Inspection on 13/07/09 for Gildawood Court

This inspection was carried out on 13th July 2009.

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

Other inspections for this house

Gildawood Court 20/10/09

Gildawood Court 23/04/09

Gildawood Court 29/04/08

Gildawood Court 30/04/07

Gildawood Court 17/10/06

Gildawood Court 09/11/05

Gildawood Court 05/07/05

Gildawood Court 13/01/05

Gildawood Court 05/08/04

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

Random inspection report Care homes for older people Name: Address: Gildawood Court School Walk Attleborough Nuneaton Warwickshire CV11 4PJ one star adequate service 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: Sandra Wade Date: 1 3 0 7 2 0 0 9 Information about the care home Name of care home: Address: Gildawood Court School Walk Attleborough Nuneaton Warwickshire CV11 4PJ 02476341222 02476344300 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) : Gildawood Court Residential Homes Ltd care home 60 Number of places (if applicable): Under 65 Over 65 0 dementia Conditions of registration: 60 The maximum number of service users who can be accommodated is: 60 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: Dementia (DE) 60 Date of last inspection Brief description of the care home Gildawood Court is a purpose-built, 60-bed care home for older people and is registered to provide personal care for those people diagnosed with dementia. Any nursing needs are carried out by the district nurse. It provides permanent care, short stay accommodation, and day care facilities. The home is situated close to the centre of Attleborough and within a mile of Nuneaton town centre. Local amenities are within reach by foot or wheelchair, and there is Care Homes for Older People Page 2 of 13 Brief description of the care home parking at the front of the building. The home is divided into five units, which accommodate eleven, twelve or thirteen residents in each. Each unit has a lounge and dining area which is fitted with a kitchenette. All bedrooms are single and have en-suite toilets with washbasins. There are sufficient numbers of toilets and bathrooms situated around the home. There are 6 bathrooms and two of these have assisted facilities to help people in and out of the bath. There are also 5 walk-in shower rooms. There is a large activity room which is used for people who visit the home for day care and which can be accessed by permanent residents if they wish. The home has a hairdressing room and enclosed gardens. There is level access into the home and from doors into the garden areas for people with mobility difficulties or wheelchair users. The accommodation is spacious and allows for easy access by wheelchairs. Accommodation is over two floors and can be accessed via a shaft lift. At the time of inspection the fees for this home ranged from £407 - £557.85. These are subject to change. Extra charges are made for hairdressing, chiropody, Dentist consultation fees, Aromatherapist, newspapers, taxis, dry cleaning and visitor meals which need to be pre-booked. Care Homes for Older People Page 3 of 13 What we found: This inspection was carried out to check compliance with requirements issued at the Key inspection on 23 April 2009. This included a review of standards relating to care, medicine management, staffing, complaints and protection. This inspection was carried out between 9am and 5.20pm by two inspectors and during the afternoon a Pharmacist inspector attended to review medication management which took place over a period of four hours. The care of two people who use the service was reviewed and these people were also spoken to. Discussions were also held with staff working in the home and the manager and people living in the home were observed for periods of time during the day. Records viewed included care plan files, medication records, accident and incident records, duty rotas and a provider inspection visit report known as a Regulation 26 report. At the last inspection, a requirement was made for the home to ensure care plans are devised for any specialist care needs the residents may have. This includes care plans around challenging behaviour to ensure these needs are managed appropriately. During this inspection, it was found this requirement had not been met. One residents care who we chose to review was identified by the manager to display challenging behaviour. On viewing the care records for this person it was evident they had a health care need linked to continence which was considered could impact on their behaviour. We looked in the care plan to see what the management approach was to dealing with this continence problem. There was no care plan for this health care need and no directions to staff within the care file seen to monitor this. There were also no details stating if the resident was on any medication for this problem. There was nothing recorded in the care file to indicate that this health care need could be a reason for the aggressive/challenging behavior. A bowel chart that was located did not contain many entries and a member of staff commented this was Not good really and confirmed information in regard to monitoring the health care need was not being recorded anywhere else. The resident was observed during the inspection to independently use the toilet but did call for staff assistance. The person could be heard shouting and it was clear they were agitated and displaying challenging behavior. This was managed by a member of staff appropriately. The resident refused to be assisted with personal hygiene and a change of under clothing the member of staff who was assisting the person said they would have to try again at a later time. On viewing the daily records it was evident there were many episodes of challenging behaviour recorded. On viewing the care records there was no specific care plan in place for this behaviour. There was a Risk Assessment in place stating some triggers and how to try and prevent the