Inspection on 15/06/10 for Sunrise Operations Tettenhall Limited (Assisted Living)

This is the latest available inspection report for this service, carried out on 15th June 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

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Sunrise Operations Tettenhall... 10/04/08

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Extracts from inspection reports are licensed from CQC, this page was updated on 04/09/2010.

Random inspection report Care homes for older people Name: Address: Sunrise Operations Tettenhall Limited (Assisted Living) 73 Wergs Road Tettenhall Wolverhampton West Midlands WV6 9BN two star good service 29/04/2009 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: Rosalind Dennis Date: 1 5 0 6 2 0 1 0 Information about the care home Name of care home: Address: Sunrise Operations Tettenhall Limited (Assisted Living) 73 Wergs Road Tettenhall Wolverhampton West Midlands WV6 9BN 01902774100 01902774101 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Sunrise Operations Tettenhall Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 70 Number of places (if applicable): Under 65 Over 65 70 old age, not falling within any other category Conditions of registration: 0 The maximum number of service users to be accommodated is 70 The registered person may provide the following category of service only: Care Home with Nursing (Code N) 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) 70 Date of last inspection Brief description of the care home Sunrise Operations Tettenhall Ltd was first registered with the Commission in October 2007 and incorporates an Assisted Living and Reminiscence neighbourhood-these are Care Homes for Older People Page 2 of 12 2 9 0 4 2 0 0 9 Brief description of the care home registered with the Care Quality Commission as two separate services and are available as two inspection reports. Both services work closely together and this is reflected in the content of our inspection reports. The purpose built service provides spacious accommodation of a high standard. The Assisted Living service is registered to provide accommodation, personal and nursing care to seventy older people and the Reminiscence service is registered to provide care to twenty-five older people with dementia. Accommodation is provided in apartment style rooms and each apartment is very well-equipped with its own spacious hallway, kitchenette and en-suite shower and toilet facility. Some of the apartments are shared in that people have their own private bedroom, but they share bathroom facilities, kitchenette and hallway areas. The service is surrounded by well-kept gardens and patio areas, which are easily accessible for people who may have mobility difficulties. There is level access to the main reception area on the ground floor and a lift provides access between the ground and first floor. The home is near the village of Tettenhall which has an assortment of shops and community facilities such as a library. There is car parking at the rear of the building and a local bus service stops nearby. Information on fees is included within the Residents handbook. Prices vary according to the type of apartment, services and level of care required by the person. The reader is advised to contact the home to obtain up date information on the fees charged. The last key inspection of this service was undertaken on 29th April 2009. Care Homes for Older People Page 3 of 12 What we found: This unannounced inspection was carried out by our pharmacist inspector and a compliance inspector. The inspection had been triggered following a complaint about medication practices and because we had also received reports from the home about medication errors which had taken place. The purpose of the inspection was to look at medication practices. We looked at medication storage, medication administration records (MAR) and some care records. We also spent some time observing how staff interacted with people. We were at the service for eight hours and had opportunity to speak with a representative for the company who is currently overseeing management arrangements, another senior member of staff and a new manager for the service. When we looked at three peoples care records we found that the home is not adhering to legislation or good practice guidance in how it assesses plans and reviews peoples care. For a person who has a condition where they need medicine to help control the level of sugar in their blood, we saw that staff have monitoring practices in place to check the persons blood sugar. We also saw that when the persons blood sugar became very low, staff took action and gave some medicine to help increase the blood sugar. However there was nothing recorded in the care records to show that staff had looked at possible reasons why the blood sugar had become so low to reduce the risk of it happening again. The persons care plan described how their doctor should be notified when their blood sugar is low but there was nothing to indicate their doctor was contacted. We saw that staff had recorded information about the numbers of staff and equipment needed to support the person with their daily activities, but this had not been updated to reflect changes with their moving and handling needs following recommendations from a physiotherapist. There was nothing recorded to suggest the advice is being followed. From looking at their care records we saw that they developed a sore area on part of their body however there was no written entry within their care records to indicate this was looked at until eight days later, when it is documented that the person complained that the sore area was hurting them. We found that a care plan had been written about risks of the person developing sore skin, describing how a tool used to calculate the persons risk of developing pressure sores should be completed every month. We saw that the tool had not been completed for three months. The person had a care plan indicating they have problems with their bowels and pain in their stomach. The care plan included information about giving painkillers for the pain but did not include information or guidance to staff on managing the problem with their bowels which could be a causative factor for the pain. Scrutiny of where staff write about care on a daily basis indicate that staff have been applying creams but there was no clear information about the types of cream or to which part of the body they have been applying creams to, we also found this in the two other care records we looked at. For another person we saw that some care plans had been written about the care the person needs but they were either incomplete, or had not been reviewed when changes had occurred with the persons condition, such as when the person experienced increasing Care Homes for Older People Page 4 of 12 pain. We saw that a healthcare professional had advised that the home contact the persons doctor about another matter, but we could not find evidence that this happened until almost two weeks after the initial request. Whilst looking through another persons care records we saw that information had been sent to the home about application of specific type of hosiery used for medical conditions, which suggested that it had been recommended for the person. We could not see from the care records that this was happening. We sought further information from staff and were informed that the persons doctor had advised them not to apply the hosiery. However there was nothing in the care records to confirm that this advice had been given or when. We found that the medication records were not robust enough to demonstrate that people using the service were receiving all of their medicines as they had been prescribed. We audited a sample of the administration charts by comparing them with the medicines found in the storage area. We found evidence where the administration charts had been signed to confirm administration had taken place but the medicines had not been administered. We found that medicines could not be accounted for and were effectively missing. We found that there were signatures missing off the administration charts and therefore the home was not able to confirm whether