Inspection on 27/11/09 for Tower Bridge Care Centre

This inspection was carried out on 27th November 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Tower Bridge Care Centre 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 27/06/06

Tower Bridge Care Centre 22/11/05

Tower Bridge Care Centre 09/05/05

Tower Bridge Care Centre 06/10/04

Tower Bridge Care Centre 23/08/04

Tower Bridge Care Centre 21/04/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Townley Road, 2-3

Orchard House Nursing Home

St Josephs Rest Home

Foxley Lane (121a)

Tudor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Tower Bridge Care Centre Tower Bridge Care Centre 1 Tower Bridge Road Southwark London SE1 4TR Lead Inspector Lynne Field Key Unannounced Inspection 27th October 2009 09:00 DS0000007047.V378388.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Tower Bridge Care Centre DS0000007047.V378388.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Tower Bridge Care Centre DS0000007047.V378388.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 (128), Mental disorder, excluding registration, with number learning disability or dementia (128), Old age, of places not falling within any other category (128) Tower Bridge Care Centre DS0000007047.V378388.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE 2. Mental Disorder - Code MD The maximum number of service users who can be accommodated is: 128 28th July 2009 Date of last inspection Brief Description of the Service: Tower Bridge Care Centre is owned by Southern Cross Healthcare Group PLC and the manager confirmed that the certificate gives the correct details of ownership. Tower BCC is a large purpose-built home, with four floors, providing care for up to 128 older people, the majority of whom have single rooms with en-suite toilet and basin. As its name indicates, this home is just to the South of Tower Bridge, London, and so it is close to a wide range of services and facilities. The home provides care, including care for people with dementia to varying degrees on each floor so that on two floors nursing care is provided and on others floors care is at ‘residential’, non-nursing level. The Commission has recently reviewed the registration conditions to ensure they are within the correct legal framework and the revised conditions are listed in the preceding section of this report. There is ample communal space, lounge and dining rooms, on each floor and there is a small courtyard garden to the front of the premises; there is also car parking space in front of the building. The fees for the home range from £503 to £866 a week as at July 2009 and additional charges will be made for personal items and further charges will negotiated with the purchasing authority if the need for extra arises. Tower Bridge Care Centre DS0000007047.V378388.R01.S.doc Version 5.2 Page 5 Tower Bridge Care Centre DS0000007047.V378388.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced inspection took place in October 2008 over three days by four inspectors including the pharmacy inspector who checked the medication and dispensing practices in the home. The manager was present for two of the days of the inspection. The inspection included a tour of the home and was facilitated by the manager, one deputy manager and the hotel services manager. We spoke to twenty staff including a selection of care staff of varying responsibilities the cook, administrator, receptionist, domestic staff and the maintenance men. The inspectors checked records, including care plans, staff records and building maintenance records and took their views into consideration when we formed our opinion of the home. The AQAA was completed and returned in time and was used as part of the inspection. During the inspection the inspectors met and spoke to twenty two residents who live at the home. We were to meet twelve of the resident’s relatives and friends who gave us their opinion of the home. Residents said they liked living at the home and liked the staff. They said the “approach has changed in the past six months; the staff team now has new carers that are kind and that really care for older vulnerable people that are so reliant on them”. Healthcare professionals that visit the home said they find that standards of care practices have improved and that staff are keen to keep the improvements going. The local authority contract monitoring team said they have seen improvements, too. The inspector found that the home offers a high level of care and support to the residents. The manager and staff continue to give a good service. Staff were observed to be competent and caring. Staff interaction with residents was observed to be knowledgeable and was conducted in a respectful manner. What the service does well: We found the management of the home was open and wants to work with us and the placing authority to provide the best care it can for the residents of the home. We have already had an action plan and positive feedback about concerns raised during the inspection around medication. The home has ample space for residents to wander around. There are some good clean shared spaces with adequate bathrooms and toilets. There are a Tower Bridge Care Centre DS0000007047.V378388.R01.S.doc Version 5.2 Page 7 minimum of two spacious lounges on each floor with separate dining rooms which helps residents with dementia know it is time to eat. Supervision of staff takes place every two months and many of the staff in the past have been kind and caring with a long service record that has meant continuity of care. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is Tower Bridge Care Centre DS0000007047.V378388.R01.S.doc Version 5.2 Page 8 taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Tower Bridge Care Centre DS0000007047.V378388.R01.S.doc Version 5.3 Page 9 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.V378388.R01.S.doc Version 5.3 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4,5 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Statement of Purpose and Service users’ guide have been up dated to reflect the recent changes and are good at providing residents and prospective residents with details of the service the home provides. Residents have their needs assessed by senior staff before they move to the home and know that staff have decided that the home can meet their needs before they move there. Prospective residents and their relatives can come and look around the home and meet staff before they decide to move there. EVIDENCE: Tower Bridge Care Centre DS0000007047.V378388.R01.S.doc Version 5.3 Page 11 We checked ten residents’ files and spoke to twenty two residents, their visitors and to staff including team leaders during the course of the inspection. There were two residents who had been recently admitted. They were on different floors. We found initial assessment information in both of these files which gave good information about the resident. These were signed by their relative who had completed a form describing their personality and interests. We also found a Social Services assessment on file too. There was an admission check list that had also completed too. The second recently admitted residents file had good information about their social history and interests. As stated in the last inspection report in the past lack of details of resident’s past history was something that had been commented on but this continues to improve by including a ’Map of Life’ in the documentation, which gave basic details about a residents history. We spoke to both new residents and their families. Both families said they were pleased with how their had been admitted to the home. We were told by one family their relative had come straight from hospital to the home and had they had been assessed in the hospital. The relative said they had been given information about the home which had helped them decide if they wanted to live at the home. We were given a copy of the statement of purpose and the service user guide that had been up dated to reflect the changes in management of the home as recommended in the last report in July 2009. There are also audio tapes available for those with poor sight or are not able to understand the written word. We saw a number of assessments on file including nutritional assessment. Risk assessments are held with care plans, risks are recorded highlighting all the areas of risk, for example a resident at risk of falls has this recorded and the necessary walking aid used is listed as necessary to promote safety. Pressure relieving equipment is supplied to residents identified as at risk of developing pressure sores. There were references to resident’s religious beliefs and their culture in a positive way. We saw other information included information about advocacy, personal details and a property list. An initial care plan is set up when residents are first admitted. For many residents it is not possible to have a trial visit because either they are in hospital or too infirm to undertake the visit. In most of these cases it is family members or friends who come to look a round the home and take information back to their relatives to help them decided if the home is for them. In one case the family we spoke to had initially thought the home would suit their relative because this is the area they lived in all their lives. However as the family live many miles away, they continue to be happy with the home but they are having difficulty visiting because of the distance. They said if their relative moved closer to them they could visit more often and their extended family could do so too. Tower Bridge Care Centre DS0000007047.V378388.R01.S.doc Version 5.3 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10, People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans have improved and reflect residents’ needs and goals but all evaluations must be kept under monthly review. The handling of medication has improved but there are still some areas that need to be addressed. The organisational development and training given to staff since the previous inspection has lead to residents being treated with dignity and respect at all times. EVIDENCE: Four inspectors including the pharmacy inspector spent one full day at the home and the lead inspector went back unannounced for a second visit and visited on a third day to speak to the manager. On the first day of the Tower Bridge Care Centre DS0000007047.V378388.R01.S.doc Version 5.3 Page 13 inspection we all visited different floors and focused on the quality of care delivered and the experiences of people living there. We checked ten residents care files on three of the floors we inspected and saw staff are recording all notable changes and the response to these. Care planning documentation is good, each folder is well organised. For each area where assistance and support is needed a specially developed care plan is in place. Residents have individual health care plans that give an overview of their general health and acts as an indicator to changing health needs. One resident we selected for case tracking had records of results of regular blood sugar monitoring. Pressure relieving equipment is supplied to residents identified as at risk of developing pressure sores. Residents have nutritional assessments undertaken at the time of admission. After that residents are weighed regularly according to care plans. We noted staff are not using the nutritional tool (MUST) that was introduced at the home, effectively. We saw one resident was highlighted as at risk in the weight book, where all residents’ weights are recorded. This is not fully effective and has the potential of not recognising that important changes in body weights are taking place. Staff need use the nutritional tool to undertake effective nutritional screening. We have made a recommendation about this. On one floor we saw care plans that had been were reviewed monthly. They covered a range of issues such as dementia / sight problems / moving and handling/ falls / nutrition / money/ continence/ care needs / sleep/ spiritual and social care. We noted on another floor some of the evaluations appear to have not happened possibly due to change to nursing staff on the unit. All monthly evaluations need to be kept up to date. We have made this a new requirement. A number of assessment tools are used. Risk assessments are kept with care plans, risks are recorded highlighting all the areas of risk, for example a resident at risk of falls has this recorded and the walking aid used is listed as necessary to promote safety. For another resident with leg ulcers there are records held of the referrals made to the Tissue Viability nurse and evidence of the response by staff to recommendations made by the Tissue Viability nurse. There were records to confirm the progress and response to treatment with evidence of ongoing wound assessments. Continence assessments are undertaken for residents on the records we viewed and found that continence management was good on all of the days of the inspection. Some family members said that this is not always the case. Realistically in a home of this size and because of the care needs of the residents who live there will be times when there is a smell of urine. As long as it is dealt with as soon as the issue arises it should not become a problem. We spoke to the hotel services manager who said they try to deal with any incontinence as soon as it happens and in this way it does not become an ongoing problem. It’s about staff educating staff and being vigilant. Tower Bridge Care Centre DS0000007047.V378388.R01.S.doc Version 5.3 Page 14 We heard from a healthcare professional who visits the home several times each week. They said they have found standards of care practices have improved in recent months and that staff are keen to keep the improvements going. We observed how care and nursing staff interact with residents. Calming and reassuring responses by staff were observed when episodes of challenging behaviour were experienced. Throughout the day we observed many examples of good practice now demonstrated by staff. We were able to speak to twelve nursing and care staff who were on duty during the course of the inspection apart from observing interaction of other staff and residents. They demonstrated a good knowledge of the residents, and spoke of the little things important to each individual, the staff team have become more stable. This was consistent with reports received from a health professional that visits the home regularly. Residents receiving support and help with personal care had this done discreetly, with doors kept closed to ensure privacy. We found residents have the choice to shower or bath when they wish and are supported to be independent in their personal hygiene where possible. We observed residents being encouraged to keep themselves clean and tidy but saw one resident was resistant to being helped with this by staff and did not want to change their clothes. When we commented on one resident wearing a dress with a frayed hem the staff said the relative keeps bringing it back after mending it. We saw staff make appropriate responses and continued to encourage residents to change their clothes. Sometimes without any success because the resident has made the choice not to do what is asked of them. The home works closely with external professionals and specialists for advice and support. Residents have the choice and the support of staff to receive visits local services for medical, dental, hearing and sight checks. Regular appointments are seen as important and there are systems in place to make sure residents are reminded and appointments are not missed. We met a dentist that was visiting residents on the second floor following a request for home visits. The GP holds weekly surgeries at the home for consultations. We met the psychiatrist who holds weekly consultations with those having mental health issues. Pharmacist Report: The safe handling of medicines was assessed by a commission pharmacist inspector. They looked at medication records, medication storage, medication supplies and care plans for a selection of these people. They also observed people being given their medicines by the nursing and care staff. At this inspection, evidence from medication records showed that the home is not meeting the medication standard on all floors. Tower Bridge Care Centre DS0000007047.V378388.R01.S.doc Version 5.3 Page 15 We observed staff giving medication and completing medication records. This was done accurately on two of the floors, providing evidence that staff are following the homes procedures, ensuring medicines are given safely. On one of the other two floors, medicines were given late on the day of the inspection, the lunchtime medicines were still being given at 3pm due to staffing issues, for five medicines with a variable dose, staff were not indicating on the record how much was given, some medicines had been handwritten onto the medication chart, with no counter-signature for accuracy, two medicines had a dose change, with no initials and date to show who made the change, and one resident was supposed to have had the dose of their medicine reduced after 7 days but this had not happened. On the other floor, a controlled drug was not being stored in the controlled drugs cupboard, although all other prescribed medicines are being stored safely, one resident has not been given a prescribed medicine for Parkinson’s Disease for over a week although this was in the medicines cupboard, one medicine was out of stock for five days, another resident is being woken up at 2am and 6am to take doses of a medicine which is unnecessary and may increase the risk of falls due to disturbed sleep, and one blood glucose monitor was being used for more than one resident, increasing the risk of infection. Tower Bridge Care Centre DS0000007047.V378388.R01.S.doc Version 5.3 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has reviewed how it assesses and provides social, recreational and educational