CARE HOMES FOR OLDER PEOPLE
Branch Hill Branch Hill House Hampstead London NW3 7LS Lead Inspector
Pippa Treadwell-Smith Unannounced 11 May 2005 10.00 am
th 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 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Branch Hill G58 s37333 Branch Hill v210478 110505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Branch Hill Address Branch Hill House Hampstead London NW3 7LS 020 7794 8075 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) London Borough of Camden Ann OKeeffe Care Home 49 Category(ies) of DE- over 65 (52) registration, with number of places Branch Hill G58 s37333 Branch Hill v210478 110505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 28th Novemebr 2004 Brief Description of the Service: Branch Hill House is a care home, which caters for 52 older people within the category of dementia. The home is owned by the London Borough of Camden but managed within the local mental health and social care trust.The building is an old country house, which has been adapted and extended to provide accommodation and facilities for the service users. It is situated in open parkland and reached through double gates. Parking is available to the front of the home.Accommodation is over three floors both in the original part of the home and the new extension. A shaft lift and stairs gives access to upper floors. Internally the home has been divided into five separate living units. Each unit is self-contained with a sitting-cum- dining area, bedrooms and a kitchenette. There are assisted baths, showers and toilets on each unit. All bedrooms have a wash hand basin and fitted wardrobes. There is a large activity room on the ground floor, which also offers a designated smoking area. Branch Hill G58 s37333 Branch Hill v210478 110505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was the first one organised for the new inspection schedule from 1st April 2005 to 31st March 2006. It took place over one day and lasted six and a half hours. There were two inspectors, one of whom was on induction training. Most of the inspection was spent talking to service users and observing the interaction between them and the staff. The remainder of the time was spent examining a variety of records including care plans and servicing documents. A partial tour of the premises was done. Twelve of the service users were spoken to and there were discussions with five of the care staff and feedback was given to the manager and her senior team. What the service does well: What has improved since the last inspection?
The repairs and improvements to the fabric of the building have been completed. Areas, which required re-decoration, have now been addressed. Residents said that they were happy with their bedrooms and are able to bring in their own personal possessions. A new service user guide has been recently introduced, which offers service users valuable information about the home. There has been a move to introduce a better format of care plan for residents. These are referred to as person centred plans. They are being introduced for
Branch Hill G58 s37333 Branch Hill v210478 110505 Stage 4.doc Version 1.30 Page 6 new residents only and some are very good. They contain all the relevant information necessary so that the service user will be well looked after. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Branch Hill G58 s37333 Branch Hill v210478 110505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR 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) Scoring of Standards Statutory Requirements Identified During the Inspection Branch Hill G58 s37333 Branch Hill v210478 110505 Stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 & 3 (Standard 6 is not applicable to this home) New service users are given sufficient information about the home to make an informed choice about whether they want to move into the home. EVIDENCE: A new service user guide has been recently introduced and is available for all distribution. A copy of the guide has been given the inspector whilst on the premises. It contains all the relevant information and the manger confirmed that it would be part of the referral and admission process. One of the criteria for admission is that a service user must be assessed by a Care Manager as in need of personal care. An inspection of the care records showed that the service users had been subject to a comprehensive assessment process prior to and during the admission procedure. There is a policy in place for handling crisis admissions. Branch Hill G58 s37333 Branch Hill v210478 110505 Stage 4.doc Version 1.30 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 & 8 The service users’ needs are known to care staff but not always documented in sufficient detail. There has been some progress towards person centred planning but this has been limited. EVIDENCE: Individual plans of care are available. The manager confirmed that there had been decided to introduce care plans based on the person centred planning approach for all new service users on admission. A comparison between the old and new style care plans shows that key workers need to start implementing the new process for all service users. This same comparative study showed that there were large gaps in the information being recorded in the older style of care plan. In several instances the care plans reflected the need to offer choice and respect a person’s dignity however five care plans were inspected of service user from varying ethnic backgrounds. In all cases social histories were absent and there was little written evidence to suggest that cultural needs were being addressed. In one instance, a recommendation had been made for a service user to have access to Asian videos and films but the unit did not have a video player and the service user’s television was in need of repair. Dietary needs were recorded but this was not always reflected in the menu although staff and service users said that they had choices.
