Random inspection report
Care homes for older people
Name: Address: Apthorp Lodge Nurserymans Road off Brunswick Park Road London N11 1EQ two star good 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: Duncan Paterson Date: 1 9 0 6 2 0 0 9 Information about the care home
Name of care home: Address: Apthorp Lodge Nurserymans Road off Brunswick Park Road London N11 1EQ 02082114000 02082114109 manager.apthorplodge@fremantletrust.org www.fremantletrust.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) : The Fremantle Trust care home 108 Number of places (if applicable): Under 65 Over 65 50 6 52 dementia learning disability old age, not falling within any other category Conditions of registration: 0 0 0 The maximum number of service users who can be accommodated is: 108 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: Old Age, not falling within any other category - Code OP(maximum number of places:102),Dementia - Code DE (maximum number of places: 102), Learning Disability - Code LD (maximum number of places: 6) Date of last inspection Brief description of the care home Apthorp Lodge is a large care home registered to provide care for 108 residents. The registration for the service allows care to be provided to older people, people with
Care Homes for Older People Page 2 of 13 Brief description of the care home dementia and adults with learning disabilities. There are 50 places for people with dementia, 52 places for older people and 6 places for people with a learning disability. The home is a large detached three-storey building. It is purpose built and organised on three levels, with lift access to all floors. It is divided into ten units or flats. Four units are dedicated to residents who have dementia and one unit to service users who have learning disabilities. The remaining five units are for mainstream services for older people. People with dementia can also be accommodated in the mainstream units if this is where their needs can most appropriately be met. There is a kitchen, lounge and dining room in each flat. All bedrooms are single with en-suite facilities. There is also an additional assisted bathroom in each unit. There is a car park to the side of the building and gardens to the side and rear, which are partly paved and accessible to the residents. The home is situated off Brunswick Park Road. It is well served with community services and facilities located along Russell Lane and East Barnet Road. The home has a day centre, which provides services to twenty-six service users specifically from the outside community. The registered manager retired earlier this year and there are currently two interim managers providing a management presence until a new manager starts work. The interim managers are supported by a deputy manager. Seven unit leaders complete the care management team for the home. There are additional managers in charge of maintenance and catering. As a result of this inspection the Commission is taking enforcement action to secure compliance and ensure better outcomes for people who use the service. Care Homes for Older People Page 3 of 13 What we found:
This was a random inspection visit jointly carried out by the lead inspector and a CQC pharmacy inspector. We found a number of shortfalls in medication recording and administration. We found that the staffing levels had been decreased some months before when resident numbers had reduced. However, they had not been increased when resident numbers subsequently increased. We also found that staff deployment in the home needed reviewing. We were advised that new staff have been appointed including a new manager. We found that the expected new care planning system had not been introduced yet. We inspected the recording of receipts, administration and disposal of medication in all ten units of the home. We looked at storage, controlled drugs and audited stocks of medication to see if medicines were being given as prescribed. We noticed that the home had a medication policy and it was available in all units and there were sample signatures and initials so we could see who had given the medication. The history of allergies was generally completed but we did see some omissions. All medication was secure including controlled drugs and that of residents who were self-medicating. Many of the trolleys were dirty, particularly inside where liquids had spilt. We noticed lots of egg cups on the trolleys and questioned why they did not use medicine cups. The fridge to store insulin did not seem to be at the correct temperature and there were no records available to check. We noticed that in some units the records for administration were complete and accurate and signatures could be reconciled against the stock held. Throughout the home there was good practice of keeping medication profiles, protocols for administration of rectal diazepam and results of blood tests for residents prescribed anti-coagulants. Medicines for disposal were recorded and balances of controlled drugs were all accurate. However, we identified a number of discrepancies in all but one unit of the home. The discrepancies included one unit where the incorrect dose of olanzepine and mycophenolate was given. In another unit there was evidence that a sleeping tablet and antipsychotic medicine were not given on several occasions. We found two instances of self-administration risk assessments not having been updated since 2007. We found many gaps on the medication administration records (MAR) and examples of where medication had been signed for and not given. The wrong date had been entered on a MAR chart for a resident on respite care. There was an instance of care workers giving one dose of another persons medication which was similar. We found that there was a missing MAR chart for one resident which made it impossible to tell if the medication had been administered over a period of 5 days. We found a lack of information on a care plan for one resident who had been prescribed intravenous antibiotics by the hospital. We found that an exelon patch had not been applied as prescribed. We found that for one residents eyedrops there was no date of opening and we were concerned that they were past their expiry date. We found gaps for an anticonvulsant medicine and were told that a member of staff had not administered the medicine because of not knowing that the name of the medicine on the MAR was the same as the medicine as in the box of tablets. We also found that in one unit one resident had been given a medicine 4 times a day instead of the prescribed 3.
