Inspection on 18/09/07 for Kington Court Health and Social Care Centre

This inspection was carried out on 18th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Kington Court Health and Social... 13/01/09

Kington Court Health and Social... 04/06/08

Kington Court Health and Social... 19/10/06

Kington Court Health and Social... 18/02/06

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Kington Court Health and Social Care Centre Victoria Road Kington Herefordshire HR5 3BX Lead Inspector Sandra J Bromige Key Unannounced Inspection 09:00 18 September 2007 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Kington Court Health and Social Care Centre DS0000066097.V341468.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Kington Court Health and Social Care Centre DS0000066097.V341468.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kington Court Health and Social Care Centre Address Victoria Road Kington Herefordshire HR5 3BX Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01544 232333 01453 544218 Blanchworth Care Ltd Mrs Thembelihle Claries Nzama Care Home 48 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (37), of places Physical disability over 65 years of age (3), Terminally ill (1), Terminally ill over 65 years of age (1) Kington Court Health and Social Care Centre DS0000066097.V341468.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The Registered Manager`s span of management control is limited to the registered care home facility only. The minimum staffing levels to be maintained for Unit 1 (Eardisley), with 16 places for older persons requiring personal care to include a maximum of 6 dementia places (DE/E) must be 360 separately rostered care hours per week. The minimum staffing levels to be maintained for Unit 2 (Logan Jack & Staunton Wings), with 32 places for care with nursing to include a maximum of 3 physical disability (PD), 1 terminal illness (TI) , 1 terminal illness (TI/E) and 27 older persons (OP) must be 981 separately rostered care hours per week. All care staff employed to provide care for service users, with dementia and as part of the Home`s mandatory training, must begin NVQ Level 2, Unit CLI & W2 within the first 6 months of employment. 19th October 2006 3. 4. Date of last inspection Brief Description of the Service: Kington Court is a care home providing personal care and accommodation for 16 older people, 12 intermediate care places, which include 2 social services re-ablement beds, 8 older people, 4 for people under the age of 65 and 20 nursing places for older people. In total it is registered to accommodate 48 residents. It is owned by Blanchworth Care Ltd. The Home is located on the outskirts of a small market town of Kington, close to shops, and other amenities. The Home was purpose built and opened in June 2003 and consists of a twostorey building, which was built to provide a Health & Social Care centre for the town and surrounding rural area. The care home facilities are entirely situated on the first floor of the building. The care home is divided into three units; Eardisley (personal care), Logan Jack (intermediate) and Staunton Wing (nursing). The Home offers 46 single rooms, and one double room, all with en-suite toilet and shower facilities. There is a passenger and a service lift provided. The Kington Court Health and Social Care Centre DS0000066097.V341468.R01.S.doc Version 5.2 Page 5 Home has gardens at the rear and to the side of the building that are accessible via the ground floor lounge/dining area or outside via an entrance off the car parking area. The home is accessible throughout by people with a physical disability requiring the use of a wheelchair. A range of equipment is provided for residents with physical disabilities. There is no information in the current statement of purpose & service user guide about the range of fees charged by this service. Kington Court Health and Social Care Centre DS0000066097.V341468.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over 5 days by two Inspectors and a Pharmacist Inspector for two of the five days. This was a key inspection – this is an inspection where we look at a wide range of areas. To help us plan the inspection we looked at pre-inspection information in the form of an Annual Quality Assurance Assessment requested from the home some weeks earlier, survey forms received from residents (2), relatives (2), staff (4) and healthcare professionals (1). During the visit to the home care records, staff records and other records and documents were inspected. There was a tour of parts of the accommodation and interviews with staff, including the manager and other senior staff. Time was spent speaking privately with residents in their rooms as well as spending time out and about in the home observing what was happening and talking to residents. The pharmacist inspector carried out a specialist inspection of the arrangements for handling medication (National Minimum Standard 9 Care Homes for Older People) as part of the key inspection. This included looking at some stocks and storage arrangements for medicines, some medication records and the medicine policy and procedures. There were discussions with the manager, assistant director of care and four members of staff. We saw the way some medicines were given to some people in the home and we visited some rooms. We spoke to three people living in the home about their medicines. The inspection took place over 15 hours on a Monday and Wednesday. We have received five complaints about this service between July & September 2007. These complaints relate to the staffing levels in the kitchen & in the care home, the provision of health & personal care, cleanliness of the kitchen, competency of the trained staff employed in the home, allegations of poor attention to nutrition and neglect of identified residents. Two residents have recently been admitted to hospital due to dehydration and two residents have been identified as being nutritionally at risk. Due to the seriousness of the concerns the home was referred to Herefordshire Council, the lead agency for safeguarding vulnerable adults. An indepth investigation is currently in progress with the assistance of other agencies who commission care from this service. The Commissioners of this service are currently not placing residents in the home and Blanchworth has agreed to date not to admit any new residents. Kington Court Health and Social Care Centre DS0000066097.V341468.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? What they could do better: It would be helpful for people who use the service & their friends & relatives for a copy of the current Statement of Purpose & Service User guide to be displayed at the entrance to the home. The homes contract needs to be reviewed to ensure that it provides the information required to be given to all residents who are in receipt of a nursing care contribution. This requirement is outstanding from the last inspection. A thorough assessment needs to be carried out for all residents prior to admission to the home to ensure that the home are able to meet the person’s care needs and to enable an ‘holistic’ care plan to be formulated for the resident prior to or upon the day of admission. Kington Court Health and Social Care Centre DS0000066097.V341468.R01.S.doc Version 5.2 Page 8 All registered nurses need to be trained in the setting up and use of syringe drivers by a professionally recognised trainer to ensure the health, safety & welfare of residents is maintained. The home has failed to meet this requirement on two occasions. Care plans need to identify all problems and needs of residents and set out in detail the action that needs to be taken by the staff to ensure that all aspects of the individual residents health, personal & social care needs are met. They must be reviewed and updated when any changes take place. This requirement is outstanding from the last inspection. They need to make arrangements for the safe storage of all medicines – this relates to repair of the broken medicine trolley on Eardisley. They need to make arrangements for a particular person to receive sufficient pain relief in accordance with the doctor’s directions. They need to make arrangements to ascertain if a named person had received a particular medicine at 6am on 8/10/07 as the doctor prescribed. They need to make