11 and 15 December 2014
During a routine inspection
We inspected Britannia House on the 11 and 15 December 2014. Britannia House is registered to provide accommodation and support to people, many of whom were elderly and living with dementia. The service can provide care and support for up to 21 people. There were 18 people living at the home during our inspection.
Britannia House is a service belonging to Britannia Care Homes (Sussex) Limited and is a family run business.
Accommodation is provided over three floors with communal lounge and dining areas. Britannia House is situated in the coastal town of Bexhill, which benefits from good rail and road public transport links and a wealth of local shops and amenities.
A manager was in post however they were not the registered manager, but had submitted an application for registration with us. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider. The previous registered manager had left the home at the end of October 2014.
People spoke positively about the service and commented they felt safe. Our own observations and the records we looked at did not always reflect the positive comments people had made.
People’s safety was being compromised in a number of areas. Medication was not administered as prescribed and its management meant that required medication was not always available when needed. Care plans did not reflect the complexities of some people’s needs and incident and accident information was not used proactively or always taken into account when reviewing risk assessments. Where injuries were sustained, this was not always reported to the local authority safeguarding team when needed. Inadequate infection control oversight meant that people were not protected from the risk of infection. The building was not adequately maintained and the equipment available did not suit everybody’s needs. Staffing levels were stretched and did not reflect the most recent needs analysis.
The provider was not meeting the requirements of the Mental Capacity Act (MCA) 2005. Mental capacity assessments were not completed in line with legal requirements. Staff were not following the principles of the MCA. We found restrictions imposed did not consider whether people could consent to these measures or if a less restrictive practice could be used. Mandatory and needs based staff training had significantly lapsed.
Although a quality assurance framework was in place, it was ineffective. This was because it did not provide adequate oversight of the operation of the service.
There were some positive aspects of care at the service. People were very complimentary about the caring nature of the staff. Staff interactions demonstrated they had built rapports with people and people responded to this positively. People told us staff were kind and compassionate and respectful of their privacy and dignity. However, we found some interactions were task led and other practices did not promote people’s dignity. It was not clear that people were actively involved in the planning of their care.
People were able to see their friends and families as they wanted. There were no restrictions on when people could visit the home. The visitor we spoke with told us they were made welcome by the staff. Everyone we spoke with was happy with the food provided. Some people enjoyed the activities provided, but other people told us they were limited and there were not enough staff to support them to go outside. Feedback was regularly sought from people, relatives and staff.