Inspection on 17/06/10 for Astley Hall Nursing Home

This inspection was carried out on 17th June 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 but made no statutory requirements on the home.

Other inspections for this house

Astley Hall Nursing Home 12/04/10

Astley Hall Nursing Home 18/11/09

Astley Hall Nursing Home 06/08/09

Astley Hall Nursing Home 05/07/07

Astley Hall Nursing Home 20/07/06

Astley Hall Nursing Home 13/10/05

Astley Hall Nursing Home 28/04/05

Astley Hall Nursing Home 02/03/05

Astley Hall Nursing Home 18/01/05

Astley Hall Nursing Home 19/04/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Random inspection report Care homes for older people Name: Address: Astley Hall Nursing Home Astley Hall Church Lane Astley Stourport-on-Severn Worcestershire DY13 0RW one star adequate service 10/08/2009 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: Sally Seel Date: 1 7 0 6 2 0 1 0 Information about the care home Name of care home: Address: Astley Hall Nursing Home Astley Hall Church Lane Astley Stourport-on-Severn Worcestershire DY13 0RW 01299827020 F/P01299827020 Carisastley@aol.com None Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Kailash Jayantilal Patel,Mr Jayantilal James Bhikhabhai Patel Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 48 Number of places (if applicable): Under 65 Over 65 0 48 0 dementia old age, not falling within any other category physical disability Conditions of registration: 29 0 48 The maximum number of service users to be accommodated is 48. 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 withi the followng categories: Old age not falling within any other category (OP) 48 Physical Disability (PD) Age 50 years and over 48 Dementia (DE) Age 50 year and over 29 Care Homes for Older People Page 2 of 17 Date of last inspection Brief description of the care home 1 8 1 1 2 0 0 9 Astley Hall Nursing Home, Church Lane, Astley, is a three storey, Grade II listed building, set in 20 acres of parkland and situated two miles outside Stourport-onSevern. Astley village is a short travelling distance away. Astley Hall is registered to accommodate up to 48 residents who require nursing and/or personal care needs relating to old age and physical disabilities. A maximum of 29 residents of the 48 may have dementia illnesses and 2 people with a physical disability may be between 50 and 65 years of age. Accommodation is provided on all three floors of the home, and access to all floors is gained via stairs or a central passenger lift. Mr and Mrs Patel are the registered providers. The current charges for living at this home can be obtained by interested parties by contactiing the home direct. Information regarding the home was available from the reception area in the Statement of Purpose, the Service Users Guide and the most recent Inspection report. Copies of these documents are given to each new resident or their relatives. Care Homes for Older People Page 3 of 17 What we found: The focus of inspections undertaken by the Care Quality Commission (CQC) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. The last key inspection of this service was completed on the 12th April 2010 and received a poor, zero star quality rating as a result of this inspection. The reason for this visit was to monitor compliance with five immediate requirements that we made at the previous key inspection on the 12th April 2010. These related to proper provision for the health and welfare of all people using the service with the safe handling and administration of medication being the main focus of this random inspection. This random visit was undertaken by an inspector and a pharmacist inspector over one day. At the time of our visit there were thirty-four people living in the home. The home did not know that we would be visiting that day. At the time of the visit we spoke to the provider, acting manager, business support manager and a manager from one of the providers other homes to give feedback about our observations. These are our findings: The provider has recently appointed an acting manager who was already working at the home and is a trained nurse in mental health. We were told by the registered provider that they are in the process of recruiting a full time manager and have been interviewing for the position. We looked at two peoples range of care plans, one indepth and another partially. These are plans which give staff information about what people are able to do independently. They also say when staff need to support people to meet their individual needs and how they should do this. All of the care plans that we looked at provided staff with the information required to meet each persons individual needs with some reviews having taken place. We are aware that care plans are being put into a new format and were shown some by staff. One member of staff has been working at the home to purely focus upon care planning. The staff member will ensure all plans are updated, meet individuals short and long term needs, hold enough information to guide staff and an acknowledgement of any risks to safeguard people receiving care. Also the old care plans are lacking in a person centred approach to meeting peoples individual needs in ways that suit them best. However, we are aware that although the new care plans are an improvement on the old ones the member of staff must talk to the people living in the home and or their representatives as they are mainly working from the old care plans and