arrangements to ascertain if a named person had received a particular medicine at 6am on 8/10/07 as the doctor prescribed. Blanchworth need to investigate and report back to us about the discrepancy of five ampoules of a particular injection in the controlled drug record book and provide an explanation for the incorrect record. They need to make arrangements for a named person to receive particular eye drops in accordance with the doctor’s directions and her needs. They need to make sure all medicines are given to residents according to the doctors’ directions and with written plans in place for medicines prescribed to use ‘as required’. They need to make sure full and accurate records for the receipt and administration of all medicines are maintained. Blanchworth need to make sure waste medication or unwanted stocks of medicines are being handled so as to comply with current legislation. They need to make sure all medicines are available to give according to the doctors’ directions to make sure that all people in the home receive the correct amounts of medication for their health needs. Blanchworth need to fix the medicine trolley clamp securely on Logan Jack and move the position for keeping the trolley out of direct sunlight. This is so that medicines are always kept securely and below 25°C and will help to make sure people who live in the home receive medicines that are of the correct potency. Kington Court Health and Social Care Centre DS0000066097.V341468.R01.S.doc Version 5.2 Page 9 They need to make sure that when staff take blood samples for blood glucose monitoring for people living in the home the lancing device used is safe to use in a care home environment as described in Medical Device Alert MDA/2006/066 issued by MHRA in December 2006. This is to reduce the risk to people living in the home of cross infection linked with the use of the wrong sort of lancing device. They should arrange to see and check all prescription forms in the home before they are sent to the pharmacy for dispensing. They should arrange to use the standard yellow anticoagulant book and for dose changes of anticoagulants make sure they are confirmed in writing by the prescriber on all units as detailed in Patient Safety Alert 18 from the National Patient Safety Agency. They should put in place more controls to keep account of the use of the blank prescription pad kept on one unit. Residents’ care plans should reflect what choices people who live in the home are given about how their medicines are administered and their consent to the way in which staff handle their medicines. They should use the correct wording for statutory warning notices wherever oxygen is stored or used in the home. Residents need to be provided with a varied, appealing, wholesome and nutritious diet, which is suited to individuals assessed and recorded needs to ensure that they are not at risk of malnutrition. Staff employed to work in the home must have the competencies and skills needed to provide the care required and must receive training in relation to the homes policies to ensure that residents are protected from harm. Systems need to be put into place to ensure that all equipment is serviced at the required intervals to ensure that residents and staff are protected from harm. The staffing levels and the competency of the trained staff employed in the home needs to be reviewed to ensure that residents are not placed at risk of harm. Staff commencing work in the home prior to receipt of a full CRB disclosure need to be supervised by a designated staff member who is appropriately qualified and experienced to carry out this role to ensure that residents are not placed at risk of harm. All staff must receive structured induction training to ensure residents are not placed at risk of harm. Kington Court Health and Social Care Centre DS0000066097.V341468.R01.S.doc Version 5.2 Page 10 A report needs to be submitted to us outlining any action deemed necessary to be taken by the home in response to the care plan audit undertaken in July 2007 to ensure that the health & welfare needs of the residents are met. Notifications need to be sent to the Commission without delay for all deaths, illness or events in the home to demonstrate that the health, safety & welfare of the residents is being maintained at all times. The service of food on Eardisley & Logan Jack needs to be reviewed to ensure that it is presented in an attractive manner. The current provision of equipment used for the service of meals to residents should be reviewed to ensure that there is sufficient equipment to enable food to be served in an appropriate and timely manner. The use of communal flannels in the home needs to be reviewed in line with current guidance from the Department of Health & Health Protection Agency to reduce the risk of cross infection. Documentation needs to be provided to record the maintenance checks for bedrails to ensure that maintenance can be monitored. An action plan needs to be submitted to the Commission to indicate what steps are being taken to recruit a manager for this service. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Kington Court Health and Social Care Centre DS0000066097.V341468.R01.S.doc Version 5.2 Page 11 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kington Court Health and Social Care Centre DS0000066097.V341468.R01.S.doc Version 5.2 Page 12 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4 & 6 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents’ contracts are not providing the information that is required about the nursing contribution payments to ensure that they are aware of how these form part of their weekly fee. All residents are not being thoroughly assessed prior to admission to ensure that the home is able to meet their individual care needs and to enable a care plan to be formulated prior to or upon admission. Sufficient training is not being provided for all of the trained staff on the nursing units to ensure that the specialist needs of residents admitted for intermediate and end of life care will be met by the Home. EVIDENCE: There was not a copy of the home’s statement of purpose and service user guide on display at the entrance to the home. It would be helpful for people who use the service & their friends & relatives if this document was available. This document was seen on the Blanchworth intranet, it does not contain any Kington Court Health and Social Care Centre DS0000066097.V341468.R01.S.doc Version 5.2 Page 13 information for prospective residents about the range of fees charged by this service. Contracts were seen for the residents case tracked on the Blanchworth intranet. A contract dated June 2007 for a resident receiving nursing care did not contain any information relating to the payment of the nursing contribution. This was required in the last inspection report. The pre-admission assessment for one resident was not dated or signed by the assessor. A thorough assessment had not been undertaken as important aspects of care such as oral health, weight and foot care needs had not been established for this resident. See management section. A syringe driver has recently been in use in the home. The training records for two registered nurses working in the home were seen. There was no evidence to show that they have received any training for the setting up and use of syringe drivers. This was confirmed through discussion with one of the registered nurses. The unit called Logan Jack provides intermediate care. The home’s statement of purpose & service user guide which is a combined document last reviewed on the 6th October 2007 describes this unit as offering, ‘a short term programme of nursing/medical care in a residential setting for people who are medically stable but need a period of rehabilitation to enable them to gain sufficient physical function and confidence to return safely to their own home’. Evidence gathered during the inspection shows that a resident has been residing on this unit for six months and in our opinion this is not short term. A healthcare professional reported concerns about residents on this unit staying in their rooms the whole time and issues getting staff to assist with the rehabilitation of the residents such as encouraging them to use the communal day facilities to improve their mobility. They reported that these concerns