Inspection on 17/05/05 for Three Bridges Nursing & Residential Home

This inspection was carried out on 17th May 2005.

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 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 &... 01/12/05

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

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 Nook Lane Latchford Warrington Cheshire, WA4 1UB Lead Inspector Gill Matthewson Unannounced 17 & 26 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 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 F51 F01 S5158 Three Bridges V227165 170505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Three Bridges Nursing & Residential Home Address Nook Lane Latchford Warrington Cheshire WA4 1UB 01925 418059 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) Highfield Care Management Limited Ann Woods Care Home 52 Category(ies) of Old age, not falling within any other category registration, with number (32) of places Dementia - over 65 years of age (20) Physical disability (2) Dementia (2) Mental Disorder, excluding learning disability or dementia - over 65 (1) Three Bridges F51 F01 S5158 Three Bridges V227165 170505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 The home is registered for a maximumm of 52 service users including:* 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). * 1 named service user in the MD(E) category (mental disorder over the age of 65) to be accommodated in the unit registered for DE(E). 2 The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 3 The registered manager must attain NVQ Level 4 in Management by 31st December 2006 Date of last inspection 07/10/04 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 F51 F01 S5158 Three Bridges V227165 170505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Following the previous inspection a statutory requirement notice had been served requiring the registered provider to obtain Criminal Records Bureau Disclosures for all staff. This requirement had been addressed prior to this inspection. Since the last inspection the company registered in respect of Three Bridges has merged with another care home provider. This inspection was carried out by two inspectors of the Commission. The lead inspector spent two hours planning the inspection by reviewing previous inspection reports and the service history over the last twelve months. The inspection took place over two days with a total time of nine hours and included a tour of the building, inspection of records, observation of staff practice and discussion with five service users, four relatives and eight staff. The standard of care within the unit for the physically frail was good. The main concerns were in relation dementia care unit, where there had been recent staff changes. The inspection was carried out over two days because the situation on the dementia care unit gave cause for concern on the first visit. The registered manager indicated that this was not a typical day and subsequently raised concerns about the conduct of the agency nurse with his employer. When inspectors made the second unannounced visit the situation on the dementia care unit was much improved, residents were more settled and the atmosphere was much calmer. Feedback was given to the Registered Manager and Regional Manager. What the service does well: All prospective residents are assessed by the registered manager or unit manager prior to admission to ensure that the home will be able to meet their needs. Residents are referred to appropriate health care professionals promptly when needs arise. Three Bridges F51 F01 S5158 Three Bridges V227165 170505 Stage 4.doc Version 1.30 Page 6 Three residents on the unit for the physically frail and three visitors on the dementia unit all said that ‘the staff are lovely’, that they are very helpful and respond promptly to any requests. Residents also expressed their satisfaction with the standard of catering in the home. What has improved since the last inspection? What they could do better: The home could provide more information to prospective residents prior to admission to ensure they have all the information they need to make an informed choice prior to making a decision whether to live there. Assessment documentation could be improved to ensure that staff on duty when a resident moves into the home have all the information necessary to devise a comprehensive plan of care. Residents’ care plans on the dementia unit need improving to ensure that staff have access to all the information they need to meet all the residents’ needs. There needs to be consultation with residents about their recreational requirements and a programme of activities devised to meet those requirements. Three Bridges F51 F01 S5158 Three Bridges V227165 170505 Stage 4.doc Version 1.30 Page 7 There needs to be an increase in the staffing levels at night and an investment in staff training on the dementia care unit to ensure that residents needs can be met. Requirements and recommendations have been made in respect of these matters. 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 F51 F01 S5158 Three Bridges V227165 170505 Stage 4.doc Version 1.30 Page 8 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 Standards Statutory Requirements Identified During the Inspection Three Bridges F51 F01 S5158 Three Bridges V227165 170505 Stage 4.doc Version 1.30 Page 9 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 standard(s) 1&3 Not all prospective residents have the information they need to make an informed choice about whether to live in the home. Prospective residents have their needs assessed prior to admission to ensure that the home has the resources to meet those needs. EVIDENCE: The home had a satisfactory statement of purpose and resident’s guide, but this was only given out prior to admission if a relative visited the home. See Recommendation 1. Seven residents were reviewed as part of the case tracking exercise. In all cases assessments had been carried out prior to admission, but the documentation gave very limited information to staff on duty at the time of admission regarding residents’ needs, particularly in relation to mental health needs. Some of the assessment forms were undated and unsigned, and none gave any indication as to where the assessment had been carried out. See Recommendation 2. Three Bridges F51 F01 S5158 Three Bridges V227165 170505 Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8&10 The care planning system in