Inspection on 08/06/06 for Three Bridges Nursing & Residential Home

This inspection was carried out on 8th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 &... 01/12/05

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 Anthony Cliffe Key Unannounced Inspection 8th June 2006 09:00 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.V293467.R01.S.doc Version 5.1 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.V293467.R01.S.doc Version 5.1 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.V293467.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum 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) Date of last inspection 1st December 2005 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. Three Bridges is located in the Latchford area of Warrington, close to a shops and pubs. It is a short bus ride from Warrington town centre. It 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 en-suite facilities. The home has car parking to the front and a large garden to the sides and rear, which is easily accessible. Fees range from £316 to £584. Three Bridges Nursing & Residential Home DS0000005158.V293467.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two regulatory inspectors undertook this unannounced site visit. The Key inspection was arranged as part of the Commission for Social Care Inspection’s (CSCI) regulatory programme under Inspecting for Better Lives. The site visit took place over 8 hours. Feedback was given to the manager. Records were inspected and staff practice was observed. Discussion took place with residents, visitors, a visiting professional and staff. A tour of the premises was undertaken. Information was collected from a pre inspection questionnaire and people who returned questionnaires sent out by the CSCI. What the service does well: What has improved since the last inspection? What they could do better: Ensure residents’ care plans include consistent information obtained about them that reflect their needs and are reviewed regularly. Ensure pre admission assessments are signed and dated by the person completing them. Three Bridges Nursing & Residential Home DS0000005158.V293467.R01.S.doc Version 5.1 Page 6 Policies and procedures for managing medicines should be followed to eliminate instances of bad practice, which place residents’ at risk of not receiving their medicines safely. Ensure residents personal monies are managed, accounted and individually stored. Improve the maintenance of the building and provision of safety equipment so residents’ safety is not placed at risk. Provide further opportunities for staff to undertake an NVQ level 2. 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.V293467.R01.S.doc Version 5.1 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.V293467.R01.S.doc Version 5.1 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information is available for residents and their representatives. Residents’ needs are assessed prior to moving in but assessment records need to be signed and dated by the person completing them. EVIDENCE: Two residents who had recently moved into Three Bridges were case tracked. They both had either a pre admission assessment by staff from Three Bridges or a social worker prior to moving in. One resident was an emergency admission and care plans and a review of care were completed on the day of moving in and review of care had taken place seventy two hours after moving in with her social worker. The other resident had all necessary assessments and care plans to meet her needs and these were completed in details from information obtained prior to her moving in. The pre admission assessment of the resident had not been signed or dated by the nurse who completed it. One of the residents talked about moving into Three Bridges and said ‘ I have only been here a week, it’s a bit confusing. The other residents are very nice. My son visits every day and he made the decision I move here. He chose the place and handled all the monies. It’s been a good idea being cared for. I am eating and getting the help I need. Staff have made sure I am drinking plenty. I have Three Bridges Nursing & Residential Home DS0000005158.V293467.R01.S.doc Version 5.1 Page 9 a cup of tea first thing in the morning. They ask me when I get up if want a drink. I can find my way around and staff help me. They help me when I need to use my wheelchair. It’s all still strange but I am being well looked after’. See recommendation 1. Three Bridges Nursing & Residential Home DS0000005158.V293467.R01.S.doc Version 5.1 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 the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is assessed as poor. This judgement has been made using available evidence including a visit to the service. Residents’ plans need to improve to ensure that health and social care needs are recorded, reflect residents’ needs and reviewed regularly. Medicine management and administration is unsafe and residents are at risk of not receiving their prescribed medicines. Residents are treated with dignity and respect. EVIDENCE: Four care plans showed that a wide range of assessment documents were completed; with a care plan to address residents’ needs. From looking at care plans, observing staff working practices and talking with residents, staff and visitors the health needs of residents were generally met. There were several examples of good practice regarding the care of residents and recording of personal, social and health care. On moving into Three Bridges a resident who was an emergency admission had all care plans completed in the specified time period. The resident had been provided with an incontinence aid to promote dignity. At a review of care shortly after moving in the resident’s family requested this not to be used and for staff to ensure the resident was prompted to use the toilet. This decision was recorded in the review, daily records and the care plan revised to record the decision. The resident had been identified as not eating and drinking adequately. These needs were assessed and care plans in place to