Inspection on 27/08/09 for Elmslea

This inspection was carried out on 27th August 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 26 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 27/04/10

Elmslea 15/02/10

Elmslea 10/02/10

Elmslea 13/11/09

Elmslea 17/09/09

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

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: Elmslea 34 Dunheved Road Launceston Cornwall PL15 9JQ     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Helen Tworkowski     Date: 2 8 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 47 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought 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 The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 47 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: Mrs Irene Stanbury,Mr Henry Stanbury care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: 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 15 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 47 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was a Key Unannounced Inspection, covering all aspects of the service at Elmslea. The inspection was carried out over two days, on the 27th August 09 between 9.50 a.m. and 6.00 p.m. by Mr David Jones (Pharmacy Inspector) and Ms Helen Tworkowski (Regulatory Inspector). The second day of inspection was carried out by Mr Brendan Hannon (Enforcement Team Inspector) and Ms Helen Tworkowski on 28th August 09 between 8 a.m. and 6 p.m.. We spoke with ten of the people who live at Elmslea, issues covered included medication, daily activities, and choices and decision making. We also spoke with one of the staff. As part of this visit we looked at the way medication is managed, including the written records. We looked at the way staff are recruited, inducted, trained and supervised, as well as at the number of staff on duty. In addition we looked at the records of care, including care plans and risk assessments, as well as at the daily notes. Care Homes for Adults (18-65 years) Page 5 of 47 We sent surveys to all fifteen people who live at Elmslea, we received 4 back. We also sent them to staff who work at the home, and 5 were returned, and to professionals who have contact with the service, 2 were returned. Care Homes for Adults (18-65 years) Page 6 of 47 What the care home does well: What has improved since the last inspection? What they could do better: We found that the structures and routines that some individuals might need, were imposed on everyone living at Elmslea. People are required to get up before a set time (9 a.m.), to be in their bedroom by 9.30 p.m., to attend Chapel every Sunday, and to have meals and drinks only at set times. Whilst it is recognised that some individuals may need a degree of structure in their lives, this can be agreed with them through their care plan, the imposition of such rules and restrictions on everyone at Elmslea is unacceptable and must change. The management of medication is poor. There is no proper account of medication held in the home and administration records inaccurate and not completed in a timely manner. The practice of leaving medication in pots for individuals to help themselves to, is dangerous. We also found that procedures that must only ever be carried out on the express instruction of a medical professional, and after suitable training were being carried out, without any knowledge or agreement of the relevant professionals. The recruitment records of staff showed that proper checks had not been carried out. This means that staff who may not be suited to work in the home, may have been Care Homes for Adults (18-65 years) Page 7 of 47 employed. We were also concerned that there was no record of a comprehensive or structured induction to the work. It was of concern that Mr and Mrs Stanbury are rostered to work between 8.00 a.m. and 10.30 p.m. and are on call between 10.30 p.m. and 8.00 a.m., almost every day of the week, with virtually no breaks. We recognised that Mr and Mrs Stanbury invest great energy and demonstrate a huge commitment to the people at Elmslea. However the manner in which the home is run does not allow people their rights or give them the opportunity to develop skills or social maturity to enable them to reach their full potential. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 47 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 47 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The information provided to people who live at the home is incomplete, and could mean that people who move to the home (or their representatives) are not aware of all of the rules at Elmslea. The people who live at Elmslea cannot be confident that their needs will be known about in sufficient detail before they move, to decide if their needs can be met once they move. Evidence: We discussed the Statement of Purpose and Service User Guides with Mr and Mrs Stanbury. These are documents produced by the Registered Provider (Mr and Mrs Stanbury) that detail the sort of service provided and the facilities in the home. The Statement of Purpose is aimed at professionals, whilst the Service User Guide is aimed at people who use or might use the service. We talked with Mr and Mrs Stanbury about a number of areas in these documents where phrases such as conforming to the group ethos, strong peer group pressure to conform to its norms, and They (the people who live at Elmslea) are welcome to invite relatives or suitable friends for meals. We discussed with Mr and Mrs Stanbury that where there are reasonable expectations of behaviour or reasonable rules then these must be made explicit and Care Homes for Adults (18-65 years) Page 10 of 47 Evidence: given in writing before a person moves to the home. This is so the individual can decide if they wish to move. We talked with Mr and Mrs Stanbury about the importance of avoiding having rules that everyone is required to adhere to, when it may only be one or two individuals who have the need for such boundaries or guidance. Mr and Mrs Stanbury have supplied the Commission with amended versions of the Statement of Purpose and Service User Guide following our Key Inspection in March 09. We agreed to respond to the amended documents, this work is still outstanding. We also discussed issues with Mr and Mrs Stanbury the importance of being clear that whilst they had a role in deciding who or who could not enter their care home; this