This inspection was carried out on 12th May 2010.
CQC found this care home to be providing an Adequate 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.
Random inspection report
Care homes for older people
Name: Address: Newbury Manor Nursing Home Newbury Lane Oldbury West Midlands B69 1HE one star adequate 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 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: Ian Henderson Date: 1 2 0 5 2 0 1 0 Information about the care home
Name of care home: Address: Newbury Manor Nursing Home Newbury Lane Oldbury West Midlands B69 1HE 01215321632 01215330727 Telephone number: Fax number: Email address: Provider web address: www.newburymanorhome.co.uk Name of registered provider(s): Name of registered manager (if applicable) Mrs Carol Ann Pearce Type of registration: Number of places registered: Conditions of registration: Category(ies) : Superior Care (Midlands) Limited care home 47 Number of places (if applicable): Under 65 Over 65 0 47 0 learning disability old age, not falling within any other category physical disability Conditions of registration: 1 0 1 The maximum number of service users who can be accommodated is: 47 The registered person may provide the following category of service only: Care home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 47 Learning disability (LD) 1 Physical disability (PD) 1 Date of last inspection Care Homes for Older People Page 2 of 12 Brief description of the care home Newbury Manor is a purpose built home registered in 1997 to provide personal and nursing care to a maximum of forty seven older people. Superior Care took ownership in February 2002. The property is close to Oldbury town centre and the Midlands motorway network. The home has a large car park; a garden with a paved patio area and seating surrounds three sides of the building. There are two floors and two lifts. Single and double bedrooms each have a toilet and washbasin. Curtained dividers are provided for the privacy of people sharing rooms. All bedrooms are fully furnished and decorated, with profiling or divan beds according to need. There are sufficient bathrooms with assisted baths or showers and additional toilets. There are two lounges and a dining room on the ground floor, and private meeting rooms. On the first floor there is a lounge and kitchenette for people and visitors to help themselves to refreshments. Additional charges are made for hairdressing, some activities, toiletries and newspapers, if wanted. Information provided by the owner about fees indicated they ranged from GBP358 to GBP588 per week. The nursing element is retained by the home for people who are not self funders. For up to date information on fees people are advised to discuss the details when making enquires. Care Homes for Older People Page 3 of 12 What we found:
We visited the home on 17 May 2010 to assess its compliance with one outstanding requirement from the July 2009 key inspection and four requirements made from the random inspection visit of February 2010. The two outstanding medication requirements from the July key inspection and three medication requirements made following the random inspection visit of February 2010 were checked by our pharmacist inspector on 12 May 2010. We had issued a statutory requirement notice in relation to medication management on 31 March 2010, but this has been withdrawn due to it failing to get delivered to the providers address. We did however find continual breaches in the medication requirements on our visit of 12 May 2010 and will be talking to our enforcement team about further action. We looked at the care documentation for four people living at the home during our visit of 17 May 2010. We also spent time talking to staff some relatives and people living in the home. We looked specifically at the care records in relation to moving and handling. Further work is required on these to ensure that staff have clear instructions on how to transfer someone if they require assistance. We observed staff practice in relation to moving and handling and this has improved since our last visit. The new care manager has implemented an easy reference guide for staff to follow in relation to selecting the appropriate sling. The majority of staff have received training in manual handling. We looked at how the home manages peoples needs for adequate nutrition and fluids. The home completes a nutritional screening tool that identifies those people considered to be nutritionally at risk . We observed three people living in the home having their breakfast at 11:05am and observed that morning drinks were being given out until 11:30am. We were told that the people eating their breakfast at 11.05am had chosen to do so. We looked at the care records of one the persons observed having breakfast at 11:05am and found they were unable to make such decisions due to cognitive impairment. We also found that this person had been assessed as having concerns in relation to nutrition. We highlighted our concerns to the management team about the lateness of the breakfast and morning drinks and the fact that this would impact on peoples well being. The July 2009 key inspection also highlighted concerns in relation to timing of meals. We stated in this report: this can potentially have an impact on peoples nutrition and hydration needs due to long periods between meals for example supper and breakfast on the following day. Then to be offered a large meal two hours later after breakfast may mean some people refuse or only eat part of their meals and this may add to peoples confusion and swings in blood sugars. We looked at care plans for people who display behaviour that challenged. Care plans were found to be in place but further work is required to ensure they are person centered. On discussions with staff it was found that they were aware of how to care for specific individual needs but this was not being recorded and therefore could not be reviewed and evaluated in a formal manner. We looked at staff recruitment records for four members of staff. These records contained required checks against the Independent Safeguarding Authority [ISA] and a Criminal Records Bureau disclosure [CRB]. We found the home could make improvements. We did not see any risk assessments in place for staff that had been allowed to start work with
