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Inspection on 09/05/05 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 9th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 current manager continues to bring improvements to the home, including the recruitment of new staff. Staff are motivated and committed to their work. In many cases staff demonstrate good communication skills, understanding the importance of smiling and maintaining good eye contact. The home continues to succeed in encouraging and maintaining good links between service users and their relatives, who visit frequently, and create a positive and more open atmosphere in the home. Food continues to be largely fresh and `home made`, in contrast to many other homes in this sector that are increasingly relying on frozen produce and `ready meals`. The home displays both these inspection reports and the complaints procedure in the reception area of the home, encouraging visitors to look at them, and understand their rights and those of service users. Service users are unanimous in their praise of the private accommodation offered.

What has improved since the last inspection?

The home assesses the needs of service users before they are admitted giving staff more opportunity to plan and provide for their needs. The home have made good progress healing service users` pressure sores, a sessional nurse being used to improve wound care. Permanent nursing staff have been recruited and the shift patterns altered on the third floor to provide more staff in the evenings, when service users need to go to bed or may be more active. The home has been redecorated, part of an ongoing program to improve communal areas and provide new furniture. The recording of Medication has improved and staff are more aware of medication and how it meets service users` needs. All medication was in stock and available to service users and staff know when to refer service users to their GP and other health professionals if they had concerns.

What the care home could do better:

Staff at the home do not have sufficient time to spend with service users so that they can get to know them and maintain strong relationships. This means they are less likely to know what their needs are and certainly less likely to know what their wishes and feelings are, making it difficult to provide care in the way they would like. The home need to provide more information in assessments before service users are admitted, to ensure all needs identifiedby social and health care professionals are met, and planned for. A particular weakness is planning to support service users to remain active and retain communication skills. The home must respond consistently to service users` wishes and preferences for food, and certainly where service users need certain types of food on medical grounds. While the home are good at encouraging complaints, they need to respond to these as an opportunity to improve the quality of care, to be clear with complainants about all the elements of a complaint and what will be done about it. Service users find the lighting and lack of available natural light difficult and uncomfortable and this should be reviewed. The existing staff group need to be encouraged and retained, in particular senior carers responsible for other staff, with a review of pay and other incentives to build their confidence and make them feel more valued for this important role. Bathrooms, in particular those without natural light where service users are confused, need to be made more homely, and welcoming.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Tower Bridge Care Centre 1 Tower Bridge Road Southwark London SE1 4TR Lead Inspector Mark Stroud Unannounced 9 May 2005, 10:00 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 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 and Care Homes for Adults 18 – 65*. 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 G52-G02 S7047 TowerBridge V226569 090505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Tower Bridge Care Centre Address 1 Tower Bridge Road Southwark London SE1 4TR Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 7394 6840 020 7394 7198 Southern Cross Healthcare Services Limited CRH(N) Care Home with Nursing 128 Category(ies) of DE(E) dementia - over 65 registration, with number MD(E) mental disorder - over 65 of places OP old age PD physical disablity PD(E) physical disability - over 65 Tower Bridge Care Centre G52-G02 S7047 TowerBridge V226569 090505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 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 2 On the ground floor, 29 residents aged 65 years and above 3 On the third floor, 31 residents with dementia, and/or persons with mental health disorders 4 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 Date of last inspection 31 January 2005 Brief Description of the Service: Tower Bridge Care Centre G52-G02 S7047 TowerBridge V226569 090505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two Regulation Inspectors assessed general care and one pharmacy inspector assessed the management and administration of medication over three days in May 2005. The quality of care at the home is improving. What the service does well: What has improved since the last inspection? What they could do better: Staff at the home do not have sufficient time to spend with service users so that they can get to know them and maintain strong relationships. This means they are less likely to know what their needs are and certainly less likely to know what their wishes and feelings are, making it difficult to provide care in the way they would like. The home need to provide more information in assessments before service users are admitted, to ensure all needs identified Tower Bridge Care Centre G52-G02 S7047 TowerBridge V226569 090505 Stage 4.doc Version 1.30 Page 6 by social and health care professionals are met, and planned for. A particular weakness is planning to support service users to remain active and retain communication skills. The home must respond consistently to service users’ wishes and preferences for food, and certainly where service users need certain types of food on medical grounds. While the home are good at encouraging complaints, they need to respond to these as an opportunity to improve the quality of care, to be clear with complainants about all the elements of a complaint and what will be done about it. Service users find the lighting and lack of available natural light difficult and uncomfortable and this should be reviewed. The existing staff group need to be encouraged and retained, in particular senior carers responsible for other staff, with a review of pay and other incentives to build their confidence and make them feel more valued for this important role. Bathrooms, in particular those without natural light where service users are confused, need to be made more homely, and welcoming. 