Inspection on 29/01/08 for British Home and Hospital for Incurables

This inspection was carried out on 29th January 2008.

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

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 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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

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

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

British Home and Hospital for... 28/07/05

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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Ashlong House

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Barrington Lodge Nursing Home

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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 London SW16 3JB Lead Inspector Ornella Cavuoto Unannounced Inspection 29 , 30 January & 1 & 4 February 2008 10:00 th th st th British Home and Hospital for Incurables DS0000032400.V353356.R01.S.doc Version 5.2 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.V353356.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 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.V353356.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service British Home and Hospital for Incurables Address Crown Lane Streatham London SW16 3JB 0208 670 8261 020 8766 6084 chris.morland@britishhome.org.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) British Home and Hospital for Incurables Christine Lilian Morland Care Home 127 Category(ies) of Physical disability (127), Physical disability over registration, with number 65 years of age (0) of places British Home and Hospital for Incurables DS0000032400.V353356.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th December 2006 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. 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 units 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.V353356.R01.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 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced inspection that took place over four days. The responsible individual and registered manager were both present for the inspection on different days. Prior to the inspection approximately twenty- five service users’ surveys were sent to the home for distribution. Fifteen of these were sent back. In addition, the Annual Quality Assurance Assessment (AQAA) was sent to the home in advance of the inspection to be completed. This requires that the home provide details and evidence of how they have met National Minimum Standards (NMS), areas where they have sought to improve and areas where improvements are still needed. This document will be referred to in the report. During the inspection sixteen service users were spoken to and one relative. In total thirteen staff were spoken to; five nurses, five carers, the finance manager, the maintenance manager and the catering manager. Other inspection methods that were used included examination of records and a partial tour of the building. What the service does well: Feedback about the home and staff varied, but overall service users responses within surveys received back and from service users spoken to were positive about the home and support received. Comments made included; “ We get well looked after” Regarding staff “On the whole they are very, very good. They are caring and will do things for you if you ask and if they can”, “ Hands on carers and maintenance staff are very good”, “ I really enjoy staying here”, “ All in all I’m pleased with the food, the activities, people around residents, staff, they are all a nice bunch of people”. Service users needs are assessed prior to being admitted to the home to make sure their needs can be met. Service users are supported to make their own decisions and to be independent in that they are encouraged where possible to do things for themselves. There is a varied and nutritious menu and a choice of food is available including those that meet the specific cultural needs of service users. Overall service users receive personal support in the way they prefer and the home provides hairdressing and a manicure service. Health care needs are well met and the home has onsite physiotherapy services. Service users are clear to whom to make concerns and complaints known and complaints are investigated and addressed appropriately. The home is well maintained and standards of hygiene are excellent. Staff are supported to obtain relevant qualifications to make sure they are able to do their work to a competent standard and other training is arranged. British Home and Hospital for Incurables DS0000032400.V353356.R01.S.doc Version 5.2 Page 6 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. British Home and Hospital for Incurables DS0000032400.V353356.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection British Home and Hospital for Incurables DS0000032400.V353356.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of service users had been fully assessed before they were admitted to the home EVIDENCE: A total of eleven personal files belonging to service users were looked at during the inspection, four of these had been admitted to the service since the last inspection. All contained evidence that assessments had been obtained prior to the service users being offered a place to ensure that a suitable placement could be provided in which their needs could be fully addressed. British Home and Hospital for Incurables DS0000032400.V353356.