Care Homes for Older People Page 4 of 12 only an ISA adult first check or any other information on their application that may indicate a need to formally risk assess. The home must be able to demonstrate that it is taking all precautions to prevent unsuitable people from working with vulnerable adults. Concerns were raised with us by one set of visitors in relation to the chair their relative was sitting in which was dirty and also their relatives wish to see a dentist. They stated however that The care is good. Her bedroom is nice always clean. We raised these concerns with the management team at the time of the visit. We examined a sample of the medication records on 12 May 2010 along with the medicines present in the home in order to determine whether the home had systems in place to demonstrate that medicines were being administered as prescribed. We found that the home was not always recording the receipt of medicines coming into the home. As an example of this we found that 5 tablets of a medicine that was used to treat calcium and vitamin D deficiency had been received on the 5th May 2010 but the administration record showed that 13 tablets had been administered. We found that any medication carried over from the previous month was not being taken into account and added to the new quantities at the start of the new month. As an example of this we found that 200 analgesic tablets had been received on the 9th May 2010 and since then 18 tablets had been administered. We therefore expected to find 182 tablets present in the home but we found that 230 tablets were present in the home. We were therefore unable to determine through the audit process whether the medicine administration records were accurately demonstrating the administration of the analgesic tablets. We found evidence of the medication administration record charts being signed but the medication not being administered. An example of this was with a dry powder inhaler that had been prescribed for a person that was using the service. This particular inhaler had an indicator that showed the user how many doses were left before it ran out. The inhaler would have had 120 doses upon opening and the administration records showed that since opening a quantity of 10 doses had been administered. We would have expected therefore that the indicator on the inhaler would be showing that there were 110 doses available for the users. We found that the indicator was showing that there was 120 dose still available indicating that no doses had been administered. We also found that where variable doses had been prescribed the records did not show what quantity had been given. We also found that the home had been administering 7 different types of medicines to one of the people using the service and had not been recording the fact that these medicines had been administered because an administration record chart had not been written out by the home. We found overall that the care plans were poor for containing information about the administration of medicines. In particular we found little or no information about how and when medicines prescribed on a when required basis should be administered. We also found little evidence to support the administration of the when required medication. We found no information about how the home was to manage the administration of medicines that had been prescribed with a variable dose. We also found very little written information about when and why medication had been changed or discontinued. We found that the home did not have an ongoing assessment programme to ensure that the staff that were administering any forms of treatment were administering these treatments safely and in accordance with the homes policies and procedures. In light of some of the issues identified during the inspection the assessment of the staffs competency to administer these treatments safely must be carried out as a matter of
Care Homes for Older People Page 5 of 12 urgency. Following the last inspection the home had produced an action plan setting out how they were going to address the failings found by the inspectors. The action plan had stated that regular audits of the medicines would be taking place in order to ensure that medicines were being handled correctly and administered as prescribed. We found during the inspection that no such audits were taking place. We found on the day of the inspection that the maximum and minimum temperatures of the medication fridge were 16 degrees Celsius and 3 degrees Celsius respectively. The daily temperature record showed that the fridge was being maintained within the accepted temperature range. A member of staff was asked to demonstrate how the temperature was being taken and from this demonstration it could be seen that the staff were not following the instructions properly to obtain accurate readings of the maximum and minimum temperatures. This meant that the medicines being stored in the fridge had possibly not been stored at the temperature specified by the manufacturers. In summary the medicines management systems within the home were found to be poor and were not safeguarding those living in the home. As a consequence of a continued breach of the Care Homes Regulations 2001 with respect to the management of medicines medication records were seized under the provision of the Police and Criminal Evidence Act 1984. What the care home does well: What they could do better:
There must be improvements in the way the home assesses, monitors and evaluates the care of people living in the home in relation to care planning. This will ensure the safety and well being of people living in the home. Staff recruitment records need to demonstrate a robust approach to recruitment has occurred to protect the well being of people living at the home. The timing of meals and drinks provided must be reviewed and action taken to ensure people living at the home receive food and drinks that meet their nutritional needs. The service needs to ensure that the administration records can demonstrate that the people who are using the service are having their medicines administered as prescribed. The service needs to ensure that the service has care plans which will have all the information about why a medicine was prescribed about why a medicine was discontinued and on how to administer when required medicines safely and effectively. The home must ensure that all medicines are stored securely and at the correct temperature. Care Homes for Older People Page 6 of 12 The home must ensure that the medication administration practices do not place people at risk. The home must ensure that the staff administering medication to the people who use the service are safe and competent to do so. 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 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 9 13 Staff must ensure that people living in the home receive their medication as prescribed and records demonstrate this. To ensure that people receive their medication as prescribed. 22/04/2010 2 9 13 Medication must be 22/04/2010 adminstered to the person it has been prescribed to as per clinicians orders. Any reason for omission must be recorded and the dlinician informed. 3 9 13(2) Staff must ensure that people living in the home receive their medication as prescribed and records demonstrate this. To ensure that people receive their medication as prescribed. 30/09/2009 Care Homes for Older People Page 8 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, 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 18 To ensure that staff are suitably qualified experienced and competent to safely administer medication before they administer medication to people who use the service. To ensure that people receive their medication as prescribed 12/07/2010 2 9 13 To make arrangements to ensure that medication is stored securely and at the correct temperature recommended by the manufacturer. To ensure that medicines remain safe and do not become contaminated. 12/07/2010 3 9 13 Appropriate information relating to medication must be kept for example in risk assessments and care plans to ensure that staff know how to use and monitor all medication including as directed and when required 12/07/2010 Care Homes for Older People Page 9 of 12 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 so that all medication is administered safely correctly and as intended by the prescriber to meet individual health needs. To ensure that people receive their medication as prescribed 4 29 19 The home must carry out a risk assessment for people commencing work on an Independent Safeguarding Authority adult first check and take appropriate action to reduce any risks. To safeguard people living at the home. To ensure the safety and well being of people living in the home 5 29 19 The home must carry out a 12/07/2010 risk assessment for people commencing work at the home that may have a positive Criminal Records Bureau check [CRB] and put the appropriate safeguards in place to reduce any risk, to safeguard people living at the home. To ensure the safety and well being of people living in the home 12/07/2010 Care Homes for Older People Page 10 of 12 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 7 Care planning and records for moving people safely must be based on a thorough assessment of needs and show how care is to be delivered. These must be accessible to staff delivering the care and be a reflection of the care being given and reviewed at the point where a persons needs change or on a routine basis and staff must be aware of these changes. Care planning and record keeping for behaviour that challenges must be based on a thorough assessment of needs and show how care is to be delivered. These must be accessible to staff delivering the care and be a reflection of the care being given. These must be reviewed at the point where a persons needs change or on a routine basis and staff must be aware of these changes. This will ensure that people living at the home have their needs met and their rights promoted and protected. The home should review the mealtime and drink experience for people in the home to ensure meals and drinks are served at the appropriate time that they receive the appropriate support and that it is a pleasurable experience. This review should take into account the number and deployment of staff to meet nutritional needs. A review of cleaning should take place in relation to chairs and wheelchairs and systems implement to ensure chairs are clean. 2 7 3 15 4 19 Care Homes for Older People Page 11 of 12 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 12 of 12 - 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!
