Inspection on 23/09/08 for Branch Hill

This inspection was carried out on 23rd September 2008.

CSCI found this care home to be providing an Good service.

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 02/08/06

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 26/11/2008.

CARE HOMES FOR OLDER PEOPLE Branch Hill Branch Hill House Branch Hill Hampstead London NW3 7LS Lead Inspector Pippa Canter Unannounced Inspection 23rd September 2008 10:00 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.V371874.R02.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.V371874.R02.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 020 7431 1126 anna.okeeffe@camden.gov.uk 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 50 Category(ies) of Dementia - over 65 years of age (50) registration, with number of places Branch Hill DS0000037333.V371874.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Dementia, over 65 years of age - Code DE(E) The maximum number of service users who can be accommodated is: 50 2nd August 2006 Date of last inspection Brief Description of the Service: Branch Hill House is a care home, which caters for 50 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 £881. 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. In response to the recent legislation regarding smoking, there is a designated smoking room on the first floor. Branch Hill DS0000037333.V371874.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people using this service experience good quality outcomes. This unannounced key inspection was completed over one day from mid morning to late afternoon. A total of 6 hours was spent in the care home. Prior to the inspection, we reviewed the information that the Commission for Social Care Inspection had about the home. This included the Annual Quality Assurance Assessment (AQAA), which was completed and returned by the registered manager. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We reviewed and summarised the incident reports supplied by the home. Postal questionnaires were circulated for people living in the home as well as health and social care professionals. The feedback got feedback from the surveys enabled us to plan the focus of the inspection. We have looked at the information collected from the previous inspection and relevant information from other organisations. During the visit we looked at the premises and visited people in their own rooms with their permission. People living in the service and staff were spoken to and the serving of lunch was observed on one of the units. Staff were observed going about their duties and interacting with residents. We followed the care for six (6) people who are currently living in the care home. The care plans were compared with the care being given. The choice of care plans reflected people’s gender, specific health care conditions and cultural needs. The inspection focused on aspects of care, daily activities, staffing levels, supervision, complaints and adult protection. Staff recruitment and training records were looked at as well. Samples of health and safety records were seen. All those who have contributed to the inspection process are thanked for their input. What the service does well: People moving into the care home have a thorough assessment. This ensures that staff have all the information they need to meet the person’s needs and match their aspirations. Prior to and during this inspection, we received some very positive comments about the home itself, the staff and manager as well the quality of care. The staff in the care home provide a good standard of personal care for the people Branch Hill DS0000037333.V371874.R02.S.doc Version 5.2 Page 6 they look after. There is a support system in place for friends and relatives who visit the care home and they are made to feel welcome. There is a pleasant and open atmosphere in the home, which make people feel confident to raise any concerns they may have. 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. The summary of this inspection report can be made available in other formats on request. Branch Hill DS0000037333.V371874.R02.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.V371874.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 only - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a clear and consistent assessment process in place. The admission procedure is designed to support people and ensure that people’s needs and aspirations can be met. EVIDENCE: We looked at the care records for six people living in the care home, one of which had been admitted since the last inspection. We talked to staff and people living in the home. Prior to the inspection we had received surveys from people who use the service. All people admitted to the care home, do so through the care management approach. There were comprehensive needs assessments available on each care file and evidence that each person had been visited by a senior member of staff prior to their admission. Branch Hill DS0000037333.V371874.R02.S.doc Version 5.2 Page 9 All relevant information had been translated into an initial care plan. Feedback received prior to this key unannounced inspection confirmed that admission to the care home is a planned process. People, including relatives are able to visit the care home prior to the admission. All placements are being reviewed following the first six weeks of the stay. One family felt that the care being given was good. Branch Hill DS0000037333.V371874.