Inspection on 08/06/10 for Crown Meadow Care Centre

This inspection was carried out on 8th June 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Crown Meadow Care Centre 18/03/10

Crown Meadow Care Centre 09/04/09

Crown Meadow Care Centre 24/05/07

Crown Meadow Care Centre 25/09/06

Crown Meadow Care Centre 27/02/06

Crown Meadow Care Centre 29/07/05

Crown Meadow Care Centre 16/11/04

Crown Meadow Care Centre 26/05/04

Crown Meadow Care Centre 11/02/04

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: Crown Meadow Care Centre Bayleys Bridge Tipton West Midlands DY4 0HB zero star poor service 18/03/2010 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: Morag Ross Date: 0 8 0 6 2 0 1 0 Information about the care home Name of care home: Address: Crown Meadow Care Centre Bayleys Bridge Tipton West Midlands DY4 0HB 01215200700 01215578279 Telephone number: Fax number: Email address: Provider web address: www.schealthcare.co.uk Name of registered provider(s): Name of registered manager (if applicable) Southern Cross Care Centres Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 35 Number of places (if applicable): Under 65 Over 65 35 old age, not falling within any other category Conditions of registration: 0 The maximum number of service users who can be accommodated is: 35 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) 35 Date of last inspection Brief description of the care home Crown Meadow Nursing Home provides nursing care for up to 35 people who are over 65 years of age. The home is situated on a main road close to Great Bridge, Tipton and other local shops and amenities. The property is a purpose built three-storey building Care Homes for Older People Page 2 of 12 1 8 0 3 2 0 1 0 Brief description of the care home with parking to the front and garden at the rear of the property with patio and seating that can be used when the weather permits. The home consists of 31 bedrooms, there are some shared bedrooms as well as single occupancy and all have en-suite facilities. There is a large lounge/dining room on the ground floor fronted by a conservatory, which forms the entrance of the home plus a small quiet lounge on the first floor. Bedrooms are located on all floors and there is a hairdressing salon and staff room on the second floor. There are two passenger lifts giving access to all areas of the home and there is one assisted bathroom that is suitable for people with mobility problems on each floor; showers are also available in most bedroom en-suites. Information in the form of a welcome pack and service user guide were available in the reception area, so people had access to information about the services and facilities availaable in the home. The notice advised people to ask for a copy of our latest inspection report if they wished to see it. The information available did not include the range of fees and people will need to discuss this with the manager at the time of making enquiries. Care Homes for Older People Page 3 of 12 What we found: We sent the service a warning letter dated 28th April 2010 relating to concerns with the safe handling of medicines. We received an action plan from the service dated 28th May 2010, which stated that action had been taken to improve these issues. A visit was made to the service by the Head of Medicine Management from Sandwell Primary Care Trust (PCT) on 1st June 2010. We were sent a copy of this report. It was of concern that the general outcome from this visit stated that There are a number of issues that have not yet been fully addressed from previous visits by the PCT medicines management team and other agencies. The pharmacist inspector from CQC visited the home on 8th June 2010 in order to check that the service had undertaken improvements in medicine management and to check compliance with the requirements that had been issued at the previous inspection. The outcome of this visit showed that there continued to be several issues that had not been fully addressed despite written assurance that action had been taken. We looked at medication storage, some care records and medication administration records. We spoke to two members of staff and the relief manager. We looked at the Medication Administration Record (MAR) charts, which were printed by the pharmacy and found that staff signatures were recorded for the administration of medicines. However, we found that some of the medicine records were confusing particularly when codes were documented onto the MAR charts with no reason documented to explain what they meant. We found two examples of poor recording on the MAR charts. We saw that one person had recently been prescribed two creams. One cream was prescribed to be applied three times a day. There was no information recorded on the MAR chart to inform staff where to apply the cream. We saw that the MAR chart was only signed twice a day and that a code F had been recorded on two occasions. The code F is defined as other on the MAR chart, however this had not been completed by staff and therefore it was not clear what the code F meant. One member of staff told us that the code F was used when a carer applied the cream and not a nurse. We were told that a separate form was used by care staff to record application of creams. There was no evidence of a form for this person and there was no