Care Home: Bridge House

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What the care home does well The manager and proprietors of Bridge House have a strong commitment and drive in wishing to provide an excellent service at the home. The home has a number of methods to ensure that people`s needs and wishes are known, recorded and responded to in a `person centred way`. This is undertaken through such methods as an open and engaging management style, one to one support and time spent with those who live at the home talking with them about their care. Residents, staff and relatives, meetings are held to ensure that all are consulted. There are clear lines of accountability within the home. The manager ensures that no individual is admitted into the home unless there has been a full assessment of their needs and that the home are confident that they are able to support them to maintain their skills and lead a fulfilling life.The home has an excellent care planning system, which is holistic, and this specifies how identified needs are to be met. Care plans are regularly reviewed and there is an ongoing assessment and monitoring of individual`s needs and the service is tailored accordingly. Individual`s care records were reviewed at this visit and it was found that the plans in place had been generated from either a care management assessment or the homes own detailed assessment. Information contained within care records included: an individual`s admission record which contained information about the reason for admission, health care support services involved, next of kin, family contact details and medical history. Each person also had risk assessments, records of health professionals visiting, daily records of individual`s routines, medication information and a care plan. The care plan identified the areas in which the individual required support and detailed how staff intervention and support would be provided, the support and the situation is evaluated and dated. When examining the care plans it was evident that the home had spent time with individual`s discussing their wishes and choices and it was seen that, where able, individual`s had signed their care plan confirming the validity of its contents. We also saw that the home reviews individual`s care plans at least on a monthly basis, and sooner should a need be identified. It was very evident from talking with staff and the individual`s living in the home that people receiving a care service can choose when to get up and retire to bed. During our visit one person living at the home told us that there were times when they have been supported with bed rest in their room. People told us that staff were attentive and caring and that "nothing is too much trouble, staff are kindness itself". Within people`s notes we saw that staff monitor peoples wellbeing on a daily basis, people are supported well, ensuring that they were receiving the care and support needed as outlined within their plan of care. People living in the home are registered with a local doctors practice. Medicines are supplied to the home using a weekly blister pack system. All the medicines used in the home are given by staff. We checked the medication systems used to make sure that they meet the required standards. The home uses a local pharmacy for their medications and gets support from them. Good practice guidelines are followed such as having a photograph of the person needing the medication on their chart. We recieved four completed surveys from professionals who visit the home. Within the surveys these people told us that the homes assessment arrangements `always` ensures that accurate information is gathered and that the right service is planned for people, that the home `always` seeks advice and acts upon it in order to meet people`s social and health care needs and to improve upon their wellbeing. Additional comments from people included; "A well organised and efficient care setting, I have never had, or heard of any problem with medicines management at Bridge House. They are a pleasure to deal with and I would have no doubt in recommending them to potential residents". Another professional told us; "There is a welcoming, friendly and homely atmosphere at Bridge House". The pharmacy provides printed medicine administration record sheets for staff to complete when they give medicines. These are kept with each persons medicines, along with a copy of the homes medicine policy. This means that staff can be clear about how to give medicines safely. Medicines were given from the labeled packs provided by the pharmacy. Staff signed the administration record as they gave the medicines. We checked a sample of `controlled` medicines and these indicated that they had been given as prescribed by the doctor. The records of administration had been completed fully.During our visit time was spent with people who live at the home, no concerns were raised to us. Those living at the home said: "I am very happy living here", "Staff here are very kind". Bridge House is located within the pleasant, semi - rural area of Frampton Cottrell. It is wheelchair accessible. There are gardens to the rear of the house these were seen to be well tended. Due to the good staffing levels at the home the routines of daily living and activities are flexible and varied to suit the expectations, preferences and abilities of individual`s. Individual`s are encouraged to continue with any activities outside of the home. Those that are able to, can go out as they wish and there are no restrictions made on their movements. We saw that within individual`s care plans the home had spoken to people in order to ascertain information about their social interests, hobbies, religious and