Inspection on 27/06/06 for Tower Bridge Care Centre

This inspection was carried out on 27th June 2006.

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

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

Other inspections for this house

Tower Bridge Care Centre 27/11/09

Tower Bridge Care Centre 28/07/09

Tower Bridge Care Centre 19/08/08

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 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 09/07/2008.

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 27th June 2006 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.V298397.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.V298397.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 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 (1), Dementia - over 65 years of age registration, with number (0), Mental Disorder, excluding learning of places 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.V298397.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 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 22nd November 2005 Date of last inspection Brief Description of the Service: Tower Bridge Care Centre is a large modern home, over four floors, with rooms for 128 older people, the majority of whom have single rooms with en-suite toilet and basin. The ground floor was for 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 7 vacancies. The fees for the home range from £492 to £653 a week. Tower Bridge Care Centre DS0000007047.V298397.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over the 27th, 28th and 29th June. The manager was on leave and so the deputy manager assisted with the inspection. On the last day the area manager was also present. The inspector had the opportunity to speak to a large number of service users, their visitors, staff and visiting professionals. She returned for a short conversation with the manager on her return from leave. 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. Tower Bridge Care Centre DS0000007047.V298397.R01.S.doc Version 5.2 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 Tower Bridge Care Centre DS0000007047.V298397.R01.S.doc Version 5.2 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): 3,4,6. 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. However, if service users suffer from dementia, they and their relatives cannot be sure that their needs for specialist care will be met. EVIDENCE: All service users are assessed by the home manager or one of her staff before they are admitted to the home. These assessments mean that service users’ care plans can be drawn up on admission to the home. The home does not yet meet the specialist needs of the 75 of service users who suffer from dementia and professional advice is still needed to adapt the environment to orientate people. However, a start has been made on training staff, providing activities and looking, in care plans, at the effect their dementia has on service users’ daily living skills and how best to help them. There are also plans in place to extend these initiatives and some good training in dementia care has been agreed. The home does not provide intermediate care. Tower Bridge Care Centre DS0000007047.V298397.R01.S.doc Version 5.2 Page 8 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Health Care and medication administration in the home is of a good standard. Service users cannot yet be sure that all their care needs will be met through the care planning process. There is also evidence that not all staff understand service users’ needs for respectful interactions and that some institutional practices do not uphold service users’ dignity. EVIDENCE: Care plans were checked on all floors. Some were very good, with individualised, detailed care covering all aspects of need. They also had risk assessments where needed, including how to deal with challenging behaviour. However others seen were not of a good standard. They did not cover service users’ social and emotional needs or the support needs that their dementia brings. They were also not individualised or detailed enough and did not include risk assessments where needed. Throughout the home care plans did not include detailed life histories which are important for service users suffering from dementia. There was also little evidence of care plans having been drawn up with the involvement of the service user or their representative. Generally, care plan reviews did not also cover all areas. Tower Bridge Care Centre DS0000007047.V298397.R01.S.doc Version 5.2 Page 9 The files generally showed good health care provision. Service users’ health care needs are well assessed and recorded. Monitoring of weight, or skin condition was seen to trigger referral to other health care professionals when needed and the specialist advice given is then incorporated into care plans. Nursing care was well recorded. The nurse from the Care Home Support Team did not report concerns about nursing care and was pleased that the home had accessed training in areas where there had been concerns such as medication and nutrition. She considered the home is now doing well in documenting and acting on nutritional needs. Medication administration was checked on all floors and was generally good. Areas highlighted by the pharmacy inspector at the last inspection had been improved on. Some service users and their relatives were positive about care given, a daughter said that her mother has a “ nice relationship with carers” and another said of the carers “they respect her dignity in every way”. There were also some more negative views. On the day of inspection a family were discharging their mother early from a respite placement because she felt a carer had been disrespectful towards her. Another service user, while saying that staff on the whole were very good, also said that “I can’t get used to people being rude to me-some staff don’t say hallo if I talk to them.” Some practices were also noted that do not show thought being given to service users’ dignity. One instance is that at mealtimes they have blue plastic aprons are provided instead of napkins. Another is that provision of appropriate toiletries was seen in many cases to be inadequate, meaning that proper provision of personal care could not be guaranteed. Tower Bridge Care Centre DS0000007047.V298397.R01.S.doc Version 5.2 Page 10 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. 