recorded evidence that care staff were applying the cream. A second member of staff told us that the code F was used when the person applied the creams to themselves. We saw no recorded evidence that the person was applying the cream to themselves. We looked at the MAR chart for a second person who was prescribed three inhalers. We saw that the code F was documented for every administration, however the reason was not documented on the MAR chart. We were told by a member of staff that the code F meant that the person looked after the medicines themselves. We saw no recorded evidence that the person looked after their medicines. We discussed these findings with the relief manager who could not give an explanation for these records. This means that the records were not clear and it was not possible to determine if prescribed medicines were being given as prescribed by the GP. Medicines were not always given to people as prescribed. For example, we found that two people had not been given their prescribed medicines in accordance with the directions of a GP. The first person was prescribed a short course of antibiotics to treat an infection. We checked the MAR chart and found that the medicine had not been given according to Care Homes for Older People Page 4 of 12 the stated directions. When we checked the amount of capsules remaining they did not match the amount recorded on the MAR chart that were recorded as given. This means that the person had not been given their antibiotics correctly. The second person was prescribed a pain relieving medicine to be given every three days. We found recorded evidence to show that on one occasion the person had their medicine after four days and not the prescribed three days, which means that they had not had their prescribed medicine for pain relief for one day. This means that people were at risk of harm and their health and welfare needs were not being met. Changes made to medicines were not clearly recorded on the MAR charts. For example, we saw that a recent change in the dose of one persons medicine had not been clearly recorded. The new dose had been written over the top of the original dose. It was untidy, confusing and not clear. It was of concern because the medicine record had been altered and the original dose had been deleted. This means that the records had been altered and did not show what dose had been given to the person prior to the new dose change. The change had been countersigned by two staff. We discussed this issue with the relief manager who agreed that the changed dose was unclear and demonstrated poor practice. This means that the person was at an increased risk of being given an incorrect dose of medicine and therefore was at an increased risk of harm. The storage temperatures of medicines were not being monitored regularly and we saw records of temperatures above 25 degrees C. The room tempertaure should be maintained below 25 degrees C to ensure the stability of medicines. This had been identified as an immediate risk by the Head of Medicine Management from Sandwell Primary Care Trust on 1st June 2010 and had requested immediate action to be taken within 24 hours. This had not been done. We looked at the June 2010 temperature records and saw that the room temperature was recorded at 27 degrees C for four days. No action had been taken to ensure the temperature was below 25 degrees C. We saw an air conditioning unit was present in the room, however it was not plugged in. We were told by one member of staff that it was not their responsibility and it had not been on when they arrived. This means that medication was not stored within the recommended temperature ranges and were at an increased risk of deterioration making the medicine ineffective and possibly harmful to the people they are being given to. Medicines were not always stored according to the manufacturers guidelines or according to the directions on the medicine label.For example, we saw that eye drops for two people were stored in a cupboard, however they should have been stored in a refrigerator until opened. The pharmacy label attached to the two bottles stated Store in a refrigerator only until first opening. After first opening store below 25 degrees C. This had not been done. The room temperature was also above 25 degrees C which greatly increased the risk of deterioration of the medicine. This means that the eye drops were at an increased risk of being ineffective and possibly harmful to the people they were prescribed for. Personal care plans were not kept up to date with information relating to peoples medication. We looked at four individual care plans with the relief manager in order to check what records were available relating to peoples medicines. Two people were prescribed eye drops, however there was no information in their care plans relating to any problems with their vision or any record of the prescribed eye drops. One person was prescribed a pain killer. We found a care plan for pain but there was no information about the type of pain or severity. There was no record of the pain killer recorded in the care Care Homes for Older People Page 5 of 12 plan. One person had recently been prescribed a tablet for an allergy to be given when required. We looked at the care plan, however there was no recorded information about the medicine