Care Home: Three Bridges Nursing & Residential Home

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What the care home does well People that use services live in a welcoming and comfortable homelike care home, which has been improved to offer a brighter living space and has a choice of quieter areas in which to sit as well as dining space so have more choice where they spend their day and free time. People that live at the home made positive comments about living as Three Bridges and said, "I love living here it`s great. I love living and working here. I like the staff the best they are lovely girls always friendly. I have a nice bedroom and I can use it when I want to sit and have my lunch and talk to my husband. We get good food and I`m really well fed". A visitor said, "My wife loves being here and I look forward to visiting as they`re a friendly bunch and you get offered a drink and home made cakes". Another visitor said "Mum loves being here. I always see her happy and smiling". There is a training programme so staff were provided with the training and support to do their jobs. There is a stable staff group who have positive attitudes to the people that live at Three Bridges so staff treat people with dignity and respect. Appropriate staffing levels are provided so people that use services were supported around their needs. The personal care and health needs of people living at Three Bridges are met to a good standard so they are supported to maintain their personal appearance and hygiene. Visitors are made welcome and their comments support this. A varied menu is available so people living in the home can choose different meals and have a cooked breakfast if they wish. Regular health and safety checks of the building are carried out as well as a continual programme of redecoration and purchasing of furniture and equipment so people that use services live in a safe and well maintained building. What has improved since the last inspection? The care plans of people that use services contained more information about them and their abilities to care for their own needs so staff knew when people needed support and help to meet their needs. What the care home could do better: An application for the manager to become registered with the Care Quality Commission must be made so that we and the people that live and work at Three Bridges will be confident the home is run in their best interest. The home should improve how decisions about daily living made by people that use services are reflected in their care plans so staff and others involved in their care understand how important people`s daily decisions about their lives and decisions about their future are to them so the agreements about how they make or are supported to make decisions are clearly understood.The home should use communication plans to guide staff about how people that use services communicate their needs so staff can understand and support people that use services to tell them what they want. People that use services should be provided with more opportunities to be involved in recreational and social activities of their choice so they can live fulfilling lives. The home should provide the complaints procedure in different ways and make this more accessible so that people with memory problems can understand and have access to it so they have confidence they can make a complaint so their concerns are listened to and acted upon. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Three Bridges Nursing & Residential Home Nook Lane Latchford Warrington Cheshire WA4 1UB     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: Anthony Cliffe     Date: 1 1 0 6 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 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 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 Older People Page 2 of 32 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 Older People Page 3 of 32 Information about the care home Name of care home: Address: Three Bridges Nursing & Residential Home Nook Lane Latchford Warrington Cheshire WA4 1UB 01925418059 01925414818 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Southern Cross Care Management Limited Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 52 Number of places (if applicable): Under 65 Over 65 0 32 dementia old age, not falling within any other category Additional conditions: 20 0 The registered person may provide the following category of service only: Care home with nursing - Code N. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum places - 32), Dementia - Code DE (maximum places - 20) . The maximum number of service users who can be accommodated is: 52. Date of last inspection Brief description of the care home Three Bridges is a care home providing nursing and personal care and accommodation for 54 older people, 20 of whom have dementia. Three Bridges is located in the Latchford area of Warrington, close to a shops and pubs. It is a short bus ride from Warrington town centre. It consists of a two-storey building with all resident Care Homes for Older People Page 4 of 32 Brief description of the care home accommodation on the ground floor. There is a separate unit for the residents with dementia. There are 52 single bedrooms and 1 double bedroom. Four of the bedrooms have en-suite facilities. The home has car parking to the front and a large garden to the sides and rear, which is easily accessible. Fees range from three hundred and eighty two to six hundred and seventy pounds per week. Information about the home can be obtained directly from the manager or the providers web site on the internett. Care Homes for Older People Page 5 of 32 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: References to we, our or us represent the Care Quality Commission This unannounced visit took place on 11 June 2009 and lasted over eight hours. One inspector carried out the visit. This visit was just one part of the inspection. Other information received about the home was also looked at. Some weeks before the visit the manager was asked to complete a questionnaire called an Annual Quality Assurance Assessment (AQAA) telling us what they thought they did well, what they needed to do better and what they had improved upon since our last visit to the home, to give us with up to date information about the services provided. This