Inspection on 19/08/08 for Tower Bridge Care Centre

This inspection was carried out on 19th August 2008.

CSCI found this care home to be providing an Adequate service.

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

Tower Bridge Care Centre 27/11/09

Tower Bridge Care Centre 28/07/09

Tower Bridge Care Centre 30/01/08

Tower Bridge Care Centre 27/06/07

Tower Bridge Care Centre 22/01/07

Tower Bridge Care Centre 27/06/06

Tower Bridge Care Centre 22/11/05

Tower Bridge Care Centre 09/05/05

Tower Bridge Care Centre 06/10/04

Tower Bridge Care Centre 23/08/04

Tower Bridge Care Centre 21/04/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Townley Road, 2-3

Orchard House Nursing Home

St Josephs Rest Home

Foxley Lane (121a)

Tudor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/11/2008.

CARE HOMES FOR OLDER PEOPLE Tower Bridge Care Centre Tower Bridge Care Centre 1 Tower Bridge Road Southwark London SE1 4TR Lead Inspector Michael Williams Key Unannounced Inspection 19th August 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Tower Bridge Care Centre DS0000007047.V369646.R01.S.doc Version 5.2 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. Tower Bridge Care Centre DS0000007047.V369646.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tower Bridge Care Centre Address Tower Bridge Care Centre 1 Tower Bridge Road Southwark London SE1 4TR 020 7394 6840 020 7394 7198 towerbridge@schealthcare.co.uk 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 Healthcare Services Limited Mrs Virginia Cheytan Care Home 128 Category(ies) of Dementia (128), Mental disorder, excluding registration, with number learning disability or dementia (128), Old age, of places not falling within any other category (128) Tower Bridge Care Centre DS0000007047.V369646.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing: Code N to service users Of the following gender: Either whose primary care needs on admission to the home are Within the following categories:Old age, not falling within any other category, Code OP Dementia, Code DE Mental Disorder, Code MD The maximum number of service users who can be accommodated is: No. 128 30th January 2008 2. Date of last inspection Brief Description of the Service: Tower Bridge Care Centre is owned by Southern Cross Healthcare Group PLC and the manager confirmed that the certificate gives the correct details of ownership. Tower Bridge CC is a large purpose-built home, with four floors, providing care for up to 128 older people, the majority of whom have single rooms with en-suite toilet and basin. As its name indicates, this home is just to the South of Tower Bridge, London, and so it is close to a wide range of services and facilities. The home provides care, including care for people with dementia to varying degrees on each floor so that on two floors nursing care is provided and on others floors care is at ‘residential’, non-nursing level. The Commission has recently reviewed the registration conditions to ensure they are within the correct legal framework and the revised conditions are listed in the preceding section of this report. There is ample communal space, lounge and dining rooms, on each floor and there is a small courtyard garden to the front of the premises; there is also car parking space in front of the building. The fees for the home range from £500 to £850 a week as at August 2008. Tower Bridge Care Centre DS0000007047.V369646.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 Star. This means the people who use this service experience adequate quality outcomes. This inspection visit took place on 19th August 2008 when the lead inspector Mr. Williams was accompanied by two other inspectors, Mrs Ford and Blenkinsopp. In addition to the visit we also took in account other information provided by the home since our last inspection, earlier in 2008, including their Annual Quality Assurance Assessment [AQAA] and various notifications. We also received information about a number of complaints and concerns investigated by Social Service Departments. A number of questionnaires were distributed to residents, visitors and staff. During our visit we were able to speak to a wide range of people including residents, visitors, staff including ancillary staff and the manager. We thank them for their contribution. What the service does well: What has improved since the last inspection? We made a number of requirements, 14 in all, earlier this year and the manager has worked hard to address these matters we judged as needing improvement. Their action plan was produced in a timely manner and advised how they would approach matters. The result is each resident now has in place a pre-admission assessment; care plans have been revised and although sometimes rather complex they provide a greater detail about the individual resident; documents are now being signed and dated to make clear when and by whom they were compiled. We asked for more aids and adaptation to be made available and actually offered to residents, such as plate-guards to assist in eating, and these are now available and being used. Other matters include Tower Bridge Care Centre DS0000007047.V369646.R01.S.doc Version 5.2 Page 6 the need to improve ‘end of life’ care more particularly the documentation to support care and this is now much improved so residents ‘last wishes’ are known and acted upon. There have been improvements to the décor in some areas of the home and (internally at least) this is generally a nice, spacious care home with lots of communal spaces and large bedrooms and, especially when personalised by residents, look very comfortable and homely. Plans are in place to improve staff understanding of the social care needs of residents with emphasis on the cultural background of residents including the majority of residents who are, according the home’s