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Inspection on 17/06/10 for Huyton Hey Manor Residential Care Home

Also see our care home review for Huyton Hey Manor Residential Care Home for more information

This inspection was carried out on 17th June 2010.

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 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

Since our last visit the service has put into place better recording of controlled drugs, the documentation now listed the medication, dose and who it was for.

What the care home could do better:

The management of medication needs to be made safe in order to make sure that people receive their medications correctly. Staff training and competency is in need of developing and the management team needs to make sure that medication records are audited in order to check that medication is being given correctly. Staff need to make sure that they give medications as prescribed by the doctor or external professionals in order to meet people`s health care needs. Care plans need to reflect people`s needs in order to make sure that staff can give pain relief medications correctly. Care records also need to give staff clear instructions on how to meet people`s needs, including their nutritional needs. Risk assessments for self-medication, nutrition, moving and handling and bed rails need to be put into place, kept up to date, accurately written and actions followed in order to maintain the safety of people living in the home.

Random inspection report Care homes for adults (18-65 years) Name: Address: Huyton Hey Manor Residential Care Home Huyton Hey Road Huyton Knowsley Merseyside L36 5RZ zero star poor service 24/03/2010 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: Julie Garrity Date: 1 8 0 6 2 0 1 0 Information about the care home Name of care home: Address: Huyton Hey Manor Residential Care Home Huyton Hey Road Huyton Knowsley Merseyside L36 5RZ 01514893636 01514266415 angharad-huytonhey1@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Angharad Lloyd Williams Type of registration: Number of places registered: Conditions of registration: Category(ies) : Cranford Care Homes Limited care home 30 Number of places (if applicable): Under 65 Over 65 30 30 old age, not falling within any other category physical disability Conditions of registration: 0 0 Service users to include up to 30 OP and 30 PD(E) The service may admit one named service user under pensionable age. The service should employ a suitably qualified and experienced manager who is registered with the CSCI Date of last inspection Brief description of the care home Huyton Hey Manor is a converted building for older people. The service has sufficent accomidation for 30 people whose primary diagnosis is that of old age. The building is Care Homes for Adults (18-65 years) Page 2 of 12 2 4 0 3 2 0 1 0 Brief description of the care home situated in its own grounds in a residential area close to local amenities and Huyton Village centre. There is parking availiable at the front of the building and gardens at the rear. Accommodation is provided on three floors and there is a passenger lift to all levels. The service has a variety of aids and adaptations in place around the home to assist people with their mobility. Twenty-four of the bedrooms are single, three are double and none of the bedrooms have en suite facility. Huyton Hey Manor is owned by a small group that has three homes in total. Fees for the service are in line with the rates from Knowsley social services. Information about the service is availiable in the managers office. Care Homes for Adults (18-65 years) Page 3 of 12 What we found: The reason for this random inspection was to make sure that the requirements made in the two Statutory Requirement Notices, dated 5th May of 2010, had been complied with and the service were no longer in breach of the regulations. We also checked that they had complied with the requirements from our last visit. A Statutory Requirement Notice is a legal notice, which is sent to the provider and the manager when there has been a breach of regulations. The notice describes which regulations have been broken and what the provider must do to put right the breach. It also gives the date by which this must be done. We then follow up the notice by visiting the service to make sure that actions have been taken to meet the requirements and regulations. The requirements in this notice were made to make sure that people who lived in the services health was not at risk from poor medication practices. At this visit evidence available showed that the service had not complied with the notice. A pharmacist inspector together with the lead inspector carried out the visit. The visit lasted approximately sixteen hours over two days. During which time we looked at records regarding, staff training, care plans, medication records, assessments and the services policy and procedures. We spoke with staff, people who live in the home and their relatives. The manager was unavailable and full feedback on our findings was given to the provider and his representative. At the end of the visit we took photocopies of some of the records due to the serious nature of our concerns about the handling of medicines and provision of care within this service. We looked at how the service stored medications in the service. We found that medication was not stored in a safe and secure manner at all times. One person had an oxygen cylinder that was seen to be stored on a main corridor next to a fire exit. This is unsafe as oxygen needs to be stored in a locked room with a sign on the door stating that oxygen is stored here. We checked to see what medications people had in their own bedrooms and saw that three people had creams in their bedrooms and one person had an inhaler. The medication had no been risk assessments in order to determine that they were safe to