did not extend as far as deciding the suitability of friends. The Service User Guide also gives information about social outings and church attendance. These issues are considered later in the report. The Service User Guide did not include a copy of the terms and conditions of residence or a sample contract and a summary of the views of the people who live at the home. Two people have moved into the home so far during 2009. We inspected both their care files. We found that for one person not enough information had been gathered in advance of their admission. An assessment was received by the home from their commissioning Local Authority two weeks after the person had arrived in the home. Mr and Mrs Stanbury agreed that not enough information had been obtained by the home before this person was offered a place at the home. A Care Programme Approach (CPA) was developed for the second person by the NHS and was obtained by the home. Mr and Mrs Stanbury stated that it was received before this person arrived at the home. Mrs Stanbury said that she had also had had telephone conversations with involved professionals before agreeing to offer this person a place at the home. However there was insufficient information within the CPA upon which to make a decision to offer a place at the home and there also was no documentary record of the telephone conversations Mrs Stanbury said she had had regarding this persons needs, before they were admitted to the home. Care Homes for Adults (18-65 years) Page 11 of 47 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Elmslea are not always allowed to make day to day decisions in their lives. These limits on decision making are not recorded in Care Plans and have not been agreed, with individuals or their representatives. Care Plans are general and lack specific information about peoples needs and how these are to be met. Evidence: We spoke with six of the people who live at Elmslea about the day to day routines in the house, and the choices and decisions that they are able to make. All of the people we spoke to told us that unless you were unwell you had to be up by 9 a.m. every day of the week. One person described what happened when she refused to get up, and how she was made to get up. We were also told that everyone had to be in their bedroom by 9.30 p.m., and that everyone had to go to Chapel on a Sunday morning. Some of the people told us that they were happy to get up early and liked going to Chapel, however this was not the case for everyone. When we asked people about what would happen if they decided not to get up or not to go to Chapel, we were told that there was no choice, and that if you had a lie in, you got told off by Mrs Care Homes for Adults (18-65 years) Page 12 of 47 Evidence: Stanbury or one of the other residents. One person told us that they thought that there might be the option of staying up later, but everyone else we spoke with considered that you had to be in your room by 9.30 p.m. There was no evidence in Care Plans to reflect that individuals needed to be in their rooms by 9.30 p.m. Most of the people we spoke with told us that the reason for this rule as so that Mr and Mrs Stanbury could have some peace and quiet. Mr and Mrs Stanbury told us that they were unaware that there was such a rule, and thought that this rule might be coming from one of the people who lives at the home. Mr and Mrs Stanbury said that they would ensure that everyone that lives in the home would be told that there was no rule against staying up after 9.30pm and that people could stay up later than 9.30pm if they so wished. The care planning files of the 2 most recently admitted people were inspected. As previously mentioned within the Choice of Home section the information gathered about peoples needs before admission was inadequate. The care planning files inspected also showed that the homes initial written assessment was taking place some time after admission. In both cases an Assessment of Daily Living Skills was carried out approximately 2 months after they were admitted to the home. One person had had an Assessment of Mental Health approximately a week after they were admitted. In general each persons care planning information was too brief and generalised. There was little information on peoples specific aims and goals that they had decided they would try to achieve during their stay at the home. There was only limited information in peoples care plans about their care needs, behaviours and potential triggers prompting these behaviours. There was also a lack of detailed planning documenting the agreed strategies the home uses to address these behaviours and to support the persons well being and mental health. Detailed care planning will help the service to recognise and plan a service which meets each persons individual needs. We looked at the risk assesments on every persons care planning file. There was a risk assessment on each one of these files. However a number showed no evidence of review or amendment for some time. We noted that 2 showed no evidence of review for more than a year. In a similar way to care planning, risk assessments are not detailed enough to give a clearly identify the risks that may relate to each persons and the preventative measures the home will employ to manage these risks. Some comments made within these Risk Assesments are inappropriate. For example one Risk Assessment under preventative measures showed a negative relationship with other involved Care Homes for Adults (18-65 years) Page 13 of 47 Evidence: professionals by stating that there was a need to, Protect (the service user) from unwaranted, unsolicited involvement by helping agencies. In another a service user was described as, Apathetic (and) unable to retain information. Such comments and language do not show a positive approach from the service towards service users and other involved professionals. Care Homes for Adults (18-65 years) Page 14 of 47 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Elmslea have the opportunity to engage in a range of activities and occupations that they enjoy and find fulfilling. Meals are well and imaginatively cooked, with fresh ingredients. There are over rigid rules around when drinks and snacks are allowed. Evidence: All of the people we spoke with were able to explain that they had busy lives. A couple of people said that they helped Mr Henry Stanbury on the farm, or helped doing household