or why it was necessary.This means that the care plans were not kept up to date with regard to peoples medication which increases the risk to their health and welfare. We gave full feedback to the relief manager. We explained that the requirements relating to medication management had not been met. We explained the shortfalls identified in this random inspection and that we were concerned about the control and handling of medicines in the service depite assurances that action had been taken. We explained that people continued to be at risk of harm. We explained that the evidence taken from this inspection would be examined with a view to further enforcement action being taken against the service. We visited the home on 17 June 2010 to assess its compliance with three outstanding requirement from March 2009 key inspection and the eighteen requirements made at the key inspection of March 2010. One of the outstanding medication requirements from the July 2009 key inspection had been met. Five of the requirements from the key inspection of March 2010 had been met, twelve requirements had not been met and one was not due to be checked till July 2010. We had issued a statutory requirement notice in relation to medication management, needs assessment and recruitment. A Statutory Requirement notice is the first stage in our enforcement action. We also sent the home a warning letter in relation to poor record keeping and care planning which had led to needs not being recognised by staff at the home and therefore not being met. We also have specific concerns about how the home is meeting peoples nutritional and hydration needs which again relates to poor record keeping and staff not acting in a proactive manner to meet these needs. Staff rotas also did not reflect the staff on duty and at present the home has only one permanently contracted trained nurse working specifically for this home, which effects the consistency and continuity of care. We looked at how peoples nutritional needs are dealt with. We found that identified risks were not leading to referrals being made to the dietetic service by staff working in the home. We found one example where it was at the tissue viability nurse request that a dietetic referral was made despite the service user losing weight for some time and having their food and fluid intake monitored . We found that monitoring of food and fluid intake was not consistently occurring. We were not able to evidence whether snacks or drinks were being given between meals for example, between tea and breakfast next morning. We found recordings in the daily information sheets stating people had eaten and drunk well, when the recorded fluid intake for the day was just above one litre. It is recommended that two litres of fluid should be consumed per day unless otherwise instructed by a persons medication practitioner. Without accurate information the service cannot demonstrate that it meets the nutritional and hydration needs of someone identified as being at risk. The majority of people living in the home are now offered breakfast in their bedrooms. Staff told us better as no one going too long without a meal. Breakfast was completed on the day of the visit by 10.30am. The staff rota records were also found not to be an accurate record of staff working in the home. For example: we were informed that a worker from an agency had worked the night shift but this was not reflected on the rota for the night of 16 June 2010 but the name of the permanent member of staff who did not work the shift remained on the rota. We were informed that the number of staff working in the home has increased, however Care Homes for Older People Page 6 of 12 the number of permanent staff working in the home has decreased. There is only one permanent qualified nurse currently working in the home. The organisation is seconding qualified nurses for short periods of time within the home from other homes with the group and we were informed that the service is advertising for new nursing staff. The Relief manager working in the home told us that staffing levels have been reviewed and that there are six carer and two trained nurses working in the home of a morning and five carers and one trained nurse of an afternoon. Staff told us that the new ratio was sufficient to meet people needs. We found evidence during the inspection that the home is now identifying safeguarding concerns and referring to the appropriate agency for investigation. We looked at staff recruitment and found concerns. The home had been advised by the Independent Safeguarding Authority first (ISA first) to await a full Criminal Records Bureau disclosure (CRB) they ignored this advise and commenced employment of the person in the home. Staff can be taken on to work in care homes on an ISA first whilst awaiting a CRB disclosure but only in exceptional circumstances, whilst the CRB for this particular individual show no concern, the home should not have ignored the ISA first recommendation as they were potentially placing people at risk. The key inspection report of 18 March 2010, required you to ensure all staff had training in relation to the Mental Capacity Act 2005 by 30 July 2010. The Acting Manager Terri Brindley informed us that you had a proposed date in August 2010 by which you would be in compliance with