Inspection on 05/11/09 for Fairways

This inspection was carried out on 5th November 2009.

CQC found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Fairways 05/11/09

Fairways 23/07/09

Fairways 21/08/07

Fairways 24/08/06

Fairways 14/09/05

Fairways 10/05/05

Fairways 23/08/04

Fairways 23/06/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Random inspection report Care homes for adults (18-65 years) Name: Address: Fairways The Fairways Fuller`s Field, Swan Lane Westerfield Ipswich Suffolk IP6 9AX zero star poor service 24/07/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Mark Andrews Date: 0 5 1 1 2 0 0 9 Information about the care home Name of care home: Address: Fairways The Fairways Fuller`s Field, Swan Lane Westerfield Ipswich Suffolk IP6 9AX 01473214966 01473214997 manager-fairways@careaspirations.com 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) : Care Aspirations Limited care home 8 Number of places (if applicable): Under 65 Over 65 0 learning disability Conditions of registration: 8 The maximum number of service users who can be accommodated is 8 The registered person may provide the following categories of service only: Care Home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD Date of last inspection Brief description of the care home Fairways Residential Home is situated in a residential area of the village of Westerfield on the outskirts of the town of Ipswich. The home was first registered in April 2004 and offers care and accommodation for up to eight service users who have a learning disability coupled with challenging behaviour. Fairways is owned and administered by Care Aspirations, a specialist independent healthcare provider, established in 1986, Care Homes for Adults (18-65 years) Page 2 of 11 2 4 0 7 2 0 0 9 Brief description of the care home who provide residential care and private hospital services for adults within this service user group. During the visit the inspector was informed that the fees for the home range from £1283 to £2607 per week dependent on the care that each resident required. Care Homes for Adults (18-65 years) Page 3 of 11 What we found: This inspection of medication was undertaken by the Commissions pharmacist inspector Mark Andrews following issues raised in relation to the homes medication practices at the recent Key inspection. During this inspection we examined the arrangements in place for the storage, administration and record-keeping for medication. The findings of the inspection were discussed with both the service manager Paul Mills and Mark Simon (Operations Manager). Medication is stored in two cabinets within the central ground floor office which is itself secure. A medicine refrigerator is available, however, at the time of inspection this was not in use for refrigeration but used to store medicines for external application. Within the back up storage cabinet a separate compartment exists for the storage of controlled drugs. Whilst this does not meet the requirements of the Misuse of Drugs (Safe Custody) regulations a senior member of staff confirmed that the home has not recieved controlled drugs for people at the home. However, should the home receive such medicines, at present, the home would be in breach of these regulations. We observed that the morning medicine round started at 10.10am and was completed at approximately 10.50am. However, the medication chart records state that the morning medicine round is undertaken at 09.00am and records completed confirm this. We looked at medicines prescribed for people living at the service and found that for some there may be the possibility of adverse reactions arising as a result of doses given as late as 10.50am and then again at lunchtime scheduled at 13.00pm. When we observed the preparation of medicines in the central office room we noted that procedures followed were satisfactory. We saw, however, that one person had their oral medicines prepared for administration in yoghurt. A member of care staff involved with this confirmed that the person was being administered this medicine covertly when they refused the medicine. The deputy manager stated that all persons at the home lacked mental capacity and that assessments had been conducted under the Mental Capacity Act but when we asked to see the assessment for this person the home was unable to provide it for examination. The deputy manager showed us a letter from the GP authorising the administration of one of the persons medicines by this route but this was dated 2005 and had not been reviewed. We raised this with the manager as a matter of concern. During the inspection we looked at previous and current medication charts and medicines available for administration. We found there to be some medicines that had been received at the home but with no or inadequate records of their receipt completed. We also found some medication chart records were incomplete because they did not provide full written dose directions. We found omissions in records for the administration of medicines where we could not determine if the medicine had been administered and safe medicine administration procedures had not been followed. We also found that there is no auditable system in place to account for medicines that are supplied in original containers (not monitored dosage system (MDS) containers) and that are held over from one 28-day medication chart period to another. However, where we were able to conduct sample audit trails we found there to be discrepancies where medicines could not be accounted for and records did not confirm that medicines were being administered as Care Homes for Adults (18-65 years) Page 4 of 11 prescribed. We raised this with the manager as an area of concern. We found that for some medicines available for active administration there were no medicine entries on medication charts and so it was unclear if these medicines should still be administered. We found that for one medicine prescribed for use specifically when another medicine was being witheld that it too had not been given to the person. We also looked at medication charts to establish if all medicines had been obtained and received for administration