Care Home: Bridge House Nursing Home

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What the care home does well Provides a very good standard of care that is individually tailored to residents needs. Residents benefit from a core of established, well trained and caring staff. The home is well furnished, is homely and has extensive grounds for the benefit of residents. The health and safety systems operating in the home protect residents and staff. Plans of care clearly detail the needs of residents and ensures staff know how to meet those needs. The service listens to the views of residents to ensure that the home is run in their best interests. What has improved since the last inspection? Improvements have been made to the fabric of the home for the benefit of residents and includes refurbished bedrooms and the purchase of items of furniture and equipment to aid the mobility of residents. The range of staff training has improved and will benefit residents by the provision of a well trained staff team. Implemented new pre-admission assessment documentation and provided lengthier stays for prospective residents to enable them to see if the home meets their needs and preferences. Provided specific training for activities personnel to ensure the most appropriate stimulation for residents. What the care home could do better: To continue the ongoing refurbishment of the home. Continue to maintain the very good standards of care and strive for further improvements. The manager wishes to improve access to various areas in the home for the benefit of wheelchair users. Key inspection report Care homes for older people Name: Address: Bridge House Nursing Home 64 High Street Twyford Berkshire RG10 9AQ     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: Sally Newman     Date: 1 0 0 9 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 Nursing Home 64 High Street Twyford Berkshire RG10 9AQ 01189340777 01189344173 bridge_care@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Bridge House Holdings Limited The registered provider is responsible for running the service care home 47 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 47 The registered person may provide the following category of service : Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Dementia (DE) Date of last inspection Brief description of the care home Bridge House is a listed Georgian building just off the main Twyford high street and is close to the village shops. The towns of Henley-on-Thames, Wokingham and Reading are a short distance by car or public transport. The home is set in ten acres of grounds with an orchard and a walled garden. In addition to the extensive gardens, there is a Care Homes for Older People Page 4 of 23 Over 65 0 47 47 0 Brief description of the care home sitting room, dining room, library, drawing room and conservatory for residents. The bedroom accommodation available varies in style and size. The Care Home provides 24 hour nursing care for older people and is registered to provide care for six individuals with dementia. There is a range of additional facilities available by arrangement including chiropody, dental care, and physiotherapy. The homes proprietor is Bridge House Holdings Ltd who own other care homes in the UK. Fees charged range from £875 to £1000 per week and does not include toiletries. Additional charges are made for hairdressing, chiropody, newspapers and outside activities such as visits to the theatre. Intermediate care is not provided 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 was an unannounced inspection that was conducted over the course of three days and included a visit to the service of just under 6 hours duration. The last inspection of this service was undertaken on 21st September 2007. Information provided by the service prior to the visit and a range of records were seen and were used to formulate the judgements and the outcome of this inspection. In addition, time was spent with the manager, the Head of Care, three care staff, various ancillary staff were spoken to and 10 residents were spoken to, of which 5 were in private. A range of bedrooms and communal areas of the home were seen and observation of care practice was undertaken throughout the course of the visit. The provider has a range of polices and procedures relating to equality and diversity. From the evidence seen by the inspector and comments received, the inspector considers that this service would be able to meet the needs of individuals with various Care Homes for Older People Page 6 of 23 religious, racial or cultural backgrounds. One complaint about this service has been received by the Commission since the last inspection and this was dealt with by the home appropriately. This home is very well managed and continues to provide a very good quality of care to the residents living there. Residents are satisfied and are confident their views will be listened to. No requirements or recommendations have been made on this occasion. Care Homes for Older People Page 7 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 8 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 9 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. Prospective service users and their representatives can be confident that they will be provided with the information necessary to determine whether the service will meet their needs. Evidence: Evidence was provided from examination of documentation, from information provided by the service prior to the visit and from discussion with the manager, staff and residents. Three files were seen and information for the most recent resident admitted to the service was reviewed. These were detailed and provided sufficient information to enable staff to meet their needs and form the basis of the plan of care. Each were individually assessed as to their needs and preferences to ensure that the process of admission was as smooth as possible and caused the least anxiety. Residents spoken to confirmed that they were able to visit the home with relatives if they wished in order to look around, meet staff and other residents and ask any questions or queries they might have. 