the medicines had been administered. We found with one of the people we looked at, that some of their medicines did not arrive in time for them to be administered on the first day of the medication cycle. We found that these medicines did not arrive until 3:30pm on the second day of the cycle. We found that the morning doses were consequently administered at 3:30pm.This was concerning as there was no evidence that the persons doctor had been contacted to check that the administration of these medicines at this time of day was not detrimental to the welfare of this person. We found that one of the medicines concerned was a modified release preparation and should be administered at 12 hourly intervals or as near as possible to a 12 hourly interval. The administration of this modified release medicine at 3:30pm and then at 6:30pm meant that the interval between doses was only 3 hours. We were told that two people administer their own medication. We asked the home to show us how they had looked at the peoples abilities to do this and any possible risks associated with them taking their medicine. We found that the home had not done this. We were shown a copy of a blank document as an example of what should be completed when people administer medicines themselves. This shows that the home has got the processes but is not putting them into practice. We looked at a folder which contained medication error reports. This showed that there have been a significant number of errors reported, particularly in April of this year. Whilst looking through the folder we found a report, which was poorly completed but mentioned briefly that a wrong does of antibiotic and the wrong antibiotic had been given. We asked the two company representatives for further information regarding this incident and they confirmed they were not aware of this error. We looked at the persons care records for further information which showed that a doctor had been contacted for advice when the error occurred, but staff had failed to report the incident to more senior staff, which should have happened according to the company medication policy. We also found that an analgesic patch which was classed as a Controlled Drug had been not been changed on the correct day and as a consequence the person that had been prescribed these patches would not have received the correct level of pain control. These particular Care Homes for Older People Page 5 of 12 patches must be changed every three days but we found that on one occasion the patch was not changed for four days. We were again concerned that a medication error report had not been completed and none of the senior staff had been made aware of the incident. We were informed that staff who were administering medicines had received training on the safe handling of medicines and also on how to use the administration system used by the home. We were told that once the training was complete the staff underwent three observational assessments before they were allowed to take responsibility for the administration of medicines. We asked if there was an on going programme of assessments to ensure that staff continue to administer medicines safely. We were told that a programme had not been in place but one had recently been implemented as part of the action plan to improve standards around the handling and administration of medicines. We also found that the homes policy was to audit 25 percent of the MAR charts on a weekly basis. The policy directs staff to audit a different 25 percent each week so that by the end of the month all of the MAR charts had been audited at least once. We looked at the folder containing these audits and looked back as far as February 2010. We found that these audits had not been completed on a weekly basis however we recognised that the new management team were determined to ensure that this policy was achieved. We spent some time in one of the lounges and saw that some staff had better approaches with people than other staff. A person who lives at the home was heard asking a group of care staff about activities due to take place later in the day. The staff did not appear eager to find the answer to the persons query. It was sometime before another member of staff entered the lounge and they responded to the persons query quickly, obtaining a copy of the homes activities programme and they took time to explain different events due to take place. This member of staff and another staff member had very good approaches in how they spoke with people. They appeared eager to ensure people were comfortable, assisting them with drinks and talking with them. We saw they had good techniques whilst using equipment to help people move. The company representative acknowledged that staff are of varying competencies and described how it is the homes intention to ensure that all staff undergo refresher induction training, even if it means staff re-visiting training they have already completed. We saw from monitoring visits undertaken by the company since February 2010 that it had been identified that the service was not being managed well and remedial action was needed. The company representative described the actions being taken to improve the home and thus outcomes for people. One of these actions includes restricting admissions to the home until the company is satisfied that improvements have occurred, which is considered to be a positive action taken by the company. At the end of the inspection we were given action plans listing various actions being put in place within a specific timescale. This provides some reassurance that the company is trying to resolve shortfalls. We will re-visit the home to ensure improvements have taken place and are sustained. We will also be monitoring compliance with the requirements which have arisen from this inspection. What the care home does well: People are provided with an environment which is furnished to a very high standard. Care Homes for Older People Page 6 of 12 We observed that activities take place and that people are able to have visits from individuals who are important to them. What they could do better: 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 £ 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 Older People 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 7 12 People should have their care 30/07/2010 planned and provided according to their individual needs, preferences and abilities. This is to ensure people receive the care they need and the monitoring that their conditions require. 2 8 13 Any risks to the health, safety and well-being of people living at the home must be identified, recorded and managed according to the persons wishes and capabilities and on advice from professionals involved in their care. This is to ensure unnecessary risks to the heath and safety of people are identified and as far as possible eliminated. 30/07/2010 3 9 18 To ensure that staff are suitably qualified, experienced and competent to safely administer medication before they 30/07/2010 Care Homes for Older People 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 administer medication to people who use the service. This is to ensure people receive their medication from suitably skilled staff 4 9 13 To ensure that there is an effective system in place to request obtain and retain adequate supplies of prescribed medicines for people. This is so the prescribed medicine can be given them as and when prescribed. Regulation 12(1) 5 9 13 The records of the receipt, 30/07/2010 administration and disposal of all medicines for the people who use the service must be robust and accurate. This is to demonstrate that all medication is administered as prescribed. 6 9 13 Appropriate information relating to medication must be kept, for example, in risk assessments and care plans to ensure that staff know how to use and monitor all medication including when required and self administered medication. This is to ensure that all medication is administered safely, correctly and as intended by the prescriber to meet individual health needs. Care Homes for Older People Page 10 of 12 30/07/2010 30/07/2010 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. 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