Care Homes for Older People Page 4 of 13 We were told that staff were due to have a medication training update. Audits by managers were not available for inspection and there was no copy of a current BNF for careworkers to look up information. We visited nine of the ten units to check staffing levels. We were able to talk with staff, a number of residents, some visiting relatives as well as observe practice. We also spoke with one of the interim managers, the deputy manager and a number of the unit leaders. Our main finding was that there is a need to review and increase staffing levels. We were told that the home had reduced the staffing levels in the flats that provide care for older people. There are five of these flats in the home. We were told that the staffing levels had been reduced some months beforehand when resident numbers had dropped. However, they had not been increased when residents numbers increased. We found that the four dementia care units of the home have a higher staffing ratio than the other units. In three of these units units there are three staff on duty throughout the day. The fourth, smaller unit, has two staff on duty throughout the day. We were not advised of difficulties with the staffing level for these units. The five units for older people vary in size. On the day of the inspection the variation was from the smallest unit providing care for six residents up to the largest providing care for 12 residents. The largest unit had two staff on duty throughout the day but here we were told that the needs of residents had become higher in recent weeks and that was having an impact. For example, we were told that breakfast had not finished that day until 10.30am. The two units on the second floor have two staff on duty until 2.30pm but only one for the afternoon shift. A third member of staff floats between the two units providing assistance where needed. We were told by staff in these units that the staffing levels sometimes caused difficulties such as when staff had to accompany residents to hospital or when staff on duty were not trained in medication. The staff said that the needs of residents was high. For example, we were shown evidence that two residents in one of the flats had been diagnosed with dementia. A resident on this floor felt that the staffing level was low and that was having an impact. She said that, staff are so busy and I have to do things for myself. A small unit on the first floor had one member of staff on duty throughout the day. On the morning of the inspection this work was being carried out by a new member of staff who had not completed medication training. As a result medication on that unit was being managed by a member of staff from the next door flat. In this next door flat there were two members of staff on duty until 11.30am after which there was one member of staff for the rest of the day. There were 8 residents living in this flat. The person in charge that morning was therefore also responsible for medication for the two units. We were told that in this flat one resident needed help from two people to transfer. When this help is needed, we were told, the care worker (if working alone) obtains help from staff elsewhere in the building. We were also told of other staffing issues. The interim manager said that a new manager has been appointed and that new permanent staff have also been appointed. Having permanent staff and not relying on agency staff should address some the staffing
Care Homes for Older People Page 5 of 13 matters. In the meantime, some action is needed as we found the following. On the afternoon of the inspection there were no unit leaders on the rota to work in their units. There is an assigned unit leader for each unit (seven in total) with some unit leaders line managing more than one unit. There was a unit leader on duty in the afternoon but that was to provide duty cover for the overall home rather than a specific unit. When on duty, unit leaders are based in the main office providing help where needed throughout the home. The deputy manager was present in addition to the unit leader on duty but apart from that the units were being run by care staff. The senior staff we spoke to said this was an issue to do with how the staffing rota was set up and was to be changed. We were told that the duty system had been changed in relation to unit leaders. In the morning only one unit leader was on duty rather than two as had previously been the case. Unit leaders we spoke to said that this had had an impact and they felt more pushed for time now. On the morning of the inspection the deputy manager was on duty and having also to answer the telephones and the front door. There were no administrative staff present. We were told that this was only the case on alternate Fridays. Other than that there were administrative staff present. Other staffing matters we were told about included some feedback that not having permanent staff and dedicated staff for each unit made matters difficult. This should ease when the newly appointed staff start work. The night staff level on the second floor was also mentioned as an issue. There is currently one night worker for the two flats on this floor which is currently 21 residents. This should be reviewed. The learning disabilities unit was visited. There were three people resident with a fourth in hospital. There were two staff on duty throughout the day. When we visited, just