Random inspection report
Care homes for older people
Name: Address: Alston House 380 Aylestone Road Leicester Leicestershire LE2 8BL one star adequate 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: Naveeda Knopp Date: 0 4 0 6 2 0 0 9 Information about the care home
Name of care home: Address: Alston House 380 Aylestone Road Leicester Leicestershire LE2 8BL 01162915601 01162915611 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Margaret Madden care home 19 Number of places (if applicable): Under 65 Over 65 19 19 19 2 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category sensory impairment Conditions of registration: 0 0 0 0 Service user numbers. No person falling within categories OP, MD(E) or DE(E) may be admitted to the home when 19 persons of categories/combined categories OP, MD(E), DE(E) are already accommodated within the home. Service user numbers. No person falling within category SI(E) may be admitted to the home when 2 persons of categories/combined categories SI(E) are already accommodated within the home. The maximum number of persons to be accommodated at Alston House is 19. Date of last inspection 0 4 1 1 2 0 0 8 Care Homes for Older People Page 2 of 14 Brief description of the care home Alston House is a care home for older persons, providing accommodation and personal care for up to nineteen residents some of whom have mental health needs, dementia and/or a sensory impairment. The home is situated on the Aylestone Road in Leicester approximately 15 minutes away from the city centre. There are shops within five minutes walking distance from the home and there is a small park nearby. Accommodation is on two floors with the upper floor accessed by lift or stairs. There are three lounges, two dining room areas and a conservatory on the ground floor. The home offers both single and shared bedrooms some of which come with ensuite facilities. A large parking area is to the front of the home and there is a wellmaintained secure garden to the rear of the home. Current charges range from £360.00 per week to £400.00 per week. Additional charges are in place for hairdressing, chiropody treatment and transport to appointments. Details of all charges can be found in the homes Statement of Purpose document, (a document which provides relevant information about the home) which is given to everyone living in the home and those interested in living in the home. A copy of the latest Inspection report is available at the home, or it can be accessed via the CQC website: www.cqc.org.uk. Further information about the home is available from the acting manager. Care Homes for Older People Page 3 of 14 What we found:
Medication is supplied in a monitored dosage system from the Pharmacy. Medication administration record sheets (mars) are mainly computer generated with some blanks been used. We saw confirmation on these records that the home are recording the quantities of medicines when received in from Pharmacy. But this was not happening for everyones medicines and when medicines were continued to be used from a previous month ie carried forward balances not always recorded on to the current mars. Sample signature sheets were present in both mar folders. The list has not been updated and contained staff who do not work at the home any longer. The sheet listed five names but showed only 3 signatures. A new resident had a start date on the current mars as 03/06/09 but signatures for administration started on the 04/06/09- not clear why there was a delay in giving all her medicines on the morning of this inspection. Paracetamol was prescribed for this person as a dose of two tablets be taken four times day. Evidence seen that this was not given and treated as a when required (prn dose). Non of the morning doses had been given by 11.57 on the morning of the inspection. This was discussed with manager who stated that there was a query over her medicines so they were awaiting the outcome. Reviewed this persons previous months mars. Dates of administration were not clear. The manager explained that this was a mistake made by a carer who was in training. His signature did not appear on the samples of signature list. For another person the home used a blank mar to complete the administration record. They had handwritten the name of the person and drug name and date but it did not state the month, the timings of doses or the quantities received. For a person who uses the service, a dose of a pain relief was prescribed to be taken as one or two tablets four times a day. The home recorded the administration but not the variable dose. For another person, Paracetamol 500mg tablets was prescribed as a dose of two to be taken four times a day but the corresponding mars show that only giving this once daily. Chloramphenicol eye ointment was handwritten on a mar with no confirmation signature to ensure it had been accurately entered. The staff were not following the same recording practises when medicines had not been taken which made auditing of medicines difficult. A person is prescribed an inhaler of Ipratropium 20mcg as a dose of two puffs prn. Mars showed that this was used daily since 25/05/09. This person is also given a Ventolin inhaler at a dose of 2 puffs prn. Again using daily since 25th May 2009. But there was no indication on the daily notes or mars as to when in the day this was given. Thus hard to see if their condition was deteriorating. For a diabetic person who uses the services, the home were monitoring his blood glucose levels regularly. But the protocol in place to inform staff when and what action to take if readings are outside set limits was inadequate.