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 &10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. All service users had a care plan in place but not all the plans had addressed the personal and social support needs of service users in sufficient detail and care plans had not always been updated to reflect service users’ changing needs. Service users were supported to make decisions about their lives. Not all risk assessments to address service users’ needs were in place nor had they all been regularly reviewed. Not all service users were confident that information about them was handled appropriately and confidences were kept. EVIDENCE: Of the eleven personal files that were inspected nine were case tracked. All the files looked at had a care plan in place. Overall, all the care plans had addressed health care needs in good detail. In respect to personal and social support needs files did include some information about service users personal life history including employment, family and personal relationships. Yet, overall the extent to which care plans had addressed personal and social support needs was variable across the units, for example it was noted within British Home and Hospital for Incurables DS0000032400.V353356.R01.S.doc Version 5.2 Page 10 some of the files a separate form ‘Choices/Activities/Interests/Likes and Dislikes’ had been completed with or by service users in which good detailed information had been obtained about their personal preferences regarding personal care and daily routines, food, activities and any hobbies and interests they had. However, specifically on two of units where files were inspected this form had not been used. Subsequent to the draft report information was received that the form was being trialled. Consistency in this area is needed. Furthermore, it was noted that the information gathered from using this form was kept separate within service users’ personal files rather than being used to inform care plans that had been drawn up. It is recommended that this information actually be recorded within the care plans so it is more accessible to all staff using them and care plans are more person centred. All the files inspected apart from two included a form signed by service users indicating they had seen their care plan and they agreed with its content and all care plans had been reviewed at least six monthly with some reviewed once to two monthly. Five of the files seen did include a review form that detailed service users’ progress in respect to their individual needs. It was reported by the registered manager this form was used to send to the placing authority prior to them carrying out an annual placement review updating them on the service users’ situation. The form indicated the service user should sign it but apart from one neither the service user or a relative or representative where appropriate had signed the form. Nor had the staff member completing the form always signed it. It is important this form is completed with the service user or a relative or representative where appropriate and it is signed as indication of their agreement of its content. Furthermore, despite regular reviews being undertaken of care plans it was noted that these did not always clearly specify changes or progress in service users’ needs or even where reviews had noted changes care plans had not always been updated as needed to reflect these. For example, for one service user who had developed a pressure sore, reviews of their care plan had cited no changes but daily records included information about the development of the pressure sore and that appropriate action had been taken with a wound chart being commenced. For another service user changes in their ability to mobilise had been noted in monthly reviews but neither the care plan nor their mobility assistance plan had been updated (For further details see Standard 9)(See Requirements & Recommendations). The majority of service user surveys received indicated that they had been able to make their own decisions on a daily basis about what they wanted to do. Service users spoken to also confirmed that they were supported to make their own decisions. For one service user where it was identified limitations had been imposed on them regarding a personal choice due to concerns about their welfare and that of others living in the home there was evidence that this had been addressed with them with involvement from their social worker. This information was clearly outlined within their personal file. However, in terms of independent advocacy, although the responsible individual and registered manager reported this could be accessed from specific placing authorities and British Home and Hospital for Incurables DS0000032400.V353356.R01.S.doc Version 5.2 Page 11 voluntary organisations this information was not accessible to residents. It is recommended that a list of organisations and contact details be placed on the notice boards on each unit for service users’ information (See Recommendations). At the last inspection a requirement was specified that manual handling assessments and risk assessments in place for service users must be reviewed. At this inspection, it was identified that risk assessments addressing nursing needs such as nutrition, continence, and pressure sores had been reviewed three to six monthly. However, not all service users for whom bed rails were used had a risk assessment completed. Fall risk assessments had not all been reviewed at least six monthly. In respect to manual handling assessments there were two different forms seen on files, a mobility assistance plan and a patient-handling plan. Subsequent to the draft report information was received that the mobility assistance plans and patient handling forms were being trialled. Although all personal files seen included either one or both forms some had not been signed or dated and reviews had not been recorded. Due to not being dated it could not be identified if a review was required. Furthermore, as mentioned in respect to Standard 6 one mobility assistance plan that was seen had not been fully updated to detail changes in the mobility of the service user (See Requirements). In respect to confidentiality information about service users was kept in locked filing cabinets on each unit. However, some service users spoken to expressed concerns that they had heard staff discussing matters relating to other service users including an issue, which had been subject to an adult protection investigation within the home (For further details see Standard 23). Furthermore in speaking to care staff working at the home it became evident that not all were clear about their responsibilities in relation to confidentiality, for example when confidentiality may need to be breached and that they need to make service users aware of this who may be wanting to share personal information with them. This needs to be addressed with all staff working within the home (See Requirements). British Home and Hospital for Incurables DS0000032400.V353356.