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 G52-G02 S7047 TowerBridge V226569 090505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Standards Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6-10 and 18–21) (Standards 11–17) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37–43) Tower Bridge Care Centre G52-G02 S7047 TowerBridge V226569 090505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. 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. Prospective service users have an opportunity to “test drive” the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 4 Service users are assessed to ensure their needs can be met at the home before admission but the home do not record and agree a plan with them before they are admitted so they know that all their needs will be met and how. EVIDENCE: The home has assessments of the needs of service users completed by health and social care professionals. The home complete assessments themselves to see if they can meet service users’ needs. There was evidence that the home are careful to make sure they can meet the needs of service users before admitting them, including needs in written assessments and using these in plans for individual care. However, on the last day of inspection a service user had been assessed without identifying they needed a pressure-relieving mattress. Staff at the home had realised this omission and arranged for a pressure-relieving mattress, but this was not used for the first 24-hours of admission. One staff member said that they had written up the service user’s Tower Bridge Care Centre G52-G02 S7047 TowerBridge V226569 090505 Stage 4.doc Version 1.30 Page 9 care plan in their own time at home, because this was not completed before admission, as it should be. Another service user’s continence needs had not been correctly assessed by the home and not included in a written plan for their care as it should. Tower Bridge Care Centre G52-G02 S7047 TowerBridge V226569 090505 Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6-10 and 18 –21 (Adults 18-65) 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. Including their physical and emotional health needs. 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. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. Service users receive personal support in the way they prefer and require. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 7, 9, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 Health care is improving at the home. Social care is not planned clearly enough with service users’ wishes and feelings neglected in some cases. Medication handling has continued to improve and standards have been maintained since the last inspection in October 2004; medication recording and monitoring were of a good standard on 3 of the 4 floors. There was evidence of regular monitoring of service users’ conditions, referrals to the home’s GP and procedures were being followed, indicating that the medication needs of residents are being met, and their safety ensured. Tower Bridge Care Centre G52-G02 S7047 TowerBridge V226569 090505 Stage 4.doc Version 1.30 Page 11 On one floor significant issues were observed. This floor had been handling medication well in October 2004. The range of issues indicated that residents’ medication needs and safety are not being met on this floor and the home must take action to ensure that the standard is improved. EVIDENCE: After admission, all service users have a written plan which describes how staff will meet their needs. Health and personal care is described in sufficient detail in most cases, an improvement since the last inspection, except for plans found on the first floor. Staff provide a good standard of health care, and record this in daily records for each service user, so that everyone knows it is being done. Staff were seen providing good care throughout the inspection, and where they are not sure or need advice, they refer to health professionals like occupational therapists, speech and language therapist or physiotherapists. There has been substantial improvement in the management of pressure sores with the number reducing, and good records kept of how they are being treated. Where there are concerns about a service user’s eating or significant weight loss, the home need to monitor the intake of food and where necessary support service users to know they are passing waste regularly, so that the home can provide additional support if required. On the second floor several clinical waste bins used to dispose of pads and other waste had not been emptied. One health professional said they were concerned that a staff member had provided personal care to a service user in front of them. Another staff member brought attention to a service user’s incontinence in a communal area. The manager was informed of this and agreed to remind staff to uphold service users’ dignity and privacy and provide further training as required. Another service user and relative were concerned that their stated preference for the gender of carer had been ignored for the second time. On the first floor, plans were not all up to date and were not reviewed in enough detail. On the ground floor, one service user experiencing a gradual change in behaviour, indicated by their increasing agitation and aggression, did not have their care plan changed to reflect how staff managed and supported these changes. They were described in a review as having ‘good relationships with others’ while daily recording described them as ‘very aggressive’ and ‘very confused’. Another plan for a new service user said their communication was good, while staff were clear it was