Inspection on 07/01/08 for Britannia Lodge

This inspection was carried out on 7th January 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Britannia Lodge 09/01/07

Britannia Lodge 18/01/06

Britannia Lodge 30/08/05

Britannia Lodge 01/02/05

Similar services:

Chesham House

Argyll House

Dorset Lodge

Acacia House

Falcon House

Dial House Nursing Home

Cromwell Avenue (9)

Abbey Lodge

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

CARE HOME ADULTS 18-65 Britannia Lodge 1 Ailsa Road Westcliff On Sea Essex SS0 8BJ Lead Inspector Nicola Dowling Unannounced Inspection 7th January 2008 09:00 Britannia Lodge DS0000060903.V357401.R01.S.doc Version 5.2 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 Lodge DS0000060903.V357401.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 Adults 18-65. 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 Lodge DS0000060903.V357401.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Britannia Lodge Address 1 Ailsa Road Westcliff On Sea Essex SS0 8BJ 01702 432927 01702 432927 nurselynne@hotmail.com Telephone number Fax number Email address Provider Web address Name of registered provider Name of registered manager Type of registration No. of places registered (if applicable) Wardour Group Ltd Ms Linda Knight Care Home 15 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (14), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (1) Britannia Lodge DS0000060903.V357401.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th January 2007 Brief Description of the Service: Britannia Lodge is an established residential care home with nursing for those with enduring mental health care needs. The cost of care at this home ranges from £835 - £952 per week. The home is registered to accommodate those who are admitted under section 7 and section 25 of the Mental Health Act 1983. The home is a modified traditional residential property situated within a residential area. It is in close proximity to local bus and train routes and to local amenities including local and main shopping areas of both Southend and Westcliff. The home is registered for 15 residents. The residents’ accommodation is situated on both floors and assisted access is provided by a passenger lift. There are single and double bedrooms. Britannia Lodge DS0000060903.V357401.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This key inspection site visit took place over a six-hour period on one day. The site visit consisted of a tour of the home, meeting staff and residents, observing the care given and reading of documents. Most of the residents were seen and some were spoken to. The manager of the home was on duty and assisted with the inspection. In addition the Annual Quality Assurance Assessment (AQAA) and survey forms that were received also contributed to this report. The inspector would like to thank the staff and residents for their help and hospitality during the visit. The proprietor is planning to extend the home to create four extra bedrooms. This is currently at the planning stage. What the service does well: What has improved since the last inspection? The environment continues to improve with cleaner brighter toilets, new laundry equipment and redecoration around the home. Documentation regarding service users has improved with the introduction of new files. The smoking area has heating and lighting making it a more comfortable area for service users to smoke in. Games equipment for the service users entertainment has been purchased, including badminton nets, a dartboard and computer games. Britannia Lodge DS0000060903.V357401.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Britannia Lodge DS0000060903.V357401.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Britannia Lodge DS0000060903.V357401.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager provides enough information and time to assist the service user in deciding if the service can meet their individual needs. EVIDENCE: All service users have a service user guide given to them. However when some residents were asked about it they couldnt remember. The guide is available to all the service users if they want to read it. Some information in the service user guide needs to be updated. For example, weekly communal meetings have changed, as has the address of the Commission for Social Care Inspection. There is evidence that the home provides sufficient information to the service user, their family and placement officers to enable prospective service users to decide if the home can meet their needs. Information from the eight service users surveys that were returned indicated that six were happy with the information that they had received before they moved into the home. Two indicated that they had been at the home for some years and had no choice in their placement. However all placements have been reviewed by placement officers and are successful. The manager undertakes the pre-admission assessment. The manager is a registered nurse in mental health and has good experience in this area of care. The staff team is a mixture of mental health and general trained nurses. Most Britannia Lodge DS0000060903.V357401.R01.S.doc Version 5.2 Page 9 carers have a National Vocational Qualification (NVQ) in care. The assessment is detailed and takes into account service users differences. The assessment is done over a period of time and prospective service users have the opportunity to try the home on an overnight stay to test it for themselves. There have not been any new admissions to the home this year. There is also documentary evidence that contracts are in place and that service users have signed these. Britannia Lodge DS0000060903.V357401.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can be assured that their confidences will be kept and that their care is planned with them. EVIDENCE: Service users have a care plan that details their needs. They also have a monthly review with their key worker and daily care notes that record how they spend their day. The service users spoken with were aware of their care plan and one was able to describe how their key worker helped them. For example going out for shopping, walks and personal care tasks. One care plan that had been reviewed had not had the whole plan reviewed since 2004. This lack of evaluation also applied to a risk assessment that had not been reviewed for fourteen months. This was brought to the attention of the manager. The manager is aware of this and has addressed this mater in the AQAA form as an area for further improvement. The manager encourages service users to make their own decisions and to take responsible risks. For example one service user has gradually managed Britannia Lodge DS0000060903.V357401.R01.S.doc Version 5.2 Page 11 to go out into the community unescorted with a small amount of money to spend. The manager helps other service users manage their money by having agreed daily amounts to spend. The service users are in agreement with this as it helps with their budgeting. There is good practice regarding confidentiality at the home. A new handover system means that information is recorded and not passed on by memory. The staff handover is held in private and service users files are held securely. Britannia Lodge DS0000060903.V357401.