Random inspection report
Care homes for adults (18-65 years)
Name: Address: Elmslea 34 Dunheved Road Launceston Cornwall PL15 9JQ zero star poor service 28/08/2009 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: Helen Tworkowski Date: 1 5 0 2 2 0 1 0 Information about the care home
Name of care home: Address: Elmslea 34 Dunheved Road Launceston Cornwall PL15 9JQ 01566777661 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 Irene Stanbury,Mr Henry Stanbury care home 15 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Conditions of registration: 15 Service users to include up to 15 adults aged 18 - 65 on admission with a mental illness (MD), some of whom may have a secondary minor learning disability. Total number of service users not to exceed a maximum of 15 Date of last inspection Brief description of the care home Elmslea is registered to provide accommodation and personal care for 15 adults with a mental health needs, some of whom may have a secondary minor learning disability. The care home is situated in a quiet residential area of Launceston. The recreation park and leisure centre are nearby and the town centre amenities are a short walking distance. All the bedrooms are single, and all but one have with en suite facilities. There are various communal spaces and garden areas for residents to use. Details of 1 3 1 1 2 0 0 9 Care Homes for Adults (18-65 years) Page 2 of 17 Brief description of the care home the cost of care, and information about the home (Statement of Purpose and Service User Guide) are available from Mr and Mrs Stanbury. Care Homes for Adults (18-65 years) Page 3 of 17 What we found:
This was a random unannounced inspection, which took place over five hours on the 15 th February 2010, by Regulation Inspectors Helen Tworkowski and Gail Richardson. The purpose of the inspection was to review how the Registered Manager had addressed the Immediate Requirement made on the 10th February 2010. The Immediate Requirement was about the management of diabetes in the care home and was made to ensure that peoples needs are properly met, in accordance with good care practices and the laws regulating care homes. Because of the risk of breach of confidentiality within this report there is limited detail included, however, all supporting evidence was discussed with the Registered Manager/Providers. We spoke to two people using the service in general conversation, we spoke with the Registered Manager and feedback was given to the Registered Manager/ Provider and also the other Registered Provider. We looked at care records for one person and further documentation relating to the management of diabetes. We found that the immediate requirement had not been met and the relevant documentation was seized under Code B of the Police and Criminal Evidence Act. What the care home does well: What they could do better:
The Immediate Requirement made on the 10th February 2010 required that the Registered Manager must ensure that there is a clear and comprehensive policy and guidance to direct how diabetes will be managed, including the administration and monitoring of insulin. This had to be implemented and completed by 5pm 12th February 2010. Regulation 13 (2) of the Care Homes Regulations 2001. The Registered Manager has reviewed the supervision of insulin administration and this had been partially undertaken to support people using the service. It was also evident that whilst some supervision is now undertaken this is not consistently done with no record is maintained of why it is supervised on some occasions and not others. Further risk assessment and a clear plan of responsibility must be put in place to ensure that when insulin administration is not supervised that the systems in place are safe and
Care Homes for Adults (18-65 years) Page 4 of 17 support the people using the service. It was evident from the records of recent supervision that following the increase in supervision doses of insulin had to be varied. This was not as evident in previous records and would indicate that this increased level of supervision must be maintained. It is evident from records seen that the supervision of insulin management is not always undertaken by a person with appropriate training and ability to manage this process safely. The Registered Manager must ensure that the responsibility and role of person assuming responsibility must be clarified at all times. This is needed to ensure the safety of all people using the service. The Care plan for diabetes care which is currently in place has been reviewed and some alterations made. This document needs further review to ensure that all areas of care are included. The Registered Manager must ensure that all aspects of diabetic care are included. This includes management of exercise, dietary needs and physical care needs such as injection site rotation. The care plan in place must accurately reflect the instruction in documents also used as monitoring and medication administration records. This will prevent any confusion about the care to be provided and ensure the safety and appropriate care provided to people using the service. 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 Adults (18-65 years) Page 5 of 17 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 2 14 The Registered Provider must 01/05/2010 have a copy of a comprehensive written needs assessment of a person, before any stay Elmslea, including a trial visit. People must be confident that their needs will be known and can be met if they move to Elmslea. This requirement was made on 17/3/09 and due to be met by 1/6/09. No new people have been admitted since the last inspection the due date has therefore been extended. 