Inspection on 22/05/08 for Astley House Care Centre

This inspection was carried out on 22nd May 2008.

CSCI found this care home to be providing an Poor 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 House Care Centre 08/05/09

Astley House Care Centre 27/10/08

Astley House Care Centre 03/12/07

Astley House Care Centre 12/06/07

Astley House Care Centre 06/06/06

Astley House Care Centre 28/06/05

Astley House Care Centre 18/01/05

Astley House Care Centre 24/08/04

Astley House Care Centre 24/02/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Astley House Care Centre 1 Lypiatt Road Cheltenham Glos GL50 2SY Lead Inspector Janice Patrick Unannounced Inspection 22nd May 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Astley House Care Centre DS0000016373.V363981.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Astley House Care Centre DS0000016373.V363981.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Astley House Care Centre Address 1 Lypiatt Road Cheltenham Glos GL50 2SY Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 08453 455742 01242 255971 helen.haughton@blanchworth.co.uk Mrs Sally Anne Manby Roberts Mr Jeremy Walsh, Mr Roy Harris Manager post vacant Care Home 33 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (27) of places Astley House Care Centre DS0000016373.V363981.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The 7th proposed Dementia Care bed, currently occupied by one named service user without a diagnosis of Dementia, will become a 7th Dementia Care bed when that specified service user no longer requires the bed on their discharge or death. 3rd December 2007 Date of last inspection Brief Description of the Service: This care home is registered with the Commission of Social Care Inspection (CSCI) to provide nursing and personal care, predominantly to the older person. There are some beds designated to the care of those with dementia. It is situated in a residential area very near to Cheltenham Town centre and is in close proximity to local shops, amenities and bus services. Accommodation is on four floors, and consists of 28 single bedrooms and 3 shared bedrooms, all of which have en suite facilities. Access to all floors can be gained by a passenger lift, which is large enough for a wheelchair. Behind the home is a sizeable paved garden area, which provides a private outdoor area for residents and which is wheelchair friendly. Off road parking is provided at the side and front of the building. There are steps to the front entrance but wheelchair access can be gained through the paved area at the back. The fees depend on the type of care being provided and the room occupied. Fees at the time of this inspection range from £475.00 (personal care, single room with ensuite) to £654.00 (higher nursing care, single room with bath en suite). The home’s terms and conditions outline any additional charges. The home does not display their previous inspection report. Astley House Care Centre DS0000016373.V363981.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. The home Inspector carried out this inspection over two days between the hours of 10.25am and 6.35pm. One of the Inspector’s from the Regional Enforcement Team was also present. We (The Commission for Social Care Inspection, CSCI) inspected the care that people were receiving. We inspected the records kept in relation to this and looked at how peoples’ specific health care needs were being met. We explored how peoples’ privacy and dignity is maintained and how they are able to make choices and have a say in what happens to them. We inspected areas that give added quality to someone’s life such as their ability to socialise, opportunities for recreational activities and the choice and standard of food. We looked at how the home protects people from abuse, which included the home’s policy and procedure and additional areas such as staff recruitment and staff training. Arrangements for the general management of the home were inspected and included a look at staff rosters and health and safety records. We inspected how the service seeks the views of interested parties on its performance and how any improvements to the service are planned and carried out. We were also accompanied by one of the Commission’s pharmacist inspectors who looked at some of the arrangements for the management of medicines following concerns at the last key inspection on 3rd December 2007. The pharmacist looked at some stocks and storage arrangements for medicines, some medication records and procedures. We spoke to some people in the home and saw a nurse administer some medicines to various people in the home. We talked with the nurse on duty and the Director of Education and Development for Blanchworth Care who came to the home during the inspection. The pharmacy inspection took place over eight and a half hours on the first day. Astley House Care Centre DS0000016373.V363981.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: It would be helpful to a visitor who maybe considering the home for themselves or a relative, to have available in the reception area a full copy of the home’s literature (Statement of Purpose & Service user Guide) and a copy of the Commission’s previous inspection report on the service. The pre admission assessment still needs to be more thorough and not just be a process driven paper exercise. Repeated shortfalls were found in care planning, staff require specific guidance particularly in the areas of nutrition/weight, wound care and moving and handling where poor and conflicting practice was identified. Any additional assessments pertaining to these specific areas need to be completed correctly and the information used to up date the care plan. At the moment several documents are functioning in isolation and are not being completed competently. This has resulted in legal nursing documents being confusing and in some places demonstrating large omissions in care. There are several repeated areas of poor practice within the medication system, which are clearly identified within this report. An Immediate Requirement was issued during this inspection to ensure immediate safety and further shortfalls will be followed up within a short period of time. Arrangements for the monitoring of weight and nutritional risk must improve to protect the very vulnerable. Astley House Care Centre DS0000016373.V363981.R01.S.doc Version 5.2 Page 7 How nurses communicate the healthcare needs of people amongst each other and when reviews are due to be done, is still poor and must improve to ensure people receive the care they require. This is with particular regard to shortfalls in wound care. There is repeated poor practice in the safe moving and handling of people. Guidance is poor for staff and despite staff training, practices are dangerous and causing injury to the person that is being moved. People are still not being consistently offered a choice of food at lunchtime. Although the home has a complaints policy and procedure people do not have complete faith that their complaints are taken seriously. This must improve and any concerns made to the home recorded. These shortfalls lead people to believe that the service is not being transparent in this area. People in this home are not being protected against abuse and harm. Despite staff being trained in elderly abuse awareness, the connection between poor care practices and abuse are not being realised. This is made worse by a lack of recognition by senior staff that these risks need to be properly managed and the person protected. The Registered Provider must change the arrangements currently used to determine how many staff are required in relation to the ‘actual’ needs of those in the home. The home is repeatedly functioning with inadequate numbers of staff, which is resulting in repeated shortfalls in care despite the Commission making past requirements to try and improve this. During this inspection one of the Regional Enforcement Team inspected this area and further action is being considered to achieve compliance. The Registered Provider must put in place arrangements so that the home is competently managed on a day-to-day basis so that identified poor practices are eradicated and so that peoples’ health and welfare is protected and maintained. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can Astley House Care Centre DS0000016373.V363981.R01.S.doc Version 5.2 Page 8 be made available in other formats on request. Astley House Care Centre DS0000016373.V363981.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Astley House Care Centre DS0000016373.V363981.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can obtain a degree of information about the home prior to moving in, which may help them or their representative make an informed decision. Although there is evidence of written pre admission assessments, admissions appear process driven resulting in some care needs not being identified, which then leads onto needs not being adequately planned for. EVIDENCE: This outcome has been assessed using the Commission’s Key Lines of Regulatory Assessment (KLORA) and although assessed as ‘adequate’ there are shortfalls in the pre admission assessment process that require addressing so that individual needs are adequately identified. The Statement of Purpose and Service User Guide were last updated in May of this year. A very brief summary of this is on display in the reception area but Astley House Care Centre DS0000016373.V363981.R01.S.doc Version 5.2 Page 11 not the whole document. The Registered Provider can supply further information about the home on request. There are three people registered with the Commission as Registered Providers for this service. The above document only names one, so this needs amending to match the registration certificate, which is also on display. As part of the admission process a written pre admission assessment is completed. This aims to identify care needs prior to the person moving in so that the home can be sure that these needs can be met once the individual has been admitted. During the previous inspection in December 2007 there were shortfalls in this process and information was not gathered and documented in a robust manner. A requirement was made to ensure this was done. During this inspection we read a pre admission assessment for one person. This had been completed in the home over the telephone as the person was then living in another county. The assessment form had been completed three days prior to the admission and did not say whom the information was taken from. When we later spoke to the nurse on duty about this person she said that one of the main areas of care for staff to be aware of was current weight loss. The nurse explained that this person suffered from dementia and had not received the amount of support at mealtimes she required in her previous care home. None of this important information was on the pre admission assessment form. The previous requirement has therefore been repeated. We saw in other peoples care files that the home does receive ‘Assessments of Care Needs’, which are carried out by the local funding authority before some admissions. Astley House Care Centre DS0000016373.V363981.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Due to a lack of general management and organisation people in this home are not having their care needs adequately met, despite staff being caring and well meaning. Peoples’ health and welfare is being put at risk due to a lack of staff competency and effective communication; all of which is avoidable. The arrangements for the management of medication are not always robust enough to protect the health and well-being of all people living in this home. EVIDENCE: This outcome has been assessed using the Commission’s Key Lines of Regulatory Assessment (KLORA), it is because of the number of shortfalls and the level of risk that people in this home are being placed in is why this outcome has been assessed as poor. We read in detail the care plans and assessments for four people including additional care plans and assessments after observing specific areas of peoples care. These additional observations related to how peoples’ wounds were being Astley House Care Centre DS0000016373.V363981.R01.S.doc Version 5.2 Page 13 cared for, how people who were at risk of losing weight were being monitored and how people were being moved and handled. The wound care records were confusing and not completed competently. One person’s wound care record referred to three different areas on the individual’s back, the thoracic spine, the lumbar spine and the ‘vertebral’ spine (which is a medically inaccurate description). This made it unclear as to where the wound was and how many there actually were. We ascertained from the nurse on duty that this person had one pressure sore, which poor positioning in a chair had caused. We saw a bandage on another person’s ankle, which had staining on it from the wound underneath. The guidance in the care plan dated 17/2/08 stated: ‘dress daily or when dressing off’. The wound care plan dated 28/3/08 gave instruction that a certain type of dressing must be used. The most recent dates recorded for dressing changes were 14/5/08, 12/5/08 and 10/5/08, which is not daily. On reporting back our concerns about the staining on the bandage the nurse on duty informed us that the wound is not dressed daily but every three to four days and the dressing type mentioned in the care plan was not being used anymore. Further confusion pursued when we read that the last change of dressing was recorded as being done on the 16/5/08 and the type of dressing referred to in the care plan had been used. A third person’s wound care records demonstrated that this person was suffering a reoccurring injury, in the same place on her leg when being transferred in and out of the wheelchair. These injuries had occurred in January, March and April of this year. In January this necessitated a visit to the hospital for stitches. During this inspection we saw that an accident form had been completed on 3/5/08 for a more recent injury to the same place and when we went to see this person we saw a dressing. There was however no record of this in the wound care plan. The nurse on duty was not aware of this recent injury either. This same lack of communication was identified in the previous inspection and the home’s Improvement Plan said that nurses would address this by entering dates for review in the diary and communication in staff handovers would be improved. As qualified nurses this action should be automatic. To add to the confusion and lack of communication the event and injury was later found recorded in the care plan for falls. This had not been the result of a fall and wound care has a separate section for recording. So unless this person had experienced a fall, nursing staff would probably not read this care plan until the next monthly review. Our main concern is that this individual is experiencing a repeated trauma to her leg that in some way is avoidable but, there was no evidence to suggest staff had taken or thought about any action to prevent this. Further lack of guidance was seen in the moving and handling assessments and care plans, which was resulting in poor practice. This is a repeated concern from our last inspection in December 2007 and was also the subject of an enforcement letter issued by the Health & Safety Executive in December 2007. Astley House Care Centre DS0000016373.V363981.R01.S.doc Version 5.2 Page 14 Again, several moving and handling assessments/care plans, including those of the person discussed above, stated that it takes two staff to move an individual but did not go onto explain how. We believe this lack of guidance is why we saw one person with round shaped bruises in-between her thumb and forefinger, indicative of her being possibly pulled up from a seated position by her hands. On approaching this person (who suffers from dementia) she indicated that she wanted to get up by voluntarily holding her hands out to us. If staff are standing this person by holding onto her hands and pulling this will more than likely be the cause of this very distinctive bruising. We witnessed exactly this move being carried out by two care staff later in the