Inspection on 13/09/07 for Britannia House

This inspection was carried out on 13th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 House 14/06/06

Britannia House 08/11/05

Britannia House 07/06/05

Britannia House 08/12/04

Britannia House 28/06/04

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

CARE HOMES FOR OLDER PEOPLE Britannia House 7-11 Jameson Road Bexhill-on-sea East Sussex TN40 1EG Lead Inspector Caroline Johnson Key Unannounced Inspection 13th September 2007 09:50 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 House DS0000021401.V340217.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. Britannia House DS0000021401.V340217.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Britannia House Address 7-11 Jameson Road Bexhill-on-sea East Sussex TN40 1EG 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) 01424 217419 Britannia Care Homes Limited Vacant Care Home 21 Category(ies) of Dementia (21) registration, with number of places Britannia House DS0000021401.V340217.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The maximum number of service users to be accommodated is twenty-one (21). Service users must be older people aged sixty-five (65) years or over on admission. Service users with a dementia type illness only to be accommodated. One named service user aged under sixty-five (65) years on admission to be accommodated. 17th November 2006 Date of last inspection Brief Description of the Service: Britannia House registered to accommodate 21 older people with a dementia type illness. The property is an adapted building situated a short level walk from Bexhill town centre with its shops and access to bus and rail routes. Accommodation is provided on three floors with a shaft lift and a stair lift fitted to assist those who may have problems managing stairs. Bedroom accommodation consists of 3 double and 15 single rooms. The registered providers are Britannia Care Homes Ltd who also owns another three homes in the area. The home makes CSCI reports available to prospective residents and/or their relatives/representatives upon request. The fee charged as of July 2007 is £366 to £440 per week. Additional charges are made for chiropody and hairdressing. Britannia House DS0000021401.V340217.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. As part of the inspection process a site visit was carried out on 13 September 2007. Over the course of the inspection there was an opportunity to spend time with the proprietor and the new manager and to meet in private with two care staff. Time was also spent talking to residents and observing staff interactions with the residents. A wide range of records were seen including the preadmission assessment and care plan for one recently admitted resident along with three other care plans. In addition records held in relation to staff recruitment and training, medication, complaints, activities and health and safety were examined. A tour of the building was also carried out. Since the last inspection the Commission has received one complaint about the home. Issues raised as part of the complaint have been investigated as part of this inspection, some areas were founded, some were not founded and in some cases it was not possible to substantiate, as it would have been one persons word against another. Following the last key inspection a random inspection was carried out in November 2006 to follow up on the requirements and recommendations made at the June 2006 inspection. The majority of the requirements and recommendations made in June 2006 had been met. At the time of the last inspection there was an acting manager in place. However, she has since left her position and a new manager has been recruited. The new manager has submitted her application to the Commission to register as manager and this is currently being processed. What the service does well: The home is well maintained, bedrooms are comfortable and have been personalised with photos and small items of each of the resident’s own furniture to make they more homely. There are good training opportunities for staff to ensure that they have the skills to meet the needs of the residents and a large number of staff are due to commence NVQ (National Vocational Qualification) training in the near future. The company has a good quality assurance system in place ensuring that all aspects of the home are monitored on a regular basis. All equipment in the home is serviced on a regular basis. Relatives are invited to the home to attend bi-annual care plan meetings. In advance of the inspection surveys were sent to the home for relatives to comment on the quality of the care provided in the home. Comments included ‘the front door is opened promptly. Meals always smell and look appetising they are plentiful and frequent’. ‘Different types of activities, painting, music, Britannia House DS0000021401.V340217.R01.S.doc Version 5.2 Page 6 light exercise and the staff are very capable, attentive, caring and professional’. ‘Its small, welcoming and seem to take care of most of his needs. We saw many homes before choosing Britannia and chose what we thought was the best. What has improved since the last inspection? What they could do better: A full review is required of staffing arrangements with particular reference to the busiest times of the day and to any risks posed by minimal staffing levels. Residents’ individual weights need to be monitored regularly in terms of weight gain/loss and any action required as a result documented in their care plans. Attention must be given to ensuring that there are no gaps in the record keeping for medication administered to residents and if medication is refused an explanation must be given as to the reason and if any further action was taken. In relation to complaints more detailed records need to be kept of any complaint made to the home along with how they have been investigated and any action taken as a