This inspection was carried out on 20th April 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.
Random inspection report
Care homes for adults (18-65 years)
Name: Address: Josephine Butler 34 Alexandra Drive Liverpool Merseyside L17 8TE zero star poor service 04/02/2010 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: Maggy Howells Date: 2 0 0 4 2 0 1 0 Information about the care home
Name of care home: Address: Josephine Butler 34 Alexandra Drive Liverpool Merseyside L17 8TE 01517277877 01517277877 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Philip David Wade Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Harold Smith care home 21 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Conditions of registration: 21 The registered person may provide the following category/ies of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning diability or dementia - Code MD The maximum number of service users who can be accommodated is: 21 Date of last inspection Brief description of the care home Josephine Butler House was an older building converted for use as a care service. There were gardens to the rear and front, with a car availiable at the front of the building. The service was located in Liverpool near the Sefton Park area of Liverpool. Access to Sefton Park, Lark Lane, shops, pubs and public transport was a short five to
Care Homes for Adults (18-65 years) Page 2 of 9 0 4 0 2 2 0 1 0 Brief description of the care home ten minute walk. The service was registered to provide support to younger people between the ages of 18-65 years of age that have mental health needs. Accommodation was provided on three floors with the communal areas lounge, dining room, games room and smoking area on the ground floor. All the bedrooms accommodation was provided in single bedrooms with a passenger lift to all floors. The weekly fee was 450 pounds per week. Information regarding the services known as the service users guide provided was not availiable for view. Care Homes for Adults (18-65 years) Page 3 of 9 What we found:
We visited the home to see whether or not requirements made in a Statutory Requirement Notice (a legal document) had been met. We had required that a number of improvements be made to the way in which medicines were handled, stored, administered and recorded in order to meet the legal standards stated in the Care Home Regulations 2001. We looked at how medicines were stored, handled and recorded. We looked at a sample of stocks and records and spoke with the deputy manager and residents. Overall we found that there were still some serious shortfalls in the way medicines were managed within the home. This placed the health and well being of people living here at unnecessary risk of harm. We found that whilst medication was stored in a locked trolley within the managers office, the trolley could easily be accessed and opened by unauthorised people. Medicines must be stored securely at all times in order to prevent them from being mishandled or misused. We found gaps on the current medicines records and other mistakes that meant the records were not accurate. We found that staff had handwritten some entries onto the medicines charts, for example when medicines had been received from hospital. These entries did not include all the warnings necessary to give these medicines safely and they had not been checked and signed by another member of staff. We saw that dose changes had been made, but these could not be verified with any other records. Inaccurate records can lead to mistakes that can place peoples health and wellbeing at serious risk of harm. We carried out detailed checks of some stocks and records and found that medicines could not always be accounted for. We saw evidence that some medicines had been signed for, but not actually given, whilst others could not be accounted for and appeared to be missing. In many cases it was not possible to tell whether or not the medicines had been given correctly. We found that clear explanations had not been recorded when medicines were not given, for example, one medication for mental health problems had not been given for two days, as stock was not available. At the start of the cycle, there had been enough stock to last until the next supply was due, however no action had been taken to investigate why medication had gone missing. The health and well being of people living in the home is at serious risk of harm if medicines are not given as prescribed. We looked at how medicines were given to people who were on periods of leave away from the home. We found that whilst records had improved, there were still no recorded checks to determine whether or not the medication had been taken correctly whilst away and, more seriously, no back up plans to supply extra medication should the period of leave be extended. This meant that people did not always receive their medication properly whilst away. We looked at how medicines and staff competency were audited (checked). There was no evidence that staff had been formally observed giving and recording medicines. We saw
Care Homes for Adults (18-65 years) Page 4 of 9 evidence that the manager had written to one member of staff about administration and recording errors on two separate occasions, but the staff member had not been offered further training and continued to handle medication unsupervised. Given the serious nature of some mistakes it was evident that staff still need to have their competency formally assessed to make sure they have the necessary skills to handle medicines safely. The manager had recently completed a medication audit, but a number of mistakes and discrepancies had not been identified, for example fridge temperatures being out of the required range and recording errors. This meant that problems had not been rectified by the manager. Some concerns had been identified, but no action had been taken to address these concerns. We looked at a sample of care plans. These are the documents that tell staff how to meet the needs of people living in the home. We found that some of these had not been reviewed for over a year. Some of the information in these records was inaccurate e.g. current medication. There was no detailed information in the care plans telling staff how to meet the nursing needs of people living in the home, for example how to respond to epileptic seizures or mental health problems. This meant that staff were unlikely to respond consistently and peoples needs were at risk of being unmet. 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 5 of 9 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 23 13(6) All management and staff 30/04/2009 must have training in the management and awareness of abuse so that people livibg in the home can be assured of being fully protected from any potential risk of abuse. ( Previous requirement date of 1/10/08 not met) There must be an effective 01/05/2009 staff team with sufficient numbers as previoulsy determined by the manager to support peoples assessed needs at all times. This will ensure that people who live in the homes needs can be met. Staff supervision must be in place at least six times a year to ensure staff can be monitored ,supported and training needs identified. Staff supervision must be in place to enable staff development. 23/03/2010 2 33 18(1)a 3 36 6 4 42 23(d) All staff must receive updates in fire safety and this must be recorded. This is to ensure all staff are aware of fire safety and can 01/06/2009 Care Homes for Adults (18-65 years) Page 6 of 9 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 maintain safety in this area. Care Homes for Adults (18-65 years) Page 7 of 9 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 17 All care plans need to be up 31/05/2010 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 peoples needs. 2 20 13 Medication must be stored securely at all times in order to prevent it from being misused or mishandled 31/05/2010 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 8 of 9 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Adults (18-65 years) Page 9 of 9 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