opportunities for all residents through consulting with them and their relatives. The residents are give a good choice of food but needs to make sure the food stays hot after being served. It was well presented, tender and tasty. More effort could be made for mealtimes to be a pleasurable, social occasion as possible. EVIDENCE: There has been a change in management structure which has made a significant difference. The new home manager has introduced unit managers overseeing the nursing and residential floors, with team leaders taking responsibility on each floor. We noted working practices are overseen by senior Tower Bridge Care Centre DS0000007047.V378388.R01.S.doc Version 5.3 Page 17 staff. We saw they routinely monitored staff attitude and approach to the privacy and respect given to residents. We found on our visit that there was evidence of a change in the staff team. We observed that staff display kindness, tenderness and empathy and saw residents felt reassured by this. We spoke to fifteen relatives during the course of the inspection and the majority expressed positive views on the improvements experienced in recent months and said this was due to the changes made to the staff team. One of the relative spoken to said “the approach has changed in the past six months. The staff team now has new carers that are kind and that really care for older vulnerable people that are so reliant on them”. As we toured the home there was information about events and activities on various notice boards. The notice board in the entrance hall of the home displayed photographs that had appeared in the local newspaper of birthday celebrations. We saw there were photographs of other communal events that the home had put on for the residents as well. Two residents have celebrated achieving their one hundredth birthdays. The daughter of one resident spoke of the care given at the home and “the good care they received at the home by the staff that work here”. Some relatives praised individual members of staff. Family and friends feel welcome and know they can visit the home at any time. There are signs that the home is making more progress with individuals and making effort for the activities to become more person centred. We observed good interaction between staff and residents on a number of occasions during the inspection. We spoke to both activities coordinators and they told us of their plans and arrangements the home are making to improve the activities available and of the appointment of new activities coordinator. We were given a copy of the activity plan. Care staff are encouraged to assist in activities and have had training in this. Residents who are not able to or it is not appropriate for them to join in the group activities have individualised sessions in their rooms. This might be a hand massage or talking to them. The coordinator said they were speaking to all residents about what they would like to do and any activities they enjoyed. They showed us the choice cards they had made of pictures of various activities. They have shown these to the residents who have said, pointed or indicated their likes. Based on this, any relatives input and what they know of the resident, they are developing an individual activity plan for each resident. On one floor we visited we saw residents sitting listening to music playing. Most were clearly enjoying it, singing along and dancing in their seats, while others were less engaged with it. There were some balls that staff were encouraging residents to play with, catching and rolling them. At the same time tea and biscuits and fruit were being served. The fruit was well presented, easy to eat, and it was good to see they were giving a fresh alternative. It seemed to the inspector that there was too much was going on. They saw a resident struggle a bit to keep hold of their cup of tea when a ball was thrown Tower Bridge Care Centre DS0000007047.V378388.R01.S.doc Version 5.3 Page 18 and went towards them. A staff member had a book of black and white pictures which had film stars from a period familiar to residents. We observed the resident was concentrating on the pictures and enjoyed this. Another group were participating in a reminiscence sessions, we observed how residents with little verbal expressions engaged positively in this activity. Hand care is promoted and observed that female residents were supported to keep their nails clean, manicured and use nail varnish. One lady we spoke to said they went out to the day centre. They were one of the youngest residents in the home. We noticed staff were having difficulty pushing their wheelchair. They said they tried to be independent as much as possible but because of the chair found this difficult. They and staff might benefit from them having a motorised wheelchair if funding could be found for this. We joined in and shared lunch in the dining rooms. Tables were pleasantly prepared for the lunch with flowers on the tables. We noticed residents were sat at the table quite a while before the meal was ready to be served which meant people with dementia who could not sit still kept getting up, wandering off and being brought back. It would be better not to sit them at the table till the meal was ready to be served. There were appropriate numbers of staff were present to assist those needing help. Despite the presence of a large number of staff the meal took a long period to serve from the trolley and we found the food got cold quickly. The plates were not heated before hand and this could be a contributory factor to the cold food. We spoke to the hotel services manager about this and he said he would try to find a solution. He was concerned if the plates were heated residents might get burnt. We observed an agitated relative on the corridor who waited impatiently to assist his wife with her lunch. We observed that pureed meals were served in an appetizing manner for those who needed this type of diet. One choice was beef casserole and mashed potato, the meat was tender, vegetables were