Inspection on 18/01/10 for Gillibrand Hall Nursing Home

This inspection was carried out on 18th January 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Gillibrand Hall Nursing Home 11/03/10

Gillibrand Hall Nursing Home 02/06/09

Gillibrand Hall Nursing Home 02/07/07

Gillibrand Hall Nursing Home 03/05/06

Gillibrand Hall Nursing Home 03/02/06

Gillibrand Hall Nursing Home 04/08/05

Gillibrand Hall Nursing Home 31/01/05

Gillibrand Hall Nursing Home 19/08/04

Extracts from inspection reports are licensed from CQC, this page was updated on 14/03/2010.

Random inspection report Care homes for older people Name: Address: Gillibrand Hall Nursing Home Folly Wood Drive Chorley Lancashire PR7 2FW one star adequate service 02/06/2009 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: Denise Upton Date: 1 8 0 1 2 0 1 0 Information about the care home Name of care home: Address: Gillibrand Hall Nursing Home Folly Wood Drive Chorley Lancashire PR7 2FW 01257270586 01257232989 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Century Healthcare Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 50 Number of places (if applicable): Under 65 Over 65 0 50 0 dementia old age, not falling within any other category physical disability Conditions of registration: 50 0 50 The registered person may provide the following category of service only: Care home with nursing - Code N. 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 - Code OP. Dementia - Code DE. Physical disability Code PD. The maximum number of service users who can be accommodated is: 50. Date of last inspection 0 2 0 6 2 0 0 9 Care Homes for Older People Page 2 of 13 Brief description of the care home Gillibrand Hall is a listed building, set in its own grounds, within a residential area close to Chorley town centre. Public Transport does serve the area nearby and the home is now accessible via the new Gillibrand north estate. The home provides care for up to fifty residents of either sex that have nursing and/or personal care needs. At the time of the site visit, forty-two people were living at the home. Accommodation is set on two floors. Currently, the ground floor offers accommodation for residents who require nursing or personal care and the first floor for residents who suffer from dementia. The first floor is served by a passenger lift . A number of rooms are equipped with en-suite facilities and both floors have enough communal space. Residents have use of an enclosed courtyard, and garden areas to the front of the building, both of which are furnished with appropriate garden furniture. Information about the facilities and services provided can be found in the homes Statement of Purpose and Service User Guide. The current fees for residential accommodation at Gillibrand Hall range from £435:00 per week to £686:50 per week. Care Homes for Older People Page 3 of 13 What we found: This unannounced, random inspection site visit to Gillibrand Hall Nursing Home was undertaken by the lead inspector and a pharmacist inspector. The visit in total, lasted for a period of just over eight hours. We spoke with the Managing Director of the company, the acting manager at the home and several members of the qualified staff team. Discussion also took place later in the visit, with the Director of Nursing. We also looked at a number of records relating to care planning, staff recruitment and medication practices. At the last key inspection that took place in June 2009, these three key areas were identified as requiring improvement. This random inspection visit was to establish how much progress had been made. At this site visit we looked at the care records of eight people living in at the home. This included some people accommodated in the dementia care unit. An individual plan of care is generally developed for each area of need. However we found some inconsistencies. Although the majority of individual care plans were detailed and clearly informed staff of the specific needs of that particular person and how those needs were to be met, other care plans were less well developed and did not really advise staff of how to address an identified need. For example, one care plan evidenced said, All staff to be aware of the symptoms ***** may experience, but did not go on to say what these symptoms were or what staff should do if these symptoms were noted. Another individual care plan for the same person said, Everybody to be supportive and sympathetic towards **** but again gave no details of how the support and sympathy could be best offered. In respect of somebody else the social needs care plan said, Needs encouragement to join activities. There was no instruction about what activities the resident may actually enjoy, what activities the resident was to be encouraged to join in with or how staff were to encourage this person. This sort of detail promotes, good person centred practice and gives specific guidance to staff. Without this sort of detailed information, care planning remains generic and lacks a person centred focus. This can lead to an inconsistent service with the social care needs and requirements of the individual being unmet. In another instance, although there appeared to be a evidence in the daily diary notes of a recent, possibly recurrent health condition that could be linked to some previously recorded episodes of a similar condition, there was no specific care plan in place. Similarly there was clear evidence from documentation completed by staff at the home that at least one person suffered from auditory hallucinations. Again there was no care plan in place to advise staff how to respond to these episodes or how best to support this particular resident during these periods. For another person, there was clear documented evidence that this person may experience depressive episodes or try to harm themselves but again there was no care plan in place advise staff what to do if they were concerned, or what triggers may suggest medical intervention was required. These are important issues that has potential to seriously impact on the well being of the individual resident. Care must also be taken in the words used when writing, reviewing or amending care plans. One care plan in respect of mood and emotion gave specific information about a particular resident. This mood and emotion care plan had been reviewed some months Care Homes for Older People Page 4 of 13 later and the written review information suggested that there had been a deterioration in mood and emotion. However through discussion with the acting manager, it appeared that any changes had been