Care Home: Bridge House

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What the care home does well The home has good systems to admit new people to the home, although this has not happened for a number of years. Each person living at the home has a care plan which sets out the way in which staff meet the individual person`s needs. These were well written and contained detailed information. Staff said that "We take care of all people living at Bridge house" A relative said, "The care of my son/daughter is excellent". People are supported and encouraged to make decisions and to remain as independent as possible. The home has good systems for managing complaints and all staff are trained in protection of vulnerable adults (POVA) What has improved since the last inspection? Programme of redecoration throughout the home. What the care home could do better: The social, leisure, occupational and educational needs of people need to be addressed. further opportunities need to be made available. Better systems to store medication on the ground floor of the home should be considered. Facilities should include a fridge and a controlled drugs cuboard. Medication records should be signed by two people where changes have been made. A full audit of the environment should be carried out and any furnishings, fixtures and fittings should be replaced without delay. Any staff who are employed should be given a full induction and all staff should receive a minimum of six supervision sessions each year. Key inspection report Care homes for adults (18-65 years) Name: Address: Bridge House High Street Normanby Middlesbrough TS6 0LD     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: Tanya Newton     Date: 1 1 1 2 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 Adults (18-65 years) Page 2 of 26 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 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 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 Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: Bridge House High Street Normanby Middlesbrough TS6 0LD 01642452365 F/P01642452365 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.voyagecare.com Milbury Care Services Ltd care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: One named individual who is above the age category is allowed to reside in the home. Date of last inspection Brief description of the care home Bridge House is a large old house located in a quiet cul-de-sac within easy walking distance of local shops and other community facilities. All accommodation is provided in single bedrooms. Externally there is a large and pleasant garden. Weekly fees are £1040.00. 7 Over 65 0 Care Homes for Adults (18-65 years) Page 4 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: The inspection was unannounced and carried out over 4 hours. Prior to the inspection the home submitted an annual quality assurance assessment (AQAA) which provides the Commission with information about the service. This information is used to help inform the inspection process. Surveys were also sent out to the home. We received one completed by a person living at Bridge House and two completed by relatives. We also received three completed surveys from staff working at the home. Comments from these have been included throughout the body of the report. During the inspection a tour of the building was taken, records, policies and procedures were examined and people were spoken too. Care Homes for Adults (18-65 years) Page 5 of 26 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 Adults (18-65 years) Page 6 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 7 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. The home admits people only after a full assessment of needs has been carried out. This helps to ensure that the placement is appropriate. Evidence: There had been no admissions to the home for a number of years, however the acting manager said that any future admissions would be preceded by a rigorous preadmission assessment procedure involving a multi-disciplinary assessment as well as an extended assessment conducted by staff from Bridge House. Prospective residents would be invited to visit the home on several occasions, including overnight stays, so that his/her compatibility with existing residents could be assessed as well as the homes ability to meet needs. Following admission there would be a trial period before a decision was made as to the long- term suitability of the placement. One person confirmed in a survey, that they were asked if they wanted to move into the home and had been given information before deciding it was the right place for them to live. Care Homes for Adults (18-65 years) Page 8 of 26 Evidence: Each person is given a Service Users Guide in a pictorial easy to read format. The guide contained a copy of the homes complaints procedure and a contract that showed the weekly fees. Care Homes for Adults (18-65 years) Page 9 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. People are supported to take risks and make decisions and choices about all aspects of their lives and these are recorded within their individual care plans. Evidence: Each person has a care plan which sets out the way in which the home will meet their needs. Two care plans were examined during the inspection. They contained detailed information about each persons needs and the way in which these should be met. The plans focused very much on peoples strengths and abilities and focused on ways of maintaining independence. Care plans and daily records indicated that people were encouraged where possible to make decisions and choices about all aspects of their lives. Where this was not possible, it is clearly recorded within their individual plan of care. Staff have adopted a person centred approach to ensure that people are involved as far as possible in the development of their care plan. The staff demonstrate clear knowledge of each individual which has enabled them to develop additional strategies to help overcome Care Homes for Adults (18-65 years) Page 10 of 26 Evidence: communication difficulties and assist people in making decisions. This information was included within individual plans of care. Risk assessments were an integral part of each care plan. Risks were clearly identified and then strategies were put in place to minimise