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Inspection on 18/11/09 for Hillport House

Also see our care home review for Hillport House for more information

This inspection was carried out on 18th November 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

We told the provider that at the key visit of 02 October 2009, controlled drugs were not being recorded properly and the current system was not robust enough to provide an audit trail of the medication received into the home. We required that the service ensures that the management and recording of controlled medication is improved within 72 hours. Regulation 13(2). We found during this random visit on 18 November 2009, that the service is now recording the administration of the Controlled Drugs on the Medicine Administration Record (MAR) charts in addition to the Controlled Drugs register. We found that both strengths of the Buprenorphine patches were still being recorded on the same page but this was rectified during the inspection with the help of the pharmacist inspector. We found on the day of this random inspection that this requirement had been met. We told the provider that during the key visit of 02 October 2009, not all prescribed medication was being kept secure. We found an example of medicated cream located in one person`s bedroom. As a consequence, all occupants and visitors had access to this medication, which could, if used inappropriately, affect the health and welfare of those concerned. The service is required to ensure all medicated creams/ointments are stored securely, within 24 hours. Regulation 13(2). We found during this visit 18 November 2009, that all creams, ointments and lotions known as the creams had been removed from the rooms of people who used the service and are now located in the treatment room. We found that the non medicated creams had been relocated into the spare mobile drug trolley and the medicated creams had been relocated into the trolley being used to store all of the current medicines. We found that the staff are finding it difficult to sustain this arrangement with the non medicated creams and discussions took place with the member of staff who had been set the task of improving the handling of medicines on how the availability of these creams would bebest achieved. We found that this requirement had been met. We told the provider that during the visit of 02 October 2009, staff were not measuring the maximum and minimum temperatures on a daily basis, which they must do to ensure that the fridge is maintained at between 2 and 8 degrees centigrade. We saw the maximum temperature showing as 12 degrees, which exceeds the recommended temperature range of 2-8 degrees. The service was required to ensure that medication kept in the fridge is stored within the recommended temperature range, within 24 hours. Regulation 13(2). We found during the visit on 18 November 2009, that the maximum and minimum temperatures of the fridge are being measured and recorded on a daily basis and the fridge is being maintained at between 2 and 8 degrees Celsius. We found that this requirement had been met. We told the provider that on the 02 October 2009, the administration instructions for one person`s Risperidone medication stated that it should be administered before meals. We observed during our visit that this does not happen. The service was required to ensure that medication is administered as prescribed within 24 hours. Regulation 13(2). We observed medication administration during the visit of 18 November 2009, and are satisfied that medication is now being administered as prescribed. We found this requirement was met. We told the provider that on 02 October 2009, we found that there was no explicit plan of care in place for one person relating to his diabetes. This means that care staff deployed in the home do not have important information to be able to address his health needs in a crisis. We required the provider to ensure that there is an individual plan of care in place to provide information to care staff as to how they must provide care for this gentleman and any other person who may not have a plan of care in place by within five days. Regulation 15(1). During this visit of 18 November 2009, the individual we were concerned about had been discharged from the service. But we looked at care records of other people and found that changes are being made to the records to be sure that staff have the information they need to deliver the care required. We have been informed by the provider that the care records for the assessment unit are to be reviewed. We found this requirement was met. We told the provider on 02 October 2009 we saw a record for one person stating they had sustained a fracture that was unexplained; there was no evidence of an investigation into this or a safeguarding referral. As a result, we have made a referral under safeguarding procedures. We required that the provider follow safe guarding procedures and any instructions as a result of a strategy meeting within 12 days. Regulation 12. We have been notified that an investigation under safeguarding procedures has been carried out. We found that this requirement has been met.We told the provider that we could not be confident from the information provided during the visit of 02 October 20O9 that all staff have received mandatory training. We required the service to provide us with evidence of this within fourteen days. Regulation 18. We found at this visit that the service has liaised with the Human Resources department to establish an accurate record of staff training. A registered manager from another service has been asked to carry out individual supervision and appraisal sessions with all staff to establish any training gaps. A training programme will then be developed. We found that this requirement has been met. We told the provider that during the visit of 02 October 2009 we found that it had taken 6 days for staff to obtain a urine sample for one person who was suspected to have a urinary infection. This delay was unacceptable and may have resulted in the person suffering unnecessarily. The provider was required to ensure that staff act promptly to obtain the necessary advice or medical treatment for people using the service, within 24 hours. Regulation 12. We found at this visit on 18 November 2009, that people are being referred promptly to health professionals when they become unwell. The service has concerns about the response of the GP and a meeting had been arranged for the 18 November 2009 to discuss these matters. We found that this requirement has been met.

