Inspection on 08/04/10 for 17 Park Avenue

This inspection was carried out on 8th April 2010.

CQC found this care home to be providing an Poor 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.

Other inspections for this house

17 Park Avenue 12/01/10

17 Park Avenue 17/02/09

17 Park Avenue 23/11/07

17 Park Avenue 26/01/07

17 Park Avenue 25/05/06

17 Park Avenue 10/11/05

17 Park Avenue 16/05/05

17 Park Avenue 24/01/05

17 Park Avenue 23/11/04

17 Park Avenue 17/03/04

17 Park Avenue 09/12/03

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2010.

Random inspection report Care homes for adults (18-65 years) Name: Address: 17 Park Avenue Park Avenue, 17 Hockley Birmingham West Midlands B18 5ND zero star poor service 14/01/2010 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: Brenda ONeill Date: 0 8 0 4 2 0 1 0 Information about the care home Name of care home: Address: 17 Park Avenue Park Avenue, 17 Hockley Birmingham West Midlands B18 5ND 01215233712 Telephone number: Fax number: Email address: Provider web address: faisalazam@london.com Name of registered provider(s): Name of registered manager (if applicable) Park Avenue Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 22 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Conditions of registration: 22 The maximum number of service users who can be accommodated is: 22 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: Mental Disorder, excluding learning disability or dementia (MD) 22 Date of last inspection Brief description of the care home 17 Park Avenue is a care home for up to 22 adults that are experiencing mental ill health. The home is situated close to local amenities such as shops, places of worship and public transport links. Care Homes for Adults (18-65 years) Page 2 of 14 1 4 0 1 2 0 1 0 Brief description of the care home There are six shared bedrooms and ten single bedrooms, none of which have en suite facilities. There are two lounges on the ground floor. The home has a passenger lift and there is ramped access to the front of the building. Some adaptations have been made to bathrooms to enable people with a physical disability to shower and bathe. Information is shared with people who live at the home during house meetings and there are leaflets describing how to make complaints available in the entrance hall. Many of the people living in the home do not speak English as a first language. The staff team have the skills collectively to communicate with people in their first languages. The range of fees charged for living at the home was not detailed in the service user guide. People should contact the home direct for this information. Care Homes for Adults (18-65 years) Page 3 of 14 What we found: The focus of inspections undertaken by the Care Quality Commission (CQC) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. The last key inspection of this service was completed on the 14th January 2010. This random visit was undertaken by two inspectors over seven and a half hours. The home did not know that we would be visiting that day. The reason for this visit was to check compliance with the requirements made at the key inspection. We did not look at the requirement in relation to medication as the pharmacist inspector had visited the home on March 30th to check this. During our visit we looked at two care files in detail which included care plans, daily records, medical reports and risk assessments. We also looked at staffing rotas, staff recruitment records, the fire risk assessment and some servicing records for the equipment in the home. We spoke with the acting manager, deputy manager, operations manager, two staff members and three of the people living in the home. The pharmacist inspection lasted two and a half hours. Six peoples medicines were looked at together with their Medicine Administration Record (MAR) charts and care plans. All feedback was given to the new manager, deputy manager and the newly appointed operations manager. These are our findings: There had been no changes to the care plans that were in place. However some people did have care planning booklets in place that had been partially completed. These included some of the likes, dislikes and preferences of the people living in the home. When complete these would provide staff with good information so that they are able to support people in the way they want to be supported. Care plans that were in place were not being updated as the needs of the people living in the home changed. For example the mental health of one person had deteriorated so much so that a psychiatric assessment had been requested. The care file stated the persons mental health remained stable. The records showed that this person was having some incidents of behaviour that was difficult for staff to manage. Staff were completing incident forms for this and they appeared to be managing the behaviours consistently but there was no written guidance for staff. This could lead to the individual receiving inconsistent care particularly when newer staff were on duty who did not know her well. This could be detrimental to her well being. At the key inspection one person had quite a comprehensive plan in place for managing their diabetes but staff were not following this. At the time of this inspection this management plan could not be found when asked for. We were shown a diabetic protocol which was general information about diabetes and a risk assessment. The risk Care Homes for Adults (18-65 years) Page 4 of 14 assessment was not robust and said such things as inform G.P. if blood sugar is high often but there was no indication of what was considered to be high or what often meant. The acting manager told us that the G.P. had stated staff were calling too often about blood glucose levels but there were no records of this. She stated staff were to ring NHS direct as indicated on the emergency procedure if blood sugars were above 25. However, records showed that the staff had contacted the G.P. at a variety of blood sugar levels indicating that they were acting in an inconsistent manner. The acting manager then showed us other documentation for recognising low blood sugars, being overweight, poor circulation for the individual concerned. Then staff showed us another folder with information about diabetes and written on the cover of this was what the persons safe blood/sugar levels were. It was not possible to ascertain exactly what staff were to do and when in relation to this persons