Inspection on 16/05/06 for Britannia Care Home

This inspection was carried out on 16th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Britannia Care Home 03/07/08

Britannia Care Home 30/08/07

Britannia Care Home 23/01/07

Britannia Care Home 10/01/06

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

CARE HOMES FOR OLDER PEOPLE Britannia Care Home 4 Thorn Street Girlington Road Bradford BD8 9NU Lead Inspector Sean Cassidy Key Unannounced Inspection 16 May 2006 09:30 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 Britannia Care Home DS0000061941.V292011.R01.S.doc Version 5.1 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. Britannia Care Home DS0000061941.V292011.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Britannia Care Home Address 4 Thorn Street Girlington Road Bradford BD8 9NU 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) 01274 770405 Girlington Nursing Home Ltd Ms Shaheen Kauser Care Home 25 Category(ies) of Dementia - over 65 years of age (25) registration, with number of places Britannia Care Home DS0000061941.V292011.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th January 2006 Brief Description of the Service: Britannia Care Home is situated in the Girlington area of Bradford, which is approximately 1 mile from the city centre. The home is located in a multicultural area and the home provides a service for a wide range of multicultural service users including Older People and Younger Adults. There is a very good range of facilities located close to the home including shops, public houses, churches and mosques. The home is well served by public transport. The premises are purpose built with accommodation provided on 3 floors. There are both single and double bedrooms available with a shaft lift linking all floors. There is a ramp to the front of the building, which provides good disabled access. The provider provided the CSCI with information regarding the home in the Pre Inspection Questionnaire. Other information was provided on request. The fees charged by the home range from £318.15 to £477.47 per week. The provider indicated that there were no additional charges made to residents. Britannia Care Home DS0000061941.V292011.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by two inspectors and lasted two days. The lead inspector was provided with information prior to the site visit. Questionnaires were sent to other Health Professionals that visit the service and questionnaires were given to residents and relatives on the day. Four residents were case tracked as part of the inspection. Other resident files were inspected along with a significant number of other documents relating to the care home. What the service does well: What has improved since the last inspection? There is now a more consistent management system in place compared to the previous inspection. The provider has now developed a training programme to ensure staff receive training in areas such as Manual Handling, Fire training and COSSH training. The manager has attempted to make improvements with the care planning documentation. Britannia Care Home DS0000061941.V292011.R01.S.doc Version 5.1 Page 6 What they could do better: The home must improve the systems for ensuring existing and prospective residents are informed of the services that are on offer. The aims and objectives of the home are not set out in a way that meets the standards. The shortfall hinders prospective residents from being able to make informed choices. The specialist dementia needs, cultural and religious needs are not properly provided for by the home and major improvements are needed to meet the standards in this area will be met. Although the manager has attempted to improve the assessment and care provision for residents, much improvement is still needed. Residents are not appropriately assessed and care plans are not provided for all care needs. Particular attention must be paid to risk assessment of residents in areas such as pressure care, falls, nutrition and moving and handling. The registered nurses must be more aware of their professional accountability in the above areas and also with the appropriate administration and storage of medications. Improved medication systems and processes must be developed to properly protect the residents. Issues have been identified with regards to resident privacy and dignity. Improved carer understanding of these personal needs is essential. Major improvements are needed to ensure the residents’ social, cultural recreational and occupational needs are provided for. The Statement of Purpose must highlight how the home provides for these needs. Residents were able to highlight the lack of provision in these areas. Improvements are needed in the areas of autonomy and choice. Both inspectors identified this lack of resident involvement in decisions about how their life is run. This is particularly relevant to the provision of meals in the home. The menus show little variation from week to week. Resident feedback highlighted that there were foods they would like to have but are not provided. Improvements are needed in the areas of complaints and protection. Some residents spoken to felt they are not properly enabled to complain. There was a feeling that complaints were not listened to and therefore they felt that it was not a productive process. Improvements are needed with the way in which complaints are recorded. The complaints procedure needs to be written in other languages and formats so