Inspection on 12/05/10 for Ashbourne House Nursing Home

This inspection was carried out on 12th May 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashbourne House Nursing Home 25/01/10

Ashbourne House Nursing Home 29/10/09

Ashbourne House Nursing Home 01/05/08

Ashbourne House Nursing Home 21/05/07

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 17/07/2010.

Random inspection report Care homes for older people Name: Address: Ashbourne House Nursing Home 376-378 Rochdale Road Middleton Manchester Lancashire M24 2QQ zero star poor service 25/01/2010 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: Lucy Burgess Date: 1 2 0 5 2 0 1 0 Information about the care home Name of care home: Address: Ashbourne House Nursing Home 376-378 Rochdale Road Middleton Manchester Lancashire M24 2QQ 01616432060 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Silverdale Care Homes Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 29 Number of places (if applicable): Under 65 Over 65 0 29 dementia old age, not falling within any other category Conditions of registration: 29 0 The registered person may provide the following category of service only: 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. The maximum number of service users who can be accommodated is: 29. Date of last inspection Brief description of the care home Ashbourne House Nursing Home is a converted and extended home located a short distance from the centre of Middleton, owned by Silverdale Care Homes Limited. Care Homes for Older People Page 2 of 15 2 5 0 1 2 0 1 0 Brief description of the care home The home is registered to care for up to 29 people with personal care needs, nursing needs and those with dementia. Accommodation is provided over two floors, the majority of it on the ground floor. Part of the first floor of the building is not available to residents because of structural defects that are being repaired but repairs have not yet been completed. The range of fees at the time of our key inspection were 347.71 pounds to 460.32 pounds per week. Additional charges are made for Chiropody and Hairdressing Care Homes for Older People Page 3 of 15 What we found: The purpose of our visit was to look at what progress had been made following our key inspection on the 25 January 2010. As a result of our findings we issued a Statutory Requirement Notice due to poor medication practice. Other areas of concern were also identified with regards to care planning and assessment, staff training and development, staff recruitment and levels, routines, health and safety and management and conduct. Due to our concerns we held a management review meeting to consider what further action we need to take. This included a meeting with the Registered Provider, Area Manager and Acting Manager on the 15 March 2010 to discuss our concerns and what action they intended to take to make the improvements needed. We also contacted the Local authority and advised them of our concerns in line with the Safeguarding Policy and Procedure. During the meeting the Registered Person was asked to expand on the information provided within the improvement plan ensuring this addressed all areas of concern, how they intended to address them along with timescales for completion. We also asked for a copy of the refurbishment plan so that we can monitor the completion of work within the home during our future visit. The Registered Person was also reminded that copies of the monthly monitoring visits undertaken by him were to be forwarded to us each month to evidence that he was monitoring the service provided. Whilst a refurbishment plan and monthly reports have since been received an up to date improvement plan was not. The home was sent their Annual Quality Assurance Assessment (AQAA) on the 2 February 2010 and asked to complete and respond by the 2 March 2010. A reminder letter was sent on the 11 March 2010 with a further timescale to response by the 18 March 2010 as this had not been returned within the specified timescale. A completed document was received on the 22 March 2010. The Registered Person is reminded that this is a legal requirement and requests must be responded to in a timely manner. Following our last visit the Acting Manager submitted her application to register with us. A fit person interview was conducted however prior to a decision being made the Acting Manager withdrew her application. Therefore at present there is still no Registered Manager at the home. The current quality rating for the home is 0 stars, outcomes were judged as being poor following our key inspection in January 2010. Due to this and other concerns raised with the Local Authority, placements are currently not being made at the home. Prior to this visit we received information about the attitude and behaviour displayed by a member of staff towards residents and staff. The information was passed to the Registered Person to investigate. A response has been received from the Registered Person. Through his investigation he determined that the allegations were unfounded. Whilst we found improvements had been made in relation to information held about people, staff recruitment and the environment. There were still significant shortfalls with regards to the safe management and administration of medication. Care Homes for Older People Page 4 of 15 The reason for this inspection visit by the pharmacy inspector was to check that the requirements made in the Statutory Requirement Notice, dated 4 March 2010 and the requirements made following our inspection visit on 25 January 2010 had been complied with and you were no longer in breach of the regulations. A Statutory Requirement Notice is a legal notice, which is served on the provider when there has been a breach of regulations. The notice describes which regulations have been broken and what the provider must do to put right the breach; it also gives the date by which this must be done. We then follow up the notice by visiting the service to make sure that actions have been taken to meet the requirements and regulations. The requirements in this notice were made to make sure that residents health was not at risk from poor medication practices. The Statutory Requirement Notice made the following eight requirements that had to be complied with, met, by 25 March 2010. 