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 &17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home does provide a range of activities within the home but these have not catered to all the individual needs and preferences of service users. Service users have generally been able to be part of the local community. Service users have been supported to maintain contact with family and personal relationships and to be as independent as possible with their rights to privacy observed although not all staff have treated service users respectfully. In general service users were satisfied with the meals provided which were varied and nutritious. EVIDENCE: The home has a weekly activities schedule in place that offers activities to service users on a daily basis in the morning and afternoon. The activities coordinator runs the sessions with the help of volunteers whilst the activities manager organises activities and entertainment. Activities provided include a quiz, indoor bowls reminiscence, bingo, karaoke, coffee mornings organised by British Home and Hospital for Incurables DS0000032400.V353356.R01.S.doc Version 5.2 Page 13 service users themselves, amongst others. Regular entertainers and special events are also held within the home. During the inspection entertainment with dinner had been organised for the weekend to which service users could invite family and friends. To attend tickets needed to be purchased at a small cost. The home has a large Victorian concert hall, a large recreational area with a shop. A large activity room with a kitchen area designed for people with disabilities. In addition, the home has a computer room that is equipped with a number of computers for use by service users. A tutor comes in weekly to support those individuals wishing to learn or improve their IT skills. Subsequent to the draft report it was reported art teaching is available five afternoons a week and service users can be assisted by volunteers, where necessary. During the inspection a quiz was observed that was well attended with approximately 15-20 service users present. Records of those that had participated in activities had also been maintained. However, at the last inspection it was specified that the home needed to ensure that activities were provided to meet individual service users’ needs and at this inspection this had not been addressed. It was evident that the activities provided by the home were aimed at meeting the needs of those service users that were mobile and more able to join in. There were no arrangements in place to ensure those service users that were bed bound were provided with opportunities for social interaction or stimulation. This was discussed with the activities manager and co-ordinator. It was reported by the co-ordinator that the needs of service users that were bed bound were considered to be the responsibility of nursing and care staff but staff spoken to expressed how they did not have the time to interact with service users in this way. This was confirmed by observations during the inspection. Furthermore, some of the surveys sent back and individual service users spoken to commented that they found weekends and evenings particularly ‘boring’ and not having any visitors contributed to this. This would indicate that more consultation with service users around activities is required and it is recommended this is carried out (See Requirements & Recommendations). There was evidence that service users’ links with the local community had been maintained in that as mentioned in relation to activities outside entertainers regularly visited the home. The chapel within the home is used several times a week by the Anglican and Roman Catholic communities. Other services are held by Baptist and Methodist congregations. Next to the home there is a primary school and the children come into the home from time to time, for example at Christmas to do carol singing and put on their nativity play for service users. In addition, there was evidence that individual service users did make use of the local community, for example one service user was supported to go on a monthly shopping trip, two services users went to watch the rugby at Twickenham at the weekend during the time the inspection was held and some service users regularly attended the local pub. The home has also organised some trips, for example one service user commented on how a few service users had been taken to Crystal Palace Park earlier in the year. However, individual service users who were not able to go out unaccompanied British Home and Hospital for Incurables DS0000032400.V353356.R01.S.doc Version 5.2 Page 14 said that they would like more opportunity to go out and often had to rely on when visitors came to see them to do so as staff were busy. The responsible individual and registered manager acknowledged the home had limited transport facilities to take more than a few service users out at a time. Furthermore, the home’s AQAA recognised that continuing to improve community links was an area to be addressed by the home and that the option of increasing the number of volunteers who can befriend individual residents and be available to go out with them on trips was under consideration. Although evidence indicated this standard was met, it is recommended that the home pursue the option of increasing volunteers as well as exploring any other options to support those service users who would like to go out more regularly (See Recommendations). All service users spoken to stated that their family and friends came to visit on a regular basis and were made to feel welcome by staff. A relative spoken to also confirmed this. Discussions with service users confirmed that staff respected their rights, for example by knocking before entering their rooms. Yet, it was