Inspection on 20/10/09 for Gildawood Court

This inspection was carried out on 20th October 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Gildawood Court 13/07/09

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 23/04/2009 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: Sandra Wade Date: 2 0 1 0 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 are Care Homes for Older People Page 2 of 12 1 3 0 7 2 0 0 9 Brief description of the care home enclosed gardens for people to use as they wish. There is parking available to the front and far end of the building. The home is divided into five units, which accommodate eleven, twelve or thirteen people in each. Each unit has a lounge and dining area which is fitted with a kitchenette and there is hairdressing room which all units can access. 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 six bathrooms and two of these have assisted facilities to help people in and out of the bath. There are also five walk-in shower rooms. There is a large activity room which is used for people who visit the home for day care and this can also be accessed by people who live in the home if they wish. 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 over two floors, is spacious and has a passenger lift to allow for easy access by wheelchairs. At the time of they key 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 12 What we found: This inspection was carried out to confirm that the home had complied with two Statutory Requirement Notices issued to them at the last inspection. These notices were issued due accidents and incidents not being reported to us as they should and for not ensuring suitable plans of care being were in place for people with specialist health care needs such as challenging behaviour. We also checked compliance with requirements made at the last inspection in relation to the deployment of staff and management of medication. This inspection confirmed that both the Statutory Requirement Notices and the Requirement on the deployment of staff had been met. One Requirement in relation to auditing staff competence in administering medication had not been met. This inspection was carried out between 9.15am and 5.10pm by two inspectors and also included a inspection of medication by a pharmacist inspector. Discussions were undertaken with the Manager and staff working in the home. People were observed in communal areas and various records were viewed. These records included care plans and their associated documentation, duty rotas, staff diaries and 24hour handover reports, accident and incident records and medication records. Following the last inspection a number of incidents had been reported to us following challenging behaviour that had occurred between people living in the home. Two people in particular were regularly involved in these incidents. Action had been taken by the manager to arrange for a review of the care needs of these people which resulted in them being reassessed by a pschogeriatrician. We were told that these people have recently been reallocated to a more suitable environment where their care needs could be met more effectively. A number of other incidents that had been reported to us were followed up during this inspection to check that the actions stated had actually been carried out. One person for example was identified to smoke and could become aggressive if they wanted a cigarette and this was not given. Care plans in place confirmed that action had been taken to change the care regime of this person following a number of challenging behaviour incidents. The changed regime included the person being offered a cigarette on rising in the morning to prevent any trigger of their inappropriate behaviour. Records showed that since this change had been implemented there had been a significant reduction of incidents. Staff spoken to were aware of the need to ensure this person was provided with cigarettes and knew where to locate them. One member of staff was not aware of the content of the care plan and how this behaviour should be managed. Information they told us was not in keeping with instructions in the care plan. This was discussed with the manager with a view to ensuring care staff know what information is held within care plans so they can ensure a consistent approach is adopted in meeting the care needs of people. A person whose challenging behaviour had increased due to their progressed dementia was being closely monitored by staff. Incidents that had occurred had been recorded and Care Homes for Older People Page 4 of 12 reported to us. Staff stated that half hourly checks of this person were being carried out in an attempt to prevent any onset of their challenging behaviour. Records in place showed that these checks were being done. The manager was able to confirm plans to further reduce the triggers of this behaviour and prevent any possible challenging behaviour towards other people living in the home. A person living in the home was observed to have red and swollen limbs. Care records were detailed in recording how these should be managed and monitored. This person had also sustained additional wounds including a skin tear. A suitable short term care plan has been developed for this. Body charts were in use showing the location of the wounds and the dates these had been identified. Risk assessments had also been completed showing areas of risk such as poor nutrition which could impact on the healing process of these wounds. Actions were clearly identified for staff to follow to manage these risks. Although good care plans had been developed for the person with swollen limbs, we found on speaking to staff that they were not always aware of what was contained in them. For example staff were not aware of what the medical problem was for this person although they knew the district nurse visited them to apply dressings and provide any treatment necessary. Staff were also not aware of the frequency of visits that were made or how often dressings should be changed. In one case the person had refused to see the district nurse resulting in their dressing not being changed. There were no clear records in place showing what had been agreed with the district nurse in terms of following this up. Care records stated the nurse will visit two to three times per week but records of visits undertaken showed this not to be the case. Care records therefore did not reflect the care arrangements in place. Staff were completing daily records each day but these did not always report on the persons health and the staff support provided in relation to