This is the latest available inspection report for this service, carried out on 29th July 2009.
CQC found this care home to be providing an Excellent service.
The inspector found no outstanding requirements from the previous inspection report,
but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.
Random inspection report
Care homes for adults (18-65 years)
Name: Address: 62-66 Windermere Road 62-66 Windermere Road Up Hatherley Cheltenham Gloucestershire GL51 5PL three star excellent service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: David Jones Date: 2 9 0 7 2 0 0 9 Information about the care home
Name of care home: Address: 62-66 Windermere Road 62-66 Windermere Road Up Hatherley Cheltenham Gloucestershire GL51 5PL 01242242684 Telephone number: Fax number: Email address: Provider web address: www.brandontrust.org Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : The Brandon Trust care home 12 Number of places (if applicable): Under 65 Over 65 0 0 learning disability physical disability Conditions of registration: 12 12 The maximum number of service users who can be accommodated is 12. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Learning disability (Code LD) Physical disability (Code PD) Date of last inspection Brief description of the care home Windermere Road currently has eleven bedrooms, as two rooms have been used to make one large one to meet a persons specific need. The home provides residential nursing accommodation for adults with learning and physical disabilities who may have complex needs, and a qualified nurse is always on duty. The home is situated within an area that has easy access to Cheltenham town centre. The home benefits from being
Care Homes for Adults (18-65 years) Page 2 of 11 Brief description of the care home on the main route into Cheltenham where public transport can be accessed. The accommodation consists of three connected bungalows, two with four single bedrooms, one with three single bedrooms, and all bungalows have a fully adapted bathroom and a lounge diner. The home has a well-equipped sensory room. There is a pleasant garden with an accessible patio and raised flowerbeds. The front of the property has ample space for car parking. The home is run by Brandon Trust and Advanced Housing manage the property, which include all the repairs. The fees range from 1200 pounds per week. The assessment of fees are calculated according to needs assessment. All personal items are not included in the fees. Care Homes for Adults (18-65 years) Page 3 of 11 What we found:
At this random inspection one of our (the Care Quality Commission) pharmacist inspectors specifically examined some of the arrangements for the handling of medicines. The manager has kept us informed about some problems with medication earlier in the year and the actions taken to deal with these. Our inspection was therefore to check that there were still safe arrangements in place for administering and handling medicines in this home. We looked at some stocks and storage arrangements for medicines and various records about medication. We spoke to the manager and deputy manager. We gave feedback during the inspection to the manager. The inspection took place during a three and a quarter hour period on a Wednesday morning. We thank the staff for their assistance during our visit and the positive way in which they approached this inspection. At the time of this inspection no people living in the home were assessed as able to self medicate and look after their medicines so they were totally dependent on the staff for this part of their care. Registered nurses were responsible for handling and administering all medicines to people living in the home. During the period of our inspection staff administered medicines to people living in the home on time and were aware of the importance of this. We discussed the times for giving medication, particularly about making sure that there is at least a four hour interval between doses of certain medicines and of achieving an even spread of doses throughout the day. This helps get the best effect from medicines such as painkillers and antibiotics. We saw that there was information kept about each persons choices or preferences and consent issues for medication along with reference to their best interests statements where needed. We looked at records for one person who has medication administered in a particular way and saw that these had been developed to make sure that their best interest was considered. The manager told us there had been no changes since this had been written in 2007 but there should be a way to demonstrate that this sort of information is regularly reviewed. We also spoke to the manager and deputy about any cultural or equality and diversity issues affecting medication for people living in this home and they told us that there was nothing related to medication they have identified at the moment. There were arrangements for keeping records about medication received, administered and leaving the home or disposed of (as no longer needed) for each person living in the home. Accurate, clear and complete records about medication are very important in a care home so that people are not at risk from mistakes with their medicines and so that there is a full account of the medicines the home is responsible for on behalf of the people living there. We found that the home kept comprehensive records about medication and in recent months had made a number of changes. One of the more critical records was the preparation of the medicine administration record charts each month. Two registered nurses were now responsible for this in a planned and coordinated way in order to make sure that the records are up to date and accurate and so reduce the risk of mistakes that have sometimes occurred in the past. We pointed out the medicine name on one chart (Calcichew) was different from that on the copy of the original prescription (Calcichew D3). Care was also needed with dose units. We pointed out an example written in milligrams (mg) that should have been in micrograms (mcg). Care Homes for Adults (18-65 years) Page 4 of 11 We found that routinely administered medicines were generally signed as administered. This indicated that people living in the home were receiving their medicines as prescribed. We also made some checks of the packs of medicines