Inspection on 11/02/10 for Briarlea

This inspection was carried out on 11th February 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Briarlea 17/12/09

Briarlea 26/11/09

Briarlea 09/07/09

Briarlea 06/06/07

Briarlea 01/07/06

Briarlea 15/09/05

Briarlea 28/04/05

Briarlea 27/09/04

Briarlea 15/04/04

Briarlea 06/02/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 25/04/2010.

Random inspection report Care homes for older people Name: Address: Briarlea Badsey Road Evesham Worcestershire WR11 7PA one star adequate service 10/07/2009 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: Andrew Spearing-Brown Date: 1 1 0 2 2 0 1 0 Information about the care home Name of care home: Address: Briarlea Badsey Road Evesham Worcestershire WR11 7PA 01386830214 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Briarlea Care and Supported Living Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 26 Number of places (if applicable): Under 65 Over 65 0 26 0 dementia old age, not falling within any other category physical disability Conditions of registration: 18 0 18 The maximum number of service users to be accommodated is 26. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category (OP) 26 Physical Disability (PD) 18 Dementia (DE) 18 Date of last inspection 2 6 1 1 2 0 0 9 Care Homes for Older People Page 2 of 12 Brief description of the care home Briarlea provides residential accommodation and care for older people who may have a physical disability and/or mental health needs associated with old age. It is owned by Briarlea Care and Supported Living Limited, which is a family owned company, both directors of which are actively involved in the running of the home. The home is situated just outside Evesham in a rural area with pleasant views over the local countryside. Apart from its road frontage the home is surrounded by a level garden and orchards. The premises consist of a two-storey house. There are twenty two single bedrooms and two double rooms. The majority of the single bedrooms have en suite toilets. A passenger lift links the two floors of the home. There are two communal lounges, a large sunlounge, a dining room, three communal bathrooms and communal toilets. Car parking is available at the side of the home. For up to date details on the fees charged the reader should contact the provider directly as this information was not included within the Service Users Guide at the time of our key inspection in July 2009. Care Homes for Older People Page 3 of 12 What we found: This random inspection was carried out by one regulatory inspector and a pharmacy inspector from the Care Quality Commission. The inspection was carried out over one day. During our last key inspection in July 2009 we identified concerns regarding the management of medication, care planning, risk assessing and having safe systems in place regarding potential hazards. It was pointed out within our report that each of these areas could potentially place people using the service at risk. We carried out a random inspection during November 2009 and we identified further concerns regarding the safe keeping and management of medication. As a result we issued an immediate requirement notice. We recognised some progress in relation to care plans and risk assessments however we brought to the attention of the registered persons that further action was needed to ensure that they were up to date. Similarly, in relation to safe systems, we acknowledged some progress but further action was needed to ensure these were addressed reliably. The pharmacy inspector visited in December 2009 to check compliance on our requirements regarding medication. We again identified a number of areas where improvement was needed. These areas were as follows. Firstly that staff needed to accurately record the administration of medication. Secondly that a system needed to be put in place regarding the requesting, obtaining and retaining of adequate supplies of medication to ensure their availability to administer as prescribed. Thirdly to ensure care plans are kept up to date regarding changes in peoples medication. Fourthly to ensure that medicines are handled and administered in accordance with the medication policy and that staff follow good practice guidance. Finally that arrangements are made to ensure medication is stored at the correct temperature. We issued a Statutory Requirement Notice regarding these shortfalls. This inspection was therefore to check compliance with the Statutory Requirement Notice and other requirements as issued within the earlier reports. MEDICATION We previously found that controlled drugs were not stored as required as the cabinet provided was too small to accommodate the medication held. We saw a new controlled drugs cabinet however it had not, at that time, been fixed to the wall. Assurance was given that this cabinet would be fitted without further undue delay. We found that some bottled medication was stored outside of the current small cabinet. Within the current cabinet we found two tablets in a plastic pot. The acting manager assured us that she would find out why these tablets were there. We looked at the temperature records in relation to both the fridge and the room used for storing the medication trolley. The records showed both of these to be within the required range. We saw information on display within the staff area about the importance of signing for Care Homes for Older People Page 4 of 12 medication. In addition we were told that staff had received letters within their wage packs about signing for