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Inspection on 18/01/06 for British Home and Hospital for Incurables

Also see our care home review for British Home and Hospital for Incurables for more information

This inspection was carried out on 18th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The service provides personal care well and there is a good physiotherapy department. The maintenance of the building continues to be good. Food provision is also good as there is a wide variety of freshly cooked food.

What has improved since the last inspection?

More information about service users likes, dislikes and needs are being included in the care plans which have improved since the last inspection, with service users and their families being included in the care plan process. The physiotherapist is reassessing all service users and this is being included in the service users care plans.

What the care home could do better:

There has not been a registered manager since February 2005 and the home must have a registered manager. The responsible person must either apply to be the registered manager or nominate a suitable person to be the registered manager.

CARE HOME ADULTS 18-65 British Home and Hospital for Incurables Crown Lane Streatham London SW16 3JB Lead Inspector Lynne Field Unannounced Inspection 18th January 2006 09:00 British Home and Hospital for Incurables DS0000032400.V272094.R01.S.doc Version 5.0 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 British Home and Hospital for Incurables DS0000032400.V272094.R01.S.doc Version 5.0 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 Adults 18-65. 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. British Home and Hospital for Incurables DS0000032400.V272094.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service British Home and Hospital for Incurables Address Crown Lane Streatham London SW16 3JB 0208 670 8261 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) enquiries@britishhomes.org.uk British Home and Hospital for Incurables Care Home 127 Category(ies) of Physical disability (127) registration, with number of places British Home and Hospital for Incurables DS0000032400.V272094.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th August 2005 Brief Description of the Service: The British Home & Hospital for Incurables (BHHI) is a voluntary care home for 127 people. It is a registered charity with a Board of Management. BHHI provides purpose built accommodation for people who are chronically sick and physically disabled. The aim of the home, highlighted in the statement of purpose is: “ to provide high quality nursing care with high levels of clinical and recreational support thereby assisting each resident to achieve maximum possible independence”. The BHHI is 5 minutes from local shops and near to all the local transport facilities. It is close to Streatham Common and a short drive from all the amenities in Streatham. The building is a large Victorian building, which has a distinctive presence in the area. It is maintained to a high standard and an extension, which was built in 1996, is in keeping with the existing building. There are two wings on each floor known as East and West Wing. The newer wing created 48 single rooms all en suite. A kitchen was completely rebuilt in 2001 where the food is cooked and brought to each floor in portable Bain Maries. The Home has a physiotherapy department with two full-time physiotherapist and two full-time physiotherapy assistants who see all service users. British Home and Hospital for Incurables DS0000032400.V272094.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over one day in January 2006. The inspection focused on service users care plans, the quality of care and service delivery. The requirements from the previous inspection were checked and had been mostly been met with the home continuing to develop the care plans with the service users and their families. During the course of the inspection the inspector spoke to a range of staff including the responsible individual, deputy matron, two team leaders, four care staff as well as other professionals, domestic and clerical staff. Part of the inspection was spent in a service users meeting and twenty-two service users were spoken to at varying lengths though out the day. What the service does well: 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. British Home and Hospital for Incurables DS0000032400.V272094.R01.S.doc Version 5.0 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection British Home and Hospital for Incurables DS0000032400.V272094.R01.S.doc Version 5.0 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 &4 The statement of purpose and service users’ guide are excellent in providing service users and prospective service users with details of the services the home provides enabling the service user to make an informed decision. EVIDENCE: The inspector was told copies of the home’s statement of purpose and service users’ guide, which were inspected and contained all the information to meet this standard at the previous inspection in August 2005 have not needed to be changed. These are given to each service user at the time their assessment is done to help them decided if the home is able to meet their needs. The inspector examined the files of two service users who had recently been admitted to the home. Each had a named key worker. There were preassessments for each service user, which provided evidence that service user’s needs had been assessed, and that objectives had been set up for staff to follow to meet needs. The inspectors identified that service users are able to visit, often