have been raised through the weekly multi-disciplinary meetings held for residents in this unit. Discussion with staff employed in the home raised concern relating to the skills of the registered nurses deployed to take charge of this unit, such as having to alert them to the need to carry out a bladder washout, sitting in the office whilst the general practitioner conducts their rounds and giving information to the registered nurse and it not being recorded in the care records. Concerns have also been raised recently during the course of safeguarding procedures about the skills and competency of the registered nurses working in the home in relation to the use of syringe drivers, and management of residents needing treatment through intravenous infusion. Kington Court Health and Social Care Centre DS0000066097.V341468.R01.S.doc Version 5.2 Page 14 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The care records are not accurately identifying all residents’ care needs and are not providing a clear action plan to ensure that the residents receive appropriate and consistent care at all times. This has placed people living in the home at risk. Individual risk assessments are not being reviewed on a regular basis and accurately to ensure that risks to residents are identified and acted upon. This has placed residents at risk. Although there are some adequate arrangements for some aspects of managing medication, the inspection found poor practices in managing medicines and inaccurate medication records and this adversely affected the health and wellbeing of some people in the home and is putting others at unacceptable risk. EVIDENCE: Kington Court Health and Social Care Centre DS0000066097.V341468.R01.S.doc Version 5.2 Page 15 Care records were looked at and residents and their individual care were case tracked on four out of the five visits to the home during this key inspection. Two identified residents’ care was case tracked on three occasions. Evidence referred to in the previous section about the inadequacy of the preadmission assessment for an identified resident has an impact on the quality of the care plan due to all of the information not being available to formulate and provide the basis for the care to be delivered. Care plans are not person centred and are not being monitored and reviewed as stated in the homes statement of purpose & service user guide which states ‘At all times the care plan will strive to maximise an individual’s potential to retain or recapture their independence’. The quality of the information seen was very poor. Poor outcomes have been found for identified residents relating to lack of sufficient fluids and not taking appropriate action when residents are consistently losing weight. Two residents have recently been admitted to hospital due to dehydration and two further residents have been identified as being nutritionally at risk. A nutritional risk assessment was seen for an identified resident dated 27/06/07 and the score was 15 ‘high risk’. The home’s documentation for this score states ‘give extra nutrition’. There is evidence to show that this resident is losing weight and there had been no review since June. This resident has been recently treated for dehydration in hospital. The care plan for decline in physical health states, ‘encourage fluids’, but makes no reference to the need to monitor the resident’s fluid intake. The care plan had not been changed since January 2006. A care plan for diet was seen dated 04/09/09. The care plan refers to the use of a food supplement, but did not state how often this was to be given to the resident. It also had an action for staff to monitor the resident’s fluid intake, although there was no information for staff to indicate how much fluid they should be trying to get the resident to drink each day. The fluid charts for this resident were seen. They were of a poor standard and did not provide sufficient information to show that they were offering the resident fluids at regular intervals. In the case of another resident staff recorded in the assessment that their ‘skin bruises easily’. There was no action stated in the hygiene care plan for staff to check the resident’s skin whilst giving personal care. The resident has a risk assessment for falling out of bed and the last entry was dated 03/04/07 following an incident the day before when the resident was found on the floor in the bedroom. Entries seen in the care plan and on the accident form contained conflicting information about where the resident was found after the fall. One entry states ‘found on floor at the bottom of the bed’ and another states ‘found on the floor by her bed’. The care plan dated 14/03/07 refers to Kington Court Health and Social Care Centre DS0000066097.V341468.R01.S.doc Version 5.2 Page 16 the use of bedrails for this resident. Although the care plan refers to the use of bedrails for this resident, we were unable to establish from the care records if bedrails were in use at the time of the fall on April 2nd 2007. There were no bedrails on the bed at the time of the inspection. The manager when asked confirmed that ‘no bedrails used for sometime as the resident is not safe’. The care plan had been reviewed on the 03/09/07, although it is evident from the above information that the trained staff have not reviewed the care plan accurately. The care plan indicates that the resident is ‘Immobile & chairbound’. There is no evidence in the care plan about the use of any pressure-relieving mattress on the bed. There is no action plan about how to move the resident and the numbers of staff needed and any equipment used. It is evident from an evaluation entry in the care plan that a wheelchair is used to transport the resident, but this is not in the care plan. The resident’s nutritional risk assessment contains evidence that the resident has been losing weight since March 2007, but the there is no evidence to show that they have acted on the findings until September 2007 following a formal review of this resident by the Primary Care Trust. There is evidence that the trained staff in the home have not reviewed this resident’s and other residents’ nutritional risk assessments accurately and have not been taking appropriate action following completion of risk assessments. A trained nurse when asked about the above resident reported that there were ‘No concerns about X’s nutrition now’. The resident is ‘not weight bearing’, ‘we lift X onto chair’, ‘no belt used or sliding thing’. The trained nurse when asked about the type of pressure relieving mattress the resident was using went to ask another trained nurse and reported that the resident was on an ‘ordinary mattress’. The resident was not on an appropriate mattress for her skin care needs. Written feedback from a healthcare professional visiting the home stated that ‘Staff are very stretched at times to manage care needs’. Staff surveys forms stated, ‘Communication could be better especially when we start work in the afternoon, we could really do with a handover which we rarely get.’ General Practitioners have recently raised concerns about the lack of provision of healthcare for identified residents living in the home and the competency of the trained staff working in the home. A detailed medicine policy is available to staff so that they have written direction as to how the home expects them to handle medicines safely. The manager updated this with the April 2007 version during the course of the inspection. Some sections of this document need reviewing. For example the section on disposal of medicines does not reflect the practice at Kington Court and does not comply with current legislation about the disposal of waste medicines. The section on covert administration of medicines needs to reflect provisions of the new Mental Capacity Act. The homely remedies medicine list needs reviewing. Kington Court Health and Social Care Centre DS0000066097.V341468.R01.S.doc Version 5.2 Page 17 Following a complaint to us in May 2007, which the home investigated and dealt with, we know that one person was given the wrong dose of tablets over a period. There was evidence of some medication audits taking place but it is not clear what action has been taken to put right the issues identified and how the home uses this as a way to make procedures safer for residents in the