Inspection on 28/07/05 for British Home and Hospital for Incurables

This inspection was carried out on 28th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 but made no statutory requirements on the home.

Other inspections for this house

British Home and Hospital for... 15/01/09

British Home and Hospital for... 29/01/08

British Home and Hospital for... 12/12/06

British Home and Hospital for... 18/01/06

British Home and Hospital for... 15/02/05

British Home and Hospital for... 15/07/04

British Home and Hospital for... 16/02/04

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

CARE HOME ADULTS 18-65 British Home and Hospital for Incurables Crown Lane Streatham SW16 3JB Lead Inspector Lynne Field & Kate Matson Unannounced 28 July & 9 August 2005 th 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 G52 G02 32400 BHHI 236535 280705 Stage 4 uiv.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service British Home and Hospital for Incurables Address Crown Lane, Streatham, SW16 3JB 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) 0208 670 8261 020 8766 6084 noelle.kelly@britishhome.org.uk British Home and Hospital for Incurables Care Home with Nursing 127 Category(ies) of Physical disability (127) registration, with number of places British Home and Hospital for Incurables G52 G02 32400 BHHI 236535 280705 Stage 4 uiv.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th February 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 one full-time physiotherapist and three full-time physiotherapy assistants who see all service users. British Home and Hospital for Incurables G52 G02 32400 BHHI 236535 280705 Stage 4 uiv.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection, which took place over one and a half days, concentrated on the requirements from the last inspection as well as looking at service users care plans, quality of care and service delivery and record keeping. During the course of the inspection eight staff and 20 service users were spoken to as well as one visiting professional. The inspectors concentrated on assessing care plans at this inspection as well as an analysis of a recent complaint. What the service does well: What has improved since the last inspection? What they could do better: The inspectors found some care plans were good but others were not, with the quality of the information contained in the care plans patchy throughout the service. Care plans still need to be improved. There is a need to improve communication and work in partnership with other professionals and outside agencies. British Home and Hospital for Incurables G52 G02 32400 BHHI 236535 280705 Stage 4 uiv.doc Version 1.40 Page 6 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 G52 G02 32400 BHHI 236535 280705 Stage 4 uiv.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection British Home and Hospital for Incurables G52 G02 32400 BHHI 236535 280705 Stage 4 uiv.doc Version 1.40 Page 8 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 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 inspectors examined six care plans in order to assess the home’s care planning arrangements. For one service user a risk assessment had not been completed. There were pre-assessments 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. British Home and Hospital for Incurables G52 G02 32400 BHHI 236535 280705 Stage 4 uiv.doc Version 1.40 Page 9 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 standard(s) 6, 9 & 10 Care planning arrangements are not consistent throughout the home. There is some good care planning in parts of the home and service users express satisfaction with the service. However, action needs to be taken to make sure that care plans and assessments are reviewed and evaluated regularly. EVIDENCE: Six care plans were inspected in detail. The care plans were randomly selected from three of the six units within the home. The inspectors identified that the care planning arrangements varied between the units. There were some good examples of care planning documentation where there was good accountability, as well as detailed information and assessments such as tissue viability and pressure ulcer care. However, in other parts of the home the care plans had gaps in accountability such as risk assessments not being updated, wheelchair provision not being reviewed and some care plans not being updated. The management team reported that a new initiative called “essence of care” had been introduced at the home. Staff are to receive training and the programme will be used throughout the home. British Home and Hospital for Incurables G52 G02 32400 BHHI 236535 280705 Stage 4 uiv.doc Version 1.40 Page 10 The inspectors spoke with twenty service users throughout the inspection. Service users made reference to staff being helpful, having lots of activities and having the freedom to move around the home. All service users indicated they liked living in the home but one in particular said she enjoyed living in the home because she was free to move around independently and safely. British Home and Hospital for Incurables G52 G02 32400 BHHI 236535 280705 Stage 4 uiv.doc Version 1.40 Page 11 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 standard(s) 11, 12, 13, 14, 15, 16 & 17 There is a new activities coordinator who is developing the activities programme and facilities provided for service users. Activities provision has been balanced towards physical needs to date and could be extended to cover service users emotional needs and personal development. Food provision continues to be of a good standard and liked by service users. EVIDENCE: One of the inspectors spoke with the activities coordinator who had recently started at the home. The activities coordinator was able to describe the initiatives she had started including music therapy and the development of an IT service. Service users are able to access the internet within a dedicated IT area. During the inspection there was a bingo session attended by approximately twenty service users as well as a church service being held in the Chapel. Other service users were following their own interests including painting, meeting with other service users and listening to music. British Home and Hospital for Incurables G52 G02 32400 BHHI 236535 280705 Stage 4 uiv.doc Version 1.40 Page 12 One of the inspectors spoke with a visiting advocate and the service user she was visiting. One of the issues raised by service users was the desire for some service users to have fulfilling intimate relationships. The advocate visits the home on a regular basis. A requirement is given for future activities provision to include more assessment and provision of emotional and personal development services. The inspectors identified that the services provided were balanced more towards physical needs rather than emotional. For example, there is a physiotherapy department, which provides a daily service. Service users told the inspectors that their needs were met, in the main, within the home, and that it was rare for them to go out of the home. Relatives and friends