cultural needs and had responded to these appropriately. People we spoke with at the home told us that they enjoyed the entertainment provided at the home and in particular enjoyed it when entertainers visited and `sing along`s` were held, another person told us how much they had enjoyed it recently when a `harpist` played at the home and they were able to have a go on the instrument. People living at the home confirmed they are able to participate, or not, in activities as per their choice. Individual`s are also supported on a one to one basis and time is allocated to staff for this, people confirmed to us that they are allocated up to an hour each week, one person said I just like it when staff sit and talk with me about the `olden days`. Local clergy visit the home and provide a religious service for those who wish to What the care home could do better: There were no requirements and no recommendations made as a result of this visit to the service. We continue to believe that Bridge House provides and excellent service, in which individual`s needs (both on an practical and emotional support level) these are known by the home and responded to efficiently ensuring positive outcomes for those who live at the home. Random inspection report Care homes for older people Name: Address: Bridge House 31 Rectory Road Frampton Cotterell Sth Gloucestershire BS36 2BN three star excellent service The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Odette Coveney Date: 2 0 0 5 2 0 1 0 Information about the care home Name of care home: Address: Bridge House 31 Rectory Road Frampton Cotterell Sth Gloucestershire BS36 2BN 01454772888 Telephone number: Fax number: Email address: Provider web address: bridgehouserh@btconnect.com Name of registered provider(s): Name of registered manager (if applicable) Miss Rachel Louise Parnell Type of registration: Number of places registered: Conditions of registration: Category(ies) : Bridge House (Residential Home) Limited care home 16 Number of places (if applicable): Under 65 Over 65 16 old age, not falling within any other category Conditions of registration: 0 The maximum number of service users who can be accommodated is 16 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Bridge House is a purpose built care home that the owners, Jane and David Parnell, built in the grounds of their cottage. The Brochure states that a family, as a family, runs the home. Jane and Davids daughter Rachel Parnell is the registered manager of Care Homes for Older People Page 2 of 12 Brief description of the care home the home. Bridge House is located in a semi rural position, with the River Frome running alongside the grounds. Bridge House is sited at the end of a quiet residential area and provides a home for sixteen older people. The home also provides day care and will also offer respite care when a vacancy is available. In the grounds there is a model railway and on Bank Holidays the home has open days. The steam engines are available for rides and the home provides refreshments. Although there are small shops available in Frampton Cottrell, the nearest main shops are in Yate, approximately five miles away, and Bristol about ten miles away. There is a bus service from Frampton Cottrell to both places. The home has good community links and is run on Christian based principles. Fees charged at the home are available upon request; prices are based upon individuals level of need. Care Homes for Older People Page 3 of 12 What we found: This unannounced random inspection took place over six hours and was completed in one day. The manager and proprietors were present during the inspection and fully participated and engaged in the process. Evidence for our opinion about the service and the quality of care provided was gained from a whole range of different sources, including:- Information provided within surveys we recieved prior to our visiting the home. We recieved thirty nine completed surveys, of these fifteen had been completed by the people who live at the home. Sixteen had been completed by relatives/friends of those who live at Bridge House, four had been completed by staff who work at the home and the remaining surveys had been completed by visiting health/social care professionals to the home. Comments made by people were of a consistent standard, praising the high quality of the service that is provided at the home. Some of the comments made, retaining peoples anonymity, were shared with the proprietors. At this visit we also reviewed the information forwarded to us by the manager in the Annual Quality Assurance Assessment questionnaire (AQAA), completed prior to our visiting the service. The AQAA had been completed in depth and the information provided within this gave detailed examples of how the service meets its aims and objectives, as outlined within the homes statement of purpose. The AQAA was well written and the information provided evidence and examples of the high quality standards provided at the home. During our visit we spent time speaking with people who live and work at the home and reviewed a sample of individuals care records. During our visit we also looked at some of the homes other required documentation, such as fire and complaints records. We also observed staff practices and their interactions with the people who live at Bridge House. The purpose of the visit was to establish if the home is meeting the National Minimum Standards and the requirements of the Care Standards Act 2000 and to review the quality of the care provision for the individuals living in the home. We also spoke with the manager about the new Health and Social Care Act 2008 and the responsibilities of the service. The home have applied to us The Care Quality