noted that those service users whose rooms were situated in the old part of the building although they were able to lock their rooms from the outside they were not able to do so from the inside. The registered manager reported that ‘do not disturb signs’ were available. However, to uphold service users’ right to privacy it is advised that inside locks for these rooms are fitted. In terms of promoting independence, service users stated staff supported them to be as independent as possible. Care staff also mentioned the importance of enabling service users to be independent and to allow them to do as much as they can for themselves, which was positive. This was also reflected in care plans. In addition, it was observed that service users were able to choose how to spend their time to join in the activities provided or spend time alone in their rooms and the majority of service users’ surveys received back confirmed that they were able to do what they wanted. However, on two separate occasions on different units where service users were being supported with personal care by two staff, nurses and carers it was observed that they were having personal conversations rather than interacting or addressing the service user. This is not appropriate and is not respectful or sensitive to the needs of the service users. This needs to be addressed with all staff in terms of reinforcing their responsibilities to treat service users respectfully (See Requirements and Recommendations). Feedback from service users about the food did vary with some individual service users expressing dissatisfaction although the majority of service users stated they were happy with the meals provided by the home. Comments made included; ‘ Its nice I like it’, ‘Food is fine for me. There is always a choice’, ‘On the whole the food is very, very good’. The home has a threeweek rolling menu in place that was looked at. This confirmed that service users were provided with a choice of meals that were varied and nutritious. British Home and Hospital for Incurables DS0000032400.V353356.R01.S.doc Version 5.2 Page 15 Each floor has a dining area although service users can eat in their rooms if they prefer. A lunch- time and a supper -time were observed. These were relaxed and unhurried. The food served was as specified on the menu and was well presented. Service users’ who required assistance to eat were provided with support in an appropriate and respectful manner. In addition, since the last inspection in January 2007 the home had carried out a survey with service users and staff who are provided with the same food in the staff canteen. As a consequence of the survey, it was reported by the catering manager that more meals that meet the culturally specific needs of service users had been introduced. A service user spoken to confirmed they did receive meals that met their cultural needs. Also, a specialist menu was provided approximately once monthly in addition to the main menu that offered dishes comprising of Indian, Thai and Chinese food amongst others. British Home and Hospital for Incurables DS0000032400.V353356.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall service users stated they had received personal support from staff the way they preferred. The health needs of service users had been well addressed. The Pharmacist Inspector assessed standard 20 separately. EVIDENCE: Apart from individual service users spoken to who stated they had not received personal support in they way they preferred, the majority spoken to were satisfied with the way staff had supported them. Also, responses within surveys received back regarding staff treating them well were in the main positive. The home operates a key worker system to promote continuity and consistency. In addition, the home does not use agency staff and has a low staff turnover with the majority of the staff working within the home having done so for many years. As a result they are very familiar with service users and their needs, which was confirmed by staff spoken to. The home also provides a hairdressing and manicure service for service users within the home. British Home and Hospital for Incurables DS0000032400.V353356.R01.S.doc Version 5.2 Page 17 Overall, evidence from service users’ personal files and other records maintained indicated that health care needs had been well addressed. There was evidence that risk assessments in respect to nutritional needs, continence, pressure sores had been completed and also assessments with regards falls and mobility had been done although as stated in respect to Standard 9 some improvements were required in the completion and reviewing of these. Service users had had their weight monitored monthly apart from a few gaps noted from files of service users inspected from two of the units. The home has links with a GP that regularly visits the home and there was evidence that service users had been supported to attend hospital appointments and there had been liaison with a range of other health professionals including neurologists, speech and language therapists, psychiatrists and primary health services such as chiropodists/podiatrists, dentists and opticians. There is also on site physiotherapy services provided for service users. The pharmacist inspector inspected the home’s medication on the first day the inspection was held. The outcome of this is addressed in a separate report. British Home and Hospital for Incurables DS0000032400.V353356.