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Inspection on 06/01/09 for Elsenham House Nursing Home

Also see our care home review for Elsenham House Nursing Home for more information

This inspection was carried out on 6th January 2009.

CSCI 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 11 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The Home provides accommodation in a variety of settings, it comprises of four properties, divided by one house in between; this gives the residents a choice of accommodation depending on their needs and their move toward more independent living. One resident told us "I really like it here because they help me to become more independent". There is a homely feel to the environment. The meals are managed well and the meal times are very flexible depending on what the residents are doing. The menus are well balanced and nutritious. Two residents we spoke with said that they liked the food and that there were always choices. Activities are managed well and the residents are supported to follow their own pursuits and are supported to be involved with activities outside the home setting.

What has improved since the last inspection?

Some more areas of the home have been refurbished and decorated and the area outside has been tidied up. The Home has started to monitor the quality of the services it offers. The smoke room has now been well ventilated and the smoke does not permeate into the rest of the home.

What the care home could do better:

Improvements need to be made in all aspects of handling, administration and recording of medicines. All medication entering the home must be recorded and records kept of all wastage. The care plans do not always reflect the current needs of the residents with prompt revision following changes identified. The process for supervision of staff needs to improved so that it becomes a more formal and a continual process. The system for assessing residents prior to admission needs to be improved to ensure that all needs can be met before admission and records maintained for this process. The staff training programme covers all mandatory training but this needs to extended to include training in relation to meeting specific needs of the individuals who use the service. The service must ensure that the information that it provides in the AQAA is accurate.All matters highlighted in this report suggest that a more robust monitoring and oversight of the management of the home is required for its safe management. The service needs to respond to all requirements as enforcement could be considered.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Elsenham House Nursing Home 49-53, 57 Station Road Cromer Norfolk NR27 0DX     The quality rating for this care home is:   zero star poor service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Marilyn Fellingham     Date: 0 6 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 29 Information about the care home Name of care home: Address: Elsenham House Nursing Home 49-53, 57 Station Road Cromer Norfolk NR27 0DX 01263513564 01263511511 elsenhamhouse@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Elsenham House Ltd care home 31 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Additional conditions: 31 One named service user over the age of 65 may be accommodated. Date of last inspection Brief description of the care home Elsenham House is situated in an urban location, on the outskirts of Cromer and comprises of four properties, divided by one house in between. The first three properties were built in approximately 1890, they have small rear gardens where there are lawned areas and patios for Service Users use. Public transport services include a bus service every 15 minutes and a train service from Cromer every 20 minutes. Fiftyseven Station Road, Cromer, the fourth property, is intended as a unit where Service Users are encouraged to develop their skills and become more independent, prior to moving back into the community. Many of the Service Users are encouraged to promote as much independence as is possible and are facilitated to continue to engage in outside the Home activities and work experience. Care Homes for Adults (18-65 years) Page 4 of 29 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 was an unannounced visit that took place over six hours. The Inspector was accompanied by the Commissions Pharmacy Inspector. The key inspection for this service has been carried out using information from previous inspections, information from some residents and people who work in the home. The main method of inspection used was case tracking. This involved selecting individual care plans and information available about people who live in the home and tracking their experience as a result of the support provided. Care Homes for Adults (18-65 years) Page 5 of 29 During our visit a tour of the premises was undertaken and residents records and staff files were looked at. What the care home does well: What has improved since the last inspection? What they could do better: Improvements need to be made in all aspects of handling, administration and recording of medicines. All medication entering the home must be recorded and records kept of all wastage. The care plans do not always reflect the current needs of the residents with prompt revision following changes identified. The process for supervision of staff needs to improved so that it becomes a more formal and a continual process. The system for assessing residents prior to admission needs to be improved to ensure that all needs can be met before admission and records maintained for this process. The staff training programme covers all mandatory training but this needs to extended to include training in relation to meeting specific needs of the individuals who use the service. The service must ensure that the information that it provides in the AQAA is accurate. Care Homes for Adults (18-65 years) Page 7 of 29 All matters highlighted in this report suggest that a more robust monitoring and oversight of the management of the home is required for its safe management. The service needs to respond to all requirements as enforcement could be considered. 