Commission) in order be registered under the new legislation and were able to demonstrate to us during our visit a sound understanding of the essential standards of quality and safety. What the care home does well: The manager and proprietors of Bridge House have a strong commitment and drive in wishing to provide an excellent service at the home. The home has a number of methods to ensure that peoples needs and wishes are known, recorded and responded to in a person centred way. This is undertaken through such methods as an open and engaging management style, one to one support and time spent with those who live at the home talking with them about their care. Residents, staff and relatives, meetings are held to ensure that all are consulted. There are clear lines of accountability within the home. The manager ensures that no individual is admitted into the home unless there has been a full assessment of their needs and that the home are confident that they are able to support them to maintain their skills and lead a fulfilling life. Care Homes for Older People Page 4 of 12 The home has an excellent care planning system, which is holistic, and this specifies how identified needs are to be met. Care plans are regularly reviewed and there is an ongoing assessment and monitoring of individuals needs and the service is tailored accordingly. Individuals care records were reviewed at this visit and it was found that the plans in place had been generated from either a care management assessment or the homes own detailed assessment. Information contained within care records included: an individuals admission record which contained information about the reason for admission, health care support services involved, next of kin, family contact details and medical history. Each person also had risk assessments, records of health professionals visiting, daily records of individuals routines, medication information and a care plan. The care plan identified the areas in which the individual required support and detailed how staff intervention and support would be provided, the support and the situation is evaluated and dated. When examining the care plans it was evident that the home had spent time with individuals discussing their wishes and choices and it was seen that, where able, individuals had signed their care plan confirming the validity of its contents. We also saw that the home reviews individuals care plans at least on a monthly basis, and sooner should a need be identified. It was very evident from talking with staff and the individuals living in the home that people receiving a care service can choose when to get up and retire to bed. During our visit one person living at the home told us that there were times when they have been supported with bed rest in their room. People told us that staff were attentive and caring and that nothing is too much trouble, staff are kindness itself. Within peoples notes we saw that staff monitor peoples wellbeing on a daily basis, people are supported well, ensuring that they were receiving the care and support needed as outlined within their plan of care. People living in the home are registered with a local doctors practice. Medicines are supplied to the home using a weekly blister pack system. All the medicines used in the home are given by staff. We checked the medication systems used to make sure that they meet the required standards. The home uses a local pharmacy for their medications and gets support from them. Good practice guidelines are followed such as having a photograph of the person needing the medication on their chart. We recieved four completed surveys from professionals who visit the home. Within the surveys these people told us that the homes assessment arrangements always ensures that accurate information is gathered and that the right service is planned for people, that the home always seeks advice and acts upon it in order to meet peoples social and health care needs and to improve upon their wellbeing. Additional comments from people included; A well organised and efficient care setting, I have never had, or heard of any problem with medicines management at Bridge House. They are a pleasure to deal with and I would have no doubt in recommending them to potential residents. Another professional told us; There is a welcoming, friendly and homely atmosphere at Bridge House. The pharmacy provides printed medicine administration record sheets for staff to complete when they give medicines. These are kept with each persons medicines, along with a copy of the homes medicine policy. This means that staff can be clear about how to give medicines safely. Medicines were given from the labeled packs provided by the pharmacy. Staff signed the administration record as they gave the medicines. We checked a sample of controlled medicines and these indicated that they had been given as prescribed by the doctor. The records of administration had been completed fully. Care Homes for Older People Page 5 of 12 During our visit time was spent with people who live at the home, no concerns were raised to us. Those living at the home said: I am very happy living here, Staff here are very kind. Bridge House is located within the pleasant, semi - rural area of Frampton Cottrell. It is wheelchair accessible. There are gardens to the rear of the house these were seen to be well tended. Due to the good staffing levels at the home the routines of daily living and activities are flexible and varied to suit the expectations, preferences and abilities of individuals. Individuals are encouraged to continue with any activities outside of the home. Those that are able to, can go out as they wish and there are no restrictions made on their movements. We saw that