Inspection on 02/08/06 for Branch Hill

This inspection was carried out on 2nd August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Branch Hill 23/09/08

Branch Hill 11/10/05

Branch Hill 11/05/05

Branch Hill 29/11/04

Branch Hill 10/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Branch Hill Branch Hill House Branch Hill Hampstead London NW3 7LS Lead Inspector Ms Pippa Canter Unannounced Inspection 09.30 2 August 2006 nd X10015.doc Version 1.40 Page 1 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 Branch Hill DS0000037333.V287294.R01.S.doc Version 5.2 Page 2 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 DS0000037333.V287294.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Branch Hill Address Branch Hill House Branch Hill Hampstead London NW3 7LS 0207 794 8075 Telephone number Fax number Email address Provider Web 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 O’Keeffe Care Home 49 Category(ies) of Dementia - over 65 years of age (52) registration, with number of places Branch Hill DS0000037333.V287294.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Not applicable Date of last inspection 11th October 2005 Brief Description of the Service: Branch Hill House is a care home, which caters for49 older people within the category of dementia. The home is owned by the London Borough of Camden and under the management of the Housing and Adult Social Care directorate of the council. The current scale of charges is £679. The building is an old country house, which has been extended and adapted to provide accommodation and facilities for 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 building and the new extension. A shaft lift and stairs gives access to the 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 in each unit. All bedrooms have a wash hand basin and fitted wardrobes. There is a large activity room on the ground floor, which also acts as a designated smoking area. There are three other designated smoking areas in the home. Branch Hill DS0000037333.V287294.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over the course of one day by two inspectors. The visit lasted a total of 7 hours. The Registered Manager was available and assisted the inspection along with additional input from the staff on duty, service users and visitors. Records such as care plans, daily logs as well as accident and incident logs were examined. A tour of the building was made with attention to the rooms of the service users being case tracked. Some service users were asked for their views of the running of the home and talked about their experiences of living there. Relatives also contributed their comments. Staff were observed carrying out their duties and were involved in general discussion with the inspectors. Prior to the inspection the manager returned a pre-inspection questionnaire and a self-assessment audit. Four service users, seven relatives, a community nurse and a general practitioner returned questionnaires giving their views about the home. At the end of the visit feedback was given to the Registered Manager and representatives of the management team. A comment card about the inspection process has been sent by email for completion and return to the Commission for Social Care Inspection (CSCI) What the service does well: The home has an admission process that is designed to support the new service user to adjust to living in a care home. A comment from a relative was,“ My father is a new resident and has been made more than welcome. He has settled in well at this stage, with lots of support in a very caring environment”. Admission are only made to the home, if a full needs assessment has been done and staff in the home know they can meet the new service user’s health and care needs. Staff work hard at ensuring that service users have regular access to health care services. The philosophy of the home reinforces the importance of treating service users with respect and dignity. The home has a very good record for staff achieving a nationally recognised qualification. One comment from a relative was “There is nothing to say except Branch Hill House is a lovely home and the care workers are marvellous. I cannot fault the staff at all.” Family and friends are welcome and know that they can visit the home at any time. The home has an experienced cook who meets with service users, to Branch Hill DS0000037333.V287294.R01.S.doc Version 5.2 Page 6 listen to their choices and suggestions for the menu. Individuals can be catered for. One service user said, “The meals are delicious”. What has improved since the last inspection? 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 DS0000037333.V287294.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Branch Hill DS0000037333.V287294.R01.S.doc Version 5.2 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 the following standard(s): 3 (Standard 6 is not applicable to this home) The quality in this outcome area is considered to be good. This judgement has been made using available evidence, including visits to the service. Service users are supported to make an active choice to move into the home. Their needs are assessed and they are only admitted if the assessment identifies that the staff can meet their needs and aspirations. EVIDENCE: The care records of five service users were looked at some of whom had been admitted since the last inspection. Community care assessments were available and there was clear evidence that the home has undertaken an assessment of their own. Three service users commented that they had received sufficient information about the home prior to moving in. The admission process also includes visits to the home. One service user has commented “I visited