Care Home: Bridge House

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What the care home does well Overall we felt the standard of peoples care plans were good and they did focus on the individual person. People said they could make choices in their life whilst staying at Bridge House. People made comments such as "staff support me to get on with my life". The service provided, promoted and encouraged development of social and practical skills. This ensured that people had the opportunity to participate in leisure activities and live as part of the community. People very positive about the level of care and support they received at Bridge House and made comments such as: "The staff are excellent" "The staff helped to make sure that I did not lose my individuality even though I live with other people at Bridge House" "The staff are lovely and do a good job". People said the home was always kept clean and they felt comfortable living there. Staff interviewed said that they really enjoyed working at Bridge House and got a lot of job satisfaction. We found that the staff were very enthusiastic to improve the service further and support people in the home so they could become as independent as possible. We found that all managers were committed to ensuring that people staying in the home were consistently well cared for, safe and happy. What has improved since the last inspection? There had been positive action on the two recommendations listed within the last inspection report. The recommendations relating to management and staff supervision have been acted upon and improved. What the care home could do better: Some staff need further medication training. Some medication practices need to improve so that people`s health and welfare are protected. Some further improvements are required in the homes quality assurance programme so that the home continues to be run in the best interests of people who live at Bridge House. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Bridge House 43-45 Bridge Street Barnsley South Yorkshire S71 1PL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Mike ONeil     Date: 1 2 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: Bridge House 43-45 Bridge Street Barnsley South Yorkshire S71 1PL 01226208101 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Janet Barlow care home 9 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Additional conditions: 9 The maximum number of service users who can be accomodated is: 9 The registered person may provide the following category 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: Mental Disorder, excluding learning disability or dementia - Code MD, maximum number of places 9 Date of last inspection Brief description of the care home Bridge House is one of a group of services operated by Mrs. Janet Barlow and comprises three domestic properties at 43 Bridge Street, 45 Bridge Street and 12 Bridge Gardens. The houses are in a residential area within walking distance of the town centre of Barnsley. Each property has one shared and one single bedroom and can accommodate three people. Whilst Bridge House is registered as a care home for a maximum of nine people with mental health needs, elements of the service provision are of a supported living nature. Care Homes for Adults (18-65 years) Page 4 of 26 Care Homes for Adults (18-65 years) Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This is what was used to write this report. Information about the home kept by the Care Quality Commission. Prior to the visit the service had submitted an Annual Quality Assurance Assessment (AQAA) which detailed what the service was doing well, what had improved since the last inspection and any plans for improving the service in the next twelve months. The AQAA also included data as to when utilities and equipment at the home was serviced. Information from the AQAA is included in the main body of the report. An unannounced visit to the home. This was carried out by Mike ONeil, regulation Care Homes for Adults (18-65 years) Page 6 of 26 inspector on 12th May 2009 and included talking to 3 staff and Janet Barlow, registered home manager and registered provider about their work and the training they have completed. And checking some of the records, policies and procedures the home has to keep. Some time was spent observing staff supporting people and talking with 4 people. We wish to thank the people living in the home and the staff for their time, friendliness and co-operation throughout the inspection process. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Adults (18-65 years) Page 8 of 26 following this report, you can contact them using the details set out 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. Care Homes for Adults (18-65 years) Page 9 of 26 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this 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 were individually assessed prior to admission to ensure their needs could and would be met. Evidence: Care plans showed that people within the service had been assessed before moving into the home. Risk assessments and a detailed plan of care reflected any specialist interventions. The manager and staff liaised with professionals, the person and their families to find out about peoples needs. People said they had visited Bridge House on several occasions to meet other people and the staff and to test drive the service before deciding to stay on a more permanent basis. Care Homes for Adults (18-65 years) Page 11 of 26 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans provided staff with sufficient information to meet the needs of people who use the service. People were assisted and supported by staff to make decisions and choices about all daily living needs. Evidence: Three peoples plans of care were seen. These contained information on aspects of personal, social and health care needs. The plans contained some good profile information, including records of medical /mental health support and risk assessments for all aspects of peoples day-to-day lives and behaviours. People said they were aware of what was in the care plans and said they participated in regular reviews with staff. Overall we felt the standard of the plans were good and they did focus on the individual person. (Person centred) People said they could make choices in their life whilst staying at Bridge House. For example people said they often went out into the community with or without support Care Homes for Adults (18-65 years) Page 12 of 26 Evidence: from staff, chose what they wanted to do during the day and whom they preferred to spend time with. Staff were seen to be supporting people in day-to-day activities. Care plans identified levels of support people needed. The manager and staff said they were working hard to develop plans further, with people, to promote as much independence as they could. People were supported in taking risks as part of their daily living to enable them to be as independent as possible. People made comments such as staff support me to get on with my life. Risk assessments were in peoples care plans and had been regularly reviewed with staff, people and other professionals. Care Homes for Adults (18-65 years) Page 13 of 26 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service provided, promoted and encouraged development of social and practical skills. This ensured that people had the opportunity to participate in leisure activities and live as part of the community. People were given the opportunity to exercise their right of choice regarding their daily lives. Evidence: People had the opportunities to develop practical life skills and social skills and make the most of their abilities. Daily routines within the home were flexible and individual, for each person who uses the service. Activities were arranged for each individual. Group activities were also available. The home also employs an enhanced support worker. Her role includes supporting people on a 1 to 1 basis and helping them develop their independence and try to live a fulfilling life. Care Homes for Adults (18-65 years) Page 14 of 26 Evidence: People said they visited shops, pubs and other amenities in the town. People said they had been assisted to attend the local leisure centre. Other people said they attended day centres, college courses, social clubs and other meaningful activities such as paid employment and, from