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Inspection on 07/01/10 for ICS 2 Laurel Drive

Also see our care home review for ICS 2 Laurel Drive for more information

This is the latest available inspection report for this service, carried out on 7th January 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home is clean, spacious, well decorated and nicley furnished, creating a homely environment for people. The home ensures that peoples` healthcare needs are addressed. Peoples` basic care and support needs are met, and they looked comfortable and content in their surroundings. The care assistants spoken with had a good understanding of the clinical reasons why the medicines had been prescribed enabling them to support the persons clinical needs better.

What the care home could do better:

The home must improve its admission process, and ensure that the relevant referal documentation is sought prior to agreeing to offer a place.The home must improve its care planning and risk assessment processes so that people can be confident that their assessed needs will be met appropriately. The home must ensure that people are offered a varied selection of activities that reflect and include their interests and any hobbies that they may have. The medicine management must improve to safeguard the health and well being of the people who use this service.

Random inspection report Care homes for adults (18-65 years) Name: Address: ICS 2 Laurel Drive 2 Laurel Drive, The Bridleways Hartshill Nuneaton Warwickshire CV10 0XP two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Justine Poulton Date: 0 7 0 1 2 0 1 0 Information about the care home Name of care home: Address: ICS 2 Laurel Drive 2 Laurel Drive, The Bridleways Hartshill Nuneaton Warwickshire CV10 0XP 02476393496 01527546888 allan.smith@individual-care.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Individual Care Services Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 5 Number of places (if applicable): Under 65 Over 65 0 learning disability Conditions of registration: 5 The maximum number of service users who can be accommodated is: 5 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: Learning disability (LD) 5 Date of last inspection Brief description of the care home 2 Laurel Drive is a purpose built bungalow situated in a small residential estate in the village of Hartshill, near the town of Nuneaton in Warwickshire. The home is registered for five younger adults with learning disabilities. The home is within walking distance Care Homes for Adults (18-65 years) Page 2 of 12 Brief description of the care home of local facilities and amenities. The home has use of its own transport, which can accommodate wheelchairs. The shared space in the home consists of a lounge, dining room, kitchen, two bathrooms and shower room. There are six bedrooms, one of which is used as a sleep in room for staff. There is also a utility room housing the laundry facilities. There are well-maintained gardens to the rear and sides of the property. Care Homes for Adults (18-65 years) Page 3 of 12 What we found: This random inspection visit was undertaken to assess compliance against key national minimum standards. The visit lasted three and a half hours and was undertaken by a regulation inspector and a pharmacy inspector. Their findings are presented separately within the body of this report. The home has not had a registered manager in post for at least twelve months. At the time of this visit the home was being managed by an acting manager who told us that she had been in post since November 2009. She also told us that she is being supported by a registered manager from another of the organisations homes for one day a week. She told us that this is to work on rewriting peoples support plans, which include care plans and risk assessments. Two support workers were on duty during the inspection. The acting manager arrived during the visit and the supporting manager arrived shortly before the visit ended. For this visit we chose to case track someone who has moved into the home within the last twelve months. This was so that we could assess the services admissions procedure, care planning processes and medication management. We looked at this persons support plan. We could not find a Community Care Assessment or Community Care plan detailing the persons care and support needs. We would expect this to be the main referral document that the service uses to determine whether a placement would be appropriate. We did see a faxed copy of an NHS Healthcare Checklist however this was not dated or signed and there was no supporting letter with it. We asked the acting manager if this was the formal referral document. She said that she was unsure as the admission had taken place prior to her being appointed. The supporting manager said that she was aware that the transition from the persons previous placement into Laurel Drive had not been a good one. We were also unable to find any assessment documentation completed by the home prior to the person moving in or indeed after. There were no records the person visiting the home prior to moving in and no review documentation after a trial period to confirm whether it was an appropriate placement that could meet the persons needs. We saw care plans and risk assessments that had been provided by the persons previous placement. We were told that these were of no use as they persons needs had changed drastically very quickly and they were no longer reflective of their abilities and skills. We were also told that the persons needs, skills and abilities had continued to change since moving in to the home and they now required full support with all of their daily functions. We looked for care plans and risk assessments relating to the persons needs, skills and abilities, and were told that none had been put in place since they moved into the home. The acting manager said that this was now being addressed. We read a care plan for eating and drinking that had been completed in December 2009. We also read guidelines that had been compiled for showering and dressing by the acting manager. These provided step by step tasks for supporting the person with this. No other care plans or guidelines were available to provide staff with information on how to meet Care Homes for Adults (18-65 years) Page 4 of 12 assessed needs. We saw information that confirms that this person is being supported with their healthcare needs appropriately. Records were in place detailing visits to routine healthcare professionals such as the dentist, Dr and district nurse. The outcome of each appointment was recorded along with any action that was necessary. We also saw appointment records and reports from more specialised healthcare professionals such as a physiotherapist, dietician, speech and language therapist and continence nurse. We asked whether there was an activities programme in place for the person we case tracked as there were no records of any interests, hobbies or activities in their support plan. We were told that they like staff to chat to them and to go out. During the visit all five people living in the home sat in the lounge and watched Mamma Mia on DVD. No other activities were offered to anyone during the visit. As recorded later in this report, the pharmacist inspector looked at four care plans in relation to medication and clinical needs. We saw that information within three of these care plans was identical within the healthcare sections, and included statements such as X is prone to chest infections and requires a bath in the evening instead of the morning, demonstrating that the care plans were not person centred or appropriate to peoples individual needs The pharmacist inspection lasted two and a half hours. Four peoples medicines