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Inspection on 20/07/10 for Charlotte Rose House

Also see our care home review for Charlotte Rose House for more information

This inspection was carried out on 20th July 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

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

The service has systems in place for the ordering and supply of medicines and has taken advice from the supplying pharmacist. Staff have received training in medicine management.

What the care home could do better:

The inspection identifies significant and widespread failings in medicine storage, recording, administration and control. We cannot be assured that people are receiving their medicines as prescribed by staff who follow safe procedures. Compliance with requirements set at previous inspections were not examined during this inspection.

Random inspection report Care homes for older people Name: Address: Charlotte Rose House 1 Norwood Road Skegness Lincs PE25 3AD one star adequate service 13/07/2009 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: Mark Andrews Date: 2 0 0 7 2 0 1 0 Information about the care home Name of care home: Address: Charlotte Rose House 1 Norwood Road Skegness Lincs PE25 3AD 01754762119 Telephone number: Fax number: Email address: Provider web address: pcoulson@chaucerhouse102.wanadoo.co.uk Name of registered provider(s): Name of registered manager (if applicable) Mrs P D Coulson Type of registration: Number of places registered: Conditions of registration: Category(ies) : Lonrush Ltd care home 20 Number of places (if applicable): Under 65 Over 65 19 0 old age, not falling within any other category physical disability Conditions of registration: Date of last inspection Brief description of the care home 0 1 1 6 0 9 2 0 0 9 Charlotte Rose House formerly known as Chaucer House is a home providing personal care to people who are over the age of sixty-five. It is situated in a residential area of Skegness within a short car ride of the town centre. Local services are within walking distance of the home and include a hotel-restaurant, post office and shops. The home is a detached three-storey building with accommodation for people who use the service on both ground and first floor levels. There is a passenger shaft lift and stair lift for access to the upper floors. There are fifteen bedrooms, five of which are shared occupancy, although at present no one shares a bedroom. To the front of the premises Care Homes for Older People Page 2 of 13 Brief description of the care home there is a patio area for sitting out and a small lawn and seating area to the rear. There are no on-site parking facilities for cars although on-street parking is available at the front and side of the home. The home is registered to provide personal care for up to twenty people, nineteen older and one younger physically disabled person. Eight people were living in the home at the time of the inspection. The current fees for the home range from £360 to £446 per week with additional charges made for hairdressing, dry cleaning, social transport and personal effects. Information about the day-to-day operation of the home and fees, as well as a copy of the last inspection report, is available in the main entrance hall of the home. Care Homes for Older People Page 3 of 13 What we found: The inspection was conducted by the Commissions pharmacist inspector Mark Andrews to assess the homes management of medicines for people living at the service. We looked at how medicines are stored, administered and recorded by looking at current and recent medication charts and associated records. We discussed our findings with the manager and senior carer at the time of the visit. On arrival for inspection the manager took us to the medicine trolley which was at the time located in a ground floor corridor. Whilst the trolley was locked we noted that the keys to the medicine trolley were located in a tray on top of the trolley therefore medicines were not secure. When the manager located the keys to the medicine storage room we looked at the arrangements for medicine storage in a dedicated medicine storage room. The cupboards used to store back up supplies of medicines are not lockable, however, the manager said the room was only accessible by authorised senior carers and the room door had a lock type which ensures the door is locked when closed. The cabinet used to store controlled drugs, however, does not comply with Misuse of Drugs (Safe Custody) Regulations. We asked to see records of medicine refrigerator temperatures. The most recent records related to November 2009 and therefore there was no evidence that the refrigerator temperature had recently been within the accepted temperature range for the storage of medicines. At the time of inspection the digital reading on the refrigerator indicated 5 degrees Celsius which is within the accepted range. The home has a controlled drug register for the additional recording of controlled drugs. We noted that the records did not include the strengths of controlled drugs registered. We checked the only controlled drug present and found the remaining quantity correct against the register. We did not observe the administration of a medicine round during this inspection, however, whilst in the medicine storage room we observed a senior carer preparing medicines for a person to take. The carer completed records for the administration of the persons oral medicines prior to giving them and this is unsafe practice. In addition, we noted that records for medicine administration are normally double signed by a second member of staff and we were told that the involvement of a second person to witness