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 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 29 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 29 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of personalised needs assessment means that peoples diverse needs are not identified and planned for before they move into the home; this can also mean that other residents could be placed at risk. Evidence: We looked at the records for one newly admitted resident to the home, no evidence was available to indicate that the residents needs had been assessed before admission. The information provided by the Home to us about the admission process was contradictory as the AQAA states that each resident has a pre admission assessment to ascertain whether the Home can meet their needs. There was nothing in the admission notes of this resident to what medication they were taking, what challenging behaviour they presented. In view of this it is very difficult to ascertain how a care plan had been formulated and if the Home could meet this residents needs. Care Homes for Adults (18-65 years) Page 10 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The information within the care plans is not sufficient to ensure that the residents needs are met in a consistent way. Evidence: We saw five of the care plans for residents living in the home. One of the care plans had scant information and lacked detailed information of how to meet this residents needs. For example it states that anger management protocols must be applied, but there is no information how the staff must do this and when questioned the staff did not know what it meant. This resident had undergone some changes with their medication but there were no notes to suggest why. There was no evidence of this resident having been involved in the care planning process and when asked if they knew about their care plans they stated that they did not know what they were. Three other care plans we looked at had evidence of the residents involvement in the process and also had been evaluated. The fifth care plan we looked at was not detailed enough to provide the care that Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: would meet this residents needs. For example this resident with MRSA had no care plan for this and guidelines for the care that needed to be put in place and particularly in relation to spread of infection. The plan also lacked detailed instruction for care relating to difficulty in breathing and other care essential for maintaining correct temperature levels and oral hygiene. On questioning the staff who were on duty none of them had any knowledge of how to care for this resident in relation to their physical needs. The staff we spoke with told us that they were aware of the care plans but they actually did not understand many of the entries. One resident has a problem of not adhering to smoking policies within the home and there was not a detailed care plan to say how this could be dealt with. We also noted that none of the care plans had reference to the residents mental health capacity. The information provided by the home to us about care plans was contradictory as the AQAA states that every resident has an individual care plan that covers all aspects of their aspirations and daily needs, it also told us that the care plans are reviewed. Although the AQAA states that the registered manager checks the care plans on a regular basis there was no evidence of this. Some of the staff we spoke with were able to say how they supported the residents and how they encourage them to make choices and live more independent lives. The residents we spoke with told us that they chose when to get up in the mornings and when to go to bed, they also told us that they decide what they are going to do every day. One resident told us I have been on holiday and I chose where I wanted to go and the staff helped me do this. Another said I go horse riding because thats what I want to do. The administrator is responsible for maintaining records relating to the system for looking after residents monies for those who are unable to do this for themselves. The money is kept secure and records in place with two signatures for all transactions, the residents themselves are encouraged to sign to confirm receipt of money wherever possible. We did a spot audit of one residents monies and we found the balance to be in credit by four pounds. Care Homes for Adults (18-65 years) Page 12 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported to take part in meaningful activities and are helped to exercise choice in their daily lives. Meals are manged well. Evidence: Discussion with some residents and staff and recording on file evidenced that the home offers many opportunites for personal development, socialisation and further education. The staff we spoke with are aware of the need to promote the residents self esteem and confidence. The residents are encouraged to go out into the wider community and join in activities that are not part of the home. We spoke with one resident who told us that they had been out in the evenings and also enjoyed going to football. Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: One resident told us that they had been doing some gardening and another told us about their shopping expedition that day. Although we saw planned programmes for activites we did not see indivual documentation for this except in the small unit ajoined to the main house where the residents are seeking a more independent lifestyle: there were good records for all their activites and their duties within the house. We looked at examples of menus and noted that they appeared nutritious and well balanced; those residents we spoke with told us the meals were good and one resident said I like the food here. Mealtimes are relaxed and the residents are not restricted by set meal times. There was a bowl of fruit in the dining room and the residents have the facility to have hot drinks when they wish. The staff told us that some residents if able, go home for short periods and we saw entires in the daily notes to confirm this. All the residents are offered a key to their rooms and this was confirmed by those residents we spoke with. Staff were seen to knock on doors before entering and gained residents permission before entry. Care Homes for Adults (18-65 years) Page 14 of 29 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. The personal and healthcare needs are not met consistanly and the way in which medication is managed means that residents are at risk. Evidence: As previously mentioned in this report the care plans are not detailed enough about the personal and healthcare, including mental health needs of the residents to ensure that these are met in a consistent way. The carers when asked had very little knowledge about some of the entries in the care plans and also had no knowledge to give appropriate care to one resident in particular. The inspection of the medication standard was conducted by the Commissions pharmacist inspector Mark Andrews. During the inspection we looked at how the home is storing, administering and recording medicines. We also looked at associated records such as peoples care notes. Most medicines are stored in a lower ground floor office in cabinets and a medicine refrigerator. A stable type door allows people living at the home to come to this room Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: to have their medicines administered without entering the room. The medicine refrigerator is not lockable. We were assured that the door to the room is locked when unattended. An additional cupboard is in use beneath the stairs on the lower ground floor but the door to this cupboard is not robust for medicine storage and the cupboard is regularly accessed by staff who are not authorised to access, handle or administer medicines to obtain other items stored there. The cabinet in use for the storage of controlled drugs does not comply with the Misuse of Drugs (Safe Custody) Regulations and so is unsuitable for this use. We advised Mr Dupuis on the suitability of another cabinet located within the home. We noted that several daily records for the medicine refrigerator had been recently omitted so we could not determine if medicines stored within the refrigerator had recently been stored within the accepted temperature range. The majority of medicines are supplied in and administered from 7-day cassettes. This is shown on medication charts to assist nursing staff when administering medicines. Other medicines in original-type containers are also in use. We noted that strips of clozapine tablets in sachets had been removed from their labelled containers by which staff could easily refer to prescribed directions. When we examined current and some previous medication charts we found there to be some records of medicine administration that had been deleted. There were also gaps in records where we could not determine if medicines had been given to people as prescribed. This included clozapine tablets which puts peoples health and welfare at risk. We conducted sample audit trails of medicines against their records and found that a significant number of medicines received had not been recorded. Where there were records for the receipt of medicines most frequently the date of receipt was not stated. The home conducts its own internal audit trails of medicines but this was most recently undertaken two months prior to the date of inspection. We used medicine stock figures from the homes own internal audit and found there to be discrepancies with almost each medicine we looked at and they could not be accounted for in full. A member of staff on duty said that some peoples medicines may occasionally be administered to other people prescribed the same medicine when the medicine becomes unavailable at the home. We discussed with nursing staff effective auditing techniques during the inspection. There was no accounting system at all for clozapine which is an important medicine prescribed for the treatment of schizophrenia. We noted errors that had arisen with this medicine where the medicine had not been administered and also where staff had attempted to give a person the medicine but it was refused because the person said it had already been given. We also noted that some records for when medicines were not given did not state the reason why they were not administered. We found there to be Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: medication chart entries for some medicines that had not been in use for significant periods of time. We looked at care notes for a resident who had recently had their daily dose of antipsychotic medicine pericyazine increased two-fold by the prescriber. There were no records relating to contact the home had with the prescriber and records prior to this time did not reflect deteriorating mental health for this person. Nursing staff on duty confirmed that the home does not keep separate notes of contact with healthcare professionals. For this same person there was a care plan referring to two medicines that could be administered to them at the discretion of nursing staff (PRN) for the management of aggression. However, one medicine had been discontinued and the other now prescribed for regular administration only. We noted that care plans for the use of such medicines did not include measures that would benefit