Inspection on 13/08/09 for High Oaks

This inspection was carried out on 13th August 2009.

CQC found this care home to be providing an Good 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

High Oaks 22/12/09

High Oaks 17/12/09

High Oaks 26/10/09

High Oaks 03/07/07

High Oaks 05/12/06

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

Random inspection report Care homes for adults (18-65 years) Name: Address: High Oaks Rectory Road Gissing Diss Norfolk IP22 5UU 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: Mark Andrews Date: 1 3 0 8 2 0 0 9 Information about the care home Name of care home: Address: High Oaks Rectory Road Gissing Diss Norfolk IP22 5UU 01379674456 01379677094 info@high-oaks.co.uk 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) : High Oaks Farm Limited care home 18 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Conditions of registration: Date of last inspection Brief description of the care home 18 High Oaks is a registered nursing home providing residential nursing care for up to eighteen residents of both sexes, who have mental health problems. The home also provides short-term care. The current proprietor took over in July 2003, and is using all rooms for single occupancy. Communal areas are in the main part of the home, with bedrooms in a converted single storey extension. The home is in a rural setting, and affords peace and tranquillity for residents. Access to local towns and facilities, requires use of the homes own transport as access to public transport is limited. Specialist support services required are accessed via G.P referrals. Fees range from £875 per week to £1600 Care Homes for Adults (18-65 years) Page 2 of 11 What we found: On arrival for the inspection we found that the morning medicine round was underway with medicines for three people living at the service yet to receive their medicines. The registered nurse on duty confirmed that there is currently no-one managing their own medicines in their rooms however some people sometimes self-administer their own medicines when they arrive at the medicine storage room. This process is supervised by the registered nurse on duty. Following completion of the morning medicine round we looked at current medication charts and found there to be omissions in the records where it could not be determined if the prescribed medicines had been administered. In addition, by this, safe procedures had not been followed because records had not been completed. We found some omissions relating to the morning medicine round on the day of inspection. We asked the registered nurse about this who confirmed the medicines had actually been given and who then completed the records. We later asked the manager about the omissions who was unable to explain them but who said he was aware of some of them because he was conducting audits. During the inspection we conducted audits of medicines available for administration against medication records attempting to account them. We found there to be numerous discrepancies where we could not account for medicines including surpluses and deficits of medicines. We checked many of these discrepancies with the manager who was unable to account for them. We found that the homes system for medicine administration was confusing as medicines were being administered from containers located in storage cabinets and not from the medicine trolley available in the room. It was not always possible to audit trail medicines available. We were concerned to find that there were deficit discrepancies for some medicines such as psychotropic amisulpiride and diazepam tablets. For a recent course of antibiotics we found a surplus of four tablets and so became concerned that records for its administration were being completed when the medicine was not being administered. We asked the manager about a medication record code F where there was no explanation what this meant. The manager was unable to explain this record. We also found medicines where records indicated they were not being administered in line with most recent prescriber instructions. For example, one person prescribed lactulose liquid prescribed 10ml to be taken daily was from the records actually being administered twice daily. Another medicine, an anti-fungal cream, was prescribed for twice daily application but had only been administered once daily for a period of three days. We also noted when looking at current and some previous medication charts that a number of medicines had not been available at the home for administration as scheduled and therefore they had not been given to people as intended by prescribers. This can place the health and welfare of people living at the service at significant risk. We asked the manager about this who said that he was aware the home was experiencing difficulties with the GP surgery when ordering prescriptions. There were no records confirming actions taken by the home to obtain medicines. Care Homes for Adults (18-65 years) Page 3 of 11 When we looked at how medicines of a psychotropic nature prescribed for PRN (as required, occasional use) were being handled by staff, we found that there was no care plan guidance for their use and records did not confirm the reasons for their use and so the home could not justify their use. For one medicine clonazepam 0.5mg tablets the written dose was two tablets up to four times daily when required but from the records this was being given four times daily each day without records justifying its use. The registered nurse on duty said the person is better on two tablets four times daily regularly and that they need to experiment before putting forward the idea to the consultant. The same person was also prescribed psychotropic (and sedative) lorazepam where the manager confirmed there were no written directions or care plan for its use. We also noted some people living at the service who were frequently refusing their medicines. One person was said to have recently been admitted to the home but that the consultant was aware the person was refusing their medicines. However, the manager could not provide records that confirmed that this issue had been raised with the prescriber and action was in place to deal with this. 