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Overall, service users were aware of how and to whom to make their complaints known but service users had not been fully protected from abuse. EVIDENCE: The majority of service users’ surveys received back and service users spoken to, stated they were aware of who to talk to if they were not happy and how to make a complaint. On each unit a copy of the home’s complaint policy had been made accessible by being placed on a notice board. As mentioned in respect to Standard 7 it was also advised that information about independent advocates be placed on notice boards to make this more accessible to service users. The homes complaint log was checked there had been two formal complaints made since the last inspection; one was from a relative that they were dissatisfied with the aspects of the care received by their relative whilst the other was regarding dissatisfaction with a staff member’s attitude and their behaviour. The Matron, who also is the responsible individual for the home, had appropriately investigated both matters and the complainants had been informed of the outcome within timescales outlined within the home’s policy. The first complaint was partially substantiated whilst the other was not substantiated. There was also evidence of an informal complaint made by several service users on one of the units that they were receiving their breakfast late, which British Home and Hospital for Incurables DS0000032400.V353356.R01.S.doc Version 5.2 Page 19 was being looked into by the Matron at the time the inspection was held. Subsequent to the draft report information was received that two people had withdrawn their names from the letter of the complaint. In relation to adult protection, since the last inspection there has been one adult protection concern that involved an investigation being carried out by the local authority relating to an allegation of physical abuse. The allegation was made anonymously to the CSCI to which the local authority was alerted. This was partially substantiated. The investigation into this matter also raised concerns about the fact that the registered manager had been aware that the incident had occurred and although they had taken measures to reprimand the staff member involved, had failed to take appropriate action in line with adult protection procedures and did not report the incident to the CSCI, the placing authority or the adult protection co-ordinator of the local authority in which the home is located. In addition, at this inspection two adult protection concerns that involved physical and emotional abuse by two staff members towards a service user were identified. There was evidence in respect to the incident involving emotional abuse that the matter had been addressed internally in that disciplinary action had been taken against the staff member and therefore had been substantiated. Yet, in relation to the second issue of physical abuse it was evident that the allegation had not been adequately investigated by the home and so the outcome of the matter was not clear. Furthermore, adult protection procedures had not been followed. Neither matter had been reported to CSCI or the local authority. Despite both incidents being historical having occurred in approximately August and November 2007, CSCI took measures to alert the local authority following the inspection and the registered manager was also directed to discuss these matters with the adult protection co-ordinator. The registered manager reported they had received training on adult protection and therefore should be aware of the procedures to be followed when adult protection concerns are reported or identified. In order that service users are protected from abuse they must ensure that these procedures are implemented at all times. Some of the staff that were spoken to reported they had not completed training in adult abuse or if they had completed it, it had been some time ago. Although the majority of them showed some understanding of the different types of abuse and action to be taken if they suspected or identified abuse it was evident speaking to individual staff that they needed to increase their awareness in this area. Records detailing how many staff had completed training in adult abuse were not available (For further details See Standard 35). There was some evidence within staff files that training had been completed but for those staff members who had certificates these confirmed that this had been undertaken some time ago. The registered manager reported some sessions had taken place within the home last year led by the adult protection co-ordinator and more sessions were to be arranged for this year. However, given the issues identified through the inspection it is to be required that all staff working within the home that have contact with service users must complete training in this area including domestic and kitchen staff (See Requirements). British Home and Hospital for Incurables DS0000032400.V353356.R01.S.doc Version 5.2 Page 20 In respect to service users’ finances the finance officer was spoken to. It was reported that approximately ten service users managed their own money with the home supporting the majority to manage their finances. The home has robust procedures and systems in place to manage service users’ finances with individual records being kept, receipts maintained and monthly statements produced that are given either to the service user or their relative. There is an annual external audit and internal monthly audits are carried out of the finances The finance officer also reported that measures were being taken to ensure that service users, particularly those that had accumulated a lot of savings, opened their own bank accounts to allow them to earn interest on their money instead of keeping all their money within the home’s account. For service users that do not have capacity formal financial representation was being arranged. British Home and Hospital for Incurables DS0000032400.V353356.