Care Home: Bridge House

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What the care home does well Bridge House is a detached property situated within private grounds. There is a large well maintained garden with ample parking for visitors. People living at the home, their relatives and staff were asked for their comments about the home. People commented; ‘all the staff work well together and are always there to help’, ‘the residents are happy and receive excellent care’, ‘training is good and regular updates’, ‘everyone is working extremely hard at the moment to ensure the home is the best possible’, ‘we provide care and support that meets peoples needs’ and ‘staff work great as a team now that the old team have gone and we have a brilliant team now. What has improved since the last inspection? The care plans are a lot better. They now contain more information about how people are to be cared for. The home has recruited a new manager, who has now been in post for approximately 4 months. This has offered staff more support in carrying out their role and in addressing some of the improvements required. Comments were received from staff with regards to the new manager. They said; ‘the manager is fantastic, very supportive and always there when you need her’, ‘you can approach her about anything and she will help you no matter what’, ‘the home has improved dramatically in the past few months’ and ‘I’m very happy to be working with the new manager’. A new activity worker has also been appointed. This has enabled more choice in people’s daily routines with activities both in and outside of the home. Improvements had been made with regards to the management of people’s medication. The recruitment process has improved with records to show that people are being checked prior to them commencing work. This ensures that people at the home are being protected. What the care home could do better: There has been very little improvement to the environment of the home. Many areas of the home are in need of redecoration and refurbishment. Despite us asking for a redecoration and refurbishment plan following the last inspection, we have not received one. The residents are entitled to live in a home that is well decorated, as well as being pleasant and comfortable to live in.Bridge HouseDS0000008412.V376601.R01.S.docVersion 5.2Arrangements to ensure that individual risk assessments regarding the administration of medicines covertly and when residents are away from the home are fully documented. A training plan must be developed for the forthcoming year so that all staff receive quality training relevant to their role ensuring they have the knowledge and skills needed. The manager must make application to register with us, providing the home with stable leadership and direction ensuring people receive a quality service. An up to date check should be carried out on the call bell systems ensuring people are able to call for staff should they need assistance. Records should be clearer with regards to fire drills showing that all staff are aware of the procedure to follow should an emergency arise. Key inspection report CARE HOMES FOR OLDER PEOPLE Bridge House Topping Fold Road Bury Lancs BL9 7NQ Lead Inspector Lucy Burgess Key Unannounced Inspection 09:30 7th October 2009 DS0000008412.V376601.R01.S.do c Version 5.2 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. Bridge House DS0000008412.V376601.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 Bridge House DS0000008412.V376601.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bridge House Address Topping Fold Road Bury Lancs BL9 7NQ 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) 0161 764 1736 0161 797 5045 bh1europeancare@aol.com www.europeancare.net European Care (UK) Limited Manager post vacant Care Home 34 Category(ies) of Dementia (10), Old age, not falling within any registration, with number other category (34) of places Bridge House DS0000008412.V376601.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care home only - Code PC, 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 (The maximum number of places: 10) The maximum number of people who can be accommodated is: 34 Date of last inspection 25th February 2009 Brief Description of the Service: Bridge House is owned by European Care (UK) Ltd. The home is registered to provide care and accommodation for up to 34 older people. The range of fees are from £368.89 to £481.57. This is dependent on funding arrangements and room preferences i.e. larger rooms with en-suite facilities. Bridge House is an attractive detached house situated in a residential area approximately 1 mile from Bury. The majority of bedrooms are on the ground floor. There are twenty-eight single bedrooms and three doubles. Twenty of the single rooms are en suite. There are well-maintained spacious gardens, which are easily accessible to the residents and visitors. There is also ample space for car parking. In addition to care staff, the home also employs cooks, kitchen assistants, domestic staff, a maintenance worker and an administrator. Bridge House DS0000008412.V376601.R01.S.doc Version 5.2 Page 5 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 was the second key inspection visit for Bridge House, which included a site visit and took place over one day by 2 inspectors and a pharmacy inspector, for a period of 9 hours. The service did not know that the inspectors were to visit. During the visit time was spent looking at records including care files, recruitment and health and safety. Time was also spent looking at the environment. A full audit of the medication system was also carried out. Due to concerns identified at the key inspection on the 23rd February 2009, management reviews had taken place to discuss what action was needed. An