not. Plans could be more detailed and useful if the home took all the information given in Community Care Assessments completed by social workers, and consulted with service users or their relatives and friends. The home make sure they have copies of these assessments and keep these in service users’ files, so the information is available to staff. The manager and several staff said that the home rely on relatives to complete information, which is often left incomplete; for instance an entry of ‘not quite sure’ for a wedding anniversary, or ‘not fussy’ regarding preferences for food. Tower Bridge Care Centre G52-G02 S7047 TowerBridge V226569 090505 Stage 4.doc Version 1.30 Page 12 Medication Administration Records (MAR), facilities for medication storage and evidence of monitoring and review of residents’ conditions due to medication were inspected on all floors. On 3 of the 4 floors (Ground and 3rd floor residential units, and 2nd floor nursing units), recording and monitoring were of a good standard. Examples of this were: -All administration recorded -Refusals documented and action taken -All food supplements and external products being recorded -All receipts and returns documented ensuring a stock audit trail -District nurses recording the administration of insulin on the residential floors -Air-conditioning units now in place to ensure medication is being stored at the appropriate temperature -Temperature recording being carried out for all medication rooms and fridges -Staff aware of residents medication needs -Staff carrying out regular medication audits to identify and resolve issues On one floor (1st floor nursing), significant shortfalls were observed due to staffing issues at the time of the inspection. Specific issues were fed-back to the Deputy Manager on the day of the inspection and included: -Prescribed items not being given in the dose prescribed e.g. once daily instead of twice daily -Medication being administered but not signed for -Doses being missed with no explanation on the MAR chart -Dose amendments on MAR charts with no staff initials and date for the change -The application of external products not being recorded -Air-conditioning unit in the medication room not on and the temperature of fridge going up to 14C instead of 2-8,so products being stored at incorrect temperature conditions -Food supplements not being given with no explanation on MAR chart -No receipt quantities on the MAR chart for a controlled drug -Items, which are given on a weekly/monthly/3-monthly basis e.g. hydroxycobalamin injections, were not given in some cases and no date specified for the next dose. Tower Bridge Care Centre G52-G02 S7047 TowerBridge V226569 090505 Stage 4.doc Version 1.30 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 11 – 17 (Adults 18-65) are: 12. 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. Including opportunities for personal development. Service users engage in appropriate leisure activities. Service users maintain contact with family/ friends/ representatives and the local community as they wish. And have appropriate personal, family and sexual relationships. 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. 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15, 16 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 & 14 Service users have good contact with relatives and friends, but are often isolated and/or unstimulated. Food is good, but not always tailored to the needs of service users. EVIDENCE: Relatives visit the home frequently and are welcomed by staff. The home employs two activities co-ordinators. Currently they are providing support for small groups, with some one to one support, and are about to meet with other activity co-ordinators in other local homes to share information and good practice. They supported a small group of service users to the Imperial War museum the week before the inspection. One service user said they enjoyed a service held on the morning of the last day of inspection. Due to the size of the home, these workers cannot support service users effectively on a one to one basis, or in small groups, so they need the assistance of support staff to do this work. Plans for the stimulation and exercise of service users were not well developed and did not describe the actual support that would be provided, relying on generalisations like ‘staff to try and find out’, or ‘introduce to activity co-ordinator’, or ‘likes to sit in reception area’. Staff were not seen spending Tower Bridge Care Centre G52-G02 S7047 TowerBridge V226569 090505 Stage 4.doc Version 1.30 Page 14 time talking to service users. Three service users said that staff visit them for personal and health care, but not to talk to them. One service user said ‘I never see other residents, even my next door neighbour, and don’t get to know staff’. The majority of service users on the Ground, First, and Second floors were seen spending long periods of time in their own rooms. A number of service users on the third floor repeatedly walk up and down the corridor. Given their needs, it is likely that they would be unable to choose to stop doing this without support to focus on an activity. The home needs to review this against risks of falls from fatigue. Areas where they walk do not contain objects or pictures that would provide stimulation while they are walking. Staff were seen asking service users walking to stop when tea was being served, or for mealtimes. The corridors do not have natural light. The garden area for the home is small and not routinely used by service users during the inspection, except those able to leave the home independently. One relative said the garden is rarely used. The manager said that staff are waiting for warmer weather. Service user files were found without risk assessments regarding falls and aggression from service uses, where risks were seen by the inspector on the third floor. One service user said they received food that did not meet their needs, despite having asked the home to provide certain foods. On the ground floor service users were well supported at meal times, staff respectful and unhurried, while on the first floor where more service users needed support to eat, some had to wait up to twenty-five minutes for others to finish before they got the support to