Random inspection report
Care homes for older people
Name: Address: Country Court Southcoates Lane Hull East Yorkshire HU9 3TQ one star adequate service 18/02/2009 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: Steve Baker Date: 1 2 0 5 2 0 0 9 Information about the care home
Name of care home: Address: Country Court Southcoates Lane Hull East Yorkshire HU9 3TQ 01482702750 Telephone number: Fax number: Email address: Provider web address: countrycourt2005@yahoo.co.uk Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Pearl Dusk Limited care home 34 Number of places (if applicable): Under 65 Over 65 34 34 dementia old age, not falling within any other category Conditions of registration: 0 0 Exception statement - permitted to provide care for one named person under pensionable age. Date of last inspection Brief description of the care home Country Court is purpose built building, which provides care for up to thirty-four older people, who may also have dementia. The home is situated to the East of the city of Hull, with shops, health facilities, community services and public transport all easily accessible. All accommodation is on the ground floor with all rooms providing single accommodation. Nine rooms have en-suite facilities. The home has three bathrooms and one shower room. There is a large lounge, a dining room and a small
Care Homes for Older People Page 2 of 10 1 8 0 2 2 0 0 9 Brief description of the care home conservatory. A additional quiet lounge also has a small conservatory attached. An inner courtyard is available and accessible for residents to use should they wish to sit outdoors. A small car park is available at the front of the home. According to information in the homes Annual Quality Assurance Assessment document, the weekly fees are 348.50 pounds to 391.50 pounds. There is no top-up fee. Optional extras include chiropody, hairdressing, newspapers and toiletries. Care Homes for Older People Page 3 of 10 What we found:
During the visit we examined the homes medication policy & procedures, all current and 15 older medication administration record (MAR) charts, and the medication ordering, storage & handling arrangements. We also observed medicines being given to people with breakfast. The medication policy we were shown is a commercial document acceptable for general use but there are no locally developed medication procedures to help staff working in the home. The manager and staff are unable to readily refer to current professional best practice guidance, new medicines information or new regulatory changes as there is no computer or internet access in the managers office. Some recent internal training has taken place, but further update training, regular competency assessments and spot checks of practice would ensure all staff are working consistently in line with current professional best practice guidance. There are very few administration gaps on the MAR charts meaning that people living in the home can expect to receive their prescribed medicines correctly. Some of the gaps on the MAR charts are due to staff having to wait for new supplies of medicines to be prescribed and dispensed. We were told that one GP practice will only prescribe a fixed quantity of painkillers irrespective of the dose being taken or the calculated amount needed for a whole month. Arrangements must be put in place to prevent such gaps in treatment. This improvement will need the understanding and full co-operation of local NHS practitioners and managers. Hand written entries on the MAR charts describing medication changes are clear and detailed so all staff will understand them. During the visit we saw that medicines were left insecurely in an open hallway opposite the managers office as there is insufficient storage space to lock them in the medication trolley. The walk-in storage cupboard is unsuitable for storing the quantity and nature of medicines kept in the home. The wooden cabinet for storing controlled drugs does not meet the current safe custody regulations and must be replaced urgently to provide the additional security needed for these medicines. Staff have insufficient working space to enable them to handle and record medicines accurately and safely. This may lead to record keeping errors or medicines being misplaced. No temperature records were available so staff can not be sure whether all medicines are stored correctly at temperatures and conditions recommended by the manufacturer. Medicines needing cool storage are kept in a refrigerator in a separate room. The temperature records suggest this refrigerator may need defrosting more regularly or that the thermometer may need to be replaced. The opening dates of medicines with a limited life once opened are now recorded so staff will know that they are safe to use when needed. The person in charge of ordering medication should see the regular monthly prescriptions before a supply is made. The prescription is the authority for the staff to administer medication to the person. This also provides an opportunity to check if any new medicines or dose changes are included. Any problems with prescriptions can be addressed at this point rather than after the supply has been made. The checking of prescriptions is an important part of the management of medication. What the care home does well:
Clear and detailed records are kept of how medicines are used in the home. The records of controlled drugs usage are now clear and accurate. Changes made by hand to the MAR charts are written in a way that all staff can follow.
Care Homes for Older People Page 4 of 10 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 10 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 8 13 Risk assessments must fully 30/04/2009 reflect the identified risk and behaviour management plans must be in place to manage any behaviours that can be challenging to the resident or to others. This will ensure that staff are aware of how to minimise risks and have clear guidance in how to support people in a consistent way. 2 9 13 Staff must ensure that resdents receive medication as prescribed. This is to ensure the health and welbeing of residents and to ensure the prescribers instructions are followed. 31/03/2009 3 29 19 Full staff employment checks, including povafirst checks and two written references must be in place prior to the start of staff working in the home. This will help to ensure only appropriate people are employed to work with vulnerable adults and help to safeguard them from abuse. 31/03/2009 Care Homes for Older People Page 6 of 10 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 4 30 18 Staff must be trained to 30/09/2009 meet the increasing needs of residents in the home in areas such as dementia care and conditions affecting older people. This will ensure that staff have the skills and knowledge to care and support people with a range of needs. 5 38 13 Risk assessments for the use 31/03/2009 of bed rails must be completed thoroughly in line with health and safety guidelines. This will ensure the actual need for a bed rail has been assessed and ensure the correct match between the resident, bed, mattress and bed rail. This will help to avoid any unsafe fittings and prevent accidents. Care Homes for Older People Page 7 of 10 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 12 An effective system must be 31/07/2009 in place to request, obtain and retain adequate supplies of prescribed medicines. This makes sure people can be given their medicines as and when needed. 2 9 13 Arrangements must be made 31/07/2009 to ensure that controlled drugs are stored securely in accordance with the requirements of the Misuse of Drugs act 1971, the Misuse of Drugs (Safe Custody) Regulations 1973 and in accordance with the current guidelines from the Royal Pharmaceutical Society of Great Britain. This will provide the additional security necessary for this type of medicine. Care Homes for Older People Page 8 of 10 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 Regular, monthly prescriptions should be seen and checked before medicines are received from the pharmacy. This makes sure a check can be made that all the medicines required have been prescribed and that any changes are recorded. Storage temperatures must be monitored in order to show that medicines are being kept at temperatures and conditions recommended by the manufacturer. Storage arrangements and facilities should be enlarged to ensure all medicines are stored securely in a way which allows staff to handle medicines safely and efficiently. Competency assessments and spot checks of practice should be carried out and recorded so that all staff are seen to be working in line with the homes procedures. The medication policy & procedures should be updated in line with current professional guidance so that staff understand how to handle and administer medicines safely in the workplace. 2 9 3 9 4 9 5 9 Care Homes for Older People Page 9 of 10 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 10 of 10 - 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!