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,26,29 &30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained, attractive and has been made as homely as possible. Generally service users bedrooms meet their needs. The home has been adapted so it accessible to all service users and there is sufficient equipment necessary to support service users available. The home was clean and hygienic. EVIDENCE: The home is large and spacious with lifts to all floors. Many of the service users have electric wheelchairs with controls that are custom built to suit each service user. This enables service users to be able to move around the home independently. The environment is generally good. There is a difference between the older and newer parts of the home with more en suite facilities, for example, within the modern extension. However, the extension blends in well within the overall style of the building and as mentioned previously there are lots of spaces for activities. British Home and Hospital for Incurables DS0000032400.V353356.R01.S.doc Version 5.2 Page 22 Service users’ bedrooms varied in size with those in the newer part generally being larger. Rooms seen were personalised. This did vary but it was evident that service users were able to have personal possessions in their rooms if they wanted. The home is suitable to meet the needs of service users and all parts are accessible. There was a very high standard of cleanliness throughout the home and there were no offensive odours. The domestic staff had undertaken a National Vocational Qualification (NVQ) Level 1 in Interior Cleaning and eleven of the staff were coming to an end of completing a NVQ Level 2. The home has good laundry facilities situated away from the preparation of food. Service users spoken to were complimentary about the services provided by the laundry staff. This standard is exceeded. British Home and Hospital for Incurables DS0000032400.V353356.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,34,35 &36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff had been supported to achieve a relevant qualification to enable them to work at a competent level. There were sufficient staff but staffing levels should be kept under review. The home’s recruitment practices had not fully protected service users. An annual training plan and individual records for staff detailing training undertaken had not been completed but there was evidence that training needs were being addressed. Regular supervision of staff had still not taken place. EVIDENCE: It was reported within the home’s AQAA that 56 of care staff had either completed or were in the process of undertaking a NVQ Level 2 or 3. At the inspection the registered manager reported that this had increased to 65 . This did not include bank staff. As a result the home had met the target specified within the National Minimum Standards (NMS) that 50 of staff should have achieved a NVQ. Two of the five care staff spoken to were doing their NVQ Level 3 and one reported that they were due to start studying for the NVQ Level 2 in February 2008. A third of the staff are qualified nurses. British Home and Hospital for Incurables DS0000032400.V353356.R01.S.doc Version 5.2 Page 24 In relation to staffing levels, on one floor each of the two units had five staff including a nurse during the day whilst on the other floors each unit had four staff including a nurse. On the afternoon/evening shift there were four staff including a nurse on one floor for each unit and three staff including a nurse on the other floors for each unit. During the night there were three staff including a nurse allocated to each floor for both units. In addition, there was a number of ancillary staff on each unit to support nursing staff with cleaning and meal times. It was reported that this was to maximise the time available to nursing and care staff to be able to deliver care and meet service users’ needs Observations of staff through the inspection indicated that staff were always busy. This was also identified at the last inspection. In particular at this inspection it was noted that staff did not have time to sit with service users or to interact with them. However, in terms of meeting personal care needs these were well met with service users presenting as well groomed and dressed. Individual service users that were spoken to did comment that they had to wait to be attended to by staff but the majority did not mention this as a concern. Staff spoken to stated that it was difficult to do everything that was needed with many of the service users requiring two carers to assist with manual handling and personal care. However, apart from the lack of staff interaction with service users (See Standard 12 for further details) there was no other evidence to indicate that there was insufficient staff to be able to meet service users’ needs. Consequently, this standard is deemed met although the previous recommendation that reviews of staffing levels in accordance with service users’ levels of dependency should take place is to remain in place (See Recommendations). To check the home’s recruitment practices, nine staff files were inspected three of which belonged to staff that had commenced working in the home since the last inspection. All the files included a completed application form, two references and copies of appropriate identification documents had been obtained. In respect to Enhanced Criminal Record Bureau (ECRB) checks there was evidence for one of the newly recruited staff members that they had commenced working within the home with a portable ECRB. It was reported by the Responsible Individual that this was allowed in accordance with the CRB guidelines which state specific circumstances in which portability of ECRBs are permitted. However, on checking this guidance following the inspection it was identified the information did not actually apply to the individual recruited by the home and the criteria for allowing portability given in the guidance had mistakenly been applied. Furthermore, for another staff member a record that an ECRB had been completed could not be identified. The staff member had worked for many years with the home prior to CRB checks being introduced but an application should have been completed. Finally, from a list detailing all staffs’ CRB details, it was noted that for two other staff that had been recruited some time ago CRB checks obtained from Scotland had been accepted. This is not allowed and these disclosures are not valid within England. The responsible individual reported that it had already been agreed with the board of trustees for the home that three yearly renewal of CRBs should be carried out and as a British Home and Hospital for Incurables DS0000032400.V353356.R01.S.doc Version 5.2 Page 25 result of these issues being identified they would ensure that this would include the two staff