helps us to determine if the management Care Homes for Older People Page 6 of 32 of the home see the service they provide in the same way we do and if our judgements are consistent with home owners or managers. During our visit we looked at various records and the premises. People that use services, relatives, staff, the manager and a health care professional were spoken with and gave us their views about the service. We provided questionnaires to people using the service, staff and health and social care professionals involved in their care so they could tell us their views about the service the home provides. In May 2008 we did an annual service review of the home, which told us the home was still providing a good service. An annual service review is a summary of our knowledge about how a service that has not had a visit in the last year is still performing. It is also how we decide if a service is still as good as we thought it was since our last visit or annual service review. In August 2008 a commission pharmacy inspector did a short inspection to check on how the home managed the medicines of people that use services. During that visit the pharmacy inspector found some things that were not being done correctly and needed to be put right so the medicines of people that use services were managed safely. The pharmacy inspector made requirements, which are things that have to be done so that owners or managers of services show us they work with us to put things right. We found the requirements made in August 2008 had been completed at this visit. What the care home does well: What has improved since the last inspection? What they could do better: An application for the manager to become registered with the Care Quality Commission must be made so that we and the people that live and work at Three Bridges will be confident the home is run in their best interest. The home should improve how decisions about daily living made by people that use services are reflected in their care plans so staff and others involved in their care understand how important peoples daily decisions about their lives and decisions about their future are to them so the agreements about how they make or are supported to make decisions are clearly understood. Care Homes for Older People Page 8 of 32 The home should use communication plans to guide staff about how people that use services communicate their needs so staff can understand and support people that use services to tell them what they want. People that use services should be provided with more opportunities to be involved in recreational and social activities of their choice so they can live fulfilling lives. The home should provide the complaints procedure in different ways and make this more accessible so that people with memory problems can understand and have access to it so they have confidence they can make a complaint so their concerns are listened to and acted upon. 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 Older People Page 9 of 32 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 10 of 32 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. Information is provided to people about Three Bridges in a way they can understand so they can decide if the home is suitable to meet their needs. Information is gathered about their needs so they can decide if the home can provide the right care to meet their needs. Evidence: The information provided to people that use services, called the statement of purpose and service user guide, were made available in different ways such as on a CD or audio cassette. This meant they had information provided to help them decide if they wanted to live at the home. Information was provided to people that use services in an information pack which included a statement of purpose, service user guide, brochure, newsletter and information about menus and activities so they had information about the facilities and services offered at the home. Care Homes for Older People Page 11 of 32 Evidence: We could see that people that use services had individual information gathered about their needs before they moved into the home. We could see that people that use services were involved in giving information to the home about their needs, or information was sought from their relatives or others involved in their care. This meant that staff at the home had helpful information to help them provide the right support and care for the person when they moved into Three Bridges. The information we saw that had been gathered about people before they moved into the home included details about their needs. We saw this covered information about their social interests and hobbies, medical information on their physical and mental health, how they communicated with people, maintaining their safety, managing finances, help with personal care, and their life histories so staff had information about the people they cared for and supported. We could see that in other records that the process of gathering information usually involved families and health and social care professionals. Important information was obtained about people that use services from families and health and care professionals so staff had information about them before they moved into the home. Care Homes for Older People Page 12 of 32 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. People are supported to be safe and well but information held about them does not support that they are directly included in the decision making process so they are not always involved in everyday decisions or decisions about their care. Evidence: We saw that a lot of information was gathered about the needs of people that use services so staff had information to provide support and care. The home uses a person centred approach to care but does not use person centred thinking and planning to provide care and support to people living at the home. This means their care is not always based around their needs and choices. Person centred planning is a really good way for people that use services to take control of their lives. Person centred thinking helps staff that care and support people who live at the home to listen to them and then to get what they want. A person centred plan contains information on what is positive about people that use services for example what people like and