were looked at together with their Medicine Administration Record (MAR) charts and care plans. Two support workers were spoken with and all feedback was given to the acting manager. The home stored all the medicines in a locked cabinet. The medicines were not stored in individual containers within this making it quite difficult to find the medicines for each person. It was agreed that individual lidded boxes would be purchased to improve the storage. All the prescriptions were seen prior to dispensing and a photocopy taken but it was noted that they were not used to check in the medicines and MAR charts as intended as one error was seen and it could not be demonstrated whether it was a dispensing or prescribing error and no action had been taken to check and address the error. The MAR charts recorded many medicines that were no longer prescribed. These had not always been deleted even though there were no medicines to actually administer, so it was unclear why they were still recorded on the MAR chart to administer. In one instance there were two duplicate MAR charts for the same medicine. Staff were unsure what to do with the extra MAR chart so kept them together. This may increase the risk of duplicate recording or actually administering the medicine twice. We were assured that the pharmacist had been spoken with and for the following cycle, only the current medicine regime would be recorded on the new MAR chart. The quantities of the medicines received into the home were recorded, but not all the balances carried over from previous cycles. The majority of medicines though could be audited. These indicated that not all the medicines had been administered as prescribed and records did not reflect actual practice. At the beginning of the inspection two members of staff were discussing whether a cream or shower wash had been used and Care Homes for Adults (18-65 years) Page 5 of 12 then retrospectively signed the MAR chart for the previous day. This is poor practice. Two people undertook the medicine round. It was observed that one care assistant prepared the medicines but they were then administered by another care assistant who then signed the MAR chart. If the care assistant had prepared the medicine incorrectly and a different care assistant signed they had administered it she would thus take full responsibility for the error. This was pointed out to the care assistants who said this was company policy. The acting manager said it was not. Further training is required to ensure that the homes policies and procedures are followed. There were no protocols detailing how and when to administer medicines prescribed on a when required basis. Without such information staff may not administer the medicines as the doctor intended. One medicine had been prescribed last July for one clinical condition but it was administered recently for another and not as the doctor intended. Reviews of when required medicines do not take place on a regular basis. Cream management was poor. In many instances they had not been administered as prescribed and there were no supporting care plans detailing their use. Care plans were poor. There was little information regarding the clinical conditions of the people who used the service and three care plans looked at all had identical information recorded in each health care plan. This did not reflect the actual health needs of the individual person. Doctors visits had been recorded along with the outcome though so it was possible to track why a medicine had been prescribed or stopped for example. The management had no quality assurance system to assess individual staff competence in the safe handling of medicines but the acting manager was keen to implement such a system to improve the standard within the home. What the care home does well: What they could do better: The home must improve its admission process, and ensure that the relevant referal documentation is sought prior to agreeing to offer a place. Care Homes for Adults (18-65 years) Page 6 of 12 The home must improve its care planning and risk assessment processes so that people can be confident that their assessed needs will be met appropriately. The home must ensure that people are offered a varied selection of activities that reflect and include their interests and any hobbies that they may have. The medicine management must improve to safeguard the health and well being of the people who use this service. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Adults (18-65 years) Page 7 of 12 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 8 of 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 1 2 14 A formal assessment must be carried out before a decision is made about whether a service can meet peoples identified needs. This will ensure that prospective peoples needs can be met by the home. 30/04/2010 2 6 15 People must have person 30/04/2010 centred care plans that clearly reflect their individual needs. Information must be recorded in sufficient detail so that staff are able to provide appropriate care and support for people. Risk assessments must be carried out for any areas of potential risk. The outcome of these assessments must be used to inform care planning and minimise identified risk. This will ensure that staff have the information 30/04/2010 3 9 13 Care Homes for Adults (18-65 years) Page 9 of 12 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 necessary to support people with taking risks safely. 4 20 13 A quality assurance system 05/03/2010 must be installed to assess staff competence in their handling of medicines. Appropriate action must be taken when these indicate that medicines are not administered as prescribed and records do not reflect practice, to ensure that all medicines are administered as prescribed and this can be demonstrated. This is to ensure that individual staff practice is assessed on a regular basis and appropriate action is taken if audits indicate that staff do not administer the medicines as prescribed. 5 20 13 The quantity of all balances 05/03/2010 of medicines carried over from previous cycles must be recorded and the MAR chart record the current drug regime only. This is enable audits to take place to demonstrate the medicines are administered as prescribed 6 20 13 A system must be installed 05/03/2010 to check the prescription prior to dispensing and to check the dispensed medication and the medicine charts against the prescription for accuracy. All Page 10 of 12 Care Homes for Adults (18-65 years) Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action discrepancies must be addressed with the healthcare professional. This is to ensure that all medicines are administered as prescribed at all times 7 20 13 The medicine chart must 05/03/2010 record the current drug regime as prescribed by the clinician. It must be referred to before the preparation of the service users medicines and be signed directly after the transaction and accurately record what has occurred. This is to ensure that the right medicine is administered to the right service user at the right time and at the right dose as prescribed and records must reflect practice Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 20 It is advised that all external medicines, for example, creams and ointments are recorded on a separate MAR chart and kept in the persons room together with the preparation to ensure that staff record exactly what they have applied. It is recommended that one person only takes full responsibility for the preparation, administration and recording of medicines. 2 20 Care Homes for Adults (18-65 years) 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 Adults (18-65 years) can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. 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