Inspection on 23/08/10 for Charlotte Rose House

This inspection was carried out on 23rd August 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Charlotte Rose House 20/07/10

Charlotte Rose House 16/09/09

Charlotte Rose House 13/07/09

Charlotte Rose House 06/05/08

Charlotte Rose House 24/04/07

Charlotte Rose House 11/05/06

Charlotte Rose House 23/11/05

Charlotte Rose House 01/06/05

Charlotte Rose House 13/01/05

Charlotte Rose House 12/08/04

Charlotte Rose House 23/03/04

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Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

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 3 0 8 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 2 0 0 7 2 0 1 0 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 14 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 14 What we found: This inspection was conducted by Sue Hayward and the Commissions pharmacist inspector Mark Andrews who followed up on issues raised during the previous random inspection of 20 July 2010 in relation to the homes management of medicines for people living at the service. During the inspection we looked at some peoples care records, talked to some people living at the service and to staff, looked at recruitment records, how medicines are being stored and administered and medication records. We discussed our findings with the manager and senior carer at the time of the visit. On arrival for inspection the senior carer took the pharmacist inspector to the medicine trolley which was at the time located in a ground floor corridor. The medicine trolley was locked and keys were being held by the manager so medicines were secure. The senior carer told us arrangements were being made to secure the medicine trolley to a wall in this area. We noted, however, that lighting in this area is poor and may impact on the safety of medicine administration from the medicine trolley. The manager informed us that a controlled drug cabinet had been ordered and would be fitted in due course. The senior carer on duty said that she and the manager were the only members of staff currently handling and administering medicines at the service. On arrival, we were told that all medicines scheduled for morning administration had been given. However, we noted a number of medicines where records of medicine administration had not been completed and so where records did not demonstrate that medicines had been given. We did not observe medicines being administered during this inspection but when discussing detailed findings we were told that staff were still recording medicine administration prior to medicine administration and this was leading to inaccuracies in record-keeping. We undertook an audit of medicines against current medication records. We confirmed the arrangements the home had put in place to account for medicines but we found a significant number of numerical discrepancies both in surplus and in deficit. We confirmed some of these with the senior carer or manager who could not explain many of the discrepancies. We noted that where medicines had been prescribed with variable doses the medication chart medicine entries had been changed to indicate that a definitive dose was to be given. We noted that where carried forward figures had been recorded for some medicines at the start of the 28-day medication chart cycle, some of these figures were inaccurate and we identified ongoing issues around medicine stock control. We noted that for one person recently on leave from the service, many of their medicines were no longer at the home. The senior carer confirmed that records of the medicines provided to the person on leaving had not been kept therefore none of these medicines could be accounted for. Whilst since the previous random inspection, many medicines had been removed for disposal there were still a number of medicines being held that were no longer in use and had not been disposed of. For one medicine, we noted that this was still listed as an actively prescribed medicine in the persons care plan notes We found there to be some improvement in relation to keeping records of prescriber interventions in relation to peoples medicines, however, for one person there was a care note record of a GP request on 11 Aug 2010 to change the dose of a medicine from two tablets in the morning and one at lunch-time to one tablet three times daily but we found that this dose change had not been implemented and recorded on the medication chart Care Homes for Older People Page 4 of 14 and the manager confirmed that this change had so far not taken place. We found that a medicine recently prescribed for a person suffering nausea/vomiting on or around 13 Aug 2010 was still in a pharmacy bag within the medicine trolley and had not been recorded on the persons medicine administration chart. We looked at medication records for a person prescribed two types of painkillers. The first was a controlled drug painkilling patch for application every three days where its administration was due on 21 Aug 2010 but it was recorded as administered on 22 Aug 2010 which would have been the fourth day. The second was a painkilling tablet for which we found there to be a surplus of 3 tablets. The senior carer said the person had not suffered pain as a result of these discrepancies but no explanation for them could be provided. We noted that for two people a liquid laxative medicine that was prescribed for twice daily administration was being considered for administration three times daily each day. We looked at records with the senior carer and noted that the medicine was recorded as administered three times on 6 Aug, 14 Aug, 18 Aug 2010. The opinion of the senior carer was that whilst records indicated this on 6 Aug, she did not agree that they did on 14 Aug and 18 Aug 2010. For another person, a pain-relieving gel was prescribed for three times daily application but medicine administration chart records indicated it was being administered each morning only. For the same person, another similar pain-relieving gel was prescribed and written on the medication chart for use as directed with no further written directions. Records for this medicine indicated it was also being applied each morning. When we asked the senior carer about the application of both medicines she informed us the medicines were for application to separate areas of the persons body but confirmed there was no written care plan guidance for staff to refer to about the external administration of each of the medicines. We noted that since the previous random inspection, at our request, a GP review of treatment for a person had taken place and this was recorded in care notes. This led to a prescription of antacid tablets. When we asked where these tablets were, we were informed that this person self-administers the medicines and stores them in their room on a bedside cabinet. When we asked, we were also told that the medicines are not kept securely within the persons room nor had there been a risk assessment conducted in relation to this persons ability to safely manage their medicines. For another person, self-administering their medicines, when we looked at care notes there was a risk assessment recorded 21 Jan 2008 and an evaluation record of 29 May 2009 but no recorded evidence that staff are closely monitoring aspects of safety around this persons self-management of medicines. For one person, records indicated that a medicine scheduled for daily administration at night had not been administered to the person for three consecutive nights before the day of inspection because there were none available. When we discussed this with the senior carer we concluded that the home had not taken prompt and timely action to obtain this medicine to ensure continuous treatment. We looked at the care files for three people who live at the home. We saw that the files contained information about peoples preferred routines such as times of rising and retiring, and the way in which they wished their personal hygiene to be carried out. General risk assessments were in place about needs such as mobility, toileting, and personal hygiene, and records showed that they are evaluated monthly. The files also Care Homes for Older People Page 5 of 14 show that people are able to make their own decisions about their