This inspection was carried out on 10th August 2009.
CQC found this care home to be providing an Adequate 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.
Random inspection report
Care homes for older people
Name: Address: Anna Victoria Nursing Home Peace Haven Pole Barn Lane Frinton On Sea Essex CO13 9NH one star adequate service 26/01/2009 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: Derek Brown Date: 1 0 0 8 2 0 0 9 Information about the care home
Name of care home: Address: Anna Victoria Nursing Home Peace Haven Pole Barn Lane Frinton On Sea Essex CO13 9NH 01255675609 01255673791 cnunn@annavictorianursinghome.org 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) : Anna Victoria Nursing Home care home 28 Number of places (if applicable): Under 65 Over 65 2 28 old age, not falling within any other category physical disability Conditions of registration: 0 0 Persons of either sex, aged 65 years and over, only falling within the category of old age (not to exceed 2 persons) Persons of either sex, aged 65 years and over, who require nursing care by reason of a physical disability (not to exceed 28 persons) The total number of service users accommodated in the home must not exceed 28 persons Date of last inspection Brief description of the care home Anna Victoria provides nursing and personal care for up to 28 older people. The home provides palliative care for up to 3 residents with a terminal illness. Anna Victoria is owned by a charitable organisation, named Anna Victoria Nursing Home. The home is
Care Homes for Older People Page 2 of 11 2 2 0 5 2 0 0 9 Brief description of the care home founded on Christian principles and there is a Christian ethos in the home. The home is a two-storey building that was purpose built when first opened in 1992. There are 28 single en-suite bedrooms on two floors that are accessible by stairs and a lift. The home offers large communal areas. The rear of the home has an enclosed wellmaintained garden and is accessible by ramps. The open plan sensory garden to the front of the premises provides a pleasant outlook from the home. The home has a visitors room and overnight accommodation can be arranged. There is a loop system installed at the home for the benefit of those with a hearing impairment. The home is accessible by car and the nearest railway station is nearby. Parking is available for staff and visitors in the large car park located to the front of the home. The home is located within walking distance of the main shops in Frinton-on-Sea. The fees range from £695 to £772 per week and include toiletries, aromatherapy massage and reflexology. There are additional costs for chiropody, hairdressing and newspapers. This information was provided to the CSCI in January 2009 Care Homes for Older People Page 3 of 11 What we found:
The purpose of this inspection by a pharmacist inspector was to assess progress towards meeting the requirements made on the Key Inspection of 26th January 2009 and again following the Random Inspection on 22nd May 2009. A requirement was made to ensure that nurses make accurate records of all medicines they administer, document the reasons why any are omitted and provide a clear audit trail of all medicines within the home. The timescale for compliance was 15/06/2009 having not been met by the previous timescale of 16/03/2009. During this inspection we looked at the medication and medication records for 8 people resident in the home. We found discrepancies in the records for 7 of these people. The discrepancies relate to (but are not limited to): Gaps in the records made when medicines are given to people giving no indication of whether medicines are administered or not; records showing that medication had been omitted but the reason why was not always recorded; when medicines were prescribed to be given in variable doses e.g. one or two tablets the actual quantity given was not always recorded. This could result in people receiving too much or too little medication; medication prescribed to be given four times a day but the record shows it only given at this frequency on one day out of the 20 days the treatment was given; an instruction to stop medication on 19/7/2009 was ignored and the treatment continued until 04/08/2009 without any recorded justification for this; medication prescribed and labeled for one person used for the treatment of another; medication prescribed to be used three times a day but only recorded as being used once a day; discrepancies in the level of stock of medication for two people which indicates that medication records may be inaccurate. We therefore considered that the requirement stated above has not been met by the given timescale and enforcement action is being considered. In addition to the above we found that where medication is given in variable doses, there was no guidance in care plans detailing the circumstances of their use and which may put people at risk of receiving medication inappropriately. A further requirement has been made about this. Also, on arrival at the home the clinical room was left unlocked and the room was unattended. Prescribed medication was left on top of trolleys and benches in the room and the refrigerator used