What the care home could do better:

We told the provider that during the key visit of the 02 October 2009, we could not evidence that medication was being properly recorded, we required the service to, ensure that the receipt, administration and disposal of all medication is recorded accurately so that the home can evidence that each person`s medication has been administered as prescribed. All records must be accurately maintained within five days. Regulation 13(2). We found on the 18 November 2009 the home was still not recording the receipt of all medicines. We found that any medicines being carried over from the previous month were still not being taken into account and added to the quantities at the start of the new month. We found that on three occasions staff had signed to say they had administered a cream that had not been in the home for the previous 12 months. We found that the staff had been administering one particular brand of an antacid but were signing the MAR chart to confirm that they had been administering another particular brand. We found that some medicines were missing and could not be accounted for. We found during this visit that although there had been some improvements in the handling and recording of medicines, the improvements were not significant enough to conclude that this requirement had been met. We told the provider that during the key inspection visit of 02 October 2009, we found that the medication trolley was left open and unattended while two senior staff were administering medication to different people at the same time. We were also concernedthat although we have been told that medication training has been provided neither we or the interim manager could find evidence of competency assessments. We made a requirement that the service must ensure that staff that are trained to administer and follow medication administration procedures to ensure that people are safeguarded from the risk of mistakes. And take action to ensure that staff who are trained to administer medication are competent to do so within seven days. Regulation 13(2). We found at the random visit of 18 November 2009 that all of the staff (except for one) who are responsible for administering medicines had attended a medicines refresher course run by Lloyds Pharmacy. We found that none of these staff had undergone any competency assessments to ensure that the information they had received during the training had been implemented into their administration and handling procedures of medicines. In light of some of the issues found during the inspection this needs to be given a high priority to ensure that the people who use the service are safeguarded from the risk of mistakes. We found during the inspection that this requirement had only been partly met.

Random inspection report Care homes for older people Name: Address: Hillport House Porthill Bank Newcastle under Lyme Staffordshire ST5 0AE Zero star poor 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: Wendy Jones Date: 1 8 1 1 2 0 0 9 Information about the care home Name of care home: Address: Hillport House Porthill Bank Newcastle under Lyme Staffordshire ST5 0AE 01782635073 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Staffordshire County Council Social Care And Health Directorate Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 30 Number of places (if applicable): Under 65 Over 65 0 dementia Conditions of registration: Age: Dementia (DE) age 50 and above. 30 The maximum number of service users who can be accommodated is: 30 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: Dementia (DE) 30 Date of last inspection Brief description of the care home Hillport House is a local authority care home, run by Staffordshire County Council. The home specialises in the care of older people who are mentally frail or who have mental Care Homes for Older People Page 2 of 11 Brief description of the care home health needs. The home is registered for 30 older people, and is located in Porthill, providing good access to a wide range of local community resources. There are pleasant gardens, particularly an enclosed safe garden courtyard in the centre of the building that can easily be accessed by people using the service. Accommodation is provided on two floors, with access to the upper floor being facilitated by a shaft lift and stairs. The first floor is used to accommodate people requiring a period of rehabilitation following discharge from hospital. People who may use the service and their supporters should contact the provider for information about the fees for the service. The only things not covered by fees include hairdressing, magazines, newspaper and personal items. Care Homes for Older People Page 3 of 11 What we found: We undertook a unannounced random inspection visit on 18 November 2009, to check that the service has complied with the requirements we made in a warning letter to the provider following a key inspection visit of 02 October 2009. We send a warning letter to a provider where there are serious concerns about the safety and well being of people using the service. There have been other areas of concern we did not include in the warning letter that have been recorded in the key inspection report, we will check that these matters have been