Care Home: Branch Hill

What the care home does well Branch Hill House is a homely environment in an attractive setting. It has a welcoming presence. From speaking with people living with dementia at Branch Hill and discussions with relatives, staff members, a volunteer and a social worker, it was apparent that the home provides very good care and support to the residents and that staff would try their utmost to comply with the wishes of the people that are looked after in the home. It was also apparent that it was high priority for the management and staff team to give the people living there the best lives that they can possibly give. A good referral process was in use. The needs assessments were robust. The personalized care plans showed evidence of regular reviews to meet the changing needs of individuals. A relative with whom we spoke described the home as providing "excellent services". A person living at the service described it as, "warm and welcoming". Various forms of music therapy is extensively used in this home to stimulate and inspire the people living there. Other strategies such as Cognitive Stimulation Therapy (CST) and Dignity Challenge are used to boost and motivate the people living and working at the home. Dignity and respect are key principles that are enshrined in the home`s philosophy of care. Staff demonstrated creativity in using a theatre company to engage the people living and working in the home in the preparation and filming scenes from plays performed by actors from the theatre company. Three people at the home talked about their enjoyment of Casablanca, a production performed by actors supplied by the theatre company. The home continues to have an annual Fete, which is well planned and organized each year. It is generally well attended and supported by people living within the local community and relatives. Essentially, the home conducts its own dementia care mapping periodically with input from an outside organization. This practice enables staff to look at how individual people engage and interact with one another. Further, it enables the staff to explore, develop and improve the way that they support the people living at Branch Hill. The management and the staff are very aware of the importance of equality and diversity issues and this was confirmed by two people from different ethnic and cultural backgrounds. People living at the home were safeguarded and protected by the recruitment process for staff and volunteers. It was good to see the recognition of achievement certificate provided to a care worker at the home for work undertaken over and above their call of duty. The home is to be congratulated for achieving a five star rating from the environmental standard agency, for the standard of hygiene and cleanliness of the kitchen. What has improved since the last inspection? The home has made significant improvement in all aspects of the service. They had increased the number and type of activities at the home. More outings are arranged including more outdoor activities according to individuals` choice. Students from various colleges are used as volunteers. Students from one college organized an activities programme which is said by staff to enable them to interact more with the people living at the service. Students from another college visit the home on Saturdays and involve the residents in arts and crafts. This was described by the manager as "intergeneration". They work more closely with Age Concern to provide befrienders. Staff have now been recruited to fill the vacant posts. What the care home could do better: The management and staff are aware of where improvements need to be made. A recommendation has been made for the Responsible Individual to resume the monthly monitoring visits and to leave a copy of each report in the home for inspection. Key inspection report Care homes for older people Name: Address: Branch Hill Branch Hill Branch Hill House Hampstead London NW3 7LS     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Pearlet Storrod     Date: 2 8 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Branch Hill Branch Hill Branch Hill House Hampstead London NW3 7LS 02077948075 02074311126 anna.okeeffe@camden.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): London Borough of Camden Name of registered manager (if applicable) Ann O`Keeffe Type of registration: Number of places registered: care home 50 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is: 50 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia, over 65 years of age - Code DE(E) Date of last inspection Brief description of the care home Branch Hill House is a care home, which caters for 50 older people within the category of dementia. The home is owned by the London Borough of Camden and is run by the Housing and Adult Social Care directorate of the council. The building is an old country house, which has been extended and adapted to provide accommodation and facilities for service users. It is situated in open parkland and reached through double gates. Parking is available to the front of the home. Accommodation is over three floors both Care Homes for Older People Page 4 of 30 Over 65 50 0 Brief description of the care home in the original part of the building and the new extension. A lift and stairs gives access to the upper floors. Internally the home has been divided into five separate living units. Each unit is self-contained with a sitting-cum-dining area, bedrooms and a kitchenette. There are assisted baths, showers and toilets in each unit. All bedrooms have a wash hand basin and fitted wardrobes. There is a large activity room on the ground floor. In response to the recent legislation regarding smoking, there is a designated smoking room on the first floor. The fee is currently £901 per week. A financial assessment is undertaken for those people who are unable to pay the full charge. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 3 stars. This means that the people who use this service experience excellent quality outcomes. This unannounced key inspection took place on Friday 28 May 2010 between 09.45 and 18.15 hours. A tour of the home was undertaken, and we were able to speak with a number of people living at the service, staff who were on duty, visiting relatives, a visiting social worker, a volunteer, the registered manager and briefly to the Mayor of Camden who visited the home during the inspection. We used the previous key inspection and the annual service review reports and the self assessment document also known as the Annual Quality Assurance Assessment (AQAA), to inform this inspection. We looked at the homes policies and procedures, records, individual files for people Care Homes for Older People Page 6 of 30 living at the home and staff personal files, which we had examined prior to the site visit. The homes registration certificate was appropriately displayed and their insurance certificate was in date. Care Homes for Older People Page 7 of 30 What the care home does well: Branch Hill House is a homely environment in an attractive setting. It has a welcoming presence. From speaking with people living with dementia at Branch Hill and discussions with relatives, staff members, a volunteer and a social worker, it was apparent that the home provides very good care and support to the residents and that staff would try their utmost to comply with the wishes of the people that are looked after in the home. It was also apparent that it was high priority for the management and staff team to give the people living there the best lives that they can possibly give. A good referral process was in use. The needs assessments were robust. The personalized care plans showed evidence of regular reviews to meet the changing needs of individuals. A relative with whom we spoke described the home as providing excellent services. A person living at the service described it as, warm and welcoming. Various forms of music therapy is extensively used in this home to stimulate and inspire the people living there. Other strategies such as Cognitive Stimulation Therapy (CST) and Dignity Challenge are used to boost and motivate the people living and working at the home. Dignity and respect are key principles that are enshrined in the homes philosophy of care. Staff demonstrated creativity in using a theatre company to engage the people living and working in the home in the preparation and filming scenes from plays performed by actors from the theatre company. Three people at the home talked about their enjoyment of Casablanca, a production performed by actors supplied by the theatre company. The home continues to have an annual Fete, which is well planned and organized each year. It is generally well attended and supported by people living within the local community and relatives. Essentially, the home conducts its own dementia care mapping periodically with input from an outside organization. This practice enables staff to look at how individual people engage and interact with one another. Further, it enables the staff to explore, develop and improve the way that they support the people living at Branch Hill. The management and the staff are very aware of the importance of equality and diversity issues and this was confirmed by two people from different ethnic and cultural backgrounds. People living at the home were safeguarded and protected by the recruitment process for staff and volunteers. It was good to see the recognition of achievement certificate provided to a care worker at the home for work undertaken over and above their call of duty. The home is to be congratulated for achieving a five star rating from the environmental standard agency, for the standard of hygiene and cleanliness of the kitchen. Care Homes for Older People Page 8 of 30 What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a clear and consistent assessment process in place. The admission procedure is designed to support people and ensure that peoples needs and aspirations can be met. (Standard 6 does not apply to this service) Evidence: The aim of the home is to meet the assessed needs of individuals living with dementia, in such a way as to ensure maximum quality of life for the individuals. We looked at the assessments of needs for five people living at the home. From discussion with the homes manager and as outlined in the self-assessment document, the home insists on receiving a copy of individuals needs assessments and care plans prior to admission to the home. Each person had a needs assessment that was robust before admission. The assessment process focused on achieving positive outcomes for the people living at the home. The ethnicity and diversity needs of individual people are included in all areas like religion, culture, social, disability. Peoples cultural, ethnicity and religious needs were generally well documented and implemented. Those who Care Homes for Older People Page 11 of 30 Evidence: wish to attend church services are encouraged and supported to do so either with staff escorting them to the local church or via a taxi for those with mobility problems. The home provides appropriate support to people moving in. They recognize that a change within an individuals environment could be difficult and stressful for people diagnosed with dementia. Prospective people who use services are encouraged to visit. A member of staff supports the individual to make them feel welcomed and comfortable. A person living at the home with whom we spoke mentioned this. The self- assessment indicated that all residents admitted in the last 12 months had viewed the home prior to admission. This was not always the case previously, as some individuals were admitted directly from hospital. There was evidence of continuous