repairs. Some of the residents are involved in the local church community, and attend coffee mornings, or take part in charitable activities. One person told us that she works at a local shop. We observed that activities were taking place in the house, some people were making childrens clothes for a charity, others were cooking or cleaning. People were occupied and purposeful. There are rosters on the wall that specify who is going to help with tasks such as washing up. As has been already Care Homes for Adults (18-65 years) Page 15 of 47 Evidence: noted, we were told that everyone goes to Chapel, on a Sunday. Some of the people we spoke with did not wish to attend Chapel, and would rather stay at home, but they had no choice. This is unacceptable, people must have the option of staying at home and spending their time in the way that they choose. We asked some of the people we spoke to about whether they felt that they enjoyed what they did, for the most part people said that they did. One person told us that he/she did not always enjoy the work, but preferred it to doing nothing. As was noted in the first section of the report the Statement of Purpose states that people can have suitable friends to visit. We spoke with one person about a friendship that she had developed, she said that she was not allowed a particular gentleman friend, although her Community Psychiatric Nurse had encouraged her to have such a friendship. One of the people at Elmslea has a dog, and another has a cat. These pets seem to be particularly valued and it was very positive to see that these animals could be accommodated within the household. The people who live at Elmslea help prepare and cook the meals, one person told us that on the previous evening she had cooked chicken in a ginger and chili sauce, with rice, followed by a rhubarb Eves pudding. Some of the produce comes from the garden, and we were told that residents are involved in going shopping. We saw some of the food that is prepared in the home and it was of a very high standard. We asked people about the times of meals and was told that the meals and drinks are at set times, and that no drinks were allowed outside these times. Residents told us that they had to be in their room by 9.30 p.m., if they wanted a drink later in the evening then they had a sink with water. No hot drinks are allowed in rooms. As has already been noted earlier in the report, breakfast is 8.00 a.m. to 9.00 a.m.. Whilst we recognize that there is a need for set meal times, it is not apparent why drinks and snacks are not available throughout the day, particularly as some individuals are working toward being more independent. Care Homes for Adults (18-65 years) Page 16 of 47 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at Elmslea have privileges such as going out, given and withdrawn, based on goals that they do no always have a choice about. Behavioural techniques are applied without a proper initial assessment, or checks and balances. There were poor arrangements in place for administering, handling and recording medication which puts people who live in this home at risk. Evidence: Many of the people who live at Elmslea are independent in managing many of the aspects of their personal care. As has already been noted restriction are being placed on the times people get up and go to bed. These restrictions are not agreed in the individual care plans, and do not appear to always benefit the individuals who live in the home. Some of the people at Elmslea should be developing the skills and competences in leading more independent lives. Such abilities are unlikely to be developed when basic decisions such as the time to you go to your room in the evening are made for you. We were told that there are trips out on Fridays and Saturdays, to various local towns. Care Homes for Adults (18-65 years) Page 17 of 47 Evidence: One person told us that Mr and Ms Stanbury like people to go out. Another person told us that if he/she behaved badly then he/she would loose his/her privileges and would be stopped from going out. Residents told us that there is a weekly register after Thursday tea. Mr Stanbury, sits at the head of the table and calls out peoples names in turn and he and the people who live at Elmslea discuss whether the individual has met their goals. We asked who set the goals, and was told that it could be the individual concerned or Mr Stanbury. The individual is then awarded points for how well they have done. One person said that his/her aim was Not to have a paddy in the week, however as he/she had had one yesterday he/she did not know whether he/she would be allowed out. The Statement of Purpose states that there is an emphasis on self-help and behaviourism, however this system of rewards and withdrawal of privileges does not reflect good practice. There is no analysis of particular behaviours or of any triggers, for example if an individual looses his or her temper, what are the circumstances in the lead up to the loss of temper, and what does the individual get out of the behaviour. Without this analysis then the application of rewards is not appropriate. On the first day of this key inspection one of our (the Care Quality Commission) Pharmacist Inspectors specifically examined some of the arrangements for the handling of medicines. We looked at some stocks and storage arrangements for medicines and various records about medication. We spoke to Mr and Mrs Stanbury and to four people living in the home about their medicines. We gave feedback about medication to Mrs Stanbury at the end of this first day. We raised concerns about medication at the last key inspection, since then the providers have informed us that they have made some changes to the way medication is managed.The pharmacy has now supplied most medicines in weekly dose packs for each person together with a printed four week medicine administration record chart. Staff support some people in the home to self medicate. We saw some assessments in place about this but these were not the proper risk assessments that are needed to make sure the arrangements are safe for everyone in the home. We found that medicines were kept in bedrooms which were not locked. The medicines were not kept locked away within the bedrooms. In one bedroom we saw there was a drawer with a lock but a key was not available and the medicines were not in the drawer. We found that medication was being potted up into small