some knowledge gained from other staff. This does not show a fully person centred approach to care planning. Person centred care is about involving individuals in the process, listening and talking with them about what care and support they want. We are aware that some people who live in the home have dementia and are not always able to fully engage in Care Homes for Older People Page 4 of 17 conversation but with aids some may and others may require their representatives to speak on their behalf. We acknowledge that more person centred care plans were being put in place but this may take some time. However, in the meantime we would still expect to see that all care plans are accurate and reflect peoples current needs with ongoing evaluation in place. This is an area that will be looked at further when we next inspect the home. We looked at some of the recent accidents that had been recorded and were concerned to find that one person was noted to have a skin tear on the 4th June 2010. We would have expected to see a clear audit trail of wound care, such as, descriptions, measurements or photographs. This would give important information about the healing or deterioration of the wound but this was not the case which resulted in insufficient monitoring to assess whether the wound was healing or deteriorating. This was to the detriment of this person as on the 14th June 2010 it was noted that this persons wound had deteriorated and they had been prescribed antibiotics as their wound had become infected. We were also told that staff observed there to be a maggot in this persons wound area. We established that this person has dementia and we would expect the nursing staff to have informed their next of kin and or representative about their skin tear. However, this persons next of kin and or representative had not been informed about their skin tear and or about it now being infected and their doctor prescribing antibiotics. Also this person never received their antibiotic on one occasion due to them being asleep. We regard it as important for this person to receive their antibiotic as prescribed by their doctor to help in the healing process of their wound. Therefore we would have expected nursing staff to have acted in the best interests of this person to ensure that they do receive their antibiotic as prescribed. Due to our concerns about nursing competencies and practices within the home we have told the provider and acting manager about the things they must do immediately. These are called immediate requirements and are listed at the end of this report. It is important that these requirements are met to make certain peoples health and wellbeing is being fully promoted. Since this random inspection the acting manager has given us some information about how the home will be meeting the immediate requirements we made. We will be reviewing what the acting manager has told us when we next inspect the home. It has been acknowledged that we were told about some further improvements that are currently being undertaken at the time of this random inspection. For example, meal choices, staff training is being planned and arranged, regular audits are being completed and the gas and electric certificates are in place and so on. These will all be focused upon when we next inspect the home so that we can be confident people are living in a home that is well run and meets their needs safely. The pharmacist inspector checked the management and control of medicines within the service. We looked at medication storage, some care records and medication administration records. We spoke to staff and the Acting Manager. We found an improvement in stock control of medication and only medication that was Care Homes for Older People Page 5 of 17 needed for people was stored in the home. All medication that was no longer required was removed for destruction. This means that it was easier for staff to locate peoples medicines and ensure that they were available to give. The requirement we made relating to the unsafe and unnecessary storage of peoples money and personal valuables in the controlled drugs cabinet had been met. We saw that only controlled drugs were stored in the controlled drug cabinet according to legal requirements. However, we found that money for people living in the home was stored in another medicine cupboard. We were informed by the Acting Manager that staff knew that money was not to be stored in the medicine cupboards. This means that there was an increased risk of unnecessary access to the medicine storage area and also that peoples money was not stored correctly. We looked at the MAR charts, which were printed by the pharmacy and overall found that they were documented with a signature for administration or a reason was recorded if medication was not given. However, we found that three people upstairs had not had their Medication Administration Record (MAR) charts documented for the 09:00 hours medicine administration time on the day we visited. We found that the three MAR charts were located together in the MAR folder. We checked the medication in the blister pack system and saw that the medication had been removed for the 09:00 time on 17th June 2010. We spoke to the nurse in charge who explained that there had been a problem with giving one of the people their medicines and that was why three of the MAR charts had not been signed. The nurse in charge signed the three peoples MAR charts in the presence of the pharmacist inspector. This