admire about them and their gifts and talents. Information should be included about what and who is important to people that use services from their viewpoint, as well as what people Care Homes for Older People Page 13 of 32 Evidence: want for their future. A person centred plan should have information about how people that use services want to be supported, so they stay healthy, safe and well. This is called a support plan but may be called a care plan. This should be detailed enough to provide a living description of how people that use services want to be supported, how they make decisions and says who will do what by when. The information the manager sent to us before the visit said that people that use services had individualised care based on information gathered about all the important areas of their lives and this involved them and others with an interest in their care. Care plans said positive things about how people could help themselves but care plans did not tell us how people wanted their care to be arranged and how staff would provide support or care to help them to care for themselves. The care plans we saw gave details as to the personal care needed by people that use services but did not always say how they preferred their their personal care to be arranged or planned around their daily routines so care based on their personal preferences was not always provided. For example routines around personal care and bathing. Care plans provided staff with some guidance on supporting people to remain independent by encouraging them to choose their clothes, attend to their personal care and saying they liked to remain smart. Care plans included details of the health and social care professionals involved in their care. Care plans and daily records showed that staff acted on recommendations from professionals such as psychiatrists, dietitians, skin care specialists and speech and language therapists. Care plans contained information of how to help people remain safe and healthy, called risk assessments. These told staff about how people could put themselves at risk of harm due to them not recognising risks to themselves because of their physical or mental health. These risk assessments meant that staff could support people to remain safe. We found that information in risk assessments was being repeated so several risk assessments were being written for the same or similar conditions or risk to peoples health. This could be confusing as to what the risks to people were. Care plans contained important information about people that use services. Examples of these were that nutritional information called a nutritional assessment said a person using the service had problems with eating and swallowing. A risk assessment and care plan had been written so the persons eating and weight could be watched. This advised staff to weigh the person and make sure she ate her meals as she had lost some weight and needed to be seen by the doctor but did not tell staff at what point they needed to contact the doctor if more weight was lost. The manager said that Southern Cross Health Care has a policy that if a person loses more that 2 kilogrammes they need to be seen by a doctor, so staff were not following the Care Homes for Older People Page 14 of 32 Evidence: providers guidance. We saw good examples of a person using the service being at risk of falls and guidance to staff that the person must be helped when walking to prevent them from falling. This information was consistently recorded in risk assessments. We saw in reviews of care that the person had not had a fall for three months so staff were following the guidance in place and preventing people from falling. We saw that care plans about how people that use services communicated were used and told staff about the difficulties that people had in making themselves understood or if they had difficulties understanding words or no longer used words due to them having dementia. We did not see the home using plans that told staff about the individual ways or different methods that people living at the home used to communicate so they could understand them and support them to tell staff what they wanted. The information the home had about people that use services was about their needs, routines and lifestyle but this information was not reflected in the care plans the home had written to support and provide care for them. This meant that staff did not have the information to provide individualised care. Care plans did not reflect a person centred approach and only contained a little information on how people could care for themselves or be involved in their personal care so did not support the claim the home used a person centred approach. We could see many examples of how people that lived at the home chose their daily routines and followed their own lifestyles but this was not reflected in the care plans written about them and we could not see how they had been involved in the writing of their care plan so would not know what was written in them. We could see that relatives and people that use services were involved in reviews of care and these were held regularly so they had an opportunity to contribute to their care plans. We saw that staff treated people that use services with courtesy, dignity and respect and sought their views about how they wanted to be supported. We saw staff help them make decisions. We did not see information about how people that use services made decisions or where they lacked capacity, experience or judgement to make decisions so could not confirm why, when, where and how staff supported them to make decisions or what decisions they made for them or supported them to make. The home has access to local general practitioner surgeries and point of contact nurses. The point of contact nurses visit the home and decide if people that use services need to see a doctor or require further medical intervention in non urgent medical cases. This means that people that use services have quick access to medical support when needed. We saw peoples care records that the home completed nutritional screening on everyone admitted to the service and repeated this so people Care Homes for Older People Page 15 of 32 Evidence: at risk of malnutrition were regularly monitored and the necessary action taken where people were at risk. People