Inspection on 09/03/10 for Hastings

We looked at the care of two people who use the service. We saw they had care plans in place. Overall, one care plan was well written, informative and person centred. For example, a thorough assessment of the person`s care needs had taken place before they moved into the home to ensure the home were able to meet their care needs. The care plan had been written using this information, ensuring information was available for staff about this person when they moved into the home. We saw a `Life Story Book` had been completed. This gave a very good overview of the person`s social background, information about their health and their individual preferences, wishes and beliefs. A thorough assessment of the person`s activities of daily living was available in the care records so staff can see at a glance important information about this person and the help they need from them. We saw the care plan was person centred and contained clear information for staff telling them the care this person needed. We saw one person had developed sore skin due to them becoming frail. We saw the District Nurses were overseeing the care of this person. We saw specialist equipment was being used to reduce the pressure on this person`s skin when they are in bed and sitting in a chair. We saw this person was currently spending all their time in bed and the care staff were changing this person`s position on a regular basis to prevent their skin becoming sore and to help the current sore areas heal. We saw that this person`s sore skin was improving due to the good standard of care they were receiving. We saw that the people we case tracked had been helped to look their best by staff, for example, people had clean cloths and their hair and nails were well looked after. We saw the staff had contacted the Doctor when the people were showing signs of being unwell and had carried out the Doctors instructions about their care. We saw staff had arranged for bloods tests to monitor the blood levels of certain specialist medication they were giving one person. The pharmacist inspector visited the home on 9th March 2010 to check the management of medicines within the service and found that there was an overall improvement in the management and control of medication.We saw that all medication was stored securely. Medication requiring storage in a controlled drug cabinet was stored correctly and met the legal requirements. We saw that peoples medication were stored neatly and easy to locate. This means that medication is safe and therefore the people who live in the service are protected from harm. We looked at the medication administration record (MAR) charts and overall found that they were well documented with a signature for administration or a reason was recorded if medication was not given. We saw that the times of administering medicines were clearly highlighted on the MAR charts with clear directions recorded for the administration of medicines that needed to be given at special times. For example,we saw that one person was to be given a tablet once a week before breakfast. There were clear directions available for staff to follow to ensure the medicine was given according to the prescribers instructions. This ensured that staff knew when to give medicines. Two members of staff checked the medicine records for accuracy and detailed the reason for any changes directly onto the MAR chart. This helped to ensure that accurate medicine records were available for people living in the home. For example, we looked at the medicine records for a person who had recently been admitted to the home. The person had been prescribed five medicines. We found that four out of the five of the medicines were accurately recorded and had been signed as given on the MAR chart. One of the medicines, a scalp application to treat a severe inflammatory skin disorder, had not been signed. We checked the bottle available, located inside the medicine trolley, which had not been opened. The storage of medicines for external use should not be stored with medicines for internal use to prevent contamination. We discussed these findings with the manager who agreed that the scalp application should not be stored in the medicine trolley next to internal medicines and also that the application had not been applied according to the directions of the prescriber. The manager dealt with this finding immediately and contacted a relative to check when the scalp application needed to be applied. This means that overall there are arrangements in place to ensure that medication is administered as directed by the prescriber, however the service needs to ensure that all medicine preparations are given according to directions. We found that other medication records were generally up to date. For example, we saw current records for the receipt and disposal of medication. We saw that written informatio from a GP relating to peoples medicines, such as changes to a dose, were kept next to their MAR chart for staff to refer to. These records helped to ensure there was a clear audit trail of medication. We found that counts and checks made on medication were accurate, which showed that people who live in the service were being given medication as prescribed by a medical practitioner. Overall We saw better documentation, records and checks made on peoples medicines and therefore the requirements for medication from the previous inspection had been met.

