Random inspection report
Care homes for older people
Name: Address: Harriet`s 119 Main Street Distington Workington Cumbria CA14 5TA two star good 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: Nancy Saich Date: 2 7 0 4 2 0 1 0 Information about the care home
Name of care home: Address: Harriet`s 119 Main Street Distington Workington Cumbria CA14 5TA 01946831166 01946834373 harriets@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Southern Cross Healthcare (Focus) Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 41 Number of places (if applicable): Under 65 Over 65 0 41 dementia old age, not falling within any other category Conditions of registration: 41 0 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 - Code OP (maximum number of places: 41) Dementia - Code DE (maximum number of places: 41) The maximum number of service users who may be accommodated is 41. Date of last inspection Care Homes for Older People Page 2 of 14 Brief description of the care home Harriets is a purpose built home situated in the village of Distington, midway between Workington and Whitehaven. The home has been open for a number of years but is now owned by Southern Cross Healthcare. The Southern Cross group of companies operate a number of care and nursing homes throughout Britain. The home is registered to care for older adults or people who need care because they suffer from dementia. Further information may be accessed from the home or via the Southern Cross website Care Homes for Older People Page 3 of 14 What we found:
We undertook an unannounced random inspection after receiving some information about concerns related to medication and other matters. The lead inspector, Nancy Saich, arrived at the home at 7:45 a.m on the above date and was joined around 9:30 by Angela Branch, pharmacy inspector. They remained in the home until late afternoon. They checked records, met with the manager and staff and spent some time with people who live in the home both individually and in groups. We had also sent out a small number of surveys to staff and residents (10 surveys were sent to each group) as part of our annual checks on services. The residents surveys were returned to us with names and most had been done with the manager. The information on these was limited. We received three staff surveys that had some useful comments that reflected our findings. The main focus of the inspection was on three areas -- the delivery of personal and health care, staffing arrangements in the home and matters relating to management systems. We found matters of concern in all these areas. Both inspectors fed back their concerns to the manager and a number of requirements and recommendations have been made. The pharmacy inspector looked at the handling of medicines by checking relevant documents, storage and meeting with the manager, Mick Adams, and other staff. This inspection took approximately six and a half hours. Overall, we found that the handling of medicines was poor and placed the health and well-being of residents at risk. What the care home does well: What they could do better:
We looked at records for receipt, administration and disposal of medication and these were poor leaving residents at risk of medication errors. Records for administration of medicines contained mistakes. For example, one record was signed four times a day for nearly three weeks for a medicine that was only prescribed three times a day. This suggested that they had received an incorrect dose. The disposal of some medicines was
Care Homes for Older People Page 4 of 14 poorly recorded so that some were unaccounted for. We were concerned about the arrangements for administration of medicines to residents who go out. We looked at one recent occasion and the records made at the time suggested that the resident did not receive the medication that was important for maintaining their health. We did a stock check of a sample of medicines and this showed that on occasions medicines were not given as prescribed. For example, courses of antibiotics were not completed leaving residents at risk of infection. We also saw that a resident received morphine three times in one day when they should only have received it twice. We looked at a sample of care plans for management of health care. Many of these gave little, and often no, information on the management and monitoring of health care issues. This means that staff did not have adequate information to ensure that residents health was managed well. For example, we noted that a doctor had requested that staff monitor a resident for symptoms of an under-active thyroid. There was no care plan in place for this and when we asked a member of staff what symptoms they would look out for they did not know. In another case a resident on a blood-thinning medicine had no care plan for this. This means that staff did not have any guidance for monitoring for adverse effects and for managing safely the frequent dosage changes that are needed. We also saw that staff did not always follow care plans. For example, the care plan for a diabetic said that blood sugars needed to be checked twice a week but this had only been done once in the previous four weeks. There was also poor follow-up of concerns. We saw that a doctor was to prescribe a cream for itch but more than a week later this had not been received or followed-up leaving the person exposed to an uncomfortable skin condition. We saw that some medicines ran out so residents went without the treatment needed to keep them well. This included a blood-thinning medicine, antidepressants and painkillers. The daily record for one resident who went without their pain killer said on the second day ... very distressed today due to having no pain killer. We checked the controlled drugs. A stock check was in order. However, the controlled drugs cabinet was not attached to the wall as required by