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 and are not made available to enough service users. Those service users suffering from dementia still lack activities geared to their needs. Food is good, but the way the food is served can mean it is not as enjoyable as it should be. EVIDENCE: The home still has only one activities organiser as the other has been sick for over a year; a carer is being used to cover this post. Both members of staff are enthusiastic about their job and both they and care staff sit and take part in one-to-one activities with service users. 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. Most have taken part in very 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 a high level of stimulation and orientation. Relatives who were otherwise very happy with the home said that more activities are needed. Tower Bridge Care Centre DS0000007047.V298397.R01.S.doc Version 5.2 Page 11 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 all service users consulted said that the food was tasty and plentiful. However on the day of inspection the lunch, which is the main meal of the day, was not presented in a manner which enabled service users to best appreciate it. Tables did not have condiments, napkins, water or any drinks on them. The sheets which indicated the choices previously made, were mostly not being used, and service users were being asked what they wanted. However staff did not check what food was on offer, guessed, and were wrong in the choices they offered. Also brown gravy which the cook said was meant to be added to pureed food was put on a white chicken stew. Tower Bridge Care Centre DS0000007047.V298397.R01.S.doc Version 5.2 Page 12 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is responding well to complaints. It is also working to protect service users from abuse. EVIDENCE: The homes’ has a complaints policy and the documentation seen showed that complaints are being properly investigated. The manager also holds a weekly “surgery”. There is a vulnerable adults policy and the manager has been properly alerting agencies when there have been concerns of abuse in the home and has then properly investigated. Service users who have bed rails now have assessments and risk assessments in place. A start has been made in training staff on working with vulnerable adults and this needs to continue. Tower Bridge Care Centre DS0000007047.V298397.R01.S.doc Version 5.2 Page 13 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): 19,20,21,23,24,26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The accommodation is generally good although at the moment there are maintenance issues and work is still 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. 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, however service users in the lounges still need enough occasional tables to put their hot drinks on as they are held precariously on their laps. It was also noted that the third floor dining room was uncomfortably hot, on what was not a particularly hot day. Tower Bridge Care Centre DS0000007047.V298397.R01.S.doc Version 5.2 Page 14 Although a beginning has been made, the three units providing dementia care are still not providing environmental adaptations required to orientate and stimulate service users with dementia. An exception to this is the reminiscence room which has been made out of one of the lounges on the third floor and is excellent. Some maintenance problems were noted. On the ground floor, a toilet and bathroom had stains on the ceiling and the staff toilet had black mould in the corner, while the disabled toilet had the seat off. On other floors there were similar instances including sodden carpet outside walk-in showers. A facilities manager has just been appointed and it is hoped he will address these issues. 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. Most service users’ rooms still have only one chair, so that they cannot properly entertain visitors. It was also noted that some bedclothes were of extremely poor quality, were not matching sets and the under sheets did not fit. The manager said that new bedclothes had been ordered. The ensuite bathrooms did 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. The home was clean and all systems to prevent the spread of infection were seen to be in order. Tower Bridge Care Centre DS0000007047.V298397.R01.S.doc Version 5.2 Page 15 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service Service users are well protected by the home’s recruitment practise and the number of staff with an NVQ qualification is good. Staffing presence throughout the home does not always seem adequate. A training programme to ensure that staff are trained to meet the needs of all service users is still needed. EVIDENCE: There has been ongoing recruitment over the past six months. Rotas showed full staffing and on the day of inspection the home was fully staffed. Nevertheless a majority of service users, relatives, staff or visiting professionals spoken to, said that they felt it was short staffed “it seems they are short of staff”, “there are never any staff to ask” “the staffing level is not ideal”. It was noted on the 3rd floor that for a period of over an hour there was no staff to supervise people wandering in the corridor, although care plans for some of those said that they needed to be monitored at all times. This issue was discussed with the assistant manager and area manager who felt it was a question of