Care Home: Bridge House

What the care home does well The staff at Bridge House form good relationships with residents and get to know residents` needs. The home is kept clean and safe for the residents and meets their needs. Residents` friends and relatives are welcomed and may stay as long as they wish. This is appreciated by residents. The company continues to make improvements to the service provided to residents. There is a good rapport between staff and residents and between staff and management. Seventeen surveys were returned including 13 from residents, 3 from staff and one from a health care professional. All the comments received were positive about the care received by residents. What has improved since the last inspection? There have been improvements in the food served to residents. The menu now includes meals offered to people who have different cultural tastes. All the requirements made at the last inspection have been met: medication records The staff` files checked demonstrated that staff are fully vetted prior to commencing employment. What the care home could do better: Two recommendations are made as a result of this inspection. Although the home is fully staffed there are 8 care staff posts which are vacant. The appointment of permanent staff will ensure greater continuity of care for residents. A certificate stating clearly the status of the electrical wiring check and the date when the next inspection is due is recommended. Key inspection report Care homes for older people Name: Address: Bridge House 1 Forty Hill Enfield Middlesex EN2 9HT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Diaman Balraj     Date: 2 0 0 5 2 0 0 9 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 23 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. 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 Care Homes for Older People Page 3 of 23 Information about the care home Name of care home: Address: Bridge House 1 Forty Hill Enfield Middlesex EN2 9HT 02083630045 02082454246 ruby.chung@enfield.gov.uk www.enfield.gov.uk London Borough of Enfield care home 37 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) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is: 37 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: Dementia, over 65 years of age - Code DE(E) Date of last inspection Brief description of the care home Bridge House is a large purpose-built care home near Forty Hill in Enfield. The home is owned and managed by Enfield Council. The nearest station is Gordon Hill and the amenities of Enfield town are a short bus ride away. The home is registered to provide care for thirty-seven people who are over the age of 65 and have dementia. There is a car park at the front of the building. The home comprises three floors. The first floor is accessed by a lift. There are three lounges, a kitchen and a dining room on the ground floor. There is a safe enclosed garden at the back of the home. A separate respite care unit with a small lounge and dining room is located on the first floor. The entrance to the home is protected by an intercom system and closed circuit television. A coded keypad is used to exit the building for the safety of Care Homes for Older People Page 4 of 23 Over 65 37 0 Brief description of the care home the residents. The fees for the service are #623 per week. Following Inspecting for Better Lives the provider must make information available about the service, including inspection reports, to people living at Bridge House and other stakeholders. Inspection reports produced by the Commission of Social Care Inspection (CSCI) are available upon request from the registered manager/provider. Care Homes for Older People Page 5 of 23 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection took place over one day, lasting eight hours and was unannounced. The inspection was undertaken by Dia Balraj and took place on Wednesday the 20th May 2009.The inspection included meeting with the manager, the assistant manager. We made contact with the service manager from Enfield Council by email. We spoke with six residents of the home and seven staff members. A number of residents were unable to give their view on the home due to dementia or ill health. The quality of care given to residents was also assessed by observation and by meeting with relatives of two residents. Quality assurance questionnaires received by the home were also checked. Five resident files and four staff files were inspected. A tour of the home took place and two mealtimes were observed as well as a detailed inspection of food records. There were thirty three residents living at the home including eight respite care residents. Care Homes for Older People Page 6 of 23 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 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. Care Homes for Older People Page 7 of 23 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 23 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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. The evidence gained including a visit to this service suggests that potential residents can feel assured that they will be assessed before moving into the home so that their needs can be identified and met. Evidence: We inspected the assessment records of four residents. These included one new resident and a resident with high needs. Examination of these four residents files showed that their needs had been fully assessed prior to admission. This also included a form which their families had completed giving information on their needs and preferences. Each resident had an interim care plan giving staff guidance on their care needs as soon as they moved into the home. This care plan was updated as residents needs changed. The written information reflected the residents needs. The home does not provide intermediate care. Respite care is provided within a separate unit in the building. People using this Care Homes for Older People Page 9 of 23 Evidence: service have a separate lounge and dining room from the permanent residents of the home and are looked after by dedicated staff. Care Homes for Older People Page 10 of 23 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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 needs are reflected in comprehensive care plans and the standard of personal care and health care they receive is good. Residents are treated with dignity and respect. Medication records were in order but it is still necessary for all staff involved in the administration of medication to be aware of the systems used and for management to do regular checks. Evidence: We assessed these standards by looking at the personal files of four residents. These included a resident with high dependency needs and a newly admitted resident. The files had an assessment of their needs and a person centred