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Inspection on 02/07/09 for Elizabeth House Care Home

Also see our care home review for Elizabeth House Care Home for more information

This inspection was carried out on 2nd 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 2 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

Staff were friendly and helpful to people living in the service. Medicines in the drug trolley and new fridge are stored neatly in an orderly manner.

What the care home could do better:

This inspection has identified that further improvements could be made in medicationmanagement.

Random inspection report Care homes for older people Name: Address: Elizabeth House Care Home 2 Church Hill Avenue Mansfield Woodhouse Mansfield Nottinghamshire NG19 9JT zero star poor service 22/04/2009 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: Mathias Foundling-Miah Date: 0 2 0 7 2 0 0 9 Information about the care home Name of care home: Address: Elizabeth House Care Home 2 Church Hill Avenue Mansfield Woodhouse Mansfield Nottinghamshire NG19 9JT 01623657368 01623631720 d.ramnarain@btinternet.com RAMNARAIN9@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Vijay Ramnarain,Surendra Dev Lutchia,Mr Vivek Obheegadoo care home 16 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 16 old age, not falling within any other category Conditions of registration: Date of last inspection Brief description of the care home 0 2 2 0 4 2 0 0 9 Elizabeth House is a care home providing personal care and accommodation for 16 older people. The home is located in Mansfield Woodhouse, in a quiet residential area and close to shops, pubs, the post office and other amenities. The home is an older style domestic property with a more recent two-floor extension. There are 14 single, and 1 double bedroom, which are located on both floors and there is a passenger lift. There are a variety of lounge areas. There is a garden that is only accessible people who have good mobility. There is limited car parking available on the homes driveway and further parking is available on the street. The manager told us on the day of the inspection that the current range of fees are between £1,420 to £1,460 per month. Care Homes for Older People Page 2 of 12 Brief description of the care home There are additional costs for newspapers, chiropody and taxis. Care Homes for Older People Page 3 of 12 What we found: The reason for this inspection was to assess compliance with the following three requirements previously made, including concerns evidenced during a visit by Lynda Dyer (Regulation Inspector) on a Key Inspection on 22nd April 2009. The pharmacist Inspection visit on 2nd July 2007 involved examination of medicines and the storage facilities, medicine charts, records and we case tracked three people living in the service. Discussions took place with two senior carers on duty during the time of the inspection. Feedback was provided and the outcome of this inspection is as follows: If a change is made to the Medication Administration Record (MAR chart) then the reason for the change must be recorded, dated and signed. This will ensure people receive their medication as prescribed. No changes to the current medicine charts had been found. However both senior care staff was able to correctly explain the procedure of recording this in the care plan, in the handover sheet, to double sign, to date and if necessary seek advice from the manager. This indicates that this requirement has been met. Prescribed medicines,including inhalers must be administered as prescribed by their GP. To ensure peoples healthcare needs are met. A sample check was made on a persons inhalers. The number of signatures on the medication chart and the number of doses administered indicated by a counter on the inhaler correlated. This indicates that medicines are administered and staff followed instructions as the doctor prescribed. This requirement has been met. Staff must not sign the MAR until the medication has been administered to the person for which it is prescribed. This will ensure people receive their medicines safely. During the Inspection period the next medicines round was not due. However both senior care staff on duty correctly explained and were fully aware of the procedure to sign the medicine charts immediately after each medication has been administered. The sample medicine charts examined were signed for the lunch-time medication, the balance of medication remaining was found to be correct, which indicates that this requirement has been met. The sample checks undertaken indicated that the medicines are administered and staff followed instructions as the doctor prescribed.However we found on the medicine charts details of different eye drops for administration but they did not state for which eye. The care plan stated which eye and the staff were aware. Some of the medicine cassettes received had the weekly strips incorrectly placed for example starting on the wrong day of the week. The staff were informed to liaise with their supplying pharmacist and to inform the pharmacy soon as the weekly strips on the cassettes are not correct. Sample medication charts indicated medicines received and administered were signed. However this was sometimes difficult to track as medication, which is carried forward from previous stocks of medicines including nutritional supplements were not recorded. Staff do not always put their medication policy and procedure properly into practice. We found some lactulose received and signed in as 560ml as printed on the medicine chart when the actual supply received into the home was 500ml. We found a notice of the procedure if a drug error occurs. However this does not detail the current contact details of the Commission. This recommendation was made during the last Key Inspection report. Care Homes for Older People Page 4 of 12 We found the staff were not aware that when incidents occurred that Regulation 37 notification to be completed and then sent to the Commission. We found that the staff were not aware of the findings of the last Key Inspections report and the requirements that were made. There is evidence in the care plan of health treatment and intervention, and a record of general health care information. We viewed one care plan which has now been amended and updated. Staff have recorded and checked blood pressure on a monthly basis.The care plan states that the district nurses monitor blood sugar levels.There was an action plan what to give the person for example cakes/sweets; to record and report concerns to the GP. There was written directions for action to take when there is high blood sugar or low blood sugar but there was a gap in the information for example no indication to