eat they needed. One relative and staff expressed that insufficient food is provided to service users on the third floor. The manager said this had been reviewed, and would discuss this further with staff to ensure adequate supply of food between the evening meal and breakfast the following day. The quality of food at lunchtime is good with fresh ingredients being used. Tower Bridge Care Centre G52-G02 S7047 TowerBridge V226569 090505 Stage 4.doc Version 1.30 Page 15 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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. Including neglect and selfharm. The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The home encourages complaints but need to work harder to respond clearly, listening carefully to complainants. EVIDENCE: The home holds a complaints procedure in the reception area. The manager demonstrated that the level of complaints has decreased since the last inspection. The manager recognised that the home need to work hard to maintain positive relationships with all relatives and that this includes responding to all complaints as opportunities to improve practice, to listen and try to understand the views of relatives and service users, and work together to develop a quality service. Handling of complaints was discussed, and advice given to the manager and deputy manager regarding responses to complaints. Tower Bridge Care Centre G52-G02 S7047 TowerBridge V226569 090505 Stage 4.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) 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. Shared spaces complement and supplement service users’ individual rooms. Service users have sufficient and suitable lavatories and washing facilities. Provide sufficient privacy and meet their individual needs. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. And lifestyles. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 22, 24 The accommodation is good and improving. EVIDENCE: Lounges, dining rooms and other communal areas have been redecorated and new furniture purchased since the last inspection. Further redecoration is required and the home has a program to complete this work. The home needs to review furniture at the home. Service users on the third floor had nowhere to place teacups when seated in the lounge area, some spilling tea from cups they were trying to hold for long periods. All service users spoken to said they liked their rooms and enjoyed spending time in them entertaining family and friends. They valued having their own toilets. Service users do not enjoy the lack of natural light. The home has white boards to prompt service users with dementia, but these are hard to read. Corridors where service users with dementia spend a lot of time do not provide many prompts or stimulation, for instance with the use of interesting objects of reference or pictures. There are Tower Bridge Care Centre G52-G02 S7047 TowerBridge V226569 090505 Stage 4.doc Version 1.30 Page 17 some picture signs to direct service users and photos are used to identify service users rooms, and these should be developed. Bathrooms, particularly on the third floor, need to be made more homely. Tower Bridge Care Centre G52-G02 S7047 TowerBridge V226569 090505 Stage 4.doc Version 1.30 Page 18 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 36 (Adults 18-65) are: 27. 28. 29. 30. • • • Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. 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. Service users benefit from clarity of staff roles and responsibilities. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers standards 27, 29 and 30 (Older People) and Standards 34 and 35 (Adults 18-65) the key standards to be inspected at leat once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 29 The home employ committed positive staff, but need to ensure there are enough of them and that they encourage staff to remain at the home and develop their skills to meet service users’ needs and understand their wishes and feelings. EVIDENCE: Staff spoken to across the four floors of the home were seen to be fully occupied providing basic health and personal care to service users. Staff said that they routinely have insufficient time to take breaks and work over their contractual hours. Evidence from the inspection shows staff working very long hours, particularly on the first floor. On the second floor staff levels were not significantly higher despite the high level of needs, including support to eat, and to transfer. The manager is recruiting new staff particularly on the first floor, as well as continuing to try to recruit a ‘nursing manager’ to oversee the first and second nursing floors. When staff are recruited, their work histories are checked and other checks made to protect service users. Staff receive training relevant to the health and social care needs of service users. Tower Bridge Care Centre G52-G02 S7047 TowerBridge V226569 090505 Stage 4.doc Version 1.30 Page 19 Staff were seen to be positive about their work and committed to individual service users. Relatives praised the quality of staff at the home, but recognised that staff appear not to have time to talk to service users and encourage them to express their needs. Service users are unclear about who their key worker is, someone they should get to know better. All staff spoken to described anxiety that the wage structure at the home provides a low level of financial reward, particularly where staff take on more responsibility as seniors, supporting staff around them. The manager acknowledged this. Some service users and relatives said they had difficulty communicating with some staff who had English as a second language. Tower Bridge Care Centre G52-G02 S7047 TowerBridge V226569 090505 Stage 4.doc Version 1.30 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 37 – 43 (Adults 18-65) are: 31. 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 a well run home and from competent and accountable management of the service. 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. Service users are confident their views underpin all self-monitoring, review and development by the home. 32. 33. 34. 35. 36. 37. 