observation, it was clear that people living at Bridge House had their own preferences and likes that they were able to follow. People were supported to maintain family links and had the opportunity to meet people and make friends. Some people said they were looking forward to going on holiday next month with the staff and other friends. People were given the opportunity to exercise their right of choice regarding the provision of meals and were supported by staff to eat as healthily as possible. Snacks were also available for people who wanted to independently cook their meal. People said they carried out the shopping at the local supermarket on a weekly basis. Care Homes for Adults (18-65 years) Page 15 of 26 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health is monitored and arrangements for dealing with health issues were met with support from health professionals. Medication policies and procedures were generally well managed ensuring the safe administration of medication. Evidence: Care plans showed that peoples health was monitored and people had access to health care facilities and any relevant specialists that were necessary. Records showed that people were assisted and supported by staff to make decisions and choices about all daily living needs. Information of peoples personal care needs was recorded, this also included peoples wishes and preferences, or when staff provided personal support in daily routines. Risk assessments were in place to identify any risks and how they can be managed. These assessments involved people and other professionals. Care Homes for Adults (18-65 years) Page 16 of 26 Evidence: People were very positive about the level of care and support they received at Bridge House and made comments such as: The staff are excellent The staff helped to make sure that I did not lose my individuality even though I live with other people at Bridge House The staff are lovely and do a good job. Medication checked was securely stored. All medications administered had been signed for. A recommendation was made to ensure that where handwritten entries of medication are needed that two staff check and sign to confirm that the dosage and administration of medication recorded is correct. Staff said that, if appropriate, people were enabled to maintain control of their medication, with self-administration risk assessments in place. Risk assessments had been completed. Two people said they were self medicating and that staff had been very supportive in helping them to achieve this goal. Staff said they had received medication training and some records were seen of this training having taken place. Some staff however had not received any formal medication training for over 3 years. Staff did say that the manager regularly observed staff during medication administration and they were also provided with in house training. We would recommend that all staff undertake more formalised and accredited medication training on a more frequent basis. Care Homes for Adults (18-65 years) Page 17 of 26 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints procedure was accessible to people. Policies and procedures were in place on adult protection; this promoted and protected people who use the service. Evidence: A complaints procedure was in place, this was in an appropriate format and was accessible to people. People said if they had any concerns they would feel very comfortable in speaking to the manager or any member of staff about them. People said they knew how to make a complaint and who too. Staff confirmed they were aware of protection polices and procedures, they were able to describe the action they would take on receiving any allegations. Records were seen of recent adult safeguarding training people had undertaken. This ensured people who use the service were safe and protected. Care Homes for Adults (18-65 years) Page 18 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was well maintained clean and comfortable, so that people living in the home had an environment that could safely meet their needs. Evidence: Bridge House comprises three domestic properties situated in Bridge Street and Bridge Gardens and inspection of them all confirmed they were clean and being well maintained. People said the home was always kept clean and they felt comfortable living there. People were supported by the staff to take responsibility for cleaning the houses as part of their care programme to develop and/or maintain their independent living skills. Care Homes for Adults (18-65 years) Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this 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 get good support from staff who are trained and competent. Recruitment policies are followed ensuring the safety and protection of people who live at the home. Evidence: People and staff said staffing levels were adequate. People said that staff were available when needed and they knew how to contact the managers 24 hours a day. Three staff files were checked. The files contained a range of information including two references and a declaration of health and identification. The staff had undertaken a criminal record bureau check (CRB), at the enhanced level. For the members of staff recently recruited it demonstrated that a Protection Of Vulnerable Adults check had been carried out before they commenced employment. This confirmed thorough recruitment practices were in place, which was sufficient to safeguard people. Staff interviewed said that they really enjoyed working at Bridge House and got a lot of job satisfaction. We found that the staff were very enthusiastic to improve the service further and support people in the home so they could become as independent Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: as possible. Staff were able to talk about the various training courses that they had attended. Development and training records were checked these records showed when staff had completed mandatory training and were also undertaking refresher training. Care Homes for Adults (18-65 years) Page 21 of 26 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall management of the home was good, with policies and procedures in place to protect and safeguard people who use the service. Evidence: The registered manager has many years experience within the caring profession and is currently undertaking her Registered Managers Award. A manager who is a qualified registered mental health nurse and another recently appointed deputy manager form part of the management structure of the service. We found that all managers were committed to ensuring that people staying in the home were consistently well cared for, safe and happy. The managers and provider had ways in which to check out the quality of the service that they were providing. Regular staff meetings were arranged. The manager had recently undertaken a satisfaction survey of the service. The results of this survey were seen and were very positive. People who use the service met with the management of the home on a regular basis. Minutes of meetings held were seen. The Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: registered provider and managers visit the home very regularly, 3 to 4 times a week people said. People and staff said they were able to talk to the managers at any time. However, a report, as required, wasnt being written following these visits. A report should be written, at least every month and kept at the home. The fire risk assessment had been reviewed in March 2009. No issues requiring attention were highlighted in the review. Staff said they had received recent fire safety and other health and safety training .A sample of records showed that staff were receiving this statutory training. These measures will promote the safety and welfare of the people. Care Homes for Adults (18-65 years) Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 3 20 20 39 Two staff should witness handwritten entries on medication administration records. Staff should receive practical and theoretical medication training at frequent intervals. The registered provider or their representative should produce a monthly written report on the conduct of the care home as required by regulation 26 of the Care Homes Regulations. Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or 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. 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