that all residents and their relatives are aware of how to make a complaint if they so wish. Appropriate training must be provided to all staff in Adult Protection and there should be a good understanding and awareness of this area. The whole environment of the home must be properly audited and improvements made to ensure the environmental standards will be met. The environment does not always meet the residents’ needs and does not have a maintenance programme in place. A number of the fixtures and fittings need replacing and the décor requires upgrading. Britannia Care Home DS0000061941.V292011.R01.S.doc Version 5.1 Page 7 The service does not support or encourage the development of a competent staff team in key areas. Training provided is very limited, with areas not being identified and not targeted at relevant individuals. Training provided tends to be internal, with a lack of willingness to seek external providers to deliver priority specialist training. The service has a poor recruitment procedure with shortfalls in recording and the process. Residents are never involved in the recruitment of staff. The manager of the home has only basic management skills and minimal experience to run a home. Training, development and supervision of staff is inconsistent. The manager does not understand strategic planning and review. Policies and procedures are not reviewed or kept up to date. Residents’ interests are not safeguarded as evidenced by poor record keeping. This has lead in some circumstances to putting service users at risk, for example by not appropriately assessing residents and providing care plans to meet their needs. Quality assurance monitoring is not regarded or implemented as a core management tool. Other professionals have identified concerns regarding the care provision within the home, which ultimately reflects on the manager. The home has not produced any clear health and safety policy or training programme and there is a significant level of risk to residents through health and safety non-compliance. Many of the records needed to ensure residents are appropriately protected were not in place. Health and safety concerns and poor management mean that residents are not adequately protected or safe. 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. Britannia Care Home DS0000061941.V292011.R01.S.doc Version 5.1 Page 8 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 Britannia Care Home DS0000061941.V292011.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 Existing residents, prospective residents and their representatives are not provided with suitable information to assist them to make informed choices about the home. The staff group do not presently have the knowledge, skills or experience to meet the care needs of the residents. EVIDENCE: The Statement of Purpose does not contain sufficient information needed to ensure prospective residents and their representatives are enabled to make an informed choice about moving into the home. The Service User Guide has not yet been developed. Discussions were held with the manager and provider and advice was given to assist in the development of both these documents. The majority of residents living at the home are from an Asian background but they are not provided with any written information in a language or format they understand. Residents spoken to were not provided with any information regarding the home. The provider and manager gave assurances that these documents will be written and provided to the residents as soon as possible. Britannia Care Home DS0000061941.V292011.R01.S.doc Version 5.1 Page 10 The home does not ensure that residents or their representatives are provided with contracts regarding their stay at the home. They do not provide residents with copies of the homes Terms and Conditions and therefore they are not properly informed of their rights and responsibilities during their stay. The resident files showed that residents are admitted via a number of methods. Most are pre assessed by a senior member of the team visiting the prospective resident. Some are admitted via emergency transfers and one was admitted from a telephone conversation. The assessment documentation needs to be developed further as there was insufficient information recorded to enable the staff to develop sufficient care plans to meet each individuals needs. The manager agreed that this would be done as a matter of priority. Evidence from resident files showed that they are not benefiting from having their care needs reassessed at regular intervals or when their needs change. This prevents the appropriate care being provided. These issues were discussed with the manager and advice was given to assist with ensuring this standard will be met. Discussions were held with both the provider and the manager regarding the Dementia Care service they are registered to provide. Both inspectors were concerned about the lack of insight, training and knowledge of the staff group with regards to this specialist area. The training records of both the care staff and qualified staff provide evidence that they are not meeting the care needs of the resident group. No evidence of current good practice in Dementia care was evident within the home. This was discussed with both the manager and provider and assurances were given that Dementia training would be accessed to ensure the care needs of the residents would be met. Evidence obtained from speaking to residents, relatives, staff and care