improvement plan was requested and provided and a statutory requirement notice was served with regards to medication concerns. We carried out a random inspection on the 8th June 2009 to follow up on compliance with regards to the statutory requirement notice. We found that serious concerns still remained in relation to the safe handling of medication. Due to this a further management review was held with our enforcement team. At present the local authority is not making placements at the home. As part of the inspection process the manager was asked to complete an Annual Quality Assurance Assessment (AQAA), which was then forwarded to us. Information provided detailed what had taken place over the last 12 months and the improvements the service wished to make to develop and improve the service further. Feedback surveys were also sent to people living at the home, their relatives and staff. We received a good response with 18 completed surveys, 5 from people at the home, 5 from relatives and 8 from staff members. Comments have been included in the report. All the key standards were looked at during this inspection visit as well as the action taken to address the requirements identified during our last visit. Bridge House DS0000008412.V376601.R01.S.doc Version 5.2 Page 6 What the service does well: Bridge House is a detached property situated within private grounds. There is a large well maintained garden with ample parking for visitors. People living at the home, their relatives and staff were asked for their comments about the home. People commented; ‘all the staff work well together and are always there to help’, ‘the residents are happy and receive excellent care’, ‘training is good and regular updates’, ‘everyone is working extremely hard at the moment to ensure the home is the best possible’, ‘we provide care and support that meets peoples needs’ and ‘staff work great as a team now that the old team have gone and we have a brilliant team now. What has improved since the last inspection? What they could do better: There has been very little improvement to the environment of the home. Many areas of the home are in need of redecoration and refurbishment. Despite us asking for a redecoration and refurbishment plan following the last inspection, we have not received one. The residents are entitled to live in a home that is well decorated, as well as being pleasant and comfortable to live in. Bridge House DS0000008412.V376601.R01.S.doc Version 5.2 Page 7 Arrangements to ensure that individual risk assessments regarding the administration of medicines covertly and when residents are away from the home are fully documented. A training plan must be developed for the forthcoming year so that all staff receive quality training relevant to their role ensuring they have the knowledge and skills needed. The manager must make application to register with us, providing the home with stable leadership and direction ensuring people receive a quality service. An up to date check should be carried out on the call bell systems ensuring people are able to call for staff should they need assistance. Records should be clearer with regards to fire drills showing that all staff are aware of the procedure to follow should an emergency arise. If you want to know what action the person responsible for this care home is 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. Bridge House DS0000008412.V376601.R01.S.doc Version 5.2 Page 8 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 Bridge House DS0000008412.V376601.R01.S.doc Version 5.2 Page 9 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): 3 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. At present no new placements are being made at the home until such time the standard of care provided has improved ensuring resident’s needs are fully met. EVIDENCE: Over the last year no new placements have been made at the home due to issues identified at previous inspections. Due to this the local authority made the decision to suspend placements at the home until such time they were satisfied that people would receive a good standard of care and were kept safe. Bridge House DS0000008412.V376601.R01.S.doc Version 5.2 Page 10 Therefore we were unable to review the assessment information gathered prior to people coming to live at the home. We will look at this area during our next inspection. Standard 6 is not applicable to this service, as they do not provide intermediate care services. Bridge House DS0000008412.V376601.R01.S.doc Version 5.2 Page 11 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 and 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. The care plans reflect the care needs of the residents. Whilst medication practice was better further improvements are still needed to ensure the system is safe and people receive their prescribed medication. EVIDENCE: Individual care plans were in place for each resident. A care plan details the care and support needs that a resident may have and also shows how those needs are to be met by staff. The care plans of 3 residents were looked at. They contained enough information to show how the care needs of the residents were to be met. They also provided information about the resident’s daily routines and their Bridge House DS0000008412.V376601.R01.S.doc Version 5.2 Page 12 interests. This helps the staff and the resident plan for their daily activities so that they can get as much enjoyment out of their lives as possible. The care plans were checked regularly by the staff so that any change in the resident’s condition could be identified and action taken if necessary. In the care plans that we checked we saw that the staff looked at whether or not there was any risk in relation to the residents developing pressure sores. They also looked