including an overnight stay, before moving into the home. Once the service user had moved into the home there was an initial general assessment, which included background information, such as likes and dislikes, leisure and recreational information, medical history nutritional information. The physiotherapist told the inspector that all service users have a physiotherapy assessment in their first week at the home. British Home and Hospital for Incurables DS0000032400.V272094.R01.S.doc Version 5.0 Page 8 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 Care planning arrangements are becoming consistent throughout the home. Staff assist service users and involve their relatives in the planning of their care and decisions in their life. Potential risks are identified and the service user is supported to take risks within a risk management framework. EVIDENCE: The inspector viewed six service users files, including two of the service users who had recently moved into the home. Care plans now follow the “essence of care” format, which has been introduced at the home. The inspector could see an improvement in the care plans and risk assessments. These were reflecting the needs and aspirations of the service users. The service users had signed care plans and this included that the care plan could be shared with relevant staff and next of kin. A service user meeting, which is held monthly, was being held on the day of the inspection. Service users said the inspector could join them for the meeting. British Home and Hospital for Incurables DS0000032400.V272094.R01.S.doc Version 5.0 Page 9 The meeting follow an agenda set by the service users and is chaired by a service user. Minutes from the last meeting were distributed. Two of the items on this agenda were meals and food and recycling of waste, such as newspapers and glass bottles. Both items were fully discussed. One service user stated the lampposts needed repainting. At the end of the meeting the date for the next meeting was set. Since the inspection the matron has clarified that the lamppost do not need repainting but the service user had asked for them to be painted green to merge with the background. This was not possible because this would mean the service users with some visual impairment would be at risk of bumping into them. After the meeting the service users told the inspector that this was where they were consulted about any proposed changes that were to take place. This was done through the activities coordinator, who sits in on the service user meetings, representing the management of the home and passes on any information that service users need to be told about, as well as consulting with the service users about any changes that the management of the home may be suggesting. There were notices put up to remind service users about the meeting and minutes were put on notice boards after the meeting for service users to read. Service users told the inspector they like living at the home. A new service user to the home told the inspector they were pleased with their room and had all they needed. The service users’ daughter was very happy with how her mother had settled in and had made new friends. One service user has their own van and can go out with her family when they want to. British Home and Hospital for Incurables DS0000032400.V272094.R01.S.doc Version 5.0 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 15 Service users are able to take part in culturally appropriate activities, leisure activities and are part of their local community. They are actively encouraged to develop social skills. Service users are able to maintain relationships with friends and family. EVIDENCE: The home has a large well-equipped activities area, which consist of several large rooms. This includes kitchen with a dining area. Service users told the inspector several of them come there to cook a communal meal with the support of the staff and invite other service users to share the meal. On the day of the inspection, many service users were in the hairdressing room. They said they enjoyed having their hair done and they could also have a manicure. British Home and Hospital for Incurables DS0000032400.V272094.R01.S.doc Version 5.0 Page 11 The inspector visited the art room and spoke to five service users who were there taking part in a variety of art projects. Two service users gave the inspector a copy of poetry they had written, which was very impressive. One service user showed the inspector a booklet of his poems that he had allowed to be sold at the summer fair. Another service user showed the inspector paintings and poems she had done before coming into the home and said how pleased she was to be able to do this here and it helped her emotionally by making her happy to know she could still do these things. The inspector met two service users families, who said they felt very welcome and were encouraged to take part in the home. One family take their relative out most Sundays to church in their own van they have bought for the purpose of having greater freedom. British Home and Hospital for Incurables DS0000032400.V272094.R01.S.doc Version 5.0 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Service users receive personal support, in the way they prefer. Medication is being stored and handled safely. EVIDENCE: Six care plans were inspected. The home has a new assessment form, which asks for more information, and from this care plans are being developed. These have improved since the last inspection and care files contain information for staff on service users who need personal support with their preferred personal care routines. One service