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Inspection on 21/10/08 for Lucas Court Nursing Home

Also see our care home review for Lucas Court Nursing Home for more information

This inspection was carried out on 21st October 2008.

CSCI found this care home to be providing an Poor service.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The focus of this inspection was to check compliance with requirements which had not been achieved, however managers and staff were co-operative with the inspection process and expressed a commitment to improvement. People were observed to be treated with respect and the nurse was mindful of maintaining dignity and respect during the administration of medication.

What the care home could do better:

Improvements are needed to the way people`s medication and healthcare is managed as identified by continuing concerns and breaches of regulations in this area.

Inspecting for better lives Random inspection report Care homes for older people Name: Address: Lucas Court Nursing Home Northampton Lane North Moulton Northampton NN3 7RQ The quality rating for this care home is: The rating was made on: zero star poor service 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 random inspection of this care home. A random 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: Kathy Jones Date: 2 1 1 0 2 0 0 8 Information about the care home Name of care home: Address: Lucas Court Nursing Home Northampton Lane North Moulton Northampton NN3 7RQ (01604)493233 01604493234 lucascourt@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Southern Cross Healthcare Services Limited care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability 0 0 0 6 Over 65 28 1 60 6 Conditions of registration: All service users in the category of DE(E) must be accommodated on the first floor. Two named female service users may be accommodated in the category of Mental Disorder, until such time as they leave the home. No further service users may be admitted in this category No one falling in the category of DE(E) may be admitted into the home where there are 28 service users who fall within the category of DE(E) already accommodated in the home No one falling in the category of PD may be admitted into the home where there are 6 service users who fall within the category of PD already accommodated in the home Care Homes for Older People Page 2 of 12 No one falling in the category of PD(E) may be admitted into the home where there are 6 service users who fall within the category of PD(E) already accommodated in the home. No one falling in the category of OP may be admitted in the home where there are 60 service users who fall within the category of OP already accommodated in the home. To be able to admit the named person under 65 years of age named in Variation Application No. V000020533 dated 13th May 2005. To be able to admit the named person under 65 years of age named in variation application no V000029387 dated 7th February 2006 Date of last inspection Brief description of the care home Lucas Court is a care home providing personal and nursing care for up to 60 people. Currently Lucas Court provides care for older people, older people with dementia, older people with a mental disorder and people with a physical disability. Southern Cross Healthcare owns the home and it is located in the village of Moulton on the outskirts of Northampton. The village has some local shops and public houses and is on a bus route in to Northampton. The home is a two storey building with the first floor allocated for dementia care, and care for people with mental health needs. Fifty of the bedrooms are single rooms with forty-eight of these rooms having en-suite facilities. There are five double rooms in the home. The home has a passenger lift. There is an enclosed well-maintained garden to the rear of the home, which is accessible to wheelchair users, and a car park. A scale of charges confirmed as being current at the time of the inspection in July 2008 states that fees are from 650 pounds to 750 pounds perr week. The fees quoted are exclusive of any free nursing contribution, which is collected from the Primary Care Trust by Southern Cross Healthcare. Local Authorities who are funding people are charged at a set rate. These people will be asked for a top up fee, which varies according to their ability to pay. The fees include personal care and where applicable nursing care, meals and accommodation. Chiropody, hairdressing services, and newspapers can be arranged and are charged separately. Other costs would include clothing and toiletries. Information about the services provided including the complaints procedure is displayed in the foyer of the home. This includes the statement of purpose, a service user guide and a copy of the most recent Commission for Social Care inspection report. Care Homes for Older People Page 3 of 12 What we found: The inspection was unannounced and conducted by three inspectors, one of which was a pharmacist inspector. The purpose of the inspection was to check compliance with some of the requirements made at previous inspections. A number of requirements have been made during inspections which have taken place from July 2008. This inspection focused on requirements made about the management of medication and health care. A Pharmacist Inspector was involved in assessing and gathering the evidence for the inspection relating to medication. Other requirements will be checked at inspections in the near future. During the inspection there were indications that previous requirements had not been met and regulations had been breached. We served a Code B notice prior to continuing our search for, and seizure of evidence. This notice is issued in accordance with the Police and Criminal Evidence Act 1984 and explains powers and rights. Copies of records were copied and seized during the inspection and consideration is being given to enforcement action. A temporary manager who is a registered manager in another Southern Cross Care home was managing Lucas Court at the time of the inspection with support from a project manager. We were advised that the plan was for the temporary manager to be at Lucas Court at least until Christmas. The