Care Home: Bridgeside Lodge Care Centre

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What the care home does well Bridgeside Lodge provides a safe, warm, and welcoming environment for the people who live there. It is well maintained and furnished and decorated in a homely fashion. All bedrooms are of a good size allowing personal possessions to be accommodated. Each room has an ensuite toilet, shower and wash hand basin. There are also assisted baths for people who prefer a bath. The design of the building, separating the services into separate units lessens the impact of the overall size. All the people who returned surveys to us and to whom we spoke to told us that the standard of care was very good, that they felt supported by kind and resposive staff and that the home was very well managed. We received positive feedback on the receptivity and proactive approach of the new manager, and the way the home had improved since she had taken up the role. The home has full disabled access, which is important as many of the service users can only get around in wheelchairs, or use walking aids, such as frames. There is a robust recruitment process, comprehensive induction, and relevant training programme. Assessment and care planning are good and meets the needs of the residents, many of whom have complex needs. Complaints are responded to promptly and fully investigated. What has improved since the last inspection? Quality assurance visits are regular and records of these visits are available in the home. What the care home could do better: It is recommended that the home continue to develop specialist training to meet the needs of current and prospective residents. This includes equality and diversity training. Key inspection report Care homes for older people Name: Address: Bridgeside Lodge Care Centre Bridgeside Lodge 61 Wharf Road Islington London N1 7RY     The quality rating for this care home is:   three star excellent 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: Margaret Flaws     Date: 1 2 0 6 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 25 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 25 Information about the care home Name of care home: Address: Bridgeside Lodge Care Centre Bridgeside Lodge 61 Wharf Road Islington London N1 7RY 08444725175 08444120625 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Blackberry Hill Ltd care home 64 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home Bridgeside Lodge is owned and operated by Blackberry Hill Ltd, which is a subsidiary of Forest Health Care. Although the home is registered to admit service users over the age of 65 years, in the category of general nursing care, some of the service users can be aged 60 years. The home is a modern purpose built home. It occupies a site overlooking the canal. The nearest underground station is The Angel and the home is within reach of many bus routes. Bridgeside Lodge is a care home with nursing for 64 people. This large property stands in its? own grounds and vehicle as well as pedestrian access is through large gates. Car parking is available at the front of the building. The current scale of charges is from #563.00 to #1382. The ground floor houses the main kitchen, laundry and the remainder of the space has been redeveloped to provide accommodate for a further 12 service users. Six of these beds Care Homes for Older People Page 4 of 25 18 0 6 Over 65 0 58 0 Brief description of the care home are designated for younger people with physical disabilities and six for older people. Further accommodation for the older service users is located on the first, second and third floors. The first floor houses the Dementia Care Unit. Each floor is self-contained and staffed separately. A shaft lift gives access to all floors. Terraces are available on the third floor to enable service users to have access to outside space and there are opportunities to view the canal from the patio at ground level. All bedrooms are single occupancy and have ensuite facilities, which include a toilet, shower and walk-in shower. Each floor has a nurses? station, two lounges and a separate dining room. There are two assisted bathrooms on each floor and single toilets. Each floor provides a pantry/kitchenette, which can also be used by visitors to make drinks. The home and grounds offer disabled access. Care Homes for Older People Page 5 of 25 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: three star excellent 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 unannounced inspection was carried out over one afternoon and early evening. The manager was available and assisted us throughout, along with the Regional Manager, who was doing a quality assurance visit at the time, and the homes Administrator. We spoke to residents, visiting relatives and staff. We inspected care plans, assessments and other care records, accident and incident reports, health and safety files, staff records and other general home records. We toured the building and visited people in their rooms, where possible. We were able to observe actvities and interactions between residents and staff. Prior to the inspection we looked at all the information we had about the home, including notifications of accidents or serious incidents, monthly reports about the conduct of the home sent by the provider and previous inspection reports. Care Homes for Older People Page 6 of 25 The home supplied us with a good quality Annual Quality Assurance Assessment. We received surveys back from ten residents (some with support from relatives to complete the surveys), six staff and three healthcare professionals. Care Homes for Older People Page 7 of 25 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 25 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 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents can feel confident that their needs and aspirations will be assessed and met. Evidence: During this inspection, we saw the files of six people living in the home, spoke to a number of residents and relatives, and looked at surveys returned by ten residents. Residents and relatives told us that their needs had been properly assessed. This was confirmed by the care plans and assessments we saw on file. Relatives we spoke to also told us that the Manager and nursing staff came out to do a thorough preadmission assessment. Full referral and other assessment information was kept on file. People are invited to visit the home, have a meal and stay overnight prior to admission. The Manager told us that, since July 2008, the home has changed the way people are accomodated in the home. Residents with dementia and younger people with physical Care Homes for Older People Page 10 of 25 Evidence: disabilities now live on all floors with other older residents. The Manager and staff told us that this had had a positive