Care Home: The Branches

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What the care home does well This home is well managed and the staff, manager and owner are friendly, welcoming and provide a good level of care. They know and understand the needs of each person living here well. Equal opportunities are promoted. Before a person moves here, the manager makes sure that The Branches is a suitable place to live and receive care. She does this by getting a copy of their Social Worker`s assessment and also by completing her own assessment before they move in.The staff also make sure that everyone who lives here is treated with dignity and respect. There is good contact maintained with family and friends and relatives are able to visit anytime. Mealtimes are pleasant and everyone we spoke to commented positively about the food on offer. There is an alternative choice of main meal and pudding if people do not want what is on the menu for that day. Mealtime are flexible, particularly at breakfast time. The building is set within its own grounds. The front of the home adjoins a local park and is surrounded by mature trees. The bedrooms at the front and along one side of the home overlook these grounds Staff receive training on topics relevant to people`s needs, such as moving and handling and dementia care awareness. Staff are also to undertake medication training. This is so they are up to date with current good practice. What has improved since the last inspection? What the care home could do better: CARE HOMES FOR OLDER PEOPLE The Branches Springwell Road Jarrow Tyne And Wear NE32 5TQ Lead Inspector Lee Bennett Key Unannounced Inspection 10:00 10th July 2008 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Branches DS0000000244.V368565.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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Branches DS0000000244.V368565.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Branches Address Springwell Road Jarrow Tyne And Wear NE32 5TQ 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) 0191 489 1208 0191 489 1208 Mr Abdul Majeed Khan Mrs Eileen Cromar Care Home 24 Category(ies) of Dementia (6), Dementia - over 65 years of age registration, with number (6), Old age, not falling within any other of places category (24) The Branches DS0000000244.V368565.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No more than 6 service users within the DE and DE(E) categories can be admitted at any one time. 15th August 2007 Date of last inspection Brief Description of the Service: The home is registered for 24 places and currently provides service for 2 people under 65 with dementia and 4 people over 65 with dementia. The home is not registered to provide nursing or intermediate care. The Branches is a large established property that has been converted into a care home, offering personal care for up to 24 older people. The home is located in a central position close to local amenities, with the added benefit of a large garden area that offers seclusion and privacy. All bedrooms are single rooms situated on two floors, and there are toilets and bathrooms situated throughout the building. There are no en-suite toilet facilities in the home. The living areas are spacious and present a homely atmosphere, and there are ample car parking spaces to facilitate easy access. There is a large well maintained garden to the front of home overlooking the Springwell Park. The home has a friendly comfortable environment and the weekly fees are £355:00 to £365:00 per week depending upon care needs. Additional charges are made for hairdressing, personal items and newspapers. The Branches DS0000000244.V368565.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 2 stars. This means the people who use this service experience good quality outcomes. Before the visit: We looked at: • Information we have received since the last visit in August 2007. • How the service dealt with any complaints & concerns since the last visit. • Any changes to how the home is run. • The provider’s view of how well they care for people. • The views of people who use the service & their relatives, staff & other professionals. The Visit: An unannounced visit was made on the 10th July 2008. During the visit we: • Talked with people who use the service, staff and the manager. • Observed life in the home. • Looked at information about the people who use the service & how well their needs are met. • Looked at other records, which must be kept. • Checked that staff had the knowledge, skills & training to meet the needs of the people they care for. • Looked around parts of the building to make sure it was clean, safe & comfortable. • Checked what improvements had been made since the last visit. After the visit: We told the manager what we had found. What the service does well: This home is well managed and the staff, manager and owner are friendly, welcoming and provide a good level of care. They know and understand the needs of each person living here well. Equal opportunities are promoted. Before a person moves here, the manager makes sure that The Branches is a suitable place to live and receive care. She does this by getting a copy of their Social Worker’s assessment and also by completing her own assessment before they move in. The Branches DS0000000244.V368565.R01.S.doc Version 5.2 Page 6 The staff also make sure that everyone who lives here is treated with dignity and respect. There is good contact maintained with family and friends and relatives are able to visit anytime. Mealtimes are pleasant and everyone we spoke to commented positively about the food on offer. There is an alternative choice of main meal and pudding if people do not want what is on the menu for that day. Mealtime are flexible, particularly at breakfast time. The building is set within its own grounds. The front of the home adjoins a local park and is surrounded by mature trees. The bedrooms at the front and along one side of the home overlook these grounds Staff receive training on topics relevant to people’s needs, such as moving and handling and dementia care awareness. Staff are also to undertake medication training. This is so they are up to date with current good practice. 