Inspection on 22/12/09 for High Oaks

This inspection was carried out on 22nd December 2009.

CQC found this care home to be providing an Poor 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

High Oaks 17/12/09

High Oaks 26/10/09

High Oaks 13/08/09

High Oaks 03/07/07

High Oaks 05/12/06

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

Random inspection report Care homes for adults (18-65 years) Name: Address: High Oaks Rectory Road Gissing Diss Norfolk IP22 5UU zero star poor service 08/06/2009 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: Mark Andrews Date: 2 2 1 2 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 2 6 1 0 2 0 0 9 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 10 What we found: We conducted this inspection to monitor compliance with the statutory requirement notice issued 25th September 2009 following the inspection of 13th August 2009 where medication issues of concern were identified. The statutory requirement notice had requirement timescales of 14th October 2009. We looked at medication-related records as far back as 23rd November 2009 during this inspection to determine if the service was now compliant with the notice. We also looked at arrangements for the storage, administration and disposal of medicines during this inspection. The home arranges peoples medicines on named shelves in two cabinets within the medicine storage room and back up supplies are kept in the medicine trolley within the room. Medicine refrigerator temperatures are monitored and recorded on a daily basis. We found temperatures had recently been within the accepted temperature range. At the time of inspection empty monitored dosage system (MDS) containers from the previous 28-day cycle were on the floor of the room. The home has a large medicine disposal bin for the disposal of medicines. The manager later showed us the inner containers of the MDS containers which were located in the medicine disposal container from the previous cycle. At this time some medicines remained in the inner containers which had not been removed for their proper disposal into the waste medicine container provided. At the time of arrival for inspection the registered nurse on duty informed us the morning medicine round was underway and that there were two people yet to receive their medicines the morning of inspection. For others said to have already received them we found when we looked at medication charts that all medicines had been recorded as administered except paroxetine 20mg tablet scheduled for one person. The registered nurse, when asked, said that the medicine had been administered to the person. Later during the inspection when we were discussing our findings of the inspection with the manager, the manager identified an error that had occurred during the morning medicine round whereby a medicine scheduled for lunchtime administration had been given to the person in the morning. The registered nurse, when asked by the manager, confirmed that they had given the person the medicine in error. The registered nurse went on to describe the pressure they had been under earlier during the morning medicine round and claimed that the medicine dosage system containers are misleading. During the inspection we conducted audits of peoples medicines available for administration against relevant medicine records attempting to account for them. We again found there to be a significant number of discrepancies where we could not account for medicines. The discrepancies were both numerical surpluses and discrepancies of medicines. We found there to be some medicines where there was no auditing system in place, some where their receipt into the home had not been recorded or where there was lack of clarity of the number of medicines received. We showed the manager the discrepancies we identified and asked her to check them. The manager agreed there were discrepancies. The manager said that when people go on social leave from the home nursing staff record D on the medicine charts however there was a problem in that it was unclear if the medicine had been provided to the person or their representative for administration whilst away from the home. The manager also said that she believed some medicines had been ordered and received into the home for periods of social leave but Care Homes for Adults (18-65 years) Page 3 of 10 that they may not have been recorded. Where we identified medicine discrepancy surpluses the manager showed us some inner MDS containers which were located within the medicine disposal bin where medicines remained in the containers where nursing staff had completed medicine chart records as if the medicines had actually been administered. The manager showed us the homes own internal audit of medicines where a number of discrepancies were shown including some we had identified. The manager said that the audit was currently being undertaken only once weekly by a nurse who had volunteered to undertake this function. We were unclear what actions had been taken if any following the identification of discrepancies. We again looked at how the home handles medicines of a psychotropic nature prescribed for PRN (as required, occasional) use. We found that for most such medicines there was not clear written guidance in place so we could not identify when it was appropriate to administer them to individuals living at the home. The manager confirmed that there was a lack of written information for staff for the use of such medicines. We checked documents relating to peoples documentation around psychological behaviour and found there was a lack of written guidance on the use of psychotropic medicines or nonmedicinal interventions to attempt prior to administering the medicines. For one person, we were told they ask for their PRN psychotropic medicine but there was no written plan around this. We also audited a sample of records for people who had recently been administered PRN psychotropic medicines and found by examination of the reverse of medicine charts, daily handover files and individual daily care records that the circumstances surrounding the administration of such medicines was frequently not being recorded so it was not possible to determine if their use was appropriate at all times. For others, records indicated that the medicines were being used in a variety of circumstances such as for one person, aggressive outburst and agitation, felt uneasy on separate days. For another person we identified from records that a psychotropic medicine prescribed for PRN use was being administered twice daily as a matter of routine and there were no additional recorded reasons for its administration. When we discussed this with the manager, she agreed that this was of concern but said that she was hopeful the medicine would be reviewed by the prescriber to that of regular use. 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 10 Care Homes for Adults (18-65 years) Page 5 of 10 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 6 14 The care plan must contain detailed information about individuals care needs. This will ensure that residents needs are met 22/07/2009 2 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. Care Homes for Adults (18-65 years) Page 6 of 10 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 Action must be taken to put 19/02/2010 in place effective arrangements that ensure the homes auditing procedures and processes accurately reflect the amount of individually prescribed medicines available at the home for each service user To promote and make proper provision for the health and welfare of service users 2 20 13 Action must be taken to ensure medicines prescribed for PRN (as required, occasional) use are only administered when it is clinically justifiable. This must be demonstrated by record-keeping practices To promote and make proper provision for the health and welfare of service users 19/02/2010 3 20 13 Action must be taken to put in place suitable arrangements for the satisfactory completion of 19/02/2010 Care Homes for Adults (18-65 years) Page 7 of 10 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 medicine administration records in respect of medicines administered to service users by workers at the home in accordance with individual prescription instructions To promote and make proper provision for the health and welfare of service users 4 20 13 Action must be taken to put 19/02/2010 in place effective arrangements at the home to ensure that any omissions in the administration of prescribed medicines and the reasons for these are clearly, legibly and promptly recorded, including any necessary actions taken in response to medication not being taken To promote and make proper provision for the health and welfare of service users 5 20 13 Action must be taken to ensure medicines are properly disposed of and cannot be retrieved from disposal containers To promote and make proper provision for the health and welfare of service users 6 20 13 Action must be taken to 19/02/2010 ensure that prescribed medicines for service users in safe control and custody of the home are given in Page 8 of 10 19/02/2010 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 accordance with the doctors instruction as specified by the pharmacy issuing the medicine To promote and make proper provision for 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 9 of 10 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). 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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