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 & 10 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal support is offered in such a way as to promote and protect a person’s privacy and dignity. The staff have a good understanding of a person’s support needs but more detail could be included in the care plan. Systems for the administration are good with clear and comprehensive arrangements in place to ensure medication needs are being met. EVIDENCE: We looked at six care plans. These were chosen as they reflected a cross section of people living in the care home through gender, ethnicity and health care needs. People responded with comments prior to the inspection through “Have Your Say” questionnaires. We spoke to people living and working in the care home as well as observing care staff going about their daily tasks. All the people living in the care home have a care plan. However they were not of a consistent standard. The care plans were noted to reflect what the person can do for themselves and what support is needed to be provided by staff. The expected benefits of this support action were also included. Branch Hill DS0000037333.V371874.R02.S.doc Version 5.2 Page 11 Generally the care plans reflected the promotion of independence, choice, privacy and dignity. However there were gaps in some of the information recorded and some entries in the daily recording did not correspond to the care plan. An example of this was that a care plan recorded that staff were to ensure the person had a balanced diet because they are at risk of poor nutrition. However the daily entries repeatedly recorded that the person has a good appetite. The risk assessment clearly recorded incidents of verbal abuse and very challenging behaviour but did not say what actions staff should take to manage or minimise these incidents. Another example was a person who was said to have recurrent urinary tract infections. Although there was an instruction to monitor and report any concerns, there were no preventive measures included such monitoring fluid intake or offering Cranberry Juice on a daily basis. A care plan records the need to toilet a person every two hours because of double incontinence but the daily records do not reflect the toileting process but do record regular incidents of incontinence. Not all night care plans recorded the preferred rising or retiring times for the person. Although a care plan recorded that chosen television and radio programmes should be put on for a resident; the care plan did not say what those choices were. There are limited life histories on the files although discussion with staff showed that they had a lot of very useful back ground knowledge about their key residents. This information needs to be recorded and used proactively to arrange individual as well as group activities. Two residents case tracked like listening to Irish music however this was only recorded on one care plan. An opportunity for two people with shared interests to socialise could be missed. However the senior staff have acknowledged that life history books are to be developed. Needs associated with culture, ethnicity and religion were generally well documented and more importantly being implemented. It was discussed with senior staff that people from an ethnic minority, even though they appear to be anglicised, that their car e plans should reflect their culture. There is evidence that care plans are being reviewed. However the reviews acknowledge that the key worker and their line manager were present but does not reflect if there was input from the person living in the care home or their relatives. All residents have access to health care. Each one is resident with a local GP practice. Where specialist needs are assessed, referrals can be made to the Branch Hill DS0000037333.V371874.R02.S.doc Version 5.2 Page 12 relevant health care professional. Staff have attended training with regards to falls. The service has a falls register, which assists in identifying when falls happen and enables staff to look at ways of preventing falls. We have noted a reduced number of notifications to the Commission for Social Care Inspection in respect of injuries to residents related to falls. A small audit of medication was taken on each wing. The service has a medication, which gives up-to-date information regarding the management of medication. All staff that are responsible for administering medication have had relevant training. All records were found to be accurate and up-to-date. Privacy and dignity are promoted within the care home. Feedback from people living in the care home reflected positive remarks about the staff. They were described as “kind”, “helpful” and “considerate”. Both values are covered in the staff induction process and good practice is discussed as part of individual supervision and team meetings. Branch Hill DS0000037333.V371874.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 & 15 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home are treated with respect and staff make sure that there is choice over events within the home. Meal times are social occasion that afford interaction and stimulation for residents. People who live in the care home are able to receive visitors and access the local community. EVIDENCE: The annual quality assurance assessment gave a good insight into the availability of activities. As discussed previously some care plans were detailed and gave people’s personal preferences where as others only gave general information. However it is clear that people are retaining links with their previous lifestyle and continue to attend day centre facilities. It is also evident that the care home has made improvements in the area of activities. More individual choices are available. Programmes have included more outdoor activities being organised. A variety of entertainment has been brought into the care home and this includes drama groups, plays and music. A music therapist has been commissioned to work with the residents. A garden has been created for residents towards the rear of the building. Staff have been Branch Hill DS0000037333.V371874.R02.S.doc Version 5.2 Page 14 motivated to do more activities outside the home as part of an environmental initiative. Several people said that liked living in the care home. All said that they could have visitors often. People visiting the home at the time of the inspection said that they are always made to feel welcome and they can usually find a comfortable and private location to visit with their relatives. A mealtime was observed on one of the units and a lot was being done to make it a social occasion. Staff sat alongside the residents to assist then and encouraged interaction. Choices were extended for each course. As previously discussed, the service is looking to develop more detailed life history plans including interests. Staff had the important information relating to significant events and important relationships within the residents’ personal lives. As such they demonstrated a good knowledge of learning about people as individuals. This knowledge needs to be recorded so that it can be fed into activities that reflect individual interests. What is apparent at Branch Hill is that the people living feel confident to move around the home. Residents were observed leaving the units and meeting up with other people in communal areas or activity rooms. Overall people had a sense of well being and there was a relaxed atmosphere despite it being a very busy day for staff. Branch Hill DS0000037333.V371874.