2 6 15 The Registered Provider must 01/04/2010 have Care Plans that are comprehensive and include details of any goals, skills being developed or therapies used. The people at Elmslea and staff need to know what help is needed and how it should be given. This requirement was set 17/3/09 to be met by 1/6/09. It has not been met. The requirment has therefore Care Homes for Adults (18-65 years) Page 6 of 17 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 been set again. 3 9 13(4)c Risk assessments must show 01/04/2010 that the safety, independence and choice has been considered and is regularly reviewed with people living in the home. This requirement was made on 17/3/08 to be met by 30/7/08 and was not met. A further due date has been set. 4 20 13 Review medicine records and 01/05/2010 care plans for people living in the home to make sure that for all medicines prescribed with a direction when required or with a variable dose there is clear, up to date and detailed written guidance on how to reach decisions to administer the medicine and at a particular dose, taking into account the provisions of the Mental Capacity Act 2005. This will help to make sure people living in the home receive the correct amounts of medication in a consistent way in line with planned actions. This requirement was made 28/8/09 to be met by 7/11/09. It has not been met. A further date for this requirement has been set. 5 20 13 Arrangements must be made 01/04/2010
Page 7 of 17 Care Homes for Adults (18-65 years) 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 to record any verbal dose changes safely. This is to make sure that people receive their medicines safely and as the prescriber intended. This requirment was made 15/10/09 to be met by 30/11/09. It has not been met. A futher date for meeting the requirment has been set. 6 20 13 Make arrangements so that 01/04/2010 any medicine that needs refrigerated storage is always kept securely within the correct temperature range indicated by the manufacturer. Use a maximum and minimum thermometer to keep daily records of the temperature in the medicine fridge. This will help to make sure medicines are kept at the right temperature to retain their potency. This requirement was made on 28/8/09 to be met by 7/11/09. It has not been met. A further date has been set. 7 20 13 Make sure that when people living in the home look after and administer any of their medicines themselves there is a full written risk assessment process in place 01/04/2010 Care Homes for Adults (18-65 years) Page 8 of 17 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 with actions taken to reflect best practice guidance and to make sure this is safe for everyone in the home. Make accurate and compete records when medicines are given to people to look after, as well as regular checks that they are using their medication correctly. This to help make sure that people are taking the correct amounts of medication and that the arrangements are safe for everyone in the home. A similar requirement was made on 18/3/09 to be met by 1/6/09. It was not met. This requirement was made 28/8/09 to be met by 7/11/09. It has not been met a further date has been set. 8 20 13 For each person living in this 01/04/2010 home you must always keep accurate, clear and complete records for all medicines received, administered and disposed of. This is to help make sure all medicines are accounted for, that people receive their prescribed medication correctly and are not at risk of mistakes with medication because of poor recording arrangements. This requirement was made
Care Homes for Adults (18-65 years) Page 9 of 17 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 27/8/09 to be met by 31/8/09, it has not been meet and a new due date has been set. 9 20 18 Make sure that any staff who 01/05/2010 administer or deal with medication for people who live at this home have completed and passed a proper formal course about the safe handling of medicines are assessed as competent to handle medication. This will help to make sure that staff are competent to manage medication safely and people living in the home are not at unnecessary risk from mistakes with their medicines. This requirement was made on 28/8/09 to be met by 30/11/09. It has not been met. A further due date has been set. 10 20 13 Make sure and demonstrate 01/05/2010 that all the arrangements for recording, handling, safekeeping, safe administration and disposal of medicines received into the care home are safe for everyone in the home by having clear, safe procedures in place that follow accepted best practice guidance and with robust checking and auditing at a frequency to
Page 10 of 17 Care Homes for Adults (18-65 years) 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 demonstrate that people are consistently having their medication correctly and all medicines are accounted for. This is to help make sure that people living in the home receive the correct levels of medication and are not put at unnecessary risk because of poor practices or recording. This requirement was made 28/8/09 to be met by 7/11/09. It has not been met. A further date has been set. 11 20 13 Make arrangements to have in place effective stock control arrangements for medication so that all medicines are always within their expiry date, only those medicines in current use for people in the home are kept and that all medicines can always be accounted for. This will help to make sure that all medication can be accounted for and that people in the home at not at risk of receiving the wrong medicines or medication that is out of date. This requirement was made on 28/8/09 to be met by 7/11/09. It has not been met. A further date has been set.