day on a person who was pulled forward from a slouched position in a wheelchair by her hands. Another person was pulled forward and up from an armchair from under her arms. The guidance in this person’s care plan stated that she required two people to stand her and that more support was required on her right side due her suffering a stroke. It did not go onto say how this person should be moved. By pulling someone forward under the arms staff are at risk of dislocating the shoulder. This risk is increased in someone who has had a stroke, as the limb is flaccid and it would also probably cause pain and discomfort. Three separate and specific comments from questionnaires sent out by us before this inspection comment: o ‘the moving and handling of people is excruciating to watch, some staff do not have clue’ o ‘I would like to know who assesses how someone should be moved and what equipment should be used’ o ‘ staff require training from a physiotherapist on how to deal with someone who has had stroke and how to position them’. These poor practices were discussed with the moving and handling trainer who happened to be in the home during this inspection to carry out update training with staff. We saw that appropriate action had been taken for two people in relation to pressure sore prevention. One had been referred to the Tissue Viability Nurse who had supplied a special pressure relief mattress and another person was sitting on a pressure relief cushion as indicated in their care plan. We examined records that show how people’s weights are recorded and how staff should monitor people who are nutritionally at risk. The company documentation contains a nutritional assessment, which at a minimum the company say should be reviewed and completed each month. A senior company manager informed us during this inspection that it is an expectation that everyone is weighed on a monthly basis and that this maybe more frequently if they are losing weight or are at risk of doing so. We were concerned to see that one person had a recorded weight of 103kg Astley House Care Centre DS0000016373.V363981.R01.S.doc Version 5.2 Page 15 (approximately 16stone 2lbs) in April 2007. Three months later this had dropped to 93kg and in September the care plan said: ‘weigh regularly, losing weight’. The next recorded weight was 90kg in October. No further weights were obtained until January 2008 when the weight was recorded as 61kg (approximately 9 stone 6lbs). Although now very poorly, this person’s significant loss of weight appears to have gone largely unmonitored. During this inspection we visited this person just before 12 midday. He was initially unable to reply as his tongue and lips were so dry. We gave him a drink and the senior company manager who was with us, looked at the fluid intake chart for that morning. Nothing had been recorded since ‘breakfast’. We later spoke to an agency carer who said she had given the person a drink at 10am and thought she had recorded this. We later saw that a chart had been completed in retrospect. It was also apparent from the side that this person was lying on when we saw him and the side that had been recorded on the turn chart that he had been turned at some point in the morning. After speaking to staff on duty we came to the conclusion that the agency carer had turned him single-handed. At around the time of this recorded turn the nurse on duty was asked to attend to a skin tear on this person’s hand. This person’s care plan clearly states that two people are required to carry out a change of position. We asked the senior company manager to investigate this further and discuss this carer’s practices with the agency that employs her. We saw that some relatives have been involved in the review of their relative’s care plan, however this does not appear to be done by including the care staff who are predominantly delivering the care. One comment within one of our questionnaires stated: ‘ care plans, what a joke’. Care records tell us that staff contact various external healthcare practitioners for advice and that some visit and are involved in providing specialist care and support. During this inspection we visited one person who was near the end of her life. Family were very happy with the care she getting and were particularly grateful to the qualified nurse on duty. We witnessed her liaising with the local doctor and pharmacist so that required levels of pain control could be maintained. We were informed that the McMillan nursing team had given initial support and guidance in this. The nurse clearly had a close relationship with the family at this difficult time and was being as supportive as she could be. Pharmacist’s Report Registered nurses were responsible for the management and administration of medicines for people living in this home. The pharmacy provided many medicines each month in special bubble packs called a monitored dose system (MDS). These help staff to easily see what medicines need administering on a particular day and time and what medicines have been administered. As part Astley House Care Centre DS0000016373.V363981.R01.S.doc Version 5.2 Page 16 of this system the pharmacy each month printed a record of all the medicines the doctor has prescribed with a chart on which staff recorded when they have administered each medicine. Staff recorded the medicines received into the home on these charts and there was a separate book in which medicines disposed of via the pharmacy were recorded. We saw that allergy sections of the medicine records were completed and that there were signed checks with previous records. There were photos with each record to help the nurses to know they were giving the medicines to the right person. Complete and accurate records about medication are important so that there is a full account of the medicines that the home is responsible for on behalf of the people living here and people are not at risk from mistakes such as receiving their medicines incorrectly. We made checks on a sample of records and medicines for some people and although we found some records and stocks were in order, we also demonstrated that complete and accurate records for medication were not always being kept and that sometimes medicines were not administered according to doctors’ directions. • Some medication records indicated that medicines had not been in stock so were not administered according to the doctors’ directions. On the day of the inspection the medicines all appeared to be available for the sample we looked at. There were gaps in some medicine administration records so it was not possible to tell if these people had received their medicines correctly. On the day of the inspection we found gaps at 1400 hrs on the medicine administration records for two medicines for two people. For one person the tablet was missing from the monitored dose blister pack. The other medicine was in liquid form so we could not tell if the medicine had been administered. The nurse on duty confirmed she had administered both medicines but had not signed the records. We were also concerned that both these people had received the previous doses of these particular medicines just three hours earlier. We found that some medication due at 8am according to the medicine records was given more than three hours late in some cases. This same issue was raised at the inspection on 3rd December 2007. This means that for some people the interval between their doses may be too short as the lunch doses were administered around 1.30pm although the medicine charts indicated that lunchtime doses were due at various times between 12 noon and 2pm. We watched the nurse administering the morning medicines to three people in one of the lounges between 10.45am to 11.15am. This took her some time as people took a while to swallow their medication. The nurse was kind and patient and not rushing people and explained what she was doing. The morning of the inspection the only nurse on duty had to administer medicines to 29 people as well as deal with other interruptions and any management issues so it was not surprising that the morning medicines were administered