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Inspection on 22/01/07 for Tower Bridge Care Centre

Also see our care home review for Tower Bridge Care Centre for more information

This inspection was carried out on 22nd January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Service users` needs are assessed before admission to the home and there are opportunities for them and their relatives to visit the home. Service users and their families report that they are treated with respect and dignity and the home facilitates good contact with relatives and friends. Risk assessments are generally good as are health and safety provision. Food provision is generally good and the service users live in accessible home with ample personal and communal space.

What has improved since the last inspection?

Unfortunately there has been a marked deterioration in most aspects of the running of the home since the last inspection. Two areas that have however improved are the assessment of risk and the interactions between staff and service users. There has also been some good training on dementia care although this needs to be spread throughout the staff group.

CARE HOMES FOR OLDER PEOPLE Tower Bridge Care Centre Tower Bridge Care Centre 1 Tower Bridge Road Southwark London SE1 4TR Lead Inspector Pam Cohen Unannounced Inspection 22nd January 2007 10:00 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 Tower Bridge Care Centre DS0000007047.V327858.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.V327858.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 Care Home 128 Category(ies) of Dementia (3), Dementia - over 65 years of age registration, with number (0), Mental disorder, excluding learning of places disability or dementia (1), Mental Disorder, excluding learning disability or dementia - over 65 years of age (0), Old age, not falling within any other category (0), Physical disability (0), Physical disability over 65 years of age (0) Tower Bridge Care Centre DS0000007047.V327858.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 7. on the first floor, 34 patients, frail elderly persons aged 60 years and above (female) and 65 years and above (male) to include one female resident aged 46 years and above on the ground floor, 29 residents aged 65 years and above with dementia on the second floor, 33 patients, elderly persons aged 60 years and above (female) and 65 years and above (male) with mental health disorders and/or dementia on the third floor, 31 residents with dementia, and/or persons with mental health disorders on the second floor, 1 patient, 54 years and above (female) with dementia As agreed on 19/06/2006 one Service user, 57 years and over, with a mental disorder can be accommodated on the second floor Two (2) service users under the age of 65, with dementia, can be accommodated. 27th June 2006 Date of last inspection Brief Description of the Service: Tower Bridge Care Centre is a large purpose-built home, over four floors, with rooms for 128 older people, the majority of whom have single rooms with ensuite toilet and basin. The ground floor provides residential care, but is now changing over to provide care for people with dementia. The first floor is for people who need nursing care and the second for people with dementia who need care of a nursing level. The top floor is for people with dementia whose needs are of a residential level. There is ample communal space on each floor and a small garden. There is car parking space at the front of the building and a small garden to the side. On the day of inspection there were 9 vacancies. The fees for the home range from £492 to £700 a week. Tower Bridge Care Centre DS0000007047.V327858.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector visited the home for an additional visit on the afternoon of 7th January. At that visit she spoke to a number of service users and their visitors and looked at care plans and medication. What she saw gave her sufficient concern to arrange a full inspection for the day of 22nd January. On that day the inspector met with the area manager, the new manager (for whom it was her first day in post) and the deputy manager. She toured the building, inspected documentation and care plans and spoke to staff and service users. She was also able to talk with the tissue viability nurse who was visiting. What the service does well: What has improved since the last inspection? What they could do better: Care planning, health care and administration of medication need to improve. Activities are not varied enough, are not made available to enough service users and there is a lack of activity geared to service users with dementia. Those service users with dementia are also not living in an appropriate environment. All complaints must be properly investigated and recorded. The home is deteriorating in terms of the fabric of the building, the furnishings and the decoration and service users do not have all the facilities they should in their rooms. They are also not enabled to have access to their personal allowances. Training, supervision and deployment of staff must improve. Tower Bridge Care Centre DS0000007047.V327858.R01.S.doc Version 5.2 Page 6 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.V327858.R01.S.doc Version 5.2 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 Tower Bridge Care Centre DS0000007047.V327858.