Care Homes for Adults (18-65 years) Page 11 of 17 01/04/2010 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 12 34 18 The Registered Provider must 01/06/2010 have a suitable system for the recruitment of staff, including receiving two appropriate written references, and a POVA check, prior to working in a supervised capacity. A CRB check must be completed before any person may work unsupervised. Only people who are suited to the work may be employed in care homes. (This requirement was made on 18/3/09 to be met by 1/6/09. No new staff have been recruited to the home, and as such the requirement has not been met, the due date has therefore been extended) 13 34 19 The Registered must ensure 01/06/2010 that arrangements are in place to ensure that they have obtained the necessary information, as specified in the regulations, for all new volunteers, before they start work at the home. This is to ensure only people suited to the work, volunteer. This requirement was made 30/9/09, due by 7/11/09. No new volunteers have started work, the due date has therefore been extended. Care Homes for Adults (18-65 years) Page 12 of 17 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 14 34 19 The Registered Providers 01/05/2010 must put in place arrangements to ensure that when staff are employed at the home with a POVA First check that they are appropriately supervised in accordance with the regulations, until a CRB clearance is received by the home. This is to ensure that people are supervised until all the relevant checks have been completed. A similar requirement to this was also made on 18/3/09 due 1/6/09, and not met. This requirement was again made on 28/8/09, due by 7/11/09. No new staff have been recruited, the due date has therefore been extended. 15 35 18 New staff must be provided with a comprehensive, structured induction to the work. New staff need to be made aware of their role, and good practice. This requirement was made on 28/8/09 to be met by 7/11/09. No new staff have been appointed, therefore a new date has been set. 01/06/2010 16 38 12 The Registered Providers 01/04/2010 must ensure that the home is managed in a manner that
Page 13 of 17 Care Homes for Adults (18-65 years) 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 respects the rights of individuals and provides them with the support they need. People who live in care homes must be treated with respect. This requirement was made on 15/9/09 to be met by 7/11/09. It has not been met, the due date has therefore been extended. 17 38 12 The Registered Provider must 01/04/2010 act in a professional manner and facilitate contact with health and social care professionals. Recording must be done in a professional manner. This is so that the people who live at Elmslea can receive the services to which they are entitled. This requirement was made 18/3/09 to be met by 1/6/09, and again on 30/009/09 due by 31/10/09. It was not met, and a new due date has been set of 1/4/10. Care Homes for Adults (18-65 years) Page 14 of 17 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 19 12 There must be a robust system in place to manage the health care needs of people who live at Elmslea, in line with good practice, supported by relevant policies, procedures and good practice guidance. This is to ensure that the people at Elmslea benfit from having their health care needs met. 26/04/2010 2 19 12 There must be systems in 26/04/2010 place in the home to ensure that diabetes conditions are adequately managed. This is to ensure that the people at Elmslea benfit from having their health care needs met. Care Homes for Adults (18-65 years) Page 15 of 17 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 Care Homes for Adults (18-65 years) Page 16 of 17 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 Adults (18-65 years) 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 Adults (18-65 years) Page 17 of 17 - 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!