files showed the home is not meeting the ethnic and cultural needs of the resident group living at the home. Specific dietary needs are not identified. Spiritual needs and care needs arising from different backgrounds are not recorded. It was noted from the recent admissions that the manager has admitted a resident outside the category of registration. This practice must stop as it places individuals at possible risk of harm. Britannia Care Home DS0000061941.V292011.R01.S.doc Version 5.1 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The home does not ensure that the residents’ needs are clearly set out in the care planning documentation. Residents are not being properly consulted as part of this process. The home is failing to meet the personal care needs of resident group. The administration, storage and disposal of medications within the home do not appropriately protect the residents. EVIDENCE: It was clear from the care planning documentation that the manager has commenced a review of this documentation and is attempting to improve it. However, substantial work is required to ensure the care needs of residents are being met. Care plans lacked sufficient detail needed to ensure care staff are able to meet the care needs of the residents. Residents or their representatives are not involved in the care planning process, which was confirmed by speaking to residents. In some cases, care plans had not been provided to meet identified care needs. The care plans are not consistently reviewed on a monthly basis and do not reflect changes in condition. This is poor practice. Britannia Care Home DS0000061941.V292011.R01.S.doc Version 5.1 Page 12 The care plans of four residents were thoroughly reviewed during the course of this key inspection. Evidence was found to show the care home is does not ensure the health and personal care of the residents are provided for and met. Concerns were raised in areas such as continence, nutrition, falls and pressure area care. Residents who had identified care needs in these areas were not being risk assessed. Weights are not consistently recorded. One individual who had obvious nutritional needs had a weight last recorded the previous year. The pressure area risk assessment was incorrect and the care plan did not reflect the correct care needed to meet that individuals needs. Two pressure area risk assessments were not correctly recorded. Wound care plans did not provide the correct information to ensure the residents’ care needs would be met. The residents are not being appropriately protected in areas such as continence, nutrition, falls and pressure sore development as they had not been risk assessed, even when it was evident that there was a clear need to do so. The registered nurses are failing to provide the care plans for residents when a pressure sore has been identified. One resident care plan showed that a resident had developed a pressure sore but did not have a care plan provided until nine days later. This is poor clinical practice and also neglect. Returned questionnaires from health professionals visiting the service showed that they have concerns about the poor standard of care provided by the home and also the poor clinical practice of the care home staff. The home does have a medication policy, which covers a number of areas including homely remedies, where staff can refer to for guidance. The policy does not include guidance for staff on Self Administration and there is no risk assessment developed to assist staff in this area. Medication charts were filled in appropriately. The inspection did identify a number of serious matters regarding the storage and administration of medicines within the home. Medicines were being given to all residents together and then signed for by the registered nurse all at the same time. This is poor practice. The manager and deputy manager stated that there were no Controlled drugs stored in the premises. However, medication was indeed stored but no one was aware of how long it had been there. This is poor practice. The homes system for storing and recording controlled drugs does not meet the required guidelines from the Royal British Pharmaceutical Society. The home has not arranged a contract with an organisation to ensure clinical (drug) waste is properly disposed of from the premises. One service user is self-administering some medication but has not been risk assessed to do so. Observations of staff and feedback from service users shows the privacy and dignity of residents is not being appropriately protected. One resident said that staff had come into her room on a few occasions without properly announcing themselves. She was in a state of undress at the time and felt very uncomfortable. One service user was shaved in the lounge. Two service users had had clothing lost. Britannia Care Home DS0000061941.V292011.R01.S.doc Version 5.1 Page 13 Not all staff knock on doors or wait for an answer before entering.This compromises individual service user’s dignity and privacy. Residents are not enabled to have privacy in their own rooms as none are provided with keys to lock their doors. Two residents said they would like to have this opportunity. Britannia Care Home DS0000061941.V292011.