so late. • • • • Astley House Care Centre DS0000016373.V363981.R01.S.doc Version 5.2 Page 17 • • • • • • • • • • • For another person tablets were still in the monitored dose blister packs on some days but staff had initialled the medicine records indicating the medicines as having been administered. For this same person there were discrepancies in the records and labelled packs of medicines about the dose of certain 50mg tablets he should be receiving. Another person was prescribed a calcium product that had to be administered six days a week avoiding a Monday (when another medicine was administered). There were some gaps on the records but at 8am on Monday 28th April 2008 the calcium dose was signed as administered when it should not have been. We found containers of creams in a bedroom that were not included on the medicine records. We found examples of medicines where the directions indicated regular use but doses were missed with no explanation. It is possible these medicines were actually used ‘as required’ but if this was the case the records and prescriptions must be amended to show the correct use for the medicines. It was hard to tell from the records and labelled medicines what the correct dose of a liquid analgesic medicine for one person was supposed to be. There was no paracetamol homely remedy stock or prescribed stock for another person yet doses had been administered and one record indicated another person’s prescribed medicines were used. Confirmation of warfarin dose changes for one person were not in writing as directed in the Anticoagulant patient safety alert from the NHS National Patient Safety Agency. We found little information in care plans to give guidance to staff on how to reach decisions for all those medicines prescribed to be administered “when required” or ‘as directed’ and few records of how staff have reached the decision to administer such medication in accordance with the provisions of the Mental Capacity Act 2005. There had been inappropriate crushing of some tablets for another person. The actual doses of medicines administered were not always recorded where a variable dose was prescribed. Checks of two antibiotics remaining in stock and in use on the day of the inspection for one person found that there were more tablets in stock than there should have been according to the administration records (one tablet for one product and five tablets for the other). This indicated that the medicine records may have been signed incorrectly or medicines were not administered according to the prescription directions. We left an immediate requirement form at the time of the inspection with the Director of Education and Development (as there was no manager for the home) for action to be taken to deal with these and to tell us about the action taken by 2nd June 2008. We received a letter from the Director of Education and Development on 9th June 2008 telling us the actions being taken to deal with these concerns. We will be following this up to see that sufficient action has actually been taken to make sure there are effective arrangements for the safe management of medicines in this home. Astley House Care Centre DS0000016373.V363981.R01.S.doc Version 5.2 Page 18 Other issues that we also raised as concerns during the inspection were – • On the day of the inspection some medication for one person was administered through a syringe-driver. We found additional records in place for monitoring this but the nurse on duty for the day who was managing this treatment told us that she had not received recent training for this procedure (last attended about seven years ago she thought). There was confusion with the nurses about the proper storage and recording arrangements for a liquid analgesic medicine and we found various practices in place some of which were not according to the Blanchworth Care medication policy. We found a tube of eye ointment for one person had been in use for more than the 28 day period stipulated by the manufacturer (this is in order to reduce risks of contamination). The other containers of eye drops or ointments we looked at had opening dates written on the containers and were still within the correct period of use. We found some improvements were needed in the way creams and ointments were handled and the recording of their application to people living in the home. We found some creams in bedrooms that had a date of dispensing or opening as far back as 2006. This indicated poor stock rotation and risks of contamination in the products. In one bedroom, shared by two people with dementia, two part-used containers of cream were found between the beds and another tube by a bed. The nurse told us that such medication should be in cupboards in the individual bathrooms or in wardrobes or drawers in bedrooms. The storage in bedrooms of containers of creams or ointments that are in use must be assessed as safe for everyone in the home We found a lancing device that the nurse told us was used to take random blood glucose tests for a person with diabetes. This device did not comply with Medical Device Alert MDA/2006/066 and was not to the standard considered safe to use in a care home setting. A safe procedure was needed for the proper disposal and recording of single wasted or spoiled doses of medicines. This was highlighted by an incident the home reported to us where medicines were found in a waste bin just outside the medication room. The Director of Education and Development confirmed she was conducting an investigation into this report and we have yet to hear about the outcome of this. The shelf life of two bottles of a liquid antibiotic mixture for one person needed checking with the pharmacy. The label directions indicated not to use more than seven days after preparation yet this was supplied for a tenday course. The nurse on duty said that the bottles were supplied on different and later days yet the receipt records and date of dispensing on the label did not support this. • • • • • • The nurse told us that no people living in the home would be safe to look after and self-administer their medicines. We did not find this shown in care plans, Astley House Care Centre DS0000016373.V363981.R01.S.doc Version 5.2 Page 19 which must reflect choices people have made about the way their medicines are managed and administered. Where people may lack capacity to consent to treatment consideration must be included in the care plans about the provisions of the Mental Capacity Act 2005 in respect of medication administration. In discussion, the nurse told us there were no equality or diversity issues that would impact on medication and the choice of gender of carer to provide personal care was included in plans. Medicines were stored safely and suitable arrangements for the management of controlled medicines were in place except for the variations in practice described earlier for the handling of a particular liquid analgesic medicine. Also the inner cupboard for these medicines must be fixed to the solid wall with two rag or rawl bolts (only one bolt was in place- there was a blank hole for the other bolt). The temperature of the storage areas and medicine fridge were recorded and were in the safe range for keeping medicines. The way the home orders the repeat prescriptions for routine medicines each month does not allow them to see the doctors’ original prescriptions. We strongly recommend that these prescriptions be seen in the home each month before sending these to the pharmacy for dispensing as is recommended best practice. This provides an opportunity for the nurses to see the actual doctors’ prescriptions (which are their authority to administer medicines) and to check that these contain the medicines they have ordered. It is also easier to sort out any discrepancies at this stage. There was a medication policy and procedures available so that all staff were aware of how the company expected medication to be handled in a safe way. There were protocols on the use of homely remedies but these had no date and looked quite old. The improvement plan Blanchworth sent to us recently following the last inspection told us that