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Inspection on 22/11/05 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 November 2005.

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

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

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

The home offers good accommodation to service users and care is offered by a motivated staff group. There are activities which service users enjoy and food is homemade and good. Contact with service users` families is good and any complaints they or the service users make are well investigated.

What has improved since the last inspection?

In the past year there have been real improvements in the quality of life for service users in the home. Early indications show that the new manager is determined to continue to drive standards up and has the competency to achieve this. The pharmacy inspector considered that medication administration continues to improve at the home and infection control has improved. The new care plan format offers a good opportunity for care planning to improve.

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 10:00 22 & 24 November 2005 nd th 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 DS0000007047.V256586.R01.S.doc Version 5.0 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. DS0000007047.V256586.R01.S.doc Version 5.0 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 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 Miss Lorna Ainsworth Care Home 128 Category(ies) of Dementia - over 65 years of age (0), Mental registration, with number Disorder, excluding learning disability or of places 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) DS0000007047.V256586.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 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 third floor, 31 residents with dementia, and/or persons with mental health disorders on the second floor, 34 patients, elderly persons aged 60 years and above (female) and 65 years and above (male) with mental health disorders and/or dementia 9th May 2005 Date of last inspection Brief Description of the Service: Tower Bridge Care Centre is a care home with nursing which offers a service to a maximum of 128 service users. The accommodation is purpose built over four floors. The ground floor and top floors are residential units for older people with dementia. The first floor is a general nursing floor and the second floor gives nursing care to elderly mentally infirm service users. At the time of inspection there were six vacancies. The front of the building faces onto a busy road and major traffic roundabout. There is a large car park to the front, a small seating area and a small enclosed garden to the side. The home is close to a range of shops and public transport. DS0000007047.V256586.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over two days on 22nd and 24th November 2005. The lead inspector was accompanied by a second inspector and by a pharmacy inspector. The manager and all the staff were helpful throughout and the inspectors had the opportunity to speak to a large number of service users, some relatives and two visiting professionals. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. DS0000007047.V256586.R01.S.doc Version 5.0 Page 6 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 DS0000007047.V256586.R01.S.doc Version 5.0 Page 7 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): 3,4. The home does not offer intermediate care Service users who move into the home cannot be sure that all their needs have been assessed. If they suffer from dementia, they and their relatives cannot be sure that their needs for specialist care are met EVIDENCE: Staff from the home assess the needs of prospective service users before they come to the home, in order to decide whether they can meet those needs. However, the assessments lack social history and social needs such as communication, family interactions, hobbies and activities. There was also an example of behaviour being described as “hostile and aggressive” but with no note of how this manifested itself or how it could be supported. A relative confirmed that they had been present at the assessment before their mother came into the home The home does not meet the specialist needs of the 75 of service users who have dementia. There were no environmental adaptations that might help orientate people. There was little stimulation either visual or through suitable activities. Care plans that were seen for service users who had dementia did not detail the effects their dementia had on their daily living skills, nor how DS0000007047.V256586.R01.S.doc Version 5.0 Page 8 best to help them. Many of the staff supporting service users with dementia had no significant training in this area. DS0000007047.V256586.R01.S.doc Version 5.0 Page 9 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): 7,9,10. Service users cannot yet be sure that their social and emotional needs and their needs for specialist dementia care will be met through the care planning process. Whilst their needs for privacy are met there is evidence that not all staff understand service users’ needs for respectful interactions. EVIDENCE: The manager said that a new care plan format was being introduced in the home. Those care plans seen, however, did not cover all aspects needed to provide care to service users. They were often good when detailing physical care needs with assessment of areas such as continence, nutrition, dental care, sleep patterns and visits to professionals such as optician or chiropodist. The home is also working with the GP to reduce falls. However, there was little note taken of the social or emotional needs of service users and few life histories. There was also no evidence of using care plans to improve the quality of life of service users by incorporating professional expertise or carers’ knowledge and experience. For instance, one service user has complex needs for emotional care and during the inspection was crying in her room. Her care plan had no strategies for helping her and although a lead nurse knew different strategies which worked on different days, this knowledge was not being recorded on the care plan so that it could be used. The result is that it was DS0000007047.V256586.R01.S.doc Version 5.0 Page 10 recorded on the daily notes that the service user was “crying all day”. On the third floor which is for people with dementia, the care plans did not detail their dementia or how to deal with the behaviour it caused. There was also little awareness of the need to assess the social and emotional needs of service users with dementia and how to meet these needs. Relatives spoken to said they had not been part of the care planning process. The CSCI’s pharmacy inspector reviewed the medication issues in the home. She found that generally there was an improvement but that there