means that people had not had their MAR charts signed immediately after each administration to ensure the record was accurate and therefore the previous requirement had not been met. We found that there was some improvement in the recording of medicine information and record keeping, however we found that not all records were up to date and recorded. For example, we looked at two peoples medicine records and checked that the amount given matched the documented records. The first person we looked at was prescribed eleven different medicines. We found that checks for six of the medicines were correct. Four of the medicines had been reviewed by a GP and discontinued. This information was documented on the persons MAR chart and also in their care plan. One medicine was prescribed for pain relief when the person required it. We saw that two tablets had been recorded as given. However, when we checked the amount available we found that none had been removed from the persons box and therefore the record did not match the amount available. We discussed this with the Acting Manager who could not give an explanation for this. The second person we looked at was prescribed eleven different medicines. We found that five of the medicine checks were correct. We could not check two medicines because one was a cream and the other was a nutritional supplement. We could not check four of the medicines because there was no record of receipt or a balance carried forward from a previous MAR chart. Overall, we found that although there was some improvement it was not possible from the available medicine records to ensure that all medicines were being given as prescribed. Due to the breach of Regulation 13(2) that we found in relation to medication we copied documents under Code B of the Police and Criminal Evidence Act and informed the acting manager and registered provider that the Commission may consider enforcement action. What the care home does well: Care Homes for Older People Page 6 of 17 Because the focus of this random inspection was on the areas of high risk where immediate requirements had been made, we may not have identified some areas of good practice. The next key inspection will give us an opportunity to look at how the home meets peoples needs in all areas. The acting manager wants to work with us to improve the outcomes for people who live at this home. We saw staff interacting with people in a respectful way. There was an open visiting policy and people were welcomed, so people living at the home were able to maintain important friendships and relationships. 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 17 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 12 Care plans must be in sufficient detail so that staff have the instructions and guidance to meet each persons needs. This will ensure to ensure risks to individuals health and wellbeing is minimised. 18/06/2010 2 7 12 All care plans must be 18/06/2010 accessible to staff delivering the care and be a reflection of the care given and be reviewed and amended at the point where a persons needs change or routinely all staff must be aware of these changes. This will enable all staff to meet individuals needs at all times to make sure peoples health and safety is fully promoted and met at all times. 3 7 13 Risk assessments must be in 18/06/2010 place for all identified areas of risks to a persons health and wellbeing which must inform staff practices. This will help to maintain peoples safety at all times. Care Homes for Older People Page 8 of 17 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 4 7 12 You must make sure that 18/06/2010 people living in the home receive appropriate levels of personal care and that this is recorded. This will ensure that their personal hygiene and dignity is promoted. 5 8 12 All staff that provide care to 18/06/2010 people who live at the home must have the knowledge, skills and competency required to meet individuals needs together with their planned care. This will make certain that individuals health and welfare is not placed at risk by staff practices. 6 8 12 To ensure that people with 18/06/2010 poor nutritional intake and or weight loss are monitored using a recognised screening tool as frequently as required by their risk assessment and care plan. This will ensure that staff takes required actions to promote peoples health and well being. 7 9 13 To make arrangements to ensure that all medication is administered as directed by the prescriber to the person it was prescribed, labelled and supplied for. This is to ensure that people 23/04/2010 Care Homes for Older People Page 9 of 17 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 get their medicines correctly and that procedures for medicine administration are safe. 8 9 13 To make arrangements to 23/04/2010 ensure that medication administration records are accurately maintained. The reasons for nonadministration of medication are recorded by the timely entry of an appropriate code or entry on the medication administration record, that the meaning of any such codes are clearly explained on each record; and that the person administering the medication completes the medication administration record in respect of each individual person at the time of administration. This is to ensure that the care service maintains accurate records of medicines administered to people including reasons for non administration of prescribed medicines. 