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3,4,5,6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users’ needs are assessed before admission to the home and there are opportunities for them and their relatives to visit the home. Service users who suffer from dementia can still not be sure that their needs for specialist care will be met. EVIDENCE: Prospective service users and their relatives are given opportunities to visit the home and a service user recently admitted to the home confirmed that this had happened. All service users are assessed by a senior member of staff before admission and brief draft care plans drawn up and put on file. The home has not progressed work to ensure that it can meet the specialist needs of the majority of service users who suffer from dementia. Some training has been delivered but this has not yet produced improvement in care planning or activities. Appropriate advice has not yet been taken on how to adapt the environment to orientate and stimulate service users with a Tower Bridge Care Centre DS0000007047.V327858.R01.S.doc Version 5.2 Page 9 dementia. As a result the units are still confusing, bland places and do not yet even have reality orientation boards which are a basic tool for working with this service group. The home does not provide intermediate care. Tower Bridge Care Centre DS0000007047.V327858.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users cannot be sure that all their needs are detailed in their care plans. They cannot be sure that all their health care needs are met and medication administration procedures are not always safe. Service users and their families report that they are treated with respect and dignity. EVIDENCE: Care plans were checked on all floors, and whilst a few were good, most were not. In general they did not cover service users’ social and emotional needs, or the behaviours and support needs that come with dementia. One service user had been admitted to the home because of mental health needs but there was nothing in the care plan about these. Most care plans did not have life histories which enable staff to relate more usefully to service users with dementia. Care plans were often not individual with, for instance, the same actions written down for all service users, and were not detailed enough to ensure that individual care is given. They often did not include such information as what the person likes to eat and drink, what time they like to Tower Bridge Care Centre DS0000007047.V327858.R01.S.doc Version 5.2 Page 11 get up and go to bed, and details of how they like personal care to be given. The care plans of three service users who had been admitted over the past 6 weeks were seen and their care plans had did not cover most necessary areas. There was also little evidence of care plans having been drawn up with service users and their relatives. One area that has improved is in the drawing up of risk assessments, where risk had been perceived and assessed. This is now good in all areas of physical risk to the service users but still needs to be improved where challenging behaviour on the part of service users may put staff or other service users at risk. Staff must also ensure that they work to risk assessments. One ladies assessment said clearly that she must have proper footwear on to prevent the risk of falls, however on the morning of inspection her footwear put her at considerable risk. Health care provision seems to have deteriorated since the last inspection. The basic monitoring is still going well. However this is not always being followed through by appropriate referrals to other professionals. One service user had been admitted to hospital the month before the inspection, having suffered from fits, however this was not noted on her file and there was no monitoring for fits, or care planning of what action should be taken. The tissue viability nurse who was visiting felt that good care was still happening on one nursing floor, but that it had deteriorated on the other. There were several concerns about medication administration. On the first visit by the inspector, one service user was found to have suffered from maladministration of medication because of mistakes in writing charts, and other nursing staff not following proper procedures. The home took prompt action to remedy these failures and deal with staff. On the second visit medication that should have been administered at 9am was still being administered at 11.30. This is not good practise. There is also no audit trail for medication that the GP was reported to have asked to be stopped. One medication had been stopped apparently because the GP wanted to monitor the effects of not having the medication, however this had not been noted on the file and no monitoring was being recorded. During both visits, staff and service users were positive about the care given to them; one visitor said that staff are “kind and polite.” Positive interactions were seen between staff and service users. The deputy manager said informal training in the area of treating service users with respect and dignity had taken place and that formal training in customer care would be happening. There are still some institutional practises however, which do not reflect respect and dignity for service users. One is the use of blue plastic aprons at meals. The other is inadequate provision of personal toiletries. Tower Bridge Care Centre DS0000007047.V327858.