What the care home could do better:

The quality of the second care record we looked at was not so good. The second care plan had not been reviewed throughly, it was not person centred, it was not up to date and did not provide enough information about the care needs of the person using the serviceto support the care being delivered by the staff in the home. We found this person was experiencing good outcomes of care, but due to the poor quality of the care records, this places this person at risk of not receiving a consistent standard of care. The following are examples of areas where further improvement could be made. The home need to ensure they assess peoples skin condition on admission and record this information in a care plan, to ensure they have a record of any skin breaks or injuries to peoples skin when they move into the home. Staff need to ensure they take into account peoples physical and mental health needs when they are completing nutritional risk assessments, as this can make a difference to the outcome of the risk assessment. If the outcome of the risk assessments is they are `at risk` nutritionally, then staff need to ensure a care plan is put into place. The storage of medicines for external use should not be stored with medicines for internal use to prevent contamination. The service needs to ensure that all medicine preparations, including external preparations are given according to directions. If people are at risk of developing pressure sores and they need assistance from staff to change their position to prevent their skin from becoming sore; the frequency of position changes and when this is carried out by staff must be clearly recorded in the care plan at all times. If specialist equipment is in use, such as an air mattress, the setting for the mattress needs to be recorded in the care plan so staff can check the mattress to ensure it is set correctly and is functioning properly. Moving and handling risk assessments need to specify all the equipment needed to be used by the staff for each individual person. For example, the type of hoist and sling size and any equipment used to move people if they are spending all their time in bed. This is to ensure the safety of the people using the service and the staff giving the care. The home need to ensure people who are spending all their time in bed have access to social activities of their choice and care plans do not state, the person is staying in bed most of the time, `so has been unable to join in activities`. We spoke to three staff about the care of the people whose care we tracked. We found two staff had a reasonable knowledge of their care needs, but one senior carer could give us no information at all about one person we talked about with them. We spoke to senior care staff and the manager and asked them if there had been any care planning training since the key inspection in November 2009, as we had made a requirement about the quality of the care plans following this inspection. They told us none had taken place. This inspection has highlighted that staff need training in this area to ensure the care plans are all of a consistently good quality. The findings from a visit made by a representative of the organisation in February 2010 also stated, `there is more work to be done on the review and development of individual care plans`. We looked at the content of the monthly visit reports carried out by a representative of the organisation. The manager confirmed these visits are now unannounced, but we found they are not being done in accordance with the Regulation. This requirement from the last inspection has not been met.

Extracts from inspection reports are licensed from CQC, this page was updated on 16/05/2010.

Random inspection report Care homes for older people Name: Address: Hastings 130 Barnards Green Road Malvern Worcestershire WR14 3NA one star adequate service 11/11/2009 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: Sandra Bromige Date: 0 9 0 3 2 0 1 0 Information about the care home Name of care home: Address: Hastings 130 Barnards Green Road Malvern Worcestershire WR14 3NA 01684585000 Telephone number: Fax number: Email address: Provider web address: hastings@heart-of-england.co.uk www.heart-of-england.co.uk Name of registered provider(s): Name of registered manager (if applicable) Ms Johann Phelps Type of registration: Number of places registered: Conditions of registration: Category(ies) : Heart of England Housing and Care Limited care home 60 Number of places (if applicable): Under 65 Over 65 0 60 0 dementia old age, not falling within any other category physical disability Conditions of registration: 60 0 60 The maximum number of service users who can be accommodated is: 60 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 60 Dementia (DE) 60 Physical Disability (PD) 60 Date of last inspection 1 1 1 1 2 0 0 9 Care Homes for Older People Page 2 of 12 Brief description of the care home This purpose built home is situated in a residential area of Malvern. There are local amenities a few hundred yards from the home and public transport to Malvern town centre. The home is purpose built on three floors, has shaft lift access throughout and handrails appropriately placed. There are 24 single bedrooms on each of the two upper floors and 12 single rooms on the ground floor. Each bedroom has en-suite facilities. Each floor has lounge and dining areas for the residents and communal toilets and bathrooms fitted with suitable aids. There is also a level garden. The registered provider is Heart of England Housing and Care Ltd. Mrs Phelps is the registered manager, although she is currently on secondment to another post within Heart of England and the interim manager is Mrs Sue Milward. The responsible individual for the company is Ms. M Shawcross. Care is provided for a maximum of 60 service users over 65 years of age of either sex who may require care due to old age, a physical disability or a mental health problem. Up-to-date information relating to the fees charged for the service is available on request from the home. Care Homes for Older People Page 3 of 12 What we found: This was an unannounced inspection which took place over one day and was carried out by one Inspector and a