Care Home: The Bridgings Limited (Redcar)

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What the care home does well People living at The Bridgings live in a home that puts them at the centre of it and clearly supports people to be as independent as possible. They are supported to live fulfilling lives with very good opportunities to pursue personal hobbies and interests. Care records are well written. They are individual and set out the level of support needed for people within a risk managed way. One person said, "I have a keyworker. I make my own daily life decision and I look after my own money". They also said they felt safe at The Bridgings, they also said, "If I was unhappy I would speak to the manager or any of the staff, you can go to all of them". Surveys were received from health professionals and they thought The Bridgings were providing a good service, they said, "The s/u who attends our service has some ongoing health issues and they appear to be responded to by the care home in an appropriate and timely manner. Communication around these issues is 2 way and regular". "We have worked closely in the past with some difficult behavioural issues, the home have been positive and open in our opinion". The home is a good place for people to live; there is a positive atmosphere and clearly very good relationships. Staff are enthusiastic about the work they do, they said, ""Think it is a well run home and I like coming to work". "It is friendly and relaxed, it is not a home it is their home and I wouldn`t leave here to go and work anywhere else". Staff are well trained, have the necessary knowledge and skill for their job roles and are very positive about the work they do. Staffing levels are acceptable and meet the needs of the people living at the home. What has improved since the last inspection? There were no requirements made at the last inspection. Three recommendation were made, one in relation to redecoration and refurbishment is ongoing and the other two have been attended to. What the care home could do better: This was a positive inspection, with few areas identified as in need of further development. The medication records do however need to detail the medication that is received into the home. It would also be helpful to have the medication protocols available within the medication administration records. The care records could be strengthened by having clearer links with the risk assessments. Some more complex care needs also need to have more specific individual care plans. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Bridgings Limited (Redcar) 7 Blenhiem Terrace Redcar TS10 1QP     The quality rating for this care home is:   two star good service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jacqueline Herring     Date: 1 6 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: The Bridgings Limited (Redcar) 7 Blenhiem Terrace Redcar TS10 1QP 01642483837 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Bridgings Limited Name of registered manager (if applicable) Mrs Cheryl Ann Carrigan Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 10 The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Learning disability Code LD, maximum number of places: 10 Date of last inspection Brief description of the care home Redcar Bridgings is registered for the care of 10 younger adults with a learning difficulty. Situated in Blenheim Terrace, a residential area of Redcar, the house is a three storey Victorian terrace house, which is in keeping with other properties in the road. Accommodation is provided for ten residents all in single rooms. Communal space consists of an upstairs lounge, with a dining room downstairs. There is a garden at the front of the house and at the rear an enclosed yard. Residents are able to personalise their rooms according to preference and taste. The fees charged are to be confirmed. Care Homes for Adults (18-65 years) Page 4 of 27 care home 10 Over 65 0 10 Care Homes for Adults (18-65 years) Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is two stars. This means the people who use this service experience good quality outcomes. This Key Inspection was to check that the home meets the standards that the Commission for Social Care Inspection say are the most important for the people who use the services, and that it does what the Care Standards regulations say it must. This inspection was conducted in one inspection day. During the inspection, a number of records were looked at, including records of people who use the service, along with staff recruitment and training records. The medication systems was also looked at. Care Homes for Adults (18-65 years) Page 6 of 27 Discussion also took place with the people living at The Bridgings, the manager and staff. The manager has completed the Annual Quality Assurance Assessment (AQAA), the services self-assessment of how well they think they are meeting standards. This was received prior to the inspection and some of information has been reflected within the report to support the judgements made. We have reviewed our practise when making requirement to improve national consistency. Some regulations from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the services are not being put at risk or harm. In future if a requirement is repeated it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: This was a positive inspection, with few areas identified as in need of further development. The medication records do however need to detail the medication that is received into the home. It would also be helpful to have the medication protocols available within the medication administration records. The care records could be strengthened by having clearer links with the risk assessments. Some more complex care needs also need to have more specific individual care plans. Care Homes for Adults (18-65 years) Page 8 of 27 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 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs met prior to admission to the home, this ensure that their needs can be met. Evidence: There have been no admission to The Bridgings since the last inspection. All of the people living at the home have done so for some time. The admission process was discussed with the manager who explained that it would be a well planned process, starting with a visit, leading to further visits and overnight stays. They also confirmed that the current people living at the home would be consulted about the any prospsective admission. Two files of people living at The Bridgings were looked at. There was assessment information within the files from care manager and other health care professionals. Care Homes for Adults (18-65 years) Page 11 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at The Bridging have a plan of care which generally gives staff the information needed to show how their needs are to met and how they are to be supported and are able to make decisions. Some clearer linkages in records would strengthen this further. Evidence: Two peoples care records were looked at in details and both were spoken to during the inspection. The care needs assessment and plan of care are a combined document covering a range of areas of need. Sixteen areas of need are assessed which includes for example, eating and drinking, personal care, sleeping along with behaviour and emotional needs, relationships and leisure and community. The plans looked at had been signed by the persons whose records they were and there was a good personal history in place. Throughout the care records, they detailed individuals choices and decision making and were clearly person centred. Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: Each person also had a separate risk assessment file, contained areas of risk and the strategies in place. Some of the areas covered included, use of public transport, monetary skills and kitchen skills. It was recommended that the risk assessments and risk management strategies be linked more clearly to the assessment of need and care plan. The current records make it difficult to cross reference information and the assessment of need does not fully relate to risks identified. Where some risks are identified for example, non compliance with medication, there is the need to have a separate more specific plan of care in place that would be evaluated more regularly. The information contained within the files in person centred and gives staff good information about the person and their lifestyle preferences. There was evidence of reviews taking place. The reviews were discussed in details, as the service was about to introduce new documentation. It was agreed that the review should continue to be an informative, value based review, which detailed the effectiveness of the care and support being provided. It was also agreed that there was the need to ensure that the reviews were then reflected in the assessment and action plans, which does not always happen. People were spoken to about the home and the care they receive. One person said, I have a keyworker. I make my own daily life decision and I look after my own money. Another person talked about their keyworker and also said, I know about my care file. Care Homes for Adults (18-65 years) Page 13 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to take control of their lives by being able to make decisions about their lives. There are good opportunities to pursue social and recreational interests. People benefit from maintaining where possible personal relationships and have their right respected. Meals are provided to a good standard within a suitable environment. Evidence: The care files looked at contained a good amount of information about peoples individual lifestyles, likes, dislikes and preferences. Discussions took place with people living at the home, staff and the manager. It is clear that people live full and active lives and there is plenty of opportunity for social, recreation, education and occupational activities. Examples of this included people working at local shops, attending college and day Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: centres, planning and going on holiday. There is a weekly plan of activities in place within the home, however the manager said that they were also in the process of developing specific individual plans. One person was looking forward to their holiday, they said they were going to Haggerston Castle on holiday but hoped to be going abroad next year. The manager and staff said that everyone is fully consulted about their holidays and the people living at the home decide which staff they want to go on holiday with. A small group are about to go on holiday to Turkey. One person spoken to said, I go to Mind several times a week and like to go to the car boot sale. You can make your own decisions, can have a lie in and spend time in your own room. Staff described a consultative and homely environment. They said, Residents meetings take place, there are regular discussions. The menu is discussed weekly and food is high on the agenda. There are a number of opportunities for people living here. They attend day centres or go to work. They like to go to Coulby Newham and we have recently been to Whitby, there is plenty of choice. A member of staff said, We always promote independence and ensure people have choices, it is a relaxed home and is flexible. A few of our residents have relationships and go out for meals with their boyfriend/girlfriend. It was good to see people going into the kitchen to make their own drinks and to make drinks for staff and visitors. Meals are planned and agreed with people but there are also alternatives available if people want. Care Homes for Adults (18-65 years) Page 15 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have their healthcare and personal care needs are met by staff who provide support in a sensitive and flexible manner. Medication systems and records are generally good, although some additional recording is needed, and only staff who have received the appropriate training have any involvement with medication. Evidence: The files looked at contained information about the involvement of other health care professionals such as consultants, gps and district nurses. There was evidence of CPAS, hospital appointment and gp appointments. Surveys were received from health professionals, they made the following comments, The s/u who attends our service has some ongoing health issues and they appear to be responded to by the care home in an appropriate and timely manner. Communication around these issues is 2 way and regular. We have worked closely in the past with some difficult behavioural issues, the home have been positive and open in our opinion. Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: One person living at the home had more complex medical needs; there was clear evidence that staff had undergone training to ensure that this persons needs could be met. Staff spoke knowledgeably about individuals and how their care needs are met and how they are supported. The medication system was looked at and was in the main good. It was confirmed that staff who administer medication are qualified to do so. The system for ordering medication was good, however there is the need to record the medication received and have an effective audit trial. A sample of Medication Administration Records (MAR) were looked at, these were well completed, with no gaps. A BNF was available and patient information leaflets were also available. It was recommended that the medication protocols be available with the MAR records, giving more readily available information for the use of as and when required medication. Care Homes for Adults (18-65 years) Page 17 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are confident their complaints would be listened to, taken seriously and acted upon, although the full procedure needed to made available. People who live at the home are protected from abuse by the homes policies and procedures. Evidence: The AQAA detailed that there had been no complaints since the last inspection and that policies and procedures are in place to give staff the correct guidance should it be needed. The records looked at showed that staff had received training in regard to No Secrets and protection of vulnerable adults and staff also confirmed this to be the case. One person said they felt safe at The Bridgings, they also said, If I was unhappy I would speak to the manager or any of the staff, you can go to all of them. The surveys received also confirmed that people were happy living at The Bridgings and that they knew what to do in the event they had concerns. Care Homes for Adults (18-65 years) Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience 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 an environment that is appropriate to the specific needs of the people who live there, it is homely and comfortable. People are able to personalise their bedrooms and the home is warm, clean and comfortable. Evidence: The Bridgings is a warm and comfortable home. There was much evidence of personalisation of individual bedrooms. People living at the home all have their own rooms, each with a lock and people are provided with their own key. None of the rooms are ensuite, although they all have a sink. Areas of the home were observed to be in need of some refurbishment. One of the corridor carpets was a potential tripping hazard, which needed attention. The ground floor toilet needed to have the light fitting mended and there was the need for a soap dispenser. The dark wood in areas were in need of redecoration. The bath panel in the first floor bathroom needed to be replaced. There was general redecoration needed. It was also identified that the home would benefit from a general spring clean, as Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: there were a number of cobwebs and observable dust in areas around the home. This was pointed out to the manager during a walk around the home. A health professional stated in a survey, There is a lovely atmosphere in the home and it feels very much like one big family. Care Homes for Adults (18-65 years) Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home have their needs were met by the numbers and skill mix of staff who were trained and competent to care for people who live at the home. People are protected by the homes recruitment procedures. Evidence: Both people who live at the home and staff said there was sufficient staff on duty to meet peoples needs. A duty rota is available, which needs to be cross referenced with other records to show the staff on duty. The manager confirmed that 7am till 9pm there were two staff on duty and one member of staff at night who does a sleepover. Two staff files were looked at during the inspection, one for the most recent person appointed and one for a more longer standing member of staff. Generally the records were in good order and contained the required information such as fully completed application form and appropriate references. There was discussion about one member of staff, as they had commenced employment with a CRB that had been transfered from the previous job. The manager and proprietor agreed to take immediate action to address this. The manager confirmed that staff would not commence employment until the appropriate CRB had been obtained. Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: A training plan was in place and in both of the files looked at there was an individual training record with a range of certificates. Staff spoken to confirmed that the mandatory training was on a continuous rolling programme but that they also had opportunities of other training that relating to mental health and medical conditions of people living at the home. This included, challenging behaviour, epilepsy, diabetes and PEG feeding. Records looked at also detailed that staff supervisions take place on a regular basis and staff spoken to confirmed this. The AQAA detailed that 85 of staff are qualified to NVQ Level 2. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at The Bridgings are assured that their home is very well run. It is well managed and run in the best interests of the people who use the service. The health, safety and welfare of people who live at the home and staff was promoted and protected. Evidence: A new manager has been appointed since the last inspection who has the required qualification and knowledge to manage The Bridgings and who is registered with CQC. People spoken to about the home believed it to be a well run home that had the needs of the people living there at the centre of what it does. Staff spoken to said, Think it is a well run home and I like coming to work. It is friendly and relaxed, it is not a home it is their home and I wouldnt leave here to go and work anywhere else. Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: The annual business plans was looked at and among other areas contained plans for the year including improvement to the environment, ongoing staff training and seeking the view of people using the service. There was also a training profile in place and the staff supervision plan for the year. The AQAA detailed maintenance and service details. A sample of these records were looked at and there was a matrix in place detailing when the servicing of equipment is next due. The records showed that regular maintenance, servicing and checks are carried out and that the fire alarm and water temperatures are checked on a weekly basis. Care Homes for Adults (18-65 years) Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 There must be a record of medication received within the home, showing that it has been checked. This will ensure that any discrepancies are identified and that people have their medication in stock. 30/05/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 The assessment of need, care plans and risk assessments could be enhanced further with clearer linkages between the different information and with more specific care plans for certain areas of risk. Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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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