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Inspection on 17/09/09 for Elmslea

Also see our care home review for Elmslea for more information

This inspection was carried out on 17th September 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

We found that medication that had recently been received into the home, had been counted and signed as received. Where people were administering their own medication, there was a record of how much medication they had been given for the coming week, and this had again been signed. This meant that it was possible to audit and check that there was the correct amount of medication held in the home at any time. We talked with Mrs Stanbury about how she administered medication, and she confirmed that where she administered medication directly to people, rather than leaving the medication in containers for people to collect at a later time. We spoke with one of the people who lives in the home and asked them about their medication, and they confirmed that they were given it directly by Mrs Stanbury.

What the care home could do better:

When we arrived at 10.30 a.m. we found that the Medication Administration Records had not been signed for the previous evening or earlier that morning. We looked at the bubble packs of medication, and found that the medication appeared to have been administered. The medication administration records (MAR sheets) have must be signed at the time of administration of medication, by the person administering the medication. This helps to ensure that the records are always up to date and avoids errors or confusion. We looked at the homely remedies that are kept in the home. These are medicines such as paracetamol that can be taken for minor illnesses. We found that that there was a large selection of medications for various minor ailments, however many of these medicines were past there use by dates. Mrs Stanbury told us that she did not have a homely remedies policy. It is important that such a policy is in place, as it will help ensure that such medication is properly managed. We also looked at how medicines requiring regular monitoring were managed. We found that when the monitoring occurs that the change of dose is normally communicated in written form. However we found that on one occassion this had not happened and although we were told of a verbal conversation about the dose to be administered there was no written record of this conversation. Also it did not appear that the instructions given verbally had been followed. This means that the person may not receive theirmedicines as prescribed for them. We also noted during this inspection that the care plans are stored in an unlocked cupboard in the lounge. This meant that all of the people in Elmslea had access to each others records. Records are confidential to the individual and to be kept stored in a secure manner.

Random inspection report Care homes for adults (18-65 years) Name: Address: Elmslea 34 Dunheved Road Launceston Cornwall PL15 9JQ zero star poor service 02/03/2009 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 7 0 9 2 0 0 9 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 provides accommodation and personal care for up to 15 adults with a mental health needs. 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 with en suite facilities. There are various communal spaces and garden areas for residents to use. Details of the cost of care are available from Mr and Mrs Stanbury. 0 2 0 3 2 0 0 9 Care Homes for Adults (18-65 years) Page 2 of 10 What we found: This was a Random Inspection to follow up immediate requirements relating to medication, made at an earlier visit on 27th and 28th August 09. This visit started at 10.30 a.m. and ended at 1.05 p.m.. The visit was carried out by two inspectors, Brian Brown, (Regional Lead Pharmacist), and Helen Tworkowski, (Regulation Inspector). As part of this visit we looked at the way medication was administered, accounted for, and stored. This included looking at the stocks of medication held in the home and at the records kept, including the medication administration records (MAR sheets). We also talked with Mrs Stanbury about how she administers and manages medication, and with two of the people who live at the home. What the care home does well: What they could do better: When we arrived at 10.30 a.m. we found that the Medication Administration Records had not been signed for the previous evening or earlier that morning. We looked at the bubble packs of medication, and found that the medication appeared to have been administered. The medication administration records (MAR sheets) have must be signed at the time of administration of medication, by the person administering the medication. This helps to ensure that the records are always up to date and avoids errors or confusion. We looked at the homely remedies that are kept in the home. These are medicines such as paracetamol that can be taken for minor illnesses. We found that that there was a large selection of medications for various minor ailments, however many of these medicines were past there use by dates. Mrs Stanbury told us that she did not have a homely remedies policy. It is important that such a policy is in place, as it will help ensure that such medication is properly managed. We also looked at how medicines requiring regular monitoring were managed. We found that when the monitoring occurs that the change of dose is normally communicated in written form. However we found that on one occassion this had not happened and although we were told of a verbal conversation about the dose to be administered there was no written record of this conversation. Also it did not appear that the instructions given verbally had been followed. This means that the person may not receive their Care Homes for Adults (18-65 years) Page 3 of 10 medicines as prescribed for them. We also noted during this inspection that the care plans are stored in an unlocked cupboard in the lounge. This meant that all of the people in Elmslea had access to each others records. Records are confidential to the individual and to be kept stored in a secure manner. 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 4 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 1 4 The Registered Provider must 01/06/2009 have a Statement of Purpose that contains all the information that is required in the regulations and standards. A copy of this document must be sent to the Commission. The Commission and other interested parties need to know what services are provided in the home. 2 1 5 The Registered Provider must 01/06/2009 provide a Service User Guide to everyone who lives in the home. This document must contain all the elements specified in the regulations and standards. A copy must be provided to the Commission. People who live at Elmslea or who are thinking about such a move need to know what sort of service is provided. 3 2 14 The Registered Provider must 01/06/2009 have a copy of a comprehensive written needs assessment of a person, before any stay Elmslea, including a trial visit. Care Homes for Adults (18-65 years) Page 5 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 People must be confident that their needs will be known and can be met if they move to Elmslea. 4 6 15(2)b People living in the home are 30/07/2008 fully involved in the planning of their care and this is regularly reviewed with them. The Registered Provider must 01/06/2009 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. 6 7 12 The Registered Provider must 01/06/2009 ensure that any restrictions or limitations placed on people at Elmslea, are undertaken with their consent or informed by the Mental Capacity Act. People must be protected from unnecessary risk however they must not have their liberty restricted arbitrarily. 7 9 13(4)c Risk assessments must show 30/07/2008 that the safety, independence and choice has been considered and is regularly reviewed with people living in the home. Page 6 of 10 5 6 15 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 8 19 13 The Registered Provider must 01/06/2009 ensure that risk assessments are drawn up in relation to people who look after their own medication. People need to be able exercise their independence, however must also have the support they need. 9 23 12 The Registered Person must implement the Mental Capacity Act. Restrictions and limitations may only be placed on people in line with this legislation and the relevant guidance. People who live in care homes have the same rights as any other person. 01/06/2009 10 33 17 The Registered Provider must 01/06/2009 have a record of staff who are rostered to work in the home. The provider and staff must be accountable for the work they carry out. 11 33 17(2)Sch 4.7 Duty rosters must be kept to 31/05/2008 demonstrate that there is always sufficient staff in such numbers as to meet the needs of people living in the home. The Registered Provider must 01/06/2009 have a suitable system for Page 7 of 10 12 34 18 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 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. 13 38 12 The Registered Provider must 01/06/2009 act in a professional manner and facilitate contact with health and social care professionals. This is so that the people who live at Elmslea can receive the services to which they are entitled. Care Homes for Adults (18-65 years) Page 8 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 10 12 Confidential care records 30/11/2009 must be kept securely and only accessed by those who have the right to view them. People have a right to have confidential information kept in an appropriate manner. 2 20 13 (2) Arrangements must be made to record any verbal dose changes safely. This is to make sure that people receive their medicines safely and as the prescriber intended 30/11/2009 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 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 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. 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