them. Regular monitoring and reviews take place to ensure that risk assesssments remain appropriate. Care Homes for Adults (18-65 years) Page 11 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities and opportunities for personal development are limited by the resources available to the home. The home has a relaxed atmosphere and people are supported to be independent at mealtimes. Evidence: We looked at the daily records held in the home They were quite detailed and were completed three times a day. From reading these notes we could get a full picture of how each person had spent their time, what they ate, where they went and an indication of their emotional well being. The records did show a weakness in supporting people in meaningful activities. We know from comments that we have received that some people were concerned that staffing levels may impact on people being able to go out. The manager told us that she was introducing individual activity charts and was working towards getting more people out to college. She said that more staff had been recruited and she was aiming to maintain a higher ratio so that Care Homes for Adults (18-65 years) Page 12 of 26 Evidence: people could be better supported in individual activities. Her expectation was that people would have an activity every day. During our visit everyone was in the house. A member of staff took one person out to the shops to buy some treats to have for the afternoon while they were watching a film. One member of staff had phoned in sick and the inspection visit meant that only two staff were available to support the service users as well as cooking and keeping the house tidy. One person we spoke to told us about members of their family who visited and how he went to the pub for lunch with his brother. When we arrived people were finishing breakfast. We observed the lunchtime meal. It was tuna pasta bake. Some people ate from trays in the lounge, some people ate at the table and one person chose to sit at the breakfast bar. Some people had plate guards and one person received support through prompts. They were blind and although eating independently they needed to be reminded to slow down to avoid choking. Throughout the visit the people in the home were relaxed, responsive and free to move where they wanted. Two staff surveys raised comments about the activities, stating that they should be better. One also said that the food could be improved upon. Care Homes for Adults (18-65 years) Page 13 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 and personal care needs are well recorded and met by the home. Systems for storing medication could be improved upon. Evidence: Staff support people to maintain as much independence as possible in relation to their personal care needs. Personal care is delivered sensitively and in the manner preferred by the individual, so that privacy and dignity is maintained. Comments from relatives include, We are very pleased with the care our relative receives and know that they are happy and The care is excellent. Care plans contained detailed information about the way in which peoples individual health needs should be met. There was clear evidence to show that a range of health professionals have input at the home. This included community psychiatric nurses, the behavioural team, community nurses, GPs, opticians and dentists. Medication systems were viewed. The home has clear policies and procedures in place for the safe storage, handling, administration and return of medicines. There are also Care Homes for Adults (18-65 years) Page 14 of 26 Evidence: clear protocols in place for administering as and when required medication. These have been signed by peoples GPs. In the main medication recording charts were being completed accurately. However, for any medication which has been changed, where a hand written entry is required on the MAR sheet, this should be signed by two members of staff to avoid any errors. The home should consider an alternate place to store medication. At present it is stored in the office and has to be carried downstairs during each medication round. The facilities for storing controlled drugs should also be considered as at present these are not available. The home should also consider purchasing a drugs fridge. It is acknowledged that during the time of the inspection neither controlled drugs, nor items needing storage in a fridge were available. Care Homes for Adults (18-65 years) Page 15 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. There are clear policies in place for managing complaints and protecting people from abuse. Evidence: The home has a complaints procedure that describes clearly the process for making a complaint, who would deal with it, the timescale for the process and what to do if the complainant was not satisfied with the way in which the matter had been handled. A copy of the procedure is included within the service users guide. People living at the home are also given a Letting us know what you think accessible version of the complaints policy. The home has not received any complaints since 2004. Minor concerns are dealt with on a daily basis. Policies and procedures are in place to safeguard people from abuse. A copy of the No Secrets adult protection procedure was available to staff who had all received appropriate training in the Protection of Vulnerable Adults (POVA). Financial records were viewed, accurate records were being maintained and there were clear policies regarding how peoples money should be managed. Care Homes for Adults (18-65 years) Page 16 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a spacious clean home with a nice garden area but the quality of furnishing in the communal areas was poor. One bathroom was in a poor state of repair limiting choice for the people who live at the home. Maintenance issues need to be responded to in a more timely manner, to make sure that people live in a good environment. Evidence: We were shown around the house and the garden area. Individual bedrooms had been decorated and the manager indicated which rooms were due to have new beds and floor coverings fitted. All of the rooms we saw were very spacious and each one had a wash hand basin. We noticed in a lot of bedrooms that the plugs were attached to sinks by pieces of string. The manager said that new plugs would be fitted