medicine administration is the homes current policy. However, when the carer prepared these medicines there was no second person involvement. We also noted other records relating to medicine administration on the morning of inspection that had not been completed by a second person and concluded that this process is not being reliably adhered to. We looked at medication charts currently in use. These were located in a folder with a specimen signature list of members of care staff authorised to handle and administer peoples medicines. There were interleaving cards with named identifying photographs of people who are prescribed and administered medicines. We noted that for some medicines there were no records for their receipt into the home and we were unable to account for these medicines. We also noted that whilst there were few gaps in records for the administration of medicines, for medicines prescribed with Care Homes for Older People Page 4 of 13 variable doses such as co-codamol 1-2 tablets to be taken four times daily, records did not indicate if one or two tablets had been administered therefore these medicines also could not be accounted for. We looked at medicines supplied in monitored dosage system (MDS) containers and for one person saw that a medicine remained in the container when a corresponding record had been completed on their medicine chart as if the medicine had been administered. We also audited a number of medicines not supplied in MDS containers and found that for most there were significant numerical surpluses suggesting the medicines had not been administered when records of their administration had been completed. We raised this as a matter of concern at the time of inspection and asked about the homes internal auditing procedures. The senior carer on duty said they conduct twice monthly numerical audits of medicines but we noted this was last undertaken and recorded on 11th June 2010. In view of our findings in relation to discrepancies we recommended that very frequent monitoring and auditing is conducted and suggested how this may be effectively achieved. We examined medicines available in the medicine trolley against current and some previous medication charts. We found there were medicines available in the medicine trolley which were not recorded as administered on current medication charts. For example, a cardiovascular medicine Persantin was available in the medicine trolley but not recorded as administered. The senior carer said this medicine had been stopped by the prescriber but when we asked to see documentation relating to contact with the prescriber this could not be provided. This medicine had not been removed from the medicine trolley for disposal so presenting risk. We also saw a number of other medicines in a storage cupboard that had been retained since 2009 and not disposed of. For another person living at the home we noted a laxative medicine Macrogol sachets were recorded on the medication chart for administration each day but records indicated they had only been administered from 12th July 2010 to the time of inspection. There were no records indicating why the medicine had not been given and no care planning relating to the use of the medicine at specific circumstances. We noted a painkiller prescribed for regular administration four times daily but which was recorded as being administered mornings only. We noted oral liquid medicines for a person at the home that were labelled as supplied early 2010 where there were additional unused supplies in the storage cupboard and became concerned that these may have not been administered as prescribed. One of these was sodium valproate liquid which may have been prescribed for the prevention of epileptic seizures. The senior carer said that this person has not had a seizure whilst living at the home and there was no care planned documentation for seizure management for this person. We discussed how liquid medicines can be audited and monitored. We also noted some medicines that were recorded on medication charts for administration but which were not available as medicines labelled for corresponding people. We later looked at medicines in the rooms of two people living at the service and were accompanied by the senior carer. We found that one person had two antacid medicines in their room including a bottle of Gaviscon liquid labelled for another person living at the home. We discussed why the person needed regular non-prescribed antacids and what action had been taken in relation to this. We urged a GP review for this person. We noted that in both peoples rooms medicines including external preparations were not secured so presenting risk to people. We were told that there is a person living at the home who self-administers their eye Care Homes for Older People Page 5 of 13 drops and inhalers. We looked at recorded risk assessments which were last reviewed September 2009 for which elements relating to safe storage of medicines or the persons capability in relation to the handling and self-administration of eye drops or inhalers were not recorded. We noted the home does not record when such medicines are supplied to people or how the use of them is monitored. We looked at records for the administration of anticoagulant warfarin and found that whilst again were unable to audit and account for the medicines, there were clear records of blood testing and results. We noted, however, that doses of 3mg daily have been continuously prescribed but as well as 3mg tablets there were also 1mg tablets available in the medicine trolley superfluous to need. We asked to see recorded evidence that authorised staff had received training in relation to medicine management. We were told that training had recently taken place but certificates of attendance had not yet been received. We agreed that we could accept written confirmation from the training provider which we later received. We were told that a further training event is being planned. However, the manager was unable to provide recorded evidence for ongoing monitoring and assessment of staff competence in handling and administration of medicines. 