behaviour escalating. This Risk Assessment however did not Care Homes for Older People Page 4 of 13 mention any triggers that may be caused by bowel problems. The manager had told us that the person may request to go out to a certain place which may also trigger the challenging behaviour and this also was not mentioned. The resident had been referred to a specialist to follow up their continence problem but it was evident from records in place that the member of staff who had attended the appointment with the resident was not fully aware of their symptoms or medical history. This meant that a fully informed decision around the treatment plan could not be made. Tests were proposed as well as future appointments but it was not evident from records in place that any future appointments to follow this up were made. Another person living in the home was identified to be receiving visits from the district nurse to apply dressings to their legs. There was no care plan on the file suggesting why this was. During discussions with a member of staff it was confirmed that the resident had fluid retention in their legs which sometimes led to the breakdown of skin. As there was no care plan in place it was not clear how this was to be managed by staff. A member of staff spoken to did state that they were elevating the persons legs regularly. During the inspection the member of staff concerned wrote out a new care plan to ensure staff would be clear on how this was to be managed. At the last inspection a second requirement was made that all accidents and incidents which impact on the safety and wellbeing of the residents must be reported to us. This included where medical intervention was sought. It was identified at this inspection that there were accidents and incidents recorded that we had not been informed about as required. This included four incidents in June 2009 which involved a resident hitting another resident, verbal and physical aggression towards people and an incident where one resident grabbed another resident around the throat. An accident recorded on the History of Falls sheet in one care file had not been recorded in the accident book or incident book. This person had fallen on three occasions in June and July 2009 but there had been no Regulation 37 notice sent to us reporting this person had sustained multiple falls. The failure to report these accidents and incidents to us means we cannot be sure the home are identifying that these can impact on the health and safety of others. We also cannot be sure these incidents and accidents are being appropriately managed to safeguard people living in the home. A third requirement made of the service was to ensure there are sufficient members of staff available to meet the needs of residents at all times. This matter had been outstanding since October 2006. We found that staff numbers in the home were made up of a number of management staff, a general assistant, senior carers, carers and ancillary staff but the way these staff were being deployed was not effective in ensuring the needs of people living in the home were being met consistently. There remains incidents that occur in the home which staff do not always recognise due Care Homes for Older People Page 5 of 13 to staff being busy carrying out other duties in the home. During this inspection a resident was found in an ensuite bathroom shouting for help. They explained they had fallen and said they had been shouting for ages. On checking the unit for a member of staff it was found the senior carer was giving out medications and the second carer on duty for this unit was on their break. The general assistant was with the senior carer who was giving out medications and went to the resident while the senior carer put the medication trolley away to then go and assist. At 10.12am a second resident was observed to be shouting for help. They were observed to be leaning over the side of their chair holding a cup. A member of staff who undertakes the cleaning said this person tends to shout for help most of the time. It was not until 10.30am a carer was observed to go in to the room and remove the cup and speak to the resident after which they became quiet for a while and went to sleep. Whist staff remain caring and supportive towards people living in the home, they also continue to be busy carrying out their work and do not always realise some of these incidents are happening. This can place residents at risk of harm. The staffing arrangements in the home do not appear to allow for staff to regularly walk the floor to check residents who stay in their rooms or those who may wander around the corridors to ensure they are safe and suitably supported when needed. In view of this a new requirement has been issued around staffing arrangements in the home. A fourth requirement made of the service was to ensure all prescribed medication was available for administration. The medicine management was assessed in three of the five units in the home. Six peoples medication was looked at together with their Medicine Administration Record (MAR) chart and some care plans. Two care supervisors were spoken with during the inspection and feedback was given to the manager and the care supervisors. The home had installed a system to check the prescriptions prior to dispensing and to check the dispensed medicines and MAR charts received into the home. Despite communication with the community pharmacy, the MAR charts listed many medicines that were no longer prescribed. The home was active in crossing these out but this resulted in some people having as many as five MAR charts instead of one or two increasing the risk of actually missing the entry to administer a medicine. The quantities of most medicines received had been recorded enabling audits to take place. Not all balances carried over from previous MAR charts had been recorded so it was not possible in these instances to confirm the medicines had been administered as prescribed. On