address them. Records showed the resident gained Three Bridges Nursing & Residential Home DS0000005158.V293467.R01.S.doc Version 5.1 Page 11 weight in the first week of living at Three Bridges. The resident had been referred to the continence advisor with the family’s agreement. Another resident who had recently moved in did not use English as her first language but could communicate in English. The resident had been referred to the optician, and audiologist for treatment. Chiropody treatment had been provided and three reviews of care with the social worker had taken place. Another resident who had recently moved in had a well written physical and social assessment, which included family relationships and social contacts and provided a useful pen picture and life history. Information recorded involvement form the district nurse and dietician. A range of care plans had been written to meet the resident’s needs but these had not been reviewed since April and weekly progress reports since May. In a resident’s care plan whose first language was not English the care plan for communication identified that the resident would revert to communicating in her first language. The care plans stressed that staff should encourage her to use English so they could understand her. It was evident form the resident’s daily records and care plans reviews that there had been some communication problems, which resulted in the residents being distressed. When the resident’s son was used as an interpreter it was evident from care plans reviews that the resident’s communication and general needs improved. The incidents of her falling reduced when it was communicated she should use the call bell and they reduced to ‘no falls recorded this month’ for two consecutive months. The care plan from the social worker identified the risk of the resident becoming socially isolated if an interpreter was not used. The resident appeared withdrawn and did not initiate conversation with residents or staff but when her son visited and they conversed in her first language she was animated, held his hand and demonstrated love and affection. The use of her son as an interpreter was not identified in her care plan. The resident had a history of anxiety and was involved with the mental health services but a care plans to address this need was not in place. An appointment with the psychiatrist however was arranged. The resident said about her stay at Three Bridges ‘ my memory is poor but I know I have been here a few months, February I think I moved in. I can understand staff; they are good and care for me. I don’t mind being here it’s not home or like home. It’s been difficult for me to settle in. I speak in my first language but staff doesn’t understand me. I can speak English but don’t always get the right words. Staff know where I am from and respect my origins. They don’t make anything of it. They haven’t asked me about my country of origin or my life there, but I know they respect me. The problem about understand me is that I think in my first language, so talk in it’. Advice was given to the registered manager about the dignity of a resident and how his behaviour could upset other residents. He was observed to walk out of his bedroom to an adjacent bathroom undressed from his lower half. The manager confirmed that the resident had been referred for reassessment of his memory as there had been deterioration in his ability to make judgements about himself. Three Bridges Nursing & Residential Home DS0000005158.V293467.R01.S.doc Version 5.1 Page 12 Equality and diversity were discussed with the registered manager. She was aware of the issues of communicating with a resident whose first language was not English and identified a relative as an interpreter. She verified that the majority of residents are placed from the Warrington area and two residents from out of the area. She demonstrated an awareness of the importance of promoting equality and diversity. Three Bridges employs a number of staff from outside of the United Kingdom and they are a well integrated staff team. Medicine management and administration was examined on both the units. There were samples of staff signatures and initials were included. The medicines policy was included in the files on both units. Residents’ photographs were on file to aid identification. An agency nurse was on duty on one of the units. It was her first time of working at Three Bridges. She was observed to administer medicines to residents while leaving the medicine trolley unlocked and unattended. This practice was discussed with her and she locked the trolley but left medicines in blister packs and liquid preparations unattended on the top of it. There were numerous omissions of signatures for dietary supplement drinks, thickening agents and topical creams on the dementia care unit and two omissions of signatures for oral medicines on the general unit. On the dementia care unit food supplements were recorded as out of stock. Audits had been completed for both the general nursing and dementia care unit. The audit for the general nursing unit identified the errors found at the site visit. The audit for the dementia care unit did not identify the number of errors found during the site visit despite the audits being completed for the same month. See requirements 1 and 2. Three Bridges Nursing & Residential Home DS0000005158.V293467.R01.S.doc Version 5.1 Page 13 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, 13, 14 and 15 Quality in this outcome area is assessed as good. This judgement has been made using available evidence including a visit to this service. Residents are supported in making choices in their lifestyle and social activities needs so they have control over their lives. Residents have a choice of meals in pleasing surroundings. EVIDENCE: Three Bridges employs an activities coordinator for 25 hours a week. The activities coordinator was not on duty during the site visit but had left activities for care staff to undertake. Activities included the ‘knit one pearl one’ knitting club started by residents, arts and