operations manager for the area was also present at Lucas Court for part of the inspection. Managers and staff were co-operative with the inspection process. Managers expressed a commitment to resolving the problems and improving the care and outcomes for people rather than papering over the cracks. We were told that there continued to be a voluntary embargo on admissions as agreed between Southern Cross and Northamptonshire County Council and at the time of the inspection there were 51 people living at Lucas Court. We looked at care records including medication records for a sample of people. For some of these people we explored in more depth particular aspects of their care. We spoke with people and to some of the staff who provide their care. During the random inspection on 11th September 2008 we had found that care plans for someone who had previously been nursed on a mattress on the floor and was being nursed in bed had not been altered to reflect the change. We looked at this persons care file during this inspection and found that care plans now include this information. Staff confirmed that the changes to this persons care had made movement and handling much safer for staff and the person being moved. At the inspection in September we were told that an assessment was due to take place on the 12th September by a supplier of specialist chairs for the person referred to above, but that it was unclear who was going to fund the chair. We could find no mention of an assessment being carried out in the daily information Care Homes for Older People Page 4 of 12 record or professional visitors record of an assessment, however a care plan dated 16th September 2008 identifies that a sterling bucket chair had been brought in to be tested. The temporary manager advised that she has been unable to ascertain where the chair came from as she has contacted the supplier of the chairs who do not know anything about it. The chair would appear not to be entirely suitable as according to staff and the care plan it requires someone to be with her at all times due to the risk of falling out of it. When we visited this lady we found that she was in bed in her room. Staff confirmed that she uses the chair but this is dependent on if there are enough staff for someone to sit with her or if her family are visiting and able to sit with her. The manager advised that she was continuing to pursue an occupational therapy assessment via the General Practitioner in order to identify a more suitable chair. Wound and pressure area care had been something that had concerned us at recent inspections. We therefore looked at the records for someone we knew to have a pressure ulcer. Records showed deterioration of the condition of this pressure ulcer, they confirmed that specialist advice had been sought from a Tissue Viability Nurse, but that this advice had not been followed. Due to our concerns we made a safeguarding alert to social services regarding the care of this person. During the inspection someone who uses the service told us that they had been waiting for an appointment to have treatment for an ingrowing toe nail which was painful. The nails were seen to be long and broken in places. We looked at this persons care records and found that they had been admitted to Lucas Court in May 2008. The assessment identified that they are diabetic and require six weekly treatment by the Chiropodist which they had not been receiving. There was also information within the records of a possible fungal infection with no referral to the General Practitioner having been made. We made a safeguarding alert to social services regarding the care of this person. Our inspection on 11th September 2008 identified that one persons care plan documents read ....may make accusations about staff that do not reflect the truth or how she perceives a situation .. . There were directions for staff to ask her to repeat accusations and to assess if she is confused and genuinely upset by what she is reporting. The report advises that this is not in line with safeguarding protocols and procedures. Reviewing documents collected during the inspection on 21st October 2008, we were concerned that this care plan was still in place and has the potential to make this person more vulnerable. We alerted social services to this and also spoke with the temporary manager to confirm that this plan would be removed. The current month and previous medication administration record (mar) sheets were viewed for seven people. A medication round was observed and care plans were reviewed. Medicines are securely and appropriately stored. There is monitoring of the maximum and minimum temperatures of a clinical fridge used but there is lack of knowledge in what action had to be taken when the reading did fall out of the desired range. The mar sheets contained photographic identification as well as some photocopies of original prescriptions to ensure the correct medicine is given to the right person. Although it was seen, that the dispensing label on boxed paracetamol tablets were not Care Homes for Older People Page 5 of 12 cross checked by the nurse, selection was based on a room number handwritten on the packaging which may lead to error. Two different medicines were not available for one person in the medication cycle. Annotation on the reverse of the mar indicated that this had run out and was out of stock. The nurse maintained respect and dignity of the people using the service when issuing their medicines to them as they played bingo in a communal area. She asked if pain relief was required by a person when this had been prescribed as a when required basis. It was noted that the nurse had failed to dissolve in water a dose of a dispersible medication ( Co-benelodopa).This is prescribed for Parkinsons disease and a dispersible dose would have been beneficial for a person who needs a quick response from the medicine and who may have had swallowing difficulties. From the mar sheets it was seen that not all medicines, prescribed creams and dressing are accounted for. Anomalies were identified between prescribers instructions and the frequency of application for Daktacort ointment, Aqueous cream and the dosage for two different