user administers their own medication. This was risk assessed and continues to be monitored by staff on a regular basis. The inspector was told the home has gone over to the MDS of dispensing medication. On the day of the inspection three service users medication was checked and was correct. Service user medication is stored securely in locked medication cabinets, which are kept in a locked medication room in each of the six units. British Home and Hospital for Incurables DS0000032400.V272094.R01.S.doc Version 5.0 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 Service users know their views are listened to and acted on. EVIDENCE: Service users meetings are held monthly and all service users are invited to attend. Service users told the inspector they felt their views were listened to and acted upon. The registered provider told the inspector a service user questionnaire had been sent out and the results from that had been very useful in providing information the service users views of the home. The home had asked volunteers to assist service users that were not able to fill in the questionnaire themselves and did not want staff to help. British Home and Hospital for Incurables DS0000032400.V272094.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 28 The home meets the needs of the service users and the environment within the home is good, providing service users with an attractive and homely place to live. EVIDENCE: The home is large and spacious with lifts to all floors and many of the service users have electric wheelchairs with controls that are adapted to suit each service user. This enables service users to be able to move around the home independently. There is a rolling maintenance program, which is overseen by the estates manager and the catering and domestic services manager, who do an audit of the whole home on a monthly basis. The corridors were still in the process of being redecorated. The inspector was told by the deputy manager that all the corridors and many of the communal areas will have been redecorated in the past year. British Home and Hospital for Incurables DS0000032400.V272094.R01.S.doc Version 5.0 Page 15 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35 Service users individual and joint needs are met by appropriately trained, supported and supervised staff. EVIDENCE: Staff told the inspector they had access to a range of training. This included medication administration for the trained staff. The home has a rolling program on fire prevention training and moving and handling with staff going in rotation. The inspector was told that the home had eight sessions of training to which 120 staff attended training such as POVA, moving and handling, sickle cell disease, multiple sclerosis, feeding and swallowing. Staff said they feel adequately supported and that they receive supervision from their line manager. British Home and Hospital for Incurables DS0000032400.V272094.R01.S.doc Version 5.0 Page 16 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 The home must have a registered manager. There are systems in place to measure the satisfaction of service user and other stakeholders about care provided by the home. Working practices and associated records ensure that the health and safety of service users is promoted. EVIDENCE: There has been no registered manager since February 2005. This has been discussed in detail before and during this inspection. The inspector has contacted the CSCI Central Registration Team for advice on this matter and has passed this on to the home. The requirement that was given on 15th February 2005 at a previous inspection, to appoint a manager, is restated in this report. The inspector has been sent copies of the homes monitoring report (regulation 26) that are carried out each month by a member of the board. This is British Home and Hospital for Incurables DS0000032400.V272094.R01.S.doc Version 5.0 Page 17 responded to by the registered provider, who makes comments and informs the board of actions taken to address any service deficits. A health and safety inspection is carried out monthly on the whole building by the estates manager and the catering and domestic services manager. This includes the loft spaces, laundry and lifts. All hoists and mini bus tail lifts have Lola tests every six months. British Home and Hospital for Incurables DS0000032400.V272094.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 x Standard No 22 23 Score 3 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 x Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X X 3 X x LIFESTYLES Standard No Score 11 3 12 X 13 X 14 X 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X X X X 3 x CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 2 X 3 X X 3 x British Home and Hospital for Incurables DS0000032400.V272094.R01.S.doc Version 5.0 Page 19 Yes 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 YA37 Regulation 8 (2) (a) Requirement The registered person must ensure an application for the registration of a manager of the home is made to the Commission for Social Care Inspection. This is a repeat requirement from 15/02/05. Timescale for action 30/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations British Home and Hospital for Incurables DS0000032400.V272094.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH 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. Extracts may not be used or reproduced without the express permission of CSCI British Home and Hospital for Incurables DS0000032400.V272094.R01.S.doc Version 5.0 Page 21 - 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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