this. Whilst this does not meet the date of the requirement we will accept that you have undertaken work to meet this requirement which technically you would not have breached until 30 July 2010. There have been some improvements in care planning such as the planning for short term conditions. However, on the whole what the care plans direct staff to do and the care that is actually delivered are very different., Assessments are not taking place promptly and therefore care plans do not reflect changes in condition or needs and we have issued a Statutory Requirement notice in relation to this. An audit of pressure area care needs has taken place within the home and those identified at risk had appropriate equipment in place to meet their needs. What the care home does well: We were told by one member of staff that improvements had been made for the safe administration of medicines in the morning. The morning round of medicine administration was taking too long for one person to undertake and they had requested that two people administer medicines in the morning. This had been agreed by management and the morning medication was now undertaken by two nursing staff. We saw that two people were administering peoples medicines during the morning.This means that people were given their medicine on time. We found some improvement in care planning for short term conditions, an accident book was now available in the home as required by legislation, an audit of pressure area care has taken place and staff training is planned in the future in the Mental Capacity Act. We do however still have concerns about the homes ability to meet peoples needs on a basic level such as nutrition and hydration, assessment and planning of care needs, Care Homes for Older People Page 7 of 12 recruitment procedures and the number of permanent trained staff working in the home to provide strong clincial leadership. 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 8 of 12 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 18 17 The home must make sure 30/04/2010 that staff allowed to work in the home without a satisfactory CRB and only an ISA adult first check have a written risk assessment completed and that a copy of the risk assessment is kept in the staff members file. This will demonstrate how the home intends to protect the people living in the home when staff start work without all of the required safety checks in place. 2 18 13 The home must make sure that staff have training in relation to the Mental Capacity Act 2005 and the deprivation of liberty safeguards. This will help staff understand their role in supporting those people who do not have the capacity to make decisions for themselves. 30/07/2010 Care Homes for Older People Page 9 of 12 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 29 19 Staff must not be employed 28/07/2010 in the home if the ISA first states to await a full Criminal Records Bureau disclosure. This will promote a robust recruitement procedure to protect people living at the home. 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 1 The home needs to make sure that the details of the Care Quality Commission are correct. They should do this so people have the correct information to be able to contact the Commission if they choose to do so.(Recommendation made 18 March 2010, not looked at during this inspection) The home should source further training for staff in specialised areas such as nutrition, pressure area care and pain management. (Recommendation made 18 March 2010, not looked at during this inspection) The home should record the variable dose of medication where this is prescribed. (Recommendation made 18 March 2010, not looked at during this inspection) Page 10 of 12 2 8 3 9 Care Homes for Older People 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 4 9 Trained staff working in the home should re-familiarise themselves with the Nursing and Midwifery Council (NMC) Record Keeping document to promote and protect the health and well being of people living in the home. (Recommendation made 18 March 2010, not looked at during this inspection) All nurses working in the home should be familiarise themselves with the Nursing and Midwifery Council (NMC) Standard of Medicine Management to promote and protect the health and well being of people living in the home. (Recommendation made 18 March 2010, not looked at during this inspection) The home should have a detailed cleaning schedulre for the laundry, this should include the daily laundering of all mop heads. (Recommendation made 18 March 2010, not looked at during this inspection) When mops are not in use the home should store all mops inverted (upside down), this reductes the risk of cross contamination. (Recommendation made 18 March 2010, not looked at during this inspection) The home should keep a copy fo the induction records for new staff. They should do this so they can demonstrate new staff have been supported through the process and have received a suitable induction to social care work. (Recommendation made 18 March 2010, not looked at during this inspection) 5 9 6 26 7 26 8 30 Care Homes for Older People Page 11 of 12 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 12 of 12 - 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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