containers, prior to the time of administration, from the blister packs provided by the pharmacist. These pots are left on the work top in the kitchen for the people at Elmslea to help themselves to their medication. The people at Elmslea told us that this is how they received their Care Homes for Adults (18-65 years) Page 18 of 47 Evidence: morning and evening medication, including on the first morning of the inspection. Mrs Stanbury confirmed that she had administered medication in this manner. This is of serious concern as secondary dispensing introduces an additional unnecessary risk into medication administration. The practice of leaving medication on the counter is dangerous. This medication could be tampered with, taken in error, or taken as part of an overdose. On 2nd September we sent an urgent letter to Mr and Mrs Stanbury requiring by 9am on 4th September 2009 that medication must be administered directly from the container provided by the pharmacist, at the time of administration. Medication must be kept securely in an appropriate cupboard and not left unattended. This was a requirement at the last inspection and has not been met. In exceptional circumstances medication may be removed from the packaging in advance to allow for an individual to have their medication away from the home. We provide guidance in relation to this and is available from our website (www.cqc.org.uk). Accurate, clear and complete records about medication are very important in a care home so that people are not at risk from mistakes with their medicines because of poor recording arrangements and so that there is always a full account of the medicines the home is responsible for on behalf of the people living there. We found that the medicine administration records for people living in the home had not been signed since 24th August 2009 so there was no accurate record of medicines administered. Mrs Stanbury told us that she completes these records once each week and not at the time medicines are administered. She is therefore not following accepted best and safest practice or what was written in this homes own procedures. Records were not being kept about the medicines received into the home or disposed of so it was not possible to account for or audit the medicines that should be in the home. We explained to Mrs Stanbury that the pharmacy would generally supply a medicine disposal record book as part of the medication system supplied to the home. At 5pm on 27th August 2009 we left an immediate requirement form requiring that by 9am on 31st August 2009 for each person living in this home accurate, clear and complete records for all medicines received, administered and disposed of must be kept. We found that records of medication administration were not accurate. For example Mrs Stanbury had signed for handing over some medicines to people self medicating but these medicines were discontinued and not in the pack of medicines in the bedroom. For another person who was self medicating records were signed for two consecutive weeks (but no quantities given noted) for one tablet where the directions Care Homes for Adults (18-65 years) Page 19 of 47 Evidence: were one tablet daily for five days every three months. This indicated that a supply was given both weeks but this would not be correct. The chart did not indicate which five days in which month. For another person the medicine chart indicated one tablet to be given in the morning yet this person told us that (s)he had this about 6pm with the evening meal. For another person the time of administration of a particular tablet was not included on the medicine records. It is important for this treatment that the dose is given at the same time each day. Without proper records this would be hard to achieve particularly as this tablet could not be supplied in the weekly dose packs. Records indicated that one person only had 22 doses from a 28 dose course of antibiotics. This may be because the records were just not signed for the last part of the course but we do not know. Completing a course of antibiotics is important to make sure the infection is properly treated and reduce risks of developing antibiotic resistance. We were not clear about whether a particular capsule for one person should still be administered as the current medicine chart indicated that the medicine was not supplied as removed from the prescription. The previous months chart had Mrs Stanburys initials for every day even though the pharmacy had printed the supply as zero but Mrs Stanbury told us that she had had this capsule. As the home were not writing what was received on the records it was not possible to check this. We could not find anything in the care plan about this. This person told us (s)he was not taking this capsule.The potential use of another medicine recorded on the chart could indicate that this capsule may be needed. The duty rota indicated that Mrs Stanbury had not been on duty all day on 5th August 2009 yet medication records were initialled by her on this day. One person was applying an ointment him or her self but the medicine records did not indicate this. Medicine records contained details of some medicines where there were no initials to indicate administration. With the poor recording practices in this home we did not know if the recording was forgotten or if the medicine really was not needed. It was possibly because the medicines were no longer in use as the pharmacy had shown as 0 supplied. It is important each month when the new medicine charts are received to clarify what medicines are no longer in use and to liaise with the pharmacy to make sure the charts are up to date. Checking the prescriptions from the doctor before they are sent to the pharmacy for dispensing is another good check for any problems before the new charts are printed and medicines supplied (or not) if they have been missed. A small number of people living in the home were prescribed medication only to use when required. Records we looked at indicated these were used infrequently but in view of inaccurate recording and lack of accountability of medicines we identified at this inspection we cannot be confident that this is a true picture. Mrs Stanbury gave us Care Homes for Adults (18-65 years) Page 20 of 47 Evidence: some explanation about how she would use these medicines and told us they had not been used recently. It is important that there is clear written guidance for