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Residents do not have access to any activities or recreation. They have limited choice and control and are at risk of not having their dietary needs met. EVIDENCE: There is no programme of activities at the home. Specific needs associated with individuals’ religion, culture or disabilities are not met. Residents said there is nothing to do and “I’m bored”. TVs are available around the home and all the programming is in English. This does not meet the linguistic needs of all the residents. Individual interests are not identified or recorded. The home is not part of the local community; there is no contact with local places of worship, or recreational facilities. Visitors were seen during the inspection and they said that they could come and go when they liked and could choose where to sit. Care plans do not record individual’s capacity to make decisions nor are there any examples of how the home offers and promotes choice. Control over finances is not promoted. Keys are not available for bedroom doors. Residents’ dietary needs are not met. Examples seen included Britannia Care Home DS0000061941.V292011.R01.S.doc Version 5.1 Page 15 • • • • • • • No evidence of consultation with residents in drawing up the menu Specific needs, likes dislikes and preferences are not identified, recorded or implemented. Menus show little variation from week to week Preferences for more pies, pop and crisps have not been catered for No alternatives for desserts Teabags are left in cups. A vegetarian resident was seen given a pureed green meal that also contained meat. This is poor practice. The lunchtime meal was observed.The breakdown of the lift made it difficult for all residents to come down into the dining room. Only three residents were in the dining room, help was being given to one resident in a way that was positive and unobtrusive. On the first floor more dependant residents received assistance from one carer. This meant she was helping two people at the same time. Britannia Care Home DS0000061941.V292011.R01.S.doc Version 5.1 Page 16 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 Service users would benefit from a complaint procedure that is more accessible, transparent and productive. Although adult protection training has commenced for staff, residents continue to be placed at risk of harm as a result of care practices adopted by the home. EVIDENCE: The home does have a complaints procedure in place and it is displayed. Two complaints have been recorded since the last inspection. One was recorded appropriately but the other was not. Feedback from residents said that in a number of instances they have made complaints but they were not dealt with. There was a feeling that the home did not listen to their complaints. One individual stated that he felt that when his complaints were made he felt as if he was being accused of “lying.” Discussions were held with the provider and manager regarding the benefits of the complaint procedure and how it can be used as a quality assurance tool when implemented correctly. Assurances were given that improvements would be made in this area. The home did not make arrangements for residents to vote. Care plans do not record whether powers of attorney are held for any residents. The provider has now commenced adult protection training for staff working at the home. This is a rolling process and assurances were given that all staff Britannia Care Home DS0000061941.V292011.R01.S.doc Version 5.1 Page 17 would be provided with this training and that it will be provided annually. The home has an adult protection policy and procedure that includes a section on whistle blowing. Staff spoken to had an awareness of abuse and how to deal with it if they came across it. Concerns were raised by the staff and residents and these were presented to the manager and provider. These concerns included issues such as staff not being attentive to the toileting needs of residents and a member of staff being aggressive in manner. The manager and provider took these concerns on board and gave assurances that they would review staff attitudes and practices. The omissions of care identified in Standards 7 and 8 provided evidence that residents are being placed at risk of harm. The local Adult Protection unit are currently co-ordinating a number of concerns raised by family representatives of a service user and health professionals visiting the home. The contracts department of Bradford Social Services has temporarily suspended long term placements and day care placements to this service as a result of these concerns. The Provider gave a strong commitment to stamping out bad practice and said that one member of staff has recently been dismissed for Gross Misconduct during the course of her duties. Britannia Care Home DS0000061941.V292011.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Improvements are needed with the internal and external environment to ensure it is safe and well maintained. Generally, the home appeared clean and tidy. However, certain practices placed residents at risk of infection and possible harm. EVIDENCE: Improvements are needed with the environment of the home if it is to meet the needs of the resident group. The outside environment is unattractive and offers very little opportunity for those that can access it. There are piles of rubble and burnt material lying around that is very unattractive and detracts from the building. Residents living in the home are restricted to the internal environment as the outside is an unsuitable area to access. Two residents spoken to felt the environment of the home was,”OK” and “a bit shoddy.” The wooden handrail outside the home is unstable and places a substantial risk to