Inspection on 08/11/05 for Britannia House

This inspection was carried out on 8th November 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Britannia House 13/09/07

Britannia House 14/06/06

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 Andy Denness Unannounced Inspection 8th November 2005 10:00 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.V256857.R01.S.doc Version 5.0 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.V256857.R01.S.doc Version 5.0 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 Mira Adams Care Home 21 Category(ies) of Dementia (21) registration, with number of places Britannia House DS0000021401.V256857.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. That the maximum number of service users to be accommodated will not exceed twenty one (21). That service users accommodated will be older people aged sixty five (65) years or over on admission. That only service users with a dementia tyupe illness will be accommodated. 7th June 2005 Date of last inspection Brief Description of the Service: Britannia House is an adapted property 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 home is registered to accommodate up to 21 older people who have a dementia type illness and the registered owners are Britannia Care Homes Ltd. Britannia House DS0000021401.V256857.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over a late morning and afternoon in November and lasted four hours. To help gather evidence on how the home is performing the Inspector met with staff and the manager of the home, examined a range of records and written information and undertook a tour of the premises. In depth discussions took place with five service users. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Britannia House DS0000021401.V256857.R01.S.doc Version 5.0 Page 6 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.V256857.R01.S.doc Version 5.0 Page 7 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, 3, 5 & 6. Generally pre admission information and procedures ensure that service users move into a home that they know can meet their needs. EVIDENCE: The home has a statement of purpose, which is for distributing to potential service users and others to inform them about the home and the service that it provides. This document was examined, it was a general document which covers all homes in the group, it has been required that this individualised to Britannia House. Assessments of needs are undertaken prior to service users moving in, a selection of these were examined, they were of a satisfactory standard. One service user spoken to said that he had looked around prior to moving in. The home does not provide a rehabilitative service. Britannia House DS0000021401.V256857.R01.S.doc Version 5.0 Page 8 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 & 11. Work is still required to improve the care planning system and procedures that help ensure that service users care needs are appropriately met. Arrangements regarding medication management were satisfactory. EVIDENCE: Individual plans of care are in place for all service users, a selection was examined; some improvements have been made since the last inspection, however in some instances the plans did not include enough detailed guidance for staff; the plan of a service user whose behaviour could be challenging contained no guidance on how staff should manage difficult situations. Another plan was scant and contained little guidance for staff. Records examined confirmed that improvements have been made to the day recording systems which records what care and support staff provide each day for service users. Records examined confirmed that a range of health care professionals including GPs, District Nurses, Community Psychiatric Nurses and Psychiatrists are accessed when required to support staff in meeting service users’ needs. Because of potential risks of service users looking after their own medication, staff do this for them. A pre-packed medication system, which is easy to monitor, is used, storage and records were examined and found to be in order. Britannia House DS0000021401.V256857.R01.S.doc Version 5.0 Page 9 Observations confirmed that staff interact with service users in a respectful manner whilst ensuring them their dignity. The Inspector was told by the manager that the home does have a written procedure for staff to follow in the event of the death of a service user, it was not possible to verify this as the home’s procedure manual was not available. The manager said that if possible service users would be supported to spend their last days in the home in familiar surroundings with people that they know, this was confirmed in a letter from a relative thanking the manager and staff for their support when their relative died. Care plans examined confirmed that details are recorded which indicate service users’ wishes upon their death. Britannia House DS0000021401.V256857.R01.S.doc Version 5.0 Page 10 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 Arrangements regarding social activities were satisfactory. EVIDENCE: During the inspection staff were observed spending time with service users interacting on a one to one basis socialising and playing scrabble. The Inspector was shown details of entertainments and activities that come into the home, these included musical entertainment, a monthly visit by an activities organiser who provides mental and physical stimulation for service users via various activities, regular religious services and a ‘pat a pet’ service. Britannia House DS0000021401.V256857.R01.S.doc Version 5.0 Page 11 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. Current arrangements regarding adult protection require improvements to ensure the safety of service users. EVIDENCE: It was not possible to ascertain if service users are registered on the electoral register as the manager has only just returned the registration forms, this issue will be examined again at the next inspection. A copy of the multi agency guidelines regarding adult protection is held the home; it was not possible to check the home’s own policy and procedure regarding adult protection, as the policy folder was not available. Whilst examining records it was noted that an incident that had occurred between two service users that could have been viewed as an adult protection matter had not been referred as such and the Commission for Social Care Inspection had not been informed of the incident as is required, action has been required to address this matter. Staff training records indicated that currently only six staff have been trained in adult protection matters. Britannia House DS0000021401.V256857.R01.S.doc Version 5.0 Page 12 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, 10,21,22,23,24,25 &26. Physical standards throughout the home were good, ensuring that service users live in a spacious, comfortable, safe, well-maintained environment, which is suitably equipped to meet their needs. EVIDENCE: An inspection of all areas of the environment confirmed that physical standards throughout the