be stored in bedrooms. A review of medications to check if they had been administered to people in accordance with the prescribers and manufacturers instructions was done. We found that medication in the form of eye drops for one person had not been given correctly. The eye drops were to be given six times a day. The medication administration records (MARs) showed that this had been administrated four times a day and the prescribers directions had not been followed. The management in the home at our visit were unable to offer an explanation for this. Another person was prescribed a medication to be given when needed, (PRN). We were unable to find written instructions in the service to guide staff on how this medication was to be given or in what circumstances staff were to give. We asked the provider and the homes representative whether the service recorded this information other than in care plans or MARs. Staff told us that they thought that the medication was for agitation but were unclear as to precisely what this meant. We looked at the MARs in relation to the daily records and found that on the seven occasions this medication was given staff had not recorded any reason such as agitation for giving this medication. Staff had given the medication without instructions on how, when or why to give and had failed to follow the prescribers instructions. Care Homes for Adults (18-65 years) Page 4 of 12 A medication for one person was recorded on the MARs as 200mls on received. The person was prescribed 15 mls, twice a day. A review of the MARs showed that staff had signed for a total of between 450 and 465 mls. The bottle still contained approximately 100 mls. There was no record of any more of the medication arriving in the home. We asked the provider and staff if receipts of medication was recorded elsewhere and checked all records regarding the receipts of medication. Staff had potentially signed for 350 mls of lactulose that was not given and had therefore failed to follow the prescribers instructions. We looked at how the service recorded medications received and administrated we found that these had not been recorded accurately. One person had an oxygen cylinder available and labelled for them. There is no record that the service that they were prescribed oxygen therapy. There was no explanation within the service as to when or how to give this medication or how to monitor the person if it is needed. The provider and his representative were not able to offer an explanation for the lack of any record. Another person living in the service received a specific injection, this medication is to be given 12 weekly. There was no record on the MARs that this had been given by the district nurse. A record was located in the daily records stating that the district nurse had been and given the person an injection. This record did not state what the injection was for. Additionally there was no record as to when the next injection was due that would have supported staff to be able to make sure that this was given as needed. At least three person applies cream themselves daily. Staff had signed the MAR to say that they had administrated when this was not the case. Records were unclear and as such staff could not be sure that they were giving the people who lived in the home their medications correctly. Put in place effective arrangements to ensure that all medication is safely administered to service users. We looked at how the service made sure that they gave medication safely. We found that at least four people managed one or more of their medication. There were no risk assessments in place that supported the person to do this safely and no monitoring by the staff to make sure that the person was managing the medication safely. The provider and his representative were unable to offer an explanation and no other records that helped maintain the safety of people managing their medication were available in Huyton Hey. Night staff had not had any training in medications as a result people living in the service could not safely have their medications between the hours of 10pm at night and 8am in the morning. The manager was not available at this visit so we asked the provider and his representative if staff had been assessed as competent to give out medications. They told us that they had been watched but no formal assessment had been carried out. Four of the five staff who did give out medication were booked on training for medication administration one person had already completed additional training. Staff had not been checked that they were safe to give out medications and the majority did not have up to date training to do so. We looked at records regarding controlled drugs. We noticed that although some improvement was noticed staff had not always recorded controlled drugs when received. One person had been prescribed controlled drugs that were being given by the district Care Homes for Adults (18-65 years) Page 5 of 12 nurses. This medication had not been recorded in the controlled drugs book and it was therefore not possible to monitor that these had been given correctly. One persons record in the controlled drugs recorded was inaccurate by two capsules no explanation was available to account for this inaccuracy. As part of our visit we looked at how the service recognised and actioned when medication needed to be ordered. We found that records where disorganised and it was very difficult to see how the service ordered medications. There where two different books that on occasions provided conflicting information on what medications had been ordered and received. On at least one occasion staff recorded that they forgot to order the medications. There appeared to be little structured organisation to ordering medications. Staff stated they ordered as needed but that there was no particular routine. We noticed entries into the books for medication