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Inspection on 05/09/05 for Brookthorpe Hall Care Centre

Also see our care home review for Brookthorpe Hall Care Centre for more information

This inspection was carried out on 5th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

Systems are in place to manage medicines safely and to ensure residents receive the medicines prescribed for them. Staff have received training about medicines.

What has improved since the last inspection?

This is the first inspection of medication by a pharmacist inspector. There are no outstanding requirements or recommendations from the last inspection.

What the care home could do better:

The temperature of the clinic room could be regularly checked to ensure medicines are stored at a temperature to retain their potency. Some more information is needed on some records so that complete information about medicines administered is kept.

CARE HOMES FOR OLDER PEOPLE Brookthorpe Hall Care Centre Stroud Road Brookthorpe Gloucester GL4 0UN Lead Inspector David Jones Unannounced 5 September 2005, 11:00 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 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. Brookthorpe Hall Care Centre D51_D03_16392_Brookthorpe Hall_v247772_050905_UI_stage4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Brookthorpe Hall Care Centre Address Stroud Road Brookthorpe Gloucester GL4 0UN 01452 813240 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Frampton Residential Homes Ltd. Miss Michaela Chandler Care Home 32 Category(ies) of OP Old Age (30) registration, with number LD Learning Disability (2) of places Brookthorpe Hall Care Centre D51_D03_16392_Brookthorpe Hall_v247772_050905_UI_stage4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1) Two beds can be used for service users under the age of 65 years of age. 2) That service users under 65 years of age must be over 50 years of age. Date of last inspection 13/01/2005 Brief Description of the Service: Brookthorpe Hall is a nineteenth century building that has been sensitively adapted for its stated purpose.It is registered to provide personal care for 30 older people, with an additional category for two people with a learning disability.The home is very spacious and provides easy access with a staircase and shaft lift accessing all four floors. Communal lounges and a dining room are situated on the ground floor and residents’ accommodation is provided on three floors.The home uses contracted caterers offering a good degree of choice of meals for residents. The home has an activities co-ordinator and provides varied optional opportunities for social activity and interest. Brookthorpe Hall Care Centre D51_D03_16392_Brookthorpe Hall_v247772_050905_UI_stage4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection consisted of a specialist inspection over 4 ¼ hours on a Monday morning of the arrangements for handling medication and was carried out by a pharmacist inspector. Stocks and storage arrangements for medicines, a sample of medication records, the policy and procedures were examined. There were discussions with two staff members and one resident who self-administers medicines was spoken to. What the service does well: What has improved since the last inspection? What they could do better: The temperature of the clinic room could be regularly checked to ensure medicines are stored at a temperature to retain their potency. Some more information is needed on some records so that complete information about medicines administered is kept. Brookthorpe Hall Care Centre D51_D03_16392_Brookthorpe Hall_v247772_050905_UI_stage4.doc Version 1.40 Page 6 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. Brookthorpe Hall Care Centre D51_D03_16392_Brookthorpe Hall_v247772_050905_UI_stage4.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection Brookthorpe Hall Care Centre D51_D03_16392_Brookthorpe Hall_v247772_050905_UI_stage4.doc Version 1.40 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) N/A These standards were not assessed on this visit. EVIDENCE: Brookthorpe Hall Care Centre D51_D03_16392_Brookthorpe Hall_v247772_050905_UI_stage4.doc Version 1.40 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 9 Medicines are generally managed safely but the inspection indicated that sometimes more attention to detail is required to ensure records clearly demonstrate correct use of medicines and safe practices are in place. EVIDENCE: There are secure storage arrangements for most medicines. The temperature in the clinic room must be monitored and action taken to prevent storage exceeding 25°C (the maximum safe temperature for most medicines). At the inspection the temperature was just above this. The controlled drug cupboard is mounted on a plasterboard wall and not fixed correctly. In order to comply with The Misuse of Drugs (Safe Custody) Regulations 1973 it must be fixed to a solid wall with two rag / rawl bolts through the reinforced plate at the back of the inner cupboard (details were provided). Medicines are stored in a clean and tidy manner. Some loose blisters of tablets were in evidence on the trolley – these must be kept within the labelled box in which dispensed in order to retain full identity. There is some stock to be returned for residents no longer in the home or no longer prescribed. Medicines must only be used for the person for whom prescribed - there was evidence of some medicines prescribed for particular residents being used as homely remedies. A protocol for homely remedies is in place and these must be purchased for this use and Brookthorpe Hall Care Centre D51_D03_16392_Brookthorpe Hall_v247772_050905_UI_stage4.doc Version 1.40 Page 10 only stock on the protocol used. There was an unlabelled pot of tablets and also one medicine not include on the protocol (Stugeron). The medicines for external use kept in the unlocked office must also be kept securely. The pharmacy dispenses most medicines in a monitored dose system (MDS) and provides printed Medication Administration Record (MAR) charts each month. Some of the printing was not clear in the first section of the charts as two lines were merged. The home has already pursued this issue with the pharmacy but in the meantime handwritten notes can be made if the directions are not clear. The allergy box at the top of the chart should be completed even if the entry is ‘none known’. Liaison with the pharmacy could help with this. Some medicines are prescribed ‘as required’ and information has been included on some charts to clarify use. This must be done for any medicine prescribed ‘as required’ so that staff are clear in what