Inspection on 21/07/09 for Down House Residential Care Home

This inspection was carried out on 21st July 2009.

CQC found this care home to be providing an Poor 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Down House Residential Care Home 28/04/09

Down House Residential Care Home 29/05/08

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Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Random inspection report Care homes for older people Name: Address: Down House Residential Care Home Alum Bay New Road Totland Isle Of Wight PO39 0ES zero star poor service 28/04/2009 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: Annie Kentfield Date: 2 1 0 7 2 0 0 9 Information about the care home Name of care home: Address: Down House Residential Care Home Alum Bay New Road Totland Isle Of Wight PO39 0ES 01983752730 01983753624 clacktmc@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Trina Marie Clack care home 17 Number of places (if applicable): Under 65 Over 65 0 17 0 dementia old age, not falling within any other category physical disability Conditions of registration: 17 0 17 The maximum number of service users to be accommodated is 17. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Old age, not falling within any other category (OP) Physical disability (PD). Date of last inspection Brief description of the care home Down House offers residential care for up to 17 older people. The new owner of Down House took over the home in December 2007. The home is a period property set in spacious grounds and provides bedrooms on the ground and first floors with a passenger lift to access the first floor. The home has two small sitting rooms and a Care Homes for Older People Page 2 of 13 2 8 0 4 2 0 0 9 Brief description of the care home dining room that has recently been extended and refurbished. Residents have access to a sunny garden area with seating and tables. The fees vary according to the care provided with additional charges for chiropody and hairdressing. Other additional charges are listed in the service user guide. Care Homes for Older People Page 3 of 13 What we found: The reason for this inspection was to assess compliance with the statutory requirement notice dated 2 July 2009. You were required by 15 July 2009 to: 1. Have a system in place to ensure that medication is administered to the service users from the original labeled container. 2. Ensure that all controlled medication kept in the home for service users is stored in a suitable cabinet that meets the requirements of the Misuse of Drugs (Safe Custody) Regulations 1973 (as amended). 3. Have a system in place at the Home that will ensure that there is a clear documented audit trail of all medicines received into the Home, and administered to service users. 4. Have a system in place to ensure that all unused medicines are returned to the pharmacy and that a record is maintained. 5. Have a system in place to ensure that when PRN medicines are prescribed for a service user, that there is an individual plan for each service user in respect of the use of these medicines. 6. Have a system in place to ensure that handwritten alterations to the medication record sheets are witnessed and signed by two members of staff who are qualified to do so. At this inspection the handling of medicines was assessed by a Commission specialist pharmacist inspector. We looked at the medication administration record charts and medicines for 5 people living in the home and at the care plans for 4 of these people. We were not able to see any medicines being given to people and so we asked the senior carer on duty to describe to us how this is done. She described a safe and appropriate procedure where the new drug trolley is wheeled around the home and the medicines are given to people directly from the containers supplied by the pharmacy. A cupboard was available which meets the legal requirements for storing medicines liable to abuse, called Controlled Drugs. There were no Controlled Drugs in the home when we visited on this occasion. The Controlled Drugs that were no longer needed had been returned to the pharmacy for safe destruction. A record of their return was kept in the homes returns log. The home had an audit trail of medicines received into the home, given to people and returned to the pharmacy for disposal. All the records we looked at recorded the receipt of medicines into the home, There were no gaps on the current medication administration record charts, started on 6 July 2009. Records were being kept of medicines returned to the pharmacy. We looked at a sample of medicines supplies in the home and the amount gone matched the amount recorded as given to people in the home. Care Homes for Older People Page 4 of 13 Of the five peoples records we looked at four of them had medicines prescribed to be given only when needed. All but one of the medicines prescribed to be given only when needed had a care plan. However the care plans did not describe how staff were to decide when people would need their medicines. This means that these people may not be being given their medicines when they need them or they may be being given medicines that they do not need. When handwritten additions or alterations were made to the medication administration charts they were not always being signed and checked for accuracy by a second person. The entries on one persons chart had been signed and checked but the charts for two other people had not. We checked one of these charts against the instructions on the dispensed medicines labels and the chart had been written correctly. However it is accepted best practice for care providers to have any alteration made on the medication administration record charts checked for accuracy so as to reduce the chance of a mistake being made. Whilst action had been taken to meet the requirement it has not been met. You were required by 15th July 2009 to: 1. Ensure that there is a system in place for ensuring that any identified risks to service users are included in their care plans. 