the manager would complete a weekly audit of medicine records and check peoples’ bedrooms for creams stored correctly. At the time of the inspection there was no manager in post so it was disappointing that these regular audits were not therefore taking place. The evidence from this inspection of medication showed the need for regular audits and for a manger to be in post to make sure there is consistent and effective management of medication in the home. We were told that the assistant director of care and training had conducted a full audit of medication the day before the inspection but the results were not yet available. Various previous requirements related to care practices and documentation have been repeated in this report and because of the level of risk to people in the home, further enforcement action is being considered to seek compliance with the Care Home Regulations 2001. Astley House Care Centre DS0000016373.V363981.R01.S.doc Version 5.2 Page 20 Astley House Care Centre DS0000016373.V363981.R01.S.doc Version 5.2 Page 21 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although some people are being provided with activities and social opportunities to improve their quality of life, others are not and people are still not being consistently offered a choice at mealtimes. EVIDENCE: This outcome has been assessed using the Commission’s Key Lines of Regulatory Assessment (KLORA) and although assessed as ‘adequate’ has repeated shortfalls, which need to be addressed. One of the care staff has designated hours (10am and 4pm, Monday to Friday) when she is free from care and organises activities. On the first day of this inspection at 10:40am a game of ‘eye spy’ was being played in the lounge. The activities carer was in the room however, writing up her records at the same time, the television was on with no sound and six out of 14 people were asleep. When we moved into the second lounge the music player was put on and the television turned off. There were five people in this room of which two were asleep. We witnessed a floor game being played at another time of the inspection. Astley House Care Centre DS0000016373.V363981.R01.S.doc Version 5.2 Page 22 Comments within the questionnaires sent out by us indicate that relatives are concerned that the activities carer has to postpone activities to make up the shortage in staffing, something strongly denied by the company in previous conversations about this. We spoke to two people who liked the home very much and explained to us how they had become to be in care. They said that they do miss the social life they previously had and said that they do not get out at all. We asked if anyone had offered to take them out and they said not. We asked if any staff came to see them during the day and they said: ‘staff are very friendly and pop in and out to see them’. They confirmed that their family visit regularly and we saw one of them visiting later in the day. We saw that one other person is taken out frequently for walks by the activity carer. We were told that a non-denominational service is provided each week in the home. In the previous inspection this had ceased due to the increase in work in the local diocese at that time. There is information on how to contact a local advocacy service on the notice board and the company have made staff aware of new considerations that relate to the Mental Capacity Act 2005. Some of the company’s care paperwork will alter to accommodate these new criteria. This will relate to refusal and consent issues. On the first day of this inspection an agency chef was providing food for the day. He said he had been in the home before so knew the routines. He informed us that he was unaware of any special diets and had not been instructed by staff to cook any alternatives to the planned lunch for that day. We spoke to two people who said that no one had been into to ask them if they wanted an alternative for lunch. They also did not know what was for lunch but said: ‘it is usually very nice’. The menus say that alternatives can be provided on request. In previous inspections we have questioned this and commented that many people in this home would not be able to ask or even realise that they can so unless staff ask them if they would like an alternative, choice is not going to be an option for many. Comments in questionnaires varied from: ‘the food is excellent’ to ‘too much of the same thing stews, mince and casseroles’ to ‘not enough vegetables and salads’. On the second day the home’s cook was on duty she was able to confirm that two people had requested alternatives to the main lunch, these were ham sandwiches and one other was having ham and chips instead of fish and chips. These alternatives had been recorded but none prior to today. This was discussed with the company’s senior manager who thought this was being done as she said she had previously spoken to the cook during her visit on 13/5/08 about the need to do this. Astley House Care Centre DS0000016373.V363981.R01.S.doc Version 5.2 Page 23 The menus displayed on the board in the dining room were for the three days prior to this inspection, so were out of date. Astley House Care Centre DS0000016373.V363981.R01.S.doc Version 5.2 Page 24 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Despite there being policies and procedures in place and staff receiving training on the subject of abuse; the connection between poor practice and abuse and harming people is not being realised. So people in this home are not adequately protected. EVIDENCE: This outcome has been assessed using the Commission’s Key Lines of Regulatory Assessment (KLORA). We are aware that the home has a complaint policy with written procedures. Guidance on how to make a complaint is on the notice board in the reception area and in the hallway. Contact details for external agencies such as the Community Adult Care Directorate (CACD- formally Social Services) and the Commission for Social Care Inspection (CSCI) are included. Five out of the nine questionnaires we received back indicated that people were aware of the complaints procedure; four said they were not. The complaint file in the home did not contain any complaints or concerns except one received in August 2007, which we also investigated along with the Registered Provider. The senior company manager confirmed that the company had not received any complaints. Astley House Care Centre DS0000016373.V363981.R01.S.doc Version 5.2 Page 25 In the questionnaires that we received back one person stated that they have had to complain several times about their relative’s lack of hygiene and various other areas of care. The person then says that the improvement is short lived until they raise it again. Another person comments that Blanchworth Care only takes notice of complaints and concerns when an external healthcare professional gets involved. Staff training files show that they receive awareness training in the Protection of Vulnerable Adults (POVA). The senior company manager present at this inspection is also the company Training Manager and she explained that awareness on elderly abuse is incorporated into training on challenging behaviour and moving and handling training. The latter was being provided to some staff during this inspection and it was reiterated to staff by the trainer that poor moving and handling practices can result in abuse. The processes that help to protect people are currently very fragile in this home due to a lack of managerial leadership, staffing and monitoring of bad practices. An anonymous comment also received by us said: ‘it was pointless making any suggestions on how to improve care or the lives of those in the home, as they were not welcome’. This comment and the shortfalls observed during this inspection do not reassure the Commission that the home is meeting the aims and objectives stated within its Statement of Purpose which are: o all individuals have a right to safety o residents have a right to receive total, appropriate care, throughout their stay. Astley House Care Centre DS0000016373.V363981.R01.S.doc Version 5.2 Page 26 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 