to store medication was also unlocked. This increases the risk that medication may be accessible to unauthorised people and people it is not prescribed for. A further requirement has been made about this. We made a requirement that nurses must have refresher training on the management of medicines and an assessment of competence. The timescale for compliance with this requirement was 31/07/2009, the previous timescale of 01/05/2009 was not met. Subsequent discussion with the manager of the home had led to the timescale of this requirement being extended to 30/09/2009 as it was felt the timescale of 31/07/2009, which had been agreed on the Random Inspection of 22nd May 2009, could not be achieved due to sickness of the person delivering the training. We were assured however that a number of nurses had already completed the training and assessments of their competence had been started. During this inspection of 10th August 2009 we saw attendance certificates to show that 8 people (including the manager) had attended training, but there was no documented evidence that any assessments of competence
Care Homes for Older People Page 4 of 11 had been started. This was confirmed by the senior member of staff present on the inspection. Given the shortcomings found and detailed above, we consider that training and competence assessment must be completed as a matter of priority. We were told that the deputy manager undertakes an audit of the accuracy of medication records on a monthly basis when new prescriptions and medicines are ordered. Again, given the level of discrepancies detailed above we recommend strongly that the audit frequency is reconsidered. 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 5 of 11 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 14 The manager must ensure 01/04/2009 that residents assessments are regularly reviewed and updated when their condition changes. In order that they reflect residents current condition and the support and care they need from staff. 2 7 15 The manager must ensure 01/05/2009 that care plans are drawn up in consultation with residents, relatives and care staff where appropriate. In order that residents priorities, preferences, abilities and wishes are reflected in the plans and they are written in a language that is accessible to residents, relatives and care staff. 3 9 13 Nurses must have regular refresher training on the management of medicines and an assessment of 30/09/2009 Care Homes for Older People Page 6 of 11 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 competence. In order to ensure that they have up to date knowledge and understanding of the receipt, administration, recording and disposal of medicines. Previous timescales of 01/05/2009 and 31/07/2009 not met. 4 9 13 The manager must ensure that nurses make accurate records of all medicines that they administer, document the reasons why any are omitted and provide a clear audit trail of all medicines in the home. In order to demonstrate whether residents have received all their prescribed medicines and what dose has been administered. Previous timescales of 16/03/2009 and 15/06/2009 not met. Enforcement action may be considered 5 19 13 Risk assessments of the 16/03/2009 premises must be carried out on a regular basis and action taken whenever needed. In order to ensure that the environment is safe and meets the needs of current residents. 31/07/2009 Care Homes for Older People Page 7 of 11 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 6 26 13 Hand washing facilities 20/04/2009 facilities must be available in all areas where staff carry out personal care. Hand washing facilities facilities must be available in all areas where staff carry out personal care. 7 30 18 The manager must ensure 04/05/2009 that a training review is carried out for each member of staff. In order to identify the training needed for staff to undertake their role and provide good support and care to residents. 8 33 24 The manager must ensure that the quality assurance audits are comprehensive. In order to identify and address risks to residents health, safety and welfare. 9 38 13(4) The registered person must ensure that the laundry and maintenance cupboards are 31/03/2007 01/07/2009 Care Homes for Older People Page 8 of 11 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 kept locked when unsupervised. Care Homes for Older People Page 9 of 11 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 All medicines must locked away when not in use. So that they are not accessible to unauthorised people and/or people they are not prescribed for. 31/08/2009 2 9 14 Where people are prescribed 31/08/2009 medication on variable dose basis, there must be detailed guidance for staff on the circumstances these are used. This will ensure people receive treatment appropriate to their needs 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 9 The frequency that medication records are audited for accuracy should be reviewed in order that discrepancies are identified, investigated and rectified quickly. Care Homes for Older People Page 10 of 11 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 11 of 11 - 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!