9 15 13 Arrangements must be 18/06/2010 consistently in place so that the quantity of food eaten by people who use the home is being assessed, monitored and reviewed. This should ensure that staff take appropriate action if people are not eating enough to maintain their health and Care Homes for Older People Page 10 of 17 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 well being. 10 18 12 Training must be provided for all staff that work with people who have dementia some of whom may be assessed as having difficult to manage behaviour. This will make sure that individuals needs are met in a safe way that respects their dignity. 11 18 13 All staff must receive appropriate safeguarding training and the homes procedures to protect vulnerable people must be implemented and followed diligently at all times. This is to safeguard all persons living at the home from risks of harm. 12 20 13 The registered persons are 18/06/2010 required to undertake a documented health and safety audit of the premises, from which written risk assessments must be implemented, reviewed and action taken to safeguard all people from risks of harm within identified timescales. To include the following: (1) Substances left in the metal cabinets in communal areas should be locked away. (2) Cardboard boxes must not be piled up in the communal corridor areas of the home. 18/06/2010 18/06/2010 Care Homes for Older People Page 11 of 17 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 This is to ensure the health and safety of all people who live in the home. 13 24 13 The registered persons are 18/06/2010 required to undertake a documented health and safety audit of the premises, from which written risk assessments must be implemented, reviewed and action taken to safeguard all people from risks of harm within identified timescales. To include the following: 1) The wardrobes must be secured in all bedrooms. This is to ensure the health and safety of all people who live in the home. 14 28 12 The homes staffing levels 18/06/2010 must be reviewed. This must be in line with individuals dependency levels and available for inspection. This will ensure that people living in the home receive care in an appropriate and timely manner that meets their needs. 15 32 17 Suitable arrangements must be in place for the management of the home in the absence of a manager. This is to ensure that people can be assured that improvements to this home are made to promote the health and safety of people Care Homes for Older People Page 12 of 17 18/06/2010 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 living at Astley Hall. 16 33 26 The registered persons or a person who they instruct on their behalf must undertake monthly visits to the home as part of their quality assurance process. These reports need to available at times of inspection. This is to make certain that it is run in the best interests of the people living there. 17 33 24 To ensure quality monitoring 18/06/2010 systems are effective and demonstrate that positive quality outcomes are consistently achieved for all persons living at the home. This is to safeguard the health, well being and safety of people living at the home. 18 33 37 Notifications to the 18/06/2010 Commission must be made in accordance with current guidance. This is to comply with the law so that health, safety and welfare are protected. 19 38 12 Evidence of the worthiness of 18/06/2010 the gas must be available in the home. So that people can be confident that they live in a safe well maintained environment. 18/06/2010 Care Homes for Older People Page 13 of 17 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 20 38 13 Evidence of the worthiness of 18/06/2010 the five yearly electrical hard wiring report must be available in the home. So that people can be confident that they live in a safe well maintained home 21 38 13 Staff must receive training in 18/06/2010 infection control. This is to make sure the safety and wellbeing of individuals is promoted and protected at all time. 22 38 13 Staff must receive training in 18/06/2010 manual handling. This is to make sure the safety and wellbeing of individuals is promoted and protected at all time. Care Homes for Older People Page 14 of 17 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 1 8 15 Action must be taken to 18/06/2010 ensure that all aspects of risk assessments identify and provide guidance for all areas of risk and reflect all changes to each persons health and needs, including short term care needs. . This will make certain staff understand and review peoples specific needs so that they are not placed at risk of harm through neglect of care. 2 29 18 New staff must receive 18/06/2010 induction training appropriate to their role upon employment and updates at regular intervals. This is to to ensure that residents and staff working in the home are not placed at risk of harm. 3 30 18 The competency of the registered nurses must be reviewed. This is to to ensure they have the skills and knowledge to identify and meet the residents care needs. 18/06/2010 Care Homes for Older People Page 15 of 17 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 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 To ensure that peoples money or personal valuables are not stored in medicine storage areas. This is to ensure that there is reduced and unnecessary access to medicine storage areas. Care Homes for Older People Page 16 of 17 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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