crafts, beauty therapy, and exercise to music, gardening and coffee mornings. There were activities outside of Three Bridges with concerts and movies at other care homes in the Southern Cross Healthcare Group. Regular outings for meals and days out were arranged. Three Bridges shares a mini bus with another care home in Warrington. The handyman and activities coordinator both drive it. Activities were seen during the site visit with residents enjoying a sing a long session. A resident was celebrating her birthday and said ‘it’s my birthday today; I’m having my hair done and am going out for my dinner. I enjoy the activities I am a member of the knit one pearl one club. There are plenty of activities going on’. A resident was able to use the office telephone to take a telephone call from a great niece telephoning from the Isle of Man. This was at the suggestion of a carer and the resident looked delighted with the suggestion. The dementia care unit had many reminiscence and resource materials. Bedrooms had been identified with Three Bridges Nursing & Residential Home DS0000005158.V293467.R01.S.doc Version 5.1 Page 14 doorknockers, pictures and names of the occupants to aid them recognise their bedroom. On the general nursing unit care staff led a sing a long session. Care staff talked about their involvement in activities and a staff member said ‘ we are having a sing a long session which residents have agreed to. The activities coordinator leaves us activities to do. She always leaves something to do on the days she is not here’. A resident and his wife talked about daily routines and social activities and said ‘ I have just had a review with a lady from social services. I have said I am settled and enjoy living here. They encourage me to play the organ and I do dependent upon how I feel. I enjoy joining in some of the activities and spend time between the lounge and my bedroom. I read books on trains and canal boats. I would like to go for a ride on a train and have suggested it as a day out’. The resident’s wife said ‘ he is a quiet man but he spends most of his time socialising with other residents. He doesn’t want a daily newspaper. I visit daily and am always welcomed. There is something always going on. The activities lady is very good, very enthusiastic and always asking me if I want to join in. he is settled and I have told the social worker that. I don’t worry about him. I think he would rather be here than at home’. A visiting relative said ‘ I visit everyday and am here all day today. The place is marvellous. I see mum is always looked after and always clean and tidy. They look after her and her clothes. I see other residents are well cared for and there are always activities going on and I join in. We’re having a sing a long this morning. The staff are brilliant and I enjoy coming here’. Visitors to the dementia care unit said their relative had been helped by staff to settle in while he is getting to know Three Bridges and described staff as kind and reassuring him by encouraging him to stay for longer periods. The family confirmed they wanted their relative to have a long term placement at Three Bridges. A resident said of lifestyle choices ‘I follow my own routines they know what time I like to go to bed and get up’. Another resident said ‘ You get looked after here and we’re all going out tomorrow’. Three Bridges had developed a relationship with a local radio DJ. Staff had been involved in a quiz with residents and won compact discs and tickets to events. The DJ opened the coffee shop/ tearoom on the dementia care unit and judged an Easter bonnet competition. He provided tickets to shows as prizes and residents will be taken out to these. Photographs of the events were on view. The registered manager said he had agreed to attend the summer fair. A chef had just commenced employment at Three Bridges. The registered manager said she was pleased to have a full time chef as agency chefs had been used for the past fifteen months. Despite it only being the chefs first week he had set a number of priorities to address. He said ‘ I have not been following the set menus but using what’s in stock. I can’t answer for what’s happened previously but I am relying on staff to let me know what residents’ like or don’t like. Today they have gone around at breakfast and asked everyone what they wanted to choose from. I want to develop a menu based Three Bridges Nursing & Residential Home DS0000005158.V293467.R01.S.doc Version 5.1 Page 15 on residents’ and seasonal choices. I am used to cooking and preparing everything from fresh and basic products. I don’t cook with large quantities of frozen products. I will need time to settle in. It’s my first week but I have managed to make homemade soup and pastries. Today the choice was steak and kidney pie, pork steaks, and vegetables’. The choice of menus was displayed on white boards and confirmed the chef’s comments about choice. The evening meal choice was also displayed. This gave a choice of home made soup and sandwiches or fish and chips. A resident said of the meals ‘ you can have as much as you want’. Three Bridges Nursing & Residential Home DS0000005158.V293467.R01.S.doc Version 5.1 Page 16 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): 16 and 18 Quality in this outcome area is assessed as good. This judgement has been made using available evidence including a visit to this service. Complaints are acted on appropriately. An informed staff group and manager protect residents from abuse. EVIDENCE: The complaints policy was displayed in the main entrance to Three Bridges. No complaints had been recorded since 1st December 2005. A visiting social worker said she had held a review of a resident’s care and there was a ‘big improvement he is doing very well. The care is very good, no complaints that was the feedback from him and his wife’. One residents’ questionnaire was returned as part of the data collection from the CSCI. This recorded food and activities were poor. There was no evidence to substantiate these concerns. Two relatives / visitors comment cards