result. The home is good at ensuring that risk assessments are drawn up as necessary following reviews however, they must ensure that they are drawn up as soon as a risk is presented in an attempt to safeguard against accidents/incidents. As part of the relatives survey some comments raised included ‘I would like to see more activities taking place. There is a timetable, but I’m not sure these happen’. Another relative in response to how the home could improve stated ‘having more staff or helpers. I think they aim to have people with a real Britannia House DS0000021401.V340217.R01.S.doc Version 5.2 Page 7 commitment to ‘care’. More staff would ease the burden on those already doing the job’. My relative ‘suffers from falls sometimes the home calls and lets me know but sometimes I arrive to see a cut/bandage/bruise or similar and then I have to ask what happened’. In relation to how the home could improve another relative stated there ‘should be 4 (Staff) especially at busy times or when a resident is being labour – intensive. 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. Britannia House DS0000021401.V340217.R01.S.doc Version 5.2 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 House DS0000021401.V340217.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission procedures in place ensure that the home plans in advance how they are to meet the needs of prospective residents. EVIDENCE: There was a detailed statement of purpose held within each care plan. The owner confirmed that the terms and conditions of residence has recently been updated by their Solicitors so that it is in plain English and complies with recent guidance by the Office of Fair Trading on Care Home contracts. A pre admission assessment was seen in relation to one resident recently admitted to the home. Detailed information was obtained and plans were put in place to seek further specialist advice and support. The manager advised that they have plans to create an introductory information pack so that all clients and their relatives have full information about the home and its policies. It is also the home’s intention to update their brochure. Britannia House DS0000021401.V340217.R01.S.doc Version 5.2 Page 10 Britannia House DS0000021401.V340217.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is continuing to make progress in relation to care planning however, attention is needed to ensuring that risk assessments are considered on an ongoing basis rather than just at reviews. Emphasis should also be placed on improving recording keeping in relation to medication administered to residents and in the monitoring of residents’ weights. EVIDENCE: Four care plans were examined on this occasion. Generally the care plans had been kept up to date. One of the plans was not fully up to date but there were markers indicating that a staff member had been through the file and had marked all the areas that required updating. Britannia House DS0000021401.V340217.R01.S.doc Version 5.2 Page 12 The home aims to have care plan meetings twice a year for each resident. Relatives who choose to attend are invited. Minutes are kept of the meetings and these were seen in three of the four care plans examined. The fourth care plan was for a resident who had recently been admitted to the home. A relative of this resident was visiting the home at the time of inspection and they advised that they would welcome an opportunity to see their relative’s care plan and to attend regular care plan meetings. Minutes of the care plan meetings that were seen were not very detailed and the manager agreed that further work could be carried out both in preparing for and recording the detail and outcome of these review meetings. One resident who at the time of the last inspection was bed bound is now up and dressed and brought into the lounge on a daily basis for a few hours. She uses a recliner chair and a special cushion. There are charts in place for staff to record whenever they reposition or turn this resident. Staff advised that this resident has benefited enormously from being able to use the lounge area and they enjoy the majority of the activities on offer. In relation to another resident there were detailed objectives in their care plan but the daily records did not refer to progress with the objectives. This resident can be aggressive at times and there is some information on what staff should do if they are aggressive. However, this needs to be expanded upon so that it is clear for all staff. The manager advised that they are currently awaiting a CPN (Community Psychiatric Nurse) assessment. The home has sought advice from a resident’s GP regarding their current healthcare needs. The GP prescribed medication, which has been obtained and treatment provided but the problem still persists and the manager agreed that the GP should be asked to visit. The care plan refers to the health problem and the treatment but there is no risk assessment in place to advise staff of any actions they should be taking to prevent cross infection. There is very little reference in the daily records to this resident’s current needs and progress with the treatment. Since the last inspection the home now uses a trolley for medication so that it can now more easily be taken to the residents. At the time of inspection the manager advised that the storage area for the trolley would be moved in the coming weeks. Medication was stored securely. Overall recording of medication administered to residents was in order. In relation to two residents it was noted that there are times that the residents refuse their medication. The manager advised that this has been discussed with the residents’ doctors. Some staff record the reason why medication has not been given on the rear of the MAR (Medication administration record) chart but this is not always the case. A staff member spoken was able to describe in detail the home’s policy on what to do