Random inspection report
Care homes for older people
Name: Address: Kirklands Sullart Street Cockermouth Cumbria CA13 0EE one star adequate service 25/02/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Angela Branch Date: 0 4 0 6 2 0 0 9 Information about the care home
Name of care home: Address: Kirklands Sullart Street Cockermouth Cumbria CA13 0EE 01900822364 Telephone number: Fax number: Email address: Provider web address: www.anchor.org.uk Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Anchor Trust care home 40 Number of places (if applicable): Under 65 Over 65 29 2 2 7 dementia learning disability mental disorder, excluding learning disability or dementia old age, not falling within any other category Conditions of registration: 0 0 0 0 The home is registered for a maximum of 40 service users to include: - up to 29 service users in the category of DE(E) (Dementia over 65 years of age) - up to 7 service users in the category of OP (Older people not falling within any other category The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Two named service users in the category of MD(E) (Mental disorder, excluding learning disability or dementia over 65 years of age) may be accommodated within the overall number of registered places Two service users in the category of LD(E) (Learning disability over 65 years of age)
Care Homes for Older People Page 2 of 9 may be accommodatd within the overall number of registered place Date of last inspection Brief description of the care home Kirklands is a modern, purpose built home situated in a residential area of Cockermouth. It is within walking distance of all the local amenities in the town centre. The home is operated by the Anchor Trust and managed by Mrs. Maureen MacColl. The home provides accommodation and care for up to forty older people, thirty of who may have dementia. The accommodation is on two floors, and is divided into four living units. Each unit has a lounge/dining room, with bedrooms, toilets and bathrooms close by. The home has a passenger lift and a range of other equipment to assist people in their day-to day-lives. There are garden areas that are provided with safe and secure seating areas. There is a car park to the front of the home. 2 5 0 2 2 0 0 9 Care Homes for Older People Page 3 of 9 What we found:
The service was visited in order to check the way that medicines were handled. The pharmacist inspector assessed this through inspection of relevant documents, storage and meeting with staff. The inspection took 3 hours. Feedback was given at the end of the inspection to senior staff as the manager was not available. Overall, we found that medication is managed well so that residents health and well-being are protected. Residents were protected by comprehensive policies and procedures for managing medication. We looked at records for receipt, administration and disposal of medication and found that they were very well maintained. This means that the treatment received by residents was clear and showed that they received their medication in the prescribed dosages. Staff made clear records if medication was not given and the reasons for this. Any changes to medication were clearly recorded, signed and double-checked to minimise errors. The records for administration clearly showed the doses of medication administered where this was variable such as one or two tablets. Where medicines were prescribed when required staff documented why they had been given. We counted a sample of medicines and compared the quantities with records to check that they had been given in the right dose and could be accounted for. All the samples with the exception of one isolated case added up correctly. The service received their medicines from the pharmacy in a four-weekly cycle. We were told that the manager checked through all the prescriptions before they were dispensed so that errors could be identified and corrected before the medication was received and put into use. This is an example of good practice. The service also kept copies of the prescriptions so that queries could be dealt with easily and medication that is received could be double-checked. Concern was raised at the inspection in February 2009 that, where residents have medications with repeated doses, morning and lunchtime administrations may be too close together because the morning medicines round was large and took a long time to complete. We discussed this with staff who said that since the inspection the systems had been reviewed to prevent this. Staff described how residents with medication that was repeated during the day were highlighted and received their medication first in the morning so that there was an adequate time span between doses. We saw that residents had care plans in place for the management of medication. These were kept with the medicines administration records so that staff could refer to them easily, evaluate them regularly and update them as necessary. These included information on changes to medication that were well documented. There were also further care plans specific to individual medicines such as when required pain-killers so that staff had clear guidance to ensure safe and effective treatment. Although most of these were good there were a few that lacked information and needed to be reviewed. We looked at a care plan for a resident who received their medication disguised in food. This showed that the service did this only after multidisciplinary discussion that concluded that this was in the best interests of the resident. However, the care plan could include more detail with regard to the management of refused food and disposal to ensure the
Care Homes for Older People Page 4 of 9 safety of all residents, stability of the product, and further assessment particularly if new medication is required. We were told of a resident who looked after and took their own medication with support from staff. The care plan did not adequately describe how this was managed or the support required by the resident. We looked at the management of a high-risk blood-thinning medication that needed regular blood tests and adjustment of doses. The service managed this particular medication exceptionally well so that residents are protected from errors that could cause harm. Care plans were in place that described the safe handling of this medication and the responsibilities of staff and we noted that staff followed this. For example, one resident was due a blood test on the day of the inspection. The care plan said that staff must check that the blood tests are done. In the early afternoon we saw a member of staff double-check this and she said she was going to contact the district nurses as the blood test had not been done. The service received written confirmation from the doctor of the dose of medication required. Medicines administration records and a count of the tablets showed that the staff administered this exactly as prescribed. Storage of medication was good. We checked for medicines liable to misuse, called controlled drugs. The service did not have any of these medicines at the time of the inspection but records showed that when they previously had these preparations they were documented properly. Staff who administer medication told us that they had received training in safe handling and the supplying pharmacy provided further training on the dispensing systems in use in the service. 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 Older People 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 7 15 Care plans must be reviewed 31/03/2009 and updated, particularly where people have returned to the home from hospital. Care plans must clearly reflect the current care and support needs of people using this service. Changing needs and current objectives for health and care support must be recorded and actioned appropriately. This will help to ensure that people receive the care and support they require. 2 36 18 Staff must receive formal 30/04/2009 supervision at least six times per year. Managers and supervisors should receive training in supervisory skills and undertaking performance appraisals. Regular and structured supervision of staff helps to ensure that they are working safely and following the policies and procedures of the organisation. Supervision also helps to identify any gaps in skills and training needs. Skilled supervisors helps ensure that staff supervision is effective. Care Homes for Older People 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 3 36 18 All staff working at the home 30/04/2008 must receive formal supervision at least six times a year. (Previous timescale of 30/04/07 not met). Care Homes for Older People 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 9 It is recommended that all care plans for medication including when required medication are comprehensive so that staff have clear guidance to follow to ensure safe and consistent practices, and to identify the support required by those who self-medicate. Care Homes for Older People 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 Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People 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!