place is satisfactory for residents who are physically frail, but does not provide staff caring for those who are mentally frail with the information they need to meet all residents’ needs. The health needs of residents were well met with evidence of good multi-disciplinary working taking place on a regular basis. In the main, personal support is offered in such a way as to promote residents’ privacy and dignity. EVIDENCE: Seven care plans were reviewed. In the main, care plans and risk assessments had been drawn up, which provided staff with instructions on how to meet those residents’ needs. For those residents who were physically frail, appropriate care plans were in place for all identified needs, but they needed to be more specific in relation to equipment needed for each resident. For example, one resident’s care plan identified that they needed a hoist and sling for transferring in and out of bed and chairs, a pressure relieving mattress and incontinence pads, but it did not identify the specific type needed. See Recommendation 3. For those residents who were mentally frail, the care plan for one resident admitted the previous month had not been completed, the care plan for Three Bridges F51 F01 S5158 Three Bridges V227165 170505 Stage 4.doc Version 1.30 Page 11 another resident did not contain an action plan for identified risks and reviews of care were not up to date. See Requirement 1. However, care plans for both resident groups demonstrated that residents had been referred to appropriate health care professionals when necessary, and that their advice was followed. They also contained evidence that residents and/or their relatives were consulted when drawing up the care plans. Residents and visitors said that staff maintained residents’ privacy and dignity when attending to personal care needs, and always knocked before entering bedrooms. However, on the first day of the inspection it was observed that some residents on the dementia unit had been left with food spillages on their clothing after lunch. A visitor also said that he had raised this with the unit manager previously. See Requirement 2. Three Bridges F51 F01 S5158 Three Bridges V227165 170505 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12&15 The home does not provide adequate recreational facilities for residents. Residents are able to choose from a varied, well-balanced menu. EVIDENCE: The home had not employed an activities organiser since before Xmas. A limited amount of activities had been taking place, for example coffee mornings, bingo, dominoes, karaoke, potting plants. One of the residents said that she was ‘bored stiff’. The manager said that one of the senior care staff was attending training to become the activity organiser and would be commencing in this role for twenty hours a week at the end of June. See Requirement 2. Breakfast was served from 8.30am onwards, lunch at 1pm, dinner at 5pm and supper from 9pm. The main meal was served in the evening, apart from on Sunday. There were 2 choices for each meal, but alternatives were available if residents did not want what was on the menu. Residents on the unit for the physically frail, when questioned about the food provision, were complimentary and confirmed that suitable alternatives were provided upon request. Staff were observed asking residents what they wanted for lunch and dinner that day. They were also observed assisting appropriately at lunchtime. The first day of the inspection raised concerns about the provision of food on the unit for the mentally frail. It was observed that some of the residents were Three Bridges F51 F01 S5158 Three Bridges V227165 170505 Stage 4.doc Version 1.30 Page 13 left to feed themselves unsupervised, resulting in them eating little and spilling food down themselves. It was also observed that no-one was given a choice of food and all were given a bowl and spoon to eat with. However, on the second day of the inspection, which was also unannounced, the standard at lunchtime was the same as the other unit. On the first day there had been an agency nurse in charge with two permanent staff members and an agency carer. The unit manager and permanent members of staff were on duty on the second day. Three Bridges F51 F01 S5158 Three Bridges V227165 170505 Stage 4.doc Version 1.30 Page 14 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 standard(s) 16 The complaints procedure is not adequately publicised to give residents confidence that complaints will be taken seriously. EVIDENCE: The home had a satisfactory complaints procedure that was displayed in the foyer and contained in the residents’ guide. However, most of the residents and relatives spoken with were unaware of the procedure. See Recommendation 1. Three Bridges F51 F01 S5158 Three Bridges V227165 170505 Stage 4.doc Version 1.30 Page 15 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 standard(s) 19,22, 24&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: Generally, the premises were well-maintained and clean. A large part of the home had been refurbished last year, but a few of the older carpets were in need of replacement. In particular, the carpet in the activities room in the dementia unit and the carpet in bedroom 12A were badly stained. The manager said that she had submitted a request to the registered provider for new laminate flooring in the activities room and carpets for eight bedrooms. The over-bed table and commode in bedroom 8 were damaged. There was an offensive odour in one bedroom on the dementia unit. The resident was in the lounge, but the curtains and windows were closed. See Requirement 3 and Recommendations 4 & 5. Adequate equipment was provided to meet residents’ needs. Three Bridges F51 F01 S5158 Three Bridges V227165 170505 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29&30. The number of staff available on the dementia unit at night is not sufficient to meet the needs of the residents. Although there has been some investment in staff training, staff on the dementia unit have not been equipped to cope with residents who exhibit challenging behaviour. The procedures for the recruitment of staff are robust and provide safeguards to offer protection to people living in the home. EVIDENCE: The numbers and skill mix of staff on the unit for the physically frail were sufficient to meet the needs of the residents accommodated. The numbers of staff on the dementia unit were sufficient during the day, but were insufficient at night, when only two staff were