Inspection on 01/12/05 for Three Bridges Nursing & Residential Home

This inspection was carried out on 1st December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Three Bridges Nursing &... 04/05/07

Three Bridges Nursing &... 08/06/06

Three Bridges Nursing &... 25/07/05

Three Bridges Nursing &... 17/05/05

Three Bridges Nursing &... 07/10/04

Three Bridges Nursing &... 07/04/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Three Bridges Nursing & Residential Home Three Bridges Nursing Home Nook Lane Latchford Warrington Cheshire WA4 1UB Lead Inspector A Gillian Matthewson Unannounced Inspection 1st December 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Three Bridges Nursing & Residential Home DS0000005158.V268872.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Three Bridges Nursing & Residential Home DS0000005158.V268872.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Three Bridges Nursing & Residential Home Address Three Bridges Nursing Home Nook Lane Latchford Warrington Cheshire WA4 1UB 01925 418059 01925 414818 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) Southern Cross Care Management Limited Ann Woods Care Home 52 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (20), Old age, not falling within any other of places category (32), Physical disability (2) Three Bridges Nursing & Residential Home DS0000005158.V268872.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximumm of 52 service users to include:* Up to 32 service users in the category of OP (old age not falling within any other category). * Up to 2 service users in the category of PD (physical disability under the age of 65) to be accommodated within the beds registered for OP * Up to 20 service users in the DE(E) category (dementia over the age of 65) * Up to 2 service users in the category of DE (dementia under the age of 65) to be accommodated within the unit registered for DE(E) The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The registered manager must attain NVQ Level 4 in Management by 31st December 2006 Staffing must be provided to meet the dependency needs for the service users at all times and will comply with any guidelines issued through the Commission for Social Care Inspection 25th July 2005 2. 3. 4. Date of last inspection Brief Description of the Service: Three Bridges is a care home providing nursing and personal care and accommodation for 54 older people, 20 of whom may have dementia.The home is located in the Latchford area of Warrington, close to a shops and pubs. It is a short bus ride from Warrington town centre.The home was opened in 1989 and consists of a two-storey building with all resident accommodation on the ground floor. There is a separate unit for the residents with dementia.There are 52 single bedrooms and 1 double bedroom. Four of the bedrooms have ensuite facilities. The home has car parking to the front and a large garden to the sides and rear, which is easily accessible. Three Bridges Nursing & Residential Home DS0000005158.V268872.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out by two inspectors of the Commission and was the third inspection carried out since 1st April 2005. The previous inspection in July had raised a number of concerns about the care of residents on Bridgwater House. Subsequent to that inspection, CSCI met with the registered provider to express those concerns. The registered provider produced an action plan to address the deficiencies and provided CSCI with updates on a regular basis. This inspection took place over five hours. It included a tour of the premises, inspection of records, observation of staff practice and discussion with six service users and six staff. Inspectors were pleased to see that there had been a significant improvement in the standard of care on Bridgwater House. Feedback was given to the Registered Manager immediately following the inspection. What the service does well: What has improved since the last inspection? Residents now have a full needs assessment prior to admission, which includes assessment of mental health needs. Care plans are drawn up from these to ensure that staff have access to comprehensive instructions in how to meet residents’ identified needs. Three Bridges Nursing & Residential Home DS0000005158.V268872.R01.S.doc Version 5.0 Page 6 The activity programme continues to be developed in consultation with residents and relatives, giving residents more opportunity to participate in recreational activities. The protection of residents has improved by investment in staff training in the protection of vulnerable residents, dealing with challenging behaviour and deescalation techniques. There has also been considerable investment in staff training in other areas to ensure that they are competent to meet residents’ needs. This, together with increased staffing levels, has increased staff morale, resulting in an enthusiastic workforce who work positively with residents to improve their quality of life. The environment has been improved by the replacement of some carpets. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Three Bridges Nursing & Residential Home DS0000005158.V268872.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Three Bridges Nursing & Residential Home DS0000005158.V268872.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Residents are fully assessed before moving into the home to ensure that the home can meet their needs. EVIDENCE: The records of six residents were examined. New, more comprehensive assessment documentation had been introduced since the last inspection. The registered manager had completed a comprehensive pre admission assessment of the residents’ mental and physical health needs and an initial assessment and care plans were developed from this. The care plans were supported by risk assessments for the residents’ mental and physical health needs. Three Bridges Nursing & Residential Home DS0000005158.V268872.