Inspection on 10/02/10 for Oak Tree Court

This inspection was carried out on 10th February 2010.

CQC found this care home to be providing an Excellent service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Oak Tree Court 24/07/09

Oak Tree Court 05/07/07

Oak Tree Court 29/06/06

Oak Tree Court 01/11/05

Oak Tree Court 17/06/05

Oak Tree Court 16/12/04

Oak Tree Court 22/06/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 11/04/2010.

Random inspection report Care homes for older people Name: Address: Robins Close Nursing Home Middle Green Road Wellington Somerset TA21 9NS three star excellent service 24/07/2009 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: Sue Fuller Date: 1 0 0 2 2 0 1 0 Information about the care home Name of care home: Address: Robins Close Nursing Home Middle Green Road Wellington Somerset TA21 9NS 01823662032 01823665010 robinsclose@majesticare.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) : Majestic Number One Ltd care home 61 Number of places (if applicable): Under 65 Over 65 61 61 old age, not falling within any other category physical disability Conditions of registration: 0 0 The maximum number of service users who can be accommodated is 61 The registered person may provide the following category of service only: Care home with nursing (Code N) to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Robins Close has been part of Majestic Number One since September 2001. The home offers nursing and residential care. The registered manager of the home is Matilda Ngomane. The Home is situated in the countryside on the outskirts of Wellington, surrounded by lawn and gardens, which now includes a new level access sensory garden. The home is Care Homes for Older People Page 2 of 13 2 4 0 7 2 0 0 9 Brief description of the care home well presented and has ample parking. The home accommodates up to 61 people in total. The home is now registered to provide up to 61 nursing places however staffing and accommodation remains in place for 30 with the remainder of people having personal care needs only. Where nursing is provided the corridors are spacious and wheelchair users can be accommodated. There is a large passenger lift between floors. Other parts of the home have comfortable attractive rooms more suited to personal care. The home has been suitably adapted to meet the needs of people in the home. The home is adequately equipped and adjustable beds are provided in the nursing wing. There is a registered nurse on duty at all times. The communal areas are comfortable and well appointed and include a conservatory with views of the garden. There is an ongoing refurbishment programme that includes redecoration and carpets in bedrooms. The fees vary according to peoples dependency and needs and the room occupied. Care Homes for Older People Page 3 of 13 What we found: This unannounced random inspection was conducted over one day by pharmacist inspector Sue Fuller and regulation inspector Kathy McCluskey from the Care Quality Commission (CQC). The registered manager was available throughout this inspection and all records required were made available to us. The purpose of this inspection was to focus on the homes procedures for the management and administration of peoples medication, care planning procedures and staff training and supervision. We looked at a care plan for an individual who had, in the last few months, been admitted to hospital on two occasions as an emergency, following a hypoglycaemic attack. We were informed that, although the individual was not a diabetic, their blood sugar levels were being monitored on a daily basis. A care plan was in place headed low blood sugar. This instructed staff to ensure that blood levels remain within normal limits. No information had been recorded as to what were normal limits for this individual or what action staff should take if levels were outside of the normal limits. We looked at the blood sugar monitoring sheet and found that levels were unstable fluctuating between 4.8 and 12.9mmols. Given the individuals history, we have strongly recommended that the home record clear information regarding the acceptable levels for blood sugar and action to be taken by staff if levels are outside of the normal ranges. This care plan also stated; ensure signs and symptoms of hypoglycaemia are checked regularly. We have strongly recommended that information is recorded which will enable all staff to recognise the signs and symptoms of a hypoglycaemic attack. Action to be taken by staff should also be recorded. We examined the nutritional care plan for the same individual as their monthly weights indicated a significant weight loss of 8kg in just over a month. An assessment dated 07/02/2010 identified the individual as high risk of malnutrition. A care plan was in place dated 13/01/2010. This stated that the individual was reluctant to eat. The care plan did not mention that diet and fluid intake were currently being monitored nor did it instruct staff to offer additional snacks or that a food supplement was being used. There was no information about how to increase the calorific value of meals or of what the individuals food/drink preferences were. No information had been recorded as to the minimum amount of fluids expected over a 24hr period. We were able to see that the individual was being weighed each month though this had not been included in the plan of care. We examined available diet and fluid intake charts and noted that the individual was taking very little diet, some days only a few yogurts had been recorded. It was apparent that some meals were being refused by the individual. Fluid intake also appeared insufficient on some days. Although staff were recording the amount of fluid taken for each drink offered, totals for the twenty four hour period were not being recorded. We were unable to ascertain how concerns would be passed to the registered nurses and we were unable to see that any action had been taken to address concerns about the amount of diet and fluids taken. Care staff currently complete the intake charts which are held in the nursing office. Care Homes for Older People Page 4 of 13 We looked at nutritional care plans for two more individuals who were having their diet and fluid intake monitored on a daily basis. One did not identify that intake was being monitored or how often the individuals weight should be monitored. Neither contained information about how much fluid should be encouraged or what steps would be taken to encourage weight gain. Diet intake for one individual was