visit and are encouraged to take people out. The inspectors sat with service users as they were eating lunch. Some service users were being assisted to eat by staff and this was being provided in a positive manner. Some of the meals, although blended, were presented in an attractive way. There was a choice of food, which catered for different ethnic and religious tastes. The menus provided evidence that a wide selection of nutritious food was provided. Service users said that they enjoyed the food and liked the fact that if relatives came to visit they could have a meal with them. British Home and Hospital for Incurables G52 G02 32400 BHHI 236535 280705 Stage 4 uiv.doc Version 1.40 Page 13 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 standard(s) 18 &19 Overall, the provision of care is good but documentation needs development so that service user’s wishes about their care needs and preferences are recorded. Physical care provision is good but a review of emotional health needs provision is needed. EVIDENCE: Service users wishes about personal care provision needs to be documented. The inspectors identified that for many service users, personal care provision relied on staff knowledge of individual service users rather than recorded information about service user’s needs and preferences. The records of daily care are brief and not always signed. As identified under the standard, “Individual Needs and Choices”, above, this varies throughout the home. The inspectors found evidence that care provision is good. However, without detailed recording important preferences of service users about their care provision could be missed and staff will not be able to demonstrate some of the positive work they do with service users. The inspectors identified that service user’s physical needs are met but there is a gap in the meeting of emotional health needs. Service users told the inspector that they would like more fulfilling personal relationships. The inspectors did not identify any groups that were designed to address service British Home and Hospital for Incurables G52 G02 32400 BHHI 236535 280705 Stage 4 uiv.doc Version 1.40 Page 14 user’ emotional needs. A requirement has been given for an assessment of service user’s emotional needs to be carried out. Additional activities or groups must be provided as identified. Medication arrangements were not inspected on this occasion. British Home and Hospital for Incurables G52 G02 32400 BHHI 236535 280705 Stage 4 uiv.doc Version 1.40 Page 15 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 standard(s) 23 Managers and staff have an understanding of adult protection issues. EVIDENCE: There had been an adult protection matter. This was still ongoing at the time of the inspection. The inspectors were able to discuss the adult protection matter with the senior management team as well as with the team leader. They identified that staff and managers at the home had followed the adult protection procedure. British Home and Hospital for Incurables G52 G02 32400 BHHI 236535 280705 Stage 4 uiv.doc Version 1.40 Page 16 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 standard(s) 24, 25, 26, 27, 28, 29 & 30 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 has a homely feel to it and is clean and well kept. It is divided into six units each with a lounge and a dining area. Service users have their own bedroom with fifty five bedrooms being ensuite. 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. Service users said they were able to bring in personal items such as pictures, which helped make the bedrooms individual and suitable for the service users needs. The standard of maintenance is good and the upkeep of the building is excellent. There is a range of specialist equipment including adapted bathrooms, mobile and standing hoist as well as specialist beds. British Home and Hospital for Incurables G52 G02 32400 BHHI 236535 280705 Stage 4 uiv.doc Version 1.40 Page 17 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32 & 33 Staff treat service users with dignity and respect. Service users like and are happy with staff. EVIDENCE: Staff were observed carrying out care duties and interacting with service users. Staff were seen to work with service users with dignity and respect. Service users said that they liked staff and were happy. This inspection concentrated on assessing care plans and as a result not all the staffing standards were not inspected. They will be inspected at the next inspection. British Home and Hospital for Incurables G52 G02 32400 BHHI 236535 280705 Stage 4 uiv.doc Version 1.40 Page 18 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, The management arrangements are clear resulting in a good standard of care provision. EVIDENCE: The management of the home is firm and clear resulting in a good standard of care. The majority of service users are happy with the service provided. There is no registered manager. The requirement given at the last inspection, to appoint a manager, this is still under discussion with the Central Registration Team. Staff and service users said they found the matron approachable. British Home and Hospital for Incurables G52 G02 32400 BHHI 236535 280705 Stage 4 uiv.doc Version 1.40 Page 19 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 ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x x 2 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 2 3 3 3 2 3 3 Standard No 31 32 33 34 35 36 Score x 3 3 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 British Home and Hospital for Incurables Score 2 2 x x Standard No 37 38 39 40 41 42 43 Score 3 3 x x x x x G52 G02 32400 BHHI 236535 280705 Stage 4 uiv.doc Version 1.40 Page 20 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. 2. Standard YP6 YP9 Regulation 15(2)(b) 13(2)(C) Requirement The registered person must keep service users plans under review The registered person must identify unnecessary risks to the health and safety and as far as possible eliminate them. The registered person must provide activities that include the provision of emotional and personal development services. The registered person must maintain records in in respect of all service users which includes the information, documents and other records specified in Schedule 3 relating to the service user. The registered person must assess service users emotional needs. Additional activities or groups must be provided as identified. Timescale for action 30 October 2005 30 October 2005 30 October 2005 30 October 2005 3. YP11& YP15 YP18 & YP19 12(1)(a)( 3) 17(1)(a) 4. 5. 11 & 15 12 & 16 (2) (n) 30 October 2005 6. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. British Home and Hospital for Incurables G52 G02 32400 BHHI 236535 280705 Stage 4 uiv.doc Version 1.40 Page 21 No. 1. Refer to Standard Good Practice Recommendations British Home and Hospital for Incurables G52 G02 32400 BHHI 236535 280705 Stage 4 uiv.doc Version 1.40 Page 22 Commission for Social Care Inspection 46 Loman St 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. 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