each person about how such a medicine is to be used to meet their identified needs. We discussed with the Mrs Stanbury straightforward ways to achieve this. Any consideration of the requirements of the Mental Capacity Act 2005 must be included. As far as we could tell all medicines needed for people in the home were in stock but with the poor records and lack of accountability of stock this was hard to judge. We were told that Mrs Stanbury generally deals with medication and Mr Stanbury sometimes. It was not clear to us what happened when or if they were not available. Mrs Stanbury has told us that she has had training in relation to the safe handling of medication, however she was unable to provide us with direct evidence that of this training. We did not see if Mr Stanbury had any recent training for handling medication. Mrs Stanbury told us that they had no training with the introduction of the new medicine packs or records but had a training manual. The manual we saw in the office was just about safe needle practice with nothing about the medication system and records. The pharmacy would generally be expected to provide this before the introduction of a new system and the PCT encourages local pharmacists to provide support to care homes. It was clear in talking to Mrs Stanbury that she did not understand about the proper use of the system and records used. In addition the providers have not accessed detailed medication guidance that we publish on our website (www.cqc.org.uk) and were not aware of guidance referred to in National Minimum Standards and published by the Royal Pharmaceutical Society of Great Britain (The Handling of Medicines in Social Care October 2007). Medicine reference books in the office were published in 1997 and 2007. There were no Patient Information Leaflets about the medicines in use. The pharmacy should be asked to provide these so that people in the home can read about their medicines if they wish to and staff dealing with medicines can understand more. The standard yellow oral anticoagulant therapy book with important information for people taking this type of medication was not available. It is really important for staff also to be aware of this information when people are taking this treatment so that they are aware of symptoms to look out for that could indicate problems with treatment control. We were concerned that records indicated (and Mrs Stanbury confirmed) that recently she had carried out a bladder washout after being shown what to do but no formal training. Invasive or specialist administration such as this is the responsibility of the primary health team and should be a properly delegated clinical task if the primary health team want a care home to carry this out. Mrs Stanbury told us that staff do no other invasive or specialist medicine administration. Care Homes for Adults (18-65 years) Page 21 of 47 Evidence: With no proper training and not accessing standard medication guidance the home is operating in isolation, this inspection revealed continued poor practices with medication and recording, even though this was raised at a previous inspection this year. With the responsibility for medication remaining virtually solely with the two providers the lack of accurate medication records is a risk to people in the home should either suddenly not be available for any reason. We were shown two locked cupboards where medicines were stored. One cupboard was organised with the current medication.The second cupboard was very full and a mess. There were medicines for one person who was no longer in the home and medicines that people were no longer prescribed.We pointed out that a number of medicines were out of date. There was also one bottle of tablets dispensed in 1984. This demonstrated poor stock control and could be a risk to people living in the home. There was a pack labelled with 28 tablets which contained 46 tablets with blisters of different batch number and expiry date indicating that packs had been merged. This is risky and poor practice. There were loose blisters of tablets and capsules and even loose capsules.There was a large box of homeopathic medicines which Mrs Stanbury said she did not use for people living in the home but only for herself and family. We told her that these medicines must be kept totally away from residents medicines and in her private part of the house.We discussed what needed to be in place should homeopathic remedies be used for people living in the home. There were a number of homely remedy type medicines including ibuprofen and aspirin. These were not suitable to keep as homely remedies as there could be interactions with prescribed medicines and potentially dangerous for one person. Mrs Stanbury told us only paracetamol and Arnica cream would be used so it was not clear to us why all these medicines were in the cupboard. We did not see any protocols about using homely remedies. Without the proper records all these medicines were totally unaccounted for and the providers are very vulnerable as they did not know what should be in the home. We advised that dates should be written on new packs of medicines when first opened and a monthly count of medicines in original packs with totals of medicines carried forward noted on the medicine charts would all provide a more accountable system. In the afternoon Mrs Stanbury told us that the pharmacy had already collected a lot of the old medicines but she had not made any records about this. This was despite us having told her in the morning that records were needed for any medicines returned. She was not aware that the pharmacy are able to provide a proper medicine disposal record book. Care Homes for Adults (18-65 years) Page 22 of 47 Evidence: The cupboards were not proper medicine cupboards so consideration should be given to improving these. An unlocked cooler was used for storing some injections that needed refrigerated storage between 2 to 8 degrees centigrade. This unit was not suitable for medicine storage as it was not secure and, as this was just a drinks cooler, did not provide the stable temperature control needed to make sure medicines do not denature and become less effective. No temperature records were kept to demonstrate checks that the right temperature was always kept. A proper locked medicines fridge and records are needed to help make sure people living in the home receive medicines that are properly stored and of the right potency. We