individuals before considering the use of medicines prescribed for use on a discretionary basis. There are several people at the home who have control of their own medicines and self-administer them. We looked at how the home is supporting these people to maintain independence with their medicines. We visited the rooms of three people and found that two have safes with combination numbers to safely store their medicines. The safes were not fixed within the rooms. We identified that one of these people had a significant history of suicidal ideation. The risk assessment was being reviewed every three months but we could not identify from the persons care notes how staff would take action in the event of this person experiencing a deterioration in their mental health that would place them at risk with their medicines. Another person was not storing their medicines in the lockable drawer provided and for this person there was no risk assessment in place to monitor the risks. This person told us they were using a prescribed inhaler only once each day when it was prescribed for twice daily use. We asked the senior nurse on duty to take appropriate action to ensure this person was safely storing and self-administering their medicine. The home has an audit system in place to enable twice weekly monitoring of people self-administering their medicines but records indicated this had most recently been undertaken 11th November 2008. The home has medicine policy and procedure documentation available to provide guidance for staff handling and administering medication. Care Homes for Adults (18-65 years) Page 17 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are listened to and the staff have knowledge in safeguarding adults. Evidence: The Home does have a complaints procedure which is made available to all residents. Those residents we spoke with told us that they knew who to go to if they had any concerns and the home does have residents meetings and these are also used as a forum for the residents to raise any issues they might have; we looked at minutes for these meetings and noted the involvement of the residents. We did note however that the home still does not keep accurate records for all concerns voiced by the residents. The home continues to have protocols in place for dealing with issues relating to safeguarding adults and the staff members we spoke with were aware of these protocols and confirmed that they had had training relating to this. This was also substantiated by the training records we looked at. Care Homes for Adults (18-65 years) Page 18 of 29 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 service provides a homely environment for the residents that is safe and suits their needs. Evidence: The home provides accommodation in a number of settings. The main house provides bedrooms and communal areas such as a dining room, lounge, smoking room, conservatory and bathrooms. Part of the main house has a separate area that accommodates some residents who are adjusting to becoming more independent whilst further down the road at no fifty seven is intended for those residents who are moving back into society. Improvements have been made to the smoking room and it has been better ventilated so that smoke does not permeate into the rest of the house. The sitting room has been enhanced and re decorated and a new T.V installed. Some areas of the main house have been re carpeted and the back garden has been tidied and made safe. Care Homes for Adults (18-65 years) Page 19 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff do not receive the appropriate training or supervision to enable them to carry out their roles effectively. Evidence: When we arrived at the home three carers were on duty and one registered nurse in the main house. The registered manager was involved with taking a resident for an appointment. Two of the three carers on duty were responsible for providing escorts for those residents involved with activities, whilst the third remained in the house. Later in the morning another registered nurse came on duty. One of the residents we spoke with told us thatthe staff are good and helpful and talk to me and another told us that the staff are always busy and sometimes there is only one carer to look after us. We asked the carers about their knowledge in relation to the people they are looking after and their knowledge was very scant regarding specific care for certain individuals both in relation to mental and physical needs. We looked at training records for the home and talked to staff members which indicated a lack of training relating to specific mental conditions and in one case related to an individuals physical needs. We received a complaint about staffing levels particularly at the weekends; the past duty rosters show that the staffing levels have been adequate although sickness has Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: caused some staffing issues at odd times. The home never uses agency staff which allows consistency in care by staff who know the residents. The carers have NVQ qualifications and have attended all mandatory training and we saw records for this. We also looked at training records for new staff that have undergone an induction these were good; we also noted that staff have received training in relation to the Mental Capacity Act. A robust system is in place for recruitment and all required checks are made before anyone is employed in the home, we saw records for these. The staff members we spoke with say they feel well supported but supervision records for formal supervision are haphazard and do not always indicate that staff have received any supervision. Care Homes for Adults (18-65 years) Page 21 of 29 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. There are management shortcomings that potentially compromise the health, safety and welfare of people