Inspection on 08/03/10 for The Firs

This inspection was carried out on 8th March 2010.

CQC found this care home to be providing an Adequate 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Firs 24/11/09

The Firs 24/11/08

The Firs 12/08/07

The Firs 10/10/06

The Firs 01/12/05

The Firs 22/07/05

The Firs 01/03/05

The Firs 18/05/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 16/05/2010.

Random inspection report Care homes for older people Name: Address: Firs and 16 Margaret Road, The 141 Malvern Road Worcester Worcestershire WR2 4LN one star adequate service 30/11/2009 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: Andrew Spearing-Brown Date: 0 8 0 3 2 0 1 0 Information about the care home Name of care home: Address: Firs and 16 Margaret Road, The 141 Malvern Road Worcester Worcestershire WR2 4LN 01905426194 F/P01905426194 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) : Eldahurst Limited care home 22 Number of places (if applicable): Under 65 Over 65 0 22 0 dementia old age, not falling within any other category physical disability Conditions of registration: 22 0 22 The maximum number of service users who can be accommodated is: 22 The registered person may provide the following category 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: Old age, not falling within any other category (OP) 22 Dementia (DE) 22 Physical Disability (PD) 22 Date of last inspection Brief description of the care home The Firs provides care for fifteen people. 14 and 16 Margaret Road (known as Fern House) provides care for seven people are separate semi-detached houses that are divided from The Firs by their joint back gardens. The three properties are registered as one care home. The home is located in the St Johns area of Worcester. Both The Care Homes for Older People Page 2 of 13 3 0 1 1 2 0 0 9 Brief description of the care home Firs and Fern House are adapted and extended to provide a comfortable domestic environment for older people. The registered proprietor is the company Eldahurst Limited. The responsible individual and the registered manager is Mrs Sandra Lynne Ghalamkari. We did not obtain details on the current fees charged therefore the reader should contact the service directly. Previously we were told that the standard fee does not include hairdressing, chiropody, newspapers or having own telephone in bedroom. Care Homes for Older People Page 3 of 13 What we found: This random inspection was carried out by one regulatory inspector from the Care Quality Commission. During our last key inspection in November 2009 we identified shortfalls regarding care planning, risk assessments in relation to bed rails, ensuring medication records are accurate, staff recruitment and notifying authorities of certain events. It was pointed out within our report that each of these areas could potentially place people using the service at risk. MEDICATION We noted that a new fridge is in place within The Firs for the storage of items needing such a facility. Staff were recording the temperature of the fridge however they were getting the decimal point in the wrong place. Items we looked at in the fridge had the date of opening recorded upon them to ensure that they do not exceed there expiry date. The fridge was not locked therefore these items were not secure. Medication was stored within a lockable trolley. The trolley was chained to the wall when not in use. The key to the trolley was not, at times, held by the nominated person therefore reducing security of medication. We looked at the MAR (Medication Administration Record) sheets of some residents. At the time of our last visit we noted that MAR sheets appeared to be completed satisfactory until closer examination when we became aware of some concerns about the recording and the management of medication. The majority of sheets were on this occasion completed however we have got some concerns. We saw an occasion when staff had continued to sign for a tablet however the home had run out of this drug. We saw occasions when staff had signed that medication was given however had then signed over the top to indicated that it was not given. Staff had used a code to indicate items were omitted but had not defined why. We carried out some audits of boxed medication, these were mainly painkillers. These did not balance and in some cases the stock held was considerably lower than what it should have been according to the records. We found a similar situation regarding a bottle of laxative. Some boxed medication was not dated to show when it was opened which made auditing more difficult. We were concerned about the recording following the application of some prescribed creams. Some creams were signed for however others were not. Within the key inspection report we wrote The daily records showed that staff were applying cream however the MAR sheet was not signed. We were told that one person was having both a barrier cream and spray applied however we found that the home had run out of the cream. The spray was available however the date of opening was not recorded upon it. Staff assured us that the spray was used however the records within the home did not support this. Care Homes for Older People Page 4 of 13 We had some serious concerns regarding the recording of controlled medication. We found medicines in both liquid and tablet form which were not booked into the controlled drugs register. We found that staff had opened more than one bottle of the same medicine belonging to the same resident which is not good practice. Within the CDR (Controlled Drugs Register) staff had continued to follow on from a mis calculation. In addition the balance held of some liquid medication was significantly different to the balance recorded within the CDR. At the time of our inspection the manager could not offer an