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 Adults (18-65 years) Page 4 of 11 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 2 13 Prospective residents must 10/07/2009 be appropriately assessed by the service prior to admission to the home. This will ensure that the service can meet the needs of the individuals. 2 6 14 The care plan must contain detailed information about individuals care needs. This will ensure that residents needs are met 22/07/2009 3 14 16 The views of the residents must be sought about their interests and recorded. This will enable them to take part in meaningful and motivational activities. 22/07/2009 4 17 13 All food items should be covered and free from contamination This will prevent the risk of infected food. 22/07/2009 5 20 13 Full and accurate records must be kept for the receipt of all medicines into the home and to people prescribed them. 22/07/2009 Care Homes for Adults (18-65 years) Page 5 of 11 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 This will allow for auditing of medicines within the home and prevent the residents being at risk. 6 20 13 Full and accurate records must be written and maintained for changes in peoples health. This will ensure justification of medical intervention leading to changes in prescribed medicines. 7 20 13 Care plans must accurately reflect and give guidance on current prescribed instructions when medicines are administered at the discretion of the nursing staff. This will ensure justification of continued use. 8 23 12 All staff must receive training 22/09/2009 with regard to safeguarding adults. This will ensure that the residents are protected from abuse. 9 24 23 The smoke room must have a better ventilation system. This will ensure that the smoke does not permeate to other areas of the home. 10 24 23 Proper ash trays should be 23/07/2009 provided in the smoke room. 23/07/2009 22/07/2009 22/07/2009 Care Homes for Adults (18-65 years) Page 6 of 11 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 This will ensure that the residents self esteem is promoted 11 24 23 The accommodation must be 23/11/2009 upgraded. This will ensure that the residents live in accommodation which is homely and comfor table. 12 24 23 Paper towels must be provided in all communal wash areas. This will ensure that the universal precautions in relation to cross infection are carried out and the residents are not placed at risk. 13 24 23 (2) (d) All parts of the home must be kept clean. The premises must be kept in a good state of repair externally and internally. All parts of the home must be kept clean. This will promote self esteem in the residents and their safety. 16 32 18 Staff must receive training 23/11/2009 with regard to mental health conditions and records kept of all training that has been undertaken. This will enable them to meet Care Homes for Adults (18-65 years) Page 7 of 11 23/07/2009 03/07/2007 14 24 23 (2) (b) 15/09/2007 15 30 23 23/07/2009 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 the needs of the residents. 17 33 18 The manager must review 23/07/2009 staffing levels and outline to us how they are adequate to meet the residents needs. This will ensure the needs of the residents are met. 18 37 24 The manager must ensure that there is a system for reviewing the care of each resident provided by the service and maintaining records for this. This will ensure that the residents benefit from a well run home. 19 41 13 The manager must ensure 24/07/2009 that there is a system in place to accurately account for all residents monies held by the home and maintained with receipts for all transactions. This will prevent the residents being at risk of financial abuse. 23/07/2009 Care Homes for Adults (18-65 years) Page 8 of 11 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 20 13 The registered provider must 25/09/2009 put in place effective arrangements at the home to ensure that any omissions in the administration of prescribed medication and the reasons for these are clearly, legibly and promptly recorded, including any necessary actions taken in response to medication not being taken To safeguard the health and welfare of service users 2 20 13 The registered person must 25/09/2009 put in place effective arrangements that ensure the homes auditing procedures and processes accurately reflect the amount of individually prescribed medication available at the home for each service user To safeguard the health and welfare of service users 3 20 13 The registered provider must 25/09/2009 promote and make proper Page 9 of 11 Care Homes for Adults (18-65 years) 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 provision for the health and welfare of service users by ensuring that prescribed medicines for service users in safe control and custody of the home are given in accordance with the doctors instruction as specified by the pharmacy issuing the medicine To safeguard the health and welfare of service users 4 20 13 The registered provider must 25/09/2009 put in place suitable arrangements for the satisfactory completion of medicine administration records in respect of medicines administered to service users by workers at the home in accordance with individual prescription instructions To safeguard the health and welfare of service users 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 Adults (18-65 years) Page 10 of 11 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 Adults (18-65 years) 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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