were returned. One of these said ‘food is very poor not the type of food suitable for older people. There doesn’t seem to be any activities going on now’. The other said ‘ this is a very good home. Always clean good food and homely. Staff get on very well together. There is always ongoing projects to make it better. Relatives are always made welcome and to join in’. Both comment cards said they knew how and to whom to address complaints but had not made any. The staff training programme on adult abuse and protection of vulnerable adults was ongoing with dates planned for June 2006. One protection of vulnerable adults referral involving Three Bridges was made in February 2006. Three Bridges was found not to be at fault and improvement in document keeping was identified as the outcome. Three Bridges Nursing & Residential Home DS0000005158.V293467.R01.S.doc Version 5.1 Page 17 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 and 26 Quality in this outcome area is assessed as adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a generally well-maintained home, which is clean and hygienic but maintenance and equipment needs to improve in some areas so residents’ safety is maintained. EVIDENCE: On the dementia care unit the former office has been suggested as a reminiscence kitchen to enable residents to eat in and use this room when supervised by staff. Staff had refurbished the dining room. The theme is a coffee shop / tearoom. Staff said it was more spacious and organised. Residents were not as cramped. A staff member said it had reduced the numbers of verbal and physical incidents associated with meal times. The building is now owned by Focus. A recent in depth audit of it had been completed on the environment throughout Three Bridges. This is completed twice yearly by Southern Cross Healthcare. The handyman is employed for 37.5 hours a week. During the site visit he was decorating a bedroom. Three bedrooms had been supplied with new furniture. There is a rolling programme of improvement. Five bedrooms had been re carpeted with a further four to be Three Bridges Nursing & Residential Home DS0000005158.V293467.R01.S.doc Version 5.1 Page 18 completed. As required at the last site visit two convector heaters had been fitted in the conservatory. On the dementia care unit some bedrooms required maintenance. Overhead lighting was not working. Some of the vanity units were broken around the edges. In bedroom 38 the top of the hot water tap had been removed to prevent the resident misusing it. There was no call point cable in bedroom 36. The floor in bedroom 53 used for respite care was odorous. The number 5 was missing off bedroom 51. In bedroom 52 the resident was sleeping on the bed base located on the floor, which is a hard impervious floor covering. No soft surface was provided next to this should the resident roll out of bed. In the main there is a leak on the dishwasher despite recent repair. Water from this leaks onto the floor which staff have to constantly mop up to prevent them from slipping. See requirement 3. Three Bridges Nursing & Residential Home DS0000005158.V293467.R01.S.doc Version 5.1 Page 19 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, 29 and 30 Quality in this outcome area is assessed as good. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of staff are adequate to meet residents’ needs. Staff recruitment ensures residents are protected. EVIDENCE: Staff moral has improved. Staff talked about positive changes at Three Bridges. A senior carer assistant said ‘ there had been a big improvement lately a lot of the negative staff have left. We had a bad patch and we have all worked through it. Ann has done a lot of good work and been supported by the team. We have made improvements. Staff are keen, enthusiastic, motivated and morale has improved’. A recently employed staff member confirmed she had received an induction day of 12 hours when she was supernumerary and her first shift was just shadowing and observing another staff member. She said she had attended a training day on dementia care with Southern Cross Healthcare’s mental health trainer. She said the unit manager had discussed a variety of training she intended to introduce. She said recently employed staff had to work through an induction pack. The training programme has provided a more informed and skilled staff group but training in NVQ level 2 is needed to promote quality care. Staff care practice was seen as positive. Residents were encouraged to wipe dining tables after meals. Residents could move freely around the units and drinks were provided other than meal times. Residents were provided with prompt assistance when needed. Staffing levels on the units were generous and afforded staff time to sit and talk with residents about living in Warrington. Three Bridges Nursing & Residential Home DS0000005158.V293467.R01.S.doc Version 5.1 Page 20 Information provided by the registered manager was that one staff had an NVQ level 2 qualification and ten staff were to commence an NVQ level 2 and three an NVQ level 3. Three staff files were looked at. All contained appropriate identification documentation and completed Criminal Record Bureau disclosures. All files had two written references. There was evidence of training on staff files. The registered manager had completed a training plan for the staff team. This showed what training had been done and what training was planned for the future. It also indicates who is a qualified trainer. The manager had devised a training matrix to record which staff had training and when it was next due. Training on adult abuse and the protection of vulnerable adults was planned for June 2006. Staff had completed fire training in March and May 2006 and dates set for July, September and November. Fire drills had been done in March and May 2006 and were due again in June, July, September and November. Medication training was to be arranged. See recommendation 2. Three Bridges Nursing & Residential Home DS0000005158.V293467.R01.S.doc Version 5.1 Page 21 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, 