AQAA, indigenous white British. What they could do better: There have been 25 complaints made about the service in the previous twelve months and 21 ‘safeguarding adults’ referrals – this where the local Social Service Department has undertaken investigations into alleged malpractice. Arising from this three staff have been referred to the POVA List (which is a register of persons deemed not suitable to work with vulnerable people, introduced by the Protection of Vulnerable Adults scheme). Now that the revised certificate of registration has been sent to the home the manager is revising their Statement of Purpose so as to make clear the criteria for admission within the new, more generalised conditions of registration so as to make clear what type of care is being provided on each of the four floors. Staff need to be able to demonstrate their knowledge of the individual residents they care for, their personal life-story and their cultural background. According to the home’s AQAA of staff complement of 90 only two members of staff share the same ethnic background as the majority of residents - so staff will need a lot of support to understand the life experiences of the residents. We acknowledge that the manager is aware of this issue and is putting in place training to address staff understanding of ‘social care’ rather than nursing care or basic care of bodily functions (washing, dressing, feeding). Staffing levels were agreed with the home when we visited in April 2008 with a total of no less than four nurses and twenty care staff each day. On the day of inspection there were to have been on duty more than 4 nurses and at least 17 carers, (there are a number of vacancies in the home). It was of concern to us that staff are unexpectedly absent leaving gaps in the staff complement; even though the manager seeks to fill these unexpected gaps it leaves the home short of staff at critical times of the day such as early mornings. Some improvements are needed in the kitchen, for example people wearing outdoor clothes and staff who have been delivering personal care were allowed to walk into the kitchen when food was being prepared – this could lead to cross contamination. The stocks of food were not being stored in the correct date order – whilst there was no indication out of date food was being served strict rotation of supplies is required to ensure it never happens. The potatopeeling machine was not working and in the laundry a washing machine was broken. Bath and shower water temperatures were not being controlled by failsafe valves and need to be since water at one bath was too hot. Tower Bridge Care Centre DS0000007047.V369646.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Tower Bridge Care Centre DS0000007047.V369646.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Tower Bridge Care Centre DS0000007047.V369646.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 1 and 3: People using this service experience good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is providing important information about their service and is ensuring residents are appropriately assessed - so prospective residents can make a judgement about the home and whether or not it can meet their needs. EVIDENCE: We checked a number of care plan files on three of the four floors and spoke to residents, their visitors and to staff including team leaders. When we inspected in January we found that the admission of new people to this service appeared ‘process driven’ and not particularly personalised so in some instances there was minimal consideration of the individual needs such as details of a resident’s past history – this has now been improved so in some instances we found staff very well informed about the people they are caring for and were better able to understand the behaviour of residents – for example a resident sweeping her hand along grabs rails was once a cleaner so this activity made sense to the care staff. The service has developed a statement of purpose, which sets out the aims and objectives of the home, and includes a service user’s guide, which Tower Bridge Care Centre DS0000007047.V369646.R01.S.doc Version 5.2 Page 10 provides basic information about the service and the specialist care the home offers. Whilst on the premises we checked the proposed amendments to the Statement of purpose so as to make clearer the criteria for admission since this home has a wide range of categories including dementia care (both nursing and non-nursing) and general care also nursing and non-nursing. The guide is made available to individuals in a standard format. We were advised that each resident is given a copy and each has a contract, usually the local authority contract, but this is not kept in the main resident care folder as this is already very bulky. We previously found that not all case files contained an assessment by a suitably trained person such as the care manager making the placement but the home now undertakes to ensure that in each case such an assessment will be sought from placing authorities. Areas of strength include the statement of purpose and resident guide; the opportunity for trial visits and the assessments made at the time of admission. No requirements arise on this occasion so this section, about choice, is assessed as good. Tower Bridge Care Centre DS0000007047.V369646.