Random inspection report
Care homes for older people
Name: Address: Saltshouse Haven Nursing And Residential Home 71 Saltshouse Road Kingston Upon Hull East Yorkshire HU8 9EH one star adequate 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: Beverly Hill Date: 2 5 1 1 2 0 0 9 Information about the care home
Name of care home: Address: Saltshouse Haven Nursing And Residential Home 71 Saltshouse Road Kingston Upon Hull East Yorkshire HU8 9EH 01482706636 01482376216 Telephone number: Fax number: Email address: Provider web address: www.bupa.com Name of registered provider(s): Name of registered manager (if applicable) BUPA Care Homes (CFHCare) Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 150 Number of places (if applicable): Under 65 Over 65 150 150 150 dementia old age, not falling within any other category physical disability Conditions of registration: 0 0 0 A maximum of 5 people under 65 years of age may be accommodated in the intermediate care facility in Preston Lodge. A maximum of 7 people under 65 years of age, excluding those people referred to in condition 1 & 3, may be accommodated in PD, DE or TI categories. Registration includes one younger disabled person Preston Lodge, two younger disabled in Coniston Lodge Date of last inspection 2 4 0 7 2 0 0 9 Care Homes for Older People Page 2 of 12 Brief description of the care home Saltshouse Haven is a large care home with nursing, caring for people with a wide range of needs including dementia and physical disabilities. It is part of the BUPA group of care homes, is situated in a residential area and is close to public transport routes into the city of Hull. The home is based in six separate lodges; all connected by footpaths and covered walkways. The main lodge contains the laundry, kitchen, staff training, administration and management functions. The other five lodges are individually named and can accommodate up to thirty people in each. Preston Lodge and Meaux Lodge provide residential care. All thirty placements in Coniston Lodge are for nursing care and Bilton Lodge provides support for people with dementia care needs. Since the last inspection in July 2009 Sutton Lodge, which was for nursing care and intermediate care has closed. All Lodges have ground floor, single bedroom accommodation, a large communal lounge/dining area with a built on conservatory and a smaller quiet room for those people that wish to smoke. The home is nicely decorated and well equipped. Wellmaintained, landscaped grounds surround each lodge and there is ample car parking facilities. Information about the home and its service can be found in the statement of purpose and service user guide, which are available from the manager of the home. A copy of the latest inspection report for the home is on display in the reception area of the main lodge. The homes weekly rate is dependent on need and ranges from 359.50 to 580 pounds depending on the care required. People receiving nursing care will have an amount ranging between 106.30 pounds and 146.30 pounds deducted from the 580 pounds total, as this will be paid for by the Health Authority for the nursing part of their care. People will pay additional costs for optional extras such as hairdressing and private chiropody. Care Homes for Older People Page 3 of 12 What we found:
At the last key unannounced inspection on 24th July 2009 the home was required to improve the management of medication. Because the Commission would take enforcement action if the requirements were not met, we told the manager that we would be gathering any evidence under code B of the police and criminal evidence act (PACE). We left information about this and gave the manager a list of all the evidence we copied. Two regulation inspectors and a pharmacist inspector completed the inspection from 9am to 3pm and we looked at medication practices in three of the four units, Preston Lodge, Meaux Lodge and Bilton Lodge. We also examined staff rotas from the lodge providing nursing care, Coniston Lodge and exmained documentation such as, a behaviour management plan on Meaux Lodge and monitoring charts on both Meaux and Bilton Lodges. A pharmacist inspector examined the medication administration record charts (MARs) and the medication ordering, storage and disposal arrangements on Preston Lodge. He also observed medicines being given to people during the morning. Medication administration technique generally followed good practice but one person received their scheduled dose of painkiller some 90 minutes later than usual. It is important for peoples comfort and wellbeing that certain medicines are always given on time and arrangements should be in place to ensure this happens. Three peoples Mars indicated they had each not received one of their prescribed medicines as the home had none available to give despite the totals of these medicines remaining being recorded. Two other peoples medicines were running very low and staff were prompted to ensure new prescriptions were ordered without further delay. Arrangements and checks must be put in place to ensure sufficient prescribed medicines are always available to be given as and when needed. We found inadequate records of the use of prescribed skin creams. We were told that prescribed skin creams were being used on people by carers who had not yet fully completed appropriate medication training and assessment. Only trained staff who have been closely supervised in their practice should administer and handle prescribed medication in order to reduce the risk of error. We found administration gaps on two Mars suggesting not all medicines had been given correctly as prescribed. Hