Inspection on 02/06/10 for Carr Bank House

This is the latest available inspection report for this service, carried out on 2nd June 2010.

CQC found this care home to be providing an Poor service.

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

Carr Bank House 08/12/09

Carr Bank House 22/10/09

Carr Bank House 30/06/09

Carr Bank House 17/06/08

Carr Bank House 05/07/07

Carr Bank House 11/06/06

Carr Bank House 31/10/05

Carr Bank House 03/07/05

Carr Bank House 18/08/04

Carr Bank House 01/04/04

Similar services:

Sunny Bank (P.R.S.) Ltd

Ashwood Court Unit 1

Thornton Lodge

Alfred House Residential Care Home

Barkerhouse Road (123)

Fernhaven

Thames House

Creative Support

Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Key inspection report Care homes for adults (18-65 years) Name: Address: Carr Bank House 9-11 Heywood Street Bury Lancs BL9 7EB     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Grace Tarney     Date: 0 2 0 6 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 42 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought 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 The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 42 Information about the care home Name of care home: Address: Carr Bank House 9-11 Heywood Street Bury Lancs BL9 7EB 01617977130 01617631747 jocarrbank@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Pauline Jones Name of registered manager (if applicable) Mrs Jo-Ann Yvonne Simpson Type of registration: Number of places registered: care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The home is registered for a maximum of 14 service users, in the category of Adults with Mental Disorder (MD) under 65 years of age. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection Brief description of the care home Carr Bank House is a privately owned care home for 14 adults with mental health needs. There has been no change in relation to the weekly fees. These are 365.00 pounds per week. However this may vary depending on the persons level of assessed need. The home is located in a residential area, close to Bury town centre, within easy reach of buses and trams, shops, cafes, and other local amenities. The house consists of 2 adjoining properties that have been adapted to form a large Care Homes for Adults (18-65 years) Page 4 of 42 Over 65 0 14 0 8 1 2 2 0 0 9 Brief description of the care home house. There is a small garden at the front and a large enclosed garden at the side. There are 12 single rooms and one double. Three bedrooms also have en-suite facilities. There are 2 lounges, an activities room, and a dining room. Care Homes for Adults (18-65 years) Page 5 of 42 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The staff at the home were not told that this inspection was to take place. One inspector and a specialist pharmacist inspector spent 11 hours at the home. The pharmacist inspector was needed because at the previous inspection there were serious concerns that medicines were not always given properly or handled safely. During the inspection the specialist pharmacist inspector looked at how well medicines were handled to make sure that people who live in the home were being given their medicines properly and their health was protected. During this part of the inspection we spoke to the Deputy Manager and a senior carer who had responsibility for handling medicines on the day of our visit. We also looked at care records to make sure that health and care needs of the residents were being met. Care Homes for Adults (18-65 years) Page 6 of 42 We looked at what activities were available and whether the residents were given choices about how they spent their day. We checked what the residents were having for their meals to make sure that there was a choice of menu and that they were varied and wholesome. We spent some time walking around parts of the building to check if the requirements from the last inspection had been met. We needed to check that the rooms were well decorated and suitably furnished. We checked how many staff were provided on each shift to make sure that the residents needs were being met and we also looked at staff records to see if management recruited and trained the staff properly and safely. We also looked at the system in place for handling the residents money. This is to ensure that the residents financial interests are protected. We also looked to see how the staff deal with fire safety within the home. To get more information about the home we spent a short time speaking to 2 of the residents. At the end of the inspection we spoke to the homes Manager and gave her full feedback about our findings Care Homes for Adults (18-65 years) Page 7 of 42 What the care home does well: What has improved since the last inspection? What they could do better: Whilst there has been some improvements in the care plans, staff must make sure that when there has been any change in the condition or treatment provided to a resident, that it is recorded in their care plan. This should ensure that their needs are always met. Staff must make sure that they look at everything that could pose a risk to the residents. They must then write down in the residents record when they have done this and then what action they have taken to reduce or remove the risk. This helps to protect the residents from the risk of harm. Staff must ensure when it has been identified that there is, or has been a problem with a residents weight or diet, that they are weighed and monitored as frequently as necessary. More encouragement needs to be given to the residents so that they can undertake any hobbies, college courses, or suitable employment. There needs to be an improvement in the variety and choice of food offered to the residents. Staff must ensure that timely medical assistance is called for when a resident complains of feeling unwell. Care Homes for Adults (18-65 years) Page 8 of 42 The way that medicines are handled must be improved. The handling of medicines remains unsafe. This puts the health, wellbeing and safety of the residents at risk of harm. The way that the residents finances are handled must be improved. The system presently in place is not safe, as it does not adequately protect the residents money. More staff need to be provided to ensure that the assessed needs of the residents are met at all times. Infection control procedures must be followed, especially in the food preparation areas. To protect the safety of everybody in the home, fire drills, both for staff and residents, must be undertaken on a regular basis. In addition, the checking of the fire warning system must be done as instructed. The Manager must ensure that any incidents that affect the health and welfare of the residents are reported to us. Staff must ensure that any accident that happens is reported in the accident book. The Manager must ensure that there is a more detailed system in place that looks at the quality of the service and facilities provided in the home. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 42 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 42 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admissions process does not always ensure that peoples care needs are thoroughly assessed by the staff at the home. This does not give an assurance to people that they will receive the right type of support and care. Evidence: There have been no new admissions to the home since the last inspection. The local authority has suspended admissions to the home because it is a poor service. We therefore asked the Manager to tell us about the procedure that is in place at the home for assessing any prospective resident, in the event of any admissions in the future. An assessment looks at what help, guidance and support a resident may need in all aspects of their daily life. The Manager told us that as well as receiving information from the people who pay for the care, normally the local authority, the home staff undertake their own assessment. We looked at the document that is used in the home for assessing a residents needs. Care Homes for Adults (18-65 years) Page 11 of 42 Evidence: It is called a Working Together Document. The Manager told us that she had recently asked the care staff to update the Working Together Documents that were in place in the residents files. The one that we looked at was not completed fully and was not dated. To give a true record of a residents needs and capabilities at any given time, records need to be completed fully and be dated. Care Homes for Adults (18-65 years) Page 12 of 42 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The absence of risk assessments puts the health, welfare and safety of the residents at risk. Evidence: We looked at the care plans of 3 of the residents. A care plan gives instruction and guidance to staff to show how a resident is to be supported and cared for. We saw that there had been some improvement in the care plans. Every resident had a care plan and in the care plans that we looked at we saw that the staff were, at times, now writing in when there had been any change in the residents condition or when any incident had occurred. The daily reports were also being kept with the care plan. This makes finding information a lot easier for people. We did see however that in one instance there had been confusing and contradictory information written in a residents care plan. This was in relation to when the residents medication had been stopped. It was not clear from the information written down when this had been agreed by the GP and when it had actually happened. This resident had also recently had a minor injury. The resident had been seen by the GP and prescribed some Care Homes for Adults (18-65 years) Page 13 of 42 Evidence: medication for pain relief. The Manager told us that the resident was advised by the GP to rest the injured area as much as possible. There was no record of this in the care plan. We also saw in 2 of the care plans that the residents were not being weighed as often as they were supposed to be. Both these residents had issues in relation to either their diet or weight and therefore it is important that their weight is monitored closely. The Manager told us that all the residents are to be weighed monthly. This was not however recorded in the care plans that we looked at. Inspection of the care plans showed that the residents rights to make decisions were respected. Decisions about how they wished to spend their day were recorded in their care plans. 2 of the residents told us that they could spend their day more or less as they wished. Whilst we were there we saw that some residents were sat in the smoking room and others in the front lounge watching television. We saw evidence to show that those residents who are able to, do manage their own finances. Inspection of the care files that we looked at showed that, despite there being a possible risk to the residents with some of the actions they undertook, there were no assessments in place to minimise the possible risk. We were shown the risk assessment documents for 2 of the residents. Most of the information in them was identical to the care plan. They were not risk asssessments. We discussed this concern with the Manager We were told by both the Manager and Deputy Manager that 1 of the residents was able to go out alone. There was no risk assessment for this. We were also told that this resident was allowed to make hot drinks. There was no risk assessment for this. This was of particular concern as we saw that this resident had recently had a scalding accident in the kitchen when filling a flask with hot water. Another resident had previously been involved in an incident that could have seriously affected the residents health and wellbeing. We looked to check if a risk assessment had been put in place to reduce the risk of this occurring again. No risk assessment was in place to show how the risk could possibly be minimised. Care Homes for Adults (18-65 years) Page 14 of 42 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are limited choices for activities and involvement with the local community. There is a limited choice and variety of wholesome, nutritious food. Evidence: The Manager told us that none of the residents had any sort of employment as they had no wish to do so. We were told by the Manager that 1 of the residents had started computer lessons at the local college. We spoke to this resident who told us that the lessons were enjoyable but that it was easy to forgot what had been taught. The resident told us that it would be good if there was a computer in the home to practice on. We were made aware that the majority of the residents were able to go out by Care Homes for Adults (18-65 years) Page 15 of 42 Evidence: themselves. We saw however, that there are very limited opportunities for the residents to take part in any outside programmes of activity arranged by the staff at the home. This could help enhance their quality of life. Care home staff have a key role to play in supporting the residents to live fulfilling lives outside, as well as within, the home. The staff rota that we looked at did show that the Manager was on call for 4 hours on a Saturday and Sunday for activities if required, but there was no evidence to show that the on call arrangements had been put into use. A look at the activities file shows that, in recent times, there has been 1 trip out to a garden centre and a visit to a local museum. We were told that visitors are welcome at any time. From reading care file records we were made aware that some of the residents do go out and visit family. 1 resident had recently been to a relatives birthday party. We saw in the care notes that the relative visits the home on a fairly regular basis. We saw from care and medicine records that another resident regularly spends time away from the home to stay with a relative Each resident has a key to their bedroom and we saw that the staff do not open the residents mail. We went into the residents kitchen and the main kitchen to look at food stocks and the menus. We were told that the residents make their own breakfast. The food stocks in the residents kitchen were very low. In the fridge there was only a jar of mayonnaise. On the work top and in the bread bin there was lemon curd, a few slices of bread, some cornflakes, an opened packet of biscuits and an opened packet of savoury crackers. There was no butter or margarine. The food stocks were very sparse in the main kitchen. We were told that the main shopping is done on a Thursday. Apart from there being no ingredients for the chocolate cake being made for the evening meal, most of the food required for the menu of the day was in stock. We were told that staff were bringing in the cake ingredients later. We did hear 1 resident, who was on a low fat and high fibre diet, ask for brown bread. The resident was told that there was none. We also heard 1 resident ask for custard to go with the chocolate cake but was told there was no custard. An inspection of the menus showed that there was no dessert offered at lunchtime. Staff told us that nobody asks for one. The special diets were now being documented on the menu sheets and there was a folder in the kitchen with information about different special diets. Care Homes for Adults (18-65 years) Page 16 of 42 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of medicines is unsafe and puts the health and wellbeing of the residents at risk of harm. Evidence: We were told by the Manager that each resident was able to manage their own personal care, although some residents needed prompting. We saw evidence of this in the care plans that we looked at. We did not see however, any information about whether the residents wanted a male or female to attend to any of their personal care needs. To ensure that the dignity and privacy of the residents is preserved this should be given consideration. We saw records of where some of the residents had been to see their GP for advice and treatment. We noted however that one telephone call to a residents GPs had not been recorded. This caused some confusion when we were trying to understand why there had been a change in the residents medication. We also saw in the daily notes of 1 of the residents that the resident was complaining of a painful condition during the evening. The Manager was informed that evening and Care Homes for Adults (18-65 years) Page 17 of 42 Evidence: told the staff member that the GP would be contacted the following day. Despite this, the GP was not contacted until the second day. The GP prescribed antibiotics for an infection. We have reported this to the local authority as a safeguarding incident. We saw that all areas of medicines management were unsafe and very few improvements had been made to make sure that medicines were managed safely. We also found that none of the requirements, regarding medication, which we made at previous inspections, had been met. Storage of medication had improved. Medicines were now stored in a lockable drug trolley and most medicines were supplied using a modern monitored dose system. However at the last inspection the medication which was waiting to be collected by the pharmacy for destruction, was in an unlocked container on the floor of the staff office, which was locked by means of a key pad. All staff had access to the office and residents came into the office to take their medication. At this inspection again the medication which was waiting to be collected by the pharmacy for destruction, was in an unlocked container and again all staff had access to this office and residents visited the office to take their medication. There was still no medication fridge available to store medication which might need cold storage. At the time of inspection no medicines requiring cold storage were prescribed. However many prescribed creams for minor rashes or eye drops for eye infections often require refrigeration as do some nutritional supplements, so it is of concern that there would be no suitable storage for items which could be prescribed at any time for relatively minor ailments. The food fridges at Carr Bank are accessible to staff and residents alike and are not suitable places to store medicines. At the last inspection the Manager told us that a Controlled Drug (CD) Cupboard was on order, however when we arrived in the home on this visit no CD cupboard was on the wall. During the inspection a handyman came and put a cabinet on the wall. The cabinet did not appear to meet with the strict regulations for storing Controlled Drugs safely, the paper work with the cabinet referred to it as a safe. The Manager said that she thought it was a proper CD Cupboard. To confirm this we asked her for the delivery note or invoice. She did not give us the information we requested during the inspection. It is a legal requirement to have a Controlled Drug Cabinet even if there are no Controlled drugs in the home. Some improvements had been made regarding record keeping, however the overall quality of them remained poor. The number of gaps, where staff had failed to sign to show if they had given or omitted medication had significantly reduced. We also saw that there had been some improvement in the recording of the actual dose given when there was a choice of dose, such as 1 or 2 tablets to be taken. However these records were incomplete and there was still insufficient information recorded to Care Homes for Adults (18-65 years) Page 18 of 42 Evidence: account for all medication, especially analgesics prescribed in this way. Records about medication which was taken out by residents when they were away from the home were poor. There was a record that medication had been taken out but not the exact quantity of medication given to the resident. We also found that there was no record of any medication brought back into the home. It is impossible to account for medication or check it has been taken properly if inadequate records are made which may place residents health at risk from harm. We found some records of administration could not be relied upon. Records showed one resident had been given two doses of their liquid medication; however the quantity of medication recorded for destruction was the full 500mls which had been supplied. On examination of the medication awaiting collection for destruction by the pharmacy we found a full sealed 500ml bottle. Another set of records showed that one resident had been given a dose of two different medications on one day at the beginning of May 2010, despite the fact the medication had been discontinued at the beginning of March 2010 and the records showed none had been supplied for May. The records about returns of medications were very confusing and it is difficult to tell how much reliance can be placed on them. A new system of recording medication to be returned to the pharmacy for destruction had been introduced. The quantity to be returned was recorded only on the medication administration record (MARs). Although there is a space for this information on the MARs it is good practice to transfer this information to a book so that a list of the exact quantity of medication given to the pharmacy and a receipt can be generated. This ensures that medication no longer needed is accounted for and can not be mishandled. When we looked at the returns records in relation to the two medicines which had been discontinued we found that the total quantity supplied at the start of the March cycle was returned at the end of the cycle for both medicines. However the administration records show they were both given on 12 separate occasions during March 2010. It is impossible to tell which records are accurate. The use of unexplained symbols had also stopped. The use of a star is now explained and it directs staff to record on the back of the MARs any information. We saw this symbol was mainly used when medication was given at a different time to the prescribed time. The reason for recording this type of information is to ensure that member of staff who is responsible for administering the next dose of medication refers to the information and can adjust the dosage time accordingly. During our inspection one resident took the morning dose of medication in the early afternoon. When the evening dose of medication was due the member of staff on duty gave the Care Homes for Adults (18-65 years) Page 19 of 42 Evidence: resident the evening dose without any reference to the notes on the MARs. Failure to use the information available may have placed this residents health at risk. The records about the quantity of medication received into the home had also improved however there were a number of instances when an incorrect quantity of medication received had been recorded. The manager explained that staff had just incorrectly documented the quantity when it arrived in the home. We also found medication in the medication trolley for which there was no record of it ever arriving in the home or being prescribed for anyone living in the home. A residents first name had been written, in pen, on a box of Aspirin 300mg and two tablets were missing from the box. The manager told us that she thought maybe a resident had bought them. We asked if any checks had been made to make sure it was safe for this resident to take Aspirin with their other medication. The manager told us no such checks had been made. If medication is not accounted for it could be mishandled and place residents health at risk. If residents choose to purchase their own medication, safeguards must be put in place to ensure it is safe for them to take the medication so their health is not at risk. At the last inspection we found that no changes had been made to the way medicines were ordered from the doctor. The staff in the home still did not see what medication had been ordered by the GP. In April we received information from the Manager telling us the figure of 8 system had been implemented. This system refers to a cycle of ordering medication. The Deputy Manager told us that they do not see the original prescriptions; sight of the original prescription is part of the figure of 8 system. We found some improvements had been made in the information recorded in the care plan for staff to follow about how to give medicines which were prescribed as a variable dose or when medication was prescribed when required. Some residents were given their medicines to look after when they were away from the home, and the information was now recorded to show the risk of them doing so. However the information recorded for one resident showed they were at high risk of none compliance and overdose if the resident had control of their own medication. There were details of how medication would be handled and to whom the medication would be given when this person was away from home. However there were no arrangements detailed for the safe return of medication or how staff would check if this resident had been compliant with their medicines. It was recorded that on one occasion when the resident returned to Carr Bank several doses of their pain relief tablet were missing. The records show that this resident initially claimed that the tablets had been thrown away, however later the resident admitted taking them. This Care Homes for Adults (18-65 years) Page 20 of 42 Evidence: residents health had been placed at significant risk of harm. At the last inspection we found records to show that residents did not want to look after their own medicine, but they were still given it to look after. At this inspection we found that some residents were still looking after some of their medication despite records indicating they did not wish to do so. We found that residents were not always given their medication as prescribed or at the time it was prescribed. At the last inspection we had concerns that medication which had been discontinued had been given on several occasions after it had been stopped. We found this practice continued and one resident was given their discontinued medicines on twelve occasions after it had been discontinued. Residents health and well being could be at risk if medication which has been stopped by the doctor is given against the doctors directions. We found that medication which should be given twice daily, was not given at the times it was prescribed. On the day of inspection we saw that one resident had been given medication late in the afternoon even though it should have been given in the morning. When we looked at the records of receipt and administration for the previous full month together with the medication ready to be sent back to the pharmacy for destruction, we found that this resident had not been given the medication as prescribed. There was over 7 days doses in the medication returns which had been signed for as given. We also observed that during this inspection one resident had been prescribed antibiotics but the course had not been completed. When medication is not taken properly residents health is placed at risk. The Manager sent the medication policies to the Commission in April 2010. We found evidence during our inspection that some policies were not followed. The policy about homely remedies, medicines such as Paracetamol which can be bought over the counter, states that all such medication must be entered into the stock book. During our inspection we asked for such records but the manager told us there were none. At the last inspection we found that when residents were away from the home they were given their medication in envelopes. We told the Manager this was poor practice. At this inspection we were told that this practice had stopped. We saw that one persons medicines was now supplied in a weekly blister pack and we were told another resident filled his own medication bottle up. We also found that because the residents took out labelled boxes, the remainder of their medication was just in loose Care Homes for Adults (18-65 years) Page 21 of 42 Evidence: strips in the trolley. This is very poor practice; medication can only be given from labelled containers to the person for whom it was prescribed and supplied. Not all the methods put in place by the Manager had resulted in the safe administration of medication. In the information supplied to the Commission the Manager told us that random medication audits were done by herself, her assistant and the proprietor. The information states that they have found issues with the medication system but believe that with training, these errors will be fewer. We saw one medication audit from March which indicated that the training process had started. We were not given any other evidence of medication auditing during the inspection, nor did the Manager tell us about any audits that had been done. It is important that audits, checks on medication handling, are done regularly to ensure that medication is being handled safely and residents health is protected. We asked about training and the Manager told us that a training session had taken place on 23rd April 2010. We asked for a list of staff who had attended the training. The Manager said she did not have one and she could not give us a list of attendees. We asked the Manager if any of the staff had been assessed as competent to administer medication since they had had the training almost 6 weeks ago. The Manager told us that no one had been assessed since the training. She had assessed 3 members of staff in March before any training had taken place. We asked if she had been trained in competency assessment and she told us she had not had such training. We also asked the Manager if she had had her competency assessed in medication handling and she told us she had not had any such assessment. We have reported our concerns in relation to the medication management of 3 of the residents to the Bury Local Authority Safeguarding Team. Care Homes for Adults (18-65 years) Page 22 of 42 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are systems in place to ensure that people know how and to whom they can complain. Staff have had training in recognising abuse and know what to do if it happens. This helps reduce the possible risk of harm to the residents. The system for handling the residents money is not as safe as it should be. Evidence: We looked at the complaints procedure that was given to us. It was easy to understand and explained to people how and to whom they they can complain, and how their complaint will be dealt with. It was displayed in the staff office and we were told that it had been given out to every resident. We asked to look at the Service User Guide and the Statement of Purpose to check if it had been attached to these documents. It had not been, so we advised the Manager to do so. This ensures that any person who wishes to find out information about the home can be reassured that complaints are handled properly. There is a complaints log in the home that records if a complaint has been made and how it has been dealt with. No complaints have been made either to the home or to us since the last inspection. We looked at 6 training files to see if the staff had been given training in the protection and safeguarding of vulnerable people. All these staff had undergone the Care Homes for Adults (18-65 years) Page 23 of 42 Evidence: training. We also saw that the Bury Local Authority Policy and Procedures for dealing with any mistreatment of people was in place. This helps to assist the staff in the handling of any incident that may occur. We looked at how the staff look after the residents weekly personal allowance. We saw that the majority of the residents manage their own finances. The record of 1 resident did not always show exactly how much money was actually spent or given to the resident. The amounts spent on purchases did not always correspond with the receipts obtained. The receipts showed that the goods bought did not cost as much as the amount written down as being spent. We asked the Manager and Deputy Manager to explain the difference. We were told that the money left over was given to the resident. There was no evidence to show that this was happening. We saw that this resident was charged £25.00 weekly for cigarettes but there were no receipts. The Manager confirmed that receipts were not kept. We were told that they were bought from the local supermarket. We reported these financial concerns to the Bury Local Authority Safeguarding Team. Care Homes for Adults (18-65 years) Page 24 of 42 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents now live in much better surroundings. The home is suitably furnished and decorated. The measures in place to ensure good food hygiene are not as safe as they should be. Evidence: We looked around most areas of the home to check if the requirements from the last inspection had been met. We saw that there had been a lot of improvements to the environment. The shower room and bathrooms had been refurbished and redecorated. Most of the radiators in the home had been covered so that there was less risk of any accidents occurring to the residents. We saw that the 3 radiators in the bedrooms that we identified as being without covers on the last inspection, remained without covers. We were told that this was because the residents did not want them on. A check in their care files showed that their wishes had been documented and a risk assessment had been done. The furniture in the front lounge had been replaced and this made the room a much nicer place for the residents to relax in. We did not look in all the bedrooms but were shown the bedrooms that had recently been redecorated. Care Homes for Adults (18-65 years) Page 25 of 42 Evidence: When we first arrived at the home we noticed several hairnets that had clearly been used, as they had strands of hair stuck to them. We asked what these were for and were told for use in the kitchen to cover the cooks hair. We were told that they are shared between staff. We noted that the evening carer who was cooking the evening meal was wearing a hairnet. She told us she had taken it off the shelf in the office. She was also wearing an apron that had been used by the cook during the day. Sharing protective clothing is not good infection control practice. The designated cook for during the day was wearing lots of jewellery on her arms and hands. She did not wear any protective headware whilst we were there. This is not in accordance with basic food hygiene standards. Care Homes for Adults (18-65 years) Page 26 of 42 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There has been some improvement in the way that staff are being trained and recruited. Inadequate numbers of staff put the residents at risk of harm. Evidence: We looked at 6 staff training files and saw that there had been some improvement in staff training. The care staff had recently undertaken some essential training so that they could do their job properly and safely. We were told by the Manager that medication training had been undertaken on 24/04/2010 by the local pharmacist manager. There was no evidence however to show this medication training had been done. We were told that the staff were going to receive some training the following week. This was going to be centred on the medical conditions that some of the present residents have. We were told that there had been no training as yet on mental health issues such as challenging behaviour, deprivation of liberty and other such topics that are specific to the needs of the resident group. The number of staff on duty remains low. The home continues to be staffed with only 1 care staff member on duty every day between the hours of 5pm through to the following morning at 8am. At weekends there is only 1 care staff member on duty. Care Homes for Adults (18-65 years) Page 27 of 42 Evidence: The rota that we looked at showed that the Manager was on call for 4 hrs on a Saturday and Sunday for activities if required, although we saw no evidence that she was called in. There is no cook at weekend and no cook in the evening. On the day of inspection we saw that the evening carer was cooking and serving up the evening meal. There had been 1 new member of staff recruited since the last inspection. We looked at her recruitment file and saw that she had been safely recruited. All the checks that needed to be done were in place. Care Homes for Adults (18-65 years) Page 28 of 42 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is not being managed effectively or safely. This puts the health, safety and wellbeing of the residents at risk. Evidence: The Manager of the home has been registered with us since 2003. She has not yet obtained a management qualification although she did inform us that she was hoping to have the work that she has done to date, to be accredited the following day. This would lead to her having the Registered Managers Award. The Manager of a care home has a responsibility by law to ensure that any incidents that occur in the home are reported to us. From reading the care notes of 2 of the residents we were made aware that there had been 3 incidents that should have been reported to us. The Manager had failed to do so. This had been a requirement following the last inspection of December 2009. From reading the care notes of 1 resident we saw that the resident had been involved recently in 2 accidents in the home. An inspection of the accident record book showed Care Homes for Adults (18-65 years) Page 29 of 42 Evidence: that the accidents had not been recorded. It is a legal requirement to do so. The Manager was unaware that these accidents had not been recorded. It is the Managers responsibility to ensure that records are kept in accordance with legislation. We asked to look at any work that has been done to put in place a quality assurance system. The Manager told us that she had sent out surveys to relatives, residents and professionals such as GPs and social workers. She told us that the return response was very low and as yet she had not put together the information to do a report. We asked what else was she doing to ensure that the quality of care and services being offered to the residents was what they wanted, and was of a good standard. She told us that she had started to monitor/audit the way that care plans were being written. We did see evidence that this was being done, as she had signed to state the care plans had been audited, but she had failed to pick up the omissions/ things of concern that we identified. These were things such as residents not being weighed when they should be and confusing and contradictory information. She also told us that she had been monitoring the way that medicines were being managed. From our inspection of the medicine management system it showed that her monitoring was not effective. We identified serious concerns in the way that medicines were managed but the Manager failed to do identify them. An inspection of the fire log book showed that it was not as up to date as it should have been. The fire warning system had not been checked for 11 weeks. It has to be checked weekly. We also saw that there had been no fire drills, either for the staff or the residents. Both these issues had been identified by the local fire officer during the last inspection of December 2009. We had requested a visit that day as we had concerns then about fire safety issues. When we asked the Manager about the absence of fire drills she told us that staff had received fire training. It was pointed out to her that fire drills and fire training are not the same thing. We then asked if the fire training had taken place within the home and we were told that it had not. We then asked what the procedure was in the event of the fire alarm sounding. The answer given was not what would be required in the first instance. It was evident that the Manager did not know what the procedure to follow was. What was of further concern was the fact that on first entering the home we asked the Deputy Manager how many residents were in the home and she initially told us 10, then later told us 11. Near the end of the inspection, during our feedback, the Manager told us that there were 10 residents in the home when there were actually 11. This could have had serious implications in the event of a fire. The fact that several of the residents smoke in different parts of the home was of further concern. A requirement from previous inspections was that the water temperatures throughout Care Homes for Adults (18-65 years) Page 30 of 42 Evidence: the home must be checked on a regular basis. This is to ensure that water discharges at a safe temperature. Staff were now checking and recording the water temperatures and they were recorded as being at a comfortable and safe temperature. Care Homes for Adults (18-65 years) Page 31 of 42 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 6 15 Care plans must detail the health and social care needs of the residents. So that the current and changing health and social care needs of the residents can be met. 04/01/2010 2 7 15 Information recorded on the care plan should reflect the current and changing needs of people. Without this information there is no assurance their needs and wishes will be met. 30/09/2009 3 9 13 Comprehensive risk 30/09/2009 assessments need to be reviewed and updated ensuring information is accurate. Where additional concerns have been identified these too should be included. Providing staff with information about the level of support required so that people are kept safe. 4 9 13 Staff must make sure that 04/01/2010 any risk to the health and safety of the residents is identified and action taken to reduce or stop any identified Page 32 of 42 Care Homes for Adults (18-65 years) 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action hazard. To ensure the health and safety of the residents. 5 9 13(4) Risk assessments need to clearly identify the area of risk and the level of support required to minimise such risk so that people are safe. (Outstanding requirement 30.8.07) 30/09/2008 6 17 13 Protective clothing must be worn when preparing and serving food. To help prevent/reduce the spread of infection. 04/01/2010 7 17 16 A more varied menu must be 04/01/2010 provided that is nutritious and offers choice. To ensure that the dietary and cultural needs of the residents are met. 8 17 16 Adequate food must be provided To ensure that the dietary needs of the residents are met 12/01/2010 9 19 15 Where concerns are 04/01/2010 identified in a care plan,adequate monitoring and recording must be made with regards to the weight and dietary needs of the resident. Care Homes for Adults (18-65 years) Page 33 of 42 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Ensuring the appropriate support and intervention can be provided should concerns continue. 10 19 12(1) Accurate records must be 30/08/2008 maintained with regards to peoples dietary needs as well as accurate monitoring of their weight ensuring they are supported fully and their health and well being is maintained. 11 19 15 Adequate monitoring and 30/08/2009 recording must be made with regards to the weight and dietary needs of people where concerns are identified in the care plan ensuring the appropriate support and intervention can be provided should concerns continue. 12 19 13 Timely medical assistance 28/01/2010 must be summoned when an incident occurs that affects the health and well being of a resident. To ensure the safety, health and wellbeing of a resident. 13 20 18 All staff who administer medication must receive accredited medication training ensuring they have the competence needed to administer peoples 30/10/2009 Care Homes for Adults (18-65 years) Page 34 of 42 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action medication safely. 