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 7 to 11: People using this service experience adequate quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that the home prepares detailed care plans and can deliver appropriate care including nursing care. EVIDENCE: During the course of this and other inspections this year we have received a number of comments; some from relatives, some from un-named staff and some anonymous. They refer to concerns about staffing and the care of residents. The home records that it has received 25 complaints in the last twelve months. In contrast to the negative feedback we also received some favourable ones; lot of the residents were either complimentary, for example four residents in one lounge all looked well cared for, clean. Agreed that it’s nice in the home and staff are very good. One resident said, “I think it’s alright here” and another, “They do look after you”. Other that did not comment had no criticism or concerns to raise with us. So a mixed picture emerges of home that is considered by many to be good is considered by others to be less so. “Staff don’t seem to want to engage with residents”. Here we noticed a difference between floors; on one floor staff were fully engaged with residents and a lively, happy atmosphere was apparent whilst on another floor a more apathetic atmosphere was obvious. Other visitors tell us that there do not seem to be enough staff on duty and some that are on duty do not have a Tower Bridge Care Centre DS0000007047.V369646.R01.S.doc Version 5.2 Page 12 good grasp of English. One comment referred to a wish for staff providing personal care to reflect the ethnicity and gender of their relative. This seems to still be the case – although the staff complement is typical for a South London Care Home. By contrast one resident said, “Staff are very good, I don’t have any trouble understanding them, I have a key worker but she’s on holiday (but I am) not sure what she does though”. Southern Cross provide very detailed and extensive care planning formats for their care homes and these include documentation for various assessments, skin care, food, falls and so forth. So the Care Plans in Tower Bridge are very detailed and comprehensive. We asked that documents be signed and dated and this is now being done. We also asked that more details about the personal and social history of residents be reflected in the documentation and again the manager is committed to this; some staff were very well informed about the life history of residents but others were less well informed – some not even knowing that a ‘key-worker’ was a carer who undertook to get to know the resident and their visitors. Good practice was noted in respect of health care support with specialist being called in when the need arose, for example chiropodist and dentists and skin specialists. As part of their delivery of care staff are provided with specialist information for example in respect of infection control; information is sited in bedrooms where the information is needed. We find labelling of clothes undignified, with use of black marker pen still in use but we accept it will be some time before all clothing is appropriately marked with more dignified labelling. We checked a small sample of medication records to check that they were being completed correctly and that the staff delivering medication were clear about their responsibilities. No errors were identified in this area. We were advised that staff in the home are being and are being give guidance in end of life care; we note for example that an Occupational Therapist from a local Hospice is visiting the home to give advice on the ‘Gold Standard’ approach to end of life care. It was therefore disappointing to note last time we visited that in some instances there was little or no information about this final aspect of care. On this occasion information was clearer and ‘last wishes’ and other details about resuscitation were being recorded and kept in a readily identifiable location in each file. The manager acknowledged that this area of work is becoming increasingly important as residents make use of the new Mental Capacity Act to make known their expectations long before they become too unwell to express their final wishes. Documentation is now in place to record and review this very sensitive sort of information. Areas of strength include the detailed documentation and good assessment and care planning in many areas and also the good care that is being provided in many areas. Whilst matters requiring improvement include the need to reduce the cause for complaints since there have been a great many complaints in the last twelve - even for a home for 128 residents. There is still a need for staff to have a better awareness of the personal lives of residents and not just their basic health care needs. This section, about health and personal care, is assessed as adequate. Tower Bridge Care Centre DS0000007047.V369646.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 12 to 15: People using this service experience good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that this home has the facilities to offer a lifestyle likely to meet their needs and they will be provided with wholesome food in congenial settings. EVIDENCE: The employment of a full time activity coordinator and two assistants is very commendable; some activities were seen to be underway whilst we were visiting including visit to nearby pub It was also notable that this Public House also supports the home in other ways such as raffles – a good example of engagement with the local community. Last time we visited we noted that some staff did not seem very skilled in engaging with residents, and this was the case again. In some locations it was clear staff were very active and stimulating residents so a happy joyous atmosphere was evident but in some areas staff seemed to be no more than in attendance to observe and ‘supervise’ residents in the lounge – one carer quite extraordinarily said she knew nothing of the background of the resident, she “just cares for them”. Although possibly a kind and caring worker it shows little effort to get to know the residents and engage them in meaningful activity. Nevertheless we did met with several visitors who were quite happy with the care their relatives were getting in Tower Bridge