at whether there was any risk of the resident falling and also if a resident was at risk due to problems with their food and fluid intake. Staff also looked at and wrote down how any resident was to be assisted with being moved around and by how many members of staff and what equipment if any, was to be used to assist in safe moving and handling. We saw that residents were weighed regularly and their weight was recorded in their care notes. We saw that staff wrote in the care notes when the residents had received visits from health care professionals, such as dentists, opticians, district nurses and chiropodists. We noticed however that in 1 of the care files that we looked at, the staff had not written down that the district nurses had been in to take some blood for investigations, as directed by the resident’s doctor. We checked this out with the manager who assured us that this had happened and that the results had been received and there were no concerns. The manager was reminded of the need to ensure that all visits from other professionals were recorded. This ensures that all staff involved in a resident’s care are kept informed of a person’s condition at any one time. Throughout the day we saw that the staff spoke to the residents in a very friendly and respectful way. Bathroom and toilet doors had safety locks on to ensure privacy. We saw that staff knocked on bedroom, toilet and bathroom doors before entering. In view of the fact however that 1 of the downstairs bathrooms is cluttered with items that should not be there and the other is without a shower curtain/screen and there was a sticker attached to a toilet seat, we are of the opinion that the residents’ dignity is compromised. Several of the bedroom doors are without any locks on them. This also compromises the residents’ privacy. Comments were received from relatives about the care offered to family members. They said, ‘the staff are readily available and speak to me about my relatives general health’, ‘my relatives appears to be happy’, ‘as far as I am aware they look after him well’ and ‘they care for people you know who can’t care for themselves’. A staff member also said ‘we do our best to make it as much their home as possible and make sure they are happy’. During the inspection the specialist pharmacist inspector looked at how well medicines were handled to make sure that residents were being given their Bridge House DS0000008412.V376601.R01.S.doc Version 5.2 Page 13 medicines properly. This was because at the previous inspection we found that requirements made in the Statutory Requirement Notice had not been met by 31st May 2009 and that medicines had not been handled safely. We found that significant progress had been made to ensure that medicines were handled safely and residents health was not placed at risk. Effective arrangements had now been made to make sure that medicines did not run out and residents always had enough of their medication in the home to make sure they did not miss vital does of their prescribed medication. All medication was now stored securely and safely and we did not find any prescribed medicines in residents rooms. However we did see that when medicines were being administered at lunch time the trolley containing the medicines was left wide open on two occasions. Residents wellbeing could have been placed at risk by this careless action. When we looked at the Medication Administration Record Sheets (MARS) we saw that stocks of medication were checked on a daily basis to make sure that medication could be accounted for and to show that it had been given as prescribed. In most instances we found that these checks were effective. The manager told us that she had also done audits, checks, of medication and had initially found a number of errors and concerns but recent audits had shown that medicines handling had improved and there were very few errors seen by her on these checks. The standard of record keeping had greatly improved, in that the quantities of almost all medication was recorded when it arrived in the home. However medication for one resident had not been recorded as received which made it difficult to tell if this resident had been given her medication properly .When we looked at the current records of medication along side the stock of medicines held in the home for a number of residents we found that most people were given all their medicines properly and could be accounted for. However when we looked at the records from the previous month together with the records about unwanted medicines which were returned to the pharmacy for destruction, we found a few discrepancies, indicating that sometimes medicines may not have been given properly. The manager could not explain these discrepancies however told us that she would make sure that her next audits looked carefully at this type of problem and would put measures into place to make sure that all residents were given their medicines as prescribed at all times. Very clear information was recorded when medication was stopped or the dose was changed so that all staff had the correct information to give medication safely. Staff usually recorded the exact number of tablets they gave to residents when a variable dose was prescribed. There were a few examples of where staff had failed to do this and it made it difficult to tell exactly what dose Bridge House DS0000008412.V376601.R01.S.doc Version 5.2 Page 14 of medication the resident had taken or if their symptoms were adequately managed by the dosage. There was an improvement in the information available to tell staff which part of the body to apply prescribed cream to. However we found that the members of staff who applied the creams were not the same staff who signed the MARs so making some of the records inaccurate. The