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. Clear information is in place to enable staff to meet the health and personal care needs of residents. The arrangements for medication are robust and protect service users. Service users feel they are treated with respect. Evidence: A random sample of three plans of care was seen. All contained comprehensive information about individual needs and provided staff with clear guidance on how those needs should be met. There was evidence of regular review from discussion with the manager and all aspects of a persons lifestyle including their personal, health and social care needs are considered. There was evidence in care plans that a wide range of health care professionals are called upon to meet the health care needs of individual service users and one particular example of excellent health was noted. All residents able to provide an opinion confirmed that their personal and health care needs are well met and that staff provide a high standard of care and practice. There was evidence that mobility aids are utilised to assist service users and appropriate guidance is sought on their correct use. Staff spoken to confirmed that since the appointment of the manager the equipment provided to assist residents was plentiful Care Homes for Older People Page 11 of 23 Evidence: and were readily available on all floors of the home. The arrangements for medication were discussed with the manager. She conducts a monthly audit of the medication and has reviewed the computer system with the surgery to ensure that no omissions or errors can occur. The Primary Care Trust carried out an inspection of the medication arrangements in the home on 6.1.09 and concluded that the standard was met. All residents spoken to indicated that staff were always respectful and their right to privacy was always upheld. Staff spoken to confirmed that initial induction addresses issues of privacy and dignity and it is an area that is discussed periodically within one to one supervision. Throughout the course of the inspection staff were observed interacting appropriately with residents and knocked on bedroom doors and waited before entering. 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. A wide range of activities is offered over the seven days of the week that provide opportunity for mental and physical stimulation. Residents are encouraged to maintain contact with their family and friends and are able to have visitors at any time. The home provides a varied and nutritious menu designed to meet the needs of its service users. Evidence: An activities planner is in place that provides information for residents about activities that have been organised. There is always a range of activities each day including weekends. A wide range of different events and activities is organized by dedicated activities staff including various games, arts and crafts, quizzes, nail care and hand massage, afternoon tea in the garden or at local venues, films and music and movement. In addition, a hairdresser, chirpodist, the local library and external entertainment regularly visit the home. Recently a very successful garden party was held and it was clear from discussion that this had been enjoyed by residents. On the day of the inspection a lift engineer was awaited to fit new parts and despite the lift working it was not felt safe for residents to use it. As a result usually timetabled activities could not take place and alternatives on a mostly one to one basis were Care Homes for Older People Page 13 of 23 Evidence: being arranged. A newletter is prepared approximately every 3 months that provides information on forthcoming events, general news articles and any other features of interest that residents are encouraged to contribute to. There are regular residents meetings and it was clear from discussion with residents that some are very active and vocal with their views and opinions during these gatherings. All current residents have a range of visitors and many go out on regular short outings with their relatives and friends. This is actively supported and encouraged by the home and assistance with transport has been provided where needed. All residents are supported to attend church services and have the opportunity to vote if they wish. Residents are encouraged to bring personal items such as furniture etc when they move into the home. Whilst talking to residents in their bedrooms it was apparent that personal items were displayed and most residents had brought items of furniture. A new chef started work at the home on the day of the inspection. He was experienced with preparing food within a care home setting and was clearly confident in his role. A range of documentation was seen but not examined in detail and these including food temperature checks, fridge and freezer temperature checks, cleaning logs and menus, which are drawn up and reviewed on a regular basis. The chef confirmed that he will be talking to residents and will actively seek feedback about the food provided. In discussion with residents the food was highly complemented by the vast majority of those spoken to and several confirmed that they are provided with a choice. An environmental health food safety inspection was carried out on 7.3.09 where six items were raised. The manager confirmed that these had now been addressed. 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. The home has a complaints procedure, which is clear and accessible. Residents views and comments are listened to and acted upon. Residents are protected from abuse and exploitation by well-trained and competent staff who demonstrate knowledge of the homes abuse of vulnerable adults and whistle-blowing policies. Evidence: There is a robust complaints policy and associated procedures that residents are encouraged to utilise. There had been five complaints recorded since the last key inspection. All were dealt with appropriately and the outcome of investigations conducted were clearly recorded. It was apparent from evidence obtained on the day that residents are actively encouraged to voice there views and concerns and all those spoken to who were able to offer a view were confident that their opinions and observations are taken seriously. There was evidence in staff files that all staff receive training in the safeguarding of vulnerable adults as part of their formal induction and NVQ training in which it is a core module. Refresher training courses are also offered at regular intervals. Two staff spoken to confirmed that they had attended protection of vulnerable adults training and they were able to demonstrate good understanding of the principles and the action they should take if an allegation was made to them or they witness abuse. 