the home with my daughter before making a decision to move in”. A relative has confirmed, “ My Branch Hill DS0000037333.V287294.R01.S.doc Version 5.2 Page 9 father is a new resident and has been made more than welcome. He has settled in well at this stage, with lots of support in a very caring environment”. Branch Hill DS0000037333.V287294.R01.S.doc Version 5.2 Page 10 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 the following standard(s): 7, 8, 9 & 10 The quality in this outcome area is considered to be adequate. This judgement is made using available evidence including visits to the home. There has been an improvement in the content and presentation of the care plans but further worked is required. The health care needs of the service users are being well met. The procedure for administration of medication is not being followed in one of the units therefore it is not possible to determine whether service users’ medication needs are being met. EVIDENCE: In total, five care plans were looked at and eight service users contributed their views either on the day or through a “Have your say” questionnaire. Care staff were observed interacting with service users whilst carrying out their duties. The daily records were looked at. The pre-inspection information provided details on how service users have access to health and remedial services. A GP and a health care professional returned completed comment cards. Branch Hill DS0000037333.V287294.R01.S.doc Version 5.2 Page 11 All service users have a care plan and there is evidence that monthly reviews are generally being carried out. Each service user is allocated a key worker. An examination of the care plans showed that there has been a general improvement. The plans showed identified the strengths of the service users and the areas where they require support. The plans reflected the need to ensure that service users were offered choice, independence, privacy and dignity. However in some instances more detail is required where special needs have been identified. An example of this is a service user who is registered blind. The care plan does not show how the service users likes to be escorted; another care plan was noted to include that a service users likes going to church but the plan does not say how this will be achieved. A similar scenario is that a service user likes classical music but the care plan does not identify how this will be achieved. Although it is clear that improvements have been made to the care planning process it still needs to be more ongoing and responsive. The care planning process should be enabling for a person with dementia and informative for staff. All the information gathered about a person from an initial assessment and the subsequent things that staff learn about a service user, contribute to enabling service users to have as much autonomy as possible. Please see requirement 1. The staff in the home is working towards a more person centred approach. The home is engaged in a system of dementia care mapping and on the day of the inspection feedback was being given to a group of staff in one unit following a period of observation. The feedback identified some aspects of good practice by staff but also highlighted where improvements could be made so service users have more opportunities for well being. Staff were introducing ideas about how they could make the routine of the unit more flexible so that they could be more person focused. This is a clear indication of the home looking towards continual improvement. The pre-inspection information recorded how service users have access to health care professionals, including GP, district nurse, optician, dentist, chiropody, audiology, occupational therapist, speech therapist and a community psychiatric nurse. There was confirmation from the care records and discussions with service users that such access is available. The GP has confirmed that the staff in the home communicates clearly with the surgery and have a clear understanding of the care needs of the service users. Overall the GP is satisfied with the overall care provided to the service users. The community nurse also was satisfied with the overall care provided by staff in the home. Staff were aware of the need to provide extra fluids and fans during the hot weather. For vulnerable service users, fluid charts were being kept. The home has a policy and procedure for the administration of medication, which includes the use of homely remedies. The GP| confirmed that service user’s medication is appropriately managed in the home. The pre-inspection questionnaire identified the staff that are responsible for administering medication and the training records show that they have received medication. Branch Hill DS0000037333.V287294.R01.S.doc Version 5.2 Page 12 A small audit on medication was done in all the units. Each unit has a medication cupboard located in the dining area. Medication is dispensed via the monitored dosage system. Folders have been put together with information about the medication that service users are taking. The medication administration records were sampled in each unit. In one unit there were eight that had gaps in recording and no codes had been included. This information was fed back to the manager at the end of the inspection. Please see requirement 2. Comments were received such as “There is nothing to say except Branch Hill House is a lovely home and the care workers are marvellous. I cannot fault the staff at all.” Discussions with service users highlighted that staff respected their privacy and dignity. Care plans also reflected the values of privacy, dignity, choice and independence. The home has policies in place and the values of privacy and dignity