Archived: Branch Hill House

As a part of this inspection we spoke with three people who used the service, observed interactions between other people and staff, a consultant used by the service, the service line manager, three senior staff and two care staff.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed during the visit and what we saw in the records we looked at.

Is the service safe?

Most people required their medicines to be kept for them and given to them by staff. We judged that medicines management had improved significantly since our previous inspection and this was now done safely.

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Is the service effective?

The three people living at the home who spoke with us were happy with their care. We saw positive and polite interactions between staff and people living at the home.

We had found at our previous inspection that information about the care people required was sometimes contradictory and it had not been possible to see from the records whether care was always delivered in line with the care plan. Care plans have since improved and we found that the care needs of people could be matched to the evidence of the care that the staff team were providing to them.

Is the service well lead?

The home had a system to monitor the quality of service provided. At our previous inspection we had found that managers regularly audited the way the service was run, although important actions arising from these audits was not followed up rigorously. The service provider had since implemented a detailed action plan to improve the delivery of safe care and we judged from this inspection that the service had made the improvements that were required to achieve this.

As part of this inspection we spoke with seven people who used the service, three relatives or friends of people living there, nine staff including two duty officers, an assistant manager and the provider's group manager.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed during the visit and what we saw in the records we looked at.

Is the service safe?

The training records we looked at showed that people were cared for by appropriately trained staff.

Most people required their medicines to be kept for them and given to them by staff. We judged that medicines were not managed safely. Medicines were not always given to people in accordance with their prescriptions. The methods for checking the procedures for managing medicines were not sufficiently robust.

Is the service effective?

The people living at the home and the relatives we spoke to were happy with the care provided. Everyone we saw looked well cared for. However we judged that there was insufficient evidence to show that care was effective. Information about the care people required was sometimes contradictory and it was not possible to see from the records whether care was always delivered in line with the care plan.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers and other support staff were respectful and courteous in their communication with people. The relatives we spoke to said that the staff were very good at the home and very helpful.

Is the service responsive?

People's needs had been assessed and care plans drawn up on the basis of these needs, although it was not always clear from the information we reviewed how people or their representatives had been involved in drawing up these plans.

Relatives told us that the home was responsive to issues they raised. One relative described the additional provision staff had suggest for their relative based on their observations of that person's needs.

Is the service well lead?

The home had a system to monitor the quality of service provided. Managers regularly audited the way the service was run, although important actions arising from these audits were not followed up rigorously. Actions taken to improve the delivery of safe care were not always effective and there was evidence that staff were not sufficiently supported to provide the quality of care required.

Following our inspection, the provider sent us a plan of the actions it intended to take in order to meet the requirements of the regulations. On this visit, we spoke with the interim manager and an assistant manager. We looked at people's care records and other records relating to the service. The format of people's care records had been revised and now showed that the people, their relatives or carers were involved in discussions and agreement regarding the care provided. We also saw that there had been an improvement in the standard of recording the activities people took part in.

We saw that staff supervision was regularly taking place and that training in some key areas had been provided. However, there were other areas of staff training that were yet to be addressed by the provider. After the visit we were informed by the provider's service manager that the outstanding training was to be prioritised and would be provided by the end of March 2014.

We judged that the actions of the provider were sufficient to meet the requirements of the regulations.

The atmosphere was calm and relaxed. One person said 'It's lovely here.' Another told us, 'There are things to do every day. I like the music groups.' We saw staff interacting appropriately with people, providing care and support in a friendly and unhurried way. We had concerns regarding the standard of record keeping. There was little evidence that people and their relatives and carers had been involved in reviewing their care plans which meant that people's views may not have been taken into account. Some of the daily records of people's routines and the activities they took part in were either very brief or contained significant gaps which meant it was not possible to accurately know how people had spent their time.

Staff members were generally happy in their work. A number of them told us that the working environment had improved lately. They felt supported by management, but in some cases we found only limited evidence of regular supervision and appraisal. The training records for a number of staff were incomplete which meant that it was not possible to know if staff had received the training they needed to undertake their role.

In view of our findings, we have set three compliance actions.

We visited the home on the 14th February 2013 to check that the provider had made the necessary improvements to meet the standards. We spoke with the home's manager, one of the deputy managers and people using the service. We reviewed the action plan the home had produced after our last inspection and were shown around by the manager. We inspected records relating to seven people living at the home and other records relating to the service. We found that the provider had taken appropriate action and was compliant with Outcomes 1 and 21.

This report is supplemental to our report published in October 2012. In this report we have mentioned the name of a registered manager who was not in post and not managing the regulatory activities at the home at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.