saw some medicine procedures in the office. Some information was not up to date about the new system and was not specific about this home. It included information that was wrong. A clear medicine policy and procedures is important and should clearly set out how the providers will arrange to have medication managed safely. This information needs to be specific for this home and not simply copied from elsewhere. Care Homes for Adults (18-65 years) Page 23 of 47 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Elmslea cannot be confident that allegations of abuse will be appropriately referred to Social Services. Evidence: The home has a complaints policy, and we were told that one complaint had been received since the last inspection. Mr and Mrs Stanbury said that they met with Social Services about the issues raised and that the complaint had been resolved. We met with Mr and Mrs Stanbury a few weeks before this inspection. It became apparent in the discussions that the behaviour of one individual at Elmslea was inappropriate and abusive to other people who at the home. Mr and Mrs Stanbury said that they had sought assistance to manage this situation from professionals involved with the individual. However, Mr and Mrs Stanbury had not recognised that the abusive nature of the situation, and had not taken action to refer the matter through the Safeguarding Process. This situation had gone on for 6 months. As part of this inspection we looked at the Safeguarding Policy, this policy says that the Management of the home will investigate allegations of abuse. This is not the case, all allegations of abuse must be referred to Social Services who will decide who will carry out the investigation. Care Homes for Adults (18-65 years) Page 24 of 47 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Elmslea are provided with a high standard of accommodation, all of the bedrooms have en-suite facilities. The house is clean and well furnished and people are able to decorate their rooms in a way that suits their preferences. Evidence: We looked around most of the communal areas in the home, and were shown some of the bedrooms by the people who live in the home. The home is decorated to a high standard and the furniture is domestic in character. All areas of the home were clean, and there were no unpleasant smells. There is a well kept garden to the rear of the home. The bedrooms we saw reflected the taste and preferences of the individuals who occupied the rooms. All of the rooms have en-suite facilities. We asked people about locking their bedrooms, one person had a key but had lost it, another said she could ask for her room to be locked, and a third person had a key. Care Homes for Adults (18-65 years) Page 25 of 47 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff who work at the home are given regular support, and some training. The rota is not an accurate record of who is working in the home. We therefore cannot have confidence that there are sufficient staff in the home, particularly in the evenings. The way that staff are recruited remains poor. The people who live at Elmslea cannot be confident that they will be supported by staff fit to work at the home. Evidence: At the last inspection a requirement was made about the need to keep a rota. We found that there was now a rota in place, and this showed that Mr and Mrs Stanbury worked every day of the week, with few exceptions from 8.00 am till 10.30 pm. We were told that they also slept in every night of the week, and were therefore available to be called out every night of the week. The sleep in was not shown on the rota. One issue raised earlier in this report is that Mrs Stanbury was not rostered to work on the 5th August 09, however she has signed to say she administered medication on that day. It has already been noted that people at Elmslea have to be in their rooms by 9.30 p.m., the people who live at Elmslea say that this is because Mr and Mrs Stanbury need some peace and quiet. Given that they are shown rostered to work at this time, this is of concern. Whilst it is appreciated that Mr and Mrs Stanbury may need to have a period of peace and quiet in their lives, this must not mean that unreasonable restrictions are placed on the people who live at Elmslea. Care Homes for Adults (18-65 years) Page 26 of 47 Evidence: We looked at the way people have been recruited to work in the home since the last inspection. We found that proper checks of references and of lists of people not suited to work in the home had not been completed. Individuals had not provided a comprehensive employment history, as is required. We also found when we looked at people who had worked in the home for some time that appropriate checks had still not been completed, this included check of legal entitlement to work in the UK. All five of the staff who completed a survey said that their employer had carried out checks, such as references, before they had started work. We found that the induction procedure for one of the people who had recently started work in the home was a single sheet, and related to having seen various policies and procedures. This is not a comprehensive induction as is required. All five of the staff who returned surveys said that they had received an induction that covered everything they needed to know before they started work. We looked at the records of supervision, we found that there were records of regular staff supervisions taking place for all staff, including volunteers, in the last month or so. We spoke with one of the volunteers about her role, she described how much she got out of the work, and that she felt that the house was a home. She felt that the people at Elmslea are encouraged to do as much as possible, though choice was not always possible. We looked at the training records of staff, and whilst we found that some of the staff had received training, it was patchy. Not all staff had training in relation to Adult Protection or Safeguarding People, or in relation to Mental Health. Four of the five staff who completed a survey said that they had training that was relevant to their role, that kept them up to date with new ways of working, and gave them knowledge about health care and medication. Care Homes for Adults (18-65 years) Page 27 of 47 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Elmslea is not well managed, Mr and Mrs Stanbury are not familiar with or do not implement up to date ways