on the trolley which also helped to confirm this. We found the right records in place for two other spot checks we made of medicines on the trolley. The home has in place a system of twice daily counts of medicines so should be able to identify very quickly if people living in the home may have missed their medicines or if there is some other discrepancy. We found some very occasional gaps on a medicine administration record for one person we looked at. We could not tell the reason for this as no explanation was provided. This may be because this person did not have the medicines or the staff may have given the medicine but forgotten to sign the record. An explanation must always be included on the medicine chart. A simple way to do this is for all staff to use standard code letters to explain why a dose was missed. Another person was prescribed a medicated patch that has to be changed every three days. We found that there were conflicting records recently during the period 19 to 24 July 2009 that indicated staff had not changed the patch at the right interval. The manager was not able to find an explanation for this during the inspection but was going to investigate further. It is very important where doses are given at set intervals like this that the records are very clearly marked to alert staff to when the next dose is due. The same principal would also apply to another medicine we saw where a particular tablet was given once each week. A number of people were prescribed various liquid feed supplements. There was information for staff about using these but we only saw a record for when these were given for one person. The manager told us that this sort of record was not kept. We have published information about administration and recording of creams and nutritional supplements on our website (www.cqc.org.uk) so this must be followed. Similarly records must be kept of all prescribed creams and ointments that staff apply. This is so to help make sure that people living in the home receive their correct treatment. We saw that there were some detailed written protocols in place with information for some people who were prescribed particular medicines to use in certain defined medical situations. These were to help guide staff with making decisions about using these medicines in a consistent way to meet each persons identified needs. We also saw there were protocols in place for laxatives and painkillers that were prescribed to use when required but pointed out that more specific guidance for staff would be beneficial. The manager told us she would include additional information. Cross referencing with any communication plans may be useful to consider. The home have recently purchased a medicine trolley that is used to help with administering medicines for everyone living in the home. The staff we spoke to thought that this was a better system. The link inspector had recommended at a previous inspection that this would be a safer system for everyone in the home so it is good that this has been implemented. We looked at the other arrangements provided for storing the medicines and although these were generally suitable there were some matters needing attention. The cleaning materials kept in the medicine room (for safety reasons) must be stored properly separated from any medicines. The medicine fridge was too cold at the time we inspected
Care Homes for Adults (18-65 years) Page 5 of 11 (below freezing point); this could lead to degradation of medicines stored in here. There were arrangements for recording the temperature in the medicine fridge and these also showed that it had previously sometimes been too cold but the last time there was a record was on 3rd July 2009. The temperature control on the fridge was adjusted during the inspection and the manager said she would monitor this. We checked the items in the fridge and nothing was frozen. We advised that a number of items kept in the fridge could in fact be kept at room temperature. Controlled medicines were stored in a double locked cupboard but this was the old hospital specification so did not comply with the current regulations for storing these medicines in care homes in terms of construction and fixing to the wall. (We publish information about storing controlled drugs on our website www.cqc.org.uk.) There was a standard record book in place for keeping the extra records needed for this group of medicines. We advised it would be good practice to also keep records of another injection in here. Oxygen cylinders were kept to use in certain medical emergencies. These were stored safely and with written protocols about how and when to use. There were warning notices displayed. We provided information about the full wording for the warning notices. There were detailed medication procedures in place which the manager had revised in March 2009 and all staff were provided with a copy. There is therefore clear information available about how the company expects medication to be safely managed. We did have to point out to the manager that the arrangements for the disposal of controlled medicines were not correct for a care home with nursing. We have published information about the safe disposal of waste medicines and controlled drugs on our website (www.cqc.org.uk) so this must be followed. The manager told us that update training for the registered nurses had not yet taken place but was planned with the local pharmacist later in the year. An action plan we received from the home indicated that there would also be regular spot checks around medication for each staff member but these were not yet in place. The manager told us that she said does include medication issues in two-monthly supervision or team meetings. We also discussed involvement of carers with the administration of medicines and that this could be a nurse delegated task. The carers would need proper training and that delegation would have to be by an individual nurse at each shift as that nurse would ultimately carry responsibility for what happened on their shift. This issue was covered in the home procedures but they need to make sure that it is clear about the delegation by each nurse. What the care home does well: What they could do better:
Make sure that any individual plans, protocols or statements around medication are regularly reviewed and dated when reviewed.