within individuals care plans the home had spoken to people in order to ascertain information about their social interests, hobbies, religious and cultural needs and had responded to these appropriately. People we spoke with at the home told us that they enjoyed the entertainment provided at the home and in particular enjoyed it when entertainers visited and sing alongs were held, another person told us how much they had enjoyed it recently when a harpist played at the home and they were able to have a go on the instrument. People living at the home confirmed they are able to participate, or not, in activities as per their choice. Individuals are also supported on a one to one basis and time is allocated to staff for this, people confirmed to us that they are allocated up to an hour each week, one person said I just like it when staff sit and talk with me about the olden days. Local clergy visit the home and provide a religious service for those who wish to participate. Those who live at the home are supported to fully engage with the local community and are supported to attend church and associated meetings. We saw that people living at the home are consulted about the services provided at Bridge House, this is because the manager is readily available to the residents and also because meetings are held with the residents, at these meetings people are encouraged to speak out and give an opinion, people confirmed to us that their ideas and suggestions are acted upon. The complaints policy and procedure shows a clear timeline and action to be taken in event of a complaint. It also directs the complainant to the Care Quality Commission and South Gloucestershire Social Services. A copy is made available to residents and relatives should they request it. The Commission have received no complaints since the last site visit to the home. The home has in place a complaints logbook and it was seen that issues have been dealt with effectively and fairly. Records of recently employed staff members were viewed and contained personal information and record of identity. Other information seen included, record of previous employment, and satisfactory Criminal Record Bureau disclosures. Minor accidents and incidents were recorded and more serious accidents and incidents affecting the well-being of people who live at the home had been reported to the Commission. In walking around the home it was evident that the home is well maintained and provides a safe environment for both the residents and staff. The home is comfortable, homely and well maintained. The house is well furnished and those living at the home have personalised their rooms. People who live at Bridge House told us; This is my home, I am safe and comfortable here, another person told us; There is nowhere else I would Care Homes for Older People Page 6 of 12 rather be. A strength of Bridge House is that there is a good history of retaining staff with a wellestablished staffing group. There were sufficient numbers of staff on duty at the time of our visit, staff were observed by us to be friendly, polite and responded promptly to requests from residents. Each individual has a key worker to support them with an allocated manager being involved with the overall monitoring of individual care. It was clear that staff have developed relationships with individuals and have worked together with them and others in order to identify the needs of residents and then support the person appropriately. There was information in individual care plans that provided information to guide staff to the appropriate level of support that individuals require. Regular staff meetings are held at the home and appropriate subjects are covered in respect of the service provided at the home and in line with the needs of those living at the home. The training records of staff were reviewed and staff are well supported in this area. Records seen by us evidenced that staff have undertaken training in the following areas: First aid, fire safety, manual handling, food hygiene and dementia care. The manager confirmed to us that all staff would be undertaking refresher training in medication practices. All staff have completed protection of vulnerable adults training. Throughout the inspection both Mrs and Miss Parnell demonstrated a commitment to the provision of good quality individualised care packages in the home. We observed many occasions when both Mrs and Miss Parnell, spent time with the residents, both were supporting and reassuring to residents. Both have a high visibility in the home and give strong leadership and direction. The management at Bridge House encourages openness and discussion. The management regarded as people as individuals who are respected and are managers who listen. There are people who live at the home who have a diagnosis of a dementia, we spoke to the manager about the rights and choices that people make and spoke in length about the Mental Capacity Act. Miss Parnell was able to demonstrate a good understanding in this area. Within the completed AQAA, recieved by us prior to our visit, the home had recorded; The registered manager has written and formatted an appropriate form Lasting Power of Attorney / Public Guardian Details. A form has been completed and added to each residents care file. This was carried out during the annual care reviews and at this time all residents and relatives were given copies of the office of public guardian (OPG) booklets: Making Decisions about your health, welfare or finances -Who decides when you cant; Making Decisions a Guide for family, friends and other unpaid carers. Information leaflets were given and discussed with those who had no power of attorney arrangements and those who had enduring