and they had no complaints. We have on previous occasions met with visiting nurses who confirmed that Tower Bridge Care Centre DS0000007047.V369646.R01.S.doc Version 5.2 Page 14 the home seems to provide a satisfactory level of care and they found staff to be very caring – but language was, and remains, a point of contention; not all staff have a good grasp of English and few share the South London, ‘Cockney’ background of many residents. We heard about other community contacts including local churches and schools coming into the home as well as residents making local excursions to places of interest – however in some of our earlier questionnaires people were asking for more outings and activities – more stimulating activities were suggested and we can report that earlier in the month a group of residents had taken a day trip to Brighton – which we were told was very much enjoyed and appreciated and although quite a long day out for frailer people it does serve as a good example of such day trips. Autonomy and choice is inevitably limited by age and frailty and so it is in this care home; residents have some choice about their daily lives such as when to retire to bed or to rise, what to wear, what meal to select and when and where to wander around the home. It seems unlikely this limited range of choices will be extended for residents if staff see their role as, “We just care for them”. Mealtimes were of particular concern to all three inspectors in January. There was a lack of suitable equipment such as bedside or over-bed tables; a lack suitable eating aids such as adapted cutlery, staff were limited in their skills at meals times, either not supporting residents to eat, not encouraging residents to eat or not offering alternatives and standing when feeding residents. The situation in August had improved and aids were available and staff were attentive and considerate when supporting residents at meal times. One very good improvement was the menus on display in the dining rooms; they are now in large print and with pictures – a very great and noticeable improvement and demonstrates the home capacity and willingness to improve standards. Areas of strength include the employment of dedicated activity leaders, the involvement of the community and the generally relaxed and pleasant atmosphere of the home. The improvement reflect an improved rating for this section about daily life and it is now rated as good but not without some shortcoming such as the need for staff to be more aware of residents’ personal histories and have a greater understanding of the culture in which residents lived. Tower Bridge Care Centre DS0000007047.V369646.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 16 and 18: People using this service experience adequate quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents cannot be assured of their safety at all times but procedures are in place to alert the appropriate authorities when complaints and incidents occur. EVIDENCE: It is paradoxical that at time when the owners Southern Cross are advocating a, “Ground breaking project to tackle elder abuse in care homes, (Southern Cross Times issue 9, 2008)”, that so many complaints and incidents in Tower Bridge have been referred to the local Social Service Department, 21 in all in the last twelve months. This reflects two aspects to life in Tower Bridge, firstly there are too many times when residents, visitors and even staff feel the need to complain but it also indicates, as the manager stated in our last inspection, a greater willingness to disclose and be open to enquiry and investigation when incidents come to light. This suggests that untoward incidents are not being hidden and kept secret by the home. Such openness does mean that even the smallest event is recorded and referred to the Social Services and this may tend to inflate the numbers. We spoke to residents, relatives and staff; we checked the record of complaints and took note of the various notifications we received since the last inspection. We also received a small number of written comments that we took account of. Information on how to make a complaint was located in the bedrooms and was on display in the main lobby. Of those residents we met we have the impression that residents were happy to report their concerns to the Manager, known by all as, “Ginny”. One resident gave a clear account of things Tower Bridge Care Centre DS0000007047.V369646.R01.S.doc Version 5.2 Page 16 when she told us, “I did make a complaint about a member of staff and I know that it has been addressed”. The resident was confident that ,“Ginny always sorts any issues out when they arise”; she went on to tell us that she does have a ‘key worker’, although she is not sure that she does anything extra for her. We were also told that she had, “Never seen staff member act unprofessionally and believes people are cared for very well”. All staff with whom the inspectors met were aware of what to do in the event that abuse was suspected or witnessed. There is a vulnerable adult’s policy and an ongoing training programme for staff on safeguarding adults, and it was noted that new staff have this training. During the course of the inspections in 2007 issues of restraint were identified by the inspector – we are advised that no restraint now takes place. The home is reminded that any form of physical restraint must be recorded in accordance with regulations 13(8) and 17 (Schedule 4:o) and must be dealt with in accordance with the revised Mental Capacity Act and the new ‘deprivation of liberty safeguard’s. The manager is well informed about the procedures for referring allegations of abuse or poor practice to the local Social Service Department (before initiating any internal investigations) as well as referring to the placing authorities and of course the Commission. There have