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 safe, homely and well-maintained environment for service users. The home was clean, tidy and hygienic throughout. Evidence: The home throughout was clean and fresh smelling. The decor is homely and was complemented by the majority of residents. Maintenance is undertaken by a dedicated maintenance man and issues are dealt with promptly. The grounds are extensive and well maintained. Improvements have been made to the environment including refurbishment of eight bedrooms and the middle floor sluice. Purchase of additional equipment including profiling beds, a standing hoist and various items of furniture, and a new computer system has been installed for administrative staff. The manager confirmed in information provided before the visit that there is a dedicated cleaning staff and all COSHH materials are stored appropriately. A monthly audit of all cleanliness and control of infection procedures is undertaken to ensure the well being of residents and staff. The laundry facilities were seen and were well organized with dedicated laundry staff employed to ensure all bedding, towels and clothes were washed and cared for appropriately. Residents spoken to advised that their clothes were well cared for and they were encouraged to have them named. 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. Staff recruitment procedures are robust and protect residents from harm. Staffing levels are appropriate to meet the needs of the residents. Residents benefit from a well trained and competent staff team. Evidence: This service benefits from a longstanding and consistent staff team. Staff reported that the team work closely together and support each other. Residents who could provide an opinion advised that there is always enough staff on duty. Staff were described as marvelous, caring, approachable and friendly. Several residents stated that they felt very well cared for by staff. The manager and staff spoken to confirmed that all staff receives regular one to one sessions in private and each has an annual appraisal. In addition, regular staff meetings are held both general and role specific. Information handover meetings take place at the beginning of each shift. This ensures that the up to date needs of all residents is clearly understood. All staff are encouraged and supported to undertake National Vocational Qualifications. Of the care staff members spoken to each confirmed that they had completed NVQ 2. The manager confirmed that five staff members were now working towards NVQ 3 having completed NVQ 2 and that 7 care staff were working towards NVQ 2 qualifications. A rolling programme of training is provided for the service, and this was described as an area of improvement by those staff spoken to. The manager confirmed that she had attended a range of courses in Care Homes for Older People Page 17 of 23 Evidence: order to deliver training within the home and these included manual handling, protection of vulnerable adults, dementia and tissue viability. Staff spoken to considered the training provided was of a good standard and any special requests for training were always considered. Three staff files were seen. All contained the required documentation and provided evidence that the service has a robust recruitment procedure. One reference could not be located during the inspection but evidence was accepted from the manager that this had been undertaken. The newest member of the care staff who commenced employment on the day of the inspection confirmed that she had completed an application form, had been interviewed and had provided two references. There was evidence in those files seen that staff have an individual training profile and a personal development plan. 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. Residents benefit from a very well managed home and their views and those of their relatives are actively sought and acted upon. Thsystems for health and safety are robust and protect residents and staff. Evidence: The manager is well established in the home and is highly regarded by staff and residents. Staff described her as approachable and knowledgeable. She was also considered to be calm in a crisis. The manager is a qualified nurse and has 17 years experience in a care home environment and 7 years at management level. The manager conducts an annual service review with the use of questionnaires that are supplied to all individuals with an interest in the home. This has provided useful feedback on the service and has resulted in some changes and adaptions being made. In addition, a monthly questionnaire is provided to all residents to monitor satisfaction with the service. The manager, with the support of her staff, is very keen to continue the development of the service to ensure that residents receive the best possible care. In order to accurately monitor the performance of the home she conducts monthly Care Homes for Older People Page 19 of 23 Evidence: audits in a number of important areas. Information provided prior to the visit confirms that residents are provided with a safe place to keep their money, accurate records are kept and the entire system is subject to regular audits. The health and safety systems are robust. A range of fire equipment checks are undertaken regularly and the last fire drill took place on 7.9.09. Risk assessments have been undertaken for areas throughout the home and these are reviewed on a 6 monthly basis. There are servicing contracts in place for all equipment used in the home and these were confirmed as up to date within information supplied by the service. 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 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. 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