the regulations. This must be addressed and a requirement will be made at the next inspection if it does not comply. The service maintained a controlled drugs register but some entries were inaccurate especially in relation to the date of administration of medication. Medicines storage was cramped. The medicines fridge was too cold with a temperature of -3c at the time of the inspection. Records showed that it was below freezing on three further occasions in the previous ten days which could affect the effectiveness and stability of the medicines stored there. We were told that a new fridge was on order. The manager was doing regular audits of medication. However, these need to be more thorough so that concerns are identified and managed without delay to keep residents safe. The extent of the issues raised at this visit show that all staff who administer medication and deliver health care tasks must be trained appropriately and must be assessed as competent in the tasks. We did not look at initial assessment or preadmission arrangements in any great depth but we did meet with one person who had been admitted as an emergency admission a year ago and whose care had only recently been reviewed. We questioned whether the
Care Homes for Older People Page 5 of 14 initial assessment had been appropriate given the needs of this person. There was no social work assessment to be found in the building for this resident. After speaking briefly to this person we judged that the home had received insufficient information related to their needs and had not supported this person to be given their rights. Both inspectors read a number of care plans and met with the people themselves. Each person had a care plan but we did not meet anyone on the day who had read their care plan or who felt that their wishes were central to the planning. We read care plans that had insufficient information about a range of needs and wishes. Some care plans had not been evaluated appropriately and some had gaps that related to things that concerned the person themselves or affected their health and well-being. We had enough evidence to judge that staff in this home did not understand the care planning process. Several people had assessed needs that were not addressed in their care plans. The manager said that he would do further training with people on care planning. Care plans were under review but we judged that fundamental problems in the care planning process were not being addressed. Staff said they did not read the care plans on a regular basis. People in the service do see their G.Ps and the district nurses visit regularly. We did note that staff were not fully aware of some peoples health care needs. For example they had scant knowledge of a specific disorder and were unsure of the needs of people with mental illness. Some care plans were not detailed enough about dementia, heart disease, kidney problems or nutritional needs. Staff had limited knowledge of nutritional planning and no one had received training on this. Again the manager said this training was planned. We asked for and received four weeks worth of rostered hours for March. We also spoke to residents and staff and had some other feedback from interested parties about staffing levels. We saw that there were some shifts where staffing levels were low and that sometimes staff worked a lot of hours in the week. We judged that sometimes staffing ratios were not sufficient given the number of people with manual handling and personal care needs and given the layout of the building. We were also concerned about staffing levels because a number of people had some form of dementia. The mix of skills and experience on each shift was insufficient to make up for the problems with training and care planning and care delivery. We require Southern Cross to look at skills mix, ratios and deployment of staff in this home. We checked on some recent recruitments. We found one person working who had not had an up to date Criminal Records Bureau check, two people where references had not been sought from their previous employer and one person working with only one reference from a personal friend. We make a requirement about checks and a recommendation that the manager receives training in recruitment and selection. We also noted that new staff received the full induction in one day. There is too much information in the company induction for any person to understand their work role in one day. Induction training needs to be done properly in this service. We noted that at least one person left in charge of the home had not attended manual handling, fire safety or safeguarding training. We observed one member of staff trying to work with a person with dementia and poor mobility. This carer had not received manual handling training and had not attended dementia awareness training. Uptake of training on dementia and challenging behaviour was extremely poor (around 19 ) but a number
Care Homes for Older People Page 6 of 14 of people have these needs and can challenge the service. Care planning does not meet the needs of these residents. We want the company to ensure that they reach their staff training targets and that they make sure that staff atttend mandatory training. We also had some evidence from listening to staff and from comments made by service users and from other more anecdotal sources that would point to a need for staff in this service to undertake some training on person centred thinking and on core values, equality and diversity and on residents rights. One resident told us that they felt that there were a lot of rules and regulations in the home and another felt kept in the home against their will. We make a recommendation about this and ask that Southern Cross explore the attitudes and approaches that are part of the culture of this service. This service does have a manager in post but he is yet