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8 &10 Residents’ care plans ensure that health and social care needs are identified and met. Residents are treated with respect by the staff. EVIDENCE: There was a plan of care in place for each resident. Samples of six care plans were examined. All had a comprehensive range of risk assessment documents and gave clear guidance to staff as to the care required to meet the individual resident’s assessed needs. Care plans were written from a resident-centred perspective and identified the desired outcome of nursing interventions. Care plans and risk assessments examined were evaluated regularly with outcomes being recorded. Residents’ social and family needs were identified within the care plan, which detailed individual life histories, family links and important relationships. Care plans contained evidence that the residents and/or their families had been consulted. Residents’ personal care was identified within their care plans. Three Bridges Nursing & Residential Home DS0000005158.V268872.R01.S.doc Version 5.0 Page 10 Residents identified as being at risk of developing a pressure ulcer had a care plan and risk assessment in place that identified the use of appropriate pressure relieving equipment. Examination of records confirmed that continence assessments had been completed. Residents were also screened for risk of falls and malnutrition and appropriate nursing interventions were identified to minimise risk. Residents’ records confirmed that they had access to a GP, dental and optical services, chiropodist and other health care professionals as required, for example speech and language therapist, dietician, physiotherapist and mental health team. For example, a resident who presented challenging behaviour had been assessed by staff to see if there were any triggers to this. No patterns of challenging behaviour had been identified but staff had arranged a review of the resident’s mental health and identified a more appropriate seat to reduce the incidents of challenging behaviour. Telephone facilities were located in the main entrance and some residents had telephone facilities in their bedrooms. Staff were observed to use an appropriate form of address to residents when talking with them. The registered provider’s induction standards identified how staff were expected to treat residents and during the inspection visit staff responded appropriately to individual requests from residents. Medical examination was undertaken in residents’ bedrooms. Three Bridges Nursing & Residential Home DS0000005158.V268872.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14 & 15. Residents are consulted about their social interests and a range of activities is available. The home is conducted so as to help residents make choices in their lives. EVIDENCE: At the previous inspection in July an activity coordinator had been in post for a few weeks and residents’ social care needs were being assessed. At this inspection the assessments had been completed but the activity coordinator had left a few weeks previously. Two of the care assistants had applied for the post and agreed to job share. They were to commence in post on 5th December. Some activities were being provided, mainly in relation to residents’ individual interests and reminiscence. There was also a party night every Friday. Plans were being made to turn the hairdressing salon into a hair and beauty salon and to provide a sensory garden and internet access for residents. An inter-home sports day had been held on 9th September, some residents had recently been to another Southern Cross home to hear a jazz band perform and plans were in place for the Christmas period. Students from a local college were visiting the home to serve sherry and mince pies, a local school choir was visiting to give a carol concert and a Christmas party was planned for residents, relatives and staff on Christmas Eve. A personal Three Bridges Nursing & Residential Home DS0000005158.V268872.R01.S.doc Version 5.0 Page 12 shopping service was in place for residents to purchase clothes, toiletries and Christmas gifts. Residents said they had the opportunity to exercise choice in relation to social activities, meals and the routines of daily living. Two residents on Bridgewater House talked about their choice of meals. One resident said ‘I cannot remember how long I have lived here. I think its called Three Bridges, it’s a nice place and you get well looked after. I have just had my dinner and it was alright. I chose chicken rissoles and vegetables. I did not want the rice pudding as only my sister makes it as a I like. I have plenty to eat and I enjoy my meals. Sometimes the others can be a nuisance and they mess about. I enjoy watching sport’. Another resident said ‘I agree with him the meals are very good and you get plenty to eat. I have my own en suite bedroom and my own key to my bedroom door. I don’t need much help but the staff help me when needed. I like living here, its comfortable. I enjoy the odd game of dominoes or talking to other residents. I like to keep myself to myself and staff respect that’. However, two residents said that they liked to have an early morning cup of tea and that recently this had not been offered by some of the night staff. See Requirement 1. Residents could handle their own financial affairs if they wished and had the capacity to do so. They were also provided with information on how to contact Care Aware, an advocacy service available to all residents of Southern Cross homes. Residents were able to bring personal possessions including small items of furniture, into the home with them. Three Bridges Nursing & Residential Home DS0000005158.V268872.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Residents are adequately protected from harm by the home’s recruitment procedures and staff training programme. EVIDENCE: Warrington Adult Protection Protocol and the Department of Health guidance ‘No Secrets’ were available in the home, together with a new in-house policy on the protection of vulnerable adults (POVA). Staff received instruction in the recognition of abuse during induction training and were given a copy of the policy and reporting procedure. All staff had been provided with updated POVA training since the last inspection. Staff on Bridgwater House had also received training in dealing with challenging behaviour and de-escalation techniques. They had been provided with a copy of the home’s policy on restraint. Robust recruitment procedures included pre-employment checks on prospective employees past employment history and enhanced Criminal Records Bureau disclosures. Three Bridges Nursing & Residential Home DS0000005158.V268872.