35 and 38. Quality in this outcome area is assessed as adequate. This judgement has been made using available evidence including a visit to this service. Quality assurance needs to improve to ensure medication audits accurately reflect errors and poor practice. Financial procedures do not safeguard resident. The maintenance of the building and equipment does not ensure the safety of residents. EVIDENCE: The registered manager said she felt more motivated and the staff team share their ideas. The manager demonstrated that she and the deputy manager had undertaken unannounced visits during the night in May. A record of the visit was available and recorded that night staff had been questioned why hourly checks were completed two hourly. Staff completed records on dementia care training. Southern Cross Quality Management Support Team had completed a quality assurance visit. This was completed in May 2006. These will be carried out every six months. These cover all aspects of the management of Three Bridges and examine the evidence of audits completed by the manager, deputy and Three Bridges Nursing & Residential Home DS0000005158.V293467.R01.S.doc Version 5.1 Page 22 staff. Examples of this were that the quality assurance audit looked at care plan, medicines and pressure ulcer audits that had been completed. It also looked at recruitment of staff and the use of agency staff. An environmental health visit had taken place in April 2006 and identified contraventions in food storage. The registered manager had replied to the notice issued by Warrington Borough Council. The concerns identified were monitored during the site visit and food storage found to be appropriate. The medication audits for May 2006 were examined. The audit for the general nursing unit completed by the registered manager identified anomalies of medication being given and not signed for. She had written observations and recommendations to rectify the errors and recorded ‘these and other issues will be dealt with by having a meeting with qualified staff and these staff will have 1 to 1 supervision’. The overall score for the audit was 75 . The medicine audit for the dementia care unit completed by the deputy manager gave an overall score of 85 . The ordering and recording aspect of the audit recorded 7 out of 7 achieved a 100 achievement, yet anomalies in the recording of medicines were noted and food supplements were out of stock. A kitchen audit was completed in May and issue about food storage identified which were rectified. Fridge thermometers were purchased as a result of the audit. There is to be a full audit of resident’s personal allowances commencing within the near future as problems were identified with the recording system used. The ‘cold harbour’ system is now used which should make the financial management of residents’ finances more robust. The policy at Three Bridges is that no more than £100 per resident should be kept on their behalf. There are no arrangements to act as appointee or agent for any residents at Three Bridges. There is a holding account, which contains resident’s personal allowances, which accrues interest but this is not divided amongst residents. Personal allowances were not held individually as all monies are held in one account. The system is difficult to audit as personal allowance balance sheets were checked against the overall monies held in the account. On examination negative balances were found for some residents. A representative from Southern Cross Healthcare discussed the concerns about the management of monies held on behalf of residents and clarified that the CSCI were aware of the difficulties as the problems had been identified in other care homes operated by Southern Cross. An action plan to address the concerns will be sent to the CSCI. The pre inspection questionnaire confirmed that all but one of the required maintenance services had been completed. A landlord’s gas safety certificate was completed. Health and safety checks had been completed as required. Issues were identified about the maintenance and provision of safety equipment on the dementia care unit. See requirements 2 to 4. Three Bridges Nursing & Residential Home DS0000005158.V293467.R01.S.doc Version 5.1 Page 23 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 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 1 X X 1 Three Bridges Nursing & Residential Home DS0000005158.V293467.R01.S.doc Version 5.1 Page 24 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 OP7 Regulation 14 and 15 Requirement The registered person must ensure that records identify all residents’ needs detailing how these are to be met and keep them under review. The registered person must make arrangements for records of the audit trail of all medicines to be clear, complete and made by the staff accountable for the action at the time of the action. The registered person must make arrangements to ensure adequate stocks of medicines are maintained. The registered person must ensure that medicines audits are completed by a competent person The registered person must ensure that all areas of Three Bridges are maintained to a safe standard and safety equipment provided. Timescale for action 01/07/06 2. OP9 13 01/07/06 3. OP19 13(4), 23(2)(c) 01/08/06 Three Bridges Nursing & Residential Home DS0000005158.V293467.R01.S.doc Version 5.1 Page 25 4. OP35 16(2)(l) and 24(3) The registered person must ensure that monies received on behalf of residents are managed and suitably accounted for. 01/08/06 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. 2. Refer to Standard OP3 OP28 Good Practice Recommendations Pre admission assessments should be signed and dated by the person completing them. Further opportunities should be provided to ensure staff have access to NVQ training. Three Bridges Nursing & Residential Home DS0000005158.V293467.R01.S.doc Version 5.1 Page 26 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.V293467.R01.S.doc Version 5.1 Page 27 - 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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