Care Homes for Older People Page 4 of 14 A person who uses this service is prescribed Sudocreme which is labelled as to be applied as directed, use as a prn once daily. No information is added to care plan that relates to this need. Carer stated the cream is applied after each pad change. For another person Movelat gel dispensed as apply as directed. The dose on the mar had been written as prn. The records indicated applying once daily. Senior carer on duty stated she complains of neck joint hurting and does not want to see GP. She also said if she needs again we will apply. No information relating to this is available in the care plan or daily notes belonging to this person. We had concerns over why a discontinued medication (Prochlorperazine 5mg tablets) as stated on the mar was still being given after the discontinued date. Senior carer explained the person takes this only when she has her pain relief. But this information did not tally with the records. Pain relief was given on three consecutive days but the discontinued drug was only given for the first two days. The carer explained that when she eats she gulps when eating. None of this healthcare issue had been raised in her daily notes or care plan. A permission sheet seen for delegation of a health care task for injecting insulin. Not all current staff who carry out tasks had a permission sheet in the mar folder. Spoke to a female person who lives at the home she said she gets her medicines and is settled in the home. A person who lives at the home refused his medication (promazine liquid) and was using abusive language towards the carer giving out the medication. The carer remained calm but continued the administration by mixing the liquid medicine with a fortisip drink in a beaker. She gave the beaker with a straw to another carer who encouraged the peson to drink it. A male resident was prescribed Chloramphenicol eye ointment to be applied 4 times a day. The tube in current use had been dispensed on 18.05.09. The carers had not marked the opening date on the package.While applying this to the gentleman the carer touched his lower lid with the tip and applied to both very red sore eyes. This was also carried out while the person was stood up. He saw a GP on 10/4/09 then again on 28/05/09 regarding his eyes. No information was available in the care plans or daily notes relating to the monitoring of his eye condition. A fridge used for medicines was noted to have a temperature of 11C at 15.00 hrs. The staff were not recording the maximum or minimum temperatures just the current. On the 24/04/09 the temperature reading stated the fridge was at 18C. It was not clear what if any action was taken to rectify this reading. Dates had not been marked on used eye drops or ointments stored in the fridge even though a sheet of paper on the fridge door instructed staff to do so. Medicines would be sent back to the Pharmacy using a duplicated returns book. Unaccounted Temazepam liquid bottles was seen in the back up medicines storage cupboard. The carer stated she was awaiting to return these to the pharmacy.
Care Homes for Older People Page 5 of 14 What the care home does well: 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 6 of 14 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 13 Ensure that all risks presented to people are included in the risk assessment documentation and specific actions to be carried to minimise the risk out are recorded. Care workers must be aware of all the current risks people face and the actions they need to carry out to minimise those risks. 22/05/2009 2 16 Attend to the decoration in 22/05/2009 the downstairs shower room. People need to be cared for and supported in areas that are clean homely and well maintained. 3 7 15 Ensure that all identified needs are included in the care plan documentation 22/05/2009 Care workers need accurate information in order for them to meet the needs of the people in their care. 4 7 15 Ensure that all identified needs are included in the care plan documentation 22/05/2009 Care Homes for Older People Page 7 of 14 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 workers need accurate information in order for them to meet the needs of the people in their care. 5 8 13 Ensure that all risks presented to people are included in the risk assessment documentation and specific actions to be carried to minimise the risk out are recorded. 22/05/2009 Care workers must be aware of all the current risks people face and the actions they need to carry out to minimise those risks. 6 15 13 Ensure that when people are 22/05/2009 prescribed food supplements instructions for use are included in care plan and risk assessment documentation. Care workers need direct information to ensure that supplements are given consistently. 7 29 19 Ensure that all pre employment checks are carried out before care workers commence work at the home People living at the home must be protected by robust recruitment practices. 8 29 19 Ensure that all pre employment checks are carried out before care 22/05/2009 22/05/2009 Care Homes for Older People Page 8 of 14 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 workers commence work at the home People living at the home must be protected by robust recruitment practices. 9 35 17 Ensure that access is 22/05/2009 available to money and valuables held on behalf of the people living in the home and records kept are up to date and accurate. People need to be confident that they can access any items held on their behalf at any time. 10 35 17 Ensure that access is 22/05/2009 available to money and valuables held on behalf of the people living in the home and records kept are up to date and accurate. people need to be confident that they can access any items held on their behalf at any time. 11 37 17 Make sure that daily records 22/05/2009 are up to date and accurate. People need to be protected by accurate and up to date records. 12 37 17 Make sure that daily records 22/05/2009 are up to date and accurate. Care Homes for Older People Page 9 of 14 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 People need to be protected by accurate and up to date records. Care Homes for Older People Page 10 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 The fridge used to store 17/07/2009 medicines that require cold storage should be maintained at a temperature range of 28 C. To ensure people receive medicines that are effective. 2 9 13 All medicines that have a 17/07/2009 short in use date, once opened should have the date of opening marked on the packet. To ensure people receive medicines that are effective. 3 9 13 All staff that carry out a 17/07/2009 delagated nursing task must have their competency assessed by a relevent nurse and the manager must retain a copy of their permissions to do this task. To prevent harm to the people who use the service. 4 9 13 The manager needs to ensure that staff know what 17/07/2009 Care Homes for Older People 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 to do when a person with diabetes, blood glucose levels are outside an optimal range. To make sure that their is no further risk of decline in health of person with diabetes. 5 9 13 The medicines at the home 17/07/2009 must be accurately accounted for. Variable and refused doses should be marked on the administration record sheets. To safeguard and protect people from harm. 6 9 13 All medicines must be 17/07/2009 administered as prescribed by the GP and records should reflect when this was given. The manager should ensure that when a medicine is given on a when required basis that staff know when it is to be given, dose, frequency and when to refer back to the Prescriber. This will demonstrated people receive the medicines prescribed for them. 7 9 13 The manager must ensure that covert administration is not happening without prior approval from a relevent mutidisciplinary team. This will ensure appropriate treatment and safeguard
Care Homes for Older People Page 12 of 14 17/07/2009 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 residents health and wellbeing. 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 9 9 The manager could carry out regular medication audits to ensure that medicines are administered correctly. When handwriting medication record sheets the home can have the accuracy double checked by a second relevant trained person. The manager is to ensure that all controlled drugs are stored in controlled drugs cabinet that complies with the Misuse of Drugs (Safe Custody) Regulation 1973. 3 9 Care Homes for Older People 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 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 14 of 14 - 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!