Pharmacist Inspector. The reason for the visit was to see if the service had complied with the seven requirements made at the key inspection in November 2009. We found good outcomes of care for the people whose care we tracked and due to this made a judgement that the service have complied with six out of the seven requirements, which relate to the health, safety and welfare of the people who use the service. We found the organisation had not complied with the requirement about how they monitor the quality of the service being provided to the people who live in the home. What the care home does well: We looked at the care of two people who use the service. We saw they had care plans in place. Overall, one care plan was well written, informative and person centred. For example, a thorough assessment of the persons care needs had taken place before they moved into the home to ensure the home were able to meet their care needs. The care plan had been written using this information, ensuring information was available for staff about this person when they moved into the home. We saw a Life Story Book had been completed. This gave a very good overview of the persons social background, information about their health and their individual preferences, wishes and beliefs. A thorough assessment of the persons activities of daily living was available in the care records so staff can see at a glance important information about this person and the help they need from them. We saw the care plan was person centred and contained clear information for staff telling them the care this person needed. We saw one person had developed sore skin due to them becoming frail. We saw the District Nurses were overseeing the care of this person. We saw specialist equipment was being used to reduce the pressure on this persons skin when they are in bed and sitting in a chair. We saw this person was currently spending all their time in bed and the care staff were changing this persons position on a regular basis to prevent their skin becoming sore and to help the current sore areas heal. We saw that this persons sore skin was improving due to the good standard of care they were receiving. We saw that the people we case tracked had been helped to look their best by staff, for example, people had clean cloths and their hair and nails were well looked after. We saw the staff had contacted the Doctor when the people were showing signs of being unwell and had carried out the Doctors instructions about their care. We saw staff had arranged for bloods tests to monitor the blood levels of certain specialist medication they were giving one person. The pharmacist inspector visited the home on 9th March 2010 to check the management of medicines within the service and found that there was an overall improvement in the management and control of medication. Care Homes for Older People Page 4 of 12 We saw that all medication was stored securely. Medication requiring storage in a controlled drug cabinet was stored correctly and met the legal requirements. We saw that peoples medication were stored neatly and easy to locate. This means that medication is safe and therefore the people who live in the service are protected from harm. We looked at the medication administration record (MAR) charts and overall found that they were well documented with a signature for administration or a reason was recorded if medication was not given. We saw that the times of administering medicines were clearly highlighted on the MAR charts with clear directions recorded for the administration of medicines that needed to be given at special times. For example,we saw that one person was to be given a tablet once a week before breakfast. There were clear directions available for staff to follow to ensure the medicine was given according to the prescribers instructions. This ensured that staff knew when to give medicines. Two members of staff checked the medicine records for accuracy and detailed the reason for any changes directly onto the MAR chart. This helped to ensure that accurate medicine records were available for people living in the home. For example, we looked at the medicine records for a person who had recently been admitted to the home. The person had been prescribed five medicines. We found that four out of the five of the medicines were accurately recorded and had been signed as given on the MAR chart. One of the medicines, a scalp application to treat a severe inflammatory skin disorder, had not been signed. We checked the bottle available, located inside the medicine trolley, which had not been opened. The storage of medicines for external use should not be stored with medicines for internal use to prevent contamination. We discussed these findings with the manager who agreed that the scalp application should not be stored in the medicine trolley next to internal medicines and also that the application had not been applied according to the directions of the prescriber. The manager dealt with this finding immediately and contacted a relative to check when the scalp application needed to be applied. This means that overall there are arrangements in place to ensure that medication is administered as directed by the prescriber, however the service needs to ensure that all medicine preparations are given according to directions. We found that other medication records were generally up to date. For example, we saw current records for the receipt and disposal of medication. We saw that written informatio from a GP relating to peoples medicines, such as changes to a dose, were kept next to their MAR chart for staff to refer to. These records helped to ensure there was a clear audit trail of medication. We found that counts and checks made on medication were accurate, which showed that people who live in the service were being given medication as prescribed by a medical practitioner. Overall We saw better documentation, records and checks made on peoples medicines and therefore the requirements for medication from the previous inspection had been met. What they could do better: The quality of the second care record we looked at was not so good. The second care plan had not been reviewed throughly, it was not person centred, it was not up to date