Inspection on 25/07/05 for Three Bridges Nursing & Residential Home

This inspection was carried out on 25th July 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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 &... 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 Nook Lane Latchford Warrington WA4 1UB Lead Inspector Gill Matthewson Unannounced 25 July 2005 10:00 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 V237864 250705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Three Bridges Nursing & Residential Home Address Nook Lane Latchford Warrington 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) 01925 418059 Southern Cross Care Management Limited Ann Woods Care Home 52 Category(ies) of Old age, not falling within any other category registration, with number (32) Both of places Dementia - over 65 years of age (20) Physical disability (2) Both Dementia (2) Both Mental Disorder, excluding learning disability or dementia - over 65 (1) Both Three Bridges F51 F01 S5158 Three Bridges V237864 250705 Stage 4.doc Version 1.40 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 ageof 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. The registered manager must attain NVQ Level 4 in Management by 31st December 2006 17 May 2005 3 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 F51 F01 S5158 Three Bridges V237864 250705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by two inspectors of the Commission in response to a complaint. The inspection took place over six hours and focused almost entirely on the dementia care unit. It included inspection of records, observation of staff practice and discussion with three service users, one relative and six staff. Feedback was given to the Registered Manager and Regional Manager immediately following the inspection. Some improvements had been made since the inspection two months previously, but there remains cause for concern. This will be followed up with the registered provider. What the service does well: Satisfactory arrangements are in place to ensure that all residents receive their prescribed medications. Residents are helped and encouraged to maintain contact with friends and family and visitors are welcome at any reasonable time. Residents and relatives are able to raise concerns using the home’s complaints procedure. Complaints are taken seriously and a response is forwarded. Staff are properly vetted before being offered a position in the home. Residents’ monies and valuables are safely looked after. Health and safety equipment is regularly checked and serviced to make sure it is safe to use and staff receive regular instruction in fire safety and evacuation. Three Bridges F51 F01 S5158 Three Bridges V237864 250705 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Three Bridges F51 F01 S5158 Three Bridges V237864 250705 Stage 4.doc Version 1.40 Page 7 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 V237864 250705 Stage 4.doc Version 1.40 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 V237864 250705 Stage 4.doc Version 1.40 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) 3 Not all service users are fully assessed before moving into the dementia unit to ascertain whether the unit can meet their needs. EVIDENCE: The records of a resident who had recently moved into the dementia care unit were examined. There was a pre admission assessment that detailed the resident’s physical history and recent admission to an NHS facility before moving into the home. The resident initially moved into the frail elderly unit of the home and was then transferred into the dementia care unit. There was no pre admission assessment by staff from the dementia care unit to ensure they could meet the resident’s needs. The initial pre admission assessment did not identify the resident had any mental health needs. The assessment for NHS funding completed in March 2005 referred to ‘age related memory loss’. There was reference to a further assessment completed in June 2005 but no copy of this was available. (See Requirement 1.) Three Bridges F51 F01 S5158 Three Bridges V237864 250705 Stage 4.doc Version 1.40 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) 7,9 and 10. Service user plans do not ensure that health and social care needs are identified and met. Residents receive their medication in accordance with the doctor’s prescription. Residents are not always treated with respect by agency staff. EVIDENCE: Two resident care plans were examined. In both, the care plans had been updated and improved since the last inspection. However, the plans for the management of challenging behaviour stated that if the residents became resistive when staff were providing personal care, or aggressive behaviour was displayed, then residents were ‘to be left for ten minutes then return’. It was unclear if staff should continue to observe the resident to ensure their safety. An incident recorded in a resident’s care plan described an incident when the resident became aggressive when staff attempted to take off his t shirt. He had punched a staff member on the chin and male assistance was requested. There was no explanation as to why staff had to take the t-shirt off other than it was 11pm at night. The records for the incident stated ‘this gentleman needs a restraint policy and procedure geared toward him for potential outbursts, to safeguard the staff. Also requires three staff for incidents such as these’. A resident’s nutritional assessment recorded on regular evaluation that the resident had a normal appetite. A review of the resident’s care in July 2005 Three Bridges F51 F01 S5158 Three Bridges V237864 250705 Stage 4.doc Version 1.40 Page 11 detailed the resident’s appetite as ‘reluctant to take much diet’ and that he should be weighed regularly, yet this information was not referred to in evaluation of the nutritional assessment. In a care plan regarding a resident being unable to maintain a safe environment the action plan referred to the resident grabbing out at people and objects due to cognitive impairment and putting himself and other people at risk, yet this was not recorded as a need or a risk with no risk assessment or risk management plan in place. Medicine storage on the dementia care unit had been moved to a former kitchen, which had been refurbished to provide safe storage of medicines. Examination of the management and administration