the whole though the majority of medicines had been administered as the doctor intended and records reflected practice. A few errors were seen where staff had recorded they had administered medicines when they had not. The manager had installed a quality assurance system where staff are observed undertaking the medicine round and also tested on their knowledge of the system. These were undertaken every 8 weeks but this system had failed to prevent some of the errors seen. A more robust quality assurance system was discussed with the manager who was keen to implement it. Most medicines prescribed to be administered when required had specific protocols Care Homes for Older People Page 6 of 13 detailing when staff should offer and administer them. Newly prescribed medication requiring such a protocol did not always have one. Without such information it would be difficult for all staff to correctly administer them as the doctor intended. Some daily records and care plans were incomplete so it was not always possible to see why a particular medicine had been administered. All controlled drugs (CD) balances and respective records were correct. The storage was adequate. There was only one CD cabinet for all five units so staff had to walk between units with the CD medicine from the cabinet to the resident. This may increase the risk of an error, if an emergency occurred which required immediate attention as there was nowhere to securely put these medicines whilst being carried from one unit to the next. Medicines requiring refrigeration were stored in a dedicated locked refrigerator. The temperature at the time of the inspection was -2C, but the medicines stored inside were not frozen indicating that the thermometer was faulty. This had not been identified by the manager. Many people had been prescribed medicines to control behaviour, which was cause for concern. Whilst these were not routinely administered it was felt that not all the clinical symptoms had been fully discussed with the doctor to enable him to make an informed judgement. This was supported by a lack of, or, inadequate information in the daily records and care plans records. Some good practice was seen. When one pain relieving patch applied to the skin had fallen off the resident, staff rewrote the MAR chart recording the new dates it should be applied to avoid confusion. The care supervisors and manager spoken with both had a good knowledge of the medicines they administered and also the clinical conditions of the people they looked after. What the care home does well: What they could do better: The quality assurance system must be improved to identify individual staff practice to ensure that all the medicines are administered as the doctor prescribed. Staffing arrangements in the home need to be improved so that staff are available when needed to support the needs of people living in the home. Care plans need to be developed when care needs are identified to ensure staff know how to manage these and people receive a consistent approach to maintaining their care. Care Homes for Older People Page 7 of 13 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 Care plans need to be in 21/08/2009 place for each specialist need including challenging behaviour and be subject to review. This is to ensure all care needs of the resident are met consistently and safely. Target Date of 30/06/08 not met. Remains outstanding. 2 18 37 All accidents and incidents 21/08/2009 which impact on the safety and wellbeing of the residents must be reported to us. This includes those where medical intervention is sought. This is to demonstrate these are being identified by the home and are being acted upon appropriately to safeguard residents. 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 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 9 13 The quantity of all medicines 31/08/2009 received and any balances carried over from previous cycles must be recorded. This is to enable audits to take place to demonstrate the medicines are administered as prescribed 2 9 13 A robust quality assurance 31/08/2009 system must be implemented to assess staff competence in the safe handling of medicines and appropriate action must be taken if staff fail to administer medicines as prescribed or accurately record what they have done. This is to ensure the health of people is appropriately maintained through safe medication management. 3 9 13 The medicine chart must be referred to, before the preparation of the residents medicines and be signed directly after the transaction 31/08/2009 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 and accurately record what has occurred. This is to ensure that the right medicine is administered to the right person at the right time and at the right dose as prescribed and records reflect practice. 4 27 12 The deployment of staff needs to be kept under continuous review to ensure that sufficient staff are available to provide appropriate supervision to meet the assessed needs of the residents. This is to ensure the health and welfare of the residents can be maintained safely and effectively. 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 31/08/2009 1 9 It is recommended that all medicines prescribed on an as required basis have a supporting protocol detailing their use as the doctor intended. It is recommended that additional controlled drug cabinets are purchased and installed in each unit within the home. It is recommended that a new maximum/minimum thermometer is purchased to ensure that the medicine refrigerator temperature readings are accurate to demonstrate that the medicines are stored correctly, in compliance with their product licenses, to maintain their Page 11 of 13 2 3 9 9 Care Homes for Older People 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 stability. 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. 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. 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