2. Ensure that where a risk has been identified, there is a clear action plan in place which will provide staff with the guidance they require to ensure that the risk to the service user is minimised or eliminated. We looked at the care plans for three people living in the home and spoke to two senior members of staff. Two of the people whose care plans we looked at during the last inspection in April 2009 have since moved from the home. One care plan identified that a resident requires assistance from one carer with bathing and washing but does not provide any details for care staff on how the resident prefers support to be provided. The risk assessment dated 22/5/09 identifies some of the potential risks to the resident from bathing and the use of the hoist but does not identify the level of risk to the resident. The care plan does not record how often the resident likes to have a bath. The daily records of care record the last bath for this resident on 11/5/09 although a member of staff told us that they thought that this person had received a bath each week. A member of staff told us that the resident receives a strip wash each day, however, the daily records of care do not record whether personal care was provided or not. The care plan records that the resident requires assistance with continence promotion but there is no continence care plan in the records for this resident. The care plan identifies that the resident should be weighed each month but there are only two records of weight checks on 10/3/09 and 16/4/09. There is no evidence that a recorded weight loss has been followed up or monitored because there is no evidence in the daily records of care. The daily records of care report that the resident has been found wandering at inappropriate times but the care plan does not provide any evidence of an assessment of this behaviour and there is no risk assessment in the care plan to guide staff on how the risk of wandering is to managed to ensure the resident is safe at all times. Another care plan has had a note added on 29/5/09 to say that all food is to be liquidized until further notice. However, there is no other information in the care plan as to why this Care Homes for Older People Page 5 of 13 has been recorded and there is no evidence of a nutritional or specialist assessment that records how the risks will be managed or minimised for this resident. The risk assessment for this resident dated 3/4/09 advises care staff that they must ensure a good food and fluid intake and for this to be monitored. The risk assessment does not record food needing to be liquidised and there are no records of food and fluid input and output being monitored. For example, the daily record for 13/7/09 says poor fluid intake this pm but does not record the exact amounts or what action was taken to ensure the resident had the right amounts of fluid they needed. The care plan for another resident includes a risk assessment for the management of continence and continence equipment. The risk assessment does not record the level of potential risk to this resident. The risk assessment records that personal care to maintain good hygiene must be provided twice daily. However, there is nothing recorded in the daily records of care to confirm that hygiene care has been given. This means that the resident may be at risk from poor nutrition and hydration. Where residents have been prescribed medicines to be given as and when required there was no medication care plan included in the service user plan of care. This means that staff do not have clear guidance on how the medicine should be given and residents may not receive their medication when they need it. We spoke to two members of staff and asked how the daily records of care are checked to ensure that any concerns or changes to care needs are monitored and followed up. Care staff were not sure who has responsibility for monitoring daily records. This means that residents may be at risk of their care needs not being met or care needs overlooked. With regard to ensuring that residents receive regular weight checks where this has been identified as part of their care plan; a member of staff was not sure where the weighing scales are kept and these were eventually located at the back of cloakroom cupboard on the ground floor. The records show that residents are not being regularly weighed because the records are not up to date and staff may not be aware of this part of an individual care plan. The summary of evidence demonstrates that the home has failed to ensure that all potential or identified risks to residents are included in their care plans. Where risks have been identified, the risk assessment does not provide a clear action plan for care staff with the guidance they require to ensure that risks are minimised or eliminated. Where guidance has been provided for staff on the