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 06/11/2009 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: Vashti Maharaj Date: 0 9 0 3 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 15 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. 0 6 1 1 2 0 0 9 Care Homes for Older People Page 3 of 15 What we found:
This inspection was to check compliance with a Statutory Requirement Notice issued on 02nd February 2010. This was the third notice issued due to concerns with the way the service is managing medicines held on behalf of people at the home. The service was in breach of Care Home Regulation 13.1 in that it failed to make effective arrangements for the recording and safe administration of medicines received into the home. The notice required the service by 01st March 2010 to: 1 Make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. 2 Make arrangements to ensure that medication is administered as directed by the prescriber to the service user it was prescribed, labelled and supplied for. 3 Ensure a system is put in place to ensure medication administration records MAR accurately reflect whether medication was taken, refused, or refused and destroyed. 4 Ensure a system is put in place to ensure medication administration records accurately reflect the amount of medication received into the home. The inspection was carried out by a Commission Pharmacist Inspector and an Inspector from the Regional Enforcement Team. We inspected medication and records in 8 flats at the home, and carried out random audits to see whether the quantities of medicines in stock tallied with medication records. We reviewed records of daily checks on medication records (three times a day checks to ensure staff have signed for giving medicines) and also daily audit sheets on the quantities of boxed medicines in stock (medicines not in blisterpacks). We found that record keeping has improved since the last inspection on 21st January 2010. The daily checks have been effective in ensuring staff record when medicines are given, as on the morning of the inspection, all morning doses had been given and signed for except in two instances, one where staff had forgotten to sign the medication chart for giving a weekly tablet for osteoporosis, and in the second case where staff have signed for giving a calcium tablet but our random audit showed it had not been given. We found that the daily audits on the quantities of medicines in stock have been effective in picking up when medicines have not been given, except in two cases, the first where staff did not give a sachet of laxative powder on 4th March 2010, and the second where there were 2 more sachets of laxative powder in stock than recorded on the medication record (108 in stock instead of 106 on 09th March 2010). As we found only 4 cases where medicines in stock did not tally with medication records, and 2 of these would have been picked up during the daily checks of medication records, parts 2, 3 and 4 of the notice have been complied with. Part 1 of the notice has not been complied with as we found medicines in the store room
Care Homes for Older People Page 4 of 15 and in the controlled drugs cupboard which have been there since November 2009, and have not been returned promptly. The medicines in the store room have not been written into the returns log, and these include a sedating medicine used for agitation. The service must be able to account for all medicines, this includes checking that any medicines returned tally with records of medicines received and used. This is to ensure medicines have been given as prescribed, and to prevent misuse. The controlled drugs which have not been returned are not entered into the current controlled drugs register. Staff told us that the old register had been returned to the Pharmacy. This means that these medicines cannot be properly accounted for and they could potentially be misused. The service must ensure that medicines are returned promptly, and that justified stock checks are carried out to ensure that the quantities of medicines returned tallies with the quantities received and used. As the other parts of the notice have been complied with, we have made a decision to leave a requirement on this issue instead of issuing another Statutory Requirement Notice, however the service is still not meeting the minimum standard for medication handling and recording, and must continue to make improvements to ensure the health and safety of people who live there. We found other issues with medicines handling during our inspection. We have listed these below under What the service could do better. What the care home does well: What they could do better:
We found a medicine in one of the flats which did not appear on the current medication chart. Staff responsible for giving medicines on the day were unsure whether this had been stopped by the prescriber or was being kept for occasional use. When medicines are stopped by the prescriber, it must be clear from the records, and these must be disposed of promptly. Medicines were also being kept in trolleys in open dining areas in some flats as there has been a problem with the air conditioning units in one of the medicine store rooms. The air conditioning units have not been working properly since February 8th 2010 according to an email from the Property Manager. The trolleys are not kept secured to the walls in the dining areas when not in use, and the temperature in some of these areas is still above the recommended for most medicines, 15C-25C, e.g. records for Flat 5 show that the temperature has been above 25C for 4 days out of 9, and Flat 6 records show that the temperature has been over 25C for 8 days out of 9 from 01st-09th March 2010. No records have been kept for Flat 7 from 12th February 2010 onwards. The Provider informed us on the day of the inspection that approval has now been obtained to carry out the repair.