been a number of complaints amounting to possible poor case practice and abuse. The local authority Social Services, rather than the Commission, take the lead role in investigating such matters. They have identified that some complaints were not substantiated or were inconclusive whilst others were partly upheld as indicative of poor care practice and in these cases the home has taken appropriate action such as disciplining staff found to have been at fault and in some instance they have been referred to the POVA list (The ‘Protection of Vulnerable Adults’ list of persons deemed not suitable to work with vulnerable people). Some issues are still under formal investigation so the outcome and detail of these concerns have yet to be confirmed. The manager position is that some complaints are without foundation but have nevertheless been addressed without pre-judgement whilst a small number of the complaints do indicate that staff have behaved in unacceptable ways towards residents. Areas of strength include the openness to complains and concerns; the willingness to address those concerns and the assertive action taken to deal with staff who abuse residents in any way. Since there have been referrals indicative of abuse we conclude that residents are not entirely protected and this section about complaints and protection is assessed as adequate. Tower Bridge Care Centre DS0000007047.V369646.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 19, 20, 22, 26: People using this service experience adequate quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made so residents have a safer more comfortable environment in which to live but there are still shortcomings. EVIDENCE: The home is a purpose built four-storey building close to public transport, shops, cafés and pubs. The home and grounds are fully accessible. There is a large car park with a small front garden and a side garden adjoining it. The floors are large with over 30 rooms. Each floor has two lounges and a dining room. We toured the whole premises including residents’ areas and kitchen, laundry and other facilities. As the manager planned for, there have been noticeable improvements in some areas, old furniture has been discarded and some areas have been redecorated. Residents have equipment or aids such as plate-guards to assist independence at meal times. Other equipment such as assisted baths, raisable beds and specialised air mattresses are in place. Tower Bridge Care Centre DS0000007047.V369646.R01.S.doc Version 5.2 Page 18 Most areas were clean and fresh and free of odour though a slight malodour was noticeable in some areas at different times in the day. The manager agreed with our findings that some areas are now in need of refurbishment since the home is now ten years old. Carpets on the stair cases being a good example; they are very dirty and look unsightly. We checked water temperatures at baths and sinks and found in one location on the ground floor the bath water was 75oC. The on-site maintenance staff dealt with this immediately by locking the door pending adjustment to the safety valve. The manager also advised us the all baths had recently been serviced so this fault was somewhat unexpected and the service engineer would be called back to re-set the fail-safe thermostatic control valves. We were also advised that this fault had not been noted since the bathroom was not in use anyway and it posed little risk to residents at that time. Other points of concern we noted include a ladder left outside the premises and not padlocked, so a security risk; a smoke detector in the central stair well broken; light in this location also not working; one washing machine not working; fire door to laundry wedged open (and we note this may be because there are no extractor fans in the laundry room) and in this area a fire at the foot of the stairs was not closing fully. In the kitchen we found the cook was allowing staff in day clothes to walk through her kitchen whilst she was preparing food and this may be a hygiene risk; the potato peeler not working and food stocks not being strictly rotated in date order. We were impressed by the managers efforts to provide a ‘cinema’ room in one of the conservatories so as to make positive use of television and videos – replacing the constant television in small lounges that on-one seems to be watching. Areas of strength include the spacious accommodation and generally good standards and facilities available for residents. Matters requiring improvement include the need to continue refurbishment; to deal with issues of safety including water, fire safety and hygiene. This section, about the environment, is assessed as adequate. Tower Bridge Care Centre DS0000007047.V369646.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 27 to 30: People using this service experience poor quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has good recruitment practices in place but residents cannot be assured there are always enough staff, with the necessary skills, so as to provide the care they need and to protect residents from harm. EVIDENCE: It is very disappointing for residents, and for the managers, that many staff are very skilled, kind, caring and diligent but some are not. Our inspection of Tower Bridge in August was our third visit to this care home in 2008. During the course of the year we have received several criticisms pf staffing and staffing levels so when we visited in April the manager provided us with the proposed minimal levels of staffing that would meet the needs of residents and, since there are no nationally agreed staff to resident ratios, it is for the manager to ensure there are sufficient numbers of staff on duty to meet residents needs. Floor Daytime 8 am to 8 pm Nights 8 pm to 8 am Ground 5 carers, including the person in charge 3 carers (PIC) of the floor. First 2 Nurses and 5 carers (inc. PIC). 