future. An audit 0n 03/07/07 found that an analgesic patch change for one person was a day late –we found a similar issue at this inspection (details below). Staff who administer medicines are either registered nurses (on Staunton and Logan Jack) or carers who have undertaken training about the safe handling of medicines (Eardisley). Nurses also receive some medication training at an induction course when first starting. Not all nurses have received specialist training in use of syringe drivers although this treatment has been used recently in the home and was a requirement at a previous inspection. (See section Choice of Home) A local pharmacy provides printed Medication Administration Record (MAR) charts each month on Staunton and Eardisley. On Logan Jack standard medicine administration charts are used and nurses and doctors handwrite these. There are therefore arrangements in place for staff to keep records about medicines received into or leaving the home and about medicines administered to people living in the home. This is an important part of helping to make sure people in the home receive their medicines correctly. These arrangements are not always effective as we found some issues that need attention to make sure the records of medication are complete and accurate to help make sure people have the right amounts of medicines. • • • Some printed information about the medication is damaged by the holes punched on the left hand side of the medicine charts. The actual dose of medicine administered is not always written down where a variable dose is prescribed (one or two tablets for example). We found evidence of some medicines not being given to people living in the home in accordance with the doctors’ directions. We are concerned that without our intervention at the inspection these issues would not have been put right so quickly. There was no stock of an painkiller patch for one person - the last patch was signed as applied at 10pm on 3rd October 2007 and was due to be changed again at 10pm on 6th October 2007. On Monday 8th October 2007 during our inspection this person told us that she was in pain and the nurse confirmed no patch was in place so the lack of this medication was adversely affecting the health and wellbeing of this person. Some painkiller tablets were also prescribed to use ‘as required’ but nurses had not used these until we pointed out that this lady was in pain. There was a care plan for severe back pain that mentions use of analgesic medicines but it would be better if there was clearer information. Nurses must follow the care plan to avoid people suffering unnecessary pain. We left an immediate DS0000066097.V341468.R01.S.doc Version 5.2 Page 18 • Kington Court Health and Social Care Centre • • • • • requirement form for this person to receive sufficient pain relief in accordance with the doctor’s directions. A new supply of patches was obtained and a dose applied to this person at 6.45pm on 8/10/07. We are aware that staff had ordered this medicine but there had been problems with the surgery in providing a new prescription. Staff still must vigorously follow up this sort of issue to make sure that the health and wellbeing of people in the home is not compromised. A weekly dose of a particular medicine for one person was not signed on the medicine chart as given as prescribed at 6am on 8/10/07 so it was not known if this medicine had been administered for the next week. This places this person at risk of receiving the incorrect levels of this medicine. We left an immediate requirement form for the manager to find out if this person had received the medication as the doctor prescribed. The home subsequently told us that the dose was administered the next day at 6am and we saw the record for this during our inspection on 10/10/07. Some directions printed on the charts did not represent the way medicines were actually being used. For example some medicine directions indicated regular use but were not administered. This may be because the need for the medicine has changed but there needs to be better liaison with the surgery to make sure that the repeat prescriptions contain the latest information. If authorised trained staff checked the prescriptions in the home before sending them to the pharmacy this would help. This was a recommendation at a previous inspection. Some eye drops for another person that were prescribed to use each day had not been used since 15/9/07, as records stated that there was no stock supplied. A new stock had been received again the day before the inspection. The care plan contained little information about the use of these eye drops or why they had not been used. This person was due to see the optician again very soon but the last appointment was a year ago and there was no evidence of a recent review of the use of any of the eye drops. We were concerned as some antibiotic eye drops had been in use for a number of weeks and we could not find out from the care plan if long-term use was intended. We spoke to a carer who did not know much about why the various drops were in use. Another person was prescribed some drops to use as required for dry eyes but the last dose was signed on 27/9/07 when that section of the medicine chart was completed but was not rewritten. There was no stock on the trolley. There was nothing in the care plan about these. This person told the nurse that her eyes were sore. We left an immediate requirement form for the manager to make arrangements for this person to receive these eye drops in accordance with the doctor’s directions and her needs. The assistant director of care has informed us in writing of the appropriate action taken about this. Records of creams or ointments applied to skin were not always kept. For some people this was clearly recorded but for other people it was not possible to tell what, if anything was applied. In one care plan use of creams was mentioned but no creams were included on the medicine chart. DS0000066097.V341468.R01.S.doc Version 5.2 Page 19 Kington Court Health and Social Care Centre • • • • On visiting the bedroom we found a pot of cream labelled for another person. The daily records of care may be marked as ‘creams applied’ but this is not sufficient to tell what treatments are used and where. We carried out some audits of medicines by counting the stock remaining and comparing this with the records. In the sample looked at some audits were correct but a few others did not agree. We could not tell the exact reason for this but this is an indication that medicines may not have been administered correctly or that records are not accurately made. Records of medicines received on Logan Jack were not complete. There are records of some stock medicines received but as there are more complicated arrangements on this unit medicines are received from several different places. For example medicines received from the local pharmacy or brought in on admission are not recorded. This means that there is no complete audit trail of all medicines in the home and staff cannot account for all the medicines on this unit should they need to in order to make sure there is no mishandling. A requirement was made about this at the last inspection. In order to get consistent use of medication better written information is needed to explain the use of medicines prescribed to use ‘as directed’ or ‘as required’ particularly where people may lack capacity and where nurses are not administering the medicines. Dose changes for warfarin are given verbally by the surgery staff and are recorded in care plans and medicine charts. On one unit the medical staff sign the records for the new doses but on another unit this does not happen. Good practice advice from the National Patient Safety Agency is for these dose changes to be confirmed in writing. Safe practice is to use the standard yellow anticoagulant book as part of a safe recording system. We strongly recommend more controls are put in place to keep account of the blank prescription pad that is kept on one unit. During our inspection we saw staff giving out medicines safely to people in the home. We spoke to some people who were having their medicines. Three people confirmed they are well looked after and that staff administer their medicines with no problems and they were happy with this. We were told that nobody in the home looks