explanation for the apparent unaccounted medication. BED RAILS During our previous inspection we were concerned to read entries in the daily records about some injuries sustained by a resident as a result of bed rails attached to her bed. The risk assessment was insufficient as it did indicate due regard to guidelines issued by the Health and Safety Executive. Due to our concerns we wrote an urgent action letter to the manager regarding the need to carry out a full risk assessment regarding the bed rails without delay. We were informed that a risk assessment was completed and we saw this document during this inspection. We also saw pictorial guidance issued by the MHRA (Medicines and Healthcare products Regulatory Agency). The risk assessment was not reviewed since initially drawn up. It was of considerable concern to discover two other beds with bed rails in place, neither of these people had a risk assessment in place as to why rails were needed or regarding their use. We saw bumpers in place on each of the beds. One resident was in bed with bed rails and bumpers however the bumpers were not attached correctly and the resident could have potentially become entrapped. This could cause injury. Due to our findings and due to our concerns for the health, safety and welfare of residents we issued an immediate requirement notice. This gave the manager 48 hours to carry out risk assessments and ensure that staff have guidance in the safe use of this equipment. It was of great concern that on leaving the home we noticed a bed where the bumpers were incorrectly fitted. This bed was not occupied at the time. We had a look at the rail and on pressing down on the rail it collapsed. Despite several attempt we failed to get the rail to lock into position. This could of cause considerable injury to a resident if the rail had been pushed down when limbs were in the way. One resident was on an air flow mattress. We noticed that although the mattress appeared inflated a warning red light was illumined on the power box. Staff had not noticed this stating that an audible alarm would sound if there was a problem. We wrote to the registered manager on the 9th March to confirm what actions she needed to take in order to comply with the immediate requirement notice. On the 11th March we returned to the service to check compliance. A risk assessment was in place and highlighted the need to be aware of gap between the equipment and the head board. We measured this gap and found that it was not within the ranges recorded upon the risk assessment. Therefore there was no evidence that staff had received any guidance following our visit regarding the safe use of the rails. We noted that the red warning light was still showing on the pressure reliefing mattress power box. Care Homes for Older People Page 5 of 13 CARE PLANING AND RISK ASSESSMENTS. We previously reported on improvement and development with the care planning process in the home. Care plans have not developed any further since our last inspection and remain task orientated and lack a person centred approach which would take into account each persons individual needs and wishes. This approach would concentrate on what people can do rather than what they can not. Following our last inspection the service was required to review care plans and ensure they are up to date. We saw that a review had taken place on each care plan we viewed during both January and February 2010. We saw no records regarding any reviews carried out during 2009. The care plans themselves were in each case written some time ago. One care plan was not an accurate reflection of current care needs, for example it mentioned the person spending time in the lounge when she does not, the use of dentures when they are not and the use of pads when other equipment is used. Risk assessments were in place for some elements of the care provided. However these were not always reviewed. One risk assessment was not added up correctly. We saw a risk assessment which stated that a hoist is used. Staff told us that this equipment is not used; this was confirmed by the manager. STAFF RECRUITMENT. Within the last report we acknowledged improvement in relation to the service obtaining CRB (Criminal Record Bureau) disclosures and references prior to new employees commencing work at the home. We did however comment on the fact that gaps in employment history were evident. During this random inspection we viewed documents relating to three recently appointed members of staff. The file of one person contained no references and none could be found within the home. The names given as a referee did not include the most recent employer. The application form for employment at the home consists of a number of loose sheets of paper, these are not collated together to ensure they are all held. We were informed that new employees have a period of time shadowing a permanent and established member of staff. We saw a rota which confirmed that one recently appointed carer had another person working alongside her. OTHER Within our key inspection report we mentioned a new wet room within The Firs. On that occasion we saw two bars of soap within this area and noted that it did not have a liquid soap dispenser fitted. These were of concern due to infection control procedures. During this inspection we again saw a bar of soap within the wet room. Liquid soap is now available in this area although there were no paper towels. The hand dispenser near to the front door was empty however there was a bottle of hand gel available. We found some cleaning materials within an unlocked cupboard. These items could be potentially hazardous if handled incorrectly. Care Homes for Older People Page 6 of 13 Since our last inspection a food safety officer from Worcester City Council Environmental Health