circumstances the medicine is to be used for that resident. Further information was provided. Handwritten entries on the charts had been signed but these should be countersigned as a check for correct transcription. Some examples were noted where labels on dispensed medicines did not correspond with the MAR chart. An explanation must always be provided for this so that staff are clear as to the correct directions. The doctors’ prescriptions (FP10) are ordered by the pharmacy. The home should be responsible for this and check the actual prescriptions before these are sent to the pharmacy as this enables the manager or designated staff to have sight of the only document signed by the prescriber. In addition a comprehensive set of records are kept with a medication profile, receipt and disposal records for each resident. Information on some profiles did not correspond with the MAR chart. Records must be kept up to date to avoid confusion. It is confusing where a record is crossed out in one section to use for a different medicine - a new section should be used. Records of medicines received for residents on respite care have not been made recently so there is not a complete audit trail. A controlled drug record book is kept and also a separate administration book for temazepam. It would be much clearer if all temazepam records were kept in the main book. There must be one record kept for each medicine / strength and resident. The receipt and administration can be kept on the same page. One record checked did not correspond with the information on the MAR chart. There was also stock showing on one page for a previous resident but no tablets in the cupboard. It was not possible to check if this had been returned as the returns record book was at the pharmacy. The manager is to check this immediately and annotate the records correctly. Residents are supported to administer their own medication following a risk assessment but there was no risk assessment in place for the one person looking after their medicines on the day of the inspection. This must be put in place and regularly reviewed to ensure medicines are being taken correctly and kept safely with regard to other residents and staff in the home. A medicine policy and procedures are all in place and staff that administer medicines have received accredited training. Details were provided to obtain the latest guidelines from the Royal Pharmaceutical Society about medicines in Care Homes. Brookthorpe Hall Care Centre D51_D03_16392_Brookthorpe Hall_v247772_050905_UI_stage4.doc Version 1.40 Page 11 Some satisfactory counts of medicines to audit correct use were possible. The manager should arrange for regular audits in order monitor correct use of medicines and to regularly assess staff competence in this important task. Some of the lunchtime doses of medicines were seen to be administered using safe procedures. A recent edition of a medicine guide is available but the British National Formulary was a very old edition. Brookthorpe Hall Care Centre D51_D03_16392_Brookthorpe Hall_v247772_050905_UI_stage4.doc Version 1.40 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) N/A These standards were not assessed on this visit. EVIDENCE: Brookthorpe Hall Care Centre D51_D03_16392_Brookthorpe Hall_v247772_050905_UI_stage4.doc Version 1.40 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) N/A These standards were not assessed on this visit. EVIDENCE: Brookthorpe Hall Care Centre D51_D03_16392_Brookthorpe Hall_v247772_050905_UI_stage4.doc Version 1.40 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) N/A These standards were not assessed on this visit. EVIDENCE: Brookthorpe Hall Care Centre D51_D03_16392_Brookthorpe Hall_v247772_050905_UI_stage4.doc Version 1.40 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) N/A These standards were not assessed on this visit. EVIDENCE: Brookthorpe Hall Care Centre D51_D03_16392_Brookthorpe Hall_v247772_050905_UI_stage4.doc Version 1.40 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) N/a These standards were not assessed on this visit. EVIDENCE: Brookthorpe Hall Care Centre D51_D03_16392_Brookthorpe Hall_v247772_050905_UI_stage4.doc Version 1.40 Page 17 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x x x Brookthorpe Hall Care Centre D51_D03_16392_Brookthorpe Hall_v247772_050905_UI_stage4.doc Version 1.40 Page 18 N Are there any outstanding requirements from the last inspection? 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 9 Regulation 13(2) Requirement The temperature of the medicine storage room to be monitored and medicines stored below 25°C. Medicines must only be used for the person for whom prescribed. Medicines must always be stored securely. An ongoing written risk assessment must be in place for any resident self-administering medicines. Clear directions describing use of any ‘as required’ medicine must be documented. . Receipt records must be kept for any medicines in the home. The anomaly in the recorded stock balance of temazepam (page 11) to be resolved. Timescale for action 31/10/05 2. 9 13(2) 3. 9 13(2) 4. 9 13(2) 5. 6. 9 9 13(2) 17(1) 13(2) With immediate effect and ongoing. With immediate effect and ongoing. With immediate effect and ongoing. 31/10/05 With immediate erffect and ongoing 15/10/05 7. 9 13(2) Brookthorpe Hall Care Centre D51_D03_16392_Brookthorpe Hall_v247772_050905_UI_stage4.doc Version 1.40 Page 19 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. 2. 3. 4. 5. 6. 7. Refer to Standard 9 9 9 9 9 9 9 Good Practice Recommendations Storage for controlled drugs to comply with The Misuse of Drugs (Safe Custody) Regulations 1973. The allergy box on the MAR charts to be completed Handwritten entries on MAR charts to be countersigned as correct by a second authorised member of staff. FP10 prescriptions to be checked in the home before being sent to the pharmacy for dispensing. Receipt and disposal records for temazepam to be fully recorded in the main controlled drug record book. An up to date edition of the British National Formulary to be available in the home. Regular audits to demonstrate correct use of medicines to be carried out. Brookthorpe Hall Care Centre D51_D03_16392_Brookthorpe Hall_v247772_050905_UI_stage4.doc Version 1.40 Page 20 Commission for Social Care Inspection Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester GL3 4AB National Enquiry Line: 0845 015 0120 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 Brookthorpe Hall Care Centre D51_D03_16392_Brookthorpe Hall_v247772_050905_UI_stage4.doc Version 1.40 Page 21 - 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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