after and self-administers their medicines. We found this surprising as the home provides places for intermediate care. The care plan for one person receiving respite care did not mention what choices he had been given about his medication. The plan was ticked to indicate regular medicines are needed but the self-medication assessment form was not completed. We saw doctors visiting people in the home and care plans contained records of contact with doctors and other health professionals. Kington Court Health and Social Care Centre DS0000066097.V341468.R01.S.doc Version 5.2 Page 20 Controlled medicines are stored correctly and there are the right record books in place. In spite of a daily check on Logan Jack we found a discrepancy in the stock recorded on one page in the record book and left an immediate requirement form to sort out this matter. We now have a satisfactory explanation about this and we saw the missing record that was made in the back of the book. The record book on Logan Jack was not well kept as the pages were not always properly headed up for named people and sometimes muddled with stock items. This makes it difficult to keep a proper track of the medicines. The correct arrangements for the disposal of these medicines must be in place. For example on Staunton a proper denaturing kit must be used and two registered nurses must witness this in the record book. On Logan Jack an authorised witness is used for the disposal of these medicines. We do not consider it a legal practice for unwanted stock of these medicines to be returned to the pharmacy or taken by a visiting pharmacist. Generally medicines are stored safely and at the correct temperature to retain their effectiveness but we identified that some actions are needed. On the first day of the pharmacist inspection the medicine trolley door on Eardisley was damaged and could be opened without a key. An immediate requirement form was left to deal with this and we later saw that temporary repairs had been made to secure the medicines. The manager and assistant director of care agreed that a new trolley may now be needed and would arrange this. On Logan Jack the medicine trolley is now kept by a radiator and the southfacing window. The radiator was not turned on but the sun was shining through the window directly on to the metal trolley so at times during the day this would be too hot to keep medicines safely. The clamp securing the trolley to the wall needs more secure fixing, as the screws were very loose. On Logan Jack audits were not possible particularly for medicines held as stock and records were not in place to allow staff to know what medicines they should have or if any were missing for example. Poor practice identified was that there was an insulin pen in one medicine cupboard that we presumed was in use but there was no name to know who this was used for and there was no date to show when storing at room temperature had started. There were some other injections labelled for people who were no longer in the home or the labels had their names crossed out. The adrenaline injection was out of date. On Logan Jack we saw evidence of excess stock medicines returned to the pharmacy for credit. This practice is not legal in a care home. On one room the notice about oxygen use must be improved so that the correct statutory warning is used. The correct notices are in place in the store on Logan Jack. Kington Court Health and Social Care Centre DS0000066097.V341468.R01.S.doc Version 5.2 Page 21 We saw the wrong type of lancing device to take samples for blood glucose monitoring in the home and this presents a risk of cross infection. Suitably qualified staff must only use a single–use lancing device or a non-disposable lancing device which is intended for use on multiple patients and is used with single-use lancets. Advice has been published in Medical Device Alerts the latest alert being in December 2006 and so should have been actioned. The medicine reference book needs replacing with the new edition now so that staff are able to look at up to date information about medicines. Residents’ privacy was seen to be maintained whilst staff carried out personal care and residents were seen being taken back to their bedroom to see the General Practitioner. Kington Court Health and Social Care Centre DS0000066097.V341468.R01.S.doc Version 5.2 Page 22 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, & 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Social care plans are not in place providing evidence that the residents’ social and recreational needs are being met in line with their individual wishes and expectations. Residents are not receiving the specialist diets needed, which is placing them at risk. EVIDENCE: The home employs an activity co-ordinator who works five days per week. She also assists with personal care of residents particularly at mealtimes. The organisation produces a generic activity programmes for their homes. Activities for the day were listed on the notice boards in the home and they take place in one of the communal lounge areas on each unit. A poster was displayed about an Autumn Fayre due to take place in mid October in the reception area of the building downstairs from the care home. Music was being played during breakfast in the lounge on Staunton Wing. The music was appropriate for the age of the residents in the lounge. The activity coordinator was observed to have an excellent manner with the residents and as she is a local lady residents benefit from her local knowledge. A large homemade calendar is on the wall in Staunton Wing, although the calendar Kington Court Health and Social Care Centre DS0000066097.V341468.R01.S.doc Version 5.2 Page 23 showed that the day was Sunday when it was actually Monday. Residents asked confirmed that there ‘have been a few quizzes’ and that the activity person is ‘a woman extremely good’. It is evident from observation & discussion with the activity co-ordinator that she is involved with the care of the residents and also goes as escort with residents to appointments. Whilst she is doing this it means her main role of providing social care for the residents cannot be fulfilled. A carer when asked confirmed that residents ‘do not get enough activities as X is on care most of the time’. A social care plan for an identified resident did not include the information obtained in the ‘pen profile’ about what this resident enjoyed doing. There is evidence from the care records seen over the five visits confirming that ‘pen profiles’ are not being completed for all residents and the social care plans are of a poor quality. Visitors were seen in the home throughout the day & evening and were seen talking to the residents in the privacy of their room. The provision and service of meals to the residents was inspected during one of the days in the home. Breakfast was still being served to the residents on Staunton Wing at 10.00 am. Residents were offered a choice of cereals, porridge, bread, toast and jam/marmalade and a cooked breakfast. Residents were observed being assisted by staff to eat their breakfast. They were sitting doing this on a one to one basis and talking to them making it a social occasion. The activity coordinator was also involved in assisting residents to eat. A carer was observed having to go and get one resident’s teeth before they could eat their breakfast in the dayroom. Two residents identified as being nutritionally ‘at risk’ were observed by us one morning both helping themselves to and eating biscuits prior to breakfast and told us they were hungry. Carers were seen to wear blue aprons when serving meals. A menu is centrally generated for the Blanchworth Care Group homes. The menu for the 8th October 2007 for Kington Court was identical to one for another home in Gloucestershire. The lunch menu states an ‘alternative provided on request’ and ‘special therapeutic diets/feeds are provided when advised by health and dietetic staff’. Two residents case tracked were nutritionally ‘at risk’ and needed high protein diets and the General Practitioner had prescribed additional snacks in between meals. It was evident from their care records and discussion with kitchen staff during three visits to the home that the trained staff in the home had not communicated this to them. The identified residents were not receiving