Inspection on 26/11/09 for Briarlea

This inspection was carried out on 26th November 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 but made no statutory requirements on the home.

Other inspections for this house

Briarlea 11/02/10

Briarlea 17/12/09

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 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: 2 6 1 1 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): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Briarlea Care and Supported Living Limited 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 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. Care Homes for Older People Page 2 of 14 Brief description of the care home 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: At the last inspection carried out in July 2009, we found areas of concern which could have potentially placed people using the service at risk. As a result we made a number of requirements and set timescales for action by the registered persons. This unannounced inspection, which was undertaken by one inspector, was to assess the actions taken and the homes compliance with these requirements. Following our last inspection we were informed by a director of the company that the outcome of the report was discussed and that they were maintaining a full review of practices to see how they could improve the service and record keeping. We were therefore confident that suitable improvement would have taken place to ensure the health, safety and welfare of people using the service. The registered manager and the deputy manager were on duty when we arrived at the home. During our inspection a director of the company arrived. People assisted us in our inspection and supplied us with the information we requested. MEDICATION - Requirements 3,4,5,6 and 7 in our previous report. A pharmacist inspector took part in the previous inspection and identified a number of shortfalls regarding the recording and management of medication. As a result of these shortfalls we issued five requirements regarding different aspect of medication storage, recording and disposal. Medication in the home is administered from two trolleys one on the ground floor and one on the first floor. We found concerns within the trolley on the first floor and did not therefore view the trolley on the ground floor. These concerns resulted in a change to our inspection plan. The previous report highlighted the need to maintain records to demonstrate that medication is held at a safe temperature. We were told by the deputy manager that somebody was going to get a thermometer but that this did not happen. The deputy manager also told that somebody had planned to get one on their way home the day beforehand. Following this random inspection we were informed, again by the deputy manager, that thermometers were obtained and that records had commenced. On the first MAR (Medication Administration Record) sheet we saw that somebody had recorded M for an item on one occasion. This code means make available, this code is usually used in circumstances when stocks have run out. During our previous inspection we found that one member of staff had a signature resembling the letter M. We were told that the person concerned no longer did that and that she had not been on duty that day anyway. Neither the manager or the deputy manager could account for why the code was used as the medication was available. It was our intention to establish whether we found any further occasions when this had happened however another sheet gave us a concern which we then needed to follow more carefully. The medication belonging to the resident concerned was held in a canvas bag within the trolley. Care Homes for Older People Page 4 of 14 On viewing the dosette box (a system used by a chemist to pre pack medication in to sections marked with the day and time of administration) we noted a drug that needs to be treated as a controlled drug. As a result this drug should have been stored more securely. As the drug was within the dosette system the whole cassette needed to be stored more securely. The manager informed us that more of these drugs were held within a filing cabinet in the office. On going to the office we discovered that a supply of drugs was not in the filing cabinet but was in a carrier bag under the managers desk. The carrier bag contained 4 weeks worth of dosette cassettes as well as medications in their original boxes. The home had booked some medication in on the MAR sheet but the vast majority of this medication was not booked in. The controlled drugs register contained no information about this drug whatsoever therefore it did not have the two signatures needed to acknowledge medication as given. There was no date of opening on a box of medication found under the desk which had 7 tablets taken from it. The label on this box stated that staff were to administer one tablet from pk (the box within the carrier bag) and one from box (the dosette cassette). It seemed highly likely that staff had carried this instruction out. However having done this would mean that staff had administered medication in excess of the dose prescribed by a medical practitioner. Both the registered manager and deputy confirmed that it appeared the person concerned had received too much medication. We saw a list of medication supplied by the hospital when the person was admitted into the home. The list did not contain the drug which should be treated as controlled however medication was supplied by a hospital. In addition we saw that another drug on the list either had a line through it or close to it which could of suggested that a medic had withdrawn the drug prior to discharge. It was confirmed during our visit that nobody had contacted the hospital to query these discrepancies. We audited a number of tablets that continued to be dispensed from the original boxes and were not included within the dosette box. One drug was found to balance however, two did not. A box of painkiller contained two too many tablets when we audited these against the records held. The manager told us that although two members of staff had signed the medication in and recorded the number of tablets received they were not counted at that time to ensure the total was correct. We also noted that two members of staff had signed in a drug on the MAR sheet. However a third member of staff had noted that the MAR sheet contained a spelling mistake in relation to the name of the drug and made an amendment. Having a second member of staff checking the MAR sheet should identify any recording errors. The above findings indicate that there has been insufficient progress in meeting the requirements of the previous inspection and in providing a safe system for the management of medication. Due to the seriousness of the shortfalls we decided to issue immediate requirements regarding medication. The immediate requirements gave the service 48 hours to improve however we expected action in relation to some of the shortfalls without any delay in Care Homes for Older People Page 5 of 14 order to safeguard the well being of people living in the care home. A director of the company who was present during the inspection took our concerns very seriously and gave verbal assurance that matters would be investigated. We were informed the following day that a medical practitioner was requested and visited the home to carry out a full review of the persons medication to ensure that it was correct. CARE PLANNING AND RISK ASSESSMENTS - Requirements 1 and 2 in our previous report. We looked over three care plans and risk assessments during this random inspection. We have previously had concerns about the lack of care plans in relation to people who were newly or recently admitted into the home. During