as scheduled and found for one person Tegretol 100mg scheduled for use twice daily was not available from 16/10/09 to 26/10/09 placing the health and welfare of the person at risk. For another person salbutamol MR 4mg capsules were not available for administration on 16/10/09 only. We raised this issue with the manager as a matter of concern. For another person, for olanzapine 2.5mg prescribed with a dose of two tablets at night the MDS container on the night-time rack contained only one tablet. We discussed this with the deputy manager who said he was not aware and telephoned the GP surgery during the time of inspection. We calculated assuming that 2x28 olanzapine 2.5mg tablets had been supplied for night-time administration that there were two tablets more than expected. This suggested fewer tablets had been administered than scheduled for administration. For this medicine and some others it was clear that the 28-day MDS containers were not being used safely in a way that is synchronised with the 28-day MAR charts. In general we saw that for some medicines there were excessive stocks and for these there was no audit trail in place. We saw that from their labels some medicines available in MDS containers were supplied early in 2009. Because these medicines are prepared in heat-sealed units they must be disposed/replaced after 8 weeks and not used. We also noted some opened tubes of cream and ointment that had also been supplied early 2009 in need of disposal/replacement. We noted that people living at the home are prescribed higher doses of psychotropic medicines however we found that most have regular consultant psychiatrist appointments where their psychotropic medicines are reviewed. Others have them reviewed by their GP. We saw records for one person who had recently had attempts to reduce psychotropic prescribing regimes and that records of a recent appointment had been completed in their care notes. We also looked at psychotropic medicines prescribed for PRN (as required) administration on an occasional basis at the discretion of care staff authorised to handle and administer medicines. Whilst we saw people living at the home prescribed such medicines have care plans in place for the management of challenging behaviour there were no clear instructions about specifically when the use of such medicines can be considered. Also where variable doses are prescribed, for example, lorazepam 1mg 1-2 tablets -maximum of 3 per 24 hours, there was no guidance on when subsequent doses can be considered. In addition, without this information we were not ale to determine if records for the administration of these medicines confirm it had been appropriate for them to be given. In total there are nine members of staff currently authorised to handle and administer medicines. We asked to see evidence that each had received training but were told that copies of certificates were not held at the service. The deputy manager provided us with printed records indicating that most had received training relating only to the monitored dosage system in place at the home and for some the training had most recently been Care Homes for Adults (18-65 years) Page 5 of 11 provided in 2005. We also saw no evidence that the competence of authorised members of staff is regularly assessed. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Adults (18-65 years) Page 6 of 11 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 7 of 11 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 15 People prescribed medicines 27/11/2009 prescribed for PRN (as required) use must have care plans that give clear guidance on their use To protect the health and welfare of people prescribed medicines 2 20 14 Persons who lack mental 27/11/2009 capacity and have medicines administered to them by covert means must have an appropriate assessment under the Mental Capacity Act 2005. To protect the health and welfare of people administered medicines by these means 3 20 12 Medicines must be obtained and administered as scheduled at all times To protect the health and welfare of people prescribed medicines 27/11/2009 Care Homes for Adults (18-65 years) Page 8 of 11 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 20 13 Medicines no longer in use that have expired or are no longer in use must be disposed of To protect the health and welfare of people prescribed medicines 27/11/2009 5 20 13 Full and accurate records 27/11/2009 must be maintained for all actively prescribed medicines. This must include full written dose directions at all times To protect the health and welfare of people prescribed medicines 6 20 13 Medicines must be given to 27/11/2009 people in line with prescribed instructions. This must be demonstrated by recordkeeping practices To protect the health and welfare of people prescribed medicines 7 20 13 Medicines must be given to people at their prescribed and scheduled times. To reduce the risk of adverse reactions and ineffective medication regimens and protect the health and welfare of people living at the service 27/11/2009 8 20 13 Full and accurate records must be maintained for the receipt of medicines into the 27/11/2009 Care Homes for Adults (18-65 years) Page 9 of 11 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action home To protect the health and welfare of people prescribed medicines 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 20 It is recommended that regular and frequent auditing of medication is undertaken to enable medicines to be accounted for and promptly identify and resolve discrepancies arising It is recommended that once training has been provided for members of staff authorised to handle and administer peoples medicines that their competence is assessed on a regular basis. It is recommended that a cabinet compliant with the Misuse of Drugs (Safe Custody) Regulations is obtained and fitted for the special storage of controlled drugs. 2 20 3 20 Care Homes for Adults (18-65 years) Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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 11 of 11 - 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. 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