recognise symptoms of hyper or hypoglycaemia. Care staff were unable to recognise a change in conditions or event when blood sugar becomes very low or high to enable staff to follow the action plan and report concerns to the GP. We were informed that the controlled drugs cabinet was due to be made by DIY using metal sheeting. We informed the staff of this unsuitability as this needs to meet compliance with the statutory requirements and the controlled drugs cabinet meets the requirements of The Misuse of Drugs (Safe Custody) Regulations 1973 and either meet or exceed testing to BS 2881. Care staff on duty are undergoing a medication management distance learning course. However the staff were not aware and incorrectly stated the correct temperature range that medicines must be stored requiring refrigeration. The fridge contained a cream which was correctly stored in the fridge however a pack of injections should be stored at room temperature as stated by the manufacturers. During the inspection we found a carton of nutritional supplement which was administered to a person living in the service, but no recordings or details made in any records. We found other cartons of nutritional supplements which are usually prescribed by the GP however the cartons had no dispensing label and the staff were unclear as to whether the home has purchased these. We were informed by staff that this person living in the service have their food blended and they have problems chewing. However although this person had recently returned from the hospital with a loss of weight, staff could not provide and were not aware of any evidence of further appropriate action or intervention planned for example visits to be made by a health professional. There is evidence of medicinal creams that are kept in a persons room, however there was no lockable unit provided to ensure that the medicines are safely stored away.The unsecure storage of medicines places the health and welfare of people living in the service at risk. What the care home does well: What they could do better: This inspection has identified that further improvements could be made in medication Care Homes for Older People Page 5 of 12 management. 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 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 1 5 The homes service user guide must be up to date with regard to the current fees and how to contact the Commission. To ensure people have up to date information. 01/07/2009 2 7 15 People living in the home and 01/09/2009 their representative, if appropriate, must be involved in the reviews of their care plan and signatures obtained to give evidence of this. This will ensure people have their care delivered the way they want. 3 9 13 The home must have in place 01/09/2009 a metal storage facility for controlled drugs, which meets the requirements of the misuse of drugs regulations 1973. This will safeguard the health and welfare of people living in the home. 4 9 13 A Controlled Drugs register, with bound, numbered pages, must be provided for the secure recording of any Controlled Drugs. 01/09/2009 Care Homes for Older People Page 7 of 12 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 This will ensure any controlled medicines used by the home will be managed safely. 5 10 12 People living in the home 01/07/2009 must not be given meals that are mashed or liquidised unless this has been advised by their GP or a dietitian and is recorded in their care plan. This will help to maintain peoples dignity and choice. 6 16 22 The homes complaints procedure must have up to date details of how to contact the Commission. This will ensure people know how to contact the Commission. 7 19 23 The large window in the bedroom already identified must be assessed and repairs made if identified. The ensure it is of sound construction. 8 27 18 There must be sufficient 01/07/2009 suitable and competent staff on duty at all times to meet the needs of people living in the home. This will ensure the assessed needs of the people living in the home will be met. 9 27 18 The manager must supply 01/07/2009 Page 8 of 12 18/06/2009 01/08/2009 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 the commission with a detailed risk assessment of how they have determined the amount of staff that needs to be on duty at any time. This will show how the home intends to meet the needs of people living in the home. 10 30 18 Staff must be given training in respecting peoples choice and dignity, particularly around nutrition. This will help to ensure people living in the home have their choice and dignity respected. 11 33 24 The home must have in place 01/09/2009 a system for reviewing and improving the quality of care provided, which includes the views of people using the service. This will ensure that the home includes the views of people who use the service and can measure how well it is being run. 12 38 13 A sling must be available for staff to use that is the correct size for the service user it is intended. To ensure the health and safety of that person is maintained. 01/06/2009 01/09/2009 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 9 13 There must be arrangements 01/09/2009 for the safe and secure storage of medicines in the rooms of people living in the service at all times To safeguard the health and welfare of people living in the home The home to take prompt 01/09/2009 action to meet peoples changing nutritional needs. To safeguard the health and welfare of people living in the home 2 9 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 13 To action that nutritional supplements should be recorded and dated so there is a clear audit trail of all supplements held at the service and they can be accounted for at all times. To contact the pharmacy to review medicine cassettes with Page 10 of 12 2 13 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 incorrect weekly strips to ensure this is aligned with the medicine charts and to action any differing quantities of medicines received into the home or ambiguous directions not in line with the prescription or medicine charts. 3 4 13 13 To action that staff are made aware of the symptoms of excessively high or low blood sugar levels. To action that staff are be made aware of the accepted temperature range of medicines to be stored in the fridge and medicines stored at room temperature. The policies and procedures relating to the handling of medication should be reviewed and updated in line with the findings identified with this inspection. To consider the guidance from the Royal Pharmaceutical Society document The Handling of medicines in Social Care settings published 2007. 5 13 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. 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