14 20 13 There must be effective systems in place to ensure staff that handle medicines are trained in medicines handling and are competent to do so safely. To help make sure that people who live in the home are kept safe. 15 20 13 Effective arrangements must 22/12/2009 be put in place at the home to ensure that all medication records regarding receipt, administration and disposal are completed accurately. So that medicines can be fully accounted for to prevent mishandling. Records must also show that medicines are being given correctly and peoples health is not at risk from harm. 16 20 13 A Controlled Drugs cabinet must be obtained which complies with current legislation under the Misuse of Drugs Act (safe custody) Regulations, and must be fixed to a suitable wall in compliance with that legislation. To ensure the safe storage of controlled drugs and to comply with legislation. 17 20 13 There must be an effective auditing process in place to ensure that managers are 31/12/2009 04/01/2010 04/01/2010 Care Homes for Adults (18-65 years) Page 35 of 42 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action confident that medicines are being handled safely. To help make sure that people who live in the home are kept safe. 18 20 13 Effective arrangements must 22/12/2009 be put in place at the home to ensure that all medication is administered to residents in exact accordance with the prescribers directions. Because receiving medicines at the wrong dose, wrong time or not at all can seriously affect their health and wellbeing. 19 20 13 Medication administration records must be completed in full along with explanations where medication has not been given ensuring people are given their medication as prescribed and their health and well being is not affected. 20 20 13 All medicines must be stored 31/12/2009 safely and securely. Medicines must be stored safely to make sure they can not be mishandled and put peoples health at risk 21 33 18 Rotas should be kept under review 30/09/2009 30/08/2009 Care Homes for Adults (18-65 years) Page 36 of 42 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action ensuring that sufficient staffing are provided to meet the needs of the service. 22 33 18 Adequate staff must be provided. To ensure that the assessed needs of the residents are met at all times. 23 33 18(1)(a) Staffing levels should be kept 30/08/2008 under review ensuring staff are provided in sufficient numbers at times which best meet the needs of people living at the home. 04/01/2010 24 35 18 Management must 04/01/2010 demonstrate to us that all staff are to be provided with all mandatory training and training specific to the needs of the residents. To ensure that the staff have the knowledge,skills and competencies needed to support and care for the residents safely. 25 35 18(1)(c) (i) A programme of training 30/09/2008 needs to be developed for the forthcoming year so that staff receive all necessary training relevant to their roles and responsibilities ensuring they are competent to carry out their role safely. 26 35 18 All staff must be provided 30/10/2009 Page 37 of 42 Care Homes for Adults (18-65 years) 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action with good quality training specific to the needs of people living at the home. This should include areas such as mental health awareness and challenging behaviour. This is to ensure staff have the knowledge, skills and competences needed to support people safely. 27 37 12 The registered person must 30/08/2009 ensure that the care home is conducted in such a way as to promote and make proper provisions for the health and welfare of service users ensuring their safety and protection. 28 37 12 The registered person must 04/01/2010 ensure that the care home is conducted in such a way as to promote and make proper provision for the health and welfare of the residents. To ensure their safety, protection and well being. 29 39 24 Quality assurance systems need to be improved and clearly evidence that the service is being monitor and reviewed ensuring the improvements needed are addressed and a quality service is proivded. 30 42 37 All incidents which may 30/08/2009 30/09/2009 Care Homes for Adults (18-65 years) Page 38 of 42 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action affect the well being of residents must be reported to us evidencing the appropriate action has been taken. 31 42 37 Any incidents which may affect the well being of the residents must be reported to us. To show that the appropriate action has been taken. 32 42 23 Fire checks must be undertaken and recorded in accordance with the requirements of the Fire Precautions Act 1971 and Fire Precautions regulations 1997. To protect the safety and wellbeing of the residents,staff and people visiting the home 33 42 37 Any incidents, which occur that may affect the wellbeing of people, must be reported to the CSCI in line with Regulation 37. 30/09/2008 04/01/2010 04/01/2010 Care Homes for Adults (18-65 years) Page 39 of 42 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, Care Homes 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 17 An accurate record must be 25/06/2010 kept of any money received and administered on behalf of any resident. This includes the retaining of receipts for purchases made. To ensure that the residents finances are protected. 2 42 17 Any accidents that occur to residents, staff and visitors must be recorded in the accident book. It is a legal requirement to do so. Fire drills must be undertaken on a regular basis. To ensure the safety of the people living, working and visiting the home. 25/06/2010 3 42 23 25/06/2010 Care Homes for Adults (18-65 years) Page 40 of 42 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 2 Staff should ensure that any pre admission assessment of a prospective resident undertaken by them, is completed fully and that the assessment is dated. This should ensure that they receive the right type of support and care. Consideration should be given to asking the residents if they want a male or female to attend to any of their personal care needs. This information should then be recorded in their care plan. This should ensure that the dignity and privacy of the residents is preserved. Staff should ensure that good practice infection control procedures are in place in the kitchen. 2 18 3 30 Care Homes for Adults (18-65 years) Page 41 of 42 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Adults (18-65 years) Page 42 of 42 - 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!