members with Scottish disclosures and the staff member whose CRB check could not be identified. Copies of these checks once obtained need to be sent to CSCI (See Requirements). In respect to staff training records these were not up to date. An annual training plan/ matrix detailing training courses to be completed by staff including any mandatory training that needed to be updated and other specific courses identified to be undertaken by staff through completion of appraisals was not in place. Also, individual records listing training completed by staff within staff files had not been done and although there was some evidence of certificates seen in staff files these were of courses done in 2006 and earlier. Only one staff file checked included details of training courses completed in 2007. A template of an individual training record detailing mandatory training to be completed by staff including adult protection and medication training and to record date of appraisal and supervision sessions for 2008/09 was sent to CSCI following the inspection. However, up to date records regarding training must be kept. In respect to specific training courses there was evidence of a list of training courses provided by the Care Homes Support Team (CHST) that had been booked for 2008 for nursing staff including mental capacity, wound care, end of life care communication amongst others. Also, as mentioned, in respect to Standard 23 it was known that training sessions in adult abuse were to be held. In terms of mandatory training staff spoken to confirmed that they had manual handling training updated annually. The home has two nurses that are both qualified manual handling assessors and trainers. There was also evidence that refresher training had been organised for staff in health and safety and fire safety. The catering manager provided evidence that all kitchen and domestic staff complete training in food hygiene and health and safety including infection control, Control of Substances Hazardous to Health (COSHH) and other hazards training and this is updated annually. In respect to induction, there was evidence seen within the staff file for only one of the three newly recruited staff members that a basic induction had been completed with them. This needs to be evidenced for all staff. The registered manager reported that the Common Induction Standards would be used to induct all staff to be recruited in the future. Also, those staff not studying for a NVQ would be required to complete the Common Induction Standards work booklet (See Requirements). There was evidence that annual appraisals had been completed for the majority of staff. However, in relation to supervision at the last inspection it was identified that staff had not received regular supervision. At this inspection it was evident that staff had still not received sufficient supervision to ensure they all had completed at least six sessions a year as specified within NMS (See Requirements). British Home and Hospital for Incurables DS0000032400.V353356.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 &42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered manager is experienced and well qualified. The home has developed systems in place as part of self -monitoring to ensure the home is run in the best interests of service users although some improvements could be made in this area. The health and safety of service users have been well promoted and protected. EVIDENCE: The registered manager is experienced and well qualified and overall demonstrated a good knowledge of service users and the running of the home. The responsible individual who has worked for many years with the home and is to retire shortly also takes an active part in the management of the home and is very knowledgeable and very experienced. However, as mentioned in respect to Standard 23, concerns were identified prior to and during the inspection about the registered manager not taking responsibility to ensure British Home and Hospital for Incurables DS0000032400.V353356.R01.S.doc Version 5.2 Page 27 incidents relating to allegations of abuse had been reported to the appropriate agencies as specified within adult protection guidelines. This is a serious matter and compromises the overall quality of care provided within the home (See Requirements). There was evidence that the home uses systems as part of self- monitoring including having to submit regular reports and information to the ‘Care Governance Committee’ of the home on various matters relating to the management and running of the home including audits undertaken in respect to care plans, pressure sores and reports regarding falls, the use of volunteers amongst others. Copies of provider visits and ‘monitoring reports’ detailing the outcome of these visits (Regulation 26) had been done. In addition, service users’ meetings are held regularly confirmed by service users spoken to and minutes of the last meeting were seen on the notice board placed on each floor accessible to all service users and visitors. The home’s AQAA submitted prior to the inspection had been completed to a satisfactory standard. As mentioned in respect to Standard 17 a survey had been completed last year with service users that covered food and cleaning services provided. The results of this had been complied in a report, which was seen. The catering manager reported another one was to be completed this March/April 2008. Yet, it is also recommended that the home carry out a customer satisfaction survey that is more general covering all areas of service provision within the home to include for example, staff support, activities, the environment, complaints amongst others and this is done with relatives and professionals who have links with the home as well as service users (See Recommendations). The maintenance manager was spoken to who evidenced that the health, safety and welfare of service users was well protected. All maintenance certificates checked with respect to gas safety, fire equipment, electrical appliances and wiring, hoists and other bathing equipment were all up to date as specified within the home’s AQAA. Fire and building risks assessments were in place and reviewed regularly. The home has twice-yearly visits from the LFEPA (Fire Services) and fire alarm testing is carried out weekly and regular fire drills. Water temperatures were tested as required. British Home and Hospital for Incurables DS0000032400.V353356.R01.S.doc Version 5.2 Page 28 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 Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 3 30 4 STAFFING Standard No Score 31 3 32 3 33 X 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 2 LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 X X 3 X 3 X X 3 X British Home and Hospital for Incurables DS0000032400.V353356.