are discussed as part of the team meetings. Branch Hill DS0000037333.V287294.R01.S.doc Version 5.2 Page 13 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 the following standard(s): 12, 13, 14, & 15 The quality in this outcome area is good. This judgement has been made using available evidence, including visits to the service. Service users have a lifestyle in the home that matches their expectations and preferences. Family and friends are welcomed into the home. Service users have a choice in wellprepared meals that reflect their cultural as well as medical needs. Improvements could be made to the format of the menus so that they reflect the good practice of the home and are more accessible for service users. EVIDENCE: The pre-inspection information included a programme of activities. The same list was seen displayed in the home. Feedback from the service users confirmed that there are activities available and that they can join in if they choose to. It has already been highlighted previously in the report that the care plans do not state how needs are to be met. An example of this is service users’ liking classical musical or like going to church, the plan does not include when, who will assist and how will it get done. The advent of dementia care mapping will be able to assist staff to ensure that there are more opportunities for well being, which include interaction and activity. By the next inspection there should be further development in this area. Branch Hill DS0000037333.V287294.R01.S.doc Version 5.2 Page 14 Comments from relatives highlighted that they are made to feel very welcome in the home. This is an area that has been highlighted for development following the outcome of the visitor’s satisfaction survey. The open operates an open door policy. There are areas in the home where service users can receive their visitors or alternatively they can have privacy in their single bedrooms. One service user was receiving visitors in their room and staff had provided refreshments. A recent letter of thanks was seen from a relative, which thanked the staff for being “endlessly kind and caring towards their relative”. The comments cards returned proper to the inspection and discussion with the service users during the inspection highlighted that they are able to follow their preferred routine. Staff confirmed that they deploy themselves in accordance with service users’ wishes at busy times of the day. During the inspection staff were heard offering service users choices A menu was supplied with the pre-inspection information. It is a three-week menu, which is reviewed every two months. Although it reflects vegetarian options it does not show cultural alternatives. Two service users traced were from an ethnic background. However during the inspection a meeting was being held between the catering staff and a group of service users. This meeting highlighted that service users likes, dislikes, cultural and medical needs are catered for. Comments from the service users confirmed that they liked in the food. One service user said, “The meals are delicious”. Each unit has a list of service users who have diabetic, pureed food, Halal meat and pork or fish free diets. In one unit the menu was displayed on the table but it was not in large print. In another unit, the menu was not available. Service users said that they did not know what to expect for their next meal and were not sure how they would find out. At the plenary session it was discussed with the manager that the format and presentation of the menu was not accessible for some service users. A recommendation has been made. Branch Hill DS0000037333.V287294.R01.S.doc Version 5.2 Page 15 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 the following standard(s): 16 & 18 The quality in this outcome area is good. The judgement has been made using available evidence, including visits to this service. Service users are protected by the home’s response to complaints and potential abuse. EVIDENCE: Complaints records were examined. Staff were asked about their understanding of adult protection and what were their responsibilities in relation to potential abuse. Discussion with the staff and service users confirmed that service users have information about how to make a complaint in their rooms. Service users said that they felt confident to talk to the care staff should they have any concerns. The feedback from the comment cards confirmed that service users knew who to speak to if they were unhappy. Two out of the five service users who returned comments cards recorded that they were not aware of the complaint’s procedure. However, a relative and their parent confirmed, “The complaint procedure was explained to myself and my daughter”. The in-house policies and procedures on adult protection and whistle blowing are contained within the home’s operational policy. Discussions with staff confirmed that they had received training in the protection of vulnerable adults. Training records verified this. Staff showed that they understood the Branch Hill DS0000037333.V287294.R01.S.doc Version 5.2 Page 16 concepts of what constitutes abuse and were clear in their responsibility for reporting any suspicions or allegations. Branch Hill DS0000037333.V287294.R01.S.doc Version 5.2 Page 17 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 the following standard(s): 19 & 26 The quality in this outcome area is good. This judgement has been made using all available evidence including a visit to the service. Service users are accommodated in comfortable surroundings. The overall appearance of the home is clean and free from offensive odours. EVIDENCE: The home was toured, including visiting the bedrooms of the service users