of managing a care home. The current care practices do not respect peoples rights and choices. Evidence: This home is managed by Mrs Stanbury, who with Mr Stanbury, are also the Registered Providers. Mr and Mrs Stanbury have a range of experiences in the Social Care and Mental Health field. We are concerned that many of the requirements made at the previous inspection are outstanding, even though they had advised the Commission that these had been met. Throughout this report areas of poor practice have been identified. This indicates that Mr and Mrs Stanbury, in spite of their obvious commitment to Elmslea, have not kept pace with current good practice in many of the aspects of running a care home. We were provided with copies of survey forms that had been sent out to a range of professionals who have contact with the home, to relatives of people who live at the home, and to people who live at Elmslea. Copies of the responses were sent to the Care Homes for Adults (18-65 years) Page 28 of 47 Evidence: Commission. These responses indicate that everyone who completed the surveys was very satisfied with the service at the home.We were however concerned that when we sat down and spoke with the people who live in the home that whilst people told us about the many positive aspects of life at Elmslea, some individuals had issues and concerns. People told us that they were shouted at for being naughty and that everyone had to go to Chapel, whether wanted to or not. As has already been noted earlier in this report, some of the comments made by Mr and Mrs Stanbury in documents are do not facilitate professional relationships. We asked Mr Stanbury if we could see the Accident Book, he initally said that one was not available, as no accidents had ever happened in the home the whole time it had been opened. When we asked Mrs Stanbury we found that there was an accident book, however the format of the book is now out of date. We looked at the records relating to fire. There is a fire risk assessment dated 14/5/09. We saw that checks had been made of the fire system on a regular basis. Mr Stanbury told us that apart from the induction, the fire training staff received was the fire drill. We saw that the drills were carried out once per month, though it was not clear when in any month the drill was carried out. We discussed with Mr Stanbury whether this was sufficient. We were told that checks were made in relation to food hygiene. No Legionella risk assessment was available, we advised Mr Stanbury that guidance is available from the Health and Safety Executive on how to carry out a Legionella risk assessment. The Registered Manager is required to inform the Commission of a range of incidents, including any incident that adversely affects the well-being or safety of someone who lives in a care home. No notifications have been received in the last 12 months, however we have become aware of incidents, including ones involving the Police, where the Commission should have been notified. Care Homes for Adults (18-65 years) Page 29 of 47 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, Care Homes 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. People must be confident that their needs will be Care Homes for Adults (18-65 years) Page 30 of 47 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 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. The Registered Provider must 01/06/2009 Page 31 of 47 5 6 15 8 19 13 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 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. 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 the recruitment of staff, including receiving two appropriate written 01/06/2009 12 34 18 Care Homes for Adults (18-65 years) Page 32 of 47 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 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 33 of 47 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 20 13 For each person living in this 31/08/2009 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. 2 20 13 Medication must be 04/09/2009 administered directly from the container provided by the pharmacist, at the time of administration. Medication must be kept securely in an appropriate cupboard and not left unattended. This is to help make sure that medicines are always kept safely, are not tampered with and that people always receive their prescribed medication correctly and are not at risk of mistakes because of unsafe practices. Care Homes for Adults (18-65 years) Page 34 of 47 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 1 4 The Registered Provider 07/11/2009 must 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 07/11/2009 must 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 to be provided, and any rules with which they may reasonably be asked to comply. 3 2 14 The Registered Provider 07/11/2009 must have a copy of a comprehensive written needs assessment of a person before they come to stay at Elmslea, including for a trial visit. Care Homes for Adults (18-65 years) Page 35 of 47 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 People must be confident that their needs will be known and can be met if they move to Elmslea. 4 6 15 The Registered Provider must 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 do know what held is needed and how it should be given. 5 7 12 The Registered Provider must ensure that any restrictions or limitations placed on people at Elmslea are undertaken with their consent or informed by the Mental Capacity Act and are in their best interest . Such issues must be recorded in the Care Plan. This includes getting up and bed times. People must be protected from unnecessary risk howeverthey must not have their liberty and choices restricted arbitarily. 6 9 13 Risk asessments must show that the safety, independence and choice has been considered and is 07/11/2009 07/11/2009 07/11/2009 Care Homes for Adults (18-65 years) Page 36 of 47 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 regualarly reviewed with people living in the home. People need to be safe and risks minimised, whilst still able to lead active and purposeful lives. 7 11 12 The people who live at Elmslea must be given the opportunity and supported to make choices. This must include choices around relationships, religious beliefs, and having snacks and drinks at times that suit their needs. People who live in a care home must be given the opportunity to make their own choices, as far as possible. 