minimal. If this was the case, the review record should have reflected this. The individual person centred approach that was been provided in the home was not always supported by a specific care plan. For example, for one person the family had written a pen picture that included information that this resident enjoyed mass/communion and would welcome visits from the priest from her old church. Through discussion with the acting manager at the home, it was clear that the religious care needs of this lady were being met as requested, but there was no actual care plan in place to support this good practice. Several of the care records evidenced, incorporated a social care needs assessment format, however in the majority of cases this had not been completed. Consequently no care plan had been developed. When a social care needs plan had been developed these were generally good and advised staff how the specific social care needs of that person could be met. It appeared that although staff had been provided with documentation to ensure that assessed needs could be addressed through an appropriate care plan, staff were not necessarily using the documents provided in a consistent way. The social, religious and cultural care needs of each individual resident do matter and if not addressed, can seriously effect the quality of life for that person. It is important that these inconsistencies in care planning arrangements are addressed. The well developed care plans seen were good and provided detailed information and instruction for staff to follow. All care plans pertaining to each area of assessed needs or requirements, should be developed to the same high standard. Where a strength or need has been identified through the assessment process, whether this be associated with a medical, mental health, personal care, social, religious, cultural or any other identified need associated with that specific individual, a care plan should be in place so that all staff have clear guidance, as to how best to meet that need. Generally there was evidence that care plans are reviewed on a monthly basis, so that the information remains current and up to date. It is important that each individual element of the care plan and risk assessments are reviewed individually on a monthly basis and can be evidenced as such. However of late there has been some slippage with regard to the timing of reviews. This in part was a direct result of the registered managers post becoming vacant. For the present, a temporary manager has been appointed who is keen to make sure that the automatic monthly review of care plans takes place as recommended. It was noted that a number of records completed by staff had not been signed or dated or alternatively signed but not dated or dated but not signed. It is important that who ever write or amends a record or care plan or risk assessment takes ownership of the recording so that a clear audit trail can be made. It was also noted that in the early afternoon period in the dementia care unit, there were only two people on duty. We were told by the senior person working in that unit, that the other two member of staff assigned to work in the unit were taking their break together. Consideration should be given to staggering staff breaks so that more than 50 of staff assigned to the unit are actually working in that unit at any one time. This would help to keep people living in the unit safe, and help to make sure that assessed needs were being met. As part of the visit a pharmacist inspector looked at how medicines were being handled. Care Homes for Older People Page 5 of 13 We check a sample of medicines records and stock and spoke with several members of staff. Overall we found medicines were not always being handled safely because staff were not following the policies and procedures of the home. We found records of medicines received into home were not always complete. Two people that were currently on respite care had no records of the quantities of medicines that had been brought into the home so it was not possible to fully account for them. Medicines that needed to be carried forward to a new monthly cycle were not clearly recorded and one person went without two of their medicines because staff had thrown their supply away. We found some medicines to be out of stock because the re ordering system was inefficient, this meant some people went without important medicines for several days. Although we saw some improvements in the records of medicines given we continued to see unexplained gaps and on the day of the visit several medicines had been given that morning but the records had not been properly completed. We also saw some records incorrectly dated because staff had not checked them properly. Poor record keeping of medicines can lead to serious mistakes that can affect the health and wellbeing of people who live in the home. We looked at the times medicines were given and found some medicines were not being given at the right and best time. Medicines that should have been given before food were often given after food because the medicines round had not been properly organised. One current course of strong antibiotics that should have been given before food was being given wrongly after food. Giving medicines at the wrong time can stop them work properly and so affect peoples health and wellbeing. We looked at how liquid medicines were handled and found some mistakes that showed they were not always being given correctly. One medicine used to help a persons agitation had no information about how and when it was to be used and our checks showed it had been given at five times the prescribed dose on one occasion. We also found the stock did not add up for the last month showing it had probably been given at the wrong dose on numerous other occasions. The acting manager told us all liquid medicines were thrown down the sink when they were no longer required, this is not legal because all medicines should be properly disposed of by a special waste management company. We checked some other liquid medicines and found they did not add up showing they might have also been given at the wrong dose. We checked a further sample of boxed medicines and found some did not add up showing they had sometimes been missed. One controlled drug (a strong medicine that can be misused) used for pain was given to a person two days late, which could have resulted in them suffering unnecessary pain. A laxative powder used for several different people did not add up showing staff had signed the records but not given it. Records of external medicines such