addressed at the next key inspection visit. To determine if the provider has complied with the requirements we made. We looked at the arrangements for the storage, recording and administration of medication, the health and care records of people using the service, records of staff training and staff rosters. We spoke to staff, management and people using the service, and a consultant employed by the authority. What the care home does well: We told the provider that at the key visit of 02 October 2009, controlled drugs were not being recorded properly and the current system was not robust enough to provide an audit trail of the medication received into the home. We required that the service ensures that the management and recording of controlled medication is improved within 72 hours. Regulation 13(2). We found during this random visit on 18 November 2009, that the service is now recording the administration of the Controlled Drugs on the Medicine Administration Record (MAR) charts in addition to the Controlled Drugs register. We found that both strengths of the Buprenorphine patches were still being recorded on the same page but this was rectified during the inspection with the help of the pharmacist inspector. We found on the day of this random inspection that this requirement had been met. We told the provider that during the key visit of 02 October 2009, not all prescribed medication was being kept secure. We found an example of medicated cream located in one persons bedroom. As a consequence, all occupants and visitors had access to this medication, which could, if used inappropriately, affect the health and welfare of those concerned. The service is required to ensure all medicated creams/ointments are stored securely, within 24 hours. Regulation 13(2). We found during this visit 18 November 2009, that all creams, ointments and lotions known as the creams had been removed from the rooms of people who used the service and are now located in the treatment room. We found that the non medicated creams had been relocated into the spare mobile drug trolley and the medicated creams had been relocated into the trolley being used to store all of the current medicines. We found that the staff are finding it difficult to sustain this arrangement with the non medicated creams and discussions took place with the member of staff who had been set the task of improving the handling of medicines on how the availability of these creams would be Care Homes for Older People Page 4 of 11 best achieved. We found that this requirement had been met. We told the provider that during the visit of 02 October 2009, staff were not measuring the maximum and minimum temperatures on a daily basis, which they must do to ensure that the fridge is maintained at between 2 and 8 degrees centigrade. We saw the maximum temperature showing as 12 degrees, which exceeds the recommended temperature range of 2-8 degrees. The service was required to ensure that medication kept in the fridge is stored within the recommended temperature range, within 24 hours. Regulation 13(2). We found during the visit on 18 November 2009, that the maximum and minimum temperatures of the fridge are being measured and recorded on a daily basis and the fridge is being maintained at between 2 and 8 degrees Celsius. We found that this requirement had been met. We told the provider that on the 02 October 2009, the administration instructions for one persons Risperidone medication stated that it should be administered before meals. We observed during our visit that this does not happen. The service was required to ensure that medication is administered as prescribed within 24 hours. Regulation 13(2). We observed medication administration during the visit of 18 November 2009, and are satisfied that medication is now being administered as prescribed. We found this requirement was met. We told the provider that on 02 October 2009, we found that there was no explicit plan of care in place for one person relating to his diabetes. This means that care staff deployed in the home do not have important information to be able to address his health needs in a crisis. We required the provider to ensure that there is an individual plan of care in place to provide information to care staff as to how they must provide care for this gentleman and any other person who may not have a plan of care in place by within five days. Regulation 15(1). During this visit of 18 November 2009, the individual we were concerned about had been discharged from the service. But we looked at care records of other people and found that changes are being made to the records to be sure that staff have the information they need to deliver the care required. We have been informed by the provider that the care records for the assessment unit are to be reviewed. We found this requirement was met. We told the provider on 02 October 2009 we saw a record for one person stating they had sustained a fracture that was unexplained; there was no evidence of an investigation into this or a safeguarding referral. As a result, we have made a referral under safeguarding procedures. We required that the provider follow safe guarding procedures and any instructions as a result of a strategy meeting within 12 days. Regulation 12. We have been notified