anyone who uses it. The provider has put a poster up on the front door for all to see regarding this issue. However, one would have to use this rail to get to Britannia Care Home DS0000061941.V292011.R01.S.doc Version 5.1 Page 19 the front door to read the note and therefore renders the note ineffective. The provider was asked to fix this as a matter of priority. The provider said maintenance work is carried out within the home as a rolling programme. Evidence was seen that recent painting work has taken place. There is no maintenance programme in place to show there is a consistent renewal of fabric and décor carried out. Evidence was found to show some improvement with refurbishment has taken place and it is recommended that this continue, as some of the furnishings are very unattractive. The provider has placed CCTV cameras in the internal areas of the home. This practice could have implications for resident privacy. The standard recommends that these are only placed outside for security purposes. The provider has said that these have been placed to observe the movement of residents within the home as some have been going into rooms belonging to other residents. If staff are unable to observe the movements of residents this should be examined through staffing audits. Overall the home appeared clean and tidy during the inspection. A number of issues were highlighted that needed to be addressed to ensure the premises are suitable. Soiled articles of clothing and linen are put into black bags and taken to the laundry. The black bags are then emptied into the washing machine and then taken out of the laundry. Dirty commode basins were left on the windowsills of two bathrooms. Communal soaps are available in most bathrooms within the home. The laundry floor service is not impermeable. These practices should cease, as they are possible sources for the spread of infection. Britannia Care Home DS0000061941.V292011.R01.S.doc Version 5.1 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The staffing levels of the home do not meet the care needs of the existing resident group. The recruitment process adopted by the home fails to appropriately protect the resident group. Staff are not trained to a standard that enables them to meet the care needs of the resident group. EVIDENCE: Discussions were held with the provider and manager regarding the staffing levels of the home. The home has altered its staffing levels to reflect the number of residents living there at this present time. Some residents expressed that they felt there was not enough staff on duty to meet the care needs of the resident group, mainly at night. The lift has been broken for at least three weeks and this has caused issues regarding the care needs of residents. It was recommended that the home ensure that extra staff are placed on each shift until the lift has been fixed. The provider should review the staffing levels of staff for all shifts. Some residents spoken to stated that it sometimes takes staff a long time to answer the call bell at night. The staffing levels on all shifts should be reviewed to ensure they are set at the right level to meet the care needs of the residents. The provider stated that the home is committed to ensuring that 50 of the care staff are trained to NVQ level 2 as soon as possible. Britannia Care Home DS0000061941.V292011.R01.S.doc Version 5.1 Page 21 The recruitment file of the most recent employee showed that the home has failed to obtain the necessary information needed to ensure the residents are appropriately protected. The care staff are receiving little training in the areas of resident need. There is no structured training programme in place to assist staff development within the home. This lack of training raises concerns about the ability of the staff group in meeting resident needs. The files also showed evidence that some care staff have been given a form of induction. These documents were examined and were not in line with the Skills for Care specifications. The home offers day care services to local people. Care home staff provide this service as well as attempting to meet the care needs of the residents living in the home. Two residents spoken to were unhappy about their services being used by other persons. It was recommended that the home review this service to ensure that existing residents are not disadvantaged in any way by providing this extra service. Britannia Care Home DS0000061941.V292011.R01.S.doc Version 5.1 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 The overall management of this home is of a poor standard and the registered persons are placing residents at risk of harm from their omissions. EVIDENCE: The manager works five hours five days per week. Her role is supernumerary and should enable her to review the management systems of the home and implement change where needed. This does not happen. The manager continues to struggle to manage the home and meet the National Minimum Standards for Older People. The management cover of the home should be reviewed to ensure residents are benefiting from this role. The manager has not obtained a recognised management qualification to assist her in her role and is finding it very difficult to meet its requirements. The manager was unaware that the home was only registered to admit residents that came under the home’s category of Dementia over sixty-five years old. At least one resident has recently been admitted outside of the home’s registration. Britannia