8 18 12 The use of behavioural 07/11/2009 techniques, must be based on a proper assessement. Goals must be agreed with the indivdiuals, or be in their best interests if they lack the capacity. The mangement of rewards and feedback to the indivdual must be approriate and reflect good practice. 07/11/2009 Care Homes for Adults (18-65 years) Page 37 of 47 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 If people wish to change their behaviours then they must be given appropriate support to do this. 9 19 13 Invasive procedures must only be carried out where there has been written delegation and training by the primary health care team. This is to ensure that no one is harmed by untrained people carrying out procedures that are the duty of health care practitioners. 10 20 18 Make sure that any staff who 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. 30/11/2009 20/09/2009 Care Homes for Adults (18-65 years) Page 38 of 47 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 11 20 13 Make arrangements so that 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. 07/11/2009 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 is particularly to address the issues raised in the report.) 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. 07/11/2009 Care Homes for Adults (18-65 years) Page 39 of 47 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 13 20 13 Make sure that when people 07/11/2009 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 that the arrangements are safe for everyone in the home. 14 20 13 Make sure and demonstrate 07/11/2009 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 Care Homes for Adults (18-65 years) Page 40 of 47 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 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. 15 20 13 Review medicine records 07/11/2009 and 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. 16 23 13 Any allegation of abuse must be referred to the Social Services, the homes 31/10/2009 Care Homes for Adults (18-65 years) Page 41 of 47 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 policy must reflect this strategy. Elmsleas safeguarding policy must recognise Social Services lead role in coordinating any investigation of alleged abuse. Vulnerable people must be protected and any allegations appropriately investigated. 17 33 17 The Registered Provider must have an accurate record of staff who are rostered to work in the home. This must be amended to reflect any changes where necessary. This rota must include who is on call or sleeping in. The Registered Provider must review the level of staffing to ensure that there are always adequate numbers of staff on duty. The provider and the staff must be accountable for the work they carry out. 18 34 19 The Registered must ensure 07/11/2009 that arrangements are in place to ensure that they have obtained the necessary information, as specified in the regulations, for all new 07/11/2009 Care Homes for Adults (18-65 years) Page 42 of 47 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 volunteers, before they start work at the home. This is to ensure only people suited to the work, volunteer. 19 34 19 The Regsitered Provider must ensure that full and satisfactory information, as specified in the regulations, is obtained in relation to all new care workers, before they are employed by the care home. This is to ensure only people suited to the work are employed. 20 34 19 The Registered Providers 07/11/2009 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. 21 34 19 The Registered Provider must ensure that every care worker currently employed 07/11/2009 07/11/2009 Care Homes for Adults (18-65 years) Page 43 of 47 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 at the home has the documents required by the regulations. This is to ensure that only people who are suited to the work are employed. 22 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. 23 38 12 The Registered Provider 31/10/2009 must 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 recieve the services to which they are entitled. 24 38 12 The Registered Providers 07/11/2009 must ensure that the home is managed in a manner that respects the rights of individuals and provides them with the support they need. 07/11/2009 Care Homes for Adults (18-65 years) Page 44 of 47 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 People who live in care homes must be treated with respect. 25 38 37 The Commission must be notified of any event that adversely affects the well being of a person living at the home. Providers have a duty to make such report, which demonstrate openness. 26 39 24 The Registered Providers must that quality assurance processes are implemented. This should include ensuring that they are familar with the day to day experiences of people who live at Elmslea, and ensure no one is subject to unreasonable rules or restrictions. People who live in care homes must be treated with respect. 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 07/11/2009 07/11/2009 1 20 Obtain and use in the home accepted best practice guidance about the safe handling of medicines such as is available from the Care Quality Commission and The Royal Pharmaceutical Society of Great Britain. Care Homes for Adults (18-65 years) Page 45 of 47 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 2 3 4 20 20 20 Review and improve the storage arrangements for medicines so as to reflect best practice guidance. Arrange to see and check all prescription forms in the home before they are sent to the pharmacy for dispensing. Keep copies of the manufacturers Patient Information Leaflets for each medicine in use in the home and a copy of the standard yellow oral anticoagulant therapy book for anyone receiving this type of treatment. Make arrangements to write the date on containers of any medicines when they are first opened to use and record the quantity of any stocks of medicines that are carried forward to the next medication cycle. This is to help with good stock rotation in accordance with the manufacturers or good practice directions and to enable audit checks that medicines are being used correctly and the right quantities remain in stock. 5 20 Care Homes for Adults (18-65 years) Page 46 of 47 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). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 47 of 47 - 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!