1. Put in place effective arrangements at the home to ensure that all service users have a sufficient supply of medication to ensure that they receive prescribed medication entirely in accordance with the directions of the prescriber 2. To 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. 3. To ensure that the person administering the medication fully completes the Medication Administration Record in respect of each individual service user at the time of administration 4. Put in place effective arrangements at the home to ensure that any omissions or variations in the administration of prescribed medication and reasons for these are clearly and legibly and promptly recorded. 5. Put in place effective arrangements at the home to ensure that all medication is administered to service users in exact accordance with the prescribers instructions. 6. Put in place effective arrangements to ensure records of all medication received into the home are accurately completed. 7. Put in place effective arrangements to ensure records of all medication for disposal are accurately completed. 8. Put in place effective systems for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. The last report contained a number of requirements, which were not in the notice; some had been outstanding since December 2009 others had to be met by 25 March 2010. 1. Items of medication which are not labelled for the person they are intended for must be returned to the supplying pharmacy. 2. The manager must ensure that only medication which is currently required is kept at the home. Unwanted items should be returned to the supplying pharmacy. Care Homes for Older People Page 5 of 15 During the inspection we spoke to the homes area manager about medication practices. We also spoke to one nurse who had full responsibility for administering medicines on the day of inspection. Full detailed feedback was given to the nurse during the inspection and we gave a summary of our findings to the area manager, at the end of the inspection. The pharmacist inspector looked at medication together with records about medicines for six residents. We found that none of the requirements in the Statutory Requirement Notice or the two requirements outstanding from previous inspections had been met and the residents health and wellbeing was still at significant risk of harm. We found that the home had failed to make sure that all residents had a sufficient supply of medication. Three of the six residents could not take some of their medication because it had run out. It was recorded that one resident had an asthma attack because their inhaler was unavailable. Another resident had not been able to have medication for 8 days because the staff had failed to ensure that medication was available for her. We were very concerned that some residents did not have medication available. We issued an Immediate Requirement which stated that the area manager must identify the people who did not have a supply of their current medication and their medication must be obtained within 24 hours of the notice being issued. We also required that she must fax or email us with the details of what medication had been obtained for whom. The requirement was not met because they misunderstood what information we were asking for. This meant that some residents still did not have medication available to them and their health was at risk of serious harm. We wrote to the home again explaining exactly what information we needed and required them to provide it immediately. A similar requirement was made at the previous inspection. We looked at the quantities of medication available in the home on the day of inspection for specific residents together with the records of receipt administration and disposal. We found that not all medication could be accounted for and that it was probable that medication such as analgesia and sedatives had been shared between residents rather than administering from their own supply. Evidence was found that nurses did not complete the medication administration records at the time of administration. The nurse on duty during the inspection failed to sign for some medication she had given in the morning and then signed for it much later in the day. We also found evidence that the acting manager, who was not available during the inspection, had instructed nurses to fill in any missed signatures when they came back on duty. The general standard of record keeping about all aspects of medication continued to be poor and inaccurate. They did not always show exactly what medication had been given residents or that all medication could be accounted for. We found that residents were not always given their medication as prescribed by the doctor for a variety of reasons. On some occasions it was because there was no medication available in the home for them, some times it was because nurses failed to follow the prescribers and manufacturers directions carefully or some times the nurses failed to give residents some of the medication that they had been prescribed. We also found evidence that one resident had been given a double dose of their medication for a number of days. Care Homes for Older People Page 6 of 15 At our last inspection we found that other records about medication were also poor. The nurse on duty, during our inspection, confirmed there was still no information for nurses or care staff to follow about how to give medicines which were prescribed as a variable dose or when medication was prescribed when require. She also confirmed that no checks had been made to make sure people were safe when medication such as inhalers or creams were kept in residents rooms or they were looking after their own medication. We found evidence of poor nursing practice during this inspection. The printed instructions on the Medication Administration Record sheets (MARs) had been removed by using typex. The information was about when to give medication in relation to meals. The nurse on duty said that she had assumed that there was no longer any need to give two medicines as special times as the acting manager had removed the instructions. It is a major concern that qualified nurses ignore printed directions provided on the labels of the medicines