impact on the cutlure of the home. She said that there was more interaction between residents, residents with dementia were more engaged and options for activities were expanded. At times, this presents new challenges for staff but we observed these being well managed and thought through. We were able to case track the care of residents who had been recently referred and speak to other professionals involved in their care. Health professionals also sent us surveys which told us that care planning and assessment was good, with a multidisciplinary approach. Documentation, feedback and our observation confirmed that the assessment process for people with complex needs was ongoing, proactive and professional. Staff have a good understanding of the new Mental Capacity Act, which incorporate Deprivation of Liberty Assessments. The home provides a high level of continuing care beds. This means that many residents coming to home have high nursing needs. The Manager told us that before she took over the management, the home had empty beds. The home has rebuilt strong relationships with the local NHS trusts and local authorities and the pattern of referrals has improved. Placing authorities had completed regular reviews, which were available. We saw professionals visiting to undertake reviews with residents and they gave us positive feedback about the home. Care Homes for Older People Page 11 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are assured that their needs are understood, documented and acted on. Their privacy and dignity are respected and they are protected by the homes medication policies and procedures. Evidence: We saw six care plans, daily notes, risk assessments and other information on file. These were comprehensive and addressed peoples health (including mental health), social and personal needs. Care plans were regularly reviewed (monthly and as and when needs change) by key workers. There are night care plans in place. The staff we spoke to were able to give clear, up to date and detailed pictures of the changing needs of the people they had specific responsibilities for. They showed us the care plans and how they updated them. The Regional Manager, who was doing a monthly quality assurance audit at the time of the inspection, described how she audited the care plans to ensure they were up to Care Homes for Older People Page 12 of 25 Evidence: date and that all relevant information was recorded and an accurate account of peoples current needs. Review dates for care plans were clearly visible and had been adhered to. The Annual Quality Assurance Assessment sent to us by the home described the new care planning approach that had been put in place. Staff were observed interacting sensitively and professionally with the residents. Surveys from and conversations with people living in the home and their relatives stated that they have good access to additional medical and professional care, should they need it. There is regular involvement by health professionals such as a dietician, chiropodist, occupational therapist, tissue viability nurse, physiotherapist, GP and other specialist professionals . There is also input from community mental health teams as needed. We spoke to health professionals who visited during the day and confirmed that they had a good working relationship with the home and described their input. Because many residents are bedbound, there is a regular support from the tissue viability nurse and district nurses, good systems for monitoring pressure care and equipment provided to help maintain peoples skin integrity. The home also has supported from a team that monitors peoples swallowing and nutrition needs. Risk asssesssments were in place and reviewed regularly. There was good evidence to demonstrate that the home worked carefully to manage challenging behaviour by residents. Staff had had training in this area and were able to tell us how they supported people with complex mental health needs. Recording of incidents was factual, professional and non-judgemental. We checked the medication arrangemements. All medication is administered by qualified and trained staff referring the homes medication policy and procedures. The audit showed that the receipt, administration and disposal of medication is being managed well and records are accurate. The Regional Manager was doing a medication audit as part of her quality assurance audit. People told us that their privacy and dignity was preserved by staff. Staff were able to give good examples of how they showed respect to the residents on a daily basis. Staff were observed to have good communication skills and to communicate with some residents in their first languages. There are also good systems in place to communicate with residents who communicate differently. Poeples cultural needs are assessed and supported. This includes supporting people who are gay,lesbian or Care Homes for Older People Page 13 of 25 Evidence: bisexual and peoples different religions and beliefs. Staff have also had equality and diversity training. The home is developing a particular committment and expertise in providing end of life and palliative care. The home has researched the pattern of deaths in the home to help imrpove practice and is enrolled in the Gold Standard Accreditation Framework, which gives good coverage to this area. Staff are being trained in care planning for people who are dying and how to discuss death and dying with residents and relatives. Some staff are undertaking a Foundations in Palliative Care course. We saw examples of good end of life care plans. Care Homes for Older People Page 14 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are able to follow their preferred lifestyle. They are supported to maintain their family, community and social relationships. Residents benefit from the good, healthy food and have their nutritional needs assessed and met. Evidence: Although there were no organised activities in the home on the afternoon of our inspection, we observed people enjoying socialising and spending time in their rooms, together in some communal areas and around and about in the home. The home now employs a full time activities coordinator. Recent activities in the home included gardening, watching films, a Elvis Presley evening and a barbeque.The home is currently converting conservatory areas into a gym and a sensory room. Residents and relatives told us that they are able to choose how they like to spend their time and could choose to participate in organised activities if they wished. Staff and residents said that there had been noticeable improvements in the wellbeing and engagement of people with dementia since the home had stopped having seperate Care Homes for Older People Page 15 of 25 Evidence: specialist units. Residents and relatives told us that they were able to keep in contact