were some issues that needed addressing. She is writing a separate report that will be sent to the home. The home works to ensure privacy for its service users with lockable bathrooms and bedrooms. Staff were generally respectful to service users. However, one cleaner was seen to mimic the crying behaviour of a service user. One relative told an inspector that when her aunt rang for help some carers would respond badly to this and ask her accusingly “what are you ringing for now?” DS0000007047.V256586.R01.S.doc Version 5.0 Page 11 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): 12,13,15 The home facilitates good contact with relatives and friends. Varied activities are being developed but service users suffering from dementia still lack activities geared to their needs. Food is good, but service users do not always get the help they need to eat it. EVIDENCE: The home has two activities organisers although one has been off sick for some time. The manager hopes to develop activity link workers on each floor leaving the organisers to act as facilitators to help all staff provide one-to-one support. There was evidence of the new care plans starting to record service users’ interests but there is still a lot of work to be done in this area. There are group activities and outings. There have also been initiatives to bring in people from the community such as beautician students, entertainers and church representatives. There was little evidence of activities geared towards the needs of the service users with dementia and this is an area of expertise which will have to be improved on. Contact with families is good and visitors are free to come and go as they please. Two of the inspectors sampled the lunch and found it to be tasty, wholesome and nutritious. Food is homemade and with good portion sizes but there is limited service user choice. Menus go across the group and for a home in Peckham this means limited ethnic food provision, even though the area has a large ethnic minority elderly population. One service user’s son requested DS0000007047.V256586.R01.S.doc Version 5.0 Page 12 African-Caribbean food for his mother but was told this was only possible two or three times a week. Service users did not tend to know what meal they would be having; there were no menus in sight and carers were not good at telling them. On the second floor, service users were taken to the tables an hour before the food was served. On this floor carers were good at supporting service users to eat if needed, with good interaction. However, on the first floor this was not the case. At lunchtime a significant number of service users had nothing to eat because no one helped them. One care plan made it clear that a carer needed to sit next to a lady to help her eat but no-one did and so she was seen trying to eat mashed potatoes with her fingers. Plates were taken away untouched with no comment. One lady had her food taken to her bedroom but 30 minutes later no one had arrived to help her eat it. DS0000007047.V256586.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. The home is responding well to complaints. It is also working to protect service users from abuse but needs to be clear that unnecessary safety measures can be a form of restraint. EVIDENCE: The home responds promptly, in writing, to complaints both raised directly with the manager or through the CSCI or Southwark Social Services. It would be better if the responses made clearer whether elements of complaints were upheld or not. Southern Cross has an adult protection policy and some training has been provided for staff on working with vulnerable adults. This training needs to be given to all staff and the manager is intending to do this in conjunction with Southwark Social Services. It is of concern that the relative of a service user reported that the first night her aunt was in the home two chairs were put against her bed to keep her in. The reason for this is not clear, as she had no history of falls and is claustrophobic. There were other instances of the use of bed rails where there seemed no clear indication for their use. Bed rails were also used without risk assessments being carried out. The home’s whistle blowing procedure is in the staff handbook and has recently been sent out with staff payslips to ensure that every one sees it. DS0000007047.V256586.R01.S.doc Version 5.0 Page 14 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): 19,20,21,22,23,24,25,26 The accommodation is generally good although work is needed to make it a suitable environment for service users with dementia. EVIDENCE: The home is a purpose built four-storey building close to public transport, shops, cafes and pubs. There is a large car park with a small garden adjoining it. 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. Due to the size of the home and the lack of natural light in the corridors, it is hard to make it homely and bright although efforts have been made and should continue. Such changes, together with environmental adaptations required to orientate and stimulate service users with dementia, should provide a less institutional environment. The communal areas were generally clean, bright and pleasant although the dining room on the first floor was shabby, with no attempt made to cheer it up. Service users in the lounges still need occasional tables to put their hot drinks on The home and grounds are fully accessible. The upper floors are accessed by lifts and two were out of order, leaving only one. One of the lifts had been out DS0000007047.V256586.R01.S.doc Version 5.0 Page 15 of order for some time. Some maintenance problems were noted. On the first floor a toilet and the adjoining room had bad staining, probably from a leak; it was clear it had been there some time. A shower room smelled musty. Service users’ rooms have en-suite toilets. It was noted that toilet doors open outwards which could cause a health and safety hazard. There are bathrooms with some assisted baths on each floor, as well as walk in showers. However, on the first floor two were out of order leaving an insufficient number in use. Rooms were generally of a good size and personalised but not all service users’ rooms had two chairs so that they could properly entertain visitors. On the third floor it was also noted that bedclothes were of extremely poor quality, were not matching sets, the under sheets did not fit, and there were small hard pillows. The home was clean and all systems to prevent the spread of infection were seen to be in order. DS0000007047.V256586.