care plan advising staff on how to meet their identified needs. The care plans were comprehensive giving relevant information about each resident so that their needs can be met. The cultural , dietary, religious and language needs were recorded where appropriate for that individual. The care plans were all reviewed on a monthly basis. The home provides the opportunity for relatives of residents to be involved in monthly reviews and to say if changes are needed. Residents had signed a form to say whether or not they wanted to be involved. This is beneficial for residents who cannot speak for Care Homes for Older People Page 11 of 23 Evidence: themselves and rely on their relatives to make their wishes known. The residents interviewed stated that that they were well cared for by staff and the food was good. We also spoke to two relatives who thought the care was good. The completed surveys stated the good support provided by staff to residents. The health records of four residents were checked. Health care appointments including optical, dental and chiropody had been recorded. Appropriate pressure care equipment such as cushions and pressure relief mattresses were in place where identified in the care plan as needed. Pressure care records were kept where a resident needs support to prevent a pressure sore developing. This helps to avoid residents developing pressure sores. Risk assessments had been completed in the case of the four resdents whose records we looked at. There were a number of requirements made on medication at the last inspection. We checked and all requirements had been met. The medication records were checked on the inspection visit. it was noted that all records were in order. However the medication Administration chart for one resident had dates altered to coincide with the date the medicine is initially given. This was discussed with the Assistant Manager who stated that this was not the method used by the home. It is recommended that staff involved in the administration of medication are aware of the system used and that the Medication administration record is checked by management on a regular basis to ensure that staff follow the correct procedure. We observed residents having breakfast in both the permanent and respite unit and observed staff resident interaction in the lounges, office and corridors. We noted that staff addressed people with dignity and respect at all times. It was oberved that staff explained what they were doing at all times and were caring. Staff supporting people with eating also showed respect and considered their dignity when assisting them. Care Homes for Older People Page 12 of 23 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. 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. People living at the home are offered to take part in activities and to follow their interests. They are provided with food they enjoy and are encouraged to maintain contact with friends and relatives outside the home. Evidence: There is a planned programme of activities offered to residents. Staff were observed spending time interacting with residents. Two relatives told us that staff stimulate the residents and offer them activities. There is a list of activities in the staff room with the names of residents who enjoy those activities to guide staff. Activities are planned on a daily basis. We looked at the list of activities which had taken place the week prior to the inspection. We saw that residents had taken part in ball game, Scrabble, feet soaked and massage, drawing, domino, jigsaws, reminiscence, reading, sensory room. In addition Birthdays are celebrated with variety shows at the home. Residents are taken on outings: Lakeside shopping, Lunch at Capel Manor Gardens. Trips are planned in advance: a trip to Southend on 3rd June, River Cruise on 1st July, and trips to the London Zoo and Historical buildings. Residents visitors are encouraged and the two visitors we spoke to said that staff were welcoming and helpful to them. Care Homes for Older People Page 13 of 23 Evidence: Observations of interaction between staff and residents was very positive at all times, staff were friendly, kind and respectful. There is a four week menu in the home. Residents have a choice of 2 main courses. Staff showed residents both the main meals on offer at lunch time and allowed them to choose. On the day of inspection this was: hot pot and steam fish. We observed a resident being offered two different snacks as she had rejected both the main meals on offer at lunchtime. A resident was given a food supplement drink to ensure adequate nutrition was given to her. Staff assisting residents with eating did so in a sensitive relaxed manner which met the needs of the individual. It is recommended that menus be displayed in the dining or lounge area to give residents the opportunity to see what is being offered for lunch on any particular day. Care Homes for Older People Page 14 of 23 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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. Residents and their families feel confident that their concerns are listened to and taken seriously. Residents are protected by staff trained in recognising and reporting abuse. Evidence: Staff interviewed stated that they had attended training in the protection of vulnerable adults so that they knew what to do if a resident is abused or makes an allegation of abuse. There have been no safeguarding investigations in the last year regarding any Bridge house resident. The manager demonstrated a good knowledge of the procedures she is required to follow. The complaints had been recorded including the outcomes. Four residents were asked if they knew how to make a complaint. One knew how to complain and others said they were happy to report any concerns to staff on duty or the manager. The majority said they did not have any concerns. One said her concerns were always addressed. Care Homes for Older People Page 15 of 23 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, 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. 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 provides a comfortable and clean environment. The home is kept clean and hygienic for the benefit of residents. Evidence: All communal areas were inspected. These included the kitchen, bathrooms, four lounges, two dining rooms, lift, corridors and other seating areas. Two bedrooms were also seen. The bedrooms seen were in good decorative order and provided a homely environment for residents. The lounge and dining room in the first floor respite unit were homely and tidy. Small alcoves have been furnished so as to provide a quiet area for residents who prefer to use these areas. Attractive cushions and blankets are provided in all chairs for residents comfort. Bathrooms were clean and functional. There is an attractive and safe garden for residents to use. The standard of hygiene in the home was very good. Staff follow infection control procedures and wear protective aprons and gloves when needed. Laundry facilities are suitable. Care Homes for Older People Page 16 of 23 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. 