they are administering. This could place residents health at significant risk of harm. Most medication which was in current use was kept securely at all times during our inspection however a basket of eye drops was not locked away and some of the drops should have been stored in the fridge. A delivery of new medication had been received two days before our inspection and was stacked in unlocked crates and paper bags in the medication room. The medication had not been recorded as received and was not locked in a secure place. The nurse on duty confirmed that this was usual and would not be checked in until the night before it was needed. We also found unlabelled medication in drawers in the medication room. It is vital arrangements are made for the safe storage of all medication and that medication is labelled properly, to prevent misuse of medicines. We have significant concerns poor medication practices placed residents health and well being at risk of harm and that the requirements made in the notice were unmet and the home failed to protect the residents. All other outstanding areas were looked at by the other Inspector. This included information about people living at the home, the staff team and health and safety. Time was also spent looking round the environment as well as observing practice and taking with people. Care Plans were looked at for four people where a specific need had been identified. We found that files were more orderly, easy to follow and had been reviewed on a monthly basis. Information included a care plan, risk assessments, weight records, a record of visits from GPs etc and diary sheets. Generally records were improved and provided better information about the person however some areas could be expanded upon to clearly show the levels of support required, for example the number of staff to offer support with tasks, if any aids or adaptations or equipment is needed etc. More attention also needs to be given to the scoring of risk assessments. Some records showed that the score rated was incorrect and therefore may not have reflected an accurate risk rating. Nutritional assessments for 2 people also stated that the person should be weighed on a weekly basis however records held evidenced that this was only done on a monthly basis. On two other files looked at with regards to medication we Care Homes for Older People Page 7 of 15 found that a risk assessment for night relief medication and management of diabetes were generic assessments and did not reflect the individual needs of people. Observation made during our last visit found that residents had little stimulation or variety offered to their daily routines. Since that visit we found little evidence to show that things had changed. Information provided on the AQAA stated that an activity worker had commenced work however they have since ceased their employment. The Area Manager advised us however that a replacement was being sought. Meal arrangements were the same with some people choosing to eat in the lounge and other in the conservatory. People were seen to be offered a choice, extra helpings and plenty of drinks. Those people requiring support from staff were assisted appropriately. Comments were also received from people through the surveys we sent out prior to our visit. People commented, I would like to be visited by a minister, I have a routine, the meals are good and they keep my warm, clean and happy, good food, and were not taken out often. The Registered Person is again asked to consult with people about their daily routines affording them some control over their daily lives. Other care records showed that incidents had occurred involving the health and well being of residents including a medication error and someone needing to attend A&E. These had not been reported to us in line with regulation 37. The Registered Person is reminded that this information needs to be forwarded to us to show that appropriate action has been taken to ensure people are being kept safe. Time was spent looking at the environment with the Area Manager to see what improvements had been made as well as discussing future plans. The rooms to the front of the home were near completion. The lounge had been repainted and new carpet fitted. A new large wall mounted television was on order as well as new seating. The dining room was being painted and new tables and chairs had been purchased. The hallways had been repainted and new carpeting fitted. The shower and bathrooms had also been refurbished and cater for the physical needs of people at the home. The nurse station had been removed creating a waiting area for visitors, new seating had also been ordered for this area. The small office downstairs was now being used by nursing staff and a second office had been created downstairs for the manager and administrator. This had created a better working environment for people and ensures information is held more securely. Further work has been identified with regards to a new kitchen. Consideration was being given to how this will be done so that little disruption as possible is made. The Area Manager also explained that there were no plans at this time to redecorate the second lounge, the conservatory or bedrooms. However we were told that as occupancy increases and more funds were available further decoration would be carried out where necessary. Since our last visit there had been a number of changes within the team. Staff recruitment records were examined for four new members of the team. Information was orderly and included an application form, written references, Independent Safeguarding Authority check, (ISA), previously known as POVA, criminal record checks (CRB) as well as confirmation of a current personal identification number (PIN) made through the Nursing and Midwifery Council (NMC) for those nurses employed at the home. All checks were in place prior to people being offered employment. We did find that one carer had been offered work through an employment agency it appeared from records seen that the Care Homes for Older People Page 8 of 15 carer had commenced employment prior to a current ISA or CRB check being in place. The Area Manager agreed to follow this up. We also discussed with the Area Manager and Administrator arrangements in