Inspection on 29/01/10 for Anjulita Court

This inspection was carried out on 29th January 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Anjulita Court 08/04/10

Anjulita Court 15/12/09

Extracts from inspection reports are licensed from CQC, this page was updated on 14/03/2010.

Random inspection report Care homes for older people Name: Address: Anjulita Court Anjulita Court Bramley Way North Brickhill Bedford Bedfordshire MK41 7GD zero star poor service 15/12/2009 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: Nicky Hone Date: 2 9 0 1 2 0 1 0 Information about the care home Name of care home: Address: Anjulita Court Anjulita Court Bramley Way North Brickhill Bedford Bedfordshire MK41 7GD Telephone number: Fax number: Email address: Provider web address: www.mha.org.uk Name of registered provider(s): Name of registered manager (if applicable) Mrs Karen Darlington Type of registration: Number of places registered: Conditions of registration: Category(ies) : Methodist Homes for the Aged care home 62 Number of places (if applicable): Under 65 Over 65 0 62 dementia old age, not falling within any other category Conditions of registration: 62 0 The maximum number of service users who can be accommodated is: 62 The registered person may provide the following categories of service: 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 - Code OP, Dementia - Code DE Date of last inspection Care Homes for Older People Page 2 of 13 Brief description of the care home Anjulita Court is a stunning new building which has been designed to give a feeling of space throughout, and has been built round a large enclosed courtyard. On their website, the MHA describes it as: The impressive new building has a dramatic triple arch frontage to welcome residents and visitors into an interior full of open spaces, as well as facilities that include a hydrotherapy room, hairdressing salon, and a range of lounges - one of which is set up to allow film screenings. The spectacular entrance hall has a very high ceiling, and two walls are almost completely glass. The accommodation is divided into 4 units, each of which is selfcontained with a lounge, quiet room, sitting areas, dining room, kitchenette, bedrooms, and bathrooms. All bedrooms (a few of which are double rooms) have an ensuite shower room. There are 2 units each side of the hall, 2 on the ground floor and 2 on the first floor. The first floor units are accessed by stairs and lifts, and there is a walkway at first floor level across the hall so that people can walk from one unit to the other. There is a main kitchen on the ground floor, and a very large laundry, as well as offices, and staff facilities. The Gordon Ibbett room is on the first floor above the main entrance, and there is a coffee shop in the entrance hall. This is open to the general public and staffed by volunteers, and it is hoped will be used more and more once the flats next door have been completed, and the surrounding area has been developed into a country park. There are fenced gardens all round the building, with a series of pathways and seating areas, and a large landscaped courtyard opening off the entrance hall. There is adequate parking to the front of the building. Care Homes for Older People Page 3 of 13 What we found: This random inspection was unannounced and was carried out on 29/01/10 by 2 inspectors. The pharmacist inspector looked at a range of issues relating to medication, and checked whether the home had complied with the requirements about medication from the previous inspection. We were accompanied for part of the day by an independent member of the CQC Board, who was observing the inspectors practice. We arrived at 10:45, the board member left at about 13:00, and we left at 18:15. The pharmacist has written the sections of this report which are about medication. We did not fully check any of the other requirements we made at the last inspection. The manager told us that there had not been much progress. We looked at some of the care plans and observed what was happening around the home. We spoke with some of the staff on duty and spent time with the manager, who was on duty for the whole day. The evening before this inspection we received a letter of complaint from the family of one of the people who lives here. The manager had been made aware of the complaint by the Adult Social Care team of Bedford Borough Council, who also referred the issues to the Safeguarding team. The manager had spent a lot of time with the family. Members of the Safeguarding team had visited the home the previous day and discussed the issues with the manager, who had reviewed the persons care plan. The manager showed us that she had devised a prompt sheet for staff to remind them, for example, to make sure this person always has her hearing aids in, her glasses on, is offered regular drinks and is assisted to the dining room for her meals. We discussed staffing. The manager said that another 4 staff had left, including the administrator. More staff have been interviewed, 1 has started, 2 were starting the following week, and there were 4 who would start as soon as all the pre-employment checks had been completed. A new administrator had been appointed to start in midMarch. We looked at the staff rota and found it was not an accurate record of which staff have actually been on duty each day. At the time of the inspection the home was relying heavily on agency staff, some of whom worked regularly at Anjulita Court. We spoke with 2 staff, both from the agency. Before we left, the manager showed us an email she had received showing that staff from another MHA home would be working at Anjulita Court the following week, to support the staff here. The manager also said she now has a new area manager who is being very supportive. One of the agency staff was in the dementia unit, on her own. She was not doing anything to keep people occupied (she had been told they would just sit and watch the television); she had not