well cooked and we found it to be tasty. Everyone was asked individually what they wanted from the choice of beef or fish. The menu had photos on what was being offered. For one resident this caused confusion because the vegetable shown were carrots which they wanted but there were no carrots on the menu that day. We spoke to the hotel services manager who said he would look at the menu and how they were presented. Residents were offered a choice of orange or cranberry juice to drink with their meal and they were shown the jugs so that this helped if communication was a problem. We asked for water which they got for us but this was not given as a choice to the residents so unless they were able to ask they would get water if that was what they wanted. We thought the occasion could be used more as a social occasion rather than something that needed to happen. Tower Bridge Care Centre DS0000007047.V378388.R01.S.doc Version 5.3 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their families are given information on how to complain to the home and to independent bodies. Their complaints are taken seriously and investigated fully. Complaints within the home are handled properly and residents feel confident that their concerns will be listened to. Resident’s legal rights are adequately protected and they are protected from abuse. EVIDENCE: We saw information on how to make a complaint was displayed in the main lobby and in the statement of purpose and service user guide. We were shown the complaints book when we spoke to the manager and saw how they are logged and the outcomes. There have been ten complaints since the beginning of June 2009. The manager said the home has responded to these within company deadlines. Any safe guarding alerts are responded to promptly and we have been kept informed of out comes. We have had no concerns raised by the commissioning body. The contract monitoring team visited just before and after the inspection and there report of the home was favourable and positive about the developments in the home. Tower Bridge Care Centre DS0000007047.V378388.R01.S.doc Version 5.3 Page 20 We spoke to residents and relatives during the inspection process on all days of the inspection. When we asked the question “what do you think of the home?” and “have you any complaints?” as well as do “you know who to complain to?” As expected in a home of this size there were a variety of responses “it’s OK here, sometimes I’m lonely, I know there are activities going on but I’m not much of a joiner” “its good here, like family” “no grumbles” “everyone gets on OK, it’s fine” “my mother has celebrated reaching one hundred years, this is testimony to care received at the home by the staff that work here” and “the care is very good”. Family members gave a number of answers about who they would complain to from the nurse in charge or the key worker to the manager. The manager said he has an open door policy and will try to see family or residents at short notice if possible. They want to train staff to document verbal complaints more effectively and report concerns immediately and are encouraging staff to do this. Staff we spoke to said they aware of whistle blowing procedures and felt management respects the confidentiality of the process. The manager said it was importance of receive confidential feedback from staff or visitors. They are able to do something about bad practice if they are given information about this as demonstrated recently with the dismissal of two staff. The Advocacy service representatives visit the home and act on behalf of a small number of residents who have no relatives or friends who can do this for them. We were told by the manager they work in conjunction with agencies designated as the court appointee for nominated residents with no next of kin. Deprivation of Liberty safeguards would be requested for residents as required and they would seek advice from the local Safeguarding Adults team if management have concerns about the welfare of any of its residents. Tower Bridge Care Centre DS0000007047.V378388.R01.S.doc Version 5.3 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,23,24,25,26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is working hard to ensure the environment is safe and well maintained. They have started their refurbishment programme. A hotel service manager has been employed to oversee this work but there is still much work to be done until all bedrooms and communal spaces have been refurbished and are of the same good standard of decoration. Residents are able to bring in personal possessions and their bedrooms are comfortable and homely. They have employed more domestic staff and home was clean and there were no unpleasant smells. EVIDENCE: Tower Bridge Care Centre DS0000007047.V378388.R01.S.doc Version 5.3 Page 22 The homes manager said he had drawn up a refurbishment programme for the home and the organisation had agreed to fund it. He said he had plans to develop the outside space and has other ideas about how the home could develop. They have started on the top floor using a team of decorators who are employed by the organisation. They have redecorated the communal areas and a number of bedrooms. There are new floor coverings and furniture provided in some bedrooms and we were told they were planning to replace it all. A full time painter and decorator has been employed on a short time contract and he is concentrating on decorating bedrooms that become vacant and areas of concern. Which is good but it means those residents who have been in the home for a number of years are missing out. We were given a tour of the building. The number of domestic staff has been increased. We found the home clean and apart from the one time when there was a smell of urine in a particular area, the home smelt fresh. When we mentioned this it was immediately dealt with and the smell disappeared. The majority of bedrooms we viewed have old décor that is faded and discoloured and need to decorate. For example I visited