the care needs identified. It was therefore difficult to know if the persons health was improving, staying the same or deteriorating. This information is important so that staff can promptly identify when medical support may be needed. We were told by the manager that all of the care plans had been updated and were being monitored on a monthly basis. Senior care staff had received training on the completion of these but the care staff were still to receive this training which was planned in the next few months. The manager also confirmed that it was her expectation that staff should be clear on the care needs of the people they care for and have a knowledge of what is contained within the care plans. She agreed to follow up this matter. The manager said that the staffing arrangements for the home were still under review but since the last inspection they had employed more staff and the assistant managers were spending more time on the units to support the staff. We were told that there are usually between ten and eleven care staff working in the home and on a good day there are twelve staff. The manager confirmed that it has been approved that twelve staff can be made available to support people and they were working to ensure these numbers were maintained. On visiting each of the units we found two carers were working on each unit. Three of the units confirmed they had received the additional support of a senior carer who had been allocated as the co-ordinator. This member of staff was described as floating around Care Homes for Older People Page 5 of 12 the units to provide support where needed. Staff on one unit said that the senior carer had helped to get someone up during the morning and complete the medication round. Staff on another unit said the senior carer had popped in to check they were ok but stated they had not had any problems. Staff allocation to the units is recorded on a white board in reception each day and we found this to be accurate in regards to staff available on those units visited. This information is not retained so the home has no audit trail to demonstrate how staff are deployed in supporting the units each day. Although we were told that the assistant managers are spending more time on the units, this could not be demonstrated through the duty rotas. Some staff said that there had been more of a presence on the units! by the Assistant Managers but others had not made this observation. The manager said that staffing arrangements were still to be discussed with the provider and she would address the issue of records showing how staff are deployed across the home. On the day of inspection there were no incidents of concern observed and there was a calm atmosphere across the home. The pharmacist inspection lasted four hours. 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 eight 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 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 Care Homes for Older People Page 6 of 12 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 a person living in the home, 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: Daily records should demonstrate that care needs are being met and are being monitored where appropriate to maintain the health of the person. Care staff need to have a good awareness of information in care plans so that they know what peoples needs are and how these are to be met. Duty rotas need to demonstrate how staff are deployed across the units each day so that it is clear there are sufficient staff to support people effectively. Where people have wounds or infections and require short term care plans, records need to clearly demonstrate when these have healed or cleared so that it is clear no further staff interventions are needed. Medical histories should be fully considered as part of the care planning process to ensure people receive effective and appropriate care. Where people receive support from outside professionals there needs to be clear records Care Homes for Older People Page 7 of 12 in place about what treatment plan has been agreed and records need to demonstrate this treatment plan is being followed. The quality assurance system for medication management must be improved to identify individual staff practice to ensure that all the medicines are administered as the doctor has prescribed. 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 12 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 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. Care Homes for Older People Page 9 of 12 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 medicine chart must be referred to, before the preparation of the service users medicines and be signed directly after the transaction and accurately record what has occurred. This is to ensure that the right medicine is administered to the right service user at the right time and at the right dose as prescribed and records reflect practice 30/11/2009 2 9 13 The quantity of all medicines 30/11/2009 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. Care Homes for Older People Page 10 of 12 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 7 Daily records should demonstrate that care needs are being met and are being monitored where appropriate to maintain the health of the person. Care staff need to have a good awareness of information in care plans so that they know what peoples needs are and how these are to be met. Where people have wounds or infections and require short term care plans, records need to clearly demonstrate when these have healed or cleared so that it is clear no further staff interventions are needed. Medical histories of people should be fully considered as part of the care planning process to ensure people receive effective and appropriate care. Where people receive support from outside professionals there needs to be clear records in place about what treatment plan has been agreed and records need to demonstrate this treatment plan is being followed. 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 temperatures readings are accurate to demonstrate that the medicines are stored correctly, in compliance with their product licenses, to maintain their stability. Duty rotas need to demonstrate how staff are deployed across the units each day so that it is clear there are sufficient staff to support people effectively. 2 7 3 7 4 7 5 8 6 9 7 9 8 9 9 27 Care Homes for Older People Page 11 of 12 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 12 of 12 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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