This inspection was carried out on 6th January 2009.
CSCI found this care home to be providing an Poor service.
The inspector found there to be outstanding requirements from the previous inspection
report. These are things the inspector asked to be changed, but found they had not done.
The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.
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 zero star poor 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 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: 0 6 0 1 2 0 0 9 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: Conditions of registration: Category(ies) : Southern Cross Healthcare Services Limited care home 60 Number of places (if applicable): Under 65 Over 65 28 1 60 6 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Conditions of registration: 0 0 0 6 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 11 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. 0 7 1 1 2 0 0 8 Care Homes for Older People Page 3 of 11 What we found:
This inspection visit was unannounced and carried out by two inspectors and a pharmacist inspector. The purpose of the inspection was to check compliance with statutory requirement notices which were served on 5th December 2008. The statutory requirement notices were served as a result of ongoing breaches of regulations. Within the notices there were requirements which related to care plans, health and welfare and treatment, arrangements for people to receive where necessary, treatment, advice and other services from any health care professional, medication records and administration of medication. In order to check compliance with the requirements in the notices we checked a sample of peoples care files on both floors, spoke with people who use the service and staff. We found that that while improvements are still required and arrangements need to be made to ensure that the improvements are sustained, the requirements with the exception of those relating to medication had been met. There were care plans in place for peoples assessed needs and there was evidence that the care plans are being reviewed. We have advised that more work needs to be done on evidencing how people have been involved in the care planning and notified of the changes. Some of the care plans were very general and would benefit from being more person centred, particularly for people on the dementia unit who are less able to express preferences in relation to their care. We have also advised of the need to consider the accessibility of information. For example when looking at records relating to wound/pressure area care for someone on the first floor we found the necessary information was available but due to some duplication and inconsistent recording practices it would be easy for important information about current care to be missed. We found that there was better oversight of peoples health care needs. Nursing care on the ground floor was being overseen by a project manager and there was a better understanding of peoples needs leading to an improvement in care. One area where improvements were identified was in the management of pressure ulcers. We had been concerned at our December inspection that although improvements had been made to the prevention and management of pressure ulcers on the the ground floor we had identified two people on the first floor who were not getting the care that they needed. During this inspection we found that action had been taken to address this and a record made by a tissue viability nurse notes that the improved pressure relief has resulted in a wound being almost healed. Better systems are also in place for monitoring peoples fluid intake and people at risk of constipation and records and conversations heard confirm that staff are more proactive in reporting any concerns to the General Practitioner. We did discuss with managers the need to ensure that all nurses are careful to carry out regular observations on peoples well being noting any health changes rather than Care Homes for Older People Page 4 of 11 being totally reliant on records or carers to raise issues. This arose from an observation made by a visiting health professional which had not been noted by the nurse on duty. There was evidence within records of referrals to relevant health professionals for advice and/or treatment and opticians were carrying out eye tests on the day of inspection. We looked at medication and medication administration records (MAR) for a sample of people on both floors. There were some areas of good practice. For example there are appropriate storage cabinets for controlled drugs on both floors and the controlled drugs were checked and correctly accounted for on the ground floor. Where a medication had been discontinued, this had been removed from the current stock reducing the risk of it being administered in error. We also found that medication which required cold storage was being stored at the correct temperature. We experienced difficulties in ascertaining how many paracetamol had been administered to someone from the records. A sample check of audit records confirmed that this issue had been identified by the management team as part of the audit, together with actions to address the issue. For example they asked for variable doses to be marked on the individual medication administration records. This helps to maintain an accurate audit trail of medication received, administered and disposed of. Other examples of issues relating to records included a record of a medication where the dose had changed and more capsules had been obtained without clearly stating the strength that had been obtained. Some poor practices were found in that we found that the records for someone prescribed Doublebase cream stated apply liberally twice a day to skin of feet and lower legs and to dry skin. Signatures on the