also had visits from opticians, dentists and chiropodists so could access services to remain safe and well. Medication policies and procedures were detailed so staff understood their responsibilities and accountability for their actions when administering medicines to people living at the home. Both areas of the home had similar medicine storage facilities and used the same policies and procedures. New medicine fridges were in use with the operational temperatures of the drugs fridges regularly recorded so staff knew they were operating safely. Each storage area contained the policies and procedures for medicine administration with specimen signatures of staff responsible for administering medicines. We looked at the arrangements for the ordering, receipt, administration and disposal of medicines and controlled drugs and found no errors. This showed us that the people living at the home were receiving their medicines safely. We talked to staff who were administering medicines about the arrangements for giving out medicines during mid morning. Staff wore red aprons to show they were not to be disturbed during this busy time of the day so were able to concentrate on administering medicines safely. The deputy manager described how arrangements for the administration of medicines to fall into line with good practice had been discussed with the pharmacy which supplied medicines to the home so where possible medicines were given at times chosen around the routines of people that use services. We saw good practice in place to promote the dignity of people living at the home so they were treated with respect. We saw that when staff were providing personal care to people in their bedrooms they put a notice on the outside of the bedroom door so no other staff would walk into the bedroom to do domestic chores or check on the person so their privacy was maintained. Southern Cross Health Care have become dignity champions under the Department of Health dignity in care campaign, which means that staff are issued with information on treating people with dignity and respect and keep guidelines with them so they are aware of how they should treat people. A visiting professional said of the standard of care at the home, I always see good practice in here and started giving advice and training on end of life care to the staff here. I am already seeing good practice as a result. Care Homes for Older People Page 16 of 32 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 at Three Bridges are supported to make choices but could be offered more opportunities for recreational and social contact so they have control over their lives based on their personal choices. Evidence: An information board at the main entrance as well as notice boards in the two main areas of the home displayed information about events taking place inside and outside of the home as well as the range of activities available in the home for a month. This also displayed the complaints procedure as well as cards of thanks from relatives. Outside entertainment was provided by visiting entertainers. Local clergy visit the home to speak with people living there so they have opportunities to practise their faith. At the time of our visit the home did not employ an activities coordinator so there was no one to plan and encourage people to do activities. We saw staff actively involved in activities throughout the day so people that use services had opportunities for social and recreational contact. We saw some people that use services reading newspapers Care Homes for Older People Page 17 of 32 Evidence: and magazines, watching TV and listening to music. We saw staff sitting and talking with people that use services as well as massaging their hands, doing their nails and doing activities in the home. Staff held a game of bingo for people to take part in as well as spending time with people that lived there. We saw that the communal areas of the home usually had a staff member sitting in them so people living at the home had contact with staff. We saw people living at the home sleeping at times so they were not engaged in doing anything. Activities available also include exercise, quizzes, pampering and baking. Staff were seen to be person centred in their approach and had training in Yesterday, Today and Tomorrow, an accredited training programme from the Alzheimers Society. This meant they were trained to provide care to people whose needs resulted from living with dementia. The information sent to us before our visit to the home said that the home has meetings with relatives so families have an opportunity to say what they want from the home and include this into care for people living at the home. Visitors were seen throughout the day and were welcomed by staff. Visitors to the home said they received a warm welcome. A visitor said, My wife loves being here and I look forward to visiting as theyre a friendly bunch and you get offered a drink and home made cakes. Another visitor said Mum loves being here. I always see her happy and smiling and comforting other people. Theres always something going on. The staff always keep me informed how she is or if she needs the doctor but I just agree as they care for her really well. The routines of the home were seen to be flexible and meals were seen to be varied and supported a balanced diet with advice sought from dietitians where necessary. We saw tables were set with table cloths and had fresh flowers, a daily menu and condiments on them so people could assist themselves during meal times. The menu provided a varied diet and in the dementia care unit separate sittings were arranged with protected meal times in place to prevent overcrowding and help people with their meals so staff could support people to enjoy their meals without interruption. The home used the Southern Cross NUTMEG system a system for providing a varied and nutritional menu which included alternative choices of meals through the day and included, breakfast, lunch and tea times with a light bite menu as well. People that used services had a choice of where they went to dine or spend their free time so if they wish to stay in their bedrooms to have meals, they can. If people wished they could have have drinks making facilities in their bedrooms so have a choice of where they spent their free time. Care Homes for Older People