Care Homes for Adults (18-65 years) Page 6 of 11 Give consideration to printing a standard code on each medicine chart for all staff to use to explain if a medicine dose is missed. Also consider providing a specific space to write the full start date on each medicine chart to help make sure it is always clear to what period each chart refers. Make sure that medicines are always given at the right dose intervals and that medicines charts are very clear when doses are not given daily (every three days or weekly for example). The manager must try and determine what happened with the changing of the medicated patch during the period 19 to 24 July 2009 as identified above in this report and see if any further improvments can be made to reduce the likelihood this sort of discrepancy occurring again. Keep records for all prescribed food supplements that staff administer or creams and ointments that they apply topically to people living in the home. Review protocols for laxatives and painkillers prescribed to use when required to make sure that these give more guidance to staff about specific triggers to watch for especially where the people in the home are not able to ask when they need these. Revise some storage arrangements so as to keep any cleaning materials stored in the medication room properly separated from any medicines. Make sure that medicines kept in the fridge are always kept in the correct temperature range of 2 to 8 degrees centigrade. Keep daily records of the fridge temperature and always take action if this is outside of the right range for storing medicines. Always read the manufacturers instructions about the right temperature for storing medicines and make sure that these are followed. Upgrade the storage arrangements for controlled drugs to comply with the Misuse of Drugs (Safe Custody Regulations) 1973. Include the injection identified at the inspection in the controlled drug record book so as to provide a better account of this. Change the policy and arrangements for the disposal of controlled drugs in order to comply with the current law. Use the full warning in areas where oxygen cylinders are displayed or used. Provide additional update training for staff involved with medication and formal assessment of their competence. One of the medicine reference books should be updated to the September 2009 edition when published (the manager told us she would order this), so that staff have access to up to date and accurate information about medicines they administer. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Adults (18-65 years) Page 7 of 11 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 8 of 11 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 20 13 Make sure that the medicine 31/08/2009 fridge is always kept in the correct temperature range of 2 to 8 degrees centigrade and action is always taken to correct this if it is found to be at the wrong temperature. This is to make sure that medicines are stored at the right temperature as directed by the manufacturers in order to maintain their correct potency and not put people living in the home at risk from taking medicines that are no longer stable. 2 20 13 Update storage 30/09/2009 arrangements so that the provisions of the Misuse of Drugs (Safe Custody) Regulations 1973 are complied with when any controlled drugs are kept in the home. Make sure that any controlled drugs that are no longer needed in the home are correctly disposed of using a denaturing kit and in accordance with the
Page 9 of 11 Care Homes for Adults (18-65 years) Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action Special Waste Regulations 1996. This is to make sure of safe storage and disposal of these medicines and to comply with the law. 3 20 13 Always keep accurate, clear 31/08/2009 and complete records of any medication and prescribed products administered to people who live in the home. This particularly relates to keeping records about all prescribed food supplements and topical medication administered or applied. This is to help make sure all medication is accounted for, that people receive their prescribed treatments correctly and are not at risk of mistakes because of poor recording arrangements. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 20 Include more detail in the written guidance to staff on how to reach decisions for any medicine prescribed to be administered when required and how staff are to reach the decision to administer in accordance with the provisions of the Mental Capacity Act 2005. (This particularly refers to analgesics and laxatives). Make sure that cleaning materials are stored properly segregated from any medication. 2 20 Care Homes for Adults (18-65 years) Page 10 of 11 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 11 of 11 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
