Random inspection report
Care homes for older people
Name: Address: Caburn House 15 Caburn Road Hove East Sussex BN3 6EF two star good service 12/03/2009 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: Lawrie Allum Date: 1 0 0 3 2 0 1 0 Information about the care home
Name of care home: Address: Caburn House 15 Caburn Road Hove East Sussex BN3 6EF 01273771945 01273526795 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Orion Care Services (Caburn) Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 28 Number of places (if applicable): Under 65 Over 65 28 old age, not falling within any other category Conditions of registration: 0 The maximum number of service users to be accommodated is 28. The registered person may provide the following category of service only: Care Home only - (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) Date of last inspection Brief description of the care home Caburn House is a care home providing personal care for twenty-eight (28) older persons. The home is located in a residential area of Hove. The home provides four intermediate care places. Residents who require nursing input receive this from the
Care Homes for Older People Page 2 of 9 1 2 0 3 2 0 0 9 Brief description of the care home district nurses. There are local amenities within walking distance of the home and there is nearby links to public transport. No parking is available at the home; however paid parking is available on the adjacent streets. The residents accommodation is located over three floors. There are five double occupancy rooms that are not provided with en suite facilities. All other rooms are for single occupancy, of which four are provided with en suite facilities (toilet and hand basin). All rooms are used for single occupancy, unless people have chosen to share. There is a passenger shaft lift that services the first floor and stair lifts are available to assist residents to access other floors within the home. There are communal toilets and assisted bathing facilities located throughout the home to meet the needs of the residents. Residents have access to a paved courtyard area. Weekly fees range from £314 to £600 per week. There are additional fees; hairdressing, chiropody, newspapers/magazines, dry cleaning and personal toiletries (at cost). A full list of additional fees is provided in the Service Users Guide. This information was provided to the CSCI on the 19th February 2010. Prospective residents find out about the home through social services referrals, word of mouth and from themselves/relatives living in the area. Care Homes for Older People Page 3 of 9 What we found:
The following indicates the findings of an unannounced inspection of the service by a CQC pharmacist inspector on Wednesday 10 March 2010. This inspection was requested by the homes CQC regulatory inspector, Jennie Williams, via Phil Hale, CQC local area manager, following concerns raised by Brighton Primary Care Trust regarding the process for medicines administration. This involved transferring doses of medicines to pots with lids bearing residents room numbers before transporting around the home to residents. Such practises involve unnecessary and unacceptable risk. On arrival at about 10:10, the morning medication administration had been completed by Bert Toloza, one of the two carers on duty. I was informed that a third carer was scheduled for duty that morning but had reported absent due to sickness. The homes deputy manager, Rachel Clarke, arrived at about 11:15 and provided assistance with the inspection. Apparently the deputy manager had been working at the home during the previous night until 8:30 that morning and was due to start again at 2PM that day but returned early when informed of this inspection. Most medication was dispensed in 4-weekly monitored dosage blister packs. Medicines administration record (MAR) charts were printed by the dispensing pharmacy for most of the residents and included a record of all prescribed items. The home was on day 10 of the 28-day cycle included on the MAR charts. Preceding each residents MAR chart(s) was a sheet providing reference details of the resident, including a photograph to confirm identity. The practise of concern when administering medicines, as described above, had been replaced by administering doses to all residents from the original container dispensed by the pharmacist. However, for those residents not receiving their medicines in the dining room, where the medicines are stored, their medicines containers are transported around the home to the residents on an open trolley. This process is required to be risk assessed with respect to the security and access by residents or visitors to the home, particularly as some have conditions involving confusion. There may be occasions when staff administering the medicines may need to leave medication unattended, particularly in the event of an emergency. Provision may be required for secure storage during transporting medicines such as a closed and lockable trolley or carrying case. On most occasions where the audit of medication was unable to be confirmed from the medication records this was due to medication carried forward from the previous MAR chart not being accurately recorded. Medication records must be complete in order to establish administration is in accordance with the prescribers directions. For a resident on respite care the quantity of warfarin tablets received into the home was not recorded and therefore administration compliance was unable to be confirmed. On occasions the prescribers directions required further information to assist carers administering medication, for example, when required. Further documented information should be provided on a separate page kept with the MAR chart detailing such further information as the condition indicated, symptoms requiring administration and any other information required in order for the medicine to be safely administered. For example for pain killers this would include the site of pain.
Care Homes for Older People Page 4 of 9 The medication policies and procedures were available hanging on the wall within the medicines storage room. It is recommended to include an index to improve access to the information and to expand the procedure for medication errors to include that to be taken when the residents GP is unable to be contacted. When doses of medicines are omitted the reason for omission must be defined. It is not adequate to record as not required. Medication stored in residents rooms for the convenience of application or for self administration must be kept in locked storage to prevent unauthorised access or harm to other residents or visitors. Items either expired or no longer prescribed must be returned to the pharmacy for disposal. This included reagent testing sticks, Albustix and Multistix, which expired 05/2009 and 08/2009 respectively. A dedicated fridge for the storage of medication was available and the temperature monitored daily by recording the temperature. Although a maximum/minimum thermometer was used, only the single temperature current at the time of recording was being recorded. Staff were unaware of how to reset the maximum/minimum temperature readings and it is recommended to record these readings to ensure the correct temperature is maintained 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 9 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 6 of 9 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 Documented guidance is 05/04/2010 required to be available at the point of use for medicines where the decision to administer requires further information. To ensure medicines are administered in accordance with the prescribers directions. 2 9 13 The transportation of 10/04/2010 medication around the home to administer to residents is required to be risk assessed with respect to unauthorised access and if necessary steps taken to address the risk. To ensure security and safety. 3 9 13 Medication stored in residents rooms is required to be in locked storage. To prevent any possible harm resulting from unauthorised access to medication. 10/04/2010 Care Homes for Older People Page 7 of 9 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 4 9 13 The procedure for dealing with medication errors requires direction when the residents GP cannot be contacted. To ensure carers are able to take immediate action to safeguard service users. 10/04/2010 5 9 13 Medication records are required to be complete. To facilitate audit for assessment of correct administration. 05/04/2010 6 9 13 Items that have reached 10/04/2010 expiry are required to be returned to the pharmacy for disposal. To ensure medication is therapeutically effective. 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 2 9 9 To provide a documented index to the medication policies and procedures to avoid delay in finding information. To record the maximum/minimum temperatures of the medicines fridge, in addition to the single current temperature, to improve assurance of correct storage temperature. Care Homes for Older People Page 8 of 9 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 9 of 9 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