records about homely remedies, medicines which can be bought over the counter, had improved and medication could be accounted for. We found that usually residents were given their medicines as prescribed for them by their doctor. However we still found that some residents had not been given their medicines properly. We found that one resident had not been given one of their medicines on the day of our inspection because the medication was given outside the usual medication round time. At the last inspection we found that no effective arrangements were made for people who were away from the home during medication rounds to be given their medication. During this inspection we found that again residents who were away from the home for a variety of reasons such as visiting relatives did not have their medication as prescribed. It is important that proper arrangements are put in place to ensure that people do not miss doses of prescribed medication. Some residents were given their medicines disguised in their food, covertly, however proper assessments had not been filled out to show that this was the only way their health could be protected. We observed one such resident being given some of her medication and because of a lack of available information the carer appeared unaware that this resident needed to be given their medications covertly, no attempt was made to hide it in her food nor did she check properly that this resident had actually swallowed their medication. It is important the each resident is given their medicines in accordance with their needs and that staff are aware of how to given each person their medication properly. Bridge House DS0000008412.V376601.R01.S.doc Version 5.2 Page 15 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 and 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. People are offered a variety of activities both in and away from the home providing them with more choice in their daily routine. EVIDENCE: During our visit the manager advised us that progress had been made in this area. The home has now appointed an activity worker, who works throughout the week. On the day of our visit a large group of people were in one of the lounges taking part in several activities including armchair exercises & movement to music. The activity worker has been proactive in making arrangements for people to join in activities both in and away from the home. Day trips have also been organised, including Blackpool Lights, Fusilier Museum and an evening of entertainment at the Civic Hall. Bridge House DS0000008412.V376601.R01.S.doc Version 5.2 Page 16 Other activities have included arts and crafts, baking, board games, music and exercise. This has afforded people more choice in their daily routines. Those who choose not to join in are able to sit and watch or spend time in one of the other lounges. Staff are also actively fundraising to raise funds to pay for some of the activities and outings. We were told that this had included a summer fair, a table top sale which was taking place the weekend following our visit as well as money raised by staff paying for meals. The home also now has access to a minibus which enables them to access the local and wider community. Regular visits take place from family and friends and visitors are made welcome. The manager has held 2 recent meetings inviting relatives so that any issues or ideas can be discussed about the service provided for their relative at the home. One of staff surveys stated; ‘I feel that there is good quality 1-2-1 time spent with residents’. However comments from relatives differed. They said; ‘I have mentioned on several occasions the lack of stimulation, aware of change in managers and I have noticed some crafts taking place’, ‘no entertainment appears to be arranged’ and ‘they could provide more activities and trips out’. With the introduction of the activity worker it is hoped that these areas will be addressed. Arrangements in relation to meals remain unchanged. During our last visit we identified that the dining room had been repainted and that there were plans to replace the carpet and fit new curtains however neither of these areas have been addressed. Information also provided within the AQAA states that the home also has plans to refurbish the kitchen. The main meal is served at lunchtime with a lighter meal in the evening. However a hot meal is available throughout the day. Drinks are also served with meals and throughout the day. Menu cards continue to be placed on the tables so that people can look at the choice available. It was noted that those people requiring support were being assisted by staff, who had sat and joined them at the table. Bridge House DS0000008412.V376601.R01.S.doc Version 5.2 Page 17 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 and 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. Systems are in place with regards to responding and reporting any issues or concerns ensuing the safety and protection of people. EVIDENCE: Since our last visit in February 2009 further issues have been raised within the home. The providers have where necessary referred these to the local authority as well as making us aware. Action has been taken to address poor practice and staff have been disciplined resulting in several staff having their employment terminated. Where necessary referrals to the Protection of Vulnerable Adults register have also been made. Due to some of the concerns regular visits have been made by the local authority to monitor and review the standard of care provided. We had also carried out a random inspection in June 2009 to look at specific concerns in relation to medication management. Progress noted at that time was poor and a further management review was held. This area was reviewed again during this