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can expect their activities to be based on their individual capability and restrictions as set out in their care plan. Service users have good fresh food that they have chosen. EVIDENCE: The manager and staff encourage personal development and small successes have been achieved with some service users. For example one service user is now able to go out alone and will go out for a coffee. Other service users attend a drama group and took part in a Christmas play in the local community. Some service users suffer with a lack of motivation. For these service users the manager has developed activity sheets to provide stimulation in the home. For example art and beading classes, gentle exercise sessions and beauty therapy. Staff undertake activities on a one-one basis with service users. For example teaching computer games, cooking and helping with washing. Staff Britannia Lodge DS0000060903.V357401.R01.S.doc Version 5.2 Page 13 also take service users out to local cafes and walks or shopping. Feedback from five of the service users was positive indicating that they do what they want through the day. Three service users would like to go out more in the evenings. However due to restrictions this is not always possible. During the day the TV in the communal lounge is not on. All service users have a TV in their own room to watch the programmes they choose. Staff were observed to sit and talk with the service users and were polite and good mannered. For health and safety reasons the manager keeps the laundry, bathroom downstairs and office locked. Otherwise the service users have access to the entire home. As part of the routine of the home the manager likes to know when service users are going out. Family and visitors are welcome providing there are no restrictions written in the care plan. All service users spoken to and feedback from questionnaires were all complimentary about the food. The service users know the chef who involves the service users in the meal planning process. The chef is aware of individual preferences and dietary requirements and promotes healthy eating. For example the introduction of all fresh fruit and vegetables. Tea and coffee is served between meals. There are three meals a day with the main hot meal at lunchtime. Snacks and supper are available later to those who want them. Britannia Lodge DS0000060903.V357401.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager ensures that the service users have good mental and physical health care. EVIDENCE: We observed on the day of inspection that the service users that required support were handled and cared for in a gentle and sensitive way. Those that required emotional support were given time by staff and the manager to reassure them. One service user commented that one member of staff helps him and that he “gets on” with this member of staff. The manager has ensured that proper equipment is provided for those service users that need it. For example high-low beds, special mattresses, walking aids and hoists. Feedback from the service users was that staff “listen” to them and “help” them. The qualified staff at the home have a good knowledge of general and mental health care. However the manager also seeks advice from other professionals for example the tissue viability nurse and the Parkinsonism nurse. There is good evidence that health care is monitored and staff escort Britannia Lodge DS0000060903.V357401.R01.S.doc Version 5.2 Page 15 service users to out patient appointments for their physical and mental health reviews. Qualified nurses administer medication. We observed medication being given. Medication was given properly and demonstrated good practice. For those service users that require depot medication this is administered in the privacy of their own room. Medication seen is recorded and stored correctly. The manager also audits medication on a monthly basis. Following assessment some service users can administer their own prescribed creams. New residents will be assessed for their ability to administer their own medication. Britannia Lodge DS0000060903.V357401.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s policies and procedures offer protection to service users from abuse. The staff listen to service users views and act on them straight away. EVIDENCE: The complaints policy needs the address of the Commission for Social Care Inspection updating. Otherwise it is in an accessible place and service users know whom to approach if they have a complaint. There have not been any recorded complaints this year. However the manager prefers to deal with any issues as soon as they arise to stop a problem escalating. Service users had no hesitation in approaching the staff and said that staff listened to them. The manager arranges resident meetings so that the service users views can be heard. For example menu planning. The manager uses the Southend Policy on Adult protection and ensures that this information is cascaded to all staff. Staff at the home have attended the adult protection course and are aware of what abuse is. There have not been any adult protection incidents at the home since the last inspection. The manager has a safe system in place to ensure service users money is not misused. Service users know the procedure to gain access to their money if they have requested the manager to hold it securely for them. Britannia Lodge DS0000060903.V357401.