review and monitoring. At six weeks a holistic review with the individual, staff and social worker occurs. The individuals relative and or advocate are encouraged to attend with the expressed consent of the person. The review is to check to see how the individual feels about the placement and whether they want to continue living at the care home. The manager, assistant managers and the majority of the care staff have received training on Deprivation of Liberty Safeguards. The manager asserted that such training was essential in the admissions process, so that any pertinent issue could be identified and appropriate action taken where necessary. Everyone living at the home had an individual service contract, which included details of their placement. The documents observed were signed by the individual themself or a next of kin where the individual lacked capacity. A person told us in discussion, they look after me very well, I should show my appreciation. Another person commented, This is a happy home. In another unit an individual said, I like my key worker. A care manager who visited the home to complete the admission process with an individual said, Branch Hill is a happy home. A brief discussion occurred between the care manager and the homes manager regarding the fact that the person moving in had brought no personal belongings with them. The manager was concerned about a change of clothing for the individual as well as other essential provisions such as under garments and toiletries. The care Care Homes for Older People Page 12 of 30 Evidence: manager agreed to visit the individuals home without delay to collect some of his clothes. Care Homes for Older People Page 13 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is continuous assessment, care planning and review, which makes sure that the personal and healthcare needs of people living in the home were met. Evidence: We looked at a person centred plan for an individual in each unit. The care plans are person centred and included medical conditions, hospital admissions and details of each persons individual needs. The plans also reflected the promotion of independence, choice, privacy and dignity. They were outcome focused and showed that regular reviews were undertaken. The manager stated during discussion that they had made good progress in developing the personalized plans and that assistant managers were continually monitoring these areas to ensure that a consistent approach to delivering care and support to a high standard was maintained. We case tracked three people and we were satisfied that the individuals health and personal care needs were being met. It was evident that health care professionals such as the General Practitioner (GP) and district nurses were involved. Individuals have their health and personal care needs managed according to their needs and Care Homes for Older People Page 14 of 30 Evidence: wishes. The care records also showed referrals to and the involvement of other health care professionals and there was evidence of referrals made to the Community Nursing Team. Entries in care records showed clear evidence of collaborative care with interventions from occupational therapist, physiotherapist, chiropodist and dietician. Dental and optical needs were also included. Discussions with staff showed that they had a lot of knowledge about the people to whom they provide support and services. Any changes in the wellbeing and physical health of individuals were recorded and passed on to the duty officer to appropriately deal with. The previous key inspection report revealed that individuals life histories were limited on the records held. We observed an improvement in this area from the information available on the files that we looked at. Robust risk assessments were available and used alongside the personalized plans. The home is going through the accreditation process in relation to the Gold Standard Framework in Care Homes. Two staff members had enrolled in the End of Life care programme. The manager spoke passionately about caring for people living with dementia and she explained that they conduct dementia care mapping within the home themselves with input from an outside organization. They use the information gathered to improve the quality of care and support provided to people using the service in areas of communication, engagement, interaction and such like. She further reported that training in this regard had helped to develop, prioritise and record future care planning for people entering the home. We conducted an audit of medication in two of the five units and the records observed were found to be accurate and up-to-date. Examination of the medication policy and procedure and discussion with the manager and a staff member reflected sound management of the medication. All staff responsible for the administration of medication had the relevant training. Observation at the inspection, discussion with staff, feedback from people using the service and from examination of care records confirmed that staff respected the privacy and dignity of the people they look after. The self assessment told us that the manager of the home and the head of the Councils residential services have been registered as Dignity Champions. To this end, the manager had responsibility for the programme on dignity in the home. This entailed raising awareness on how staff interacts with individual people using the service, and it took into account how individual family members focused on dignity with their relatives. There are ten points associated with the Dignity Challenge, as observed from the chart on the staff notice board within the ground floor office. The manager affirmed that they test and monitor staff awareness, understanding and knowledge during staff meetings, supervision and Care Homes for Older People Page 15 of 30 Evidence: appraisals