Inspection on 08/10/09 for Penn House Residential Care Home

This inspection was carried out on 8th October 2009.

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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Penn House Residential Care Home 23/09/09

Penn House Residential Care Home 16/02/09

Penn House Residential Care Home 28/01/08

Penn House Residential Care Home 05/10/06

Penn House Residential Care Home 04/05/06

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Extracts from inspection reports are licensed from CQC, this page was updated on 14/03/2010.

Random inspection report Care homes for older people Name: Address: Penn House Residential Care Home 169 Penn Road Wolverhampton WV3 0EQ one star adequate service 16/02/2009 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: Ian Henderson Date: 0 8 1 0 2 0 0 9 Information about the care home Name of care home: Address: Penn House Residential Care Home 169 Penn Road Wolverhampton WV3 0EQ 01902345470 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Shanta Arjan Odedra,Mr Arjan Bhoja Odedra,Mr Vijay Odedra,Daljit Takhar,Jasvinder Takhar care home 24 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 0 24 dementia old age, not falling within any other category Conditions of registration: 24 0 The maximum number of service users to be accommodated is 24. The registered person may provide personal care (excluding nursing) and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories: Older People (OP) 24 Dementia (DE) 24 Date of last inspection Brief description of the care home Penn House Care Home provides personal care and accommodation for 24 older people with Dementia. The home is an early Victorian two - storey building that has been adapted internally to meet the needs of older people. There is easy access to local Care Homes for Older People Page 2 of 11 1 6 0 2 2 0 0 9 Brief description of the care home amenities, which includes a park, churches, temples, a library and shops. The home is located approximately 1 mile from the city centre and a local bus service stops nearby. The accommodation consists of two lounges and one of these is a large L shaped lounge, and a dining room. There is one double bedroom and 22 single bedrooms and seven of these have en-suite facilities of toilet and wash hand basin. There are communal bathrooms/showers and toilets on each floor. The home has a passenger lift, in addition to two staircases. There is a small patio, otherwise there is limited outside space for people to access. There is car parking at the front of the premises. People who use the service and their representatives are able to gain information about Penn House from the Statement of Purpose and Service User Guide. The Guide includes information on the fees charged by the home, which are noted as £349 to £420, dependent on the room and care required. The reader is advised to contact the service for up to date information on the fees charged. The last key inspection of Penn House was undertaken on the 24th September 2009. Inspection reports produced by CQC can be obtained direct from the provider or are available on our website at www.cqc.org.uk. Care Homes for Older People Page 3 of 11 What we found: The pharmacist inspector visited Penn House on the 8th October 2009 to fully assess the way the home was managing medicine on behalf of the people who used the service. 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. The medication records were poor and could not be used to evidence that medicines were being administered as prescribed. The quantity of medication received into the home was not being confirmed in writing. 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. We found gaps in the administration record and therefore it could not be confirmed whether the people using the service had received their medication. We found evidence of the medication administration record (MAR) charts being signed but the medication not being administered. We found a number of examples of this with the short course antibiotic. We found with one example that the home had indicated that 28 antibiotic capsules had been received into the home. We would therefore have expected to see 28 signatures on the MAR chart before the course was complete however we found 31 signatures had been recorded. We found that the home could not account for some medication. An example of this was with some soluble analgesic tablets. The home had indicated that 100 tablets had been received into the home and 55 tablets had been administered. We therefore expected to find 45 tablets remaining but we found 42 tablets. We also found that where variable doses had been prescribed the records did not always show what quantity had been given. Also where medication had not been administered and a generic abbreviation had been used there was no definition of the abbreviation and therefore the reason for the non-administration was not evident. We also found that some medication was being administered but a record of the administration was not being recorded on a MAR chart. We found when following the change in the dose of some diuretic tablets that the home had not discarded the original supply and had continued to use some of that supply. This in the first instance when examining the new supply gave the impression that the home had not been administering the morning dose at all. When the original supply was found it was clear that the morning dose had been administered from this supply. However this gave rise to further concerns because when comparing both sets of the Monitored Dosage System [MDS] there were two occasions where the tablets from both blisters had been removed. An explanation was given for one of the doses taken from the new supply but an explanation for the second dose could not be ascertained thus leading to the possibility that the person concerned had received two doses of the same medication on the same morning. In amongst all of this confusion the carer in charge admitted that the morning dose on the day of the inspection had not been administered. We were also concerned where the excess supply of medication was being kept because it seemed to be too far away from the trolley for the