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Inspection on 04/05/10 for Branthwaite Nursing Home

Also see our care home review for Branthwaite Nursing Home for more information

This inspection was carried out on 4th May 2010.

CQC found this care home to be providing an Good service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

We did not identify any areas of good practice relating to the handling and administration of medication at this visit.

What the care home could do better:

Records relating to medicines must be accurate to show the treatment received by residents and to protect them from errors. Medicines must be administered in the prescribed dosage so that treatment is safe and effective. Ordering procedures must be reviewed to prevent medicines running out. Care plans should be reviewed and kept up-to-date so they contain clear guidance on management of health care conditions and medication. Audit of medication should be more thorough to identify problems without delay, and staff must be assessed and shown to be competent in the handling of medication. Medicines liable to mususe, called controlled drugs, must be stored according to safe custody regulations.

Random inspection report Care homes for older people Name: Address: Branthwaite Nursing Home Branthwaite Road Workington Cumbria CA14 4SS two star good service 14/04/2009 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: Angela Branch Date: 0 4 0 5 2 0 1 0 Information about the care home Name of care home: Address: Branthwaite Nursing Home Branthwaite Road Workington Cumbria CA14 4SS 0190067111 0190068339 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Margaret Rose Visick Type of registration: Number of places registered: Conditions of registration: Category(ies) : Aspenframe Ltd care home 57 Number of places (if applicable): Under 65 Over 65 0 0 57 0 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Conditions of registration: 57 57 0 57 The registered person may provide the following category of service only: Care home with nursing - Code N To people of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Physical disability - Code PD Mental disorder, excluding learning disability or dementia - Code MD Dementia - Code DE The maximum number of people who can be accommodated is: 57 Date of last inspection Care Homes for Older People 1 5 0 1 2 0 1 0 Page 2 of 14 Brief description of the care home Branthwaite Care Home is situated on the outskirts of Workington. The home is a care home that can provide nursing care for 57 people in the above categories. There are three distinct areas in the home - the general nursing unit, a memory care unit for people with dementia and the Harrington Unit that helps people who have complex mental health needs including challenging behaviour. All of the bedrooms are single occupancy and have en suite facilities. There are pleasant communal areas in all three units. Outside, there are raised gardens at the rear, and to the front and side of the home are paved areas. Information about the service is made available in a statement of purpose and service user guide that is on display in the foyer along with inspection reports. The fees currently charged by the services range from £398 to £945 per week and this does not include personal toiletries, personal newspapers, magazines and hairdressing. Care Homes for Older People Page 3 of 14 What we found: The pharmacist inspector examined the handling of medication by looking at relevant documents, storage and meeting with the home manager Margaret Visick, the operations manager, and other staff. The inspection took five and three-quarter hours. Feedback was given to the home manager and operations manager at the end of the inspection. Overall we found that medication was poorly managed. This places residents at risk from medication errors that could adversely affect their health. We looked at records for receipt, administration and disposal of medication. We found that the records for administration were poor. There were gaps where administration signatures should be so we could not tell if residents had received their medication or not. We saw that some medicines were disposed of inappropriately and staff who were asked did not think they were recorded for disposal. We counted a sample of medicines and compared them with records. Most of the samples did not add up. For example, on occasions there was more medication left than there should have been meaning that residents had not received the full dosage, and a course of antibiotics was stopped short and this could increase the risk of further infection. We saw other examples where medicines were not given in the prescribed dosage. We checked the administration of a blood thinning medicine. The dosage of this needs to be monitored closely with regular blood tests. Too much or too little can have serious consequences. We saw three recent occasions when a dose was administered that was higher than the prescribed dose leaving the resident at risk from bleeding complications. This occurred when the dosage was changed following the results of blood tests with staff not implementing the new dose immediately. Further courses of antibiotics were not given correctly with missing doses. We also saw records that showed a sedative was given on two occasions but there were no further records to justify its use, nor was there a care plan in place for managing anxiety or agitation and the administration of sedation. Other care plans contained minimal information or were not updated. For example, we saw a case where there were complications in a catheterised resident that required medical treatment. The care plan for catheter care made no reference to the problems that would affect management of the resident. We saw that some medicines ran out so residents went without the treatment they needed to manage their health care conditions. This included pain-killers, antidepressants, sleeping tablets and a medicine for managing anxiety. Some visits by health care professionals and outcomes were well recorded but some were not and in these cases the management of acute problems was unclear. We saw a scrap of paper with an instruction from a doctor that was not dated and did not state the length of time over which the recommendation was to be implemented. Staff who were spoken to did not know when the recommendation was made and could not find any further documentation in the residents records. We checked medicines liable to misuse, called controlled drugs. We saw one medication that was not stored in accordance with safe custody regulations therefore exposing it to Care Homes for Older People Page 4 of 14 risk of misuse, nor could it be accounted for properly. Some medication had expired. A stock check of the remainder of controlled drugs was in order. The supplying pharmacist had recently visited the service to check and advise on medicines management. The operations manager had recently done a full medication check, or audit, and the home manager also did weekly audits. However, these audits need to be more thorough so that concerns are identified and managed without delay to keep residents safe. The concerns raised at this inspection show the need for further assessment of competence of staff in the handling of medication to ensure that they follow safe practices at all times. What the care home does well: 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 5 of 14 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 15 Individual care plans must 28/05/2010 reflect the needs and wishes of the individual and contain guidance for staff about nursing and care interventions and personal preferences and wishes. This must be done to comply with Regulation 15 of the Care Standards Act 2000 and to ensure that people get the highest possible standards of care. 2 8 12 The registered person must 28/05/2010 ensure that individual health and nursing care needs are met at all times. This must be done to comply with Regulation 12 of the Care Standards Act 2000 and to ensure that good health care planning is in place. This should include nutritional planning, pressure and wound care and behaviour managment to ensure people receive high standards of physical and mental health care. 3 9 13 A thorough audit of the arrangements for managing medication must be 28/05/2010 Care Homes for Older People Page 6 of 14 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 undertaken. This must be done to comply with Regulation 12 of the Care Standards Act 2000 and to ensure that medicines are managed appropriately. 