deployment of staff, rather than numbers. Files of recently recruited staff showed an appropriate recruitment and checking process. Records showed that over 50 of staff now have an NVQ in care. There has also been a lot of work on providing training for staff. This needs to continue to ensure that all staff have basic training for health and safety issues, dementia care, dealing with challenging behaviour and protecting vulnerable Tower Bridge Care Centre DS0000007047.V298397.R01.S.doc Version 5.2 Page 16 adults. There also needs to be a system for drawing up individual training plans, and a training plan for the home to ensure that staff training meets the ongoing and changing needs of service users. Tower Bridge Care Centre DS0000007047.V298397.R01.S.doc Version 5.2 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service Management of the home is good and all appropriate Health and safety systems are in place. Quality monitoring and annual development are need to ensure continual improvement. Service users do not always have access to money and staff supervision is not yet on a proper footing. EVIDENCE: The manager is experienced and competent and the improvements she has made during her six months at the home, were evident during the inspection and should be the foundation for a continuing improvement. Staff, service users and relatives were positive about her contribution. One relative who visits every day said “I have seen huge improvement, the manager is making changes and is really good.” There is a monthly sampling of service users and relatives’ views and regular meetings. The home needs to bring this quality monitoring together in an Tower Bridge Care Centre DS0000007047.V298397.R01.S.doc Version 5.2 Page 18 annual report. There also needs to be an annual development plan for the service. The systems for safeguarding service users monies were seen, and were good. Two service users on the ground floor look after their own monies, other than these however, most service users do not have access to their personal allowances and the home needs to develop policies and procedures to enable this to happen. A start has been made on rolling out a formal supervision process but this still needs to progress to fruition. All Health and Safety systems checked were in order. Tower Bridge Care Centre DS0000007047.V298397.R01.S.doc Version 5.2 Page 19 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 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 3 2 3 2 X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 2 X 3 Tower Bridge Care Centre DS0000007047.V298397.R01.S.doc Version 5.2 Page 20 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 Regulation 15(1) Timescale for action The registered person must 31/10/06 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. Target dates of 01/02/05 and 31/7/05 and 31/03/06 not met. Continued failure to comply may result in consideration being given to enforcement action The registered person must 30/09/06 ensure that risk assessments are carried out and recorded where needed. The registered person must 31/10/06 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. Target dates of 13/07/05 and 31/03/06 not met. The registered person must 30/11/06 ensure that a programme of activities is arranged and delivered to give all service users DS0000007047.V298397.R01.S.doc Version 5.2 Page 21 Requirement 2. OP7 13(4) (a,b,c) 12(4)(a) 3. OP10 4. OP12 16(2) (m,n) Tower Bridge Care Centre 5. OP12 12(4)(b) 6. OP15 12(1)(a) 7. 8. OP19 OP20 23(2)(b) 23 9. OP22 23(2)(a) 10. OP24 16(2)(c) 11. OP27 18(1)(a) 12. OP30 18(1)(a) adequate recreational activities. 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 not met. 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. The registered person must ensure that the home is properly maintained. 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 dates of 31/07/05 and 31/03/06 not met. 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 date of 30/04/06 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 date of 31/03/06 not met. The registered person must ensure that the numbers and deployment of staff meets the needs of the service users The registered person must DS0000007047.V298397.R01.S.doc 30/11/06 31/10/06 31/10/06 31/10/06 31/10/06 30/09/06 30/09/06 31/12/06 Page 22 Tower Bridge Care Centre Version 5.2 13 OP30 18(1)(c) 14. OP33 24(1)(a) (b)(2)(3) 15 OP35 12(2) 16. OP36 18(2) ensure that staff have training to enable them to meet the specialist needs of service users suffering from dementia. Target date of 30/06/06 not met 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 service users is provided. The registered person must ensure that an annual development plan and an annual report of quality monitoring undertaken, are produced. The registered person must ensure that there are systems in place for service users to have access to their personal allowances where appropriate. The registered person must ensure that the manager’s intention to introduce formal supervision of proper quality, is carried through. Target date of 30/06/06 not met 31/12/06 31/12/06 31/12/06 31/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2. Refer to Standard OP15 OP16 Good Practice Recommendations It is recommended that tables at mealtimes are set properly and that service users’ choice of food is facilitated properly. It is recommended that it be made clearer, when responding to complaints, whether the complaints made are upheld or not. DS0000007047.V298397.R01.S.doc Version 5.2 Page 23 Tower Bridge Care Centre 3. OP20 It is recommended that consideration be given as to how to improve the garden areas. Tower Bridge Care Centre DS0000007047.V298397.R01.S.doc Version 5.2 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 Tower Bridge Care Centre DS0000007047.V298397.R01.S.doc Version 5.2 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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