24, 25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements to the environment generally mean that people living in the home can now enjoy a more presentable, warm and cleaner place to live. Some arrangements are in place to minimise cross infection but shortfalls identified by the CSCI Pharmacist do compromise these. EVIDENCE: We told the senior company manager during this inspection how we felt the generally environment had improved. New carpets had replaced heavily stained ones in both lounges and the main entrance hall. The home also looked cleaner. Astley House Care Centre DS0000016373.V363981.R01.S.doc Version 5.2 Page 27 Individual bedrooms were inspected with the senior company manager. We pointed out a deep crack in the length of the wall next to the ensuite door in bedroom 18. In bedroom 6 a split in the ceiling, alongside the ensuite door was seen. As we toured the building we voiced concern about two armchairs in the hallway on the top floor. The senior company manager assured us that the Fire Officer had agreed these could be there as she explained they were fire retardant. We saw two entries in one person’s records, which showed that she had been found on the floor, under the head of the bed, on two different occasions this year. We went to this person’s bedroom and although there was a slim crash mat in place (designed to break someone’s fall from a bed) a fixed height metal bed was being used. There was no evidence to show that a referral for a high low bed had been considered. These specialised beds can be lowered almost to the floor and are considered for use where people are prone to falling out of bed but who would be more at risk if bedrails were to be used or where they refuse the use of bedrails. The Primary Healthcare Trust (PCT) usually supplies them. We saw specialised equipment for moving and handling people safely such as general hoists and bath hoists. Several people were being cared for on beds that could alter position. There were pressure relief mattresses and cushions in use. Individual bedrooms varied from being very personalised to being devoid of personal processions just clothing and toiletries. All contained the minimum furnishings required by the care standards. We saw one shared bedroom, occupied by two people that are confused. A privacy curtain was in place for use during personal care. We received just after this inspection a copy of a regulation 26 visit (unannounced monthly visit) that was carried out in February of this year by a representative of the company. This predominantly identified several items of maintenance including the lagging of hot water pipes in areas where people who live in the home spend their time. The Commission will presume that this work will be carried out fairly quickly. We visited the laundry in the morning and there were several baskets of dried clothes waiting to be folded and both washing machines had completed cycles and were full. According to the duty rosters there are designated hours for the laundry between 3pm and 7pm. This area was however generally tidy and looked clean. We did not see any hazardous fluids on display. We saw staff wearing plastic aprons and gloves whilst carrying out some care tasks. And when serving food plastic aprons were worn to reduce the risk of cross infection. Astley House Care Centre DS0000016373.V363981.R01.S.doc Version 5.2 Page 28 The home has an appropriate contract in place to get rid of waste resulting from the use of continence aids (pads etc). Astley House Care Centre DS0000016373.V363981.R01.S.doc Version 5.2 Page 29 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People are being placed at risk due to a lack of staff and despite staff training a lack of competency. EVIDENCE: This outcome has been assessed using the Commission’s Key Lines of Regulatory Assessment (KLORA), it is because of the repeated shortfall in this area and the level of impact this has on the people living in this home that the outcome has been assessed as poor. We discussed a repeated requirement in relation to what the Commission consider is an ongoing shortage of staff to meet the individual needs of those in the home. There were five on duty on the first day of this inspection (one qualified nurse and four care staff between 7am and 10am, then one carer becomes the activities carer until 4pm) leaving three care staff to work around the home. The senior company manager present during this inspection confirmed that the minimum staffing for this home is five care staff in total in the morning, which we were told includes the qualified nurse. She also confirmed that the home should ideally be aiming for six staff (including the qualified nurse) each Astley House Care Centre DS0000016373.V363981.R01.S.doc Version 5.2 Page 30 morning as indicated on the ‘Daily Staff Record’. This did not appear to be the qualified nurse’s understanding at the time, who thought the home had to work with five staff in total in the morning. We asked who decides how many staff are needed and how this decision is made. The company manager explained that the Registered Provider initially produces the monthly staff rota; it is then up to the person in charge of the home to put forward requests to cover sickness or planned annual leave. Any amendments to peoples’ dependency levels should be forwarded to the company’s head office each Monday morning. We requested to see the update sent for the Monday prior to this inspection (19/5/08). There was some confusion between the senior company manager and the nurse on duty (who had been on duty on 19/5/08) as to whether this had been sent. The senior manager gave us what she considered to be the most up to date version. This however did not show Monday’s date as we were told that the date alters to the present date each time it is down loaded. However, the version we saw dated 23/5/08 (the day of downloading it from the computer) did show that the dependency level for one person who was dying and requiring a lot ‘nursing time’ and care was blank. The dependency level for one other person who we observed as requiring a lot of care during this inspection was recorded as ‘medium’ and one other person who had to be observed every half hour because he has left the building in a confused state several times before, was entered as ‘higher residential’. These staffing numbers are the same as they were in December 2007 so despite increased needs there has been no adjustment in the numbers of staff on duty to accommodate changes in needs. In fact the home was under the number of six that the company have determined as being generally ideal on the first day of this inspection and according to the rotas often functions like this. We therefore still consider the home to be staffed according to numbers of people living in the home and generated income, not the actual day-to-day needs of people. There is also evidence that the home works below the number of five at times and managerial and administration hours are being compromised to make up shortfalls in care staff. This is due to staff sickness sometimes, but on the 7/5/08 there were 3 staff on duty. An agency carer was requested and worked 7am to 1pm but the senior qualified nurse had to take herself off administration and management duties to make up the 5th person. The duty rosters also shows that on 19/5/08 the senior qualified nurse worked 7am-7pm on administration and management duties and then did a night duty. We observed the senior qualified nurse: o attending to the person that was dying and reassuring the family, throughout the day o managing the syringe driver that was in place, throughout the day Astley House Care Centre DS0000016373.V363981.R01.S.doc Version 5.2 Page 31 o carrying out medication administration rounds which were late starting and which ran into each other (refer to ‘health and personal care outcome, Pharmacist’s report) o answering the phone generally o liaising with external healthcare specialist o trying to enter into records as she went, which was proving unsuccessful o she did not have a rest break over the two days we were in the home, only