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes 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 YA6 Regulation 15(2)(b) Requirement The registered person must ensure that service users care plans have more information about what is important to the service user including life history, preferences and relationships. Care plans to be regularly reviewed and kept upto-date. (Previous timescale of 28/02/07 partially met) The registered person must ensure that the assessment of the service users needs is kept under review and revised at any time when necessary. (Previous timescale of 28/02/07 partially met) The registered person must ensure that service users, relatives or representatives are involved in the reviewing of their care plans and this is documented. The registered person must review all service users manual handling needs and risk assessments. (Previous timescale of 28/02/07 partially met) DS0000032400.V353356.R01.S.doc Timescale for action 31/08/08 2. YA6 14 (2)(a)(b) 31/08/08 3. YA6 15(2) (c) & (d) 31/08/08 4. YA9 13 (4) (c) 31/08/08 British Home and Hospital for Incurables Version 5.2 Page 30 5. YA9 13(4) (c) 6. YA10 12(5) 7. YA12 16 (m)& (n) 8. YA16 12(4) 9. YA23 13(6) 10. YA23 13(6) 11. YA34 19 (4) & Sched 2 The registered person must ensure all relevant risk assessments are completed for service users specifically bed rail risk assessments. The registered person must ensure that all staff working within the home are made fully aware of their responsibilities in respect to confidentiality procedures and these are adhered to at all times to ensure service users welfare is maintained. The registered manager must ensure those service users who cannot participate in communal activities due to physical impairments are offered suitable opportunities for social stimulation. The registered person must ensure that all staff working in the home are made aware of their responsibilities to treat service users respectfully at all times as part of maintaining service users’ welfare. The registered person must ensure that all incidents that occur in the home that relate to adult abuse are reported to all relevant professionals and agencies as specified within adult protection guidelines to make sure service users are properly safeguarded. The registered person must ensure that all staff working in the home including ancillary staff receives training in adult abuse and adult protection procedures and records for all staff that this training has been completed are maintained for the protection of service users. The registered person must ensure that an up to date DS0000032400.V353356.R01.S.doc 31/08/08 31/08/08 31/08/08 31/08/08 31/08/08 31/03/09 30/04/08 British Home and Hospital for Incurables Version 5.2 Page 31 12. YA35 18(1)(c) 13. YA36 18(2) Enhanced Criminal Record Bureau (ECRB) check is obtained prior to allowing them to commence working in the home to protect service users. Also, that evidence for the staff members discussed in the report where inappropriate ECRB checks had been obtained and also where a ECRB check could not be identified that evidence of new ECRB checks obtained are sent to CSCI. The registered person must 31/08/08 ensure that a training plan detailing all training to be completed by staff and in respect to mandatory training in need of updating and also individual records detailing all training courses undertaken by staff should be kept on staff files. The registered person must 31/08/08 ensure that staff working at the home are appropriately supervised. (Previous timescale of 28/02/07 not met) 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 YA6 Good Practice Recommendations The registered person should try to ensure that information that is used to obtain detailed information about service users’ personal preferences and needs in respect to personal and social care that this is included in the care plans that are drawn up with them to make them more person centred. The registered person should try to ensure that information regarding advocacy is placed on the notice boards placed on each unit for service users’ information. DS0000032400.V353356.R01.S.doc Version 5.2 Page 32 2. YA7 British Home and Hospital for Incurables 3. 4. 5. 6. 7. YA12 YA13 YA16 YA26 YA33 YA39 The registered person should try to ensure that service users are consulted more about their preferences and needs with regards to activities. The registered person should try to follow up the option that more volunteers are recruited to befriend service users and take them out more regularly as requested. The registered person should try to ensure that service users’ rooms that cannot be locked from the inside measures are taken to address this with locks fitted. The registered person should try to ensure that there is a reassessment of the needs of the service users with staffing levels adjusted so as to meet those needs. The registered person should try to ensure that a more generalised customer satisfaction survey is completed with service users, relatives and professionals as part of selfmonitoring. British Home and Hospital for Incurables DS0000032400.V353356.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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 British Home and Hospital for Incurables DS0000032400.V353356.R01.S.doc Version 5.2 Page 34 - 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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