 partly met) 16. 40 17 24 To make progress to ensure that all applicable policies and procedures relating to topics set out in Appendix 3 of the National Minimum Standards for Younger Adults are put in place and reviewed on a regular basis. (Timescale of 31/01/05 partly met) To ensure that all records relating to residents are signed and dated by the person completing the information and by the resident wherever possible /or their representative; and that they are reviewed and updated on a regular basis 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 partly met, with good progress made) 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 not met) To ensure that the homes fire risk assessment, review date 31/07/05 17. 41 17(1) 30/06/05 18. 42 18(1) (c) 31/07/05 19. 42 23(4) 30/06/05
Page 31 Bridge House E55 S41949 Bridge House V221294 040505 Stage 4.doc Version 1.20 21/4/05 is reviewed and updated To submit written confirmation to the CSCI office, Halesowen that the deficits identified on the hoists service dated 2/2/05 have been rectified 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. 2. 3. Refer to Standard 5 22 24 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 staff have access to awareness / training relating to new equipment / developments relating to service user needs – NOT MET 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. 5. 6. 42 42 42 Bridge House E55 S41949 Bridge House V221294 040505 Stage 4.doc Version 1.20 Page 32 Commission for Social Care Inspection West Point Mucklow Office Park Mucklow Hill Halesowen. B62 8DA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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