action they must take to minimise risks, the evidence shows that staff do not always follow the guidance and the daily records of care do not record what action has been taken or the care provided. The daily records of care including bathing and weight records are not up to date. We were told that no-one in the home has specific responsibility for monitoring the daily records to ensure that concerns and changes are promptly monitored or followed up. This means that residents in the home are at risk from poor practice and their care needs are not being being met in a consistent and safe way. Residents are at risk because some of their care needs and potential risks of harm have not been identified and these care needs may be overlooked or not be met consistently because different staff may be providing care in different ways. We followed up one care plan with a visit to a resident who was in their bedroom. The daily records of care had stated a request for the residents bed to be vaxed with the carpet cleaner. We found that the bed of the resident did not have a waterproof covering Care Homes for Older People Page 6 of 13 and was badly soiled and stained and the mattress and bed base were wet. The room and the carpet did not smell pleasant. We made an immediate regulatory requirement to ensure that the resident sleeps in a suitable, clean and dry, bed and bedroom. 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 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 3 14 The needs of the residents must be assessed by a suitably qualified or trained person in consultation with the resident or their representative. Residents should only move into the home if the service is confident that they can meet all health and welfare needs and that staff in the home have the skills and expertise needed to meet the needs of residents. 30/06/2009 2 7 13(4) The registered manager 30/07/2008 must ensure that any risks to residents are identified in the care plan. The risk management plan must include clear written guidance for care staff on the action they must take to manage or eliminate any risk and what they must do to manage any event that may put a resident at risk of harm. 3 7 13 Health care needs must be 29/05/2009 identified in the individual care plan as well as any risks to residents. Page 8 of 13 Care Homes for Older People 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 Staff must have clear guidance on the action they must take to manage or eliminate any risks to residents health and well being. 4 18 13 Suitable arrangements must 30/06/2009 be made to prevent residents being harmed or suffering abuse, or being placed at risk of harm or abuse. The registered person must ensure that all staff receive suitable training to ensure they are aware of their responsibilities to protect residents from the risk of harm or abuse. 5 26 13 Suitable arrangements must 30/06/2009 be made to prevent infection, toxic conditions and the spread of infection at the care home. Residents must be protected from the risk of infection. Staff must have clear guidelines and suitable equipment to ensure practice in the home follows best practice guidance for the control of infection and maintaining a hygienic environment. 6 30 18 Staff working in the home 30/06/2009 must receive training appropriate to the work they do. Care Homes for Older People Page 9 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 Staff must be trained and competent to meet the needs of the residents in the home. 7 33 24 The registered manager 30/09/2008 must ensure that there are effective quality assurance and quality monitoring systems in place to measure how well the home is providing good outcomes for residents, and demonstrate compliance with the requirements of the Care Homes Regulations 2001 and meeting the National Minimum Standards. The service must have effective quality assurance and quality monitoring systems in place. The service must measure how well the home is providing good outcomes for residents and demonstrate compliance with the requirements of the Care Homes Regulations 2001 9 38 37 The registered person must 30/06/2009 notify the commission without delay of any event in the home that affects the safety or well being of residents. To protect the safety, health and well being of the residents. 29/05/2009 8 33 24 Care Homes for Older People Page 10 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 1 8 13 The registered person must 07/08/2009 make suitable and immediate arrangements to prevent infection, toxic conditions and the spread of infection. Residents must sleep in beds and bedrooms that are suitable, clean, dry and hygienic. 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 Have a system in place to 07/08/2009 ensure that when PRN medicines are prescribed for a resident, there is an individual plan for each resident in respect of the use of these medicines. Residents must receive their medicine when they need it and staff must have clear guidance on how and why medicines to be taken as and when required, must be dispensed. 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 Have a system in place to ensure that handwritten alterations to the medication record sheets are witnessed and signed by two members of staff who are qualified to do this. 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. Copyright © (2009) Care Quality Commission (CQC). 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