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home facilitates good contact with relatives and friends. Activities are not varied enough, are not made available to enough service users and there is a lack of activity geared to service users suffering from dementia. Food provision is generally good, although the time of breakfast serving is not appropriate for service users’ needs. EVIDENCE: Although both activities organisers are now working, and although the inspector saw examples of staff working to provide activity and stimulation for service users the findings from the last inspection can mostly be restated. The programme of activities is still not sufficient in amount or variety; it contains no activities for Saturdays and Sundays. There are brief notes of most service users’ interests in an activities file, and records of what activities they have taken part in over the month. However, most have only taken part in a few because activities are not being provided in the home in a way that engages more than a very small percentage of the service users. More thought is needed in order to increase both the amount and variety of activities offered; this is particularly important for service users with dementia who need Tower Bridge Care Centre DS0000007047.V327858.R01.S.doc Version 5.2 Page 13 a high level of stimulation and orientation and are not being offered this. One relative complained about the lack of trips out, and indeed there had only been two during the year - one to the seaside in the summer and one to see the London lights. As before, service users are able to have visitors at all times and families spoken to were happy with the arrangements for keeping contact with their relatives. Service users within the home have a variety of different lifestyles and are able to bring in personal possessions as appropriate. Food provision is generally good and service users were seen to be enjoying their food. However there continues to be no evidence in the home that the menus are based on service users’ wishes and there is still not a real system for choice of main meal. There were two choices on the menu, but one was changed during the morning. Staff said to the inspector that service users are not given choice before hand but are shown both meals and asked to choose. The inspector did not see this happening. It would also seem that if all service users chose one meal this would run out and they would have to have the other. On the second day of inspection breakfast did not start being served until 9.45. This is too late for service users who will have eaten an early supper the night before and who may have been up early. A service user complained that this was happening more often lately. She said that she has to have insulin half an hour before a meal. As breakfast should be served at 9 she administers it at 8.30. This means that when breakfast is delayed she is at risk in terms of her blood sugar levels. Tower Bridge Care Centre DS0000007047.V327858.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users cannot be sure that their complaints are always properly investigated. The home is working to protect service users but must ensure that it always reports properly allegations of abuse. EVIDENCE: The home has a complaints policy and procedures. Some of the complaints in the folder held by the manager were well investigated. However, it is of concern that a complaint which the commission received from a relative, who said that they had also complained to the manager, was not recorded. Another complaint which the inspector had spoken to the manager about and had received an assurance that it was being investigated, was also not recorded. In the six months since the last inspection the commission had received six complaints about this service. There is a vulnerable adults policy and an ongoing training programme for staff to have training on this issue. Since the last inspection there have been three allegations of adult abuse and it is of concern that the last one was not reported to the commission. Tower Bridge Care Centre DS0000007047.V327858.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A modern home is deteriorating in terms of the fabric of the building, the furnishings and the decoration. Service users do not have all the facilities they should in their rooms and the environment has not been adapted to be suitable for service users suffering from dementia. The home is safe throughout. EVIDENCE: The home is a purpose built four-storey building close to public transport, shops, cafes and pubs. The home together with the grounds is fully accessible. There is a large car park with a small front garden and side garden adjoining it. These are the only outside spaces and are in need of planting and upkeep. The floors are large, with over 30 rooms, and each has been split into two units. Each floor has two lounges and a dining room and the front lobby also has a seating space. The communal areas are generally clean, bright and pleasant and all areas were seen to be safe. Tower Bridge Care Centre DS0000007047.V327858.R01.S.doc Version 5.2 Page 16 The three units providing dementia care are still not providing environmental adaptations required to orientate and stimulate service users with dementia and the home has not yet obtained the professional advice needed to obtain this. Maintenance is a continuing problem and the home and its furnishings are deteriorating. The inspector saw drawers and cupboards broken with doors hanging off. Relatives reported to her such things as broken chairs and a broken bed. The facilities manager who had been appointed to address these issues is no longer employed. Service users’ rooms were generally of a good size and personalised and those asked said that they were pleased with their rooms. They have en-suite toilets and there are also bathrooms with some assisted baths on each floor, as well as walk in showers. Both the service users’ bathrooms and the other bathrooms are in needs of renovation. It was also noted that most toilet roll holders could not be reached when sitting on the toilet and these must be re-sited properly. Most service