has visited to the home. We were told that actions needed as a result of that visit have taken place. Within our previous report we recommended that advice was sought in relation to the arrangements for transporting food to Fern House. It was unclear from the managers response what advice, if any, was obtained. Since this inspection the registered manager has informed us that the food safety officer is going to visit the home again in order to look into this matter. In a double bedroom we saw a fitting made from wood and copper piping to hang privacy curtains. The whole device appeared unstable and piping is not designed for this purpose. The manager undertook to purchase curtain track similar to that we saw within another double bedroom. The pedestal on a wash hand basin was insecure and in need of attention to ensure that it is not at risk of falling. Pipe work highlighted within the previous report is now covered to prevent accidental scalding. The new boiler situated in a bathroom is not guarded to safeguard people from accidental scalding from the boiler itself or from the hot pipe work. Within our last report we stated that the manager confirmed to us that a different company operates 14 and 16 Margaret Road. We informed the manager at the time of the inspection, within our report and within a separate letter that it was vital that an application be applied for as Fern House was operating outside of the law. Since our visit an application was completed and sent to us. As some information was omitted it was necessary for the documents to be returned. During our inspection we saw the company secretary working on the forms. We were assured that the application would be returned to us within a matter of a few days. What the care home does well: What they could do better: Although we wrote within our previous report about areas where improvement was required we saw little evidence of progress in most of the areas. Improvement is needed otherwise we may consider enforcement action in the future. The shortfalls identified within this report were discussed with the manager at the time of our inspection. Care Homes for Older People Page 7 of 13 We will be carrying out a further inspection at The Firs in the foreseeable future to check that improvements have taken place and to ensure the health, safety and welfare of people using the service. 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 Older People Page 8 of 13 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 Regulation 15 (2) All people 29/01/2010 living in the care home must have a care plan which is reviewed and up dated so that it accurately reflects their health and welfare needs and provides clear guidance for staff to follow. This is so staff have the relevant details available to them in order to meet identified care needs. 2 29 19 Procedures within the home must ensure that the recruitment of staff includes obtaining an employment history and references from the most recent employer. This is so that suitable people are employed in the care home. 31/12/2009 Care Homes for Older People Page 9 of 13 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 8 13 Regulation 13 (4) (c). You must ensure that the use of bed rails is governed by a full written risk assessment, and that consent is gained for their use. Staff must be aware of the hazards associated with bed rails and must ensure that they are used safely. This is to ensure that people are safe from injury. 10/03/2010 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 8 13 Regulation 13 (2). The service must make arrangements to ensure that care plans include detailed information and instructions for staff in respect of the administration and management of medicines, including the reasons to give medicines on either a variable dose or on an as and when basis. To ensure that staff are aware of medication prescribed any the reason 31/03/2010 Care Homes for Older People Page 10 of 13 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 why it is prescribed. 2 8 13 Regulation 13 (4). Risk assessments must be in place which fully take into account risks to peoples health, safety and welfare. This is to ensure that risks to people are minimised as far as reasonably practical. 3 9 13 Regulation 13(2). Ensure that prescribed medication is available for people at all times. To ensure that peoples health and well being are maintained. 4 9 13 Regulation 13 (2). Ensure that medication administration records are accurately maintained . That the reason for non administration is recorded by the timely entry of the appropriate code or entry of the meaning of any such code is clearly explained on each record. To ensure that medication is managed safely. 5 9 13 Regulation 13 (2). Medication received into the care home must be booked in and held securely at all times. Medication which Care Homes for Older People Page 11 of 13 31/03/2010 19/03/2010 19/03/2010 19/03/2010 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 needs to be treated as controlled needs to have accurate records maintained as required by the Misuse of Drugs Regulations (Safe Custody 1973), the Misuse of Drugs Act 1971 and as in guidance issued by the Royal Pharmaceutical Society of Great Britain. To ensure that systems are in place to securely hold medication and administer them to protect people from harm. 6 19 13 Regulation 13 (4) All areas of the home accessible to resident must be kept free from potential hazards including the safe keeping of hazardous items. To ensure that people are safe. 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 19/03/2010 Care Homes for Older People Page 12 of 13 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 Older People 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. 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