blood sugar levels or where they would look for the most current information. This could have a profound effect on the well being of this person. A turn chart had been put in place for the person who was prone to developing pressure sores but this was only being signed once daily. The file with the chart in also included the turning regime. This was being kept in the office and needed to be in the bedroom so that staff had easy access to the information. A risk assessment had been undertaken for the person who had bed rails and the rationale for having these had been included. This ensured bed rails were only used when necessary. No records were being kept of the checks on the bed rails to ensure they were safe. It was very difficult to track that the health care needs of the people living in the home were being met. The records for visits to and from health care professionals were recorded in a number of places, some were on professional visit sheets, others in daily records and others were in the communication book. Records showed one person had been assessed by a psychiatrist but the outcome of this visit had not been included on the individuals professional visit sheet and it could not be determined how staff got this information. Night staff had recorded that one person had a blister which they thought was due to pressure. They had completed an incident form, left information for the acting manager at the time in the communication book and entered this in daily records. The blister was mentioned in the daily records the next day but then was detailed as being on the opposite side of the body. After this there was no mention of it. The deputy manager said the individual had seen the G.P. about this but there were no records of this or any treatment. One file included a letter from the G.P. stating that the person had opted out of having a medical test. There was no information on the file to say how this decision had been made or if the individual concerned had been involved. The current acting manager was not aware of this. The communication book being used in the home included a lot of personal information about the people living in the home. This does not ensure confidentiality of peoples personal information and is in breach of the regulations in relation to data protection. The medicine management was poor due to five errors, two of which were very serious, found during the inspection. Care Homes for Adults (18-65 years) Page 5 of 14 The home saw the prescriptions prior to dispensing and these were available to check the MAR charts and medicines received into the home. Not all the quantities of medicines had been recorded, so for these medicines it could not be demonstrated whether they had been administered as prescribed at all times. The deputy manager had installed an auditing system for some medicines. It was possible from these audits to confirm that medicines had been administered as prescribed and records reflected practice, even though the quantity of new supplies of medicines had not been recorded on the MAR chart. Gaps were seen on the MAR charts. The medicines had been administered but not recorded as such. The homes quality assurance system had failed to identify this error. The staff had administered the incorrect regime of the medicine, warfarin, used to prevent blood clots. This mistake was eventually identified and rectified but two doses of warfarin had not been administered as prescribed. This is of serious concern. The second serious error occurred when the doctor increased the dose of one medicine. A new supply was sought and administered as the doctor requested. Records indicated that the old dose had not been administered and the MAR chart recorded that this medicine had been stopped. However on inspection of the blister pack of medicine, fourteen tablets were missing indicating that they had been administered and not recorded as such. The deputy manager had identified that this strength of medicine had been stopped and removed the blister pack from the medicine trolley so it was no longer administered, but the person had potentially received one and a half times the prescribed dose for fourteen days. Other errors were seen. Two ampules of a vitamin injection were unaccounted for. The dose regime could not be confirmed. These were to be administered by the district nurse. Staff are required to keep a record of all medicines prescribed to all people even if they dont administer them personally. Staff had failed to accurately record all external healthcare professional visits, together with the outcome so it was not possible to track if the district nurse had administered these missing ampules at some point. One depot injection had been recorded to be administered on a certain date but there was no subsequent record of this visit. The MAR charts indicated that the injection had been administered on this date and the next date recorded on the MAR chart. This had not been recorded in the healthcare professional visits record. We have referred the medication issues to the enforcement team so a decision can be made as to what further action is to be taken. Some good practice was seen. The auditing system installed had ensured that these medicines had been administered as prescribed and records reflected practice. The medicine trolley was well organised so it was easy to find medicines for each person, reducing the risk of error. We were told that the staffing levels at the home had been increased and this was evidenced when looking at the rotas. This should ensure that staff are more readily available so that the people living in the home can pursue their preferred leisure pastimes. Care Homes for Adults (18-65 years) Page 6 of 14 The recruitment records for three new staff were sampled. These had improved and were more robust and should ensure only suitable people are employed to work at the home. Some references were dated after staff had started at the home but we were told these staff were being trained and not working directly with the people living in the home. The operations manager stated that a much more robust recruitment procedure was now in place for the home and he would be overseeing this. Since our last visit a new acting manager and operations manager had been appointed for the home. They were in the process of implementing some quality auditing systems in the home to ensure the service was being managed in the best interests of the people living there and so that systems were