as creams and nutritional supplements were not always complete so we could not be sure they were being used properly. The acting manager agreed that these records were not always accurate so we discussed how improvements could be made. We checked the care plans of several people that refused their medicines on a regular basis and found their mental capacity had not been properly considered. Paperwork to support this was not always completed and some of the information was out of date because it had not been properly reviewed. We gave some advice to the managers about how to improve this because failing to consider peoples mental capacity correctly can result in their rights not being fully protected. Care Homes for Older People Page 6 of 13 We looked at how the managers made sure staff were competent and made sure medicines were being handled safely. The last medicines audit (check) we saw was carried out over six months ago even though it was expected to be done every other month. Managers told us that staff had been formally assessed as competent but the paperwork to support this was not available on the day. Staff had all received some medicines handling training about a year ago. Given the number of mistakes found at this visit it was evident that competency checks and medicines training need to be repeated as soon as possible. At the last key inspection it was noted that one recently appointed member of staff had been allowed to take up their employment at the home without the required number of suitable references being received. This appeared to be an over site in an otherwise robust system of staff recruitment. On this occasion we looked at the staff files of the five people that had been recruited to work at the home since the last key inspection in June 2009. All the required references and clearances had been obtained and deemed to be satisfactory before the member of staff had taken up their employment at the home. This helps to keep people living at the home safe and to ensure that only suitable people are appointed. We also looked at staff training to establish if staff had been provided with recent health and safety training. There was clear evidence that all staff are to receive planned infection control training and manual handling training in February 2010 and planned food hygiene training in March 2010. This important training helps to protect both residents and staff. What the care home does well: What they could do better: A care plan should be developed for each area of identified need. This would make sure that staff had clear written guidance on how to meet that specific need. All care plans should be of the same high quality so that a consistent service is provided. Staff should take care to ensure that written records actually reflect the current situation for that particular individual. All individual care plans and risk assessments should be reviewed on at least a monthly basis to make sure that the information remains current. All records should be signed and dated by the person making the entry in order to take ownership of the recording. Medicines must be given to people as prescribed because receiving medicines at the wrong time, wrong dose or not at all can seriously affect a persons health and wellbeing. Records of medicines received into the home, given to people and disposed of must be Care Homes for Older People Page 7 of 13 clear, accurate and complete so that all medicines can be fully accounted for. Staff competency in giving and recording medicines should be regularly assessed to help make sure they have the necessary skills. Care plans and supporting paperwork should have detailed information about how when required medicines should be given to people to help make sure they are used properly. Procedures and paperwork should be improved to help make sure peoples mental capacity is properly considered at all times. Medicines must be disposed of safely according to the law to help prevent mishandling and misuse. 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 £ 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 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 Records of medicines 24/02/2010 received into the home, given to people and disposed of must be clear, accurate and complete. This will help make sure all medicines can be fully accounted for. Medicines must be given to 24/02/2010 people as prescribed. This is important because receiving medicines at the wrong time, wrong dose or not at all can seriously affect a persons health and wellbeing. Medicines must be disposed of safely according to the law. This will help prevent mishandling and misuse. 24/02/2010 2 9 13 3 9 13 4 15 15 When ever an assessed need 24/02/2010 is identified, whether this be at the pre admission stage, through the review system, Page 10 of 13 Care Homes for Older People 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 or if particular concerns come to light through comments/observations noted in the daily dairy notes, an appropriate care plan should be in place for that particular area of need. This would ensure that all staff had the same written guidance on how to address that specific need in a consistent way. 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 9 Care plans and supporting paperwork should have detailed information about how when required medicines should be given to people. This will help make sure they are used properly. The competency of staff when handling medicines should be regularly assessed to help make sure medicines are handled safely. Procedures and paperwork should be improved to help make sure peoples mental capacity is properly considered at all times. All care plans for each area of need should be of the same high quality that incorporates clear guidance to staff as how to address that specific need so that a consistant service is offered. It is important the the monthy review of all individual care plans and risk assessments recommences as soon as possible. Care should be taken to to make sure that written records actually reflect the current situation for that particular Page 11 of 13 2 9 3 9 4 15 5 15 6 17 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 individual. 7 17 All records should be signed and dated by the person making the entry in order to take ownership of the recording. Consideration should be given to staggering breaks so that more than 50 of the staff assigned, are actually working in the dementia care unit at any one time. 8 18 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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