sitting down when we briefly included her in our feedback o she was unable to attend to a wound, which required redressing as she had no time to do this (this was handed over to the night nurse to carry out; when we returned the next day this had not been done). o All of the above meant that the nurse in charge was unable to be aware of or manage situations resulting in poor practice (The senior company manager stayed with us throughout the inspection). During the previous Key Inspection carried out by us in December 2007 it was a similar scenario. Then, seven people were observed being brought down for their breakfast between 11am and 11.40am, again there were several additional reasons why we considered the home to be understaffed and the same senior nurse was finding it difficult to do everything. A requirement was made again then for the Registered Provider to staff the home adequately to meet the needs of the people living there. We asked the senior company manager why the staffing had not been adjusted accordingly on this occasion. We were told that if the company head office is not informed by the home, that more staff are required then they remain unaware of the need. Considering senior staff from head office are in this home on a frequent basis monitoring it (the last time confirmed as being 13/5/08) and we have been repeating our concerns about staffing levels in past inspections and still the staffing levels are not satisfactory, we consider this to be an inadequate reply. During this inspection we used additional statutory powers to gather further evidence on a lack of staff and the impact this is having and further enforcement action will be considered in order to seek compliance with the Care Home Regulations 2001. Comments in questionnaires returned to us indicate that those visiting the home are also concerned about the lack of staff on duty. Comments are from relatives and external healthcare professionals and include: o ‘ most of the time there appears not to be enough staff’ o ‘on a average day it is just four care staff who get 30 residents up and twice a week the morning starts with 3 staff to do this’ o ‘ most days there is an agency carer on duty, it’s much better if people know you’ Astley House Care Centre DS0000016373.V363981.R01.S.doc Version 5.2 Page 32 The company encourage staff to take the National Vocational Qualification (NVQ) in Care. Currently five care staff have completed this award. We inspected the recruitment files of two staff via electronic link to the company’s staff documents. One person had been recruited from overseas. Many of the documents were not completed in English making them difficult to follow, although some basic answers had been translated. It would appear that two references had been obtained and the names of these references corresponded with the references submitted on the application form. We were unable however to follow the detail of employment history due to the language barrier and dates of employment were only given in years, so any gaps in employment would not have been identified. It would appear that this person had worked previously with children and the reason for them leaving this post was not written in English. One of the requirements within the Care Home Regulations 2001 is that the new employer ascertains why someone left their previous employment, if it was with children or vulnerable adults. This person had started with the company following clearances with the Criminal Record Bureau (CRB) and the Protection of Vulnerable Adults (POVA) list. The second person had been employed prior to a CRB clearance but after a POVA clearance, into a post of responsibility. We saw that several references had been requested and responded to. We had been made aware of an unexplained period of time in this person’s employment history of which we requested that the company reassure themselves that their recruitment process had been robust. We saw that the first person had received basic induction trainings appropriate to their job. The second person demonstrates past trainings with their previous employer, which although in the past are still relevant, but we were unable to see important trainings that would be relevant to this employment such as that pertaining to elderly abuse and the Protection of Vulnerable Adults (POVA) and Fire Training. Astley House Care Centre DS0000016373.V363981.R01.S.doc Version 5.2 Page 33 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 37 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People are at risk due to a lack of day-to-day competent management and a lack of effective action being taken to rectify the situation following monitoring visits by senior company staff. EVIDENCE: The previously Registered Manager left the home in February of this year having had periods of absence from the home for several months prior to this. A new acting manager was appointed and resigned in April. The senior qualified nurse has been responsible for the day-to-day running of the home since and has been allocated supernumerary hours to attend to administration and management tasks. Astley House Care Centre DS0000016373.V363981.R01.S.doc Version 5.2 Page 34 Senior management staff from the company’s head office have visited to monitor the home and to offer support. The last such visit, which also met Regulation 26 of the Care Home Regulations 2001 was carried out by the senior company manager present throughout this inspection and was on 13/5/08. Despite a very informative Improvement Plan being submitted to the Commission in time for the 12/3/08 and telling us how the requirements in the previous Key Inspection will be complied with. During this inspection, although some new initiatives have started, such as care plan spot checks, many of the shortfalls in care practice, care monitoring and assessment, care documentation and staffing identified then have been repeated. It is evident from the contents of this report that there is a shortfall in the provision of consistent and competent day-to-day management. It is also obvious that senior company managers are aware of the shortfalls. The Registered Provider has been in contact with the Commission regarding the shortfall in management and has told us what she plans to however, it remains her responsibility to ensure that the home is able to meet the needs of those living there, safely and that the requirements in this report are complied with. The company requested the views of people living in the home and those of their relatives on the services provided, in June 2007. We saw the summary of this in the home’s entrance hall. Various key audits are completed but despite a system of quality assurance being in place and the service submitting an Improvement Plan to the Commission explaining how shortfalls are to be addressed; repeated requirements have been made within this report. This system requires a review, as it would appear to currently be a paper exercise without any positive outcomes or achievements. We inspected the records and pocket monies of three people living in the home. Each amount held for safe keeping corresponded with the records held. Receipts for Chiropody, Hairdressing and various purchases were seen. Two signatures were also seen for any withdrawals. We saw records that demonstrated that three care staff and two ancillary staff had received staff supervision between 19/2/08 and 17/3/08. The Registered Person needs to ensure that all staff receive a minimum of six sessions of supervision in a year. Astley House Care Centre DS0000016373.V363981.R01.S.doc Version 5.2 Page 35 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 3 X X 3 X 3 3 3 STAFFING Standard No Score 27 1 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 2 X 2 Astley House Care Centre DS0000016373.V363981.R01.S.doc Version 5.2 Page 36 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 13(4)(c) Requirement Timescale for action 25/07/08 2 OP7 14(2) 3 OP7 15(1) 4 OP7 15(2) The Registered Person must ensure that the admission process which includes the pre admission assessment is carried out in a robust way and that care needs are