medication. Shortly after the regulatory inspector arrived at the home we saw in a bedroom a plastic medicine pot, with a small amount of liquid medication remaining within it. On checking the MAR (Medication Administration Record) sheet we found that the medicine was not signed for. The member of staff administering medication said she was going to sign for it later on when she administered the remaining prescribed medication to the person concerned. We brought this matter to the attention of the acting manager as it was of concern that medication was not signed for at the time of administration by the person who had administered it. We looked at the MAR sheets of some residents. We noted on some MAR sheets extra information was recorded in order to provide staff with additional guidance. In addition, the time when medication was due to be administered was, in the vast majority of cases highlighted in order to assist staff. We found that the MAR sheets were signed or had a code to indicate why medication was omitted therefore this should enable a full audit trail. We viewed the blister packs containing medication regarding a small number of residents and checked these against the MAR sheets and the balance held. Some of these balanced correctly however some did not and we were not able to account for the discrepancies. On one MAR sheet it appeared that medication was not administered for a few days. The supplying pharmacy informed us that they had not dispensed medication therefore we were unable to establish where medication had come from when it was later recommenced. In addition we were unable to balance one persons laxatives as we found some sachets remaining however this did not match the total that should have been in place according to the MAR sheet. In some cases medication carried forward from the previous MAR sheet was not recorded therefore making it more difficult to audit medication. We were concerned about the recording following the application of some prescribed creams. These concerns were increased as a result of conflicting information within care plan documents and discussions with staff on duty. One MAR sheet gave instructions for a cream to be applied twice daily; the sheet was signed once daily. Staff on duty confirmed that they were only applying this cream once a day and therefore not carrying out the instructions of the prescribing medic. CARE PLANNING We looked at a small sample of care plans to see if information was correct and up to date to ensure that staff had at their disposal accurate details of peoples care needs. We made some observations during our time within the home and spoke to some of the staff on duty. We noticed that work has taken place upon these and that they are improving. We were initially told, at the start of our inspection, that one person was in bed and on a pressure relieving mattress. In addition we were told that this persons mobility was poor therefore remaining in bed. We saw the person to be on an air flow mattress supplied by the local community nursing team. The care plan stated that due to deterioration in health the person was now bed bound. The plan later stated is unable to get out of bed but sometimes may try and can no longer stand. We found similar indications regarding a lack of mobility within other sections of the care plan such as doesnt get out of bed, unable to get to shower, no longer mobile and unable to stand. The plan later Care Homes for Older People Page 5 of 12 stated that it would take 2 carers to assist with standing, that the hoist should be used and if transferring for any reason use wheelchair. We asked staff about mobility as we saw entries in the daily records which indicating that the person concerned was showered and walked to the toilet. One member of staff told us that the resident has a shower most days while another confirmed an ability to walk to the toilet with two carers. These comments did not therefore match the written care plan. Throughout our visit we saw the person lying in bed. Written records confirmed that community nurses had supplied a hospital bed and the air flow mattress. The records also stated that the nursing team had requested that a mattress is left on the floor when the resident was left along in case an attempt to get out of bed was made. The risk assessment showed that staff had identified the risk of falling from bed to be low and we saw a written entry saying has never fallen out of bed but has tried to get out and slipped. Entries within the daily records stated that the resident had slipped and fallen from bed and on one occasion was sat on the floor in the corridor. Although a mattress was seen to be underneath the bed on no occasion did we see it used as a means of cushioning any fall. Therefore the actions taken by staff did not match instructions given and the care plan did not reflect what we read in the daily notes. We saw a draft falls risk assessment document devised by the acting manager but not as yet implemented. We saw a food and fluid chart to be in use. The records stated that they were introduced to enable carers to ensure a sufficient food and fluid intake. Neither the charts or a care plan gave staff any guidance as to what sufficient is and did not give instructions regarding the action to be taken if a certain amount was not taken. A risk assessment highlighted difficulties in swallowing therefore requiring meals to be soft or liquidised. We noted that the MAR sheet showed a thickener which is used in drinks. Carers told us that they only used this in hot drinks and not in