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. The Branches DS0000000244.V368565.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Branches DS0000000244.V368565.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3. (Standard 6 does not apply). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s needs are assessed to a good level before moving here. By obtaining information about a person’s needs, everyone concerned can be confident that The Branches is a suitable place to live. EVIDENCE: Before a person moves to a care home they are entitled to have an assessment of their needs carried out, either by social services or a health care worker, such as a nurse assessor. Even when a person pays for their own care, they are still entitled to such an assessment. Most people moving here have their care arranged by Social Services, and some became aware of the home through recommendations from friends. As the people living here told us: • “The Social Worker told me about it.” DS0000000244.V368565.R01.S.doc Version 5.2 Page 9 The Branches • • “I visited it and I liked it.” “I found out about it from friends.” The manager of a care home must also obtain information about those people who would like to come here. This will include a copy of the assessment, and a summary care plan, which explains how each person’s needs are to be addressed. This is to make sure their needs are looked at and then can be properly met. For two people who had most recently moved here a social worker helped to arrange their admission. The manager had obtained an assessment and a care plan for both. Based on this information a plan of care was then developed. The manager also carried out her own detailed assessments after each person’s admission. The areas looked at included social interests and needs, diet and food preferences, and any help needed in getting around. The Branches DS0000000244.V368565.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living here receive the right level of care and support to meet their health and personal care in a well-planned way. EVIDENCE: To help guide the practice of staff, after a person has been admitted here a plan of care is written up. This is so that important areas of need, such as those around personal care, diet and social interests, can be clearly identified, and the support that staff are to provide is clearly explained. Everyone living here has a care plan file in place, and for the people whose files looked at these were clear and contained information relevant to the needs observed, or that had been assessed by the social worker. Where people do have medical needs, evidence is kept of appointments attended and other visits by healthcare professionals. This can help ensure people’s health needs are regularly monitored and met, and proper advice and The Branches DS0000000244.V368565.R01.S.doc Version 5.2 Page 11 intervention sought. Furthermore, where personal care is needed this is written down in a care plan. During the inspection, there were no instances where personal care was carried out in the public areas of the home. Staff will knock on doors before entering bedrooms, and always close doors behind them when they are providing help and personal care for people. This shows that staff are conscious of people’s privacy and dignity. The support offered by staff was carried out in a friendly, and pleasant manner. The people we spoke to told us that they (or their relative) are cared for in a good manner. Comments included: • • • “It’s the best going.” “The staff are nice here.” “They (the staff here) brought my mother around. Without them we’d have lost her.” A common area where staff help people with their health care is in the way medicines are administered. The majority of people here have all of their medicines looked after for them. To keep them safe, medicines are stored in a secure way, but the room where they are kept needs some attention to improve security further. When staff administer medication they tell the person concerned what medication they are receiving, and also follow good hygiene practices. On the whole there are clear records kept of the medicines administered by staff. The stocks held for one medicine had no clear stock balance record. Therefore we couldn’t tell if the stock held was correct. Records and stock balances were correct for the five other stocks of medicines that we looked at. On the whole, medicine records are accurate, and the reasons for medicines being missed is clearly recorded. To help ensure staff are aware of the importance of good record keeping, along with other aspects of medication management, most have attended accredited training on this topic. Those who haven’t are to attend this training in the near future. The Branches DS0000000244.V368565.