provided to care for up to twenty residents, many of whom had a high level of need. One resident required dressings to a pressure ulcer that could take two staff up to an hour to attend to, which would leave other residents unsupervised at night. Several other residents also needed two staff to assist with personal care. See Requirement 4. All care staff had received induction training that complied with the Skills for Care workforce training targets. In May staff had received training in customer care, dementia care, infection control and pressure area care. None of the care staff had achieved an NVQ Level 2 in Care, although the manager said that four staff were undertaking training at the time of the inspection and two staff were undertaking NVQ assessors’ training. See Recommendation 6. On the first day of the inspection there were two agency staff and two permanent members of staff on the dementia unit. The permanent staff Three Bridges F51 F01 S5158 Three Bridges V227165 170505 Stage 4.doc Version 1.30 Page 17 members were relatively new to the home. The registered manager was out of the home carrying out an assessment and the dementia unit manager was on a day off. Her shift was being covered by an agency nurse. A care assistant had phoned in sick that morning and their shift was being covered by an agency carer. Some of the residents were quite agitated and two were exhibiting challenging behaviour. Neither of the permanent staff had received any training in how to manage challenging behaviour. The manager said that if she had been aware that there were two agency staff working on the unit she would have transferred a more experienced member of staff from the other unit and placed the agency carer on the unit for the physically frail. The manager said that she had identified that staff were in need of training in deescalation techniques to defuse potentially volatile situations and had arranged training for four of the staff in July with more to follow. See Requirement 5. Three staff files were reviewed. All the required information and documentation had been obtained prior to them commencing employment. Three Bridges F51 F01 S5158 Three Bridges V227165 170505 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,36&37. The dementia care unit is not managed adequately enough to provide leadership, guidance and direction to staff to ensure that residents receive consistent quality care. This has resulted in some practices that do not promote or safeguard the health, safety and welfare of the people using the service. EVIDENCE: On the first day of the inspection the agency nurse reported to one of the inspectors that he had had to use restraint on a service user who had assaulted him and that he was the only member of staff on duty trained in this type of restraint. The home did not have any policies on or training in any particular types of restraint and the resident’s care plan did not refer to any type of restraint that was to be used should this resident become violent. This incident had not been accurately recorded in the incident record. The home did not conduct any audit or review of critical incidents to analyse whether there Three Bridges F51 F01 S5158 Three Bridges V227165 170505 Stage 4.doc Version 1.30 Page 19 were any contributing factors that could be addressed or whether staffing levels and skills were sufficient. See Requirement 6 & Recommendation 7. Staff did not receive formal, documented supervision on a regular basis. The registered manager had implemented a system for this to take place and had carried out the first supervision session for four of the senior staff in April. See Recommendation 8. The register of admissions was not up to date. The last two admissions had not been recorded, one entry did not have a date of admission and three did not have the name of the GP. See Requirement 7. Three Bridges F51 F01 S5158 Three Bridges V227165 170505 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 2 COMPLAINTS AND PROTECTION 2 x x 3 2 x x 2 STAFFING Standard No Score 27 2 28 1 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x x x 2 x x 2 2 x Three Bridges F51 F01 S5158 Three Bridges V227165 170505 Stage 4.doc Version 1.30 Page 21 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 OP7 Regulation 15 Requirement The registered person must ensure that residents have a plan of care for all identified needs and risks that is reviewed on a regular basis. The registered person must consult with residents about their social interests and draw up a programme of activities. (Timescale of 31.12.04 unmet) The registered person must replace the flooring in the rooms identified. The registered person must increase the number of staff deployed on the dementia unit at night. The registered person must ensure that all staff working on the dementia unit receive training in the management of challenging behaviour. The registered person must devise policies and procedures in relation to levels of restraint. Timescale for action 26.05.05 2. OP12 16(2) (m&n) 26.07.05 3. 4. OP19 OP27 16(2)(c ) 18(1)(a) 26.09.05 26.06.05 5. OP30 18(1)(c ) 26.09.05 6. OP33 12(1)(a) 26.07.05 Three Bridges F51 F01 S5158 Three Bridges V227165 170505 Stage 4.doc Version 1.30 Page 22 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. 4. 5. 6. 7. 8. Refer to Standard OP1 OP3 OP7 OP24 OP26 OP28 OP33 OP36 Good Practice Recommendations The registered person should provide all prospective residents with the homes statement of purpose and guide prior to admission. The registered person should devise documentation to allow for a more detailed recording of pre-admission assessment. The registered person should ensure that staff record the specific types of equipment required in residents care plans. The registered person should carry out an audit of bedroom furniture to identify any that requires replacing. The registered person should ensure that bedrooms are adequately ventilated to eliminate odour. The registered person should take steps to increase the number of staff training for an NVQ Level 2 in Care. The registered person should introduce a system for critical incident analysis on the dementia unit. The registered person should ensure that all care staff receive formal, documented supervision on a regular basis. Three Bridges F51 F01 S5158 Three Bridges V227165 170505 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection 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. 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