of medicines found only two minor errors, which the manager was requested to deal with. An agency staff member was observed to approach a resident without any acknowledgement or introduction and attempt to get him to rise out of an armchair by lifting him under his arm with her forearm. The resident responded by pushing her away and shouting ‘no’. The agency staff member returned with one of the regular staff that greeted the resident, put her arm around his shoulder and explained that she wanted to help him. The resident responded and went with the staff. Concerns had been raised previously about similar actions by agency staff. (See Requirements 2 and 3.) Three Bridges F51 F01 S5158 Three Bridges V237864 250705 Stage 4.doc Version 1.40 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 & 13 Residents are being consulted about their social interests and improvements are being made in the range of activities available. Families and friends are welcomed into the home at any reasonable time. EVIDENCE: At the previous inspection in May an activity coordinator had been appointed but had not commenced in post. At this inspection she informed the inspector that she had been in post for a few weeks. Prior to this she had attended training arranged by the registered provider and was in the process of assessing residents for their social care needs and fund-raising. Some activities were being provided, mainly in relation to arts and crafts. There was 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. A clothing party had been held on 21st July and an inter-home sports day was planned for 9th September. The home’s statement of purpose indicated that visitors were welcome in the home at any reasonable time. A visiting relative said that standards of care had improved recently and there had been no further incidents of his wife’s clothing stained with food. He said he visited at various times during the day and evening. Three Bridges F51 F01 S5158 Three Bridges V237864 250705 Stage 4.doc Version 1.40 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 standard(s) 16 &18 Residents and relatives have access to a satisfactory complaints procedure. Residents are not adequately protected from harm because of a lack of staff training in the management of challenging behaviour. The management of physical intervention is unclear and staff are unsure what constitutes restraint and both residents and staff are at risk of being harmed. EVIDENCE: The home had a satisfactory complaints procedure that was displayed in the foyer and included in the service user guide. The home had recently received two complaints from relatives about the staffing levels on the dementia care unit after 7pm. As a result another carer had been provided to work 7pm to 10pm five evenings a week. Warrington Adult Protection Protocol and the Department of Health guidance ‘No Secrets’ were available in the home. Staff received instruction in the recognition of abuse during induction training. The home’s adult protection procedure did not state that any allegation of abuse must always be reported to social services under the agreed protocol. (See Recommendation 1) The registered provider had previously provided detailed training in the prevention, recognition and reporting of abuse. However, most of the staff employed on the dementia care unit had been employed since the training was provided. Thirteen staff were employed on the dementia care unit. The manager said that four staff had attended the local NHS mental health service for training on dealing with challenging behaviour, which was ‘de escalation training’. Two more were due to attend on 1st September. She also said she was negotiating with a nurse assessor from Central Cheshire Primary Care Trust (PCT) to Three Bridges F51 F01 S5158 Three Bridges V237864 250705 Stage 4.doc Version 1.40 Page 14 arrange staff training on the use of physical intervention. The manager was advised to verify the training was for staff to use if necessary on any resident accommodated in the dementia care unit and not just for a resident whose care was funded by Central Cheshire PCT. The home had satisfactory policies on the management of challenging behaviour and restraint, but staff did not seem to be aware of them. A care assistant described that during assisting a resident with personal care ‘he can be aggressive at times, and hit out. We both have to shave him, one of us holds his hands to stop him hitting out’. She demonstrated that she held four of the resident’s fingers in the palm of her hands. When asked if she thought this was restraint she said ‘that would be abuse’. The staff on duty were asked if they had read the policy on dealing with challenging behaviour and all said they had not. (See Requirements 2, 3, 4, 5 & 6.) Three Bridges F51 F01 S5158 Three Bridges V237864 250705 Stage 4.doc Version 1.40 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) None of these standards were assessed on this occasion. EVIDENCE: Three Bridges F51 F01 S5158 Three Bridges V237864 250705 Stage 4.doc Version 1.40 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 & 29 The home’s recruitment practices afford some protection for residents but staffing levels on the dementia care unit are inadequate to meet the needs of the residents. EVIDENCE: This inspection was carried out as a result of a complaint regarding incidents that were alleged to have occurred on 4th & 5th July 2005 on the dementia care unit. The staff rota for that week and the current week were reviewed. For the week commencing 4th July in the main there were four staff on duty from 7am to 7pm and two staff overnight. However, on 5th July only three staff were on duty from 1pm to 7pm because one member of staff had gone off sick at 1pm. The registered manager said she was not in the home that day, but had not been informed by the unit manager that there was a staffing shortage. The staff on the unit that afternoon consisted of a registered nurse, a care assistant who had only worked one shift on the unit before and an agency care assistant who had also only worked one shift on the unit. Investigation of the complaint revealed that an incident occurred where the two care assistants were showering a resident when he became aggressive and was lashing out at them. One carer went to obtain the assistance of the nurse, but she could not attend because she was