users’ rooms still have only one chair, so that they cannot properly entertain visitors. It was also noted that some bedclothes continue to be of extremely poor quality and some beds were lacking a sheet, or a blanket or a pillowcase. Service users had a lockable space but one service user who had been newly admitted said that he had not been offered a key to this and so had nowhere to put any valuables. The en-suite bathrooms still do not have cabinets or tooth mugs, with the results that toiletries cannot be properly stored. Service users did not always have access to a bedside light. There are systems in place to prevent the spread of infection. However on the day of inspection there were several areas around the home that had a bad odour and a relative reported that over Christmas she had noted that carpets were soiled and the lounge on the first floor was smelly. Tower Bridge Care Centre DS0000007047.V327858.R01.S.doc Version 5.2 Page 17 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): 27,29,30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is evidence that the numbers or the deployment of staff is not happening in such a way as to meet the needs of the service users. Recruitment is generally good but care must be taken over the obtaining and vetting of references. The level of training within the home means that service users cannot be sure that staff are competent to do their jobs. EVIDENCE: The rotas showed that showed that the home is fully staffed, although it was seen that at one time during the past fortnight a member of staff had worked unacceptably long hours. However relatives continue to report that there is not adequate staff time available. One relative who visits the home every day said, “there is not enough staff” and that because of this care is deteriorating. Another said, “Staff are kind and polite but often short of time.” On one floor a member of staff said that they were not able to operate a key worker system or properly write care plans because they did not have enough time. The fact that breakfast was not being served until 9.30 and that breakfast medication was still being administered at well past 11am would also seem to show that there is a problem. The home’s recruitment procedures are generally good but they must ensure that there are no unexplained gaps in employment. They must also ensure Tower Bridge Care Centre DS0000007047.V327858.R01.S.doc Version 5.2 Page 18 that they always get a reference from the applicant’s last employer as a file was seen that did not have this. Training has deteriorated since the last inspection. The fact that new members of staff have not been receiving induction or foundation training to NTO specification is of particular concern. Training on dealing with dementia is being accessed but there is still only a percentage of staff who have received this. There is no training and development plan and records showed that there was a very low level of training happening. Not all staff were recorded to have done the basic health and safety training needed and there was very little training happening on the specific needs of service users. Tower Bridge Care Centre DS0000007047.V327858.R01.S.doc Version 5.2 Page 19 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): 31,33, 35,36,38.Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home was without a manger for some weeks over Christmas and there has been a quick turnover of the past two managers. Quality assurance is happening on a limited basis, but this needs to increase to ensure that the views of all stakeholders are obtained. Service users are not being enabled to access their money if this is appropriate. They are not at the moment being supported by adequately supervised staff. EVIDENCE: The registered manager who was present at the last inspection and who was in the home for about a year, left suddenly over the Christmas period. The inspection was held on the first day of a new manager and so her competence could not be assessed. Tower Bridge Care Centre DS0000007047.V327858.R01.S.doc Version 5.2 Page 20 The home is not yet producing an annual report based on the views of the service users and other stakeholders. There is an annual business plan and this could well be developed to become more focussed on outcomes for service users. At the moment it was reported to the inspector that there are no service users who have access to their personal monies. This is not part of care planning and the home must develop policies and procedures to enable service users to hold money if they wish to and are able. Supervision is not happening on a regular basis and the files seen for staff showed that they had only had one or two sessions in the past twelve months. Health and safety systems seen were good. Tower Bridge Care Centre DS0000007047.V327858.R01.S.doc Version 5.2 Page 21 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 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 3 2 2 X 2 X 2 STAFFING Standard No Score 27 2 28 X 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 1 1 X 3 Tower Bridge Care Centre DS0000007047.V327858.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? YES 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 Timescale for action 15(1) The registered person must 31/03/07 ensure that management input is provided to ensure that care plans adequately reflect the range of service users’ needs and adequately document how they will be met. Target dates of 01/02/05 and 31/7/05 and 31/03/06 not met. At the last inspection it was noted that continued failure to comply may result in consideration being given to enforcement action. The target date of 31/10/06 not met. 13(4)(b,c) The registered person must 31/03/07 ensure that risk assessments cover the area of challenging behaviour. 