Random inspection report
Care homes for older people
Name: Address: Marray House 12-14 Essa Road Saltash Cornwall PL12 4ED one star adequate service 28/07/2009 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: Gail Richardson Date: 0 2 0 7 2 0 1 0 Information about the care home
Name of care home: Address: Marray House 12-14 Essa Road Saltash Cornwall PL12 4ED 01752844488 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Enid Robertson Crofts,Mr Peter William Crofts Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 23 Number of places (if applicable): Under 65 Over 65 23 old age, not falling within any other category Conditions of registration: Date of last inspection Brief description of the care home 0 0 7 1 2 2 0 0 9 Marray House is registered to provide personal care and accommodation for up to 23 older persons. It is a detached house situated near the centre of Saltash, close to the shops, public transport and community facilities. Peoples bedroom accommodation is provided on the ground and first floors. Stair lifts are provided to assist peoples mobility. Two Communal lounge/dining rooms , kitchen and laundry areas are provided on the ground floor. Mrs Crofts has been registered as a care provider for 28 years. The fees range from 314.25 to 325 pounds per week and the fees do not include hairdressing, chiropody and newspapers. A brochure is provided for those wanting
Care Homes for Older People Page 2 of 14 Brief description of the care home more information about the home and its facilities. Care Homes for Older People Page 3 of 14 What we found:
This was an unannounced inspection, which took place over three hours on the 2nd July 2010 by Compliance Inspectors Gail Richardson and Mandy Norton. For the purpose of this inspection the term We will be used when referring to the Care Quality Commission. The last key inspection took place on the 15th and 26th April 2010. At this time, two immediate requirements were made to address shortfalls which may place people at immediate risk, we revisited the home on the 26th April 2010 to review the requirements and found that the areas identified had begun to be addressed. This inspection is to follow up on some of the requirements made relating to risk assessment, care planning and medication management. We looked at care records for four people using the service and Medication Administration Records. We found that none of the statutory requirements relating to these areas had not been addressed or met within the timescale stated. What the care home does well: What they could do better:
We previously required at inspection that risk assessments must be undertaken for each person in relation to diabetes, self administration of medication and moving and handling (Where appropriate).Timescale 20/05/2010. We looked at care records for four people. Some risk assessments were in place for three people with handling and falls risks being identified. One person did not have any risk assessments in place but was noted to have areas of risk. We looked at a risk assessment for somebody with diabetes. This was detailed but needs to include the differences between hypo and hyper glycaemic episodes to ensure that staff are clear about the difference. We previously requested risk assessments for people who self administer insulin. These are not yet in place. There are no records of how and when needles are provided and how often they are changed. There is no evidence that disposal of needles is safely managed. This lack of good risk management may place people at risk. We required that The registered person must ensure that all areas of identified need have an appropriate plan of care for staff to follow. This will ensure that staff are aware of all care to be provided. This will also provide a clear audit of all care given. Timescale 20/05/2010. We looked at care plans for four people, two had been updated to reflect a more person centred and detailed approach to care planning, these two however, were not fully
Care Homes for Older People Page 4 of 14 completed. The remaining two were one page documents which did not contain sufficient information to enable staff to follow an accurate plan of care. We noted that all four care plans did not reflect changes in need, treatment and equipment and did not provided staff with an updated plan of care to ensure that peoples current needs could be met. Care plans must be updated to reflect all areas of assessed need and all changes updated to provide staff with a clear plan of care to follow for each person. We also observed that there were poor records relating to how staff were to provide some areas of clinical care such as application of prescribed creams. Two care plans identified that creams were prescribed but did not give staff the name, dose or frequency of administration. The home maintains a daily record of each person care given. We noted that in each instance various prescribed and non prescribed creams were being applied to various areas with no consistency of practice. The creams applied varied from staff member to staff member. This inconsistency of practice may mean that care is inappropriately provided or omitted. No creams were signed for on the Medication Administration Records. In several instances creams noted to be stored in the food fridge were not written as prescribed on the Medication Administration Records. This means that staff may not be aware of creams to be provided and as a result, they be missed or creams may be given which are no longer prescribed. The food fridge used for storage did not have a current record of temperatures to ensure that storage was correct to ensure the safety of the medication. The medication stored in the fridge was stored loose and unsecured. All prescribed creams must be correctly stored, administered and a record of that administration be accurately maintained. The management of medication remains inconsistent with the Royal Pharmaceutical Guidelines. Gaps in recording were seen which means that prescribed medication may have been omitted without any indication of the reason for this. There is no evidence of an audit trail of medications given to those people who self administer. The manager must ensure that all self administered medications given to the person is recorded to ensure that an audit is available. There continues to be no appropriate storage for controlled medication and this are needs to be reviewed. We noted that hand transcribed medications for two people were not signed and dated by two staff. This is required to ensure that there is no risk of error in transcribing. 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 14 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 The registered person must ensure that all areas of identified need have an appropriate plan of care for staff to follow . This will ensure that staff are aware of all care to be provided. This will also provide a clear audit of all care given. 20/05/2010 2 7 15 Risk assessments must be 20/05/2010 undertaken for each person in relation to diabetes, self administration of medication and moving and handling (where appropriate). Following those assessments appropriate action must be taken to ensure that people are kept safe 3 9 13 The home does not have 21/05/2010 suitable storage for controlled medications and is advised to address this with secure and appropriate storage This will mean that should the storage be required at short notice the facility is readily available. Care Homes for Older People Page 6 of 14 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 4 9 13 The registered manager must ensure that all medications which are given to epople for self administration are recorded. This is required to ensure that there are records of medications provided and will provide a clear audit trail of medications taken. 