4 12 16 A programme of social and 28/05/2010 therapeutic activities must be developed for people with organic mental health problems and for people with functional mental health issues. This should take into account ability and any special needs or requirements. Where necessary individual programmes must be drawn up. This requirement had an original end date of 12/03/2010 and has been extended. This must be done to comply with Regulation 16 of the Care Standards Act 2000 and to combat lack of stimulation, disorientation and challenging behaviours in vulnerable people. 5 18 13 It is required that, through training or by other means, all staff understand their responsibilities and job role in relation to safeguarding vulnerable adults. This requirement had an original end date of Care Homes for Older People Page 7 of 14 28/05/2010 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 12/03/2010 and has been extended. This must be done to comply with Regulation 13 of the Care Standards Act 2000 and so that staff understand what is abusive and so that they also understand how to report, or where appropriate, manage any safeguarding issues. 6 19 23 IT is required that the 28/05/2010 planned improvements to different areas of the building are completed in a timely fashion and a completion report sent to the Care Quality Commission. This must be done to comply with Regulation 23 of the Care Standards Act and so that people live in a well maintained and comfortable home that has access to outside areas. 7 26 23 IT is required that suitable 28/05/2010 measures are put in place so that all areas of the home are clean and hygienic at all times. This must be done to comply with Regulation 23 of the Care Standards Act 2000 and so that peoples health and well being are not compromised and so that staff understand their responsibilities to maintain Care Homes for Older People Page 8 of 14 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 good hygiene levels when undertaking housekeeping and care tasks. 8 27 18 It is required that there are sufficient staff on each shift who have the skills and knowledge required to meet the needs of residents. This must be done to comply with Regulation 18 of the Care Standards Act 2000 and to ensure that eacg shift has workers on duty who know how to deliver appropriate care and services. 9 29 19 IT is required that any new 28/05/2010 member of staff has two references - ideally with one being the last employer;is checked against the Protection of Vulnerable Adults List and has a Criminal Records Bureau check before they start to work directly with vulnerable people. The registered person must do this to comply with Regulation 19 of the Care Standards Act 2000 and to ensure that people in the home are protected from potential harm or abuse. 10 30 18 It is required that all staff 28/05/2010 attend the basic training programme that is set out by the company. This must be done to comply Care Homes for Older People Page 9 of 14 28/05/2010 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 with Regulation 18 of the Care Standards Act 2000 and to ensure that staff are suitably skilled and knowledgeable for the work they perform. 11 36 18 It is required that all staff receive formal supervision and also have their practice observed. This needs to be done to comply with Regulation 18 of the Care Standards Act and to ensure that staff have the opportunity to discuss concerns, training needs and to reflect on practice. Staff competencies need to be checked through observation and formal supervision. 12 37 17 IT is required that a review is 28/05/2010 held on the way records are maintained in all areas of the service. This must be done to comply with Regulation 17 of the Care Standards Act 2000 and to ensure that clear and concise information is available that will help the home to function efficiently. 13 38 37 It is required that the registered person ensures that the kitchen is kept in a clean and orderly fashion; that food safety rules are applied; that staff understand how to handle hazardous substances and 28/05/2010 28/05/2010 Care Homes for Older People Page 10 of 14 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action that records are kept of food temperatures. You must do this to comply with regulation 16 of the Care Standards Act 2000 and to ensure that safe working practices are in place for food safety so that food is stored and prepared correctly in order to lessen the risk to service users. 14 38 13 It is required that all staff attend updates to manual handling training and that their competence in this is checked by persons trained to do so. This outstanding requirment has been extended. This must be done to comply with Regulation 13 of the Care Standards Act 2000 and to ensure that safe manual handling is carried out and that both staff and residents are kept as safe as possible. 28/05/2010 Care Homes for Older People Page 11 of 14 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Medicines must be given in the prescribed dosage. This will ensure that residents receive safe and effective treatment. 01/06/2010 2 9 13 Ordering procedures for 01/06/2010 medication must be reviewed to prevent medicines from running out. This will ensure that residents always have the treatment they need. 3 9 19 All staff who administer 01/06/2010 medication must be assessed as competent in the task. This is so that staff can administer medication in a safe and appropriate manner. 4 9 13 All medicines liable to misuse, called controlled drugs, must be stored in a controlled drugs cabinet. This is to comply with 01/06/2010 Care Homes for Older People Page 12 of 14 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 regulations relating to safe custody of controlled drugs. 5 9 13 All records for administration 01/06/2010 of medication must be accurate and free from errors. This will protect residents from mistakes that could cause harm to their health and well-being. 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 It is highly recommended that care plans are more thorough and are updated regularly to provide staff with clear guidance on managing residents with specific care needs so that they are managed safely and effectively. It is highly recommended that the disposal of medication is reviewed to ensure that it is appropriate. 2 9 Care Homes for Older People Page 13 of 14 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 14 of 14 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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