to see whether the home is meeting the key objectives outlined in the homes Statement of Purpose. Care Homes for Older People Page 16 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the service find the lifestyle they experience suits their expectations and preferences. They are ensured that their social, cultural, religious and recreational interests and needs are met. Contact with family, friends and the wider community is positively encouraged and people are helped to exercise choice and control over their lives. Meal times are social occasions that afford interaction and stimulation for people living at the home. Evidence: From discussions with people using the service and visiting relatives, it was evident that people living at the home were involved in activities of daily living. It was apparent that residents moved between the floors into different communal areas and participated in activities of their choice if they chose to do so. Some individuals continued to attend day centres and luncheon club facilities as they did previously when they lived in their own homes. It was pleasing to see people living with dementia either engaged in various activities of interaction with staff, each other or doing things according to their wishes. A person centred approach to the delivery of care and support services was apparent, routines, activities and plans were resident focused, regularly reviewed and could be Care Homes for Older People Page 17 of 30 Evidence: easily changed to meet an individuals changing needs, choices and wishes. A theatre company is involved in putting on performances in the home. People living in the home and staff are encouraged and supported to participate. These occur monthly and the home was preparing to shoot the performance of South Pacific in June. Two people told us that they looked forward to these. The manager said that she previously had mixed views about the involvement of a film crew but that after the first event, it became easier and that the staff and residents looked forward to filming the next show. The home uses a range of therapeutic techniques for example, music therapy, music and movement, music appreciation, massage, bingo and other activities, reminiscence and such like. Staff assist and support people to engage and interact with the activities with input from Kingsway College of Adult Education Colleges. A pianist from Kingsway College was entertaining residents, staff and visitors during the inspection. A male resident played his mouth organ and joined in the sing a long that was taking place. He played a couple of tunes independently which most people seemed to enjoy. Although not everyone attended the session, the number of people that participated was nonetheless very good. It was clear that such entertainment acted as a stimulus for the people living at Branch Hill. In addition, students from Lakefield College provided a variety of activities at the home for people living at Branch Hill, such as arts and crafts as well as dancing to Spanish and Latin music, as reflected in the self assessment document. The home also participated in a study referred to as Cognitive Stimulation Therapy (CST), which focused on providing stimulation to people living with dementia. The emphasis is to show that people with mild dementia can be kept mentally well for longer with the use of (CST) as part of their care. Furthermore, they took part in the National Association for Providers of Activities (NAPA) - Breadth of Fresh Air campaign and the manager confirmed that this had motivated them to use more outdoor activities. The annual service review carried out in January 2010 indicated that staff and people living at the home had asked for more outings. More outdoor activities were introduced as a result. For example, some people go to the local pub, trips to the park for a picnic, escorts to Swiss Cottage library where people meet and listen to authors reading from new books and escorted to the local church and such like. An annual fete is arranged each year which staff had begun to think about. This event is generally well attending by people from the local community, friends and relatives. People are encouraged and supported to maintain relationships with their friends and family members. We spoke to two family members who visited their relative during Care Homes for Older People Page 18 of 30 Evidence: the inspection. They spoke positively about the care and support delivered to their relative. The home has a good relationship with Age Concern who supplies volunteers who act as befrienders to people living at the home who do not have visitors. A volunteer said the following, There is always a good atmosphere and the staff work hard and you can tell the difference when an agency staff is working, the unit is quieter as there was not as much involvement with the residents. This was an observation on one unit where an agency staff worked. There was no obvious concern except that engagement with individual people was minimal. There was a distinct difference noted in the atmosphere within the unit when the permanent staff took over, probably because of staff familiarity with the people that they look after on a more regular basis. People are given the opportunity to choose what they want to eat and mealtimes are social occasions where people talk with each other during their meals. The meals are nutritious and well balanced. Three people with whom we spoke praised the food. The chef/cook ensures that all meat is bought and cooked for an individual on a halal diet. One person of Iranian descent reported that they were supported and encouraged to participate in activities and cultural festivities. Another person with a different cultural background confirmed this to be the case. One other person said, I enjoyed Eid very well. This individual also commented on the food stating, the