21/05/2010 5 9 13 All prescribed creams must be stored correctly at the right temperature and for their shelf life only. Medications prescribed for one person must not be re appropriated to another person. To remove labels and write names on boxes, may place people at risk of harm 21/05/2010 6 9 13 The registered person must ensure that medications are signed for correctly. This will mean that procedures are correctly folowed and medication adminstered safely 20/05/2010 7 9 13 When staff are required to hand transcribe medications onto the administration record, that two staff sign the record. This will ensure that there is no risk of error in transcribing. 20/05/2010 Care Homes for Older People Page 7 of 14 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 8 9 13 The registered person must ensure that all medication prescribed are signed for when given or the required coded indicator used to explain reasons when not given. Gaps in the Medication Administration Record must be completed to ensure that there is a clear record of all medications administered. 21/05/2010 9 12 16 The registered person is required to ensure that a programme of activities is planned for the recreation and enjoyment of people using the service. The programme is required to include social interaction for all people using the service at a level of their participation and enjoyment. 17/09/2009 10 19 12 The registered person is 20/11/2009 required to implement a repair / refurbishment programme to all areas of the home needed repair. This is with particular reference to all of the bathrooms / shower room which pose the risk of cross infection. This is required to ensure the maintenance of an environment which is safe for use by people using the service. 11 29 18 The registered person must 20/05/2010
Page 8 of 14 Care Homes for Older People 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 ensure that all recruitment checks are in place prior to staff starting work at the home. This would include and recent photograph, that all documents are signed and dated when received. That a full and detailed employment history is obtained with reasons for leaving the last employer and that Protection of vulnerable adults checks are received prior to the staff member starting work. This s required to ensure that people using the service are kept safe from harm 12 30 18 The registered person must ensure that staff training is provided for all staff to ensure that they remain updated on current good practice. This is needed to ensure that people using the service receive a good standard of care which promotes their safety and wellbeing. 13 31 12 The provider/manager is 21/05/2010 required to undertake audits of the home with relation to risk assessment, care planning, medications and recruitment. This is required to ensure that the quality of service is safe. 14 33 26 The registered person is 21/05/2010
Page 9 of 14 22/10/2009 Care Homes for Older People 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 required to undertake a visit to the home at least once a month and produce a report to be forwarded to the Care Quality Commission reviewing the areas outlined in this regulation. This is required to enable the registered person to have an overall view of the quality of the care provided. 15 38 12 The registered person must 21/05/2010 ensure that hot water outlets are monitored and that they do not exceeded the health and safetys guidance on upper limits. This is required to ensur ethat people using the service are not at risk of burns and scalds. 16 38 12 The registered person is required to ensure that all substances hazardous to health are stored securely. This is required to ensure that there is no risk of accidental ingestion. 21/05/2010 Care Homes for Older People Page 10 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 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 3 The registered person is recommended to include within the pre admission assessment peoples choices and preferences of social interests, hobbies, religious and cultural needs. This will enable the manager to make an informed decision if the persons needs can be met by the service. The registered person is recommended to include sufficient detail within each care plan to ensure that they are person centered and people receive their specific choices and preferences. The registered person is recommended to ensure that all identified care needs noted in the re admission assessment are transfered to the care plan so that peoples needs are met. Creams stored in peoples rooms are not consistently signed for when administered, this is needed to ensure a clear audit trail of prescribed medications. Creams in peoples rooms are also not dated when opened. This is needed to ensure that the creams shelf life when opened is not exceeded.
Page 11 of 14 2 7 3 7 4 8 Care Homes for Older People 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 5 9 Some medications are stored in the food fridge and are identified but not secured. This is recommended to be addressed to ensure the safe storage of all medications. It is evident that people at the home do not have the facility to lock their bedroom doors or have lockable storage for personal items. The registered manager is recommended to provide means to store securely any personal items. The registered person is recommended to ensure that cleaning is recommended to be undertaken to ensure a good standard of hygiene in the kitchen. The registered manager is recommended to ensure that all staff receive training in abuse awareness and protection of vulnerable adults to ensure the safety of people using the service. The registered person is recomended to update the homes safeguarding adults policy to reflect current practice. The registered person is recomeded to review the sleeping night provision to ensure that staff can be contacted directly. The registered person is recommended to provide an overview of staff training to identify any shortfalls in training updates and enable appropriate training to be provided. The registered person is recommended to record how staff are supervised and by whom when they start work with a Protection of Vulnerable Adults check in place but the Criminal Record Bureau check has not yet been received. The registered person is strongly recommended to ensure that staff recruitment files contain a contract of employment, job specification, interview record and medical history. A clear photograph of the staff member is also needed. We observed that the home does not display a copy of the last inspection report to enable people to read the outcomes from the last inspection. This is required to happen and the home is recommmeded to to put a copy on display. 6 14 7 15 8 18 9 10 18 27 11 29 12 29 13 29 14 31 Care Homes for Older People Page 12 of 14 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 15 33 The registered person is recommended to ensure that quality assurance audits are used to promote changes to reflect the opinion of people using the service. The registered person is recommended to ensure that regular supervision of staff is undertaken and recorded to ensure that staff are up to date with the running of the home and promote safe working practice. The registered person is recommended to ensure that toiletries left in bathrooms are not shared to reduce the risk of cross infection. The registered person is recommended to ensure that boilers are not accessible to people using the service and public visiting the home. This is recommeded to pevent people altering the temperature of hot water delivery. The registered person is recommended to risk assess all free standing units and ensure that any tip risk is addressed. 16 36 17 38 18 38 19 38 Care Homes for Older People Page 13 of 14 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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!