Page 18 of 32 Care Homes for Older People Page 19 of 32 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 at Three Bridges are protected by the safeguarding adults procedure in place so they are protected at all times. Evidence: The home has an open door policy regarding complaints. The home manager is available to listen and respond to complaints and concerns and holds a weekly surgery for relatives. The complaints procedure is displayed in the main entrance area of the home but people living in the dementia care unit do not have access to this area, as it has an electronic lock on the door so people cannot leave the unit without staff knowing, so do not have direct access to the complaints procedure. There were copies of the information given to people that use services in bedrooms called the statement of purpose and service user guide and this contained the complaints procedure. We looked at the complaints the home had received during the twelve months before our visit and these had been dealt with satisfactorily. Policies and procedures were in place to protect vulnerable adults, called the safeguarding adults procedures. The safeguarding adults procedure is how we, the local council, police and other agencies respond to and manage allegations or suspicions of abuse against vulnerable adults. The manager provided training records that showed all but five of the forty staff Care Homes for Older People Page 20 of 32 Evidence: employed at the home had received safeguarding training. Staff had received training using a DVD on how to recognise and respond to suspicions of abuse so should be able to protect vulnerable adults. We spoke to two staff and they said they had received safeguarding adults training and described what they would do if they witnessed abuse or neglect, or someone reported abuse or neglect to them. This meant they could respond to suspicions or allegations of abuse or neglect to make sure vulnerable adults were protected. The home had a copy of the Warrington Borough Council safeguarding adults procedure and had access to the local councils safeguarding adults training programme through the local training consortium. The home had made four safeguarding referrals to the local council since our last visit there and had cooperated with the local council in the investigation of these. Care Homes for Older People Page 21 of 32 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. People that use services live in a comfortable and safely maintained building so their health and safety is promoted. Evidence: We looked around the building and saw improvements in the decoration and furniture had been made. Since our last visit to the home the front doors have been replaced so it is more secure. In the dementia care unit more signs and symbols had been added to bedrooms, bathrooms and toilets so people that use services could find their way to these facilities. Bedroom doors had been personalised with names, photographs or pictures that people that use services had made so they recognised which was their bedroom. Improvements have been made in the home through an ongoing redecoration and refurbishment programme. This had included re-carpeting of the dementia care unit so people live in a comfortable homelike building. The dining room in the general unit had been redecorated to give a more homelike feel to it. The home employed a full time maintenance man to identify and rectify problems as well as maintaining equipment. Bedrooms are redecorated when they become vacant so the home continues to maintain good standards of decor. The manager said she wanted to improve the Care Homes for Older People Page 22 of 32 Evidence: garden area so a sensory garden could be created, people could use the garden area more often and be involved in activities in the garden area. The patio area was being cleaned and garden area tended to during our visit so people could sit in the garden if they wished to. The home had bought a green house so that people that use services could grow vegetables. Care Homes for Older People Page 23 of 32 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. Good employment procedures and a varied training programme are in place so people living at Three Bridges are protected by a thorough recruitment process and a skilled staff team. Evidence: We saw the staff numbers in place at the home supported the needs of people that use services so they had sufficient help with their needs. The home was not fully occupied and there were sufficient staff to provide care and support for the number of people living at the home. Additional staff were on duty to assist with domestic, laundry and catering duties. The manager works at the home five days a week and is not included in the staff on duty so is able to offer support and supervision to the staff team. The homes staff induction programme was on Skills for Care induction standards which are nationally recognised standards for people who work in social care so staff understand their roles and responsibilities. The home employs 24 care staff and 3 of these have an NVQ level 2 qualification. Additional care staff are working toward the completion of the NVQ level 2 qualification. An NVQ level 2 qualification is a nationally recognised qualification in social care. Care Homes for Older People Page 24 of 32 Evidence: We examined the recruitment records of three staff employed at the home. Recruitment procedures were good and included staff having to complete an application form, full employment history and two references sought about their suitability for employment. The recruitment of staff also included a Criminal Records Bureau (CRB) disclosure which is a check of staff to see they are suitable people to provide personal care and support to vulnerable adults. Staff were provided with a variety of training which included health and safety, food hygiene, moving and handling, safeguarding adults and nutrition. The home uses a computer programme to record all staff training as well as having individual training files so we could see they were provided with regular training to be able to do their jobs. Before our visit staff returned surveys to us that said they received regular monthly training seminars and described training as interesting and varied so were provided with the training they needed to do their jobs. Care