dealing with another resident who was also exhibiting signs of aggression towards another resident. Fortunately, the care assistants managed to cope with the resident in the shower. However, this highlights that the numbers of staff that day were not adequate to cope with the needs of the residents. Three Bridges F51 F01 S5158 Three Bridges V237864 250705 Stage 4.doc Version 1.40 Page 17 At the previous inspection a requirement was made to increase the numbers of night staff on duty in the unit. Following two complaints from relatives that the staffing after 7pm was inadequate, an additional member of staff had been provided from 7pm to 10pm five evenings a week from 18th July. A visiting relative said that there was an improvement in the evening with a twilight carer on duty from 7pm to 10pm. He said the care staff ‘worked hard and long, but there are still not enough staff at nights, they often leave residents unattended when there are only two on, lately there have been three staff on duty. I have written to the manager about this’. At the time of the inspection at least half of the residents on the dementia care unit were of high dependency, and at least three were exhibiting challenging behaviour. Twelve required two to assist with for mobility or when attending to personal care. (See Requirement 7) Three staff files were reviewed. The information in these files demonstrated that all the appropriate checks were carried out prior to the employment of any staff. Three Bridges F51 F01 S5158 Three Bridges V237864 250705 Stage 4.doc Version 1.40 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) 35 & 38 Residents’ monies and valuables are kept safely. The management of the dementia care unit does not ensure the safety of service users and staff. EVIDENCE: Three Bridges F51 F01 S5158 Three Bridges V237864 250705 Stage 4.doc Version 1.40 Page 19 The registered provider was appointee for some service users who had been in the home for over 10 years. Each had their own account. The home also managed personal allowances for service users. Receipts and invoices were given for all monies paid into and out of the accounts. A computer programme was used to record all transactions and maintain a running balance, but this had not been updated since the end of June. The manager said that she would inform the administrator that this should be done at least weekly. Any valuables handed over for safe-keeping were recorded in the service user file and stored in a safe. There was an excellent health and safety audit tool that ensured that all equipment was checked and serviced as required. On the day of the inspection some of the staff were receiving training in fire safety and food hygiene, and the Facilities Manager was carrying out a health and safety audit. All staff received annual training in moving and handling, fire safety, health and safety, food hygiene and first aid. A fire risk assessment had been completed on 14th April 2005 and there had been five fire drills since the last inspection. Five portable hoists were provided in addition to bath hoists. These had all been serviced in June. All residents had a moving and handling risk assessment, but in the case of the resident who regularly puts himself on the floor, there was no plan for how to get him up again. The unit manager said that sometimes he can get up on his own with the assistance of a staff member and other times there is a need to use a specific hoist. The complaint received alleged that staff used the ‘drag lift’ to get the resident off the floor, which could cause injury to the staff or resident. (See Requirement 8.) See also sections on Complaints and Protection and Staffing for other issues regarding safe working practices. Three Bridges F51 F01 S5158 Three Bridges V237864 250705 Stage 4.doc Version 1.40 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 x x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 x COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 2 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 1 x x 2 x 3 x x 2 Three Bridges F51 F01 S5158 Three Bridges V237864 250705 Stage 4.doc Version 1.40 Page 21 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 OP3 Regulation 14 Requirement The registered person must assess prospective residents before they move into the dementia care unit. The registered person must ensure that records that identify residents needs, and staff responsibilities in meeting their health and welfare, are kept under review and include appropriate risk assessments and risk management strategies. (timescale of 26.05.05 unmet) The registered person must ensure that residents are treated with dignity and respect at all times and agency staff must be provided with suitable induction training on how to communicate with residents diagnosed with dementia. The registered person must ensure that all staff on the dementia care unit are provided with suitable training on understanding and dealing with residents who present with challenging behaviour.(previous timescale 26.09.05 unlikely to be met) The registered person must Timescale for action 25.07.05 2. OP7 15 25.08.05 3. OP10 18(1)(a) 25.07.05 4. OP18 18(1)(i) 31.10.05 5. OP18 OP33 13(6)(7)( 31.10.05 Page 22 Three Bridges F51 F01 S5158 Three Bridges V237864 250705 Stage 4.doc Version 1.40 8) and 17 (1)(a) 6. 7. OP18 OP27 13(6) 18(1)(a) 8. OP38 13(4) 15(1) ensure that the policy on the management of challenging behaviour and use of physical interventions is supplied to all staff and clear guidance and training provided on the use of these policies. The registered person must ensure that all staff receive adult protection training. The registered person must, at all times, provide sufficient staff to meet the needs of the residents. (timescale of 26.06.05 unmet) The registered person must ensure that all residents who require assistance with mobility have a written moving and handling care plan. 31.10.05 25.08.05 25.08.05 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 OP18 Good Practice Recommendations The adult protection procedure should be amended to make it clear that all allegations of abuse should be reported to social services under the locally agreed protocol. Three Bridges F51 F01 S5158 Three Bridges V237864 250705 Stage 4.doc Version 1.40 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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