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. People living in this home benefit from trained and supervised staff. The recruitment process of staff protects residents. Evidence: The home had 8 care staff vacancies and was using agency staff to cover the vacant posts. The manager stated that the home had short listed and was interviewing tor the posts in June 2009. Two of the agency staff on duty were observed during this inspection. Both had worked at the home for a long period of time and were competent and experienced. Both were seen to be treating residents with courtesy and showed that they were aware of residents individual needs. There are currently 7 care staff on duty in the morning, seven in the afternoon and evening and three awake at night. There is at least one member of the management team in the building twenty four hours a day. This ensures that there is a manager available for advice at all times. Staff were observed interacting with residents in a relaxed manner and stimulating them. Staff were talking with residents, doing some ball games and helping them colouring. The filling in of vacant posts will enable residents to further benefit from a maintained standard care. The inspection of the recruitment records related to a sample of four staff files. All showed that staff have a CRB check, health and identity checks and two references in place before starting work. Staff had undertaken a number of training courses including working with people with Care Homes for Older People Page 17 of 23 Evidence: dementia and NVQ training. Staff interviewed showed good knowledge of working with people with dementia. It will be of benefit if staff could undertake refresher courses in medication. Staff were aware of the needs of people with dementia and the manager stated that care staff were to undertake a course relating to the Mental Capacity Act 2005. It is recommended that this be provided as soon as possible. Care Homes for Older People Page 18 of 23 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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 manager is competent and experienced at running a care home. The home is monitored by the provider, Enfield Council, to ensure a good standard of care is maintained and the home is run in the best interests of residents. The health and safety of residents is promoted. Evidence: The Assistant manager was present during the early part of the inspection. The manager, Ruby Chung arrived later and was present for the whole of the inspection. The manager possesses the NVQ level 4 and a Diploma in management studies. She had managed the home for a number of years and is suitably qualified to do so. She is supported by the assistant manager. Residents finances were discussed with the homes administrator. The majority of residents have their finances managed by family members. A requirement was made on the last inspection for the registered persons to demonstrate how they are meeting national minimum standard 35 and safeguarding residents financial interests for those residents whose finances are managed by Enfield council. The service manager Care Homes for Older People Page 19 of 23 Evidence: responded to the requirement at the last inspection in a letter dated 16th September 2008 stating how they are complying with standard 35 and safeguarding residents financial interests for those residents whose finances are managed by Enfield council. Health and safety records were inspected and a tour of communal areas was undertaken to look at health and safety matters. The records of safety inspections for the electrical wiring, gas appliances, hoists, lift, portable electrical appliances, fire alarm and emergency lighting were all checked. The date when the next electrical wiring check was due was not clear. Enfield Council has confirmed to CSCI in a letter dated 16th September 2008 that remedial works have been carried out and the next inspection is due on July 2010. This was confirmed by the service manager following this inspection. It is recommended that a certificate be issued by the Electrical engineer to confirm that the electrical installation is in a satisfactory condition and the actual date when the next inspection is due. Health and safety hazards were not observed on this inspection. Information provided regarding staff training showed that staff are given the necessary training in food safety, fire safety, infection control and first aid as well as moving and handling. The manager informed us that she had completed a survey and that the suggestions put forward had been implemented. Residents were also consulted for their views on the service at residents meetings. Relatives meetings are held twice a year to obtain the views of relatives on the care provided. Monthly management visit reports are carried out by a service manager from Enfield Council to ensure that the home is well managed. The reports are comprehensive and include interviews with both staff and residents to ask for their views on the home. There is a good rapport between members of the management team and staff. Care staff are well supported and have regular supervision. The last quality assurance survey was done in August 2008. The home has implemented some of the suggestions. Residents are now involved in choosing the colour scheme of their bedroom. The new optician used by the home ensures that residents are seen quicker than with the previous optician. Care Homes for Older People Page 20 of 23 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 Older People Page 21 of 23 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 9 it is recommended that staff involved in the administration of medication are aware of the systems used on the Medicine record chart and that management checks entries on the MAR sheet on a regular basis. It is recommended that menus be displayed in the dining or lounge area to give residents the opportunity to see what is being offered for lunch on any particular day. It is recommended that staff undertake refresher courses in medication and the Mental Capacity Act 2005. It is recommended that a certificate be issued by the Electrical engineer to confirm that the electrical installation is in a satisfactory condition and the actual date when the next inspection is due. 2 15 3 4 30 38 Care Homes for Older People Page 22 of 23 Helpline: 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). 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. 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