power of attorneys which had not been registered with the OPG. Evidence of this excellent practice in order to ensure and promote the rights and decision making process for people who live at the home was seen by us during our visit. The home are to be commended for making good progress in this area. The home have a number of methods in which to monitor and review the quality of service provided at the home and to also establish the levels of satisfaction for the people who live at the home, these include residents, relatives and staff meetings, care planning reviews, staff supervision and training. The home have also established a formal process which involves surveying the views of people in the home in areas such as the quality of care, the support they receive from staff, the quality of food and determining whether people have any areas of complaint or concern about their care. Care Homes for Older People Page 7 of 12 Prior to our visiting the service the manager had completed an Annual Quality Assurance Assessment about the service, this was well completed and sufficiently detailed, within the section of What the service does well ? some of the comments the manager had written included; Rachel Parnell has undertaken City & Guilds 325.3 in advanced care management, she is an assessor for NVQ for care staff & observes staff in practice within her role & in December 2005 gained her registered managers award. The manager has extensive training in the care field & has a sound understanding of the needs of residents, staff & legislation. She is highly competent to run the home & meet its stated aims & objectives, as outlined within the homes statement of purpose & the business plan. She undertakes continued professional development & in the past 3 years this has included: first aid; manual handling; fire; health & safety; COSHH; Safe Guarding Adults; food hygiene; person centred care; infection control; medication; continence; diabetes; dementia care; use & looking after of hearing aids; visual impairment; Mental Capacity Act & DOLS; advance care planning; equality & diversity; supervision & appraisal; nutrition & malnutrition; team building; mentoring; & the Dignity Challenge. The completed AQAA also informed us that; The home is an active member of Care & Support West (formerly ARCHA), the South Glos. Nurse Managers Group, the Care Home Learning Network and Rachel & Jane regularly attend their meetings. Rachel also works in partnership with Care Learning & South Gloucestershire Staff Training & Development Unit. The management team of 6 staff, comprises of the registered, business, care, personnel & team manager & the homes team leader. They meet regularly on Friday mornings & areas of discussion include: the needs & support requirements of residents & staff; staff training; & the future plans of the business. The AQAA also informed us that; As well as being organised & skilled in aspects of running the business, the registered manager, together with all members of the management team, actively seek and value the opinions of staff, residents, relatives & visiting professionals. Managers work closely with staff to establish, maintain & seek to improve communication/relationships & to develop skills, thus supporting the staff group in working together as a cohesive, caring team. Policies and procedures are in place at the home and all are of the standard expected for a care home, we saw that staff are familiarised with these as part of their induction programme with a more in depth approach to such policies as the whistle blowing procedure and adult protection. We saw that the home have developed a robust system for the monitoring and review of policy documents in order that their contents remain in line with legislation and current good practice. As part of this audit tool the home is able to monitor other aspects of the business such as the review of care plans, risk assessments, liability insurances and staffing obligations such as recruitment, training and formal supervision. This audit tool was an excellent example of the commitment from the providers to continually improve and develop their service in order to ensure the best possible, safe, effective service for the people in their care. The home are completing the appropriate checks on the fire equipments and recording of training and testing of equipments were satisfactory. Staff have attended fire drills to ensure that they have clear knowledge of action to be taken in the event of fire emergency. The home has a fire risk assessment in place, this was reviewed by the manager in , no areas of concern were identified. During our last key visit to the service that was completed on 22nd May 2010 one Care Homes for Older People Page 8 of 12 requirement was made. This was that manual handling risk assessments must be in place for all residents. This was because during a review of individuals records these were not in place, although we saw evidence in individuals care plans that people were being supported in this area and were assisted by trained staff with the appropriate equipment. At this visit a review of the previous requirement was made, we found that the home had developed and implemented a risk assessment, based on individuals needs and abilities. The requirement had been met in full. 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 set out on page 2. Care Homes for Older People Page 9 of 12 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 10 of 12 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, 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 Care Homes for Older People Page 11 of 12 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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