Care Home DS0000061941.V292011.R01.S.doc Version 5.1 Page 23 Discussions took place with the provider and manager as to what the process was for measuring and improving the quality of care provided to residents within the home. It is clear that this is an area that needs attention, as residents are not benefiting from a recognised quality assurance process. The registered provider said that the home assists some residents with their finances. The records were examined for one resident. It was clear that the systems adopted to assist this individual manage his monies were very poor and left the individual open to possible abuse. The registered provider or another person assisted this individual with substantial money transactions. It was unclear whether this individual had been assessed appropriately as to his capacity to complete these transactions. Carrying such large sums of money can place both resident and companion at risk. There was no documentation in his notes as to whether he was assisted to agree to this process in the first instance. The provider was informed that this matter would be referred back to the individual’s social worker and also the local Adult Protection unit. The provider and manager have now brought in the services of a training company to help assist them with staff training in areas such as Moving and Handling, Infection Control, Fire training and First Aid. This will be a rolling programme and carried out on an annual basis. The inspector pointed out that all staff, including bank staff, require fire training. Although the provision of the above is an improvement there are still areas of concern that leave residents at risk of harm within the home. The following are examples: • • There are no environmental risk assessments carried out within the home. Residents were able to access the outside without staff being aware. A member of staff had disabled the fire escape alarm at the back of the home. There was no signing in book at the entrance of the home. In the event of fire there would be no way of identifying whether everyone was evacuated. Some residents with mobility problems are accessing the stairs whilst the lift is broken. No risk assessments had been written to minimise the risk of harm to those residents. Flammable paints and fabrics were stored underneath the stairs of the home presenting a potential fire hazard. • • • Britannia Care Home DS0000061941.V292011.R01.S.doc Version 5.1 Page 24 • The rails outside the front of the home have been identified as a possible risk to users. Urgent action is needed to ensure these rails are made safe. This was not done. A resident had a bottle of white spirits present in his room. This person was known to be an abuser of such substances but no risk assessment was found to assist staff to deal with this issue. Equipment used in the home, such as hoists; bed rails and wheel chairs are not checked to ensure they are in good working order. The provider was unable to provide certification to show the electrical and gas appliances used are safe. The home does not have a contract to dispose of clinical(drug) waste from the premises. • • • • These are some of the examples where the registered persons for the home have not properly protected residents, staff and others who enter it. Britannia Care Home DS0000061941.V292011.R01.S.doc Version 5.1 Page 25 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 1 1 3 1 x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 1 2 x x x x x x 2 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 1 x 2 x x 1 Britannia Care Home DS0000061941.V292011.R01.S.doc Version 5.1 Page 26 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation Reg 4(1) Requirement A copy of the final version of the statement of purpose and service user guide must be sent to the commission.(The previous timescale of 28/2/06 was not met) Timescale for action 31/07/06 2 OP3 14 3 OP4 12,13,18 4 OP7 Reg 15 The registered person must ensure all residents are appropriate assessed prior to admission and that they are continually assessed during their stay. The registered person must ensure the care needs of the residents are met by a suitably trained staff group. Care plans must be provided for identified care needs.(The previous timescale set had not been met.) The registered person must involve the resident or their representative with the development of the care plans and risk assessments at all DS0000061941.V292011.R01.S.doc 31/07/06 31/07/06 31/07/06 5 OP7 15 31/07/06 Britannia Care Home Version 5.1 Page 27 6 OP8 12,15 7 OP8 13 8 OP9 13 times. Where this is not possible Advocacy services should be sought for assistance. The registered person must ensure the identified care needs of residents are properly met. This refers particularly to the areas of nutrition, pressure area care, continence and falls.