one resident in her bedroom and found it very shabby. There were water stains on the ceiling and the door was missing from the ensuit. Her daughter said it had been like that for a while. I was told it would be done soon. This must be a continuing rolling program till all bedrooms are of a high standard of decoration. We saw on the third day of the inspection he had completed another vacant bedroom on the ground floor and the standard of work was good. The room was to have new flooring, furniture and curtains. We met with the hotel services manager who has recently been employed to manage the domestic and catering services as well as the maintenance of the home. This is a large area of responsibility. He told about the refurbishment program he was overseeing. Many of the areas of concern we noted during the three days of the inspection we told him about were on his list to be dealt with. If they were ones he did not know about he had them dealt with if he could. For example when one resident showed us her bedroom, which was homely, we noted there was split across the carpet on the way into the room and fraying in the doorway of the ensuit. Both of these were trip hazards. We were surprised that this did not seem to have been reported by staff. We looked in the maintenance book and could not see it having been recorded. This was pointed it out to the hotel services manager and when we returned on the second day of the inspection it had been taped to make it safe. We were told they had increased the provision of profiling beds and they were working to make sure all the hoists were in working order. In response to the last report a large number of waste bins purchased for bedrooms and toilet areas. There were objects of reference on boards near the bathrooms and by the lounge where they do activities. This was a useful feature to help residents’ orientation. Tower Bridge Care Centre DS0000007047.V378388.R01.S.doc Version 5.3 Page 23 We saw the nursing stations re-established on each floor to allow staff to observe residents more easily and they planned to develop these areas more. It also gave residents more access to staff because they could see them as they walked around the home. Tower Bridge Care Centre DS0000007047.V378388.R01.S.doc Version 5.3 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The introduction of a new management structure has contributed to the improvement in the standard of care now experienced by people in the home. Staff training needs must be met and staff must attend training sessions arranged for them by the home as part of their work contract. EVIDENCE: The new manager has changed the management structure of the home. There are now two experienced senior managers. One oversees and has responsibility of both nursing floors and the other and the other oversees and has responsibility of both residential floors. Each unit has a team leader that takes the lead in that unit. Nurses with particular specialist skills such as RMN nurses are employed. We were given a copy of the rota and found the staffing levels good. On each nursing floor there were generally two nurses and five or six carers plus a student nurse on placement. The residential floors had one team leader and four to five carers. Rotas show that staffing levels are considerate to the needs of residents, well thought out and making sure that the home is staffed Tower Bridge Care Centre DS0000007047.V378388.R01.S.doc Version 5.3 Page 25 efficiently, with particular attention given to busy times of the day and changing needs of the residents. We were told the manager has suggested internal rotation of staff with staff working nights and days. This would help their professional development and they would have a rounded view of the needs of the residents because they would get to know the whole of the resident’s life style. It would also help team development. We found the quality of care that is being delivered is reflected in the views of residents and relatives we spoke to. Residents and relatives said they have confidence in the staff that cares for them. One resident and her relative made the following comments, “we have found that changes to the staffing team have introduced a kinder and more caring culture to the team”. All the staff we spoke to seemed to be clear of their role and what is expected of them. The working practices we saw indicated this too. The residents said staff are working with them know what they are meant to do and that they are generally able to meet their needs. We found that there has been much improvement in the way people are cared for, how they are valued, and the way staff respond to residents. The organisation (Southern Cross Healthcare) has introduced training for staff with emphasis being placed on the promotion of dignity in all the homes. They have a specialist trainer who has devised a training program promoting the dignity of people living in a care home and in training staff to make the appropriate responses to resident’s requests and care needs. We met the trainer who had spent four weeks in the home training staff and they said are now 18 ‘Dignity Champions’ in the home who will promote and pass on what they have learnt to other staff, getting staff to experience what it is like to be dependent on others. The trainer was very enthusiastic and explained and showed us how the program worked. We spoke to a number of staff who had completed the training and one said “it made them think more about how they spoke to residents” another said it made them more aware of what it was like to be helpless and need help from others”. We heard of the arrangements that the home are making to improve the activities available and of the appointment of new activities coordinator. The activates coordinator said they were involving care staff in the residents activities and they were more proactive in helping with residents activities now. We checked four recruitment records of recently appointed staff. The home operates a good recruitment process, following