visit. As detailed earlier in the report some progress has now been made. This will be monitored as part of our inspection process. Bridge House DS0000008412.V376601.R01.S.doc Version 5.2 Page 18 Staff have received in-house training with regards to adult protection. With some staff having also attended training through the Partnership. The manager advised us that support is being offered from the Local Authority Quality Monitoring Team, who have offered to provide further training for staff at the home. This will ensure that all staff, particularly new staff are aware of their responsibilities in this area. We also spoke with the administrator during our visit. She has responsibility for overseeing recruitment and personal finances. Systems in place were orderly and periodic checks were carried out to ensure information was accurate and in place. Bridge House DS0000008412.V376601.R01.S.doc Version 5.2 Page 19 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 and 26 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements are needed throughout the home so that people are provided with comfortable, well maintained accommodation in which to live. EVIDENCE: The home is a large detached and extended property set in large pleasant gardens. Accommodation is provided on two floors. There is no lift. The home does have a stair lift so that people are able to access the first floor rooms however this was broken. Money had been requested from head office and recently approved. Repairs to this were being arranged. Bridge House DS0000008412.V376601.R01.S.doc Version 5.2 Page 20 Downstairs there are 3 lounges and a large dining room. 1 of the lounges is used mainly as the activities room. The entrance hall is spacious and there is lots of information displayed on the notice boards for the residents and their relatives. The flooring both in the entrance hall and the corridor off 1 of the lounges was stained with paint marks. The corridors that were carpeted had carpets that, in places, were ripped and had been taped down. These could cause a trip hazard if they worked loose and cause injury. This had been identified during the last inspection. The lounge to the front of the home had been redecorated but the lounge chairs looked shabby and in need of replacement. This had been identified during the last inspection. The dining room did not have any curtains. This made the room look bare and institutionalised. This had been identified during the last inspection. The downstairs bathroom was cluttered with items that should not be there and the shower room did not have a privacy curtain/screen. The bathroom flooring was also coming away from the wall and whilst not causing a trip hazard it was unsightly. The upstairs shower room had marked flooring and the upstairs toilet seat was cracked. This had been identified during the last inspection. We looked at all of the bedrooms. Several had been redecorated and some were quite personalised with the residents’ own furniture, pictures, ornaments and photographs. Several of the bedrooms had stained or ripped carpets and were in need of redecoration. Some of the bedrooms did have an overriding safety door lock but several were without any locks. If it is safe to do so, then an overriding door lock should be fitted and the resident given a key. This will ensure both their privacy and their safety. The bedrooms were also without a lockable space for the resident to store anything that is of importance to them. This had been identified during the last inspection. In 2 of the bedrooms we saw that there were trailing electrical leads. We found out that these leads were from the pressure pads that were put in place to alert staff when the residents got out of bed during the night. These leads must be kept secure so that people do not trip over them. Although window restrictors had now been fitted to the upstairs windows, several of the downstairs windows remained without them. This poses a security risk as some of the windows were in bedrooms that were not within Bridge House DS0000008412.V376601.R01.S.doc Version 5.2 Page 21 sight of the main areas of the home. This had been identified during the last inspection. The radiators throughout the home were suitably covered. This reduces the risk of residents being harmed by protecting them from accidental burning. Disposable hand washing equipment (liquid soap and paper towels) was in place in bathrooms and toilets and disposable gloves and aprons were provided for the staff to wear. We noted however that liquid soap and paper towels were not available in the majority of the bedrooms where personal care was being delivered. Providing disposable hand washing equipment where personal care is being given helps to reduce the spread of infection and therefore helps to protect the residents health and wellbeing. The manager advised us that a plan of redecoration had been made and arrangements were being made for the handyman to complete. Unfortunately the handyman was on sick leave and therefore there had been some delay in starting the work. Alternative arrangements had been made and painting had commenced with redecoration of the old staff room, which is to be made into a relative’s room. Following this the first floor bedrooms are to be decorated. Progress in making the improvements has been very slow and now needs to be addressed without further delay so the people are offered a good standard of accommodation. Information was detailed in the AQAA of the improvement the service would like to make within the home. Again the providers are asked to provide us with a copy of the homes refurbishment plan along with timescales for completion in order that we can monitor the progress being made to the physical environment. The manager also told us about the plans to