this visit we viewed the care plan devised regarding somebody who was admitted nine days beforehand. We found a care plan to be in place which gave staff initial guidance regarding the care to be delivered. We saw evidence of risk assessments having taken place in areas such as nutrition and moving and handling. As the levels of risk identified were low the amount of detail on these assessments was not extensive. A list of medication prescribed and possible side effects was on file. We viewed another file which also contained a care plan and some risk assessments. During our last inspection we had some concerns about the documentation held regarding a resident who was a diabetic. We saw some improvement in that it was clearer how the diabetes was to be managed. We saw that care plans were reviewed on a monthly basis however on reading the daily records we identified some areas of identified care need whereby the care plan did not reflect these changes such as a pressure sore on an ankle identified by a chiropodist and the use of medication to manage bowels. We did not see any guidance for staff in relation to either of these care needs. We noted a couple of incidents involving residents in a shared bedroom however it was not clear what if any strategies were put in place to manage this. We saw no evidence that other professionals were informed of these events in order to ensure that people are safe. Risk assessments were in place regarding nutrition and skin care. We saw records following somebody falling on a couple of occasions during November 2009. No falls risk assessment was in place or any instructions regarding moving and handling this person. The above shortfalls were discussed with the deputy manager at the time of our visit. The above findings show some progress in meeting the requirements from the previous inspection but further action needs to be taken to ensure that care plans and risk assessments are fully up to date. SAFE SYSTEMS TO IDENTIFY HAZARDS - Requirement 8 in our previous report. At the start of this inspection we viewed some communal areas of the home to assess compliance with our requirement to ensure that all parts of the home, accessible to people living there, are free from hazards. Care Homes for Older People Page 6 of 14 We were not able to see one bathroom as it was in use when we were having a look around the home. We did however find another bathroom to be clean and tidy. We did not see any cleaning materials within that bathroom or within a toilet which was viewed. In addition, we did not see any toiletries belonging to residents within these areas. This indicates that products are now stored more safely. During our previous inspection we were informed that no systems were in place to monitor hot water temperatures and therefore safeguard people from the risk of scalding. In addition we were told that no systems were in place to ensure that windows restrictors were functioning correctly. As part of this visit we requested records to demonstrate that systems were now in place. A record of bath temperatures was seen in the first floor bathroom. This showed that residents are bathed in water varying between 35 and 39 degrees Centigrade. As this is the temperature of water once cooled by staff systems also need to be in place to ensure that water is not too hot at the point of delivery. We were previously informed that thermostatic controls are fitted to baths however, as these are not fail safe, systems need to be in place to monitor temperatures. A written record showed that routine checks commenced prior to the date for compliance set within the previous key inspection report. At the time of this inspection the checking system introduced had not included the first floor bathroom which is used or, a bathroom which is not used. The record showed a shower delivering water in excess of the maximum temperature recommended by the Health and Safety Executive. Although the record showed that the temperature was adjusted we had some concerns about the possibility of people, especially residents, increasing the water temperature by the use of a red button on each shower. A director of the company informed us that, as a result of our findings, he had contacted a plumper to see what could be done to reduce the risk further. A generic risk assessment was in place but it failed to show any measures to reduce the risk other than bringing the issue to the attention of staff. One bathroom on the first floor continues to be out of use. The bath does not have a hoist fitted overhead and therefore the service has assessed this room as unsuitable for people with limited mobility. This bathroom is carpeted which, as previously highlighted, is not recommended for infection control purposes. We pointed out to the manager a potential trip hazard with the carpet grip on the entry to one toilet. This needed to receive attention to prevent an accident. A record had commenced regarding the routine checking of window restrictors. During July 2009 some windows, without catches, were identified as part of this check. The record showed that the manager was informed and that the windows in question were fixed. We checked a couple of these and found that they had a restrictor in place. Following our random visit in April 2008 we wrote in our report that wardrobes were free standing; it is recommended that wardrobes be secured to prevent accidental toppling. When we visited in July 2009 we found that wardrobes remained unsecured and therefore we concluded that they continued to remain at risk of toppling over. After our inspection in July we were told that brackets had been purchased to carry out this task. During this visit we saw some wardrobes which were secured however we discovered one which was not. By the end of this random visit we were told by the registered manager that this Care Homes for Older People Page 7 of 14 wardrobe was also now secured to a wall. The above findings indicate that progress has been made in addressing safety issues in the home but further action needs to be taken to ensure that these are always managed reliably. 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 8 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 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 4 9 13 Regulation 13 (2) 31/08/2009 The service must make arrangements to ensure that there are procedures for the safe disposal of unwanted medication in order that medication is safely and correctly disposed of. So that safe system are in place and people are protected. 5 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. 6 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 Page 10 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 medicines on an as and when required basis. To ensure that staff are aware of medication prescribed any the reason why it is prescribed. 7 9 13 Regulation 13 (2) 31/08/2009 The service 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. 8 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 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 1 9 13 Regulation 13 (2) All medication must be given as prescribed by a medical practitioner. To ensure that people received the correct medication as prescribed by a medical practitioner. 28/11/2009 2 9 13 Regulation 13 (2) Records 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. 28/11/2009 3 12 13 Regulation 13 (2) Medication 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 28/11/2009 Care Homes for Older People Page 12 of 14 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 in place to securely hold medication in order to protect people from harm. 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 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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