in place to ensure the service was improved. The outcomes of the audits should be collated and a development plan for the home drawn up showing how the service is to be improved. There was a current fire risk assessment on site at the time of this inspection that showed what systems were in place to ensure people were kept safe should there be a fire. The outstanding information in relation to equipment and appliances being serviced was available for inspection. This ensured all equipment and appliances were safe to use. What the care home does well: What they could do better: This is a random inspection and therefore not all the core standards were assessed. Many of the recommendations in this report are carried forward from the last key inspection. Care plans should reflect all the current needs of the people living in the home to ensure they receive person centred care on an ongoing basis. The systems in place to ensure the people living in the home stay healthy needed to be much more robust to ensure peoples well being. Systems must be in place to ensure people are not exposed to any unnecessary risks. Medication management must be improved to ensure people receive their medication safely and as prescribed. The confidentiality of the people living in the could be further enhanced. Care Homes for Adults (18-65 years) Page 7 of 14 Systems must be in place to ensure that decisions made on behalf of the people living in the home have been made in their best interests. The quality of the service being offered to the people living in the home needs to be regularly reviewed. The home must have a registered manager so that the people living in the home can be assured the home is being run in their best interests. 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 8 of 14 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 9 of 14 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 9 13 Management plans must be in place for any behaviours that are difficult to manage. This will ensure people are safeguarded. 31/05/2010 2 19 12 There must be robust management plans in place for any ongoing health concerns. This will ensure the health care needs of the people living in the home are met. 31/05/2010 3 20 13 A quality assurance system 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. This is to ensure that individual care staff practice is assessed on a regular basis and appropriate action 21/05/2010 Care Homes for Adults (18-65 years) Page 10 of 14 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 is taken if audits indicate that they do not administer the medicines as prescribed. 4 20 13 The medicine chart must 21/05/2010 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 correct medicine is administered to the correct service user at the correct dose and time and records reflect practice All dose regimes must be 21/05/2010 clearly written on the medicine chart, checked by a second member of staff for accuracy. This is to ensure that the staff have clear directions to follow. The quantity of all medicines 21/05/2010 received and any balances carried over from previous cycles must be recorded. This is to enable audits to take place to demonstrate the medicines are administered as prescribed. An application for the registration of the manager must be forwarded to the 31/05/2010 5 20 13 6 20 13 7 37 8 Care Homes for Adults (18-65 years) Page 11 of 14 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 Commission. This will assure people living in the home that someone has day to day responsibility for the management of the home. 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 1 The service user guide should be updated to include all the current and necessary information that people would need to help them decide if the home could meet their needs. It should be made available in appropriate formats. Evidence should be available that peoples needs have been assessed prior to admission to the home and how the decision has been made that staff can meet the identified needs. Evidence should be available that people or their representatives have had the opportunity to visit the home before the admission to see if they like it. Care plans should include all the individual needs of the people living in the home and include how staff are to support them to meet their needs. This will ensure people receive person centred care. Information in the care plans should be consistent so that staff know exactly how to support people. To ensure the confidentiality of the people living in the home personal information should not be recorded in communal books. People should be encouraged to develop independent living skills so they have a more meaningful life. Systems should be in place to ensure decisions made on behalf of the people living in the home are made in their Page 12 of 14 2 2 3 4 4 6 5 6 6 10 7 8 11 12 Care Homes for Adults (18-65 years) 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 best interests. 9 13 People should have the opportunity to take part in social and leisure activities that meet their needs and preferences. Records of the food eaten by the people living in the home should be kept to show they receiving a varied and balanced diet on an ongoing basis. Staff should ensure that people receive their personal care according to their preferences and as they want. It is strongly recommended that the outcomes to and from health care professionals are recorded on the appropriate sheets so that they are easy to track. This will ensure staff have all the information necessary to care for people appropriately. The home should have an annual development plan in place that shows how the service is to be improved for the benefit of the people living there. Bathrooms and toilets should be redecorated/refurbished to make them more pleasant for the people living in the home. Facilities should be available to enable people to make snacks and drinks to enhance their independence. Fifty percent of staff should be qualified to NVQ level 2 or the equivalent. This will ensure staff have all the necessary skills and knowledge to support the people living in the home. Staff should receive regular supervision sessions so that it can be assured they can meet the needs of the people living in the home effectively. 10 17 11 12 18 19 13 24 14 27 15 16 29 32 17 36 Care Homes for Adults (18-65 years) Page 13 of 14 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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