Inspecting for better lives Thematic inspection report
Care homes for older people
Name: Address: Lakenham Residential Home Lakenham Hill Northam Bideford Devon EX39 1JJ two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. This is a report of a thematic inspection of this care home. A thematic inspection is a short, focussed inspection. 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: Susan Taylor Date: 0 4 0 2 2 0 0 9 Information about the care home
Name of care home: Address: Lakenham Residential Home Lakenham Hill Northam Bideford Devon EX39 1JJ 01237473847 01237470790 cordelia.murphy@Hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Cordelia Wai-Yu Murphy,Mr Timothy Oliver Murphy,Mr Christopher Charles Hampton,Miss Siobhan Catr care home 28 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 28 old age, not falling within any other category Conditions of registration: Date of last inspection Brief description of the care home 0 Lakenham Residential Home is a care home registered for 28 beds, providing personal care for service users in the category of old age (OP). The building is a detached former residence of the Duchess of Manchester and is situated on a large corner plot in the Northam area of Bideford. The home is sited in extensive well-kept grounds and has glorious sea and coastal views. Accommodation is provided on four floors and the home is extremely spacious with several large communal, reception and meeting areas. The home also has a Chapel on the ground floor of the home. The majority of rooms are single and en-suite, although two shared rooms are available if required. The home is accessible to all areas via a large, modern passenger lift. A copy of the Care Homes for Older People
Page 2 of 14 Brief description of the care home previous CSCI inspection report was on the main notice board making it available to staff, residents, their relatives and any other visitors to the home. Fees charged range from #390.00 to #525.00 with additional charges being made for chiropody, hairdressing, newspapers and magazines and clothing. Care Homes for Older People Page 3 of 14 What we found:
We did a random inspection after the Commission was made aware of concerns about the home as a result of safeguarding procedures. We examined the care files for 4 people. 1 person had recently been admitted. None of the files contained a letter advising the person that the home could meet their needs, and therefore there was no clear evidence about how this decision had been made. 3 files had copies of social services care plans and or hospital discharge information but on one file no pre admission assessment had been completed. 2 people living in the home did not have a care plan that gave staff clear instructions about the care they need to deliver to meet individual needs. Therefore, people living in the home cannot be confident that all staff are clear about what is required to meet each persons needs, removing possible misunderstandings which may arise from verbal instructions. We looked at how medicines are managed in the home and found significant failures. The Medication Administration Record MAR charts were found unsecured on top of the trolley in the dining room when we arrived at the home. This means that they were freely accessible to anybody in the home and did not protect the privacy of the people the records related to. Correction fluid had been used on MAR charts meaning that it was not possible to determine what had actually been administered to the people the charts related to as some entries had been obliterated. Incorrect dosages of medication had been given to one person. Medication that had been stopped by another persons GP continued to be given for 6 days. Records show the person took the medication offered on 2 occaisions and the rest of the time refused to take them. Insulin dosages for another person had been altered without written supporting evidence to show the prescriber had made these decisions. We also observed that when people were prescribed medicines to be administered with a variable dose that the actual dose administered was not recorded on all occassions. This means that it is not possible to feedback to the prescriber the effect the medicine is having for the person and also compromises the way in which future decisions regarding the appropriate dose to administer may be made. This could lead to a person not receiving the dose of medicine that they require. Records also showed that on some occasions medicines were not administered at the dose intervals prescribed and in some cases the dose intervals recorded could place people at risk of harm through an overdose. Staff administering medication had not had appropriate training to do this or been assessed as being competent to undertake the task. Controlled medication was not stored in accordance with legal requirements. The cabinet was on a partition wall and the key had been left in the lock. We seized a number of records relating to the way medicines are managed for people. As a result of these findings we are considering issuing a statutory requirement notice. We issued immediate requirements about two other issues relating to medication systems that the manager had to address by 5th February 2009. Some containers of medicines were not correctly labelled, others that had had the labels altered and others where the labels had been partially or completely removed. This presents a risk to those people receiving the medicine in that they may not be administered medicines as prescribed to them and as a result of this risk suffering harm. We found that for some products with had a limited life after opening as specified by the manufacturers Care Homes for Older People Page 4 of 14 that no record had been made to indicate when these had been opened and the use of them commenced. This means that it was not possible to determine that it was still safe to use these products and that people in receipt of them may be at risk of harm from their use. We met groups of people in communal areas of the lounge and dining room. Roast lamb with vegetables was served and people clearly enjoyed their lunch. 1 person said the meals are very nice. Variations to this had been made to accommodate likes and dislikes of people were clearly recorded in the kitchen and followed by catering staff. From our observations at lunchtime approximately 6 to 8 people presented as having a degree of cognitive impairment by their behaviour and communication. Of these, 3 people needed some prompting and 2 needed help in the form of feeding to eat the meal. We observed 3 instances of poor practice by the same 2 staff. They started to feed 2 people that had previously been doing this for themselves, and did so by first not communicating with the person and then standing over them to do it. 1 staff attempted to transfer a person from a seated position to standing in front of a zimmer frame. No handling belt was used and the person being helped lost their balance and fell back into the chair. We observed this member of staff then ask for help and observed the person being roughly handled back into a wheelchair. 