Inspection on 21/01/10 for Apthorp Lodge

This inspection was carried out on 21st January 2010.

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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Apthorp Lodge 09/03/10

Apthorp Lodge 03/11/09

Apthorp Lodge 17/08/09

Apthorp Lodge 19/06/09

Apthorp Lodge 11/06/08

Apthorp Lodge 04/12/07

Apthorp Lodge 22/05/07

Apthorp Lodge 14/08/06

Apthorp Lodge 12/12/05

Apthorp Lodge 09/08/05

Apthorp Lodge 13/01/05

Apthorp Lodge 22/07/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 10/04/2010.

Random inspection report Care homes for older people Name: Address: Apthorp Lodge Nurserymans Road off Brunswick Park Road London N11 1EQ 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: Jane Shaw Date: 2 1 0 1 2 0 1 0 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): Name of registered manager (if applicable) The Fremantle Trust Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 108 Number of places (if applicable): Under 65 Over 65 102 6 102 dementia learning disability old age, not falling within any other category Conditions of registration: 0 0 0 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) The maximum number of service users who can be accommodated is: 108 There shall be no further admissions of service users to Apthorp Lodge without the prior written agreement of the Care Quality Commission and until such a time as all Statutory Requirement Notices are complied with and an improvement plan on Care Homes for Older People Page 2 of 13 administering medication is in place and effectively working. 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 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 a new manager has been appointed. They 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. 1 7 0 8 2 0 0 9 Care Homes for Older People Page 3 of 13 What we found: This pharmacist visit was to check how safely medication was handled, following the issue of a Statutory Enforcement Notice on 20/11/09. The notice required the home to:- Make arrangements for the recording, handling, safekeeping ,safe administration and disposal of medicines received into the home. Ensure that a system is put into place to ensure that all residents are given their medication at the time and in the dose prescribed. Ensure a system is put in place to ensure medication administration records (MAR) are completed at the time of administering the medication and are accurate at all times. A reason for non administration must be recorded. We looked at medication and records in all the flats in the home and carried out some random auditing. We looked at the records of daily checks of the Medication Administration Records (MAR) and the audits the manager was carrying out. We noted that record keeping on the MAR was much improved. There were no gaps noted in the recording of receipts and administration in any of the flats. Variable doses such as one or two were being recorded accurately and several of the flats were writing dates of opening on packs to aid accurate auditing. We looked at disposal records in one flat and noticed that there were no records since November 2009. We looked at the Monitored Dosage System (MDS) and when tablets were left in a cartridge we could reconcile them to the appropriate endorsement on the MAR. We counted 65 samples of medication in total- all supplied in their original packaging, to see if records supported safe administration. In five of the flats, of a total of 27 samples audited, all were found to be accurate. In the other 5 flats we noticed 16 discrepancies in the 38 sampled. In one flat alone, three residents were prescribed a laxative powder and there were too many sachets left. This suggests that residents were not having the medicine but it was being recorded as given. There was one too many sleeping tablets left for one resident , two anticonvulsants unaccounted for another resident and one too many anti psychotic tablets for another. There were discrepancies in laxatives for other residents and medicines which protect the stomach and prevent osteoporosis. The daily checks of the MAR carried out by care workers were well completed . We looked at the regular audits carried out by the manager to see if some of the issues we identified had been picked up. We noticed that three had but the others had not. Because we identified so many discrepancies in audit, we are not able to state that the notice of 20/11/09 has been fully complied with. Further action was considered and The Commission is taking further enforcement action to secure compliance and achieve better outcomes for service users . What the care home does well: What they could do better: In five of the flats we noticed discrepancies in audit which suggests that residents were Care Homes for Older People Page 4 of 13 not always receiving their medication as prescribed. There needs to be more robust monitoring in these flats so that record keeping is always accurate. Care workers need to pay particular attention to recording accurately medicines that are brought in from home or hospital. 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 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 4 18 A programme of dementia 01/04/2010 care training, that builds on the basic awareness training given during induction, must be included in the annual programme of training. This will enable carers to offer support based on a greater understanding and knowledge of the needs of residents with dementia. 2 4 15 Contact must be made with the local authority again to request copies of the minutes of the review meetings that were held in March 2009 for residents of the Harbour Lodge unit. This will ensure that the development of the service for residents with learning disabilities builds upon agreements and recommendations arising from their review meetings. 