properly and the string removed. Although the home was spacious, clean and newly decorated, the furnishings in some of the communal areas was poor. For example some chairs in the lounge did not smell nice and the fabric was very worn. The manager explained that it had been agreed that new settees and chairs would be bought and that they were waiting for catalogs to order from. There was also a large screen television waiting to be mounted on the wall. One bath we looked at did not have any water coming out of the taps meaning that the people living at this home could not use this bath. The sink had cracks in it and freezing cold water came out of the hot tap. The Care Homes for Adults (18-65 years) Page 17 of 26 Evidence: manager said that this had been reported for repair. Although we were pleased to hear that some improvements were being made to the decoration and furnishing of the home, we felt that some of the work and replacement of items should have been completed. The home has a separate laundry room which was clean and tidy. The washing machine and dryer were in working order. The Environmental Health Officer had recently visited the home and awarded it four stars for hygiene. When we looked outside we noticed that the clinical waste bin could not be locked. We asked the manager to request that it be repaired or replaced as soon as possible as clinical waste should not be accessible once it has been placed in the bin. There was also some guttering laying on the ground that was waiting to be replaced. Care Homes for Adults (18-65 years) Page 18 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. In the main good recruitment practices and training opportunities enabled staff to meet the needs of the people they support. Staff induction and supervisions could be further improved. Evidence: On the day of the inspection there were three staff on duty. The person in charge said that ideally four staff should be on duty but that a staff member had called in sick. Some concerns about staffing arrangements had been raised prior to the inspection. One person said, A constant problem is staff turnover. I believe this is due to a poor environment in an old building and a lack of investment of both money and support for Bridge House and its staff. This leads to poor morale amongst service users and staff. The person in charge confirmed that a recruitment drive had recently taken place and that once satisfactory police checks and references had been obtained these new staff would commence employment. Three staff files were looked at during the inspection. All contained an application form, two references and a police check. Not all new staff had an up to date induction and many staff had not been receiving regular supervisions. In the surveys that we received, we asked, Did your induction cover everything you need to do the job? One answered very well, one answered mostly and one said partly. Care Homes for Adults (18-65 years) Page 19 of 26 Evidence: Training records were looked at. Out of the twelve current permanent staff ten had received training in non-violent crisis intervention (NCI). Seven of the staff held an NVQ qualification at either level 2 or 3. When staff were asked about the training all said that training was relevant to their role, helped them understand the needs of the people they supported, kept them up to date with practice and gave them enough knowledge about care and medication. Care Homes for Adults (18-65 years) Page 20 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. Quality assurance and health and safety systems and checks help to ensure the safety and well being of people living at the home. Evidence: The home does not currently have a registered manager, although this post has been advertised. An acting manager has been seconded from another home in the short term. Health and safety records were looked at. Regular checks are carried out on the building and on equipment in the home to ensure a safe and comfortable environment. Gas and electrical safety certificates were up to date. Although there was evidence of accident and incident reports being completed within the home these were not always being sent to CQC. There were various quality monitoring systems in place to gain feedback from people. The home sends out an annual questionnaire to people living at the home, their relatives, other professionals and friends. The information gained is then summarised Care Homes for Adults (18-65 years) Page 21 of 26 Evidence: and is used to inform the development plan for the home. Care Homes for Adults (18-65 years) Page 22 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 23 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 1 37 37 The home must notify CQC of any serious injury to a service user, serious illness or an event which adversely affects the well being or safety of a service user. To ensure that notifications are made to CQC in a timely manner. 29/01/2010 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 4 5 11 12 13 14 20 More opportunites for personal development should be provided. More opportunities for education and occupation should be offered. More opportunities for links with the community should be facilitated. More leisure opportunities should be provided. The home should consider different storage facilities for storing medication. Consideration should also be given to a controlled drugs storage and a drug fridge. Page 24 of 26 Care Homes for Adults (18-65 years) 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 6 20 Where a drug administration record (MAR) sheet has been changed. There should always be two signatures to confirm that change. A full audit of the environment should be undertaken and any furnishings, fixtures and fittings should be replaced without delay. The bathroom that has no water for the bath and no hot water for the sink should be repaired or replaced without delay so that people living at the home can use this room. The clincal waste bin should have the lock repaired without delay. All staff should complete a full induction. All staff should receive regular supervision which should include at least six sessions each year. 7 26 8 27 9 10 11 30 34 36 Care Homes for Adults (18-65 years) Page 25 of 26 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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