ordering that showed that staff had repeatedly contacted the local GPs or pharmacist to chase up missing medications. The owner of the service told s that they intend to change the pharmacist that supplied the medication in order to try and make it better organised. At our last visit we noticed that peoples pain relief had not been well managed. At this visit we found that this had not improved. One person wished to have their pain relief at 7am in order to give it time to work before they got up as night staff are not trained the persons needs were not being met. Another person was to have a painkiller before their dressings were changed, records showed that this was not occurring and on at least two occasions their dressings could not be changed as they were in too much pain. On both occasions the painkillers had not been given half an hour before. The care records in the home did not state that the painkillers were to be used. One of the staff members spoken with was not aware that the person was to have painkillers before their dressings were changed. We noticed that the same person was being moved on a stand aid, a lifting aid that people need to stand in to use. A recent physiotherapist assessment stated that he could not weight bare and had pressure ulcers on his feet. The care plan failed to recognise that the person was at risk both moving and handling and of further development of pressure ulcers. We looked at how the service assessed and met the nutritional needs of people that they support. Two people had nutritional risk assessments in place that stated that they were at risk and needed to be weighed weekly. Neither person had been weighed weekly. One person had lost a significant amount of weight and had not been weighed again in six weeks to determine if this had changed. The person had been prescribed a supplementary feed but no referral had been made to an external expert to review and advice on the weight lose. We reviewed care records for seven people. For all seven people the care plans did not explain vital information about their needs. Three had been updated in the last month but still failed to describe what actions staff needed to take. For example there was no mention of pain management or what actions to take, one person had pressure ulcers but there was no information how staff were to support them or what actions to take if the person removed their dressings. District nurses notes showed that the person did remove their own dressings and had asked staff to contact them in this event this information was not available in the persons plan. Two people had bed rails in place to prevent them falling out of bed. A risk assessment stated that the bars on the bed rails were not wide enough to cause the person to be Care Homes for Adults (18-65 years) Page 6 of 12 trapped. The assessments failed to recognise the gaps at the bottom and top of the bed or put into place soft padding to prevent injury. 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 7 of 12 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 7 15 All care plans need to be up 17/05/2010 to date, specific to the individual and accurately reflect how the staff are to meet peoples individual needs. All changes to the persons needs and condition need to update the care plan rapidly. Without clear records staff will be all able to meet peoplesneeds. 2 8 12 The service needs to identify 17/05/2010 the health and welfare needs of individuals living in the home and take action to make sure that they meet those needs. Where instructions are received by external professionals these must be actioned as per the directions of the professional. Not meeting peoples health and welfare needs places them at significant risk. 3 12 12 People living in the service need to be supported to make decisions with respect to the care they are to receive and their health and welfare. The people living in the service need to have so 30/07/2010 Care Homes for Adults (18-65 years) Page 8 of 12 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 far as practicable their wishes and feelings determined and take into account in all matters to deal with their health and welfare. In order to support the people living in Huyton Hey Manor make informed choices about their health and welfare needs. 4 15 16 All people moving into the 26/04/2010 home need to have their nutritional needs determined and were risks our identifies a plan that needs to be available that informs staff on how to support them appropriately. In order to prevent people from not having their nutritional needs met. 5 18 22 Service needs to update its 27/05/2010 own policy and procedure on safeguarding people living in the home. This should include how to report concerns, training and staff need and how to record any concerns of this nature. This is done in order to help safeguard the people living in the home 6 27 18 Staff need to be have 17/05/2010 effective checks in place that determine their competency to undertake their job role. In order that the provide the Care Homes for Adults (18-65 years) Page 9 of 12 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 correct support to people living in the service in a safe manner 7 33 13 The service needs to put into 17/05/2010 place effective arrangements to audit the management of medications. To make sure that people receive their medications safely. Care Homes for Adults (18-65 years) Page 10 of 12 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 7 13 Risk Assessment for the service need to be reviewed and put into place were appropriate. Particularly for self-medicating, moving and handling and bed rails. In order to guide staff to maintain the safety of people they support. 12/07/2010 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 11 of 12 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. 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