Inspection on 31/10/08 for Nottingham Neurodisability Service Hucknall - Fernwood

This inspection was carried out on 31st October 2008.

CSCI found this care home to be providing an Good 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Nottingham Neurodisability... 08/12/08

Nottingham Neurodisability... 04/12/06

Nottingham Neurodisability... 24/10/05

Nottingham Neurodisability... 13/07/05

Nottingham Neurodisability... 19/11/04

Nottingham Neurodisability... 14/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Thematic inspection report Care homes for adults (18-65 years) Name: Address: Nottingham Neurodisability Service Hucknall - Fernwood Hankin Street Hucknall Nottingham Nottinghamshire NG15 7RR The quality rating for this care home is: The rating was made on: two star good 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 thematic 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: Mathias Foundling-Miah Date: 3 1 1 0 2 0 0 8 Information about the care home Name of care home: Address: Nottingham Neurodisability Service Hucknall Fernwood Hankin Street Hucknall Nottingham Nottinghamshire NG15 7RR 01159680303 01159642747 diane.eden@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Four Seasons Homes (Ilkeston) Ltd care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability 20 Over 65 0 Conditions of registration: 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: Physical disability - Code PD The maximum number of service users who may be accommodated is 20 Date of last inspection Brief description of the care home Nottingham Brain Injury Centre, Fernwood Unit is a two-storey, purpose-built care home, owned by Four Seasons Care Homes. It is situated at the corner of Hankin Street, between its two sister units. It provides full and rehabilitatory skilled nursing care for up to 20 service users with post-trauma and polyaetiological brain injuries. All service users bedrooms are individually decorated, many have en-suite toilet facilities. Care Homes for Adults (18-65 years) Page 2 of 10 Some bedrooms have direct access via patio doors to a safe, very pleasant, enclosed garden at the rear of the property. The residents needs are well-supported, promoting independent living skills within a risk assessment framework, helping them to make active choices and to be as fulfilled as possible. The facilities within Fernwood House are conducive to achieving optimum independence for the service users. Wheelchairs can access all areas within the home, mobility aids are available such as hoists, transfer belts and strategically placed handrails and easily accessible shower and bath areas. A vertical lift is also accessible to allow easy access to the first floor of the home. The fees currently charged at the home range from #1.500 to #2890.32 per week, which does not include payments for toiletries, podiatry services, hairdressing, holidays and newspapers or magazines. Care Homes for Adults (18-65 years) Page 3 of 10 What we found: The reason for this inspection was to assess compliance with the following requirement previously made on a key inspection on 4th December 2006. This includes recent concerns raised in October 2008 by Angela Starr (Regulation Inspector) of four people living in the service have been subject to Safeguarding referrals due to medication errors. The registered person will ensure that the management of medicines within the home is effective in ensuring the safety of residents. The visit lasted 2 hours and 45 minutes. This involved examination of medicine storage facilities, records including Medicine Administration Records (MAR charts), Monitored Dosage System (MDS) and discussions with care staff. The outcome is as follows: There was evidence of audit forms for monitoring medicines and we found auditing of MAR charts were undertaken. The registered manager was absent that day; however the Manager from Milward initially came to assist. The findings had been highlighted on the forms; however we were unsure as to what follow up measures were undertaken with staff when findings and/or errors have been found. We were informed that the homes medication policies have made available to staff but we could not find indication of staff including agency staff signing to state they understood and would comply with the policies. We noted a memo instructing staff about handwritten entries on MAR chart; however not all staff signed and dated this memo to indicate that they have read this. We noted this memo does not indicate to date the chart when a second carer initials after checking the entry for accuracy. When we arrived we found staff wore red tabards during medicines round to signify they were not to be disturbed and to seek other staff if needed for assistance. We found it difficult to audit medicines as previous stock available were not carried forward e.g. Movicol Sachets and Scopoderm TTS Hyoscine Hydrobromide patch 1mg/72hrs. We found Scopoderm patches for one person in service mixed with another persons patches in the same basket. This possibly indicates staffs inadvertently are using same medicines without heeding which resident it belongs to. The upstairs bottom cupboard was found to be untidy. Individual named containers with lids should be kept for those medicines not in MDS for each person in service to avoid mix up with each persons medication. The staff signature list was found to be incomplete and did not include all the relevant care staff including agency staff. MAR charts were found recorded with medicines no longer in use. We informed the home that the community pharmacy was to be contacted by home to take off medicines no longer