Branch Hill G58 s37333 Branch Hill v210478 110505 Stage 4.doc Version 1.30 Page 10 One service user, tracked, is registered blind. The assessment did not include the preferred way that this person wished to be guided. The inspector observed a care worker leading this resident by a method that would not be recommended by the Royal National Institute for the Blind. Although this person had been in residence since December 2004, there was no evidence that talking books had been organised or that she had been introduced to another service users which whom she could communicate. Where medical needs had been recorded, there were no corresponding dates to show that the interventions had been carried out. An example of this was the need for a service user, following admission, to be seen routinely by the home’s GP, to have an appointment with the chiropodist and to be seen by a dentist. There are no corresponding dates to confirm that any of these appointments were attended. Another care plan described the service user as having “an approach to staff, which is undesirable and openly racist”. However there were no interventions recorded on how staff should respond. An example of a person centred care plan demonstrated that there was more focus on promoting the individual’s abilities and minimising the difficulties. There was fuller information about the person and how needs can be addressed. The daily entries and the monthly reviews did not reflect the contents of the care plan. There is evidence from the care records and other documents that service users’ health care needs are being addressed. It is not always apparent that residents and relatives had been involved in the care planning process. Branch Hill G58 s37333 Branch Hill v210478 110505 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13 &14 Service users are able to maintain contact with relatives and friends who are made to feel welcome. Staff know the resident’s likes and dislikes and they are able to exercise choice and control. Detailed information on a new service user was not available. EVIDENCE: A visitor’s book is signed when individuals visit the home. Visitors were seen being welcomed during the inspection. There are facilities for service users to see their visitors privately or to receive them in the lounge. Staff spoken to said visitors are always made to feel welcome and offered refreshments. Likes and dislikes are recorded as part of the care plan with preferences being identified. From talking to staff it was evident that service users were encouraged to make choices and assisted in doing so. One African Caribbean service user who had been admitted to the home three weeks ago did not have a detailed care plan. It was explained by one of the staff that this was because she was recently admitted. On interview this service user was clear about her likes and dislikes. For example preferring rice to potatoes, her preference for Caribbean food and wanting to go to church on a Sunday.
Branch Hill G58 s37333 Branch Hill v210478 110505 Stage 4.doc Version 1.30 Page 12 Branch Hill G58 s37333 Branch Hill v210478 110505 Stage 4.doc Version 1.30 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 There is a satisfactory complaints procedure in place that is accessible to service users, relatives and friends. EVIDENCE: The complaints procedure does form part of the admissions literature and copies are on display. There is a system in place to monitor and record complaints. Some of the service users spoken to say that felt okay about talking to the staff if they had a complaint. Staff spoken to say they would listen to complaints made by a relative or service user and then refer them to the relevant person. Branch Hill G58 s37333 Branch Hill v210478 110505 Stage 4.doc Version 1.30 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not inspected during this visit. EVIDENCE: Branch Hill G58 s37333 Branch Hill v210478 110505 Stage 4.doc Version 1.30 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not inspected during this visit. EVIDENCE: Branch Hill G58 s37333 Branch Hill v210478 110505 Stage 4.doc Version 1.30 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 There are systems in place to ensure that residents benefit from a safe and comfortable environment. EVIDENCE: A variety of records were looked at including fire safety, accident reporting and maintenance records. These records were found to have sufficient detail, were up-to-date and showed that the home is being managed responsibly with essential checks being made and acted upon. Branch Hill G58 s37333 Branch Hill v210478 110505 Stage 4.doc Version 1.30 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 2 15 x
COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x x x x 3 Branch Hill G58 s37333 Branch Hill v210478 110505 Stage 4.doc Version 1.30 Page 18 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 15(1) & (2) Requirement Timescale for action 31.08.05 2. 14 12(4)(b) The person centre planning approach is to be implemented for all the residents in the home. The daily entries and monthly reviews must reflect the contents of the care plan. The home must make suitable 30.07.05 arrangements to meet the religious, racial and cultural needs of all new residents. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 7 Good Practice Recommendations It is recommended that residents and relatives are asked to sign their completed care plans. Where this may not be possible, it should be recorded on the care records. Branch Hill G58 s37333 Branch Hill v210478 110505 Stage 4.doc Version 1.30 Page 19 Commission for Social Care Inspection Centro 4 20-23 Mandela Street Camden Town London NW1 0DW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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