Homes for Older People Page 25 of 32 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. Quality assurance identifies areas for further development so the welfare of people living at Three Bridges is promoted. Evidence: Before our visit Southern Cross Health Care informed us that the manager of Three Bridges had been promoted within the company and a new manager for the home had been appointed. The new manager had worked in the health and social care sector for many years so is experienced in managing a care service. We have not yet received an application from the manager to register as the manager so cannot yet confirm her suitability. Before our visit to the home we received surveys from staff that said the manager often met with them to provide them with support. Staff said they found the approach of the manager was refreshing and said she had an inclusive management style. The manager completed checks on a number of things in the home to make sure the Care Homes for Older People Page 26 of 32 Evidence: home was managed properly, important information was gathered about the home, safety was maintained, staff were doing their jobs correctly and that people that lived there were satisfied with the care they received. This was called quality assurance and was done by doing lots of checks called audits so the manager could see how everything was working. The managers checks were then checked again by her manager during monthly visits so Southern Cross Health Care, the owners of the home, were aware of any matters in the home which needed to be improved upon and could tell the manager if she was doing a good job or needed to make improvements. Managers from Southern Cross visit Three Bridges every month to do quality assurance checks, talk to people living there and staff and look at important records so they can write a report to say if they think the home is being properly managed. As part of quality assurance the home has comment cards for people that use services and others with an interest in their care to write on and say what the home does well or does not do well or make suggestions so they can comment on the quality of care, facilities offered and management of the home. The manager also held regular staff meetings so staff could contribute to the management of the home and the manager held regular meetings with relatives so they had an opportunity to discuss the management of the home. We looked at how the Mental Capacity Act, a law about making decisions and what to do when people cannot make some decisions for themselves, was used in the home. When people cannot make decisions for themselves, this is called lacking capacity. The Mental Capacity Act sets up safeguards that must be used when a person living in a care home, who cannot make decisions for themselves, is restricted in a way that deprives them of their liberty. This provides extra protection for them to make sure that anything being done is done in their best interests. Sometimes people may be stopped doing things they want to do, to give them extra protection. This may restrict them and might be done to keep them safe or protect them from harm. We saw that where restrictions that deprived people of their liberty had been used, permission had been given to use them by the local council and all the people who had an interest in the person who had the deprivation of liberties safeguards in place had agreed this was in the persons best interest to safeguard their welfare. The home does not act as appointee for any people living there to manage finances on their behalf. All people that use services have an account opened for them to deposit money for personal use but they or their relatives may choose not to use this facility so manage their finances themselves. Monies held at the home were kept to pay for chiropody, newspapers, hairdressing and personal items so people using the service could buy things they wanted. Balances were checked against the records held on the computer and the amounts held tallied against the records on the computer so Care Homes for Older People Page 27 of 32 Evidence: financial procedures were safe. Monies held on behalf of people living at the home were checked every month as part of the quality assurance system so there was an independent check of financial procedures. The AQAA told us that all the required maintenance checks and health and safety checks had been completed as required so people that use services lived in a safe building. We checked the records for fire safety and found all fire safety systems were checked regularly so the safety of people that lived at the home was promoted. Care Homes for Older People Page 28 of 32 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 29 of 32 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 31 8 An application from the manager to be registered as the manager of Three Bridges must be made to the Care Quality Commission. This is so that we and the people that live and work at Three Bridges will be confident the home is run in their best interest. 17/09/2009 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 7 The home should use communication plans to guide staff about how people that use services communicate their needs so staff can understand and support people that use services to tell them what they want. The home should improve how decisions about daily living made by people that use services are reflected in their care plans so staff and others involved in their care understand how important peoples daily decisions about their lives and decisions about their future are to them so the agreements 2 10 Care Homes for Older People Page 30 of 32 about how they make or are supported to make decisions are clearly understood. 3 12 People living at Three Bridges should be provided with more opportunities to be involved in recreational and social activities of their choice so they can live fulfilling lives. The home should provide the complaints procedure in different formats and make this more accessible so that people with memory problems can understand and have access to it so they have confidence they can make a complaint and their concerns are listened to and acted upon. 4 16 Care Homes for Older People Page 31 of 32 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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