01/01/2010 3 7 15 The registered person must 01/01/2010 ensure that when changes in the likes or dislikes of a client are noticed the care plan must be updated. This will assure residents Care Homes for Older People Page 6 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 that changes in their needs are identified, recorded and acted upon. 4 7 14 The registered person must 01/04/2010 ensure that mental capacity assessments are carried out as required and are recorded with a copy kept on the residents case file. This will assure residents that an assessment of capacity has informed the support needed by the resident. 5 7 12 The registered person must ensure that the new care plan format is implemented in the care home, after training for carers in the content and usage. This will assure residents that the format of the care plan is person centred, detailed and comprehensive so that all their individual needs are identified, recorded and addressed. 6 12 12 The registered person must 01/04/2010 ensure that activities appropriate to the understanding of and suitable for the participation in by residents with dementia are provided. The post of activities coordinator for the dementia care units must be filled. This will assure all residents Care Homes for Older People Page 7 of 13 01/02/2010 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 of opportunities for a stimulating and enjoyable lifestyle. 7 16 22 The registered person must 01/01/2010 ensure that a comprehensive record of complaints is maintained. This will assure residents, and their representatives that their concerns are listened to and acted upon. 8 19 16 A review of access to the 01/02/2010 building must be carried out. This will assure visitors to the care home that they do not have to wait to gain entry for longer than is necessary. 9 19 23 The chairs in the lounge where smoking is permitted that are worn and stained must be replaced. This will assure residents that all lounge areas provide clean and smart seating. 10 26 16 Odour control systems must 01/01/2010 be effective in all parts of the home. This will assure residents of a pleasant environment that is free from offensive odours. 11 27 18 A system of regular reviews 15/01/2010 of staffing levels must be in place to check that they match dependency levels of residents and allow residents Page 8 of 13 01/02/2010 Care Homes for Older People 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 to take part in activities outside the home. Adjustments must be made to staffing levels as required. This will assure residents that there are sufficient members of staff on duty to meet their needs and to respond to calls for assistance in a timely manner. 12 27 18 When the review of 01/06/2010 management levels in the home takes place the layout of the home, the complexity of needs of the residents, the size of the staff team and the number of tasks associated with the day to day running of the home must be taken into account. This will assure residents that the management structure supports the smooth and effficient running of the home. 13 33 26 The format of the Regulation 01/01/2010 26 report must be reviewed and a more comprehensive format developed. This will enable the care home to keep a comprehensive record of the areas inspected and of the findings so that this report informs the trustees of how well the home is operating and whether it is achieving Care Homes for Older People Page 9 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 the standards required by regulation. 14 36 18 The registered manager 01/01/2009 must ensure that carers receive individual supervision sessions which are recorded and which take place a minimum of 6 times per year. This will assure residents that members of staff are supported and that their work is monitored and kept under review. 15 38 13 The registered manager 01/01/2010 must ensure that training in safe working practice topics is refreshed when necessary e.g. manual handling training to be undertaken on an annual basis. This will assure residents that the way in which members of staff carry out their duties promotes the safety of the residents. 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 Ensure a system is put in 01/03/2010 place to ensure medication administration records (MAR) accurately reflect whether any medication was taken, refused, or refused and destroyed. This is a Statutory Enforcement Notice. So that there is evidence of accurate administration of medication 2 9 13 Ensure a system is put in 01/03/2010 place to ensure medication administration records accurately reflect the amount of medication received into the home. This is to aid stock control of medication to ensure that medicines do not run out and allow accurate auditing of medication. 3 9 13 Make arrangements for the 01/03/2010 recording,handling,safekeepi ng,safe administration and disposal of medicines Page 11 of 13 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 received into the care home. This is a Statutory Requirement Notice. This is to maintain the health and welfare of the service users. 4 9 13 Make arrangements to ensure that all medication is administered as directed by the prescriber to the service user it was prescribed, labelled and supplied for. This is a Statutory Requirement Notice. This is to maintain the health and welfare of the service users 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 01/03/2010 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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. 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