staff to keep track of it. We found that one of the people who were using the service was not able to have their analgesic medication because the home appeared to be out of stock. When challenged about this Care Homes for Older People Page 4 of 11 the carer in charge went upstairs to the excess stock cabinet and found a supply of the analgesic tablets and placed them in the trolley. At this point it was expected that the person concerned would be offered the analgesic tablets however it was not until the lunchtime medication round that the tablets were offered and administered. We found that the disposal procedure for refused or unwanted medication was poor. We found an envelope and a brown medicine bottle in the trolley that were filled with many different types of tablets. Overall it was estimated that the containers were holding a total of 80 different tablets. We found that these tablets could not be traced back to a particular person that was living in the home and therefore the homes audit trailed could not be completed and therefore their records were not robust enough to demonstrate that people were receiving their medication as prescribed. 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 when required medication. We also found very little information about when and why medication had been changed or discontinued. We also found no written confirmation from the prescriber as to what was meant by the directions as directed which appeared on a number of dispensing labels and MAR charts. . We also found very little information about the reasons for the administration of the medication and where appropriate the length of treatment in particular the administration of medicated creams. On the subject of security and storage of medicines we found that the majority of medicines were being stored in a room that was too hot to comply with the manufacturers requirements. On the day of the inspection the room temperature was measured at 30 degrees centigrade and the maximum temperature specified by most manufacturers is 25 degrees centigrade. We found that the home was not regularly measuring the maximum room temperature. The home must measure the maximum room temperature on a regular basis and if the temperature of the rooms is greater than 25 degrees centigrade steps must be taken to rectify this. We found that staff were not measuring the maximum and minimum temperatures of the fridge on a daily basis which they must do to ensure that the fridge is maintained at between 2 and 8 degrees centigrade. We found that the fridge was not being maintained within the correct temperature range and as a consequence the home was advised to dispose of the contents of the fridge, which included insulin and obtain new supplies. We found that medicated creams/ointments were being insecurely stored in the rooms of people who used the service. We found that one of these creams was required to be stored in a fridge at all times. As a consequence of this cream not being stored in the fridge there was a risk that this person would not receive the correct dose of the cream. 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 urgency. What the care home does well: The care staff were very hospitable during the inspection and were keen to discover where they were going wrong so that it could be put right. Care Homes for Older People Page 5 of 11 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 6 of 11 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 3 14 Assessment of peoples care 03/11/2009 needs must be undertaken before they are admitted to the home. This is to ensure people can be confident the home will meet their needs and avoid the home admitting people whose needs cannot be met. 08/01/2010. Unable to assess compliance fully as no new admissions to the home Care Homes for Older People Page 7 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, 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 Statuatory Requirements Notice for Regulation 13[2]. 1. Put in place safe and adequate arrangements for the ordering, recording, handling, safekeeping, safe administration and disposal of medicines received into the home. 2. That all medications received into the Home are audited and recorded on the medication administration charts 3. Ensure that medication administration records are accurately maintained including the number of tablets administered when the prescription states that one or two tablets can be given as required. The registered person shall make arrangements for the recording handling safekeeping safe administrartion and disposal of medicines received into 17/11/2009 Care Homes for Older People Page 8 of 11 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 the care home. 2 9 18 Regulation 18[1] [a] To ensure that staff are suitably qualified, experienced and competent to safely administer medication before they administer medication to people who use the service. The registered person shall ensure that at all times suitably qualified competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. 3 9 12 Statutory Requirements Notice for Regulation 12[1]. 1. To review and put systems in place at the home to promote and secure the proper provision for the health, welfare, care and treatment of people using the service 2. Make arrangements and put systems in place to ensure that all medicines prescribed to people using the service are available in the home at all times for administration as prescribed by their General Practitioner. 3. Put systems in place to ensure that information about how medications and Care Homes for Older People Page 9 of 11 17/11/2009 17/11/2009 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 creams are to be administered to people using the service is clearly documented in their care plan. 4. Make arrangements and put systems in place to ensure that all discontinued medications are removed from the medicine trolley immediately and a written record made of the amount of medication disposed of. The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. 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 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. 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