(The previous timescales set have not been met) The registered person must ensure that all residents are appropriately risk assessed in the areas mentioned above to ensure they risk of harm is minimised where possible. Staff must ensure any resident self-administering medication has been appropriately risk assessed. The registered person must ensure that the Administration, Storage and Disposal of all medications is in line with the guidelines set out by the Royal Pharmaceutical Guidelines. The qualified nurses working in the home must be aware of their professional responsibility when dealing with medicines. The registered person must ensure that all care provided within the home appropriately protects the residents privacy and dignity. Appropriate door locks should be installed on bedroom doors and residents should be provided with keys if they are assessed as able. Lockable storage space should also be provided to residents in their rooms. The registered person must ensure that residents are DS0000061941.V292011.R01.S.doc 31/07/06 30/06/06 30/06/06 9 OP9 13 30/06/06 10 OP10 12 31/07/06 11 OP12 16 31/07/06 Page 28 Britannia Care Home Version 5.1 12 OP12 16 13 OP14 12 appropriately consulted with regards to the provision of leisure and social activities. The registered person must also ensure these are provided for. The registered person must ensure that all residents are appropriately consulted regarding religious and cultural needs and they are enabled to maintain them either in or outside the home. The registered person must produce evidence to show that the resident group are properly consulted about having choice and control over their lives. Advocate services must be offered and displayed within the home. The registered person must review the whole process of food provision to ensure the resident group have been fully consulted regarding their likes and dislikes. These must be appropriately recorded and evidence must be in place to show their specific cultural and religious needs, with regards to food, are provided for. The registered person must ensure that all complaints are recorded correctly. The complaints procedure must be provided to all residents in a format suitable to their language needs. The registered person must ensure all service users are appropriately protected from harm and abuse at all times. Adult protection training must be provided for all staff. The senior staff must be prioritised.(Previous timescale set has not been met.) DS0000061941.V292011.R01.S.doc 31/07/06 31/07/06 14 OP15 12,16 31/07/06 15 OP16 22,17 30/06/06 16 OP18 13 30/06/06 17 OP18 Reg 13 31/07/06 Britannia Care Home Version 5.1 Page 29 18 OP19 23 19 OP19 14 20 OP26 13 21 OP27 18 22 OP29 Reg 19 The registered person must ensure that the internal and external environment of the home is suitable for the needs of the resident group. The registered manager should only use CCTV cameras at entrance areas for security purposes. The registered person must make arrangements to prevent infection and the spread of infection at the care home. The registered person must take action to ensure the staffing levels of the home are correct for the needs of the resident group. CRB checks must be completed for all staff. (The previous timescale set has not been met) The registered person must ensure that there are specific programmes of training available and provided to all care staff working in the home. Specific attention must be paid to the specialist needs of the resident group and the homes registration The registered person must ensure that all new care staff receive an induction that is in line with the specifications laid out by the Skills for Workforce. The CSCI must be informed in writing of any registered person absence from the home over 28 days. The management cover at the home must be improved and maintained. DS0000061941.V292011.R01.S.doc 31/07/06 31/07/06 31/07/06 30/06/06 30/06/06 23 OP30 12,18 31/07/06 24 OP30 12,18 31/07/06 25 OP31 38 30/06/06 26 OP31 9 31/07/06 Britannia Care Home Version 5.1 Page 30 27 OP31 9 The manager must commence a recognised management qualification. (The previous timescale was not met.) 30/09/06 28 OP33 24 29 OP35 13,17 30 OP36 18 Effective quality assurance and 30/09/06 quality monitoring systems, based on seeking the views of service users, are in place to measure success in meeting the aims, objectives and statement of purpose of the home. The registered person must 30/06/06 ensure that residents are properly risk assessed and consulted regarding all financial transactions. Appropriate records must be kept at all times. A staff supervision programme 31/07/06 must be introduced. (The previous timescale was not met.) The registered person must 30/06/06 ensure that all areas of the home are safe and place no harm to residents and significant others. 31 OP38 13,23 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 2 3 Refer to Standard OP1 OP2 OP9 Good Practice Recommendations It is recommended that all information made available to residents and other interested parties is made available in languages suitable to their need. The home should ensure that all residents receive a copy of the home’s terms and conditions. This should include all the areas highlighted within this standard. It is recommended that the home develop a policy for the self-administration of medication. This should also include DS0000061941.V292011.R01.S.doc Version 5.1 Page 31 Britannia Care Home 4 5 6 OP17 OP19 OP28 an appropriate risk assessment. It is recommended that the registered person registers all residents who are able to vote and enable them to do so. The registered person should produce a routine programme of routine maintenance and renewal of fabric and decoration for the home. The registered person should ensure that at least 50 of care staff are trained to at least NVQ Level 2. Britannia Care Home DS0000061941.V292011.R01.S.doc Version 5.1 Page 32 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Britannia Care Home DS0000061941.V292011.R01.S.doc Version 5.1 Page 33 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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