oral medicines ( Citalopram- an antidepressant and Zamadolstrong pain killer). The available documentation to support these discrepancies were not clear. Although a mar sheet had been signed by a doctor to indicate a change of dose for Zamadol capsules had been instigated in the previous month. The daily notes indicated a doctor had changed the citalopram dose a week a go. The nurse had not yet been furnished or had requested a new prescription with the most up to date instructions.This could lead to risk of medicines given out incorrectly as the current mars had the old dosages on which were crossed out and over written by hand. The mar sheets showed that a decreasing dose of prednisolone tablets had been handled correctly and that variable doses are marked with the quantity given. Concerns were seen regarding the documentation and application of prescribed creams/ ointments and use of prescribed dressings. The careplans relevant to tissue viability and skin integrity were unclear. Evidence was seen that instructions issued by a tissue viability nurse, regarding pain relief management for a resident who had a worsening pressure sore had not been followed through. We spoke with the temporary manager following the inspection about some of our concerns including the fact that someone had been without prescribed medication and that someone with a serious pressure ulcer (grade 4) was not receiving regular pain relief. The temporary manager confirmed that an investigation was taking place as to why a referral to the General Practitioner had not been made for review of pain relief. She also confirmed that the General Practitioner has now reviewed the medication. We have made safeguarding alerts to social services as a result of our concern. During the inspection a relative and also someone who uses the service told us that there were not always enough staff. An example was given to us of an incident where a carer was described as not being unkind but as being under stress. Weekends were identified as a particular problem. One issue that was raised was that Care Homes for Older People Page 6 of 12 there are less support staff at weekends, for example no hostesses to serve the meals and no cleaners, therefore there is additional pressure on carers who then have to take on extra tasks. We saw that each care file contains an assessment of peoples dependency needs, however we were unable to ascertain how or if this information had been used to help work out staffing requirements. The need to look at how peoples needs are being met on a practical level were discussed during the inspection, with the need to keep staffing arrangements under review. Copies of some staff rotas were taken for further review. A sample check of these confirms that where staff sickness occurs then generally a replacement is found. As people told us, staffing levels were noted in the rotas to be lower at the weekends, with less support staff, confirming the need to review this. We left details of the evidence seized during the inspection with managers and advised that this would be collated and reviewed prior to consideration of enforcement action. No further requirements were made as a result of this inspection. 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 7 of 12 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 random 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 8 12 (1) (a & b), Where it is assessed that it is 11/09/2008 necessary to monitor peoples fluid intakes, records must be checked daily and reasons for people receiving insufficient fluids investigated. This requirement with a timescale for compliance of 25/08/08 has not been met. Evidence of non compliance has been seized and enforcement action is being considered. 2 8 12 (1) (a & Peoples health and well 11/09/2008 b), 13 (1) (b) being must be monitored with prompt action/referral to healthcare professionals as appropriate. This must include the risk of constipation for those people unable to express a problem. This requirement with a timescale for compliance of 25/08/08 has not been met. Evidence of non compliance has been seized and enforcement action is being considered. 3 9 13 (2) Accurate, complete and up to 11/09/2008 date medication records Care Homes for Older People Page 8 of 12 must be kept to ensure that medication is administered correctly, safely and as intended by the prescriber to manage individual health needs. This requirement with a timescale for compliance of 26/11/07 & 25/8/08 has not been met. Evidence of non compliance was seized and enforcement action is being considered. 4 18 13 (6) All staff must receive safeguarding adults training to help protect people who use the service. Compliance with this requirement was not checked at this inspection. 30/10/2008 5 19 23 (2) (d) Carpets must be kept clean 30/09/2008 and free from odour and replaced as required to ensure people have a pleasant environment to live in. Compliance with this requirement was not checked at this inspection. 6 27 18 (1) (a) Staffing levels must be 30/09/2008 reviewed and monitored in consultation with people who use the service and sufficient staff provided to meet their needs. Compliance with this requirement was not checked at this inspection. Care Homes for Older People Page 9 of 12 7 30 18 (1) (c) (i) Staff training should be 30/10/2008 implemented to address gaps identified in the staff training matrix to ensure that all staff have up to date training to meet residents needs. Compliance with this requirement was not checked at this inspection. 8 33 24 (1) (a & b) Quality assurance systems must be effective in improving and maintaining the quality of care provided to people who use the service. Compliance with this requirement was not checked at this inspection. 30/09/2008 Care Homes for Older People Page 10 of 12 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 11 of 12 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI 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: 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 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 © (2008) 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. 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