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Inspection on 03/12/09 for Cherry Trees Care Home

Also see our care home review for Cherry Trees Care Home for more information

This inspection was carried out on 3rd December 2009.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 6 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 controlled drug balances were correct and records reflected practice. The medicine management on the high dependency unit was good.

What the care home could do better:

The home must ensure regular medication reviews are undertaken to reduce the reliance on antipsychotic medicines and sleeping tablets. The medicine management must improve on both the nursing units and the memory lane unit to safeguard the health and well being of the people who use the service. The manager must install a robust quality assurance system to recognise and rectifyproblems in the safe handling of medicines by the nursing staff.

Random inspection report Care homes for older people Name: Address: Cherry Trees Care Home Stratford Road Oversley Green Alcester Stratford Upon Avon B49 6LN two star good 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: Debby Railton Date: 0 3 1 2 2 0 0 9 Information about the care home Name of care home: Address: Cherry Trees Care Home Stratford Road Oversley Green Alcester Stratford Upon Avon B49 6LN 01789764022 01789764024 cherrytrees@barchester.com www.barchester.com/oulton Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Claire Hardcastle Type of registration: Number of places registered: Conditions of registration: Category(ies) : Barchester Healthcare Homes Ltd care home 81 Number of places (if applicable): Under 65 Over 65 0 81 0 dementia old age, not falling within any other category physical disability Conditions of registration: 67 0 14 The maximum number of service users who can be accommodated is: 81 The registered person may provide the following category of service only: Care Home with Nursing (Code N); 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) 81 Dementia (DE) 67 Physical Disability (PD) 14 Date of last inspection Care Homes for Older People Page 2 of 11 Brief description of the care home Cherry Trees Care Home is situated approximately half a mile from Alcester town centre along the main road through Oversley Green. Barchester Healthcare Ltd owns the home. The area is very rural with infrequent public transport and the nearest shops are half a mile away. The care home can accommodate up to 81 people. The registration of the care home includes older people, older people with dementia and younger people with physical disabilities. The home is divided into dedicated living units for each client group. The homes decor, furniture and furnishings are generally of a high standard, however some areas are beginning to show signs of wear and tear. The accommodation is provided on two floors with access to these via a passenger lift or stairs. It must be noted that in order to move between the two floors of the physical disability unit, staff must either use the lift, the stairs in the dementia unit of the home or go outside as there are no stairs connecting the two floors within the unit itself. All of the accommodation is single room with en suite facilities. The gardens are well maintained, being accessible to all of the current residents. There are a number of seating areas, which are well used in good weather. There is a vehicle at the home to transport the residents on trips and for appointments. Information about the home is given to prospective residents and their families via the `Statement of Purpose? and other information brochures. Information about the fees is not included in the Service User Guide but is available on request to the manager. Fees should be checked at the time of deciding to use this service as the range of fees differ on each of the three units. Additional charges are made for hairdressing, chiropody, toiletries and sundries such as newspapers. Residents also contribute to external activities. Care Homes for Older People Page 3 of 11 What we found: The pharmacist inspection lasted four and a half hours. Medicines were assessed from all three units in the home. Ten peoples medicines were looked at together with their Medicines Administration Record (MAR) charts and care plans. Two nurses were spoken with and all feedback was given to the manager. The reason for the pharmacist inspection was the home had notified the commission that one person had not received one medicine for 15 days as it had not been delivered. When this was highlighted to the nursing staff they then signed the MAR chart recording they had administered the medicine even though they had not. This was identified by the companys external auditing system. This is of serious concern as staff had not recognised they did not have the medicine for 15 days and then recorded they had administered it when they had not. All the medicines were stored on three separate units in medicine trolleys used to safely transport them throughout the home. Surplus medicines were kept in separate locked cabinets and all Controlled Drugs were stored in compliance with current regulations. The medicine round on the nursing unit did not finish until 1:40pm even though it started at 11am. This was because two permanent nurses were off sick that morning and only one replacement agency nurse turned up for work. The manager was unaware of this until 1.30pm. It was felt that the manager should have been aware of this shortfall in staff and rectified the situation earlier. Because the morning round took so long insufficient time was left between the morning and lunch time medicine round, increasing the risk of potential overdose. At least four hours should be left between doses. Currently the home does not see the prescriptions before they are dispensed so nursing staff are unable to check whether ordered medicines have been prescribed. In addition they then have no copy of the prescription to check the medicines and MAR charts received into the home for accuracy. This had resulted in medicines being unavailable for administration as staff did not recognise they had not been dispensed until the start of the 28 day medicine cycle. People therefore did not receive their prescribed medicines at all times. The quantity of all medicines received had been recorded enabling audits to take place to demonstrate whether they had been administered or not and whether records reflected practice. Medicines had been recorded as administered when they had not been. Some were unaccounted for. Gaps were common and it was not possible