Inspection on 27/04/10 for Elmslea

This inspection was carried out on 27th April 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. 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.

Other inspections for this house

Elmslea 28/05/10

Elmslea 18/05/10

Elmslea 15/02/10

Elmslea 10/02/10

Elmslea 13/11/09

Elmslea 17/09/09

Elmslea 27/08/09

Elmslea 02/03/09

Elmslea 17/03/08

Elmslea 13/06/07

Elmslea 11/07/06

Elmslea 04/01/06

Elmslea 22/06/05

Elmslea 22/09/04

Elmslea 23/06/04

Elmslea 19/05/04

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Bolealler House

Claremont Nursing Home

Althea Park House

Extracts from inspection reports are licensed from CQC, this page was updated on 29/06/2010.

Random inspection report Care homes for adults (18-65 years) Name: Address: Elmslea 34 Dunheved Road Launceston Cornwall PL15 9JQ zero star poor service 11/02/2010 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: Helen Tworkowski Date: 2 7 0 4 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): Name of registered manager (if applicable) Mrs Irene Stanbury,Mr Henry Stanbury Type of registration: Number of places registered: Conditions of registration: Category(ies) : 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 Care Homes for Adults (18-65 years) Page 2 of 17 1 1 0 2 2 0 1 0 Brief description of the care home 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 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 inspection was carried out between 10.30 a.m. and 3.30 p.m. on 27th April 10. The inspection was carried out by three inspectors: Brendan Hannon, Gail Richardson, and Helen Tworkowski. The main purpose of this visit was to follow up a Statutory Requirement Notice, which had required Mr and Mrs Stanbury to ensure that there was a safe system in place to manage the health care needs of people who live at Elmslea, in line with good practice, and supported by relevant policies, procedures and guidance. Also that there must be safe systems in place in the home to ensure that diabetic conditions are adequately managed. In addition we had been informed that a new member of staff had been recruited to work in the home, and we wished to check the recruitment procedures which had been the subject of a previous Statutory Requirement Notice. We found that two new staff had been recruited and that there was evidence that a full employment history had been obtained, prior to the individuals starting work. In addition two written references had been obtained, and checks had been made in relation to each persons criminal record and of lists of people not suited to work with vulnerable people. We looked at the way in which medication was managed, and the checks made to monitor medication given to a person who self medicates. We found that whilst there was some records of medication being given to people to administer for themselves, that there was a lack of monitoring for prescribed items such as lancets or glucose testing strips. This meant that it was not possible to check how much stock of these items was held, but also whether the individual was using more or less than might be anticipated. This could be an indicator something untoward. We found that for one lot of medication, a seven day supply, had been signed as administered twice on the same day. We asked Mrs Stanbury to explain this, and she was unable to give an account of how this might have happened. We asked Mrs Stanbury about how often the disposable needle should be changed on an insulin dispensing pen. Mrs Stanbury was unsure, and therefore would be unable to advise or support someone in this area. The manufacturers guidance on the leaflet that accompanies the pen, and that was available in the home, confirmed that such disposable needles should only be used once. Repeated use of needles increases the risk of infection, blunt needles are more painful to use, the needle may become blocked and the remaining insulin may leak or be contaminated. We looked at the records that are used to monitor an individuals well being and to vary the dose of medication to be given. We found that there were occasions, since our last visit on 15th February 10 where an incorrect dose of medication had been agreed as correct for an individual to self administer. A new care plan and risk assessment had been put in place since our last inspection, for the individual whose health care needs we were considering. The self medication assessment did not clearly identify what the individual was capable of and exactly what support was needed. The form did identify that support was needed but failed to explain this further. There was a risk assessment, however this was not comprehensive, nor had it been amended or reviewed following an incident. The Care Plan was not comprehensive Care Homes for Adults (18-65 years) Page 4 of 17 and lacked detail. For example in one part of the care plan it said that weight gain or loss should be monitored. It was not clear as to who was to monitor the individuals weight, the frequency of monitoring or what the ideal weight was, and how much variance from this was acceptable. It was not clear who was responsible for particular steps in other procedures. Issues such as site rotation or needle replacement were not covered. 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 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 16 13 A proper record must be kept 31/03/2010 of how specific dietary requirements are met. So that individuals can be confident that their needs are met and monitored. 5 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. Care Homes for Adults (18-65 years) Page 7 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 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. 6 20 13 Arrangements must be made 01/04/2010 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. 7 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 27/8/09 to be met by 31/8/09, it has not been meet and a new due date has been set. 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 8 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. 9 20 13 Make sure that when people 01/04/2010 living in the home look after and administer any of their medicines themselves there is a full written risk assessment process in place 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 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 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. 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 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. Care Homes for Adults (18-65 years) Page 10 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 11 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. 12 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 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 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. 13 22 12 Complaints must be managed in an open and professional manner. The people who use or have contact with the service must be confident that any issue raised will be dealt with appropriately. 14 24 13 Risk Assessments must be 31/03/2010 completed on all opening windows above ground floor. To avoid falls and injury. 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. 16 35 18 A training plan must be drawn up and implemented to ensure that the people who provide care and support are appropriately 17/04/2010 01/06/2010 04/04/2010 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 trained and qualified to carry out their role. The people who live at Elmsea need to be supported by competent people. 17 38 12 The Registered Providers 01/04/2010 must ensure that the home is managed in a manner that 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. 18 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 Care Homes for Adults (18-65 years) Page 13 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 due date has been set of 1/4/10. 19 40 12 There must be a comprehensive and implemented set of policies to under pin and guide the operation of the home. People need to be confident that their care will be guided by good practice. 30/04/2010 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 You must ensure that there 17/05/2010 is a safe system in place to manage the health care needs of people who live at Elmslea, in line with good practice, and supported by relevant policies, procedures and guidance. There must be systems in place in the home to ensure that diabetic conditions are adequately managed. 2 20 12 You must ensure that for 17/05/2010 each person living in this 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. 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. 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