using the service. Evidence: Since the last Key Inspection it has come to our attention and following a complaint that some aspects of the homes management and overall management of medication has not been entirely satisfactory: the AQAA that contains information supplied to us by the Home states that all problems related to medication have been solved. Although the Home has purchased a quality self assessment pack it needs to be used so that their monitoring of the quality of the service it offers can be extended so results of this can be seen and audited. Despite the arrangenments in place the Home appears to lack direction; the staff do not receive regular formal supervision and there is some lack of clarity in relation to their roles within the home. The AQAA which contains information given to us by the Home states that the staff have regular supervision sessions but this was not confirmed by those records we looked at. Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: We were unable to to look at any records for complaints or concerns received by the home. We were unable to talk to the manager of the clinical area as he was not on duty on the day of our visit so we were not able to clarify his role within the home with him since the provider had become the registered manager. The Home has an administrator who has a good understanding of the areas she is responsible for. Care Homes for Adults (18-65 years) Page 23 of 29 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 20 13 (2) People who use the service who are prescribed prn (as required) medication must have care plans in place to justify continued use of the medicine. When medication is administered to people who use the service it must be clearly recorded. This will ensure that people receive the correct levels of medication. 20/04/2008 2 20 13 (2) 20/03/2008 3 20 13 (2) All medicines that enter the 20/04/2008 home must be recorded, this will ensure that audit trails may be carried out. The home must ensure that 20/03/2008 it informs the Commission of any significant events, this will ensure that the home complies with the Care Standards Act and Regulations. 4 37 37 Care Homes for Adults (18-65 years) Page 24 of 29 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, 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 2 14 Prospective residents must be appropriately assessed prior to admission to the home. This will ensure that the service can meet the needs of the individuals. 13/04/2009 2 6 15 The care plan must contain detailed information about individuals care needs. This will ensure that residents needs are met. 16/04/2009 3 20 13 People choosing to manage 01/04/2009 their own medicines must be supported by the home by conducting and recording risk assessments and ensure their medicnes are safely stored at all times. This will ensure that risks to residents health and welfare are identified at all times. 4 20 13 Care plans must accurately reflect and give guidance on current prescribed 23/04/2009 Care Homes for Adults (18-65 years) Page 25 of 29 instructions when medicines are to be administered at the discreation of nursing staff. This will ensure justification of continued use. 5 20 12 Full and accurate records must be kept for changes in peoples health. This will ensure justification of medical intervention leading to changes in prescribed medicines. 6 20 13 Medicines must be 01/04/2009 administered to people living in the home in line with prescribed instructions and reords kept. This is a repeated requirement. This will ensure all medicines can be accounted for in full. 7 20 13 Full and accurate records must be kept for the receipt of all medicines into the home and to people prescribed them. This is a repeated requirement. This will allow for auditing of medcines within the home and prevent mthe residents being at risk. 8 20 13 Daily recordings of the temperature of the medicines fridge must take place. 06/04/2009 01/04/2009 23/04/2009 Care Homes for Adults (18-65 years) Page 26 of 29 This will ensure that medcines requiring refrigeration are stored within the accepted temperature range. 9 20 13 Arrangements must be 16/06/2009 made for the safe and secure storage of medicines. Controlled drugs must be stored in a cabinet. This will ensure the safety of the residents and compliance with the Misuse of Drugs Regulations. 10 32 18 Staff must receive training 20/07/2009 with regard to mental health and physical conditions. This will enable them to meet the needs of the residents. 11 36 18 The home must operate a system for formal supervision for staff at least six times a year. This will ensure that at all times there are suitably qualified, competent and experienced persons working in the home. 20/07/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 The care plans should have some reference to the individuals mental capacity. Care Homes for Adults (18-65 years) Page 27 of 29 2 3 20 20 safes in peoples rooms for the storage of their medicines should be fixed and non-removable. Medicine audits should be conducted more frequently to promptly identify issues arising and enable medicines to be accounted for in full. Medication charts should be reviewed ensuring medicines no longer in use are removed from them. Separate records should be kept for all external healthcare professional interventions including changes to medicine regimes. Clozapine tablets supplied in sachets should remain in their original labelled containers. It is recommended that all concerns and complaints are recorded and notes made of outcomes. It is recommended that the Home extends its sytem for monitoring the quality of the service it offers, this will make sure that the home is run in the best interests of the people who use the service. 4 5 20 20 6 7 8 20 22 39 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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