cold. We saw no written instruction about this or reasoning why it was not to be used in cold drinks. We later contacted the community nursing team who confirmed that there is no distinction between hot and cold drinks when using a thickener. We asked to see the thickener used. It became evident that the home had run out of this item for this resident and staff were therefore using thickener prescribed for somebody else. Two tins of thickener were in use both prescribed for the same person. The tin stated Once open use within 8 weeks. The date when the tins were opened was not recorded. If they were opened on the day they were dispensed they would have been open for 9 weeks. As mentioned earlier within this report staff were not applying cream as prescribed. We saw other creams in the bedroom which were not on the MAR sheet. We saw a written entry stating that carers had noticed a red mark on the persons hip and ankle and applied cream. It was not clear what cream was applied and we saw no further reference to the observation made. A care plan was in place however it was incomplete as a gap had been left where the name of a cream needed to be entered. We looked at the care plan of another resident and found some additional shortfalls. It was evident from the daily records that the person concerned was recovering from a chest infection. No care plan was in place regarding this infection and the medication prescribed. It was evident that the person concerned had had chest infections in the past however this was not reflected in a care plan. In addition we saw no care plan in place Care Homes for Older People Page 6 of 12 regarding constipation and the management of bowels. SAFE SYSTEMS IN IDENTIFY HAZARDS Within our report dated November 2009 we highlighted two areas needing attention in order to reduce the risk of injury to people using the service. At that time we found that wardrobes were not always secured to the wall to prevent accidental toppling. During this inspection we checked a random sample of wardrobes. One wardrobe was not secure however it was evident that it had been as a screw and wall plug were hanging from the back of it. Although action was taken immediately the fact that nobody within the home had noticed this may demonstrate a lack of awareness and a lack of suitable systems to ensure the environment is safe. During our inspection in November we became aware that the temperature of the hot water delivered to showers in peoples en-suites could be overridden. We were assured that a plumber has, since that inspection, visited the home and carried out work upon each unit to prevent the overriding taking place. No documentary evidence that the work was satisfactorily undertaken exists. We did however see that records are in place recording the temperature of hot water delivery. To date one shower had been tested and found to be operating within a safe temperature range. OTHER Since the last visit the registered manager has resigned from her post. The former deputy manager is currently working as acting manager and intends to apply to the commission for registration. Another member of staff is currently working as acting deputy manager. What the care home does well: What they could do better: Although we saw improvement in the management of medication and we will not be taking any further enforcement action at present, we did however bring some areas to the attention of the acting manager. As mentioned in the above sections of this report improvements are also needed regarding care planning and ensuring that the health care Care Homes for Older People Page 7 of 12 needs of people using the service are met. We will be carrying out a further key inspection at Briarlea prior to the end of June 2010 to check that improvements have taken place and to ensure the health, safety and welfare of people using the service. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 8 of 12 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 Regulation 15 (1) and (2). Care plans must be in place for each person using the service detailing how needs in respect of health and welfare are to be met. Care plans must be kept under review and revised to reflect changing needs. This is to ensure that people receive appropriate and consistant care. 30/09/2009 2 7 13 Regulation 13 (4). 30/09/2009 Risk assessments must be in place which fully take into account unnecessary risks to the health, safety and welfare of residents. This is to ensure that risks to people are minimised as far as reasonably practical. 3 12 13 Regulation 13 (2) Medication 28/11/2009 received into the care home must be booked in and held securely at all times. Medication which needs to be treated as controlled needs to be securely held as required by the Misuse of Drugs Regulations (Safe Custody 1973), the Misuse of Drugs Act 1971 and as in Page 9 of 12 Care Homes for Older People Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action guidance issued by the Royal Pharmaceutical Society of Great Britain. To ensure that systems are in place to securely hold medication in order to protect people from harm. Care Homes for Older People Page 10 of 12 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 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 Ensure that medication procedures are followed at all times to ensure the safe management of medicines. Care Homes for Older People Page 11 of 12 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. Copyright © (2009) Care Quality Commission (CQC). 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