if medication is refused. Britannia House DS0000021401.V340217.R01.S.doc Version 5.2 Page 13 Controlled drugs (CD) are stored securely. However it was noted that, in relation to one resident, on one occasion the MAR chart had been signed but not the CD register and in relation to another the CD register had been signed on one occasion but not the MAR chart. Two staff always sign the CD register, but the MAR chart is only signed by one staff member. The manager advised that they are currently seeking medication reviews for two residents as they feel that some of the medication they are prescribed on an as required basis is no longer required. The manager advised that the home uses professional advice and support where necessary to meet the needs of the residents. One resident had had an initial visit from a CPN and it was reported that the CPN would carry out a more detailed assessment in the near future. Staff confirmed that none of the residents have any pressure sores and that they work hard to prevent them occurring. Of the four care plans seen; monthly weights had been recorded in two of them. Both of the residents whose weight had not been recorded had been described as poor eaters and their last recorded weight was low. A comment in a relative survey included reference to when a resident was admitted to hospital. ‘The staff were excellent beforehand – and kept me in touch with events. They even visited her’. Britannia House DS0000021401.V340217.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are a good variety of activities on offer in the home but emphasis needs to be placed on ensuring that everyone is offered the opportunity to participate in activities and records should back this up. The emphasis on encouraging residents to have a greater say over the menus is considered good practice. EVIDENCE: On the day of inspection the land army girls provided entertainment in the home. A number of the residents stated that they enjoyed this especially singing along with all the songs. One of the residents had a birthday party and the cook supplied a large birthday cake for the occasion. One resident has a private carer who visits twice a week and regularly takes her out. A hairdresser visits the home on a regular basis. Two residents stated that they enjoy spending time in the garden. There is an apple and a Britannia House DS0000021401.V340217.R01.S.doc Version 5.2 Page 15 pear tree in the garden and tomato plants in the greenhouse. Residents were observed to be content in their surroundings. Records are kept of the activities provided which include flower arranging, memory games, art class, and board games. Entertainers come to the home to do music and motivation sessions and music afternoons. A Holy Communion service is held regularly. It was also reported that there is now a book club with afternoon tea. The owner and manager both stated that they felt that improvments have been made to the activities provided and emphasis has been made on ensuring that they are appropriate and geared to the needs of the residents. A written record is kept of the activity provided each day. In some cases the entry recorded for some residents is ‘sleeping’ or ‘wandering’. It was agreed that this is not sufficient information and that a record should be made of what action was taken to provide stimulation and participation. The manager was also able to show evidence of how she is hoping to improve the methods for recording information about activities. The intention is to have a folder with information about each resident’s past hobbies and interests and information about their current likes and dislikes. At the time of inspection she had completed information about at least three residents. All staff spoken with confirmed that there are activities offered to residents every day. It was also agreed that more thought would be given to planning activities in terms of what it is hoped to achieve from them. In the relatives’ survey one relative stated ‘I would like to see more activities taking place. There is a timetable, but I’m not sure these happen. I would like to see the duty manager’s name displayed’. The manager was confident that the changes planned would improve the quality of the activities provided. She agreed that it would be a good idea to have the duty manager’s name displayed so that any relative visiting the home would know whom to speak with. In another relative survey the comments in relation to activities included reference to ‘different types of activities, painting, music, light exercise and the staff are very capable, attentive, caring and professional’. The menus in place looked varied and well balanced. In addition to the lunch and evening meal menus, there is now a two-week breakfast menu that has recently been introduced. This shows more variety and increased opportunities for the residents to have a cooked breakfast. The manager advised that the cook comes in an hour earlier on the days there is a cooked breakfast. A clients’ food forum is also held regularly. As part of this process each of the residents take a turn to choose a meal they would like on a particular day and Britannia House DS0000021401.V340217.R01.S.doc Version 5.2 Page 16 the cook arranges the meal. Residents used magazines and cookery books to help them choose which meal they wanted. Britannia House DS0000021401.V340217.