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are a small range of social activities here, and more could be provided to offer people regular opportunities to have an interesting and stimulating time. Visitors are able to freely call, and people are offered and receive a varied, wholesome and nutritious diet and this helps to promote their wellbeing. EVIDENCE: There is no Activities Co-ordinator employed here, and the activities that are currently offered are organised by the care staff for an hour each day. Recent recorded activities included one lady visiting the local hairdressers every week, ball games, bingo, quizzes and sing-a-longs. The library visits every two months. Whilst talking to the people living here about activities in the home, comments they made included: • Yes, the library comes round. I read a lot, and like romances.” DS0000000244.V368565.R01.S.doc Version 5.2 Page 13 The Branches • • The gardens are lovely. I like to sit outside when the weather’s nice.” “There’s just the TV and sometimes bingo.” On the day of the visit, some service users were spending time in their bedrooms and other service users were sitting in lounges watching the TV or reading. One person when out with the support of a privately paid care agency. The manager told us about a show that some of the people living here went to see recently. She informed us that often service users do not want to take part in activities, nevertheless, we informed here about some useful resources and places to look for more ideas, such as those from Counsel and Care and the National Association of Providers of Activities (NAPA). There are no restrictions on visitors to the home and people spoken to during the visit were complimentary about the home and the staff team. During the visit, a meal was taken with some of the people living here. The quality of the food is good and people are offered a set meal, with an alternative offered for those who do not want what is on the menu. The people living here are given help and support in a dignified and respectful way and they are given the time to enjoy their meal without being hurried. They are also asked if they want second helpings of food. Breakfast time is flexible, being available from 8am until 11am for all, regardless of the help and support that may be require from staff. The Branches DS0000000244.V368565.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. Quality in this area is good. This judgement has been made using available evidence including a visit to this service. There are suitable arrangements in place here to protect people form abuse, and this enables people to make their views heard, and to raise any concerns or complaints they have. EVIDENCE: A complaints procedure is available within the home, and informs service users that they can contact the Commission if they wish regarding complaints. A record of complaints and suggestions is maintained. Each complaint is now documented by the registered manager. The outcome and action taken is clear. No complaints have been referred to the Commission since the last inspection. Staff have received training from the local Adult Protection Co-ordinator in the past. This was to help explain the role of adult protection, and to offer guidance to staff. The care provider has adult protection procedures, which are available in the home, should staff need guidance in this area. The local authority’s procedures are also available. The Branches DS0000000244.V368565.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is clean, comfortable and generally kept safe. EVIDENCE: The Branches is a large converted building offering comfortable accommodation in a homely setting surrounded by well maintained gardens. There are a variety of communal areas that gives service users some choice where they prefer to spend their time. As the house is an older converted building, bedrooms are not uniform and are decorated individually. None have en-suite toilets or showers, but bathrooms and toilets are located a various places throughout the home. Those people living here can bring with them some items of furniture from home and rooms displayed family photographs and personal possessions. The Branches DS0000000244.V368565.R01.S.doc Version 5.2 Page 16 Some improvements have been made to the home, including some redecoration and the laying of some new carpets. As ongoing decoration and refurbishment takes place consideration needs to continue to be given to the needs of people with dementia. There are now several good publications and sources of advice on this. All staff employed by the home receive ‘Infection Control’ training as part of their induction programme. Domestic staff keep the home at a good standard of cleanliness and free from odours. Where new wardrobes have been bought these have yet to be secured to the wall to help prevent them being accidentally pulled over. Some first floor windows also need to have restrictors fitted, and the practice of wedging open bedroom doors must cease, as this can put people at serious risk in the event of a fire. All of the bedrooms have exposed radiators and pipe-work. Surface temperatures could not be checked as the central heating was turned off. A risk assessment indicates that these have safe surface temperatures (43oC or below). All bath’s checked have safe water temperatures (around 43oC). The Branches DS0000000244.V368565.