develop the service, which would include a new extension to the building and an increase in occupancy levels. The inspectors were concerned that current issues with the home had been slow to progress and felt that these needed to be addressed before any further work was needed. The providers are aware that application would need to be made to the regional registration team in order to make any changes to the current registration at the home. Two relatives also commented, ‘the home needs new furniture, carpets and curtains’. Bridge House DS0000008412.V376601.R01.S.doc Version 5.2 Page 22 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 and 30 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. Systems are in place to ensure people are safely recruited, however more practical training could be provided for staff ensuring they have the relevant knowledge and skills for their role. EVIDENCE: A check of the duty rotas showed that there was enough staff on duty throughout the day and night to care for the residents. On looking at the rota we saw that the manager did not write down the exact hours that she was working. To ensure that there is a true record of who is on duty at any one time the manager’s hours need to be documented. A number of changes have taken place within the team. Since we visited in June 2009 the deputy manager has left employment and over the last 12 months 10 carers have left the home. This has been due to disciplinary action being taken or because some individuals have sought alternative employment. Further recruitment has now been made. Files were looked at for 5 of the new staff, including the activity worker, carers and a domestic. Information held on Bridge House DS0000008412.V376601.R01.S.doc Version 5.2 Page 23 file included; an application form, written references, POVAfirst checks, criminal record checks (CRB), terms and conditions and copies of identification. On two files it was noted that the person last employer had not provided a references, where possible this should be sought. Original copies of the CRB’s are not held in the individual files but securely within the office. With regards to training this had been provided by the local Partnership group where possible with additional course through a distance learning provider. The training records seen on those files examined showed that staff had completed training in first aid, moving and handling, health and safety, abuse, diabetes, strokes and care of the dying. However it was found that several topics had been covered over a 1 day period. We discussed with the manager the effectiveness of such training considering a number of the new staff had no previous experience of working within the care field. One of the new staff works as a domestic and had not received formal training in relation to COSHH and infection control. Good quality training should be provided by competent and experienced facilitators so that staff are able to learn the skills required to carry out their role safely. Information was seen with regards to courses that have been requested through the partnership for 2009/2010. These included all catering staff attending a food hygiene course and 4 staff booked for a moving and handling refresher. Six further staff had been placed on the waiting list. Additional training is also provided in relation to dementia care (Yesterday, Today and Tomorrow), a request had been made for all new staff to attend this course. NVQ training is also provided. A number of staff have already completed either level 2 or 3 with further members of the team working through the award. The manager has also completed level 4. The manager is asked to provide a training plan for the forthcoming year with regards to the training needs of staff, ensuring they are equipped to carry out their role safely. The manager has now implemented a supervision system and the skills for induction, which is currently being introduced to new members of the team. These must be completed so that staff are clearly supported and directed in carrying out their duties. People living at the home, their relatives and staff all commented on the support provided by staff at the home. They said; ‘all the staff work well together and are always there to help’, ‘the residents are happy and receive excellent care’, ‘training is good and regular updates’, ‘everyone is working extremely hard at the moment to ensure the home is the best possible’, ‘we provide care and support that meets peoples needs’ and ‘staff work great as a team now that the old team have gone and we have a brilliant team now. Bridge House DS0000008412.V376601.R01.S.doc Version 5.2 Page 24 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, 33, 35 and 38 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 new manager has offered stability to the home. Application now needs to be made to register with us as well as ensuring on-going and sustained improvements are made so that people receive a good quality service. EVIDENCE: A new manager has been employed by European Care. She commenced her employment at the beginning of June 2009. She is a qualified nurse and has previous experience both within hospitals and care homes. Bridge House DS0000008412.V376601.R01.S.doc Version 5.2 Page 25 The manager feels she has settled into her role and has been supported by managers from other homes within the group as well as members of the senior management team. We discussed with the manager arrangements to register with us. She explained that she has now completed her probationary period and would therefore by making application to us. This must be done without further delay. Since commencing at the home the manager has accessed training. Completing the dementia course, YTT, person centred planning and medication auditing. She