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users live in a clean and comfortable home. EVIDENCE: The manager is improving the premises and service users are involved in the consultation process. For example service users choose colour schemes and equipment that they would like for the home. As identified in the AQAA the home is smoke free and the service users have a smoking cabin in the back garden. Service users commented that they are happy with the smoking area, as it is comfortable, fully accessible and has with lighting and heating. The home is comfortable and clean. The manager employs a cleaner so that care staff can concentrate on the service users activities and care. The AQAA stated that the manager has increased the cleaner’s hours. This has produced a good result as feedback from service users surveys commented that the home was clean. New laundry equipment has been fitted as well as a new oven in the kitchen. The downstairs bathroom is functional warm and clean. However unlike other Britannia Lodge DS0000060903.V357401.R01.S.doc Version 5.2 Page 18 areas of the home it looks clinical. The manager has a planned maintenance programme to upgrade areas of the home. Most recently the downstairs toilets have been refurbished making them clean and bright. However the hand wash was missing from toilet areas. The manager will investigate the best way to address this issue. Service users bedrooms are personalised and they confirmed that they can spend time in their rooms when they want to. One service user commented on the changes in the home and that they were happy there. Service users have the equipment that they require for their individual needs. For example beds, hoists, special seating cushions and mattresses. These are regularly maintained to ensure that they are safe for use by the service users and staff have been trained how to use them. The home have a policy on infection control and the manager has recently attended an updated on this topic. Generally the home was clean and there was information for staff regarding proper hand-washing techniques. Britannia Lodge DS0000060903.V357401.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users can have the confidence that the staff that look after them are trained in care EVIDENCE: The manager employs a diverse staff team that are trained in care. For example seven of the twelve care staff have an NVQ qualification. The qualified nurses have physical and mental health experience. The new staff have enrolled on the skills for care common foundation programme. This mix of skills and experience has enabled good health care to be delivered at the home. The staff were also observed to interact well with the service users. We observed them listening to service users and spending time with them. Feedback from staff was that they felt able to give the service users choice and care for them with dignity. For example a flexible approach is taken when following a service users activity schedule. So if a service user wants to do something different the staff will facilitate this. Service users confirmed this. To fill gaps in the rota the manager uses agency workers. This is usually to cover staff leave. There is always a qualified nurse on duty at each shift. They are supported by three carers in the morning and two carers in the afternoon. Britannia Lodge DS0000060903.V357401.R01.S.doc Version 5.2 Page 20 At night there is one carer and one qualified nurse. The manager works across shifts. Staff meetings occur monthly and staff are supported by regular supervision. Staff have regular training and are “keen to learn more skills”. There was only one slippage when the recruitment files were checked. This was evidence that a criminal records bureau (CRB) check had been undertaken. To ensure a robust recruitment process the manager must evidence that these checks have been undertaken. This is to ensure that staff working in the home are fit to care for vulnerable people. Britannia Lodge DS0000060903.V357401.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The manager runs the home with the service users health and safety in mind. EVIDENCE: The manager is a trained Registered Mental Health Nurse and also holds the Registered Managers Award. The manager has good experience in mental health and is competent and fit to run the care home. Feedback from one questionnaire reported that the home is “managed very well”. The manager does undertake a quality assurance review and has recently had a consultant visit the home to critique the way the home is run. The findings have not been made available to the Commission for Social Care Inspection yet however the home manager found this a very useful exercise. A random sample of safety certificates was inspected. Fire and electrical certificates were up to date. Maintenance certificates were also in date. The Gas servicing is due this month. Britannia Lodge DS0000060903.V357401.R01.S.doc Version 5.2 Page 22 The manager did not have any environmental risk assessments for the laundry, downstairs bathroom or locked front door. Health and safety is an area that the manager intends to approach as identified in the AQAA form and taking into consideration the deprivation of liberty safeguards as identified in the Mental Capacity Act 2005. Britannia Lodge DS0000060903.V357401.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 3 3 3 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 3 29 3 30 2 STAFFING Standard No Score 31 x 32 3 33 3 34 2 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 3 x LIFESTYLES Standard No Score 11 3 12 2 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 2 x Britannia Lodge DS0000060903.V357401.R01.S.doc Version 5.2 Page 24 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 YA2 Regulation 6(a) Requirement Information in the service user guide must be updated. This refers to • Weekly community meetings. • Commission for Social Care Inspection address. This is so that information about the home is accurate and contact details are correct. The manager must continue to motivate and pursue purposeful occupation for service users. This is to encourage life skills for service users and prevent boredom. Soap must be available in all toilets. This is for the purpose of good hand hygiene. The manager must evidence that staff have had the proper recruitment checks. This refers to one CRB form that was not available. This is to ensure that staff employed at the home are fit to work with vulnerable people. DS0000060903.V357401.R01.S.doc Timescale for action 20/02/08 2. YA12 16(2)(n) 20/02/08 3. YA30 16 (2)(j) 20/02/08 4. YA34 19 Schedule 2(7) 20/02/08 Britannia Lodge Version 5.2 Page 25 5. YA42 13(4)(c) Environmental risk assessments for locked areas of the home including the downstairs bathroom and laundry area must be undertaken. This is for the reasons of health and safety so that it is clear why restricted areas of the home are not safe for service users. 20/02/08 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 YA4 Good Practice Recommendations The manager should keep a record of pre admission assessments and introductory visits that prospective residents make to the home. Not inspected as no new service users have been admitted to the home. The manager should ensure that the whole care plan is evaluated as well as the monthly reviews. This is so that long-term goals can be evaluated. 2. YA6 YA9 Britannia Lodge DS0000060903.V357401.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Eastern Regional Contact Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Britannia Lodge DS0000060903.V357401.R01.S.doc Version 5.2 Page 27 - 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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