1 Nurse and 3 carers Second 2 Nurses and 5 carers (inc. PIC). 1 Nurse and 3 carers Third 5 carers (inc. PIC). 3 carers. There were when we visited in August 22 vacancies so staffing levels will be reduced a little to reflect reduced number of residents. Our concern on the day Tower Bridge Care Centre DS0000007047.V369646.R01.S.doc Version 5.2 Page 20 of inspection was that a carer had not arrived for duty and was absent without explanation. It therefore took some hours for a replacement to be put in place. This problem was compounded by the absence of another carer who was on escort duties. Staff have complained, albeit anonymously, that there are insufficient staff on duty, particularly at weekends they say, and we acknowledge that it can be demoralising for those who are punctual and dependable to be let down by those who are unexpectedly absent. The manager has in place a ‘return to work’ procedure and deals with staff who are regularly absent. It remains the case that staff do not reflect the ethnic background of the majority of residents and the managers advises us that this is largely because the workforce in her area is made up of people from a variety of minority ethnic groups. So although a questionnaire we received earlier in the year said, “I would like (my relative) to be cared for by staff from the same ethnic background and same gender (as indicated in regulation 12.4)” there seems little likelihood this can be achieved in the short term – although male staff are employed to offer a choice in respect of gender. The manager is aware of this problem and has arranged training for staff in understanding the social and cultural norms in England. We also acknowledge some good practice in particular a middle-Eastern resident has been getting support apposite to his background. Staff agreed that they were able to access training to help them fulfil their roles. One new member of staff described the induction programme that she was undertaking and said how good it was. She was also able to confirm that appropriate pre-employment checks had been completed prior to her starting work. Comments received by staff relate to the difficulty of managing the rotas with staff shortages occurring at short notice. Some bank staff were said to be not satisfactory. All staff we spoke to confirmed updates in statutory topics including abuse. Those staff interviewed demonstrated a working knowledge of infection control procedures and dealing with Dementia. In respect of recruitment of staff we checked this year that all the necessary checks are being made including police [CRB], references, health and qualification checks. Staff training is in place and the staff we spoke to confirmed this. The staff files are well managed and indexed so as to be able to check correct procedures are being followed for each appointment. Staff induction is arranged for and staff are receiving supervision. The managers advise us that she employs 90 care staff, including nursing staff, and three have been referred to the POVA list (as being unsuitable to work with vulnerable people). Areas of strength include the safe recruitment of staff, their induction, training and supervision. Matters requiring improvement include the need to ensure staff have the skills to communicate with residents and that they are being deployed at all times in sufficient numbers to meet the needs of residents. Since the outcome for residents at the moment is that they feel that communication with staff is poor and their needs are not being fully met because there are not enough staff on duty at all times and because a number have been disciplined for poor practice this section about staffing remains assessed as poor. Tower Bridge Care Centre DS0000007047.V369646.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 31, 33, 35, 37 and 38: People using this service experience adequate quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. We are confident that the new manager have the skills to manager this service but we cannot assure residents that all standards are being met to an acceptable level. EVIDENCE: We know, from the anonymous correspondence we receive, it can be very disturbing for residents and relatives, and those supporting them, to hear about any lapses in the care being provided to a very vulnerable group of residents and we share that concern. However unwelcome these incidents are we are confident that the home is cooperating fully with the Social Service Care Managers, and the Police in some cases, to address and remedy matters when fault is identified – and it is not always the case that the home is at fault, some complaints are not substantiated and others partly so. Tower Bridge Care Centre DS0000007047.V369646.R01.S.doc Version 5.2 Page 22 We conclude that for many residents, most of them, their experience in Tower Bridge is quite positive; they get on well with the staff; the staff are described as kind and caring and the environment is mostly safe and secure. As we explained in our earlier report the new manager has been in post since January 2007. She has a nursing background and has the Registered Manager’s Award. She has worked in, and managed, services for older people since 1982. She is keeping her skills up-to-date through the internet, professional publications and attendance at local providers forums run by the Care Homes Support Team. We are advised that deputy manager is about to be employed to support the manager, we also recommend that each unit manager, one on each floor, is given some supernumerary time to ‘manage’ staff and attend to their responsibilities for example to work alongside staff and support/supervise and act as role model. This is not always possible if they are fully occupied as nurse or carer. In January when we asked for written comments we