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28 and 29. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff working here are safely recruited, appropriately trained, qualified and competent. This can help make sure the people living here are protected and receive the care they need. EVIDENCE: Before staff start working here they have to undergo a series of checks. This is to ensure they have the right skills, experience and approach for the job. There are also checks carried out to help make sure they are physically fit for the work they have to do, and do not have a criminal history that would make them unsuitable to work here. Since the last inspection was carried out here five staff have been employed. Suitable pre-employment checks, including the receipt of a Criminal Record Bureau Disclosure and two references have been obtained for all but one before they started duty. The standard application also asks for an explanation of any gaps in a persons’ employment history to help the manager get a good impression of a persons skills and experience. Once employed, staff have to receive regular training. This is to make sure they remain up to date with the requirements of their job, and with current good practice. The staff here initially attend induction training if they are new to care work, and will also receive staged induction training specific to this The Branches DS0000000244.V368565.R01.S.doc Version 5.2 Page 18 home. Following this they will also be offered periodic training opportunities. Occasionally staff development is further enhanced by topics being discussed at team meetings. Staff also receive dementia awareness training. Furthermore, those not already qualified will be supported to attain a vocational qualification in care. All but one of the staff here have achieved such an award, at NVQ level 2 or higher. The Branches DS0000000244.V368565.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people here benefit from living in a well managed home. This can help make sure their views are sought and acknowledged, and that their health and safety is promoted. EVIDENCE: The manager has been employed here since 1991, and registered as the manager since 1995. She therefore has many years experience at a senior level. She has attained relevant care and management qualifications including the NVQ level 4 award in Care and the Registered Managers Award. She has also undertaken periodic training to ensure that her knowledge is kept up-todate. The Branches DS0000000244.V368565.R01.S.doc Version 5.2 Page 20 The manager is supervised by the homes owner, who works here on a regular basis. There are clear lines of accountability. Part of her role is to ensure that important records, such as those relating to care planning, medicines, service user’s money, and so on, are maintained. The records kept at the home, were up to date, detailed, and held in a safe and secure manner. Financial records are clear, and balance with the monies held. The manager is also responsible for checking the quality of care and safety aspects of the operation of the service. In respect of health and safety, the home is largely free of hazards to the safety of service users and staff, however see the comments in the ‘Environment’ section. There are risk assessments undertaken by an independent consultant to check that working practices and As for quality checking, the manager has yet to develop and implement a system for looking at the standard of service here. There are pieces of work that she does that can contribute to this, such as holding periodic meetings, completing the Annual Quality Assurance Assessment document for us, and formally supervising her staff. However, these elements, and other ways of seeking the views of the people living here, need to be brought together, and an action plan completed to ensure quality continues to get better. The Branches DS0000000244.V368565.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 The Branches DS0000000244.V368565.R01.S.doc Version 5.2 Page 22 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 OP12 Regulation 16 Requirement The activities must be improved to provide variety and to suit service users preferences. The previous action plan date for this requirement was 01/12/07. 2. OP26 13(4)(a) Hazards present around the building, including unsecured wardrobes, missing window restrictors and wedged fire doors must be addressed to ensure service users and staff remain safe. This is a new requirement. The home must have a quality assurance system implemented to measure success of the service. The previous action plan date for this requirement was 01/12/07. All care staff must receive at least six supervision sessions per year and appropriate records kept DS0000000244.V368565.R01.S.doc Timescale for action 01/10/08 01/10/08 3. OP33 24 01/10/08 4. OP36 18 01/10/08 The Branches Version 5.2 Page 23 The previous action plan date for this requirement was 01/12/07. 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 OP29 Good Practice Recommendations The Manager should consider having an interview panel of at least two people The Branches DS0000000244.V368565.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 The Branches DS0000000244.V368565.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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