1 of the same staff was then observed pushing a person into a wheelchair that did not have the brakes applied to it. We reported these observations to the manager and looked at 4 individual staff files and training records. We spoke to 4 staff about training. 2 staff said they had not had any training since they started work at the home. 1 of the staff verified that their responsibilities includes giving out medicines prescribed for people living in the home. The staff said the boss showed me how to do it and the next day I gave out tablets. We asked whether an assessment had been done to ensure that they were safe to do this and the person said no, just the first day I was shown by the boss. We spoke to the manager was unable to produce certificates or a record to show that the staff concerned had been given training about manual handling, safe handling of medicines, nutritional care and feeding. 2 files for staff that had started employment in the previous 12 months demonstrated that pre employment checks had been done, but had no evidence of induction training having been provided. The manager was unable to produce any other record to show that these staff had been supervised or done induction training about the principles of care and safe working practices other than fire training. We asked the manager to supervise staff and provide training as a priority to cover manual handling, nutritional care and feeding. The main language of the current group of people living at the home is English. Some of the staff that we spoke had been recruited as foreign workers with varying levels of ability to speak and understand English. People living in the home made comments like [they] pick up quickly what I need and I am looked after very well. One of the staff we spoke told us that they are studying English to improve their communication skills. Similarly, the manager told us that foreign staff are helped to find courses to improve their command of English so that they can communicate better with the people living in the home. We saw evidence of this on one of the staff files we examined. We looked at duty rosters commencing 29th December 2008 for 4 weeks. Shifts had Care Homes for Older People
Page 5 of 14 been covered for staff off sick or on annual leave. The manager and provider were also listed on the duty rosters, however this did not provide an actual record of shifts worked by them other than being on or off. We discussed this with the manager and explained that an actual record of hours worked needed to be kept to demonstrate who was in charge of the home at a given time. During such periods, the manager may need to be off site conducting assessments, however they would still be in charge of the home. We explained that a record of when the manager is on duty, to include the actual hours they worked, should be kept. This will enable the Commission to establish whether sufficient time is being put into management and leadership to ensure that the home is well run for the people that live there. Staffing levels throughout January 2009 demonstrated that there was 3 or 4 carers on every morning, and 3 carers on every afternoon and evening. The provider verified that there are currently 20 people living in the home. Of the 20 people living at the home, staff verified that 2 people needed 2 staff to transfer safely. We observed that staff responded promptly when people needed help or used their call bell. We toured parts of the building and were shown some bedrooms by the occupants. The provider told us that the boiler had failed on Boxing Day necessitating the use of supplementary heating but was quickly repaired. The Commission had not been formally notified of this event, which the provider is required to do. People we spoke to said that home was warm and comfortable when outside we were experiencing a period of adverse weather with snow and icy conditions. We met relatives of a person newly admitted to the home and their comments were positive describing staff as being kind and mother is very happy and likes the food. 3 people living in the home that we spoke to made positive comments like meals are very nice and I am looked after very well. An experienced member of staff had completed the NVQ level 3 and was in the process of doing the NVQ level 4 was observed several times with different people delivering best practice in a kind and caring way. What the care home does well: What they could do better:
Clear, written assessments identifying the needs of the person concerned must be completed before an offer of accommodation is made. From this assessment a clear, written care plan must be produced detailing the care the staff need to provide which is readily accessible by the staff. This will ensure that all staff are clear about what is Care Homes for Older People
Page 6 of 14 required removing possible misunderstandings which may arise from verbal instructions. Staff must have safe handling of medicines training to ensure that people are given the correct medicines at the right time and appropriate records are kept of this. Additionally, medication must be managed to ensure that arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home meet legal requirements. Staff must have up to date training particularly with regard to manual handling to ensure that staff follow best practice when moving people to ensure this this is done safely. New staff must have induction training that provides knowledge about basic care principles for example best practice when assisting people that need help to eat. Duty rosters should accurately record when the manager is on duty. This will enable the Commission to establish whether sufficient time is being put into management and leadership to ensure that the home is well run for the people that live there. The Commission must be notified without delay about the occurrence of; serious illness, serious injury or death of a person living in the home , an outbreak of any infectious disease, theft, burglary or accident or any event which adversely affects the well-being or safety of any service user; and any allegation of misconduct by the registered person or any person who works at the care home. This will demonstrate how incidents or events are being managed and enable the Commission to assess whether this effectively safeguards people living there. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 14 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a thematic inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set.