has also arranged to attend a course with regards to the Mental Capacity Act. Feedback was received from staff with regards to the manager. Comments made included; ‘the manager is fantastic, very supportive and always there when you need her’, ‘you can approach her about anything and she will help you no matter what’, ‘the home has improved dramatically in the past few months’ and ‘I’m very happy to be working with the new manager’. Systems are in place to review the service provided. The manager has introduced auditing tools with regards to care planning and medication. The Organisation also has a quality compliance team who have recently visited the home to carry out a full audit. Action identified was currently being addressed. Over the last year regular visits continue to be made by members of the senior management team in order to monitor and review the service provided at Bridge House. The area manager also continues to complete the monthly monitoring reports in line with regulation 26. Quality reviews had also been carried out by the local authority. We looked at the arrangements for people personal allowances. Money is held for all 19 people currently living at the home. At present the residents’ bank account is dormant as all other money is managed by a relative or representative. Individual finance sheets are held which show a running balance and all transactions. Receipts are kept for all purchases. A random check was carried out on three accounts. Money held corresponded with the records. Checks were looked at with regards to health and safety and annual servicing. Up to date information was seen for the electric, fire extinguishers, profile bed, small appliances, gas, fire alarm and emergency lighting. Action was identified on the fire alarm and lighting report. We were told that this had been forward to head office for money to be agreed. As already stated the stair lift was in need of repair and this was being arranged. An up to date certificate could not be found with regards to the call Bridge House DS0000008412.V376601.R01.S.doc Version 5.2 Page 26 bell system. The administrator advised that money had been requested for this however had yet to e completed. It was advised that this was followed up. Further in house checks are made with regards to water temperatures, wheelchairs and fire safety. It is suggested that a record is made of staff involved in the drill ensuring all staff are made aware of the procedure to follow should an emergency arise. Bridge House DS0000008412.V376601.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 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 X 18 3 2 X X X X X X 2 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 2 X 3 X X X X 2 Bridge House DS0000008412.V376601.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 12 Requirement A comprehensive assessment must be carried out to ensure that the home has all relevant information about the needs of prospective residents prior to moving in ensuring placement is suitable. (Previous timescale of 1.9.08 not met) Due to there being no new admissions this was not reviewed. Area will be examined at the next key inspection. This requirement was not inspected during this inspection 2. OP9 13(2) The Provider must make sure 07/10/09 that effective systems are in place for the accurate recording and safe-administration of all medication. These systems must include arrangements to ensure that individual risk assessments regarding the administration of medicines covertly and when residents are away from the home are fully documented. The providers must supply a plan 30/12/09 of work to address the work DS0000008412.V376601.R01.S.doc Version 5.2 Page 29 Timescale for action 30/03/10 3. OP19 23 Bridge House required to the physical environment ensuring the health and safety of people living at the home is not affected. 4. OP19 13 The trailing electrical leads from the pressure pads used to alert staff when the residents got out of bed during the night must be secured so that people do not trip over them. A training plan must be developed for the forthcoming year so that all staff receive quality training relevant to their role ensuring they have the knowledge and skills needed. 30/10/09 5. OP30 18 30/11/09 6. OP31 Section 11 The provider must ensure that CSA an application to register the manager with us is forwarded without delay. 23 An up to date check should be carried out on the call bell systems ensuring people are able to call for staff should they need assistance. 30/12/09 7. OP38 30/11/09 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 Refer to Standard OP19 Good Practice Recommendations A screen or curtain should be provided in the downstairs bathroom offering people privacy whilst showering. Bridge House DS0000008412.V376601.R01.S.doc Version 5.2 Page 30 2 OP19 Overriding safety door lock should be provided if it is safe to do so and the resident given a key. This will ensure both their privacy and their safety. Lockable spaces should be provided for resident to store anything that is of importance to them. Window restrictors should be fitted to all ground floor windows ensuring the permission is secure. Disposable hand washing equipment should be provided in all areas where personal care is being given, including bedrooms. This is to help reduce the spread of infection and therefore helps to protect the residents health and wellbeing. Records should be clearer with regards to fire drills showing that all staff are aware of the procedure to follow should an emergency arise. 3 4 5 OP19 OP19 OP26 6 OP38 Bridge House DS0000008412.V376601.R01.S.doc Version 5.2 Page 31 Care Quality Commission North West Region 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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