who were being case tracked. This was done with their permission. All the bedrooms in the home are now single occupancy. The home has both assisted toilets and bathrooms. Service users said that they found their accommodation comfortable and clean. The home employs separate domestic staff and these were observed being thorough in their duties. The sample of bedrooms showed them to be clean, tidy and fresh. The personalisation of bedrooms was according to taste. Branch Hill DS0000037333.V287294.R01.S.doc Version 5.2 Page 18 Staff follow cross infection policies and procedures. Protective clothing such as gloves and aprons are available. COSHH training is available. Hand towels and soap dispensers were available in all communal toilets. Overall there were no offensive odours although underlying smells were noted in some rooms but there is a procedure in place to ensure that carpets are clean regularly. Branch Hill DS0000037333.V287294.R01.S.doc Version 5.2 Page 19 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 The quality in this outcome area is considered to be good. This judgement has been made using available evidence, including a visit to the service. Staff are deployed in sufficient numbers to meet the needs of the service users. There are training and development opportunities for staff. EVIDENCE: Staff were observed carrying out their duties; service users were asked for their views and training records as well rotas were looked at. There is a clear management structure in place with a manager and a team of assistants; therefore there is always a senior member of staff on duty. There are dedicated catering, laundry and domestic staff. Relatives said that, in their opinion there were sufficient staff on duty and the rotas confirmed this. The staff group is balanced to enable service users a choice of male, female and age related preferences. Training lists are available for inspection. The lists show that staff are receiving statutory training as well as specific training to meet the specialised needs of the service users. The home has an excellent record of permanent staff that have achieved an NVQ qualification. Branch Hill DS0000037333.V287294.R01.S.doc Version 5.2 Page 20 A sample of recruitment files were looked at some months prior to the inspection. The Commission is satisfied that the provider operates a thorough and robust recruitment and selection process. Branch Hill DS0000037333.V287294.R01.S.doc Version 5.2 Page 21 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 The quality in this outcome area is considered to be good. This judgement is made using all available evidence including visits to the service. The home is being effectively managed. Arrangements are in place to promote the health, safety and welfare of service users. A system is in place for self-monitoring through formal as well as informal means. EVIDENCE: The home is managed by an experience and suitably qualified manager who is supported in the home by a management team and receives support and supervision from the Project Manager for Residential Services. The service has circulated satisfaction survey forms to every relative or friend of all the service users in the home. Visitors were asked to comment on the welcome they receive, the degree of privacy and about the quality of the Branch Hill DS0000037333.V287294.R01.S.doc Version 5.2 Page 22 communication with the home. Any critical feedback is addressed by the home. A satisfaction survey amongst the service users will also be conducted annually. There are polices and procedures on handling service users monies and valuables. The pre-inspection information shows that the home manages the personal allowance for 7 service users. Any savings are deposited in a high street bank and service users receive monthly statements. A sample of financial records were looked at and found to be accurate. Accounts allow for an audit trail. The home has a health and safety policy in place and staff undertake appropriate training. Records show that equipment is serviced and there is a system in place to report repairs. During a tour of the premises there were no hazards observed. Water temperatures are regulated. A system to test alarm bells is in place and staff are aware of how to respond in the event of a fire. Branch Hill DS0000037333.V287294.R01.S.doc Version 5.2 Page 23 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Branch Hill DS0000037333.V287294.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No 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 OP7 Regulation 15(1) (2)12(4)( b) 13(2) Requirement Care plans must be able to show how staff are intending to meet the needs of the service users. e.g. when, who and how something will be achieved. When medication is administered to a service user the medication administration sheet must be signed by the staff. If the medication is not taken then the appropriate code must be used. When gaps are noted on the MARS sheets, these should be investigated by the management and action taken to prevent a reoccurrence. Timescale for action 31/10/06 2. OP9 31/10/06 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 OP15 Good Practice Recommendations It is recommended that the menus are made more accessible to service users. Consideration needs to be DS0000037333.V287294.R01.S.doc Version 5.2 Page 25 Branch Hill given to the size of the font, the colour of the print and paper. The menu should contain all the options available. Branch Hill DS0000037333.V287294.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Camden Local Office Centro 4 20-23 Mandela Street London NW1 0DU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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