looked at care plans; she did not know if/when any other staff would be coming to assist her; and she did not know what to do if there was a fire. We asked the manager to make sure she was told about fire procedures immediately. We looked briefly at a number of care plans. There had been little change since our inspection in December. In 2 instances, we noted that information in the care plans was not being used in the persons daily life. 1 persons care plan stated she did not like sausages but we noted at lunchtime that staff only offered her sausages. Another persons plan stated that he liked to be doing things and kept occupied: we found him walking round and round the dementia unit with nothing to do. Neither of the staff we Care Homes for Older People Page 4 of 13 spoke with had looked at, or been shown, the care plans. The manager said that MHA would be doing care plan training with some of the staff. The activities and social stimulation offered to the residents has not improved. The manager said she would be interviewing for an activities coordinator the following week. We were disappointed that staffing had not been increased to allow staff time to do activities. Pharmacist report: We carried out a specialist pharmacist inspection because of concerns raised over the safe handling of medication at a key inspection on 15/12/2009. We looked at the homes medication policy, the recording of receipts, administration and disposal of medication and carried out some random auditing to see if there was evidence that medicines were being administered as prescribed. We also looked to see how medication was reviewed by the GP, at the storage of medication and watched lunchtime medicines being given. We noticed that there were frequently omissions in the recording of adminstration. By checking the Monitored Dosage System (MDS) we could sometimes see that the medicines had been given and therefore just not signed. On other occasions though, care workers were not giving the tablets or were taking medicines from the wrong day in the cartridge and not signing. In these cases therefore, we did not have any evidence of safe administration of medication. We noticed for one resident that there were tablets left in the MDS for 28/1, the day before the inspection and gaps on the MAR ( Medication Administration Record). We noticed that this MAR was signed later in the day. One resident was prescribed antibiotic eye drops and we did not know if two doses had been administered because of the lack of recording. One resident was prescribed liquid medicines for cardiovascular disease and there were 6 gaps in administration records and we did not have the evidence if they were given or not. We noticed that care workers were not always following the instructions on the labels and on the MAR. For instance paracetamol prescribed four times a day was only being given twice a day and lactulose prescribed twice a day was being administered three times a day. Some care workers were recording variable doses such as 1 or 2 accurately but others were not. The recording of warfarin was careless and could lead to error. There was no dose documented on the MAR and the anticoagulant book was not available for checking because of a recent blood test. We noticed that the home ran out of ferrous sulphate for one resident and calcium tablets for another, for several days, in the middle of the medication cycle. Sometimes the allergy status of residents was not recorded. One resident was prescribed an inhaler regularly to prevent asthma and there were three omissions in his records for administration. We carried out some random auditing of medicines supplied by the pharmacist in their original packaging. The home had developed the good practice of recording receipts of medicines coming into home and also carrying forward balances of stock from the previous medication cycle. We were therefore able to check the accuracy of the MAR. We counted 45 samples of medication. Of these only 14 samples could be reconciled and we could be sure that the medicines were being given correctly. Two residents were prescribed medicines for parkinsons disease and there were either too many capsules left Care Homes for Older People Page 5 of 13 suggesting that they were not given but signed as given, or too few, suggesting that records of receipts were incorrect or two different strengths were being confused. There were discrepancies noted in painkillers, cardiovascular medicines and medicines for diabetes and medicines to protect the stomach. One resident was prescribed a course of antibiotics and only 19 of the 21 capsules prescribed were recorded as administered. We looked at the controlled drugs. Balances were accurate and a previous discrepancy in Temazepam tablets clarified.The controlled drug cabinets were loosely secured to a partition wall and could easily be pulled off. Storage was spacious in two clinical rooms. One was tidy and well organised and the other disorganised. The room on the ground floor was very hot and the records of temperature showed the temperature frequently reaching 29 degrees centigrade. Records on the nursing unit were incomplete. Fridge temperatures were recorded well in one unit and inconsistently in the other. Both should be recording the minimum and maximum temperature and not just the actual temperature. We noticed that the pen used as a finger pricking device for taking blood samples to test blood glucose was not of the professional type to prevent the transmission of blood borne infections. It was designed for self-testing only. The GP provided a good service and we noticed evidence of dosage changes and medication reviews and very good records of visits, in the care plan. We were told that the care workers were receiving medication training on 5/2/10 and we were shown the corporate audit carried out on 28/1/10 and we noticed it had identified some of the areas of concern that we had. None of the requirements for medication, made at the inspection