Inspection on 26/10/09 for High Oaks

This inspection was carried out on 26th October 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 2 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 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 16/02/2010.

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 6 1 0 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 0 8 0 6 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 13 What we found: We conducted this inspection to monitor compliance with the statutory requirement notice issued following the previous pharmacy inspection of 13 August 2009 where a number of medication issues of concern were identified. The statutory requirement notice had requirement timescales of 14 October 2009 so during the inspection we looked at medication related records as far back as this date to determine if the service was compliant with the notice. We also looked at the arrangements in place for the storage and administration of medicines. On arrival for inspection we found that the morning medicine round was almost complete with only one person living at the service yet to receive their medicines. We looked at current medication charts and found there to be no omissions in records for the administration of medicines for the morning round. We found that there had been improvements in the way medicines were being both stored and arranged for administration in a way that is less confusing and more auditable. However, we suggested that clear indication of peoples names on shelves in the cabinets from which medicines are administered would assist safe administration. We also found no recorded evidence of medicines not being available to administer at the home. This represents an improved outcome for people at the home who are prescribed medicines. During the inspection we conducted audits of medicines available for administration against medication records attempting to account for them. We again found there to be discrepancies where we could account for medicines including both numerical surpluses and deficits. Whilst the home now has an improved system in place to enable medicines to be more easily accounted for, numerical discrepancies are still arising. As the day of inspection was the first day of the new 28 day medication chart period and the discrepancies have arisen despite only one dose of each medicine so far administered, on discussion with the registered nurse on duty, we concluded that the discrepancies were arising because incorrect quantities of medicines have been annotated as carried forward on the new 28 day medication charts. In addition, when the registered nurse on duty described the level of medication auditing currently undertaken it became apparent that the home is not monitoring for numerical discrepancies of medicines therefore these are not being identified. We checked the discrepancies with the registered nurse on duty who agreed them. The discrepancies included deficits of psychotropic medicines and a surplus of an antibiotic course. We looked at previous medication charts as far back as 14 October 2009 and found that there are still records where medicines had not been administered as scheduled denoted by codes F or G but where no further clarification of the reasons why medicines were not adminstered was recorded. We showed some examples to the registered nurse on duty. This remains an area of concern. We again looked at how medicines of a psychotropic nature prescribed for PRN (as required, occasional use) were being handled by staff and found that since the previous inspection work had been undertaken to rationalise their use. We discussed the findings with both the manager and registered provider on 29 October 2009 and informed that a further compliance visit will take place to monitor for necessary Care Homes for Adults (18-65 years) Page 3 of 13 improvement where there are yet inadequacies. 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 13 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 The registered provider must 25/09/2009 put in place suitable arrangements for the satisfactory completion of medicine administration records in respect of Page 5 of 13 Care Homes for Adults (18-65 years) 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 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 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 Full and accurate records must be kept for the receipt of all medicines into the home and to people prescribed them. This will allow for auditing of medicines within the home and prevent the residents being at risk. 8 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 Care Homes for Adults (18-65 years) Page 6 of 13 22/07/2009 22/07/2009 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 welfare of service users 9 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 10 20 13 The registered provider must 25/09/2009 promote and make proper 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 11 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. 12 23 12 All staff must receive training 22/09/2009 with regard to safeguarding Page 7 of 13 22/07/2009 Care Homes for Adults (18-65 years) 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 adults. This will ensure that the residents are protected from abuse. 13 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. 14 24 23 Proper ash trays should be 23/07/2009 provided in the smoke room. This will ensure that the residents self esteem is promoted 15 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. 16 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. 17 24 23 (2) (d) All parts of the home must be kept clean. The premises must be kept in a good state of repair 03/07/2007 23/07/2009 23/07/2009 18 24 23 (2) (b) 15/09/2007 Care Homes for Adults (18-65 years) Page 8 of 13 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 externally and internally. 19 30 23 All parts of the home must be kept clean. This will promote self esteem in the residents and their safety. 23/07/2009 20 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 the needs of the residents. 21 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. 22 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. 23/07/2009 23 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 Page 9 of 13 Care Homes for Adults (18-65 years) 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 transactions. This will prevent the residents being at risk of financial abuse. Care Homes for Adults (18-65 years) Page 10 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 20 13 The registered person must 09/11/2009 promote and make proper 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 instructions as specified by the pharmacy issuing the medicine. The registered person must 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 protect the health and welfare of service users at the home 2 20 13 The registered person must 09/11/2009 put in place effective arrangements to ensure that any omissions in the administration of prescribed medication and the reasons Page 11 of 13 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 for these are clearly, legibly and promptly recorded, including any necessary actions taken in response to medication not being taken To protect the health and welfare of service users at the home 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 20 It is recommended that clear indication of the names of service users and their medication is made on individualised shelves in the medicine cabinets from which medicines are administered. This is to assist with the safe administration of medication to service users. It is recommended that frequent monitoring of residual quantities of medicines is conducted to promptly identify and resolve numerical discrepancies arising. 2 20 Care Homes for Adults (18-65 years) 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 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 13 of 13 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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