home are good. All bedrooms comply with the size requirements of national minimum standards; service users said that they are able to bring their own furniture with them; some have done this, which has resulted in pleasant personalised rooms. Service users have a choice of two lounges and a dining room to use; these rooms are furnished and decorated in a comfortable homely style. Heating is provided by a gas central heating system with radiators in all rooms, which are all guarded. Tests confirmed that hot water is delivered to wash hand basins and baths at a safe temperature. The home is fitted with a shaft lift and a stair lift to assist service users access first and second floor accommodation. Some bathrooms are fitted with hoists Britannia House DS0000021401.V256857.R01.S.doc Version 5.0 Page 13 to assist access to baths and handrails and other adaptations are sited throughout the home. A satisfactory standard of cleanliness was found in all areas of the home. Records examined confirmed that since the last inspection staff have been trained in infection control matters. The laundry was seen to be suitably equipped. To ensure the safety of service users it has been required that the lock on one bedroom door is changed to a type which ensures staff access in the event of an emergency. Britannia House DS0000021401.V256857.R01.S.doc Version 5.0 Page 14 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. Staffing arrangements were satisfactory although some further training is required to ensure that they have the skills necessary to meet service users needs. EVIDENCE: Care staffing levels on the day of the inspection were satisfactory; records examined indicated that this is usually the case. Staff were observed to work in caring and respectful way with service users; because of their mental health needs it was not possible to gain all service users’ views of staff, however two spoke positively of staff their comments included “quite good” and “very very nice”. Records examined confirmed that most staff are trained in food hygiene, moving and handling, fire prevention and first aid. Currently only two staff are trained to NVQ level as is required, the Inspector was told that other staff have either started or are about to start training. It was not possible to check the home’s recruitment procedures as they are held centrally at head office. Britannia House DS0000021401.V256857.R01.S.doc Version 5.0 Page 15 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, 32, 33, 36, 37 & 38. Current management arrangements are not satisfactory with the manager not having sufficient time to carry out her responsibilities fully. EVIDENCE: Since the last inspection the manager has been registered with the Commission for Social Care Inspection, she said that she is close to completing her required management training. Throughout the inspection she demonstrated a clear understanding of the needs of older people with dementia. Records examined indicated that she has only six hours per week to carry out her managerial responsibilities, this has had an adverse effect on issues, particularly the care planning system. It has been required that her managerial hours are increased. The manager and staff confirmed that formal one to one supervision is provided. The manager was observed to be enthusiastic and hardworking and led by example. Staff confirmed that staff Britannia House DS0000021401.V256857.R01.S.doc Version 5.0 Page 16 meetings do take place. At the last inspection it was required that the home again distributed questionnaires to service users and relatives to gain their views of the service and of any improvements that could be made. This appears not to yet of happened; in discussions with the manager it was agreed that this work may be better done by her, who regularly sees relatives rather that head office staff as is now the case. A selection of records was examined, these were in order. However at the last inspection it was recommended that changes were made to the current computer recording system to ensure that information cannot be altered after entering and that the identity of the staff entering the information is recorded and cannot be changed, this has not happened, the recommendation has been repeated. It was not possible to examine the home’s policies and procedures as the manual was at head office, it has been required that this is returned immediately. A selection of health and safety records was examined, these were generally in order although it has been required that the frequency of the testing of the hot water outlets, that are in place to ensure that service users are not scalded by hot water, is increased. Britannia House DS0000021401.V256857.R01.S.doc Version 5.0 Page 17 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 2 X 3 X 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 1 3 3 3 3 2 3 3 3 STAFFING Standard No Score 27 3 28 2 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 3 1 X X 3 2 2 Britannia House DS0000021401.V256857.R01.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2. Standard OP1 OP7 Regulation 4 15(1) Requirement That the statement of purpose is individualised to the home. That care plans are expanded to ensure a full description of needs and support required from staff. (This requirement was also made at the last inspection and has not yet been complied with) That adult protection training is provided for staff (08/02/06); that Social Services are consulted over the adult protection matter discussed and that CSCI are informed of significant occurrences that affect the wellbeing of service users. That 50 of staff are trained to NVQ level 2 by the end of 2005. That the hours the manager can spend exclusively on her managerial responsibilities are increased. That the manager is trained to NVQ level 4 in care and management by the end of 2005. That quality assurance questionnaires are distributed DS0000021401.V256857.R01.S.doc Timescale for action 08/02/06 08/02/06 3 OP18 13(6) 08/12/05 4. 5 OP28 OP31 18(1a) 18(1)(a) 31/12/05 08/12/05 6. OP31 18(1a) 31/12/05 7. OP33 24(1) 08/02/06 Britannia House Version 5.0 Page 19 8 9 OP37 OP38 17(2) 12(1)(a) and the results collated and acted on. (This requirement was also made at the last inspection and has not yet been complied with) That the policy folder is returned to the home. That the lock on the door discussed is altered to ensure access for staff in the event of an emergency and that the frequency of the testing of hot water outlets is increased to monthly. 08/10/05 08/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP37 Good Practice Recommendations That changes are made to the current computer recording system to ensure that information cannot be altered after entering and that the identity of the staff entering the information is recorded and cannot be changed, Britannia House DS0000021401.V256857.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 House DS0000021401.V256857.R01.S.doc Version 5.0 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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