noted to be poor. On examination of a number of diet and fluid intake charts for individuals, we noted that there had been no entries recorded for diet offered or taken beyond 1700hrs. Records therefore indicating that people were not being offered food or snacks after their tea time meal at 1700hrs. The National Minimum Standards for Older People and the Institute for Public Health recommend there should be a gap of no more than 12 hours between the last meal of the day and breakfast the following day. Additional snacks should be offered to those people with an assessed need. We examined recruitment and training records for four registered nurses and three senior care staff/care coordinators to check if staff had received up to date training in the management and administration of medication and to ensure that staff were being appropriately supervised. In all but one file, we found certificated evidence of training in the management and administration of medication which had been supplied by an external trainer. The registered manager informed us that the identified member of staff, who was a bank nurse, had not received the training as they had not covered any shifts at the home in the last year. Files contained signed copies of the homes policy on the administration of medication dated 13/01/2010. The registered manager told us that she has recently introduced competency checks for all registered nurses. We were informed that all registered nurses had been required to complete the Nursing and Midwifery Council (NMC) competency standards for the administration of medication. The registered manager confirmed that there were no formal systems for monitoring the competence of the senior care staff responsible for administering medication on the residential wing of the home. The registered manager stated that she regularly walks around the home and observes senior care staff administering the medication and that procedures are discussed at formal staff supervision sessions. We were able to see evidence of this in the staff files examined. The pharmacist inspector looked at how medicines are looked after in the home. We spoke to the manager and deputy manager, as well as a trained nurse and a care coordinator involved with giving medicines to people living in the home. People living in the home are registered with doctors from one of the medical practices in Wellington. None of the doctors visit the home on a regular basis but staff told us that they visit when asked. Medicines are supplied by the pharmacy using a monthly blister pack system. Staff told us that they were happy with this system. Staff look after the medicines for everyone living in the home apart from one person who looks after one of their own medicines. There is a policy in place for self medication, if people wish to look after their own medicines, although the wording of this may discourage people from doing so. There is a risk assessment in place to ensure that this would be safe. Qualified nurses give medicines to all the people in the home receiving nursing care. Senior care staff look after the medicines on the residential side of the home. Following a recent incident involving medicines two nurses check the medicines given in the morning and at night. This is to make sure that the right people are given Care Homes for Older People Page 5 of 13 the right medicines. Nursing staff told us they understood why this was necessary but that it meant giving medicines took much longer. This practice will be reviewed after a meeting with an operations manager from the registered provider. We saw that suitable supplies of medicines are kept. We checked a number of blister packs, which showed that medicines had been given as recorded by staff. However a clear system is not in place to allow the audit of medicines which have been supplied in standard packs or bottle. At the time of our inspection it was not possible to show that some medicines had been given as recorded. For example we checked one persons medicines and saw that out of nine medicines received, five had the expected balance left, three had an incorrect balance and one could not be checked because staff had not recorded the quantity of medicine received. This means that staff cannot show that they have given all the medicines as recorded. Staff told us that their pharmacist had also visited recently and explained how the audit system should work. They told us that they will be following the advice they had been given. The pharmacy supply printed medicines administration record sheets each month for staff to record the medicines they have given. These have generally been completed fully and are clear to follow, indicating that people have been given their medicines as prescribed. However we saw that medicines for three people had not been signed for the previous evening, although staff told us that they had been given. Any handwritten additions made by staff had clear dosage instructions and were signed, dated and checked by a second member of staff. This helps to reduce the risk of mistakes being made. Some medicines have been prescribed with a variable dose, for example one or two Paracetamol. Staff had not always recorded the amount that they had given. This means that the records do not show how much medicine the person has received. When the dose of medicine is variable the amount given must always be recorded. We saw that one person had been prescribed a medicine which needs special monitoring so that the correct dose is given. The result from monitoring, kept with the administration record and stating the current dose, was dated September 2009 and advised that a further test should be done in one month. Staff had signed the administration record for this medicine but had not written how much they had given. No up to date result was seen. It is important that all results for this medicine are received in writing and a copy kept with the administration record to ensure that the correct dose is always given. It must be clear from the record how much has been given. Records are kept of the receipt of medicines into the home. Staff must ensure that these are accurate to make sure that medicines can be audited to check that they have been given correctly. Records are kept of the disposal of unwanted medicines. Staff need to ensure that they record the date the disposal company takes the medicines away from the home. We looked at four peoples care plans to see what information they kept about peoples medicines to help them give them safely. Two people who moved