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Inspection on 16/12/09 for Forest Edge Rest Home

Also see our care home review for Forest Edge Rest Home for more information

This inspection was carried out on 16th December 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 but made no statutory requirements on the home.

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

We find that the statutory requirement notice is met.

What the care home could do better:

In order to demonstrate your ongoing and continuing compliance in this matter you must ensure that the systems that you have put into practice in Forest Edge Rest Home are embedded into the daily practice of all staff.

Random inspection report Care homes for older people Name: Address: Forest Edge Rest Home Southampton Road Cadnam Hampshire SO40 2NF zero star poor service 17/04/2009 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: Geraldine Yates Date: 1 6 1 2 2 0 0 9 Information about the care home Name of care home: Address: Forest Edge Rest Home Southampton Road Cadnam Hampshire SO40 2NF 02380813334 02380814963 forest.edge@btinternet.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) : John Henry Hughes,Mrs Linda Susan Hughes care home 22 Number of places (if applicable): Under 65 Over 65 0 0 22 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Conditions of registration: 22 22 0 The maximum number of service users to be accommodated is 22 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category : Dementia (DE) Mental disorder, excluding learning disability or dementia (MD) old age, not falling within any other category (OP) Date of last inspection 0 1 0 9 2 0 0 9 Care Homes for Older People Page 2 of 9 Brief description of the care home Forest Edge is a twenty-two bedded residential care home, opposite a garden centre, situated on the outskirts of the New Forest at Cadnam. The home is just less than four miles from the centre of Totton and close to the New Forest. The home is registered to accommodate twenty-two older people, including people with dementia or mental health problems. Forest Edge has twenty-two single bedrooms, all provided with an en suite toilet. Care Homes for Older People Page 3 of 9 What we found: These reason for this inspection was to monitor compliance with the statutory requirement notice issues on 30 November 2009. You were required by 11 December 2009 to: 1. Have a medication policy and procedure in place that conforms to the Royal Pharmaceutical Society guidance; the handling of medicines in social care and National Minimum Standards. This policy must be fully implemented and complied with by all staff. 2. To assess all staff who have the responsibility for administering and handling medication, as to whether or not they are competent to do so. You must take appropriate action, such as providing training and suspension from handling medicines, for those who do not achieve the required level of competency. The assessment must be conducted by an appropriately experienced and qualified person. 3. Ensure a system is in place to ensure all medication is administered in accordance with the prescribers instructions. You must have a system in place to monitor both the repeated refusal of medication and the requests for additional medication, such as pain relief. This system must include the need to consult the prescriber (GP) and request a review of medication. 4. You must ensure a system is in place to take appropriate action when a service user has been overdosed with medication, which must include seeking medical attention. 5. Have a system in place that ensures those service users receiving anticoagulant treatment for, example Warfarin, receive the correct dosage. This must include having their blood tests when required, the anticoagulant record book being kept in the registered Care Home, apart from when being update for blood results, the anticoagulant book is available to all staff who administer medication. You must ensure that the correct dose of medication is administered and corresponds with the prescribed dose in the anticoagulant book. 6. Ensure you provide clear written guidance to staff for each service users who is prescribed as required (PRN) medication, as to when to administer the medication and any triggers or indicators known that shows the medication is needed. You must maintain records of; date, time, dose, service user name and what medication was administered. 7. Have a system in place that accurately records all medication that is administered, including: service user name, medication name, the dosage, the date, the times, reason for refusal or unable to take medication and the signature of the person recoding the administering and/or refusal of the medication. At this visit we looked at the medication administration records and medicine supplies for 10 people and at the care plans for a selection of these people. We also looked at training records, the homes own audits of medicine usage, policies and procedures and talked to the appointed manager and two senior care staff. Care Homes for Older People Page 4 of 9 Clear policies and procedures are in place describing to staff how medicines are to be handled in the home. These have been supplemented with additional guidance in the areas that had needed attention in order to comply with the notice. These include what to do if people repeatedly refused their medicines, the actions to take if someone had an overdose of medicine and when to seek medical advice. Staff were aware of the guidance and it was seen to be put into practice. Five staff were identified as authorised to administer medicines. All of these staff have received training in the safe handling of medicines in the last 8 months. The appointed manager told us that their competency to safely administer medicines had been assessed by a pharmacist in the last two weeks, though this was not documented. A further three staff are undergoing training. These staff are not currently handling medicines. When medicines are prescribed that need regular monitoring and dose changes there are guideline on how this is to be managed. Clear instructions are provided to the home as to what the current dose is and when future tests are due. This information is available to staff when they are giving these medicines to people. If people are prescribed any medicines to be given only when needed or as required, (PRN), there is information available to the staff to describe when the medicine is needed and when to give the medicine. When any such medicine is given a record is kept of what was given, when it was given and who gave the medicine. Clear records are kept of all medicines given to people and the reason why any medicine was not given. There were no gaps or ambiguous entries on the medication administration record charts. When creams and ointments are prescribed there is clear information as to where each cream is to be applied and records to show that they are being used. There are also records to show that people who are prescribed nutritional supplements are being given these too. These records, together with the homes own audits and the supplies of medicines in the home, were able to show us that people are receiving their medicines as they are prescribed by their doctors. 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 Older People Page 5 of 9 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 Service user plans need to clearly state all a persons needs and state how these should be met. Clear support plans will ensure that a persons needs and choices will be met. 30/07/2009 2 9 13 Controlled drugs must be stored in a cupboard which meets the requirements of the Misuse of Drugs Safe Custody Regulations. To comply with the law and ensure the safety of residents 08/10/2009 3 35 17 Accurate records must be maintained to reflect all monies going in and out for each person. Records must match the receipts held. Receipts must be kept on file. It is vital that it is possible to establish when a persons money came into the home and who it was from. Records should then be maintained on all monies going in and out for that person. Receipts need to be maintained to evidence the 20/11/2009 Care Homes for Older People Page 6 of 9 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 money has come into the home and to demonstrate where the money has been spent. Care Homes for Older People Page 7 of 9 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 8 of 9 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. 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). 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