before lunch one resident was out with a member of staff. They returned for lunch. The resident told us about the places he visited including church on Sundays. We noted that there had been some improvement in this unit including a new carpet and new wall decorations. The unit looked cleaner and more attractive. We spoke with the unit leader, who is also the unit leader for another unit where he was working that day. He was able to tell us about the plans for the service and what he had done so far since becoming the unit leader. The interim manager told us about plans to introduce a new pathways tool to assist with care. We also noted that the statement of purpose had been updated with more detail now provided about the learning disabilities service. To make sure that the development plans for the service are clear and have agreed timescales a business plan, or similar, must be drawn up for this service. The business plan should detail the actions that are being taken to address the arising matters from the resident reviews carried out earlier this year by the local authority learning disabilities social work team. We were shown care plans in two of the units visited. We had expected to see the new care plans which we had been advised would be operative from April 2009. We found that the care plans in use were the existing ones. We asked staff and the management team about this and were told that they had also been expecting the new care plans to be in use. It is important that these new care plans are used as the existing ones are long and detailed. Some staff told us that they find them difficult to complete and use. Care Homes for Older People Page 6 of 13 We also asked about progress with completing the computer based system for recording and analysing staff training records. We were told that this work had not yet been completed. This had been a recommendation at the inspection of 11 June 2008. This recommendation is repeated. 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 7 of 13 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 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 4 12 Produce a business or action 01/09/2009 plan for the learning disabilities unit setting out the planned improvements for the service with agreed timescales. The plan to include actions arising from the local authority resident reviews. This will provide a detailed action plan setting out how residents needs will be met. 2 7 12 Introduce the new care planning system. This will improve the care planning arrangements and provide clearer plans for residents and staff. 01/09/2009 3 9 13 Make suitable arrangements 30/07/2009 for the recording and safe administration of medicines received into the care home. A statutory requirement notice has been issued with compliance date of 30 July 2009. Care Homes for Older People Page 9 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 To ensure better outcomes for people using the service. 4 9 13 Ensure that all residents of Apthorp Lodge are given their medication as prescribed. A statutory requirement notice has been issued with compliance date of 30 July 2009. To ensure better outcomes for people who use the service. 5 9 13 Ensure medication administration records (MAR charts) are complete and accurate at all times. A statutory requirement notice has been issued with compliance date of 30 July 2009. To ensure better outcomes for people who use the service. 6 9 13 That medication is stored in clean trolleys and adminsitered professionally using medicine cups. This is to prevent the risk of infection and cross contamination between medicines. 7 9 13 That the medicines fridge is maintained at the correct 30/07/2009 30/07/2009 30/07/2009 30/07/2009 Care Homes for Older People Page 10 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 temperature so that medicines requiring cold storage retain their potency. Daily records showing the minimum and maximum temperature must be available for inspection. This is to ensure that medicines are stored correctly and safely. 8 9 13 Dosage changes must be clearly re-written on the MAR. This is to prevent the risk of error particularly with complex doses and medicines such as Warfarin. 9 9 13 Risk assessments for residents who self-medictae must be regularly reviewed and updated. This is to support the well being of residents and maintain their independence. 10 27 18 Review the deployment of 30/07/2009 unit leaders so that there are sufficient senior staff on duty to efficiently manage the home and meet the needs of residents. The current arrangements do not provide for the adequate monitoring and support for care staff throughout the home. 11 27 18 Review and increase both 30/07/2009
Page 11 of 13 30/07/2009 30/07/2009 Care Homes for Older People 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 night and day staffing levels in the five older persons units. This will ensure that there are sufficent numbers of staff for the needs of residents. 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 A British National Formulary (BNF) should be available in the home so that staff can look up information on medicines. Complete the work to produce a computer based system for recording and analysing staff training records. 2 30 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). 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 13 of 13 - 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!