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 6 of 13 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 Care plans must be reviewed 30/09/2009 to make sure they reflect accurately peoples needs and how they are to be met. This is to make sure peoples needs and wishes are fully identified and known. 2 15 17 Records of meals must be kept in sufficient detail to show the full range of meals provided. This is to make sure that it can be demonstrated that the meals provided are well balanced and nutritious. 30/09/2009 3 16 22 The complaints procedure 06/11/2009 must be reviewed to make sure that it contains clear and accurate information about how we can be contacted. Records of any complaints raised must be kept to show details of any investigations and any action taken. This is to make sure that people are clear about how to raise any matters and they can feel confident their concerns will be taken seriously, listened to and Care Homes for Older People Page 7 of 13 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 acted upon. 4 29 19 A thorough recruitment 24/09/2009 procedure must be followed for all staff, which makes sure they are employed only after all necessary checked have been completed including obtaining satisfactory POVA and CRB checks. Staff must not be employed prior to a CRB check being received unless there are exceptional circumstances, which put the health, safety and welfare of people who use the service at risk, in which case CQC must be notified. This is to make sure people who live in the home are well protected. 5 38 13 There must be records in 30/09/2009 place to show risk assessments of the environment have been carried out. Where identified actions must be taken to reduce any risks identified. This is so peoples health and safety is promoted. Care Homes for Older People Page 8 of 13 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 Medicines no longer 06/08/2010 prescribed for use must be safely and promptly removed for disposal To ensure peoples health and welfare is protected at all times 2 9 13 Regular and thorough risk assessments must be completed and documented when people chose to selfadminister their own medicines. To ensure peoples health and welfare is protected at all times 06/08/2010 3 9 13 Medicines that are prescribed 06/08/2010 for individual people must be retained for use for the person only. Medicines prescribed for a person must not be administered to another To ensure peoples medicines are kept for their use only Care Homes for Older People Page 9 of 13 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 Medicines must be administered to people as instructed by prescribers. This must be evidenced by accurate record keeping practices To ensure peoples health and welfare is protected at all times 06/08/2010 5 9 13 Records must be completed for the doses of medicines given when they are prescribed with variable doses To ensure appropriate records are kept for medicines administered 06/08/2010 6 9 13 Records must be completed 06/08/2010 for contact received from prescribers about changes to medicine regimens To ensure accurate documentation is kept and the health and welfare of people is protected 7 9 13 Medicines must be 06/08/2010 administered to people by staff who follow safe medicine administration procedures and in line with the homes policy at all times To ensure the health and welfare of people is protected 8 9 13 Records for the receipt of medicines into the home must be completed at all 06/08/2010 Care Homes for Older People Page 10 of 13 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 times for all medicines received into the home To ensure appropriate records are kept for all medicines 9 9 13 Controlled drugs must be kept in a cabinet compliant with the Misuse of Drugs (Safe Custody) Regulations To provide an appropriate additional level of security for controlled drugs 10 9 13 The temperature of the 06/08/2010 medicine refrigerator must be monitored and recorded on a daily basis ensuring temperatures are maintained within accepted range To ensure the safety of medicine administration 11 9 13 Keys to the storage of medicines must be kept securely at all times To ensure the safety of people living at the service 12 9 13 Medicines kept in peoples 06/08/2010 rooms must be kept securely To ensure the safety of people living at the service 06/08/2010 22/10/2010 Care Homes for Older People Page 11 of 13 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 It is recommended that the competence of staff members authorised to handle and administer medicines is assessed and recorded on a regular basis It is recommended that prescriber reviews of peoples medicines are arranged It is recommended that care plans relating to medicine administration are reviewed for all persons prescribed medicines It is recommended that frequent and regular medicine audits are conducted which enable medicines to be accounted for and where discrepancies are identified prompt remedial action is taken to resolve them It is recommended that controlled drug register entries include the strength of controlled drugs recorded 2 3 9 9 4 9 5 9 Care Homes for Older People Page 12 of 13 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. 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