38. • The Commission considers standards 33, 35 and 38 (Older People) and Standards 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33 The home is well run and the quality of care improving. EVIDENCE: The management of the home has not changed since the last inspection, which promotes consistency. There is consensus that the manager has overseen improvements in the quality of care at the home since the last inspection. To assess this improvement further, the manager needs to seek the views of relatives and service users more, in addition to meetings currently held. During the inspection, the manager was absent for the first two days and the senior staff member from the ground floor provided cover for her. Tower Bridge Care Centre G52-G02 S7047 TowerBridge V226569 090505 Stage 4.doc Version 1.30 Page 21 Tower Bridge Care Centre G52-G02 S7047 TowerBridge V226569 090505 Stage 4.doc Version 1.30 Page 22 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 x 2 x 3 2 4 2 5 x 6 x HEALTH AND PERSONAL CARE ENVIRONMENT Standard No 19 20 21 22 23 24 25 26 STAFFING Score 3 2 x 3 x 3 x x Score Standard No 7 8 9 10 11 Score 2 2 2 2 x Standard No 27 28 29 30 2 x 3 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 2 15 x COMPLAINTS AND PROTECTION Standard No 16 17 18 Score 3 x x MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 x 33 3 34 x 35 x 36 x 37 x 38 x Tower Bridge Care Centre G52-G02 S7047 TowerBridge V226569 090505 Stage 4.doc Version 1.30 Page 23 yes Are there any outstanding requirements from the last inspection? 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 3&4 Regulation 14 Requirement Timescale for action 30/06/05 2. 7 15(1) 3. 10 12(4)(a) 4. 27 18(1)(a) The Registered Provider must ensure that assessments are sufficiently detailed and up to date to provide care appropriate to service users’ needs. Information on care needs gathered from family members should form part of the assessment process and be recorded on file (timescale of 22/11/04 not met). 31/07/05 The Registered Provider must 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, also that daily notes are sufficiently detailed to monitor the service user’s condition (timescale of 01/02/05 not met). The Registered Provider must 31/07/05 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. The Registered Provider must 30/06/05 ensure that staff have adequate time off between shifts. Version 1.30 Tower Bridge Care Centre G52-G02 S7047 TowerBridge V226569 090505 Stage 4.doc Page 24 5. 26 16(2)(j) 6. 8 12(1)(a) 7. 12, 14, 27 12(1(a) 16(2)(m)( n) 8. 20 23 9. 9 13(2) 10. 9 13(2) 11. 9 13(2) Waste bins must be regularly emptied to prevent crossinfection and the spread of disease in the home. Where necessary food intake and waste must be regularly recorded to ensure the welfare of service users. The manager must review staffing levels and their deployment at the home to ensure service users can express their wishes and feelings, are not isolated, and have appropriate stimulation, activity and excercise. Service users must be provided with support and furniture so that they can safely drink hot beverages while seated in the lounge. The Registered Manager must ensure that all changes made by the GP to service users medication are documented, staff implement these changes and any discontinued items are removed from the MAR charts. Partly met (not met on 1st floor only) The Registered Manager must ensure that the temperature of the clinical rooms is kept to 25C or below, and the medication fridges are kept at 2-8C. All temperature excursions must be investigated and action documented. Partly met (not met on 1st floor only) The Registered Manager must ensure that all medication, in particular benzodiazepines and antipsychotics have the dose stated on the MAR chart, and if prescribed on a “when required” basis, the maximum number of 30/06/05 30/06/05 31/07/05 31.07.05 30.06.05 30.06.05 30.06.05 Tower Bridge Care Centre G52-G02 S7047 TowerBridge V226569 090505 Stage 4.doc Version 1.30 Page 25 12. 9 13(2) 13. 9 13(2) doses in 24 hours is stated on the MAR chart, or clearly in the Care-Plan. Partly met The Registered Manager must ensure that all medication is administered as prescribed, and all instances of nonadministration documented on the back of the MAR chart. The Registered Manager must ensure that staff levels ensure the accurate administration of medication. 30.06.05 30.06.05 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 12 28 16 Good Practice Recommendations The Registered Provider should ensure that the weekend activity programme is reviewed to ensure that service users are supported to follow their interests. The Registered Provider should ensure that a minimum of 50 of staff have NVQ 2 by 2005. Staff dealing with complaints should listen carefully, breaking down the separate elements of a complaint, responding carefully to each one in turn and address any areas of disagreement so that the complainant is clear about their rights and the home is clear about it’s own response. A document designed by the Southwark Commission for Social Care Inspection (CSCI) local office has been provided to the home to help with this. The manager should review key work relationships with service users to make sure every service user knows there is a staff member they can get to know better, who can take more responsibility for meeting their needs. The manager should give relatives and service users questionairres or comment cards for those not able to attend meetings to give their views. Staff who have English as a second language should have support to develop language and communication skills. Areas used by service users with dementia should be reviewed to provide more stimulation and orientation, G52-G02 S7047 TowerBridge V226569 090505 Stage 4.doc Version 1.30 Page 26 4. 27 5. 6. 7. 33 27 22 Tower Bridge Care Centre 8. 20 inlcuding clearer orientation boards. The home need to review lighting to provide more daylight, and/or more favourable lighting for service users, friends and family, and staff. Tower Bridge Care Centre G52-G02 S7047 TowerBridge V226569 090505 Stage 4.doc Version 1.30 Page 27 Commission for Social Care Inspection 46 Loman Street London 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 G52-G02 S7047 TowerBridge V226569 090505 Stage 4.doc Version 1.30 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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