on 15/12/2009 were met. Because we noted no improvement in safely managing medication in the home and were concerned that the residents health may not be maintained, we took copies of records under Code B to consider further action. What the care home does well: What they could do better: The organisation has not been effective in ensuring the management of this home is Care Homes for Older People Page 6 of 13 adequate to make sure each person receives the care and support they need and want. The home must meet the requirements made following the previous inspection (most of the timescales have passed). This includes ensuring that there are enough staff on duty; that care plans give staff guidance on each persons care needs, and that staff follow the guidance; and that everyone who lives here is given the opportunity for activities and social stimulation. Pharmacist report: None of the 7 requirements relating to medication made following the inspection in December had been met. These requirements remain and must be met. In addition, we have made 6 further requirements relating to the handling of medication. The home needs to ensure that careworkers administer medication accurately according to the prescription and as described in the homes medication policy. They need to sign or endorse the MAR immediately after they have administered the medication. The home needs to carry out its own regular internal audits to ensure that medication is handled safely and that residents health is maintained and they receive their medication as prescribed. 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 13 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 Care/support plans must give 28/01/2010 sufficient information and guidance for staff. So that each person can be sure their individual needs will be fully met. 2 8 12 There must be evidence to show that peoples healthcare needs are monitored and met. So that peoples health is maintained. 28/01/2010 3 9 13 Medicines must be signed for 31/12/2009 at the time of administration on one MAR chart only. If not given, the correct endorsement must be used so that we know the reason for not giving. So that it is clear that medicines have been administered correctly, and we know why any medicines have not been given. 4 9 13 The controlled drugs (CD) 31/12/2009 record must be accurate and must detail what medicines are in the CD cupboard. So that we can be sure CDs Care Homes for Older People Page 8 of 13 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 are handled correctly. 5 9 13 All staff who administer medication must receive appropriate training and there must be evidence to show that their competence has been monitored. So that people who live here receive their medication safely. 6 9 13 An accurate record of disposal of medicines must be kept. So that we know medicines are disposed of correctly. 7 9 13 All medicines must be administered as prescribed. So that peoples health is maintained. 8 9 13 A system of auditing medication must be developed. So that proper audits can be carried out to ensure people are receiving their medicines as prescribed. 9 9 13 The quantity of all medicines 31/12/2009 received, and any balances carried over from previous cycles must be accurately recorded. So that audits can take place to demonstrate the medicines are administered Care Homes for Older People Page 9 of 13 31/12/2009 31/12/2009 31/12/2009 31/12/2009 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 as prescribed. 10 12 16 The choices available to 28/02/2010 people at mealtimes, and the way meals are served, must improve. So that mealtimes are pleasant occasions for everyone. 11 12 16 The level of activities offered 28/02/2010 to people who live here must improve. So that people are able to lead satisfying and fulfilling lives. 12 27 18 There must be enough staff on duty at all times. So that peoples needs are fully met. 13 30 18 Evidence must be available to show that staff receive adequate training. So that we know that staff are equipped to do their jobs properly. 14 37 26 The provider (or 28/01/2010 representative) must carry out visits as required by this regulation. The reports of the visits must be available for inspection. So that the provider can monitor the service the home is providing. 28/01/2010 28/01/2010 Care Homes for Older People Page 10 of 13 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 That the allergy status is always documented and variable doses always recorded accurately. This is to allow medicines review by the prescriber and prevent residents receiving medicines which might cause an adverse reaction. 31/03/2010 2 9 13 That the temperature of the 31/03/2010 clinical areas continues to be monitored closely and the installation of air conditioning considered if the temperature continues to regularly exceed 25 degrees centigrade. This is to maintain the potency of the medicines. 3 9 13 That the home improves its procedures for safely handling warfarin. The National Patient Safety Agency guidance must be followed. There must be written evidence of the prescribed dose of warfarin 31/03/2010 Care Homes for Older People Page 11 of 13 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 in the home at all times. This is to prevent error in administering warfarin. 4 9 13 That controlled drug cabinets 31/03/2010 are secured to a solid wall with rag bolts. This is to prevent them being removed. 5 9 13 That the home uses professional lancets when sampling blood glucose. This is to prevent the transmission of blood borne infections. 6 9 13 That the home records the minimum and maximum temperature of the fridge consistently in both clinical areas. This is to ensure that the potency of medicines requiring cold storage is maintained. 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 31/03/2010 31/03/2010 Care Homes for Older People Page 12 of 13 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). 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