Care Homes for Older People Page 5 of 15 Medicines must be stored at correct temperatures to avoid deterioration, and when stored in public areas, the trolleys must be secured to a wall. For some medicines with a variable dosage, one or two tablets, staff are not recording how many are being given. Records must indicate the actual dose given. For any medicines with a variable dosage, e.g. pain relieving medicines, and medicines for agitation, protocols should be available which give clear and detailed instructions on when and how these should be used, including the maximum dose in 24 hours. For 2 bottles of eye drops, only the outer box only was labelled with the residents name and instructions for use. It is accepted good practice to label the bottle as well as the outer box because if the outer box is thrown away or misplaced, or there are 2 residents on the same eye drops, there is the risk of incorrect use. Photographs are needed as as way of identifying residents before medicines are administered. These are missing for some residents. A fax had been received to notify the home of an increase in a residents anticoagulant medicine and this was placed with the medication record. The fax was received on 08th March 2010, but the change had not been made to the medication record by lunchtime on the day of the inspection, 09th March 2010. Although the resident did not receive the wrong dose as his dose was due later in the day, changes to medicines must be made immediately. Product Information Leaflets have been provided for all medicines used at the home, these are intended to be used to increase knowledge about the medicines held at the home, for example what the medicines are used for and potential side effects.These are stored in paper bags in the medicines trolley, and there was no evidence these are being read or used. We recommend that staff use these to increase their knowledge about the medicines they are giving to people at the service. 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 15 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 7 of 15 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 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
Care Homes for Older People Page 8 of 15 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 7 9 13 Make arrangements for the 01/03/2010 recording,handling,safekeepi ng,safe administration and disposal of medicines received into the care home. This is a Statutory Requirement Notice. This is to maintain the health and welfare of the service users. 8 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. 9 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 01/03/2010 10 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
Page 9 of 15 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 are provided. The post of activities coordinator for the dementia care units must be filled. This will assure all residents of opportunities for a stimulating and enjoyable lifestyle. 11 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. 12 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. 13 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. 14 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
Care Homes for Older People Page 10 of 15 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 free from offensive odours. 15 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. 16 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 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. 17 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
Care Homes for Older People Page 11 of 15 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 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 the standards required by regulation. 18 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. 19 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 12 of 15 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 Registered Provider must 16/04/2010 ensure that there are effective arrangements in place for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home, in particular: -ensuring that accurate and up to date records of medicines for disposal are kept -ensuring that unwanted medicines are disposed of promptly -ensuring that there is a clear audit trail of all medicines received, used and disposed of -ensuring that a record is made of the actual dose at each administration, for any medicines with a variable dose -ensuring that there are PRN protocols in place for any Care Homes for Older People Page 13 of 15 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 medicines given on as as required basis -ensuring that medicines are stored securely and at the correct temperatures To ensure that there is an audit trail for all medicines kept at the service, to provide evidence medicines have been given as prescribed to ensure the health and safety of people at the service 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 Registered Provider should ensure that photographs are available for all people at the home as a means of identifying people before medicines are given The Registered Provider should ensure that the area of application for creams and ointments is added to medication records so it is clear how these should be used. The Registered Provider should ensure that staff use the product information leaflets supplied with medicines to increase their knowledge on the medicines they are giving The Registered Provider should ensure that there are instructions on both the inner and outer boxes of eye drops to ensure correct use. 2 9 3 9 4 9 Care Homes for Older People Page 14 of 15 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 15 of 15 - 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!
