Inspection on 17/12/09 for Briarlea

This inspection was carried out on 17th December 2009.

CQC found this care home to be providing an Adequate 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Briarlea 11/02/10

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 13/03/2010.

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: Morag Ross Date: 1 7 1 2 2 0 0 9 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 1 0 0 7 2 0 0 9 Care Homes for Older People Page 2 of 14 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 14 What we found: The pharmacist inspector visited the home on 17th December 2009 to check the management and control of medicines. The key inspection on 9th July 2009 identified concerns with the management of medication. A further random unannounced inspection on 26th November 2009 also identified that medicine management systems needed to be improved. The purpose of this inspection was to check compliance with requirements relating to medicine management within the service. We arrived at 13:05pm and stayed until 17:30pm. We looked at medicine storage, medicine records and two peoples care plans and also spoke to the Deputy Manager. Controlled drug medication, which requires special storage was not stored according to legal requirements. We saw that the medication cabinet available for storing these medicines was too small. We saw controlled drug medicines which were not stored in the locked controlled drug cupboard and therefore did not meet the requirements of the Misuse of Drugs Act 1971 and the Misuse of Drugs (Safe Custody) Regulations 1973. This means that there was inadequate arrangements in the home to meet legal requirements and ensure secure storage of peoples medication.The Deputy Manager told us that a new controlled drug cabinet was on order but this can take four to six weeks to deliver. In the meantime the home had asked for advice from the pharmacist in order to ensure the controlled drugs were stored safely. We found that the majority of medication was locked and secured in two medicine trolleys or locked cupboards to ensure safe keeping. The two areas used for medication storage were secure and did not feel too warm for medication storage.We saw temperature records were available to ensure that the room temperature was within a safe temperature range. We looked at the temperature records available for the refrigerator. Medication requiring refrigeration should be stored between two to eight degrees C. We saw that the temperature was nine degrees C at the time of the inspection, which is above the safe storage temperature for medication. We saw temperature records for the refrigerator, which were consistently above 8 degrees C. We saw that insulin was stored inside the refrigerator. No action had been taken to ensure that medication was being stored within the recommended temperature ranges.This means that medicines are at an increased risk of deterioration making the medicine ineffective and possibly harmful to the people they are being given to. Medication administration records were not always clearly documented to explain what had happened to medicines prescribed for people. For example,we saw the use of a code D on one medicine administration record (MAR). The code D was defined at the bottom of the MAR chart as Social Leave. The medicine was prescribed for treating dementia in alzheimers disease. There was no further information available to explain what had happened to the persons medicine. It was not clear if it had been given or not. We were told by the Deputy Manager that the person sometimes left the home with relatives and sometimes the medicine was given when they returned. If the medicine had been given at a later time it was not documented on the medicine record. We looked at the persons care plan and found no written information about them leaving the home and how medicines were to be given. We checked the medicine available in the home and found that there was a discrepancy in the amount left compared to the recorded amount signed for administration on the MAR chart. This means that due to poor records it was not Care Homes for Older People Page 4 of 14 always clear if people had been given their medicines as prescribed.This had been identified at the previous inspections. We found that care staff had not given prescribed medicine to a person and we saw gaps in the medication administration records.For example, one person was prescribed a diuretic to reduce fluid overload. It was to be given as two tablets twice a day. We looked at the MAR chart and saw that there were three gaps from teatime of 7th December 2009 through to teatime of 8th December 2009. The records were very confusing because they had been crossed through and deleted. We checked the MAR chart together with the Deputy Manager and could see the word finished underneath the crossing out. A handwritten entry continue had also been written onto the MAR chart. We were told by the Deputy Manager that she thought there had been an error and confusion. When the tablets in the box had finished a member of staff had assumed the course was finished. Another member of staff had located the tablets in a locked cupboard and re-started the treatment as prescribed and had therefore written continue onto the MAR chart. We checked and counted the remaining tablets against the MAR chart records and found a discrepancy of five tablets that could not be accounted for. We contacted the pharmacy to check how many tablets were sent to the home and they confirmed the quantity. This means that due to poor medicine records, poor communication, poor understanding of what the medicine was prescribed for and poor practice the person did not have their prescribed medicine to reduce their fluid overload and therefore placed the person at risk of poor health outcomes. This had been identified at the previous inspections. Information relating to medication was not available in the care plan. For example, one person was prescribed insulin to treat diabetes twice a day. We were told by the Deputy Manager that a District Nurse (DN) adminsitered the insulin and kept their own records.We looked in the persons care plan and saw a document Medication Agreement dated 22nd January 2008 which stated surgery DN will draw up insulin AM for teatime. J administers insulin into leg or tummy. We found no further information relating to the self administration of insulin by the person. We asked the Deputy Manager for further information. We were told that as the Deputy Manager left at 3pm she did not know what happened. The Deputy Manager asked a member of staff what happened with the teatime insulin