correctly identified and recorded for other staff to be made aware of. The Registered Person must 25/07/08 make sure that any additional assessment, such as those relating to moving and handling, nutrition and wound care are completed competently, when required and the information cross referenced with the care plan. The Registered Person must 25/07/08 ensure that the care plans give clear guidance to staff on how individual care needs are to be met. The Registered Person must 25/07/08 make sure that the care plans generally are competently reviewed and up dated when care needs alter or change following reassessment. So that staff are giving relevant care at DS0000016373.V363981.R01.S.doc Version 5.2 Astley House Care Centre Page 37 5 OP8 12(1)(a) (b) all times. The Registered Person must ensure that all staff delivering care within the home are aware of the guidance given within individuals’ care plans and that they adhere to this in order that the correct and agreed care is given to meet that need. (This is particularly relevant to moving and handling, wound care and nutritional care and weight). (Previous timescale of 31/01/08 not met) The Registered Person must ensure that anyone at risk of not maintaining adequate nutritional intake and who is a risk off or is losing weight is appropriately monitored and the correct care organised. The Registered Person must ensure that all relevant staff record competently and as required/or as planned any care or reviews relating to nursing, healthcare or nutrition that take place during their shift. (This is with particular regard to wound care and weight monitoring) (Previous timescale of 31/01/08 not met) The Registered Person must ensure that all service users who require help to maintain their oral hygiene receive this and that in order to promote oral health that fluids are provided in intervals that prevent service users mouths becoming dry. (Previous timescale of 21/01/08 not met) When medicines are administered to people living in DS0000016373.V363981.R01.S.doc 25/07/08 6 OP8 12(1)(a) 25/07/08 7 OP8 12(1)(b) 25/07/08 8 OP8 12(1)(a) 25/07/08 9 OP9 13(2) 15/06/08 Page 38 Astley House Care Centre Version 5.2 Astley House Care Centre you must keep complete and accurate records about the medication and make sure medicines are always given as prescribed by the doctor. This is to make sure that people living in the home receive the correct levels of medication and are not at risk of mistakes with medication because of poor recording arrangements. 10 OP9 13(2) Immediate requirement form left at the end of the inspection. 11 OP9 13(2) 12 OP9 13(2) You must improve the 25/07/08 arrangements for the safe administration of medicines so that all doses are administered within an acceptable period of the stated dose time and there are safe intervals between doses throughout the day. This relates particularly to the timing of the 8am medicine round and is to make sure that people living in the home receive the correct levels of medication and are not at risk because of wrong dose intervals. You must improve the 25/07/08 arrangements for the proper disposal and recording of wasted doses of medicines so that all these are kept and disposed of safely and there are records to help keep account of all medicines. When staff take blood samples 25/07/08 for blood glucose monitoring for people living in the home the lancing device used must be safe to use in a care home environment as described in Medical Device Alert MDA/2006/066 issued by MHRA in December 2006. This is to reduce the risk to people living in the home of cross infection DS0000016373.V363981.R01.S.doc Version 5.2 Page 39 Astley House Care Centre 13 OP9 13(2) 14 OP9 18 15 OP12 12(3) linked with the use of the wrong sort of lancing device. You must make sure the storage 30/09/08 arrangements for controlled drugs comply with the Misuse of Drugs (Safe Custody) Regulations 1973. This is so that these medicines are stored securely and in accordance with the law. When medicines are 30/09/08 administered to people in the home via a syringe driver you must make sure that all registered nurses who are responsible for the management of this treatment have up to date training, by a professionally recognised trainer, in the setting up and use of syringe drivers. This is to make sure the health, safety & welfare of people living in the home is maintained. The Registered Person must, in 25/07/08 meeting service users’ personal care, healthcare needs and meeting their general welfare, so far as is practicable, their wishes and feelings must be ascertained and met. This is with particular regard to their opportunities for choosing what they would like to eat (Timescale of 01/08/07 & 31/01/08 not fully met) The Registered Person must make arrangements for staff to be adequately supervised and trained so as to eradicate poor and abusive practices. The Registered Person must ensure that the services provided in the home match with those written within the home’s Statement of Purpose in order to protect vulnerable people living in the home. DS0000016373.V363981.R01.S.doc 16 OP18 13(6) 25/07/08 17 OP18 16(1) 25/07/08 Astley House Care Centre Version 5.2 Page 40 18 OP27 18(1)(a) The Registered Person must provide enough staff in number and competency to meet the needs of all the service users and also take into account the size of the building in doing this. (This requirement has been repeated from the four previous inspections. last timescale of the 21/01/08 not met). In the absence of a Registered Manager the Registered Provider must make suitable arrangements to ensure the home is competently managed on a day-to-day basis to ensure the health, welfare and safety of service users. The Registered Person must make arrangements to ensure that service users are moved and handled competently and in a way that does not put them at risk of harm or injury. 25/07/08 19 OP31 10 25/07/08 20 OP38 13(5) 25/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations Make sure care plans reflect what choices people who live in the home have made about how their medicines are administered and their consent to the way in which staff manage the medicines on their behalf. Where people may lack capacity to consent include consideration about the provisions of the Mental Capacity Act 2005 in respect of medication administration. Improve some record arrangements so there is clear DS0000016373.V363981.R01.S.doc Version 5.2 Page 41 2 OP9 Astley House Care Centre 3 4 5 OP9 OP9 OP9 6 7 OP9 OP29 8 OP36 written guidance to staff on how to reach decisions for all those medicines prescribed to be administered “when required”. Also make a record each time of how staff have reached the decision to administer in accordance with the provisions of the Mental Capacity Act 2005. This will help to make sure that there is some consistency for people in the home to receive medication when necessary and in line with planned actions. Use the controlled drug record book to keep records of the particular liquid medication identified at the inspection and store this within the controlled drug cupboard. Where medicines are kept in peoples’ bedrooms make a risk assessment to be sure the arrangements are safe for everyone in the home. Arrange for dose changes of anticoagulants to be confirmed in writing by the prescriber as detailed in Patient Safety Alert 18 from the National Patient Safety Agency. Arrange to see and check all prescription forms in the home before they are sent to the pharmacy for dispensing. Staff should not be employed until after satisfactory clearance has been received by the Criminal Records Bureau, particularly in cases where people are responsible for the supervision and monitoring of other staff. Staff should be receiving a minimum of 6 supervisions sessions per year, which should be recorded. Astley House Care Centre DS0000016373.V363981.R01.S.doc Version 5.2 Page 42 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Astley House Care Centre DS0000016373.V363981.R01.S.doc Version 5.2 Page 43 - 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. 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