to the home from hospital had information from the hospital about their current medicines. Staff told us that one person sometimes had their medicines disguised in liquid to make sure that they take them. We saw that an assessment had been made about this persons ability to make decisions about their medicines but it was not clear whether this should Care Homes for Older People Page 6 of 13 apply to all their medicines. This assessment was dated in February 2009 and to be reviewed monthly but we did not see evidence that this had been done. There was no information in the persons medicine care plan about how they should be given their medicines. This information needs to be updated to ensure that all medicines are given in an appropriate way. One person was prescribed a medicine once daily, when required and given it every day. The care plan said this was for itching but it was not clear that this had been reviewed by the prescribing doctor. We saw that the care plans have sheets for recording each medicine a person is taking and for recording when this had been reviewed. After discussion with the manager it appeared that review meant that staff had checked the administration record to see if the person was still prescribed the medicine. It is important that medicines are reviewed by the prescriber at regular intervals to make sure that they are still appropriate for the person. A record should be made of any such review. Secure storage is available for medicines. Three medicine trolleys are used to carry medicines safely around the home. A medicine fridge is available and temperature records show this is safe for medicines. Suitable storage is available for storing controlled drugs, that need additional security. Records show that these medicines have been looked after appropriately. What the care home does well: What they could do better: The home need to ensure that care plans to meet peoples nutritional needs contain clear information about the individuals assessed needs and how these should be met by staff. The home also need to ensure that procedures are in place which will identify any concerns about an individuals diet or fluid intake in a timely manner. The home need to ensure that there is a gap of no more than 12 hours between the last meal of the day and breakfast the following day. Additional snacks should be offered to those people with an assessed need. Improvements could be made to care plans for people who require their blood sugars to be regularly monitored. Staff must ensure that a suitable system is in place to allow the audit of medicines. This is so that staff can check that they have been given as prescribed. If a medicine is prescribed with a variable dose, a record must be made of the amount that is given. This is so that it is clear how much medicine the person has received. The home needs to ensure that clear instructions are available to staff about any medicines that need to be disguised before giving and that these are reviewed regularly. This is too make sure that medicines are given appropriately and in a consistent manner. Care Homes for Older People Page 7 of 13 Staff should request that medicines are regularly reviewed by the prescriber and that the results of these reviews should be recorded in peoples care plans. This is to make sure people are given the appropriate medicines. It is important that all results and dose instructions for a medicine that needs special monitoring, are received in writing and a copy kept with the administration record to ensure that the correct dose is always given. 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 8 of 13 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 9 of 13 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 8 12 The registered person must 05/03/2010 ensure that nutritional care plans are fully reflective on an individuals assessed needs and that all interventions required to meet those needs are clearly recorded. To ensure the health and well being of people using the service. 2 9 13 If a medicine is prescribed with a variable dose, a record must be made of the amount that is given. So that it is clear how much medicine the person has received. 05/03/2010 3 9 13 The registered manager 05/03/2010 needs to ensure that clear instructions are available to staff for medicines that may be given covertly and that these are reviewed regularly. To make sure that medicines are given appropriately and Care Homes for Older People Page 10 of 13 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 in a consistent manner. 4 9 13 The registered manager must ensure that a suitable system is in place to allow the audit of medicines. So that staff can check that medicines have been given as prescribed. 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 05/03/2010 1 8 Where an individual requires their fluid intake to be monitored, staff should ensure that the amount taken over a 24 hour period is totalled so that any concerns can be more easily identified and so that appropriate action can be taken. It is strongly recommended that, for individuals with an assessed need, care plans contain information about acceptable blood sugar levels pertaining to that individual. Care plans should also provide information about what action staff should take if levels are outside of normal levels. It is strongly recommended that, for individuals with an assessed need, care plans contain clear information for staff on the signs and symptoms of hypoglycaemia so that all staff are able to respond to any concerns. It is strongly recommended that staff should request that medicines are regularly reviewed by the prescriber and that the results of these reviews should be recorded in peoples care plans. This is to make sure people are given the appropriate medicines. It is important that all results and dose instructions for a medicine that needs special monitoring, are received in writing and a copy kept with the administration record. This is to ensure that the correct dose is always given. Page 11 of 13 2 8 3 8 4 9 5 9 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 6 15 Where an individual requires their fluid intake to be monitored, staff should ensure that the amount taken over a 24 hour period is totalled so that any concerns can be more easily identified and so that appropriate action can be taken. Care Homes for Older People Page 12 of 13 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 13 of 13 - 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. 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