administration records checked from 10/12/08 until 05/01/08 showed this as being applied only once a day indicating that this was not being administered as prescribed and the requirement made in the statutory requirement notice had not been met. We were also concerned that the nurse signing the record on the day of inspection didnt check that the cream had been applied and said the carers must have applied it this morning when getting her up. Staff described the current condition of this persons skin as being a bit dry. The fact that this medication was not given as prescribed means that the requirement in the statutory requirement notice has not been met. We do continue to be concerned about the management of medication and staff ability to follow basic procedures for the safe management of medication. We had observed a nurse taking a pot containing white tablets out of the treatment room to give to a person at the end of a medication round. The medication administration sheets were left in the treatment room. While in this case we were not aware of any error being made, good practice is that they would be kept together and used to check the medication was being administered to the right person in accordance with the prescribed instructions. We found that there was no stock of a particular medication for one person and the box for the morning dose on the medication administration record had not been signed indicating that it may not have been given. However we spoke with the person who confirmed that they had the medication that morning and we also found that an audit Care Homes for Older People
Page 5 of 11 record completed the previous afternoon showed that their was sufficient stock for the morning dose. This indicated that this was a recording error. We found that the arrangements in place between the supplying pharmacist and Lucas Court for receiving medication are not sufficiently robust. Timescales for receipt of medication do not allow enough time for staff at Lucas Court to check the medication, notify the pharmacist of any discrepancies and then for the pharmacist to supply the medication. We are also concerned that the tight timescales increase the risk of error. There were at least eight medicines for different people that had yet to be received in to the home. These would be needed to continue with treatments for the following day. Following this inspection we have spoken with the project manager and also the supplying pharmacist and have been assured that they are going to meet to agree improved arrangements. While there was evidence that the requirements had not been met and that there had been breaches in the regulations relating to medication, we considered carefully the specific shortfalls and how they had affected people who use the service. We considered that it would not be proportionate or in peoples interests to proceed towards prosecution on the evidence we had gathered. We did however detail some of these concerns in a serious concern letter dated 8th January 2008 and have asked for a written response as to the actions that will be taken to address them. Verbal feedback was provided to managers throughout the inspection. No new requirements have been made as a result of this inspection. Two requirements relating to medication were issued in the statutory requirement notices served on 05/12/08. What the care home does well: What they could do better:
Although there have been some improvements in the management of medication we remain concerned that medication is not consistently well managed. For example improved arrangements need to be in place to ensure that all prescribed medicines are in continuous supply for people that use the services. Better arrangements need to be in place to ensure that all medication is given or applied according to the prescribers instructions. If creams and ointments are to be applied by carers as a delegated task , then the nurse on duty must ensure this is carried out according to the instructions on the medication administration record and that the carer is familiar with any care plan needs relating to the particular healthcare issue. Given the ongoing concerns over recent months about the management of peoples health care needs and medication there is a need for careful oversight of staff practices and competence in relation to meeting peoples health care needs and managing their medicaton in accordance with policies and procedures. This is to help ensure peoples needs are met and that they receive consistent care. Care Homes for Older People Page 6 of 11 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 11 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 9 13 (2) Accurate, complete and up to 11/09/2008 date medication records must be kept to ensure that medication is administered correctly, safely and as intended by the prescriber to manage individual health needs. 2 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. 3 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. 4 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. 5 33 24 (1) (a & b) Quality assurance systems 30/09/2008
Page 8 of 11 Care Homes for Older People must be effective in improving and maintaining the quality of care provided to people who use the service. Care Homes for Older People Page 9 of 11 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 1 9 13 Put in place effective 18/12/2008 arrangements at the home to ensure that all medication is administered to service users as prescribed. To promote and maitain peoples health 2 9 13 Put in place effective 18/12/2008 arrangements to ensure that accurate records are maintained of medications received and administered. To ensure there is a system to confirm what medication people have had. 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 10 of 11 Reader Information
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