prescribed to avoid confusion and reduce visual complication of the MAR charts supplied. We found no clear protocols as to what circumstances staff administered when required medicines. However some entries have been made in care plans. We discussed with Staff and examined MAR charts, that there was no consistency as to Care Homes for Adults (18-65 years) Page 4 of 10 when to enter coding N (offered when not required) and when other staff left a gap. There must be clear protocol and appropriate coding for their use. This will ensure a consistent approach by staff, to ensure medication is used appropriately, and will protect people from harm. We found on MAR charts entries made by staff coding M=Make available. There was no risk assessment as such, but written in the persons care plan. We were informed by staff that the person living in the service likes it as their preference. We informed the home that people in service users must be risk assessed as able to part or fully self administer their own medication. A regular compliance check must be undertaken and documented to ensure that they can handle their medication safely. We noted some MAR charts had a dot mark to signifying preparing to administer but this was not followed up afterwards to show that medicines were administered i.e. no initials were made and we could not determine if medicines had been given to people living in the home as prescribed. We found many gaps in the MAR charts for the administration of external preparations. We discussed with staff, those carers involved in applying external preparations and nutritional supplements should have a separate folder containing MAR charts to sign. The original MAR charts documented to refer to this folder. Nutritional supplements were found to be stored in a well organised tidy manner. We noted that there were fridge temp recordings made beyond the accepted temperature range and recordings were not made daily. We found staff were unaware of manufacturers instructions for the fridges i.e. to reset in order to allow new current temp values to be stored. Nothing on the record sheet stated what to do in the event of temperatures recorded beyond the accepted temperature range. This indicates that the above requirement has not been fully met. Discussions took place with care staffs on duty and in charge of medication during the time of the inspection. Feedback was given at the end of the visit. 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 Adults (18-65 years) Page 5 of 10 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 20 13 The registered person will 15/01/2007 ensure that the management of medicines within the home is effective in ensuring the safety of residents. Care Homes for Adults (18-65 years) Page 6 of 10 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 20 13 When people are prescribed 12/01/2009 medicines on a when required basis there must be clear protocol and appropriate coding for their use. This will ensure a consistent approach by staff, ensure medication is used appropriately, and will protect people from harm. To safeguard the health and welfare of people living at home. 2 20 13 A quality assurance system must be installed to assess staff competence and make arrangements for the safe handling of medicines. Appropriate action must be taken when these indicate that medicines are not correctly recorded, not administered as prescribed and records do not reflect practice. This is to ensure that all medicines are administered as prescribed and this can be demonstrated. To safeguard the health and welfare of people living in 12/01/2009 Care Homes for Adults (18-65 years) Page 7 of 10 their home To safeguard the health and welfare of people living at home. 3 20 13 The quantity of any balances 12/01/2009 of medicines carried over from previous cycles must be recorded and dated when, to enable audits to take place to demonstrate the medicines are administered as prescribed To safeguard the health and welfare of people living at home. 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 20 Medicines must be stored under appropriate environmental conditions in compliance with their product licence to maintain their stability. This will ensure the quality of medicines in use and protect residents from harm. Action to be taken for staff to follow Fridge manufacturers specifications that as soon as daily temperature readings have been taken to reset both max and min temp accordingly. Action should be taken to ensure separate records (Referred on the MAR charts) available of external preparations and nutritional drinks administered by carers to people in service. Action should be taken to ensure that when it is necessary to handwrite a medication administration record chart in the home that the member of staff writing the chart signs the chart and that a second carer checks the entry for accuracy, initials and dates the chart. The policies and procedures relating to the handling of medication should be reviewed and updated in line with the guidance from the Royal Pharmaceutical Society document The Handling of medicines in Social Care settings published 2007. 2 20 3 20 4 20 Care Homes for Adults (18-65 years) Page 8 of 10 5 20 Action should be taken to ensure individual named containers with lids should be kept for those medicines not in MDS for each person in service. Care Homes for Adults (18-65 years) Page 9 of 10 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 Adults (18-65 years) 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 © (2009) Commission for Social Care Inspection (CSCI). 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