the organisations recruitment policy and procedures. This includes formal interview, taking up two references, CRB checks and POVA checks prior to appointment. The manager has appointed twelve new care staff since coming into post and they have all followed the induction process set down in the organisations recruitment procedures. Tower Bridge Care Centre DS0000007047.V378388.R01.S.doc Version 5.3 Page 26 We were given a copy of the training matrix for the last year. Sixty seven staff have attended Challenging behaviour training, 59 Dementia training, 61 POVA training and 18 staff are dignity champions. The copy of the training statistics based on the training matrix showed on average about half the staff have not had all the training mandatory training they need /should have in the last year. This means staff training needs are not being fully met. We were told about and given a copy of the planned courses but this will still not fully meet all the staff training needs. The manager said staff were reluctant to attend training and at times said they would come but did not turn up. Tower Bridge Care Centre DS0000007047.V378388.R01.S.doc Version 5.3 Page 27 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,37,38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is being well managed by a manager of good character, long standing experience in care of the elderly. He has a strong team of managers who manage different aspects of the home well. The home is operating safe working practices and is following all aspects of the health and safety legislation that protects the health and safety of residents, staff and visitors. EVIDENCE: Tower Bridge Care Centre DS0000007047.V378388.R01.S.doc Version 5.3 Page 28 A change in management structure has made a significant difference. The new manager has made many changes since taking up his post in May 2009. He is well qualified and has had experience running a home of similar size before. He told us about the new management structure that has been introduced to the home. They now employed a second deputy and have one who is in charge of the two nursing and one who is in charge of the two residential floors. The deputies have clear areas of accountability set out in their job descriptions that we were given a copy of. We were told of the plans for the home, many have already been started to be put into place. We were sent a clear action plan with appropriate time scales that the home has worked towards. During the inspection process we found there was evidence of a change in the staff team. We saw staff display kindness, tenderness and empathy which makes the residents feel reassured. We spoke to many relatives, friends and family who expressed positive views on the improvements experienced in recent months who say they feel this is due to the changes in the staff structure and teams. As stated above, one of the relative spoken to said “the approach has changed in the past six months; the staff team now has new carers that are kind and that really care for older vulnerable people that are so reliant on them”. Residents and staff have said they have confidence in this manager and we have had good feedback from the local authority commissioning and contract monitoring teams. The manager has an open door policy and will see residents or their families at short notice if possible. They have regular residents meetings that are planned to ensure as many people can come as possible. Staff said they have regular supervision and team meetings and feel the managers and team leaders are approachable. As stated in the last report, some areas of the home are already very pleasant and comfortable including the front lobby which is a popular meeting place for residents and staff. We met the registered manager of another home who comes in the do the regulation 26 visits and the quality audit and saw copies of these visits that the home act upon. We spoke to the two maintenance men who have worked in the home for sometime. They have the responsibility to do the daily weekly checks. We checked the fire records and noted different floors are checked each week. There is a fire evacuation program in place and the fire evacuation is done every six months at a different time of day and one is done with the night staff. There was a fire risk assessment on file. All other health and safety checks were inspected and there is a range of certificates available to show these are being properly addressed in the home. Tower Bridge Care Centre DS0000007047.V378388.R01.S.doc Version 5.3 Page 29 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 3 X 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 X X X 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X 3 3 Tower Bridge Care Centre DS0000007047.V378388.R01.S.doc Version 5.3 Page 30 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP1 OP9 Regulation 15 13 Requirement Timescale for action 10/12/09 3. OP30 18 The registered person must ensure all monthly care plan evaluations are kept up to date. The registered person must 10/12/09 ensure the service improves the management of medicines to ensure the safety of residents. The registered person must 30/03/10 ensure all staff have the annual mandatory training and are suitably qualified, competent and experienced in all other areas needed to provide good, safe care to the residents. 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 OP8 OP15 Good Practice Recommendations Staff at the home should ensure that the nutritional tool is used to undertake effective nutritional screening. Staff should be encouraged to regard meal times as a DS0000007047.V378388.R01.S.doc Version 5.3 Page 31 Tower Bridge Care Centre 3 OP30 social occasion to enable residents socialize with each other. It would be good practice for staff to rotate shifts and work day and night shifts. Tower Bridge Care Centre DS0000007047.V378388.R01.S.doc Version 5.3 Page 32 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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