place for those staff working on Home Office visas. It was advised that records of hours worked were kept so that the home could demonstrate that the rules had been complied with. The training and development of staff was also explored. A copy of the training matrix was provided along with a copy of the training plan for June to September 2010. The matrix showed that only a small number of staff had undertaken any recent training. Courses had included; food hygiene, vulnerable adults, fire safety, dementia, Deprivation of Liberty, and mental capacity. The training plan showed further courses were planned for the forthcoming months in moving and handling, food hygiene, mental capacity, infection control, safeguarding and dementia. However the number of places booked still left some staff, including ancillary staff, without having received any training relevant to their role. Further training should be considered and include safeguarding, MUST, health and safety and infection control. Information provided also showed that only 6 members of staff have achieved an NVQ. This too needs to be addressed. In relation to staff induction, those files examined did contain an induction checklist. This had been completed on the day they commenced employment and outlined the policies and procedures of the home. Information was not seen with regards to a comprehensive induction in line with the Skills for Care specification. The Registered Person needs to ensure that relevant staff complete this ensuring they are informed and supported in carrying out their duties. An immediate requirement was issued at our last inspection with regard to the completion of the 5year electric circuits check. The Registered Provider confirmed with us that this had been carried out and evidence of this was seen during this visit. Further records were seen with regards to the fire alarm sounding on two occasions, the alarm was also triggered on 2 occasions during our visit. The electrician on site thought that this was due to a ceiling light being too close to the detector. This should be explored ensuring the equipment is in sound working order. What the care home does well: What they could do better: Appropriate action must be taken to ensure that where assessments identify closer Care Homes for Older People Page 9 of 15 monitoring is required that this is carried out so that the health and well being of people is not affected. We have significant concerns about poor medication practices which place residents health and well being at risk of harm and that the requirements made in the notice were unmet and the home failed to protect the residents as detailed above. The home must in consultation with residents provide more opportunities for social interaction and activities so that people have variety to their day enabling them to follow a lifestyle of their choosing. All relevant information must be held on file for those staff working at the home although employed by an agency. This is to ensure that only those people suitable to do so work with residents ensuring they are protected from harm. On going staff training must be provided to ensure their continuous personal and professional development. So that residents are confident they are being supported by competent staff that are able to meet all their needs. All new staff must complete a thorough comprehensive induction in line with the Skills for Care specification ensuring they are informed and supported in carry out their duties appropriately. The Registered Person must ensure incident reports involving residents well being are forwarded to us to show that appropriate action has been taken to ensure people are being placed at risk. The Registered Person must ensure that the fire alarm is in good working order as well as ensuring work identified on the fire risk assessment has been completed so that people living and working at the home are kept safe. 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 10 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 3 14 Initial assessments 30/03/2010 completed prior to people being admitted to the home must include all relevant information as well as support currently being from health care services so that this is reflected in the care plan. This will ensure that all relevant support continues to be provided so that person care needs are fully met. 2 9 13 There must be effective 25/03/2010 information recorded to enable staff to administer medication safely and know how to store medication safely. To prevent peoples health from being harmed by the misuse of medication. To prevent peoples health from being harmed by the misuse of medication. 3 9 13 There must be effective systems in place to ensure staff that handle medicines are trained in medicines handling and are competent to do so safely. To help make sure that 25/03/2010 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 people who live in the home are kept safe. 4 9 13 There must be an effective 25/03/2010 auditing processes are in place to ensure that managers are confident that medicines are being handled safely. To help make sure that people who live in the home are kept safe. 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 7 12 Appropriate action must be taken to ensure that where assessments identify closer monitoring is required that this is carried out so that the health and well being of people is not affected. 30/05/2010 2 29 19 All relevant information must 30/05/2010 be held on file for those staff working at the home although employed by an agency. This is to ensure that only those people suitable to do so work with residents ensuring they are protected from harm. 3 38 23 The Registered Person must ensure that the fire alarm is in good working order ensuring those people living and working at the home are kept safe. 30/05/2010 4 38 37 The Registered Person must 30/05/2010 Page 13 of 15 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 ensure incident reports involving residents well being are forwarded to us to show that appropriate action has been taken to ensure people are being placed at risk. 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 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. 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