food is very good, we are given a choice of what to eat. Care Homes for Older People Page 19 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints and concerns are listened to, taken seriously and acted upon. People using the service are protected from abuse through staff training, the ethos and practices within the home. People can feel safe and protected. Evidence: A clear and robust complaints procedure was in place. A more suitable format, designed for people living with dementia, was available in the home. The people with whom we spoke confirmed that they had a copy of the complaint leaflet and they knew who they should speak to if they were unhappy. People living at the home can air their views with their key workers or at house meetings or with volunteers, relatives or to an advocate or representative. Our findings showed that people living in the home felt that staff did listen to their views and acted on them accordingly. People living in the home are able to access advocacy support from Camden and Islington Independent Mental Capacity Advocacy (IMCA) service or from Age Concern for some people who do not have any visitors or social contacts. From discussions with people using the service, relatives and a volunteer it was clear that people felt comfortable to make a complaint to the manager and her staff if the need arose. A volunteer with whom we spoke said, I live in Kentish Town one of the Councils other residential home. I had a friend who lived at Branch Hill and I liked visiting them, so I continue to come. If I saw any bad treatment or if someone told me something and I was concerned about what they said, I would talk to the manager Care Homes for Older People Page 20 of 30 Evidence: about it. The relatives that we spoke with commented positively about the services provided at the home and they expressed no concerns. They said, We are very pleased about the way in which the home looks after .... their named relative, we have no complaints. The self-assessment referred to one formal complaint received since the last key inspection in September 2008. The complaint log showed appropriate action taken and satisfactory outcome reached. The manager and a staff member asserted that any concerns raised are dealt with by the manager and staff immediately so that nothing becomes a major concern or complaint. The home has robust policies and procedures on adult protection and whistle blowing. These are integral to the staff induction process and all staff receives training on the safeguarding of adults and the necessary procedures. This training was on going. We looked at the Regulation 37 notifications sent to us since the last key inspection and we were satisfied with the actions taken in such matters. The home has a register for recording falls that occur within the home. They use the register to look at any common issues with a view to implementing preventive measures. The manager asserted that this system was working well and that they have seen a reduction in the number of falls in the home. A cross-reference check of the Regulation 37 notifications showed a reduction in relation to the number of falls happening in the home. If a staff member did not record an incident, the manager confirmed that she would send the matter for investigation to the safeguarding team. Care Homes for Older People Page 21 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in an attractive home that is clean and well maintained. Evidence: A tour of the home was undertaken. The home is accessible to people with mobility problems. People living at Branch Hill resides in a safe, attractive and well-maintained environment, which was clean and hygienic. Residents were encouraged to see the home as their own. There is a selection of communal areas, which enables people to choose where to sit, meet with family or be actively engaged with other people in the home. The people living there were encouraged to personalize their rooms with small items of furniture like an armchair and their personal possessions such as ornaments, photographs and such like. Staff receive training in respect to health and safety and in particular the prevention of cross-infection. Domestic staff are employed to ensure that the home is kept to high standards of cleanliness at all times. The kitchen was given a rating of 5 stars at the annual health inspection, this was evident from the certificate displayed in the home. It is praiseworthy to mention that a member a domestic staff was put forward for recognition from the Council for doing work over and above their call of duty. The individual was awarded a certificate which took pride of place on a wall in the office. We looked into the room of two individuals with their permissions and agreed with the Care Homes for Older People Page 22 of 30 Evidence: information in the self assessment, that the bedrooms were personalized according to individuals choice and desires. The home was in good decorative order with an abundance of fresh flowers in different communal areas. The Mayor of Camden also visited the home and brought with him a large bouquet of flowers, which the manager placed on the grand piano in the lounge. Gardeners were attending to the garden to the front of the home. The manager reported that the potted plants on the balcony would be attended to after the front garden was completed. The standard of the environment within this home was good providing the people using the service with an attractive and homely place to live. Care Homes for Older People Page 23 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported by suitably qualified staff. Staff are trained and competent. People living at the home are protected by the recruitment policy and practices Evidence: From viewing staff files, training records, talking to people living at the service, relatives and a volunteer, it was apparent