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 & 18 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home can be confident that any concerns they have will be taken seriously and acted upon. They are protected from harm by Safeguarding Adults procedures. EVIDENCE: The AQAA stated that the home has an accessible complaints policy. This is also in an accessible format more suitable to people with Dementia. People who live in the home are able to access an advocacy service. All complaints are taken seriously and investigations and outcomes can be logged. Feedback from people living in the care home and relatives confirmed that they felt comfortable about raising any concerns. In turn staff demonstrated that they are willing to listen to any concerns and if they are unable to resolve the matter locally to refer it to higher management. The service has robust policies and procedures on adult protection and whistle blowing. These form part of the staff induction process and all staff receive training on safeguarding adults. Discussions with staff showed that they have a good understanding of what constitutes abuse and what action that need to take. Branch Hill DS0000037333.V371874.R02.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 & 26 - Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People live in a home that is always kept clean, tidy and is well maintained. Emphasis is placed on making Branch Hill homely, comfortable and safe. EVIDENCE: A partial tour of the home was made. The care home is accessible to people with mobility problems. It provides a homely environment and people living in the home have been encouraged to personalise their rooms. All bedrooms are single occupancy except one in which two people have chosen to share. There has been capital expenditure on the home. All bedrooms have repainted, all bathrooms refitted and all the kitchenettes in the units have been refurbished. All communal areas have been redecorated with new carpets laid in the corridors and main lounge. Also on a practical and safety point of view Branch Hill DS0000037333.V371874.R02.S.doc Version 5.2 Page 17 all fir doors have been fitted with automatic door closures, which will release and shut when the fire alarm is sounded. There are separate domestic staff that are responsible for keeping the home clean and odour free at all times. Universal precautions are used in the home and protective equipment such as gloves and aprons are always available for staff to use. However the practice of using bathrooms are storage spaces needs to be resolved. Staff receive training in respect of health and safety and in particular the prevention of cross infection. Hand washing facilities with paper towels and soap dispensers are available in all key areas. Soiled linen is washed separately and there are sluice cycles on the washing machines. Branch Hill DS0000037333.V371874.R02.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 & 30 -Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home are supported by suitably qualified staff. The recruitment process is thorough and appropriate checks are in place on employees. Training programmes are being targeted to make sure staff have the skills to meet needs. EVIDENCE: This service has a history of a sound and robust recruitment and selection process. Therefore a good recruitment process makes sure that suitable staff are employed to care for people who live in the home. On the files checked there were records of CRB reference numbers and dates. All volunteers are subject to checks before starting in the home. The staff group is well balanced so that residents have the choice of same gender care. Training programmes have been developed to make sure that staff have the necessary skills to meet people’s needs. All senior staff have NVQ 3 and a high percentage of care staff have NVQ 2. All staff undergo a thorough induction. The service is aware of the need to make sure that staff are appropriately supervised. However records show that staff are not receiving the Branch Hill DS0000037333.V371874.R02.S.doc Version 5.2 Page 19 recommended frequency of supervision. Discussions with staff confirm that they feel supported and find the management team approachable and accessible. Branch Hill DS0000037333.V371874.R02.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 & 38 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager of Branch Hill has a proactive approach to making a person centred home. The care home is being managed for the benefit of the people who live there. EVIDENCE: This service has a history of stable management. The manager has long experience in care homes and holds NVQ 4 Registered Managers Award. In turn the manager is supported in the care home by a senior management team and externally by the service manager. Branch Hill DS0000037333.V371874.R02.S.doc Version 5.2 Page 21 The home has a positive approach in gathering views of people who live in the home. Views are gained through residents’ meetings, reviews and individual key working sessions. People who live in the home have been surveyed to see what they want from the service. The AQAA indicated that there are polices and procedures in place on handling residents monies and valuables. Records are maintained of any personal allowance managed by the home with a clear audit trail. No health and safety issues were identified at the time of the site visit. The home has a health and safety policy and staff undertake appropriate health and safety training. Equipment is regularly services and the records kept reflect this. Branch Hill DS0000037333.V371874.R02.S.doc Version 5.2 Page 22 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 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 4 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.V371874.R02.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Branch Hill DS0000037333.V371874.R02.S.doc Version 5.2 Page 24 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. Extracts may not be used or reproduced without the express permission of CSCI Branch Hill DS0000037333.V371874.R02.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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