No. Standard Regulation Requirement Timescale for action 1 9 132 All medication must be given 19/08/2007 to residents at the dosage which has been prescribed for them. Any changes in this dosage must be recorded appropriately on the MAR chart, clearly showing the reason why this has changed and include a signature and date of the person making the recording. The MAR chart must be updated as soon as possible to include the correct dosage to be given. All medication must be given to residents at the prescribed time. Any changes in this time must be recorded appropriately on the MAR chart, clearly showing the reason why this has happened and include a signature and date of the person making the recording. The MAR chart must be updated as soon as possible to include the correct time to be given. Care Homes for Older People Page 8 of 14 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 1 9 13 Arrangements must be made 15/04/2009 to remove all medicines that are incorrectly labelled by 5/2/09. This is to ensure that people only have medicines administered that are prescribed for them, so reducing the risk of them suffering harm from inappropriate medicines 2 9 13 Arrangements must be made 15/04/2009 to arrange the disposal of all medicines that are date expired and a replacement supply obtained where necessary by 5/2/09 This is to ensure that people only have medicines administered to them that are within the expiry date specified by the manaufacturer. This is to reduce the risk of them receiving medicines that may be ineffective or present a risk of harm to people in receipt of the medicine. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 3 14 A clear, written assessment 15/04/2009
Page 9 of 14 Care Homes for Older People identifying the needs of the person concerned must be completed before an offer of accommodation is made. From this assessment a clear, written care plan must be produced detailing the care the staff need to provide which is readily accessible by the staff. This will ensure that all staff are clear about what is required removing possible misunderstandings which may arise from verbal instructions. 2 7 15 A clear, written care plan 15/04/2009 must be produced for each person detailing the care the staff need to provide which is readily accessible by the staff. This will ensure that all staff are clear about what is required removing possible misunderstandingswhich may arise from verbal instructions. 3 9 13 Arrangements must be made 15/04/2009 to ensure that controlled medicines are stored in accordance with current regulations This is to ensure medicine are stored safely so preventing the risk of diversion occurring. 4 9 13 Arrangements must be made 15/04/2009 to ensure that members of staff are provided with detailed, recorded information about how to manage people with diabetes, including medication relating to Care Homes for Older People Page 10 of 14 diabetes This to ensue that people with this condition are cared for safely and appropriately whilst living at the home 5 9 13 Arrangements must be made 15/04/2009 to ensure there are systems in place to record changes to medication, in care plans. This includes changes in instructions to medication and also to changes in doses of medication This is to ensure that there is an audit trail regarding any changes to prescribed medicines. 6 9 13 Arrangements must be made 15/04/2009 to ensure that people receive their medicines at the dose indicated by the prescriber and at the times instructed by the prescriber This is to ensure that people receive their medicines as prescribed 7 9 13 Arrangements must be made 15/04/2009 to ensure that Medication Administration Records are completed accurately and according to the prescribers instructions This is to ensure that it is possible to identify what has actually been administered to people at the home 8 30 18 New staff must have induction training that provides them with knowledge and skills about basic care principles, for example about feeding. 15/04/2009 Care Homes for Older People Page 11 of 14 This will ensure that staff follow best practice when caring for people. 9 36 18 Inexperienced staff must be supervised by appropriately qualified and experienced staff. To ensure that safe procedures are followed to that people receive the best care 10 38 13 Staff must have up to date training particularly with regard to manual handling. To ensure that staff follow best practice when moving people to ensure this is done safely and avoids any risk of accident or injury to the person 11 38 37 The Commission must be 15/04/2009 notified without delay about the occurrence of; serious illness, serious injury or death of a person living in the home , an outbreak of any infectious disease, theft, burglary or accident or any event which adversely affects the well-being or safety of any service user; and any allegation of misconduct by the registered person or any person who works at the care home. This will demonstrate how incidents or events are being managed and enable the Commission to assess whether this effectively safeguards people living there. Recommendations These recommendations are taken from the best practice described in the National Care Homes for Older People
Page 12 of 14 15/04/2009 15/04/2009 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 27 A record of when the manager is on duty should be kept, to include the actual hours they worked, must be kept. This will enable the Commission to establish whether sufficient time is being put into management and leadership to ensure that the home is well run for the people that live there. Care Homes for Older People Page 13 of 14 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 03000 616161 (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 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 14 of 14 - 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!