the specialist diets required. Lunch was observed being served on all three units. For Eardisley and Logan Jack the meals are served into individual portions in the unit’s kitchen by the chef. Lunch was beef stew with brown ale & dumplings, sliced potatoes, sweetcorn, carrots & buttered leeks with lemon layer pudding for dessert. The Kington Court Health and Social Care Centre DS0000066097.V341468.R01.S.doc Version 5.2 Page 24 agency chef when asked confirmed that all the vegetables except the potatoes were frozen. The hot trolley was broken and there was no means of maintaining the temperature of the food during service. Care staff were observed putting some residents meals in the microwave to reheat before serving. Two residents and a relative when asked about the food stated ‘most of the time the food is cold’, ‘not bad’, ‘have a choice’, ‘warm enough, sometimes maybe not’, ‘offered snacks & drink late at night’, ‘if you bring in food they will cook it for you’. ‘50 like hospital food’. Tray papers were not being used whilst serving meals to residents in their rooms. Only two plate covers were available for covering food when transporting them on trays. The chef was observed using a dessert spoon for serving and when asked reported ‘they had run out of serving spoons, they have not got sufficient for the job’. Another chef spoken with when asked stated that ‘more equipment was needed e.g. spoons, food covers’. Staff from the organisations head office confirmed that the hot trolley had been broken since the Thursday before (4 days ago). The hot trolley was observed not to have been repaired/replaced two days later. The manager stated that they are ‘waiting for the equipment manager to come back to them’. She undertook to contact head office when it opened later that morning. The hot trolley was replaced that day. On Staunton Wing the meals were portioned by the kitchen staff and brought up to the unit in the hot trolley. The food appeared hot when served and tray papers were being used for residents eating in the lounge or in their bedrooms. There were no drinks available on the dining tables until the manager reminded the staff to provide them. Kitchen records were seen – see management section. Kington Court Health and Social Care Centre DS0000066097.V341468.R01.S.doc Version 5.2 Page 25 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who use this service have access to a complaints procedure to enable them to express their concerns. Residents are not being protected from harm. EVIDENCE: Information submitted before the visit to the home by Blanchworth states they have had eight complaints in last twelve months of which four were upheld. There have been three safeguarding adult referrals & investigations. One referral of a staff member to the Protection Of Vulnerable Adults (POVA) list. We have received five complaints about this service between July and September 2007. These complaints relate to the staffing levels in the kitchen & in the care home, the provision of health & personal care, cleanliness of the kitchen, competency of the trained staff employed in the home, allegations of poor nutritional status and neglect of identified residents. One complainant was advised by us to speak and write to Blanchworth and/or the Director of Care to take the complaint up directly with the organisation. Due to the seriousness of the concerns the home was referred to the lead agency for safeguarding vulnerable adults. An investigation is currently in progress with the assistance of other agencies who commission care from this service. The Commissioners of this service are currently not placing residents in the home and Blanchworth has agreed to date not to admit any new residents. Kington Court Health and Social Care Centre DS0000066097.V341468.R01.S.doc Version 5.2 Page 26 Concerns have been brought to the attention of a senior representative of the organisation by other professionals following a recent local multi-agency safeguarding adult investigation. These relate to the lack of accountability of the registered manager for the service, and unpleasant behaviour towards the healthcare professional who highlighted a safeguarding concern by senior managers in the home. Surveys from relatives (2) and residents (1) indicated that they were aware of the home’s complaint procedures. The resident was not aware of how to complain. A survey from a healthcare professional stated ‘there have been incidents where the home have responded appropriately’. The homes’ complaints records were seen and all complaints in the file indicated they had been investigated and the complainants had received a response from Blanchworth. It appears from these records that complaints are not investigated by the home manager, they are dealt with by a representative from head office. Two newly appointed staff who were seen working in the home had not received induction training, so had not had training about complaints and the recognition of abuse. Kington Court Health and Social Care Centre DS0000066097.V341468.R01.S.doc Version 5.2 Page 27 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is a purpose built unit which offers a nice standard of accommodation to the people living there. Systems are not in place to ensure that moving & handling equipment is being checked for safety at the required intervals to prevent residents from potential harm. The management of infection control is poor, placing residents at risk of harm. EVIDENCE: The home is a modern purpose built building and the accommodation for the care home is situated on the first floor of a health and social care centre. Records of maintenance in the home for checking the safety of bedrails were inspected. The only records available were dated entries in the maintenance Kington Court Health and Social Care Centre DS0000066097.V341468.R01.S.doc Version 5.2 Page 28 person’s diary; there is no specific documentation provided by the organisation available to record the checking of bedrails by the maintenance person in the home. This needs to be addressed. The information submitted by Blanchworth prior to the inspection visit indicated that the hoists used for moving & handling residents had not been serviced since May 2006. These records and the hoists in the home were inspected and the findings were that they had not been serviced since 31/05/06 and the service due in November 2006 had not been done. A senior manager was advised immediately of this finding and the hoists were serviced the next day. The inspector had to advise that the service certificates contained incorrect information about the date of the resulting previous service and the senior manager addressed this immediately. Surveys from residents (2) confirmed that the home is clean & fresh. The home was clean and there were no bad smells noted during any of the visits. There were concerns raised from the visits in relation to the management of infection control and highlighted during the current local agency safeguarding vulnerable adult investigation. The information submitted by Blanchworth prior to the inspection visit indicated that only eight staff have received infection control training. The following issues were noted during the inspection visits: • • • • • • • • Communal flannels, (which it is policy to use in the home) are not being washed at a sufficiently high temperature to kill bacteria. There were no disposable aprons available in the laundry and staff confirmed that it was not practice to use them when handling foul washing. A stained slipper type bedpan and a bedpan with a broken handle & dirty bedpan lid were seen in the sluice. (This was brought to the attention of the manager and was addressed immediately). Staff confirmed they are using flannels for residents with MRSA and there are not enough flannels provided. Staff reported there had been a ‘resident with C Diff, room not deep cleaned afterwards and another resident was admitted the next day’. Staff reported that they use toilet paper for residents who are soiled with faeces then they wash them with a flannel. Care staff have been sent down to wash up in the kitchen wearing their care uniform. (A senior manager was immediately advised of this finding) There appears to be a high incidence of eye infections on Staunton Wing. Kington Court Health and Social Care Centre DS0000066097.V341468.R01.S.doc