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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, 30 Service users cannot always be sure there are enough staff, with the proper training, to meet their needs. EVIDENCE: The home’s rota showed that several shifts were not fully covered and during the inspection there was a shortfall of staff. Service users’ needs, especially on the two nursing floor, are high and any shortfall will cause problems. A service user said that she often had long waits for help to go to the toilet and is told that it is because the unit is short staffed. There also seems to be a culture of long shifts. The home employs several staff for whom English is a second language and are taking positive steps to provide literacy support in partnership with the GMB union and Lewisham college. This is to be commended. The home has not met the target of 50 of staff trained to NVQ 2 standard and efforts must continue to provide this training. Recruitment practise is efficient with well-kept files with evidence of checks made and systematic interviewing. The manager confirmed that staff do not start working until appropriate checks have been made. She was unclear about the status of two of these checks which are done by the company and agreed to look into this and brief the inspector on her findings. The home’s practise in taking up references does not always have the safeguards to ensure these references are genuine and one member of staff was found to have started with only one reference. The training matrix and discussion with staff showed that not all staff had necessary training in such areas as health and safety and basic food hygiene. DS0000007047.V256586.R01.S.doc Version 5.0 Page 17 Only a minority of staff had had training in the areas of dementia care and dealing with challenging behaviour, even though 75 of service users need specialist dementia care. DS0000007047.V256586.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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): 31,35, 36,38. Service users’ monies are well dealt with. Service user safety is compromised by lack of moving and handling training and formal supervision of staff. EVIDENCE: The manager had been in post for two weeks at the time of inspection, after a period of shadowing the previous manager. She is an experienced and competent manager and during the inspection demonstrated the abilities to manage the care centre. Service users monies were seen to be properly dealt with and in good order. There was evidence that some service users have access to their money and have locked drawers in their rooms if they wish to keep it there. However, assessments and care plans did not address financial issues so it was not clear if all service users who wish and are able to, are supported to control their own finances. The new format of care plans should prompt such assessments. Discussion with the manager and staff confirmed that supervision was not taking place regularly and was not of the required quality. The manager is DS0000007047.V256586.R01.S.doc Version 5.0 Page 19 clear about the need for this and intends to plan implementation of good quality supervision. The home works to ensure the health and safety of service users and staff. However lack of moving and handling training puts both these groups at risk. DS0000007047.V256586.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 2 2 3 2 3 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 2 2 X 2 DS0000007047.V256586.R01.S.doc Version 5.0 Page 21 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 OP3 Regulation 14 Timescale for action The registered person must 31/03/06 ensure that assessments are sufficiently detailed and up to date to provide care appropriate to service users’ needs. Timescales of 22/11/04 and 30/06/05 not met. The registered person must 31/03/06 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. Timescales of 01/02/05 and 31/7/05 not met. The registered person must 31/03/06 ensure that staff are given input on the need to ensure that the principles of dignity, privacy and respect inform all aspects of the work of the home. Timescale of 13/07/05 The registered person must 30/06/06 ensure that there are a sufficient number of activities specially designed for service users who suffer from dementia. The registered person must 28/02/05 DS0000007047.V256586.R01.S.doc Version 5.0 Page 22 Requirement 2 OP7 15(1) 3 OP10 12(4)(a) 4 OP12 12(4)(b) 5 OP15 12(1)(a) 6 OP18 13(7) 7 OP20 23 8 OP21 23(2)(j) 9 OP22 23(2)(a) 10 OP24 16(2)(c) 11 OP27 18(1)(a) 12 OP27 18(1)(a) 13 OP28 18(1)(a) (c) 19(1)(c) 14 OP29 ensure that service users who need help to eat are given timely and proper support. The registered person must ensure that any form of restraint is risk assessed and discussed with the service user, relatives, and interested professionals. The registered person must ensure that service users are provided with support and furniture so that they can safely drink hot beverages while seated in the lounge. Target of 31/07/05 not met. The registered person must ensure that there are sufficient bathing/shower facilities in use on the first floor. The registered person must ensure that professional advice is taken about suitable environmental adaptations needed to orientate and stimulate service users with dementia. The registered person must ensure that service users’ rooms have two comfortable chairs and suitable bed linen. The registered person must ensure that at all times staff work in such numbers as are appropriate for the health and welfare of service users. The registered person must ensure that staff have adequate time off between shifts. Timescale of 30/06/05 not met. The registered person must ensure that plans are in place to ensure that 50 of care staff are trained to NVQ level 2 The registered person must ensure that they can be satisfied on reasonable grounds of the authenticity of references. DS0000007047.V256586.R01.S.doc 28/02/06 31/03/06 05/12/05 30/04/06 31/03/06 02/12/05 31/01/06 30/06/06 28/02/06 Version 5.0 Page 23 15 OP30 18(1)(a) 16 OP36 18(2) 17 OP38 13(5) The registered person must 30/06/06 ensure that staff have training to enable them to meet the specialist needs of service users suffering from dementia. The registered person must 30/06/06 ensure that the manager’s intention to introduce formal supervision of proper quality, is carried through. The registered person must 24/12/05 ensure that an audit of staff mving and handling training is carried out, and any necessary training is given. 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 OP16 OP19 OP21 Good Practice Recommendations It is recommended that it be made clearer, when responding to complaints, whether the complaints made are upheld or not. It is recommended that efforts continue to ensure that the home, and especially the corridors, are homely and bright. It is recommended that the registered manager risk assesses the toilet doors which open outward, and takes any necessary action. DS0000007047.V256586.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH 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 DS0000007047.V256586.R01.S.doc Version 5.0 Page 25 - 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. 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