and was told that the DN did return to give the second dose. The Deputy Manager changed the care plan to show that the DN visited twice a day to give the insulin. This means that the persons care plan was not up to date to include all relevant healthcare information such as prescribed medication, which had been identified at the previous inspections. We found that requirements for medication under 13(2) had not been met. We discussed the possible outcomes with the Acting Manager. What the care home does well: What they could do better: The service needs to ensure that staff accurately record the administration of medication to people living in the service. This is in order to ensure that medicine records accurately reflect what medicines have been given to people. Care Homes for Older People Page 5 of 14 The service needs to put systems in place to request, obtain and retain adequate supplies of prescribed medicines and they are available at all times to enable administrations to be carried out as and when prescribed. The service needs to ensure that care plans are kept up to date with regard to any changes made to peoples medicines. The service needs to ensure that medicines are always handled and administered in accordance with the medicine policy and follow good practice guidance so that people receive medicines as prescribed and are protected from harm. The service must make arrangements to ensure that medication is stored at the correct temperature and in accordance with manufacturers instructions to ensure the stability of medicines. 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 6 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 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 9 13 Regulation 13 (2) 31/08/2009 The service must make arrangements to ensure that medication is stored securely at the correct temperature recommended by the manufacturer. This is to ensure that medication is held safely. Care Homes for Older People Page 7 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 4 9 13 Regulation 13 (2) 31/08/2009 The service must make arrangements to ensure that medication administration records are accurately maintained; that the reasons for non-administration of medication are recorded by the timely entry on the medication administration record; that the meaning of any codes are clearly explained on each record; and that the person administering the medication completes the medication administartion record in respect of each person at the time of administration. To ensure that medication is managed safely. 5 9 13 The service must make 31/08/2009 arrangements to ensure that care plans include detailed information and instructions for staff in respect of the administration and management of medicines, including the reasons to give medicines on an as and when required basis. To ensure that staff are aware of medication prescribed any the reason why it is prescribed. 6 9 13 Regulation 13 (2) 31/08/2009 The service must make arrangements to ensure that records are kept of all medicines received, Page 8 of 14 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 administered and leaving the home or disposed of. To ensure that safe systems are in place. 7 9 13 Regulation 13 (2) All 28/11/2009 medication must be given as prescribed by a medical practitioner. To ensure that people received the correct medication as prescribed by a medical practitioner. 8 9 13 Regulation 13 (2) Records 28/11/2009 regarding medicines to be dispensed must be accurate and up to date regarding the medication and the dose prescribed by a medical practitioner. To ensure that safe systems are in place to protect people using the service. 9 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 guidance issued by the Royal Pharmaceutical Society of Great Britain. To ensure that systems are Care Homes for Older People Page 9 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 in place to securely hold medication in order to protect people from harm. 10 19 13 Regulation 13 (4) Systems must be in place to ensure that all parts of the home accessable to people living in the home are free from hazards. To ensure the health and safety of people using the service. 31/08/2009 Care Homes for Older People Page 10 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 Regulation 13 (2) The service 02/02/2010 must make arrangements to ensure that records are kept of all medicines received, administered and leaving the home or disposed of. To ensure that safe systems are in place. 2 9 13 Regulation 13(2) Records 02/02/2010 regarding medicines to be dispensed must be accurate and up to date regarding the medication and the dose prescribed by a medical practitioner. To ensure that safe systems are in place to protect people using the service. 3 9 13 Regulation 13(2) Medication 02/02/2010 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 Page 11 of 14 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Custody 1973), the Misuse of Drugs Act 1971 and as in 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. 4 9 13 The service must make 02/02/2010 arrangements to ensure that care plans include detailed information and instructions for staff in respect of the administration and management of medicines, including the reasons to give medicines on an as and when required basisi. To ensure that staff are aware of medication prescribed and the reason why it is prescribed. 5 9 13 Regulation 13(2) The service 02/02/2010 must make arrangements to ensure that medication administration records are accurately maintained: that the reasons for nonadministration of medication are recorded by the timely entry on the medication administration record: that the meaning of any codes are clearly explained on each record: and that the person administering the medicationcompletes the medication administration record in respect of each Page 12 of 14 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action person at the time of administration. To ensure that medication is managed safely. 6 9 13 Regulation 13(2) All 02/02/2010 medication must be given as prescribed by a medical practitioner. To ensure that people receive the correct medication as prescribed by a medical practitioner. 7 9 13 Regulation 13 (2) The service 02/02/2010 must make arrangements to ensure that medication is stored securely at the correct temperature recommended by the manufacturer. This is to ensure that medication is held safely. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 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. Copyright © (2009) Care Quality Commission (CQC). 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