Version 5.2 Page 29 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff in the home are not trained, skilled and in sufficient numbers to support the people who use the service and to protect them from harm. EVIDENCE: Prior to the inspection visit we wrote to Blanchworth about the numbers of repeated notifications about staffing shortfalls in the home. Complaints about staffing levels are being investigated and monitored on a daily basis as part of the current investigation by the agencies through the local multi-agency arrangements for safeguarding vulnerable adults. Blanchworth is submitting to the agencies weekly proposed and actual staff rotas for the service. A survey from a healthcare professional (1) states ‘staff are very stretched at times to manage care needs’. Surveys from staff (4) state ‘The only way in which the service could be improved is by employing more staff, I just hope for everyones sake that some new staff join us soon’. ‘There have been a lot of staff who have left and not been replaced, we are always short staffed and I have been working stupid hours lately sometimes almost double my contract hours’. ‘I feel this is the biggest concern and am not only worried about the lack of care the service users are receiving due to this but also the health and well being of the few staff there are left here.’ Kington Court Health and Social Care Centre DS0000066097.V341468.R01.S.doc Version 5.2 Page 30 There have been concerns raised during the inspection visits about the staffing in the kitchen, these were raised with one of the senior management team and are being addressed through the use of agency staff. The manager stated that ‘the need for her to work on the floor has taken priority in the last 2-3 months due to staff shortages’. ‘Agency staff availability now much better’. The manager told us that she has no input on staffing; it is decided by head office. She also told us that she has recommended two registered nurses at night since an incident happened with an identified resident, but this has not been actioned. Observation by other healthcare professionals of the staffing levels at night suggest that the numbers of staff on duty at night should be reviewed due to the dependency of the residents. Currently (even prior to the reduction in numbers) there is only one registered nurse and 3 care staff to cover all three units. There is another registered nurse in the building, although this person sleeps in providing cover for the separate minor injuries unit downstairs. Please also refer to the health & personal care section of this report. Information submitted by Blanchworth prior to the inspection states they have 11 staff with NVQ level 2 or above and have five staff working towards NVQ level 2 or above. Two staff files were looked at in depth on the Blanchworth intranet. There was evidence of Nursing & Midwifery Council (NMC) Personal Identification Number (PIN) checks prior to employment and upon expiry of a PIN to check renewal. Neither of these trained nurses had received any training for the use of syringe drivers. Please also refer to section one (Choice of Home). One trained nurse had started work in the home upon the same day that her POVAfirst check was received and prior to receipt of a full enhanced CRB disclosure. There was no evidence to show that this trained nurse was being supervised prior to receipt of the full CRB disclosure. There was no evidence of any induction training on her file. When asked the manager confirmed that this trained nurse was on shift and not supernumerary and had not received any induction training. Kington Court Health and Social Care Centre DS0000066097.V341468.R01.S.doc Version 5.2 Page 31 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The health, safety and welfare of the residents and staff are not being protected to ensure that they are protected from harm. EVIDENCE: There is currently no registered manager for this service as she has recently resigned with immediate effect. A quality audit for this service was undertaken in June 2007 by staff from the service’s head office. The outcome of this audit is displayed on the notice boards in the home and in the statement of purpose & service user guide. The Kington Court Health and Social Care Centre DS0000066097.V341468.R01.S.doc Version 5.2 Page 32 action plan for this audit was discussed with the manager. She advised of the following areas of shortfall and any actions in response to the audit: • Care – the staff should have on site training. • Domestic – large turnover of domestic staff, but a lady started last week. • Laundry – staff are not to accept unlabelled clothes. • Food – problems due to one of the cooks being off sick. The hot trolley is to be condemned & a new one purchased, timescale unknown by the manager. • Activities – lack of these over the weekends. This has not been actioned. • Admission procedures on Logan Jack – due to new staff & lack of training. A care plan audit was carried out in July 2007 by one of the senior managers from the head office, as part of the monthly monitoring visits of the service required by regulation. This identified shortfalls in the care records. We have requested a copy of any action plan following this audit. To date this has not been submitted to us. A sample of monies held in the home for three residents were checked. This is now much easier to audit as the home are numbering the receipt to enable them to be matched against the expenditure sheet. The balances were all correct and receipts were seen for all expenditure except one receipt for chiropody for an identified resident. There have been delays in us receiving notifications relating to accidents & incidents involving residents and in notifying us of staff shortages in the home. We wrote to Blanchworth in September about the delay in sending in the notifications relating to staff shortfalls. The regulations require the service to send notifications to us ‘without delay’. It was evident from looking at a staff file that an incident took place in June 2007 relating to the non-administration of a controlled drug for pain relief to an identified resident. A senior manager from head office wrote to the trained nurse involved in August 2007, but they failed to notify us of the incident. The notification was requested at the time of the inspection visit but was not made available to us. It is evident from discussion with staff and staff files seen on the Blanchworth intranet that staff are not receiving the training required in relation to health & safety. An ancillary member of staff has not had any training in the last 12 months and last received moving & handling and health & safety training in April 2005. Two catering staff files were seen and they last received moving & handling training in July 2004 & February 2005 respectively. Care staff also confirmed that they have not received moving & handling training in the last twelve months. Concerns about the moving & handling of residents have been highlighted during the current local multi-agency safeguarding adult investigation and staff are now starting to receive this training. Kington Court Health and Social Care Centre DS0000066097.V341468.R01.S.doc Version 5.2 Page 33 Fire extinguishers have labels on them indicating that they were last serviced in June 2007. Moving & handling hoists had not been serviced since April 2006. (See environment section) The records for the maintenance of the window restraints show the last recorded check as being done on the 12/09/07. No food hygiene training certificates could be found on Blanchworth intranet for the kitchen staff. A certificate was faxed through to the home for one of the cooks dated August 2004. It is recommended that staff receive refresher training every three years. One of the catering staff stated that all of the food hygiene training for the catering staff was overdue. Kington Court Health and Social Care Centre DS0000066097.V341468.R01.S.doc Version 5.2 Page 34 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 2 1 1 X 1 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X X X X X X 1 STAFFING Standard No Score 27 1 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X 1 1 Kington Court Health and Social Care Centre DS0000066097.V341468.R01.S.doc Version 5.2 Page 35 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP2 