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 23, 25 & 26. Recent investment has significantly improved the appearance of this home creating, in the main, a comfortable and safe environment for those living there. EVIDENCE: Three Bridges Nursing & Residential Home DS0000005158.V268872.R01.S.doc Version 5.0 Page 15 All rooms met the National Minimum Standards. Residents’ rooms contained the required furnishings and were carpeted. Lockable storage space was provided and residents confirmed they could have a key to their room if they wished. There was an ongoing programme of refurbishment and four new bedroom carpets were being fitted on the day of inspection, with the flooring in the dining room of Bridgwater Suite being fitted the following week. Rooms were all naturally ventilated with windows fitted with restrictors. Windows were at a height that residents could see out of them when seated or in bed. Lighting was satisfactory and heating was adequate, with the exception of the conservatory lounge. One resident liked to sit in this room but could not do so on dull days in the winter because there was no heating in there. See Requirement 2. The home was clean and odour free throughout. Three Bridges Nursing & Residential Home DS0000005158.V268872.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 & 30. Investment in increased staffing levels and staff training has improved staff morale, resulting in an enthusiastic workforce who work positively with residents to improve their quality of life. EVIDENCE: At the time of the inspection there were 32 residents on the general care unit, 18 of whom required nursing care. Five care staff were provided from 8am to 2pm, four from 2pm to 8pm and two from 8pm to 8am. In addition, there was a first level registered nurse on duty at all times. These numbers were sufficient to meet the residents’ needs on this unit. Staffing on Bridgewater House had improved since the last inspection. Between the hours of 8am to 8pm there was one registered nurse and three care staff. Some days this increased to one registered nurse and four care staff between the hours of 8am to 2pm. Additional staff had also been provided on nights with a twilight shift from 8pm to 10pm. Staff said this had been helpful. Only four of the care staff had an NVQ Level 2 or equivalent in Care. Nine more were due to start training in the New Year. There had been significant investment in training since the last inspection, particularly for the staff of Bridgwater House. All staff were provided with induction training. The training in the first week covered fire safety, food hygiene, health and safety (including control of substances hazardous to health), moving and handling, protection of Three Bridges Nursing & Residential Home DS0000005158.V268872.R01.S.doc Version 5.0 Page 17 vulnerable adults and whistle blowing, policies and procedures, dementia awareness, customer care and the Code of Practice. After this they were assigned a mentor and given an induction workbook to complete under supervision in the first three months of employment. The home had also produced an agency induction checklist, which was completed for any member of agency staff on their first shift in the home. Other training provided this year, apart from that previously mentioned, included training in understanding the ageing process, nutrition, care planning and accountability, pressure area care, advocacy, falls risk assessment and blood glucose monitoring. Staff morale had noticeably improved since the last inspection in July. Three Bridges Nursing & Residential Home DS0000005158.V268872.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 & 33. The systems for consultation are good with a variety of evidence that indicates that residents’, relatives and staff views are both sought and acted upon. EVIDENCE: The registered manager had been in post for over a year. She is a first level registered nurse with previous experience of managing a care home. A condition of registration was made that she must attain the Registered Managers’ Award by the end of 2006. At the time of the inspection she had not commenced the training, although she had accessed a course. She said that she was awaiting approval for funding from the registered provider. See Recommendation 1. Since the last inspection the home had utilised the services of a dementia care nurse specialist to train and advise staff on the care of residents with dementia and how to improve the environment and quality of life. Monthly information Three Bridges Nursing & Residential Home DS0000005158.V268872.R01.S.doc Version 5.0 Page 19 meetings were held for relatives, staff and other visitors to inform on the changes being implemented and obtain views and suggestions for improvement. The registered manager also held a weekly surgery for all residents and relatives for them to raise any concerns. Southern Cross Operations Manager visits the home on a monthly basis to consult with residents, relatives and staff. Reports of these visits are submitted to CSCI. Three Bridges Nursing & Residential Home DS0000005158.V268872.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X X X 3 X 2 3 STAFFING Standard No Score 27 3 28 1 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 4 X X X X X Three Bridges Nursing & Residential Home DS0000005158.V268872.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? No 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 OP15OP12 Regulation 16(2)(i) & (4) 23(2)(p) Requirement The registered person must ensure that residents are provided with an early morning cup of tea whenever they wish. The registered person must provide heating in the conservatory lounge. Timescale for action 01/12/05 2 OP25 31/01/06 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 OP31 Good Practice Recommendations Funding should be provided for the registered manager to commence the Registered Managers’ Award early in 2006, in order that she may complete it by the end of the year. Three Bridges Nursing & Residential Home DS0000005158.V268872.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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. Extracts may not be used or reproduced without the express permission of CSCI Three Bridges Nursing & Residential Home DS0000005158.V268872.R01.S.doc Version 5.0 Page 23 - 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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