to register with the Care Quality Commission. We judged that we have allowed this matter to continue for some time but now expect southern Cross to deal with this. A manager must be registered with us as soon as possible. This home has a large volume of paper records but we judged that these systems were not bringing about efficiency or smooth operation of management systems. We also discovered that when new forms were introduced staff were not using them. For example bathing records showed infrequent bathing but staff said they did bath people regularly. This cant be proven as the recording was poor. We want the company to review their recording procedures and look at smart ways to help management and staff use records succinctly and appropriately. Training and competence checks for manual handling are out of date and a number of manual handling risk assessments and plans need to be updated. We want Southern Cross to deal with this breach of regulation as soon as possible. Fire drills and instructions have not been carried out at the frequency required by the fire service. We want the company to ensure that a robust system is used to check that staff receive drills and instruction during their working hours so that they understand what to do in a fire situation. 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 7 of 14 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 8 of 14 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 3 14 Full assesments must be 18/06/2010 carried out prior to admission of any new service user. This must be done by an appropriately trained person. This must be done to lessen the risk of inappropriate admissions that may lead to people being accommodated who do not need lengthy stays in residential care. 2 7 15 Care plans must be completed accurately after consultation with individual service users. This must be done so that people in the service receive suitable levels of care and support that reflect their needs and wishes. 18/06/2010 3 8 12 Suitable arrangements must 18/06/2010 be made to ensure that residents receive appropriate health care at all times. This must include nutritional planning. Care Homes for Older People Page 9 of 14 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 This must be done so that people receive good health care support and have appropriate nutrition. 4 9 13 Medicines must be given in the prescribed dosage. This must be done to ensure that residents receive safe and effective treatment. 5 9 13 All records for receipt, administration and disposal of medication must be accurate and free from errors. This must be done to protect residents from mistakes that could cause harm to their health and well-being. 6 9 13 Ordering procedures for 01/06/2010 medication must be reviewed to prevent medicines from running out. This will ensure that residents always have the treatment they need. 7 9 19 All staff who administer 01/06/2010 medication and perform health care tasks must be suitably trained and must be assessed as competent in the tasks. This must be done so that staff can deliver health care tasks in a safe and appropriate manner. 8 27 18 Southern Cross must ensure 18/06/2010
Page 10 of 14 01/06/2010 01/06/2010 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 that there are enough qualified, competent and experienced staff on duty at all times. This must be done to meet the care needs of people who live in the service. 9 29 19 The registered provider must 18/06/2010 ensure that staff do not have access to vulnerable people before all background checks are in place. This must be done to ensure that only staff who have suitable backgrounds are employed to work in the home. 10 30 18 All staff in the service must receive a full induction and attend the manadatory training set out by the company and must also attend training suitable to their job role. This must be done to lessen risk to staff and residents and to ensure that staff deliver appropriate care and services to vulnerable people. 11 38 13 The arrangements for 18/06/2010 moving and handling both people and objects must be reviewed. Appropriate training must be given and staff involved must have their competence checked by a person trained to do so.
Page 11 of 14 18/06/2010 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 This must be done to keep people safe and comfortable when being moved and to ensure good health and safety practices are in place. 12 38 23 The systems in place for delivering fire instructions and fire drills must be reviewed. This must be done to ensure that staff receive drills and instructions that allow them to deal with a fire situation. 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 18/06/2010 1 9 It is recommended that the manager undertake more thorough checks, or audits, of medication so that risks are identified and managed without delay to keep residents safe. It is recommended that arrangements for medication are reviewed for residents who have social leave so that they can take their medicines safely and at the correct time. It is recommended that Southern Cross consider steps they need to take to ensure people are treated with dignity and respect. This might include person centered thinking training and further work with the staff group on rights, dignity and equality. It is recommended that a review of the approach to recording is made so that the entire team understand how to record simply and efficiently to reflect the work that has gone on in the home. It is recommended that the manager and any other senior
Page 12 of 14 2 9 3 10 4 17 5 19 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 person involved in recruitment receive training in equal opportunities recruitment and selection. Care Homes for Older People Page 13 of 14 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 14 of 14 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