that the majority of the staff at Branch Hill were skilled and competent to carry out their jobs. This service has a history of a sound and robust recruitment and selection process. The staff files that we looked at showed that all the necessary checks had been appropriately conducted. The standards were met in relation to the Criminal Records Bureau (CRB), satisfactory references, health checks and ID confirmation and work permits where needed. Information in respect to volunteers associated with the home have to supply satisfactory references and were required to undergo checks in respect to the Criminal Records Bureau. The staff group is well balanced which enables the home to provide people using the service to have the choice of same gender care. This was confirmed by the manager who said that she had recently changed a keyworker for a resident because the client wanted a female keyworker. Care Homes for Older People Page 24 of 30 Evidence: The annual service review mentioned that the home had a number of vacant posts due to retirement and the resignation of some staff. The manager confirmed that they had now successfully recruited to all the vacant posts and were waiting for CRB clearance. The home was reliant on the use of agency staff. They used the same agency staff to ensure consistency and continuity of care in service delivery. There was sufficient staff on duty to meet the assessed needs of the people using the service. Discussions held with staff showed that they had a good understanding of the support needs of the people to whom they deliver care and support services. This was apparent from the positive relationships, which have been formed between the staff and the people living in the home, as observed. Training programmes have been developed to ensure that staff have the necessary skills to meet the needs of the people living at the home with dementia. Most of the staff have received training in dementia care. A dementia care certificate was evident in two of the staff files that we looked at. All senior staff have NVQ 3 and a high percentage of care staff have NVQ 2. All staff undergo a thorough induction. Staff had undertake training in relation to the Deprivation of Liberty Safeguards and a member of staff with whom we spoke, gave an example of how an individual might be deprived of their liberty. Discussions with two staff members and an agency staff confirmed that they felt supported. They further said that they found the management team approachable and accessible. Care Homes for Older People Page 25 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes manager has a proactive approach to making a person centred home. The home is being managed for the benefit of the people living there. Evidence: The home has a history of stable management. The manager has been registered by the Commission, and is very experienced and highly competent to run the home and meet its stated aims and objectives. The manager has support from the senior staff in providing clear leadership throughout the home with all staff demonstrating an awareness of their roles and responsibilities. The manager has a good understanding of the areas in which the home needs to improve. Planning was in place in the form of an action plan with expected outcomes and timescales for compliance. The manger was able to demonstrate improvements made within the service since the previous key inspection and along with the areas of continuous development within the service. Information received from the reviews within the home and the annual surveys conducted by the local authority, are included Care Homes for Older People Page 26 of 30 Evidence: within the action plan. Within the last year, the home has been very proactive in getting involved in a number of projects. Their participation in campaigns such as NAPAS - Breadth of Fresh Air and the Dignity Challenge has enabled the home to increase the number of activities that are meaningful to their clients. The home operates in a non-discriminatory manner. There is a multi cultural group of people living and working there, some of whom speak different languages. This enriches the home and enables appropriate matching of staff and residents. There was evidence to demonstrate that the Responsible Individual had not conducted the monthly monitoring visits each month. The last recorded visit was robust and it covered all the relevant points associated with care practices and general conduct of the home. Despite this, there was no evidence to indicate that the quality of the services offered to people living at the home had been affected. A recommendation has been regarding this. The self assessment revealed that there were effective policies and procedures in place on handling the monies and valuables belonging to people who live in the home. Records are available of any personal allowances managed by the home with a clear audit trail. There were no health and safety issues identified at this inspection. The home has a health and safety policy and staff undertake appropriate health and safety training. Equipment is serviced and maintained regularly and the records kept reflected this. Gas and other relevant health and safety checks such as testing of the fire alarms and servicing of equipment were looked at and found to be in good order. The judgments in the preceding sections of this report have contributed to the judgment in this outcome area. The inspection found that the home is providing excellent quality services to the people living there. Care Homes for Older People Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 33 The provider should ensure that regular monthly monitoring visits are resumed and takes place each month. A copy of the report should be available for inspection. Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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