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Procedures for dealing with complaints are generally good but record keeping needs to be more detailed. EVIDENCE: Records showed that there had been four complaints since the start of the year and another complaint that had yet to be written up. Two complaints had been received prior to the current manager being in post and it was noted that in relation to these, one of the complaint records did not show the details of the investigation or the letter to the complainant. Of the other complaints, one was not dated. The most recent complaint had been raised informally five days prior to the inspection and then raised formally two days prior to the inspection. It was reported that the complaint was discussed with the proprietor the previous day and she had agreed to write to the complainant but there were no written details of the complaint available. There was however, evidence that the complaint had been raised with the staff team. The complaint referred to lack of personal care and dignity. During the inspection, the complainant, who was visiting their relative, was still not happy with the initial response of the home. Britannia House DS0000021401.V340217.R01.S.doc Version 5.2 Page 18 The complainant chose to meet with the proprietor; the manager and the inspector to discuss the concerns and a number of agreements were reached. Since the last inspection the Commission has received one complaint about the home. Issues raised as part of the complaint have been investigated as part of this inspection, some of the areas were founded, some were not founded and in some cases it was not possible to substantiate, as it would have been one persons word against another. Since the last inspection there has been one adult protection investigation and the conclusion reached was satisfactory. The majority of the staff team have received training on adult protection and prevention of abuse and another course is being arranged. Britannia House DS0000021401.V340217.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people accommodated benefit from living in a home, which is well decorated, comfortable and homely. This could be enhanced further by monitoring that all work identified through the maintenance plan is attended to. EVIDENCE: Since the last inspection the whole of the building has been painted internally. One residents’ family chose to paint their relative’s room. Bedrooms are well decorated and have been personalised by the residents and/or their families on their behalf. There was a strong odour noted in three bedrooms. The proprietor advised that this had been identified on her visit the previous day Britannia House DS0000021401.V340217.R01.S.doc Version 5.2 Page 20 and she had already instructed the cleaner to shampoo the carpet in these rooms. The cleaner confirmed this and advised that he had managed to do two of the rooms identified on the day of inspection. A new office has been created on the second floor, which is used for staff supervisions and meetings and it also enables the manager to take time out occasionally for the completion of management tasks. A detailed maintenance plan was drawn up in July detailing all work required to improve the standard of the building. The timescale column on the plan was not completed. The manager advised that some of the tasks have been carried out but there is no completion date for tasks. Within the laundry area there have been new shelves fitted and there is a basket supplied for each resident’s clothing. The manager advised that they are in the process of arranging to have larger capacity tumble driers supplied to the home. Since the last key inspection a cleaning rota has been put in place to ensure that the laundry area is kept clean. The manager advised that this generally works well but the exterior of the washing machines needed cleaning. The manager advised that they are hoping to change to a liquid washing detergent to try to eliminate this problem. Records showed that staff received regular instruction in fire safety. Fire drills had also been held regularly with the last drill being carried out in July 2007. Fire safety equipment is serviced at regular intervals and tests of alarms and emergency lights were up to date. Since the last inspection the owner has arranged for a fire risk assessment to be carried out. A number of recommendations were made as a result of the assessment and the home had drawn up an action plan of the work to be carried out. However, the action plan did not include details of the timescales for completion or a signature/date for any work already completed. Britannia House DS0000021401.V340217.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The increased training opportunities for staff will ensure that the staff team are able to meet the complex needs of the residents accommodated. However, a full review of the staffing levels and routines is required to ensure that personal care is not rushed at peak times and that a safe environment can be maintained at all times. EVIDENCE: Staff levels consist of three care staff throughout the day. In addition the manager works office hours and there is a cook and cleaner. Two night staff work from 7pm until 8am. In the mornings, two of the residents require both staff to transfer them from the bed to their wheelchair. Two residents choose to have a lie in daily, three are assisted to get up and go downstairs with dressing gowns on, as they will be bathed later, and the night staff assist the remainder of the residents to wash and dress. Once dressed individual residents are taken downstairs for breakfast, which is served at 8am. This means that for a period of time they are downstairs on their own albeit staff are checking on a regular basis. The manager advised that the task of bed Britannia House DS0000021401.V340217.R01.S.doc Version 5.2 Page 22 making has recently been taken from the night staff therefore freeing up some additional time. Staff spoken with advised that they tend to come in early to receive a handover so that night staff can get away by 8am. However there is no official handover time. It was reported that a couple of residents get up at 5.30am so this is when the night staff start to get the residents up. The manager agreed that the morning routine is one of the busiest times and she is reviewing this in an attempt to make it less so. Three staff files were examined. The home ensures that thorough recruitment procedures are