in some instances to identify whether medicines had been administered but not signed as such or not administered and the reasons for non-administration not recorded. One medicine for pain relief was found in the medicine trolley but it had not been recorded on the MAR chart. It had not been removed and destroyed and it was not possible to ascertain whether any had been administered that month as no records existed. The care plan recorded that analgesics were no longer needed but it was still available to administer. Medicines had run out and staff had not ordered new prescriptions to obtain new supplies Care Homes for Older People Page 4 of 11 in time to ensure a continuous supply. In some instances nursing staff had signed they had administered medicines even though none were available to administer. Some medicines had been prescribed on a when required basis. There were no supporting protocols detailing their use. As agency staff are employed in the home these protocols are of importance so the medicines are only given as the doctor prescribed. It was seen that medicines prescribed to be administered when required had been routinely administered and in one instance at the highest dose. People new to the home brought in their medicines and nursing staff had recorded these on a new MAR chart. At no stage did the nurses check with the persons doctor to confirm their current medicine regime. It could not be demonstrated that the medicines administered were currently prescribed or whether any were missing. On the memory lane unit it was noted that half the residents were prescribed sleeping tablets, or antipsychotics or a combination of both. There was no supporting information in their care plans for underlying mental illnesses and some medicines were unlicensed for use in dementia. The nurses thought it was acceptable that so many people were prescribed these medicines despite their sedating and other untoward side effects. The care plans lacked information as to why some medicines had been prescribed. Not all external healthcare professional visits had been recorded. In addition the care plans lacked information about the peoples clinical needs. The manager agreed with this and was working towards improving them. The nurse spoken with had a good knowledge of the medicines they administered but failed to apply this knowledge to question why some medicines had been prescribed. The medicine management on the high dependency unit was good and the nurse on duty had a good knowledge of the clinical conditions of the people he looked after and what each medicine was for. The manager was unaware of the many of the problems found during the inspection. Barchester healthcare external auditing system is soley relied upon to identify problems. These are undertaken yearly and a seperate medication audit every six months. The problems identified during this routine audit had not triggered further audits. The home does not undertake its own quality assurance system to assess individual nursing staff practice to further identify poor nursing practice to enable them to address the issues. What the care home does well: What they could do better: The home must ensure regular medication reviews are undertaken to reduce the reliance on antipsychotic medicines and sleeping tablets. The medicine management must improve on both the nursing units and the memory lane unit to safeguard the health and well being of the people who use the service. The manager must install a robust quality assurance system to recognise and rectify Care Homes for Older People Page 5 of 11 problems in the safe handling of medicines by the nursing staff. 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 11 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 7 of 11 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 8 12 Care plans must be updated to include the clinical conditions of the service users and how staff should deal with them This is to ensure the health and well being of the service users 14/01/2010 2 9 13 A system must be installed to check all new service users medicine with their doctor. This is to ensure that they are administrated their current drug regime A quality assurance system must be installed to assess staff competence in their handling of medicines and used on a regular basis. Appropriate action must be taken when these indicate that medicines are not administered as prescribed and records do not reflect practice. This is to ensure that 08/01/2010 3 9 13 08/01/2010 Care Homes for Older People Page 8 of 11 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 individual nursing staff practice is assessed on a regular basis and appropriate action is taken if audits indicate that nurses do not administer the medicines as prescribed. 4 9 13 The medicine administration record (MAR) chart must record the current drug regime as prescribed by the clinician. It must be referred to before the preparation of the service users medicines and be signed directly after the transaction and accurately record what has occurred. This is to ensure that the right medicine is administered to the right service user at the right time and at the right dose as prescribed and records reflect practice 08/01/2010 5 9 13 A system must be installed 08/01/2010 to check the prescription prior to dispensing and to check the dispensed medication and the medicine administration record charts against the prescription for accuracy. All discrepancies must be addressed with the healthcare professional. This is to ensure that all medicines are administered as prescribed at all times Page 9 of 11 Care Homes for Older People 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 6 9 12 All medicines must be available for administration at all times This is to ensure that the service users receive their prescribed medicines as the doctor intended 08/01/2010 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 It is advised that there are at least four hours between medicine rounds to reduce the risk of potential overdose It is advised that all medicines prescribed on a when required basis have supporting protocols for staff to follow to reduce the trend of regularly administering medicines prescribed for occasional use only. It is advised that medication reviews are undertaken to reduce the reliance on antipsychotic medicines and hypnotics 3 9 Care Homes for Older People Page 10 of 11 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). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 11 of 11 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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