and did not provide enough information about the care needs of the person using the service Care Homes for Older People Page 5 of 12 to support the care being delivered by the staff in the home. We found this person was experiencing good outcomes of care, but due to the poor quality of the care records, this places this person at risk of not receiving a consistent standard of care. The following are examples of areas where further improvement could be made. The home need to ensure they assess peoples skin condition on admission and record this information in a care plan, to ensure they have a record of any skin breaks or injuries to peoples skin when they move into the home. Staff need to ensure they take into account peoples physical and mental health needs when they are completing nutritional risk assessments, as this can make a difference to the outcome of the risk assessment. If the outcome of the risk assessments is they are at risk nutritionally, then staff need to ensure a care plan is put into place. The storage of medicines for external use should not be stored with medicines for internal use to prevent contamination. The service needs to ensure that all medicine preparations, including external preparations are given according to directions. If people are at risk of developing pressure sores and they need assistance from staff to change their position to prevent their skin from becoming sore; the frequency of position changes and when this is carried out by staff must be clearly recorded in the care plan at all times. If specialist equipment is in use, such as an air mattress, the setting for the mattress needs to be recorded in the care plan so staff can check the mattress to ensure it is set correctly and is functioning properly. Moving and handling risk assessments need to specify all the equipment needed to be used by the staff for each individual person. For example, the type of hoist and sling size and any equipment used to move people if they are spending all their time in bed. This is to ensure the safety of the people using the service and the staff giving the care. The home need to ensure people who are spending all their time in bed have access to social activities of their choice and care plans do not state, the person is staying in bed most of the time, so has been unable to join in activities. We spoke to three staff about the care of the people whose care we tracked. We found two staff had a reasonable knowledge of their care needs, but one senior carer could give us no information at all about one person we talked about with them. We spoke to senior care staff and the manager and asked them if there had been any care planning training since the key inspection in November 2009, as we had made a requirement about the quality of the care plans following this inspection. They told us none had taken place. This inspection has highlighted that staff need training in this area to ensure the care plans are all of a consistently good quality. The findings from a visit made by a representative of the organisation in February 2010 also stated, there is more work to be done on the review and development of individual care plans. We looked at the content of the monthly visit reports carried out by a representative of the organisation. The manager confirmed these visits are now unannounced, but we found they are not being done in accordance with the Regulation. This requirement from the last inspection has not been met. Care Homes for Older People Page 6 of 12 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 Older People Page 7 of 12 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 15(1)(2) Care plans must be 17/01/2010 sufficiently detailed and care needs reviewed as peoples needs change. To ensure staff understand what is required and people can be sure their needs will be met. 2 9 13 13(2) To make arrangements 17/01/2010 to ensure the administration of prescribed medication is recorded on the medication records. To ensure people who use the service are receiving the medication as prescribed. 3 9 13 13(2) To make arrangements 17/01/2010 to ensure that care plans include detailed information and instructions for staff un respect of administration and management of medicines, including the reasons to give medicines when required and what constitutes needed for the named person. This is to ensure that there are clear directions for care staff to give medicines prescribed when required. Care Homes for Older People Page 8 of 12 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 4 9 13 13(2) To make arrangements 17/01/2010 to ensure that medication is stored securely at the correct temperature recommended by the manufacturer. This is to ensure that medication does not deteriorate which can make the medication ineffective and possibly harmful to people living in the home. 5 9 13 13(2) To make arrangements 14/02/2010 to ensure that controlled drugs are stored in accordance with the requirements of the Misuse of Drugs Act 1971, the Misuse of Drugs (Safe Custody) Regulations 1973 and in accordance with the guidelines from the Royal Pharmaceutical Society of Great Britain. This is in order to ensure that controlled drugs are stored safely to prevent misuse. 6 30 12 12(1) You must ensure that staff have the correct skills and competences to enable them to carry out their role effectively. So that people are not placed at risk of harm through neglect of care. 17/01/2010 7 33 26 The provider must carry out monthly unannounced visits to the service in accordance 27/12/2009 Care Homes for Older People Page 9 of 12 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 with this regulation, prepare a written report and supply a copy to the registered manager. To ensure they monitor the quality of the service being provided to the people who live in the home. Care Homes for Older People Page 10 of 12 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 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 Care Homes for Older People Page 11 of 12 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 Older People 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial 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. 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