Regulation 5A, 5B Requirement Timescale for action 30/11/07 2. OP3 14 (1)(a) 3. OP4 18 The registered person must provide to all residents where a nursing contribution is paid in respect of nursing provided, a statement specifying the date of payment & amount and the date that the nursing contribution is to be paid to the resident or deducted from the fees to ensure that residents are aware of how this is taking into account as part of their individual fees. Timescale of 31/12/06 not met. A thorough assessment must be 30/11/07 carried out for all residents prior to admission to ensure that the home are able to meet the resident’s care needs and to enable an ‘holistic’ care plan to be formulated for the resident prior to or upon the day of admission. All registered nurses must be 30/11/07 trained in the setting up and use of syringe drivers by a professionally recognised trainer to ensure the health, safety & welfare of residents is maintained. Timescale of DS0000066097.V341468.R01.S.doc Version 5.2 Kington Court Health and Social Care Centre Page 36 4. OP7 15(1) & (2), & 17(1)(a) 15 (1) & (2), & 17(1)(a) 5. OP7 6 OP9 13(2) 7 OP9 13(2) 8 OP9 13(2) 9 OP9 13(2) 10 OP9 13(2) 28/02/05 & 31/12/05 partly met. Timescale of 31/03/06 & 15/11/06 not met. Care plans must show how the social & emotional care needs of the resident are met. Timescale of 31/03/06 & 31/12/06 not met. Care plans must identify all problems and needs of residents and set out in detail the action that needs to be taken by the staff to ensure that all aspects of the individual residents health, personal & social care needs are met. They must be reviewed and updated when any changes take place. Timescale of 31/12/06 not met. Make arrangements for the safe storage of all medicines – this relates to repair of the broken medicine trolley on Eardisley. An immediate requirement was made. Make arrangements for a particular person to receive sufficient pain relief in accordance with the doctor’s directions. An immediate requirement was made. Make arrangements to ascertain if a named person had received a particular medicine at 6am on 8/10/07 as the doctor prescribed. An immediate requirement was made. Investigate and report back to us about the discrepancy of five ampoules of a particular injection in the controlled drug record book and provide an explanation for the incorrect record. An immediate requirement was made. Make arrangements for a named person to receive particular eye drops in accordance with the DS0000066097.V341468.R01.S.doc 30/11/07 30/11/07 08/10/07 08/10/07 08/10/07 15/10/07 11/10/07 Kington Court Health and Social Care Centre Version 5.2 Page 37 11 OP9 13(2) 12 OP9 13(2) 13 OP9 13(2) 14 OP9 13(2) 15 OP9 13(2) 16 OP9 13(3) doctor’s directions and her needs. An immediate requirement was made. All medicines must be given to residents according to the doctors’ directions and with written plans in place for medicines prescribed to use ‘as required’. Timescale of 30/11/06 not met. Full and accurate records for the receipt and administration of all medicines must be maintained. Timescale of 30/11/06 not met. Waste medication or unwanted stocks of medicines must be handled so as to comply with current legislation. All medicines must be available to give according to the doctors’ directions to make sure that all people in the home receive the correct amounts of medication for their health needs. Fix the medicine trolley clamp securely on Logan Jack and move the position for keeping the trolley out of direct sunlight. This is so that medicines are always kept securely and below 25°C and will help to make sure people who live in the home receive medicines that are of the correct potency. When staff take blood samples for blood glucose monitoring for people living in the home the lancing device used must be safe to use in a care home environment as described in Medical Device Alert MDA/2006/066 issued by MHRA in December 2006. This is to reduce the risk to people living in the home of cross infection linked with the use of the wrong sort of lancing device. DS0000066097.V341468.R01.S.doc 01/12/07 01/12/07 01/01/08 01/12/07 01/12/07 01/12/07 Kington Court Health and Social Care Centre Version 5.2 Page 38 17 OP15 12(1)(2) & (3) 18 OP18 OP38 12(1)(a) & (b) 13 (6) 19 OP19 OP38 13(a)(c) 20 OP27 18(1)(a) 21 OP27 18(1)(a) 22 OP29 18(2)(a) & (b) 19(11) 23 OP30 18(1)(C) 24 OP33 24(2)(3) & (4) Residents must receive a varied, appealing, wholesome and nutritious diet, which is suited to individuals assessed and recorded needs to make sure that they are not at risk of malnutrition. Staff employed to work in the home must have the competencies and skills needed to provide the care required and training in relation to the homes’ policies to make sure that residents are protected from harm. Systems must be put into place to ensure that all equipment is serviced at the required intervals to make sure that residents are protected from harm. The staffing levels must be reviewed to make sure that residents are not placed at risk of harm. The competency of the trained staff employed in the home must be reviewed to make sure that residents are not placed at risk of harm. Staff commencing work in the home prior to receipt of a full CRB disclosure must be supervised by a designated staff member who is appropriately qualified and experienced to carry out this role to make sure that residents are not placed at risk of harm. All staff must receive structured induction training to make sure residents are not placed at risk of harm. A report must be submitted outlining any action deemed necessary to be taken by the home in response to the care plan audit undertaken in July 2007 to make sure that the DS0000066097.V341468.R01.S.doc 30/11/07 30/11/07 30/11/07 30/11/07 30/11/07 12/11/07 12/11/07 29/11/07 Kington Court Health and Social Care Centre Version 5.2 Page 39 25 OP37 37(1) health & welfare needs of the residents are met. Notifications must be sent to the Commission without delay for all deaths, illness or events in the home to demonstrate that the health, safety & welfare of the residents are being maintained at all times. 12/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations A printed copy of the homes Statement of Purpose & Service User guide should be on display at the entrance to the home to include a copy of the most recent public inspection report. Arrange to see and check all prescription forms in the home before they are sent to the pharmacy for dispensing. Arrange to use the standard yellow anticoagulant book and for dose changes of anticoagulants to be confirmed in writing by the prescriber on all units as detailed in Patient Safety Alert 18 from the National Patient Safety Agency. Put in place more controls to keep account of the use of the blank prescription pad kept on one unit. Care plans should reflect what choices people who live in the home are given about how their medicines are administered and their consent to the way in which staff handle their medicines. Use the correct wording for statutory warning notices wherever oxygen is stored or used in the home. The service of food on Eardisley & Logan Jack should be reviewed to ensure that it is presented in an attractive manner. The current provision of equipment used for the service of meals to residents should be reviewed to ensure that there is sufficient equipment to enable food to be served in an appropriate and timely manner. The use of communal flannels in the home should be reviewed in line with current guidance to reduce the risk of DS0000066097.V341468.R01.S.doc Version 5.2 Page 40 2 3 OP9 OP9 4 5 OP9 OP9 6 7 8 OP9 OP15 OP15 9 OP26 Kington Court Health and Social Care Centre 10 11 OP26 OP31 cross infection. Documentation should be provided to record the maintenance checks for bedrails to ensure that these records are maintained and available for audit. An action plan should be submitted to the Commission to indicate what steps are being taken to recruit a manager for this service. Kington Court Health and Social Care Centre DS0000066097.V341468.R01.S.doc Version 5.2 Page 41 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Kington Court Health and Social Care Centre DS0000066097.V341468.R01.S.doc Version 5.2 Page 42 - 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. 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