that an investigation under safeguarding procedures has been carried out. We found that this requirement has been met. Care Homes for Older People Page 5 of 11 We told the provider that we could not be confident from the information provided during the visit of 02 October 20O9 that all staff have received mandatory training. We required the service to provide us with evidence of this within fourteen days. Regulation 18. We found at this visit that the service has liaised with the Human Resources department to establish an accurate record of staff training. A registered manager from another service has been asked to carry out individual supervision and appraisal sessions with all staff to establish any training gaps. A training programme will then be developed. We found that this requirement has been met. We told the provider that during the visit of 02 October 2009 we found that it had taken 6 days for staff to obtain a urine sample for one person who was suspected to have a urinary infection. This delay was unacceptable and may have resulted in the person suffering unnecessarily. The provider was required to ensure that staff act promptly to obtain the necessary advice or medical treatment for people using the service, within 24 hours. Regulation 12. We found at this visit on 18 November 2009, that people are being referred promptly to health professionals when they become unwell. The service has concerns about the response of the GP and a meeting had been arranged for the 18 November 2009 to discuss these matters. We found that this requirement has been met. What they could do better: We told the provider that during the key visit of the 02 October 2009, we could not evidence that medication was being properly recorded, we required the service to, ensure that the receipt, administration and disposal of all medication is recorded accurately so that the home can evidence that each persons medication has been administered as prescribed. All records must be accurately maintained within five days. Regulation 13(2). We found on the 18 November 2009 the home was still not recording the receipt of all medicines. We found that any medicines being carried over from the previous month were still not being taken into account and added to the quantities at the start of the new month. We found that on three occasions staff had signed to say they had administered a cream that had not been in the home for the previous 12 months. We found that the staff had been administering one particular brand of an antacid but were signing the MAR chart to confirm that they had been administering another particular brand. We found that some medicines were missing and could not be accounted for. We found during this visit that although there had been some improvements in the handling and recording of medicines, the improvements were not significant enough to conclude that this requirement had been met. We told the provider that during the key inspection visit of 02 October 2009, we found that the medication trolley was left open and unattended while two senior staff were administering medication to different people at the same time. We were also concerned Care Homes for Older People Page 6 of 11 that although we have been told that medication training has been provided neither we or the interim manager could find evidence of competency assessments. We made a requirement that the service must ensure that staff that are trained to administer and follow medication administration procedures to ensure that people are safeguarded from the risk of mistakes. And take action to ensure that staff who are trained to administer medication are competent to do so within seven days. Regulation 13(2). We found at the random visit of 18 November 2009 that all of the staff (except for one) who are responsible for administering medicines had attended a medicines refresher course run by Lloyds Pharmacy. We found that none of these staff had undergone any competency assessments to ensure that the information they had received during the training had been implemented into their administration and handling procedures of medicines. In light of some of the issues found during the inspection this needs to be given a high priority to ensure that the people who use the service are safeguarded from the risk of mistakes. We found during the inspection that this requirement had only been partly met. 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 11 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 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 13 The provider must ensure that staff that are trained to administer and follow medication administration procedures. Have been assessed as competent. to ensure that people are safeguarded from the risk of mistakes. To ensure that people are safeguarded from the risk of mistakes. 18/01/2010 2 9 13 The provider must ensure that the receipt, administration and disposal of all medication is recorded accurately. So that the home can evidence that each persons medication has been administered as prescribed. 18/01/2010 Care Homes for Older People Page 9 of 11 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 Older People 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. 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