12(1)(a,b) The registered person must 31/03/07 ensure that prevention and treatment of pressure areas is of a good standard. 13(2) The registered person must 28/02/07 ensure that procedure is followed to ensure safe administration of medication. 13(2) The registered person must 28/02/07 DS0000007047.V327858.R01.S.doc Version 5.2 Page 23 Regulation Requirement 2. OP7 3. OP8 4. OP9 5. OP9 Tower Bridge Care Centre 6. OP9 7. OP10 8. OP12 9. OP12 10. OP15 11. OP15 12. 13. OP16 OP16 ensure that recording is kept that shows that any medication that is no longer administered, has been stopped by a medical practitioner. 12(1)(a,b) The registered person must ensure that any instructions from a medical practitioner are recorded and followed. 12(4)(a) The registered person must ensure that institutional practises do not impact on the dignity of service users. 12(4)(b) The registered person must ensure that there are a sufficient number of activities specially designed for service users who suffer from dementia. Target date of 30/06/06 and 30/11/06 not met. 16(2) The registered person must (m,n) ensure that a programme of activities is arranged and delivered to give all service users adequate recreational activities. Target date of 30/11/06 not met 12(1)(a) The registered person must ensure that service users’ likes and dislikes regarding food are recorded in their care plan and that this informs the food they are given at all times. Target date of 31/10/06 not met. 16(2)(i) The registered person must ensure that breakfast is served at the stated times to protect the nutrition and health needs of service users. 22(3) The registered person must ensure that all complaints are investigated and recorded. 37(1)(g) The registered person must ensure that they inform the commission of all notifiable incidents which includes allegations of abuse. DS0000007047.V327858.R01.S.doc 28/02/07 31/03/07 30/04/07 30/04/07 31/03/07 28/02/07 28/02/07 28/02/07 Tower Bridge Care Centre Version 5.2 Page 24 14 OP19 23(2)(b) 15 OP21 16(2)(c) 16. OP22 23(2)(a) 17. OP24 16(2)(c) 18. OP24 16(2)(c) (d) 19 OP26 23(2)(d) 20 OP27 18)(1)(a) 21 OP29 19 sch 2 The registered person must ensure that the fabric of the home is properly maintained Target date of 31/10/06 not met. The registered person must ensure that toilet roll holders are placed so that they can be reached from the toilet. The registered person must ensure that professional advice is taken about suitable environmental adaptations needed to orientate and stimulate service users with dementia. This advice must be sent to the Commission. Target dates of 30/04/06 and 31/10/06 not met. The registered person must ensure that service users’ rooms have two comfortable chairs, suitable bed linen and a bathroom cabinet and tooth mug. Target dates of 31/03/06 and 30/09/06 not met. The registered person must ensure that service users are offered a key to their room and the lockable space in the room. This to be subject to risk assessment if needed. The registered person must ensure that the home is kept clean and free of odour at all times. The registered person must ensure the numbers and deployment of staff meets the need of service users. Target date of 30/09/06 not met. The registered person must ensure that the recruitment procedure is thorough and that in particular a reference is always sought from the DS0000007047.V327858.R01.S.doc 31/03/07 31/03/07 30/06/07 31/03/07 31/03/07 28/02/07 31/03/07 28/02/07 Tower Bridge Care Centre Version 5.2 Page 25 22 OP30 18(1) 23 OP30 18(1)(c) 24. OP30 18(1)(a) 25. OP33 24(1)(a) (b)(2)(3) 26. OP35 12(2) 27 OP36 18(2) applicant’s last employer The registered person must ensure that new staff have induction and foundation training to the specified standards. The registered person must ensure that there are individual training plans, and a plan for the home, to ensure that all training needed for health and safety and to meet the needs of service users, is provided. The registered person must ensure that staff have training to enable them to meet the specialist needs of service users suffering from dementia. As only a percentage of staff have received this training the requirement will stand. Target dates of 30/06/06 and 31/12/06 not met The registered person must ensure that and an annual report of quality monitoring undertaken, is produced. Target date of 31/12/06 not met The registered person must ensure that there are systems in place for service users to have access to their personal allowances where appropriate. Target date of 31/12/06 not met. The registered person must ensure that formal supervision of proper quality and quantity is carried out. This requirement has been reworded. Target dates of 30/06/06 and 31/10/06 not met 28/02/07 30/04/07 30/06/07 30/06/07 30/06/07 30/04/07 Tower Bridge Care Centre DS0000007047.V327858.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. 2. 3. Refer to Standard OP15 OP20 OP33 Good Practice Recommendations It is recommended that the manager monitors to ensure that service users are being given a real choice of main meal. It is recommended that consideration be given as to how to improve the garden areas. It is recommended that the annual development plan is more focussed on outcomes for service users. Tower Bridge Care Centre DS0000007047.V327858.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection SE London Area Office River House 1 Maidstone Road Sidcup DA14 5RH 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. 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