however they wished and that the staff were always welcoming and supportive. We toured the kitchen and saw plenty of good quality food there, including fresh fruit and vegetables. The menus were reasonably varied, offered choices and options for residents who preferred food from their own culture. Hot meals are available in the evening for those residents who prefer them. We spoke to the chef who told us how residents preferences and feedback are gathered at regular meetings and how peoples health conditions are considered when planning menus. Residents told us that the food was good and met their needs. Because the needs of some residents are high, nutritional assessments are kept up to date and accessible. Some residents have soft diets or are fed through a tube (PEG feeding). Weight loss and gain is monitored. Care Homes for Older People Page 16 of 25 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. People living in the home can be confident that their concerns are taken seriously and that their safety and wellbeing are protected. Evidence: We saw the complaints records. The home has a clear, accessible complaints procedure and people told us that they knew how to use it and who to speak to if they had any concerns. Three complaints were recorded in the past six months. They had been properly investigated and responded to. One safeguarding adults alert had been raised and proper procedures followed. The home has clear safeguarding adults policies and procedures and a a copy of the local authority adult protection procedure. Staff have been trained in safeguarding adults. Care Homes for Older People Page 17 of 25 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 clean, safe and pleasant environment for the residents to live in. Evidence: We toured the building with the Manager and unnaccompaied. Where we able to, we spoke to some people in their rooms. Bedrooms were personalised and comfortable. Communal areas were well maintained and pleasant. The home has a rolling maintenance and decoration programme. The lounges have been decorated, rooms redecorated and refurnished. The home has purchased a plasma screen television. The home was clean and hygienic at the time of the inspection. There were sound infection control procedures in place and staff had a good understanding of how prevent the spread of infection and keep the residents safe. Care Homes for Older People Page 18 of 25 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 are safely recruited, trained and resourced to meet the residents needs. Evidence: We saw four staff files. All pre employment checks had been completed properly before staff started work. Residents and relatives told us that there were sufficient staff on duty, that they could normally find a staff member when they needed to and that the staff were kind and professional. The rotas confirmed that the staffing levels were appropriate to the needs of the residents. The home no longer uses agency staff. The home continues to be staffed with a consistent and clear management structure. There is the manager, deputy and a team leader on each floor with a team of staff nurses, senior carers and care staff. There are teams of catering, laundry and domestic staff. There are monthly team meetings for each category of staff and meetings for all staff. The home has an ongoing, comprehensive and well resourced training programme of staff training. Training records showed recent training in all mandatory areas, safeguarding adults, specialist training in dementia and death and dying. It is recommended that the home continues to develop specialist training for staff in the areas in which people need care and support. It is also recommended that positive steps in equality and diversity training be expanded. Care Homes for Older People Page 19 of 25 Evidence: All staff have or are completing NVQ2 or NVQ3. Staff described the content and relevance of training they received and how they integrated what they learned into their practice. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and run in the best interests of the people who live there. Residents health and safety is protected. Evidence: The home has a new Manager, Fatma Makalo, who has applied for registration with the Care Quality Commission. She has ongoing and close support from the Regional Manager and is working hard to build a positive culture with excellant care practice in the home. Staff, residents, relatives and other professionals told us that improvements in the home are sound and that the Manager has an open and engaged management style. Staff told us that morale was good. There is a clear management structure to support the running of the home. The post of Deputy Manager is vacant and has been advertised. Some staff are undertaking mentorship and team leadership training. Staff have regular one to one and team supervision. Management systems and recording were seen to be very good, transparent and Care Homes for Older People Page 21 of 25 Evidence: accountable, and used to improve practice and quality of care. The home has an well established quality assurance system and sends out an anonymous satisfaction surveys annually. Relatives meeting minutes show that views and opinions are clearly expressed and taken seriously. We talked to the Regional Manager, who was doing her monthly quality assurance check at the time of the inspection. We also saw the reports of these inspections, which had been done monthly. This meets a previous requirement we made. There are policies for handling residents money. The manager or provider does not act as appointee for any of the service users. Where a residentss money is looked after, there are two senior people who are responsible for keeping the accounts. Accounts are kept to allow for an audit trail. There are secure facilities available for residents to store valuable items. Suitable and appropriate insurance cover is in place. The company allocates budgets in line with a business plan. The home has a health and safety policy in place and staff undertake appropriate training. Records show that equipment is serviced and there is a maintenance system in place. During a tour of the premises there were no hazards observed. Water temperatures are properly regulated. Fire safety systems are in place and staff are trained about what to do in the case of a fire. Care Homes for Older People Page 22 of 25 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 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 30 It is recommended that the programme of specialist staff training continues to be expanded to better meet the current and future needs of residents. This includes advanced equality and diversity training. Care Homes for Older People Page 24 of 25 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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