received a range of responses, from very positive to neutral and some critical. We received very few written comments this time but the residents and visitors we spoke were complimentary – acknowledging how difficult it was sometimes to care for people with advanced dementia and telling us how kind staff were. We checked records including the visitors’ book, medication, residents’ files, complaints and so forth. Record keeping remains proficient. We have identified, in an earlier section about the premises, a number of safety issues including fire safety, hygiene, security and the general fabric of the building – we have been given assurances that any safety maters will be addressed without delay, indeed the hot water in one bathroom was dealt with immediately and we are confident other matters will be dealt with promptly and effectively. Areas of strength include the commitment of managers to resolve outstanding matters including the quality of staff, their training and support; the improvements made to address shortcoming identified in previous inspections and the high regard in which the manager is held – it is the general consensus of those we spoke to that this home is, “Going in the right direction” that is, improving all the time. Matters requiring improvement are listed in other sections of this report and include a number of safety matters such as kitchen hygiene, fire safety, water safety, machine maintenance, staff numbers and so forth; all these points are of course matters reflecting the overall management of the service. We commend the home for having addressed the requirements arising earlier in the year and note although similar ones have arisen again they do not reflect a lack of action on the part of the home and owners to deal with issues identified at that time. This section, about management and administration, is assessed as adequate. Tower Bridge Care Centre DS0000007047.V369646.R01.S.doc Version 5.2 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: Good Standard No Score 1 2 3 4 5 6 ENVIRONMENT: Adequate Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE: Adequate Standard No Score 7 2 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES: Good Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION: Adequate Standard No Score 16 3 17 X 18 2 2 2 X 3 X X X 2 STAFFING: Poor Standard No Score 27 2 28 1 29 3 30 2 MANAGEMENT AND ADMINISTRATION: Adequate Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X 3 2 Tower Bridge Care Centre DS0000007047.V369646.R01.S.doc Version 5.2 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. Standard 1 OP7 OP8 Regulation 15(2)b Timescale for action Care Plans: must be revised so as 30/10/08 to include such details of each resident’s personal history that they wish to be recorded; this is so that staff will have a better understanding of their needs. Protection of vulnerable adults: 30/10/08 The home must take all reasonable steps, including the training and supervision of staff, to ensure the safety and well being of residents so they are protected from abuse. Staff skills: staff must have, or be 30/10/08 trained to acquire, the communication skills and a better understanding of cultural background of residents so as to be able to communicate with residents at a level of understanding that will enable proactive support of residents. We note that training in this area is planned for but the requirement is restated. Staff numbers: when staff are 30/10/08 absent for whatever reason they DS0000007047.V369646.R01.S.doc Version 5.2 Page 25 Requirement 2 OP18 OP28 13(6) 3 OP27 OP30 18 and 12(4)b 4 OP27 18 Tower Bridge Care Centre must be replaced without delay to ensure adequate numbers of staff are on duty at all times including, weekdays, nights and weekends. 5 OP38 13(4)a Health and safety: Residents must 30/10/08 be protected from hazards such as hot water at baths. Fire safety: the premises must be 30/10/08 maintained safely by ensuring all fire doors close full and not wedged open. This is so residents are protected from fire hazards. Fire Safety: The smoke detector in 30/10/08 the central stair well (and the overhead light) must be replaced so as to ensure it will be fully operational at all times so residents are protected from fire hazards. Equipment: Must be repaired or 30/10/08 replaced without delay including washing machine and potato peeler. Water safety: Hot water must be 30/10/08 regulated with a suitable fail safe device in areas used by residents such as baths and showers so as to protect residents from risk of scolding and burns. Kitchen hygiene; The cook must 30/10/08 ensure that people do not enter the kitchen when food is being prepared unless suitably attired in clean, white kitchen overalls. Complaints: The home must supply 30/10/08 to the Commission a summary of complaints including safeguarding referrals and the outcome of investigations since January 2008. 6 OP38 23(4)(4A) 7 OP38 23(4)(4A) 8 OP38 23(2)c 9 OP25 13(4)c 10 OP38 16(2)j 11 OP18 22(8) Tower Bridge Care Centre DS0000007047.V369646.R01.S.doc Version 5.2 Page 26 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 OP1 Good Practice Recommendations Statement of Purpose: The home is recommended to update its statements of purpose so that it reflects the agreed changes to the registration and must supply the Commission with a revised version; this is so residents and others will know what accommodation is provided and to whom. It is recommended that ‘forced’ ventilation, such as an extractor fan, is fitted in the laundry area so as to reduce need to hold fire doors open for purposes of ventilating laundry rooms. 2 OP26 Tower Bridge Care Centre DS0000007047.V369646.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Tower Bridge Care Centre DS0000007047.V369646.R01.S.doc Version 5.2 Page 28 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!