daily lives, and two people we spoke to were complimentary about the care and support they received at the home. Care plans had been signed by people, and they made reference to needs such as personal hygiene, mobility, mental state and cognition, and social interests. We saw that care plans still do not accurately reflect peoples needs, and how those needs should be met. For example, one care plan shows that staff should administer medication to the person. However there is also a form signed by the person which shows that they administer some medication themselves. This is not reflected in the main care plan. Another care plan made no reference to an eye condition that had been identified elsewhere in the care file, and the service user had told us about. Information in a further file showed that a service user suffers pain and has pain relief prescribed. Although staff were aware of this, the care plan made no reference to the need. Daily recording sheets are completed for each care plan. However they refer to the number of the plan, for example 1a, or 5a, but do not give details of what care was provided or how it was provided. Another file note showed that a service user had requested to see their GP, but daily recording sheets did not show that this request had been made or if any action had been taken in respect of the request. We saw that care records contained information about peoples specific dietary needs, and one file contained a nutritional assessment. People said they liked the food and had a choice as to where they ate it. Care records for one person showed that they have dietary allergies. Records of the meals provided included breakfast, lunch and tea choices but there was no indication of whether this specific diet had been catered for. Staff members were aware of this persons dietary needs, and they told us about the alternative foods that are provided. They were also aware of other peoples dietary needs and preferences. The people we spoke to during our visit said they could have visitors when they wanted, and they could see them in private if they wished. We saw that there is a visitors policy in place, which makes reference to visitors respecting other people who live in the home. We saw that the requirements made during our last visit to the home have now been addressed, and complaints and safeguarding information is being recorded. However some of the records we saw were not clearly dated. We saw that the complaints procedure is readily available to people, and contains the right information about how to contact us. People we spoke to said that they know who is in charge of the home, and they feel comfortable to raise any issues with her. They said they thought they would be listened to, and that their issues would be addressed. We looked at the personnel files for four members of staff. One file contained only one written reference, and another file did not contain any written references. Three staff files showed that they had commenced working at the home before a full criminal record bureau check had been received, and one file showed that the criminal record bureau check was still not in place. The manager said that staff do not do personal care whilst awaiting the criminal record bureau check, however there are no risk assessments in place, and rotas do not reflect this. Care Homes for Older People Page 6 of 14 We looked at staff rotas for a recent two week period. On some occasions the rota did not show that there was a sleeping-in staff on duty. The manger said that she currently lives in at the home and provides cover, however this is not recorded on the rota. The rota also shows where a member of staff has completed induction shifts. The manager said that she supervised the induction for the new member of staff but the rota does not accurately demonstrate this. The people we spoke to during our visit did not give any indication that the staffing of the home presented any problems. We have information to show that there is no longer a named responsible person acting on behalf of the providers for the home. We spoke to the manager about this during our visit, and we wrote to her before our visit. She said that she is currently dealing with the issue, and will confirm the new arrangements in writing to us. She also told us that in addition to provider monitoring visits, she has arranged for an independent consultancy service to visit the home on a monthy basis to carry out monitoring of the day to day running of the home. During our last visit to the home, we saw that a lock on a bathroom door did not allow for staff to gain entry in an emergency. During this visit we saw that the lock has been changed to one that allows for this to happen. We saw that since our last visit, there has been some improvement to the risk assessments for the environment, although the details in the assessments remain basic. Risk assessments now include things like radiators, electric cables, walking aids, wheelchairs and furniture. The home was seen to be generally well maintained in relation to safety issues, however we saw that the medication trolley was not securely stored. This was because the lift has broken down and it could not be taken to the first floor medical room. We did not see a risk assessment that related to this issue. 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 7 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 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 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 3 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 4 9 13 Regular and thorough risk assessments must be completed and documented when people chose to selfadminister their own medicines. To ensure peoples health 06/08/2010 Care Homes for Older People Page 8 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 and welfare is protected at all times 5 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 6 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 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 Medicines kept in peoples 06/08/2010 rooms must be kept securely To ensure the safety of people living at the service 9 16 22 The complaints procedure must be reviewed to make sure that it contains clear and accurate information about how we can be contacted. Records of any 06/11/2009 06/08/2010 22/10/2010 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 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 acted upon. 10 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. 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 7 12 Care plans must accurately 17/09/2010 reflect service users needs and how they are to be met. This is so that people are assured they will receive the care that they need. 2 7 12 Daily records must accurately reflect how peoples care needs are being met. This is so that the home can demonstrate that people are receiving the care they need. 17/09/2010 3 9 12 Effective arrangements must 10/09/2010 be made to ensure medicines are available at all times to administer as scheduled by prescribers To ensure treatment is continuous and promote and safeguard the health and welfare of people prescribed medicines 4 11 16 Menus must show peoples needs for specialist diets. 17/09/2010 Care Homes for Older People Page 11 of 14 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 This is so that the home can demonstrate they are providing appropriate meals for people. 5 15 22 Complaint records must be clearly dated This is so that people are assured that their complaints are dealt with in a timely manner. 6 29 18 Rotas must accurately 17/09/2010 demonstrate that there are sufficient staff are on duty at all times. This is so the home can show that there are enough staff to meet peoples needs. 7 29 19 A thorough recruitment procedure must be followed for all staff This is so that people living at the home are kept safe. 8 38 13 Risk assessments must be in 17/09/2010 place for all environmental needs. This is to make sure that people living in the home are kept safe. 17/09/2010 17/09/2010 Care Homes for Older People Page 12 of 14 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. © 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 14 of 14 - 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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