followed. Prospective staff must complete an application form; two references are sought, along with pova clearance and a CRB. Applicants are asked to bring in valid forms of identification. All new staff complete mandatory training and the staff matrix in place showed that the majority of the staff team were up to date in attending training. As required at the last inspection training was arranged for staff in moving and handling. Further courses have been booked to ensure that new staff attend mandatory training and in relation to one new staff member arrangements had already been made for them to receive training on pova, first aid and manual handling. The owner confirmed that nine staff have enrolled for NVQ training and they will commence training later in the month. Food hygiene training had been booked for the week following the inspection and moving and handling booked for October. Britannia House DS0000021401.V340217.R01.S.doc Version 5.2 Page 23 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has worked hard to develop and improve their quality assurance system and the benefits will obviously improve practice. The intention to provide a regular relatives forum following on from the success of the recent forum is considered good practice. EVIDENCE: At the time of the last inspection there was an acting manager in place. However, she has since left her position and a new manager has been recruited. The new manager has submitted her application to the Commission to register as manager and this is currently being processed. The new Britannia House DS0000021401.V340217.R01.S.doc Version 5.2 Page 24 manager has completed NVQ level three and is currently working towards level four and the RMA (registered manager’s award). Staff spoken with stated that they felt well supported. One staff member stated that there is a clear line of management and that if they had a problem that could not be raised within the home they would raise it with the owner. Staff stated that they receive regular supervision. The owner monitors that staff are receiving supervision. The owner confirmed that staff disciplinary matters are recorded in detail and where necessary employment advice is obtained. Staff meetings are held on a regular basis and manager’s meetings are held on a monthly basis. Minutes of these meetings are kept. As part of the home’s quality assurance system an annual development plan has been drawn up. The plan sets out the owner’s proposals for building upon the quality of the care provided in the home. In addition as part of the process satisfaction questionnaires are sent to the relatives of the residents. Records showed that there were seven responses to the latest questionnaire. The responses were collated and feedback was given to the relatives. Overall the responses were very positive and the two areas where relatives were dissatisfied were recorded along with the action the home proposes to take to improve in these areas. The home also continues to carry out periodic audits of care plans, medication, risk assessments, staff files and food. The owner recently arranged a relative forum where relatives from each of the four homes were invited to attend. A guest speaker gave a talk on dementia and on the Mental Capacity Act and how it relates to their relatives in care. Feedback from the attendees was positive and a number of relatives asked that this type of forum be held on a regular basis. Records of accidents were sufficiently detailed. However the current folder contained records of fourteen accidents but the records were numbered up to nineteen. The manager was confident that she would be able to locate the records. In relation to health and safety a wide range of documentation was seen and there were certificates in place to show that equipment was serviced on a regular basis. This included servicing for the lift, hoist, portable appliance testing, gas and legionella testing. Records also show that hot water temperatures are also tested on a monthly basis. The owner or a representative on her behalf visits the home monthly on an unannounced basis to assess the running of the home. A report of the findings is drawn up and is stored in the home. A visit had been carried out the day prior to the inspection so the results were still to be written up. Issues raised at the previous visit included the need to appoint another night care worker and a day worker along with advice to expand the activities in the home. Britannia House DS0000021401.V340217.R01.S.doc Version 5.2 Page 25 Britannia House DS0000021401.V340217.R01.S.doc Version 5.2 Page 26 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 3 X X 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 X 3 Britannia House DS0000021401.V340217.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO 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 OP7 Regulation 13(4c) Requirement Where there is a risk of cross infection, a risk assessment must be drawn up to consider this and any action that could be taken to prevent this occurring. Records must show a record of nutrition including weight gain/loss and any action taken. Records must show details of all medication including CDs administered to residents and if refused this must be documented. Records must show details of all complaints made to the home along with details of the investigation and any action taken. A review must be carried out of staff levels and routines at peak times of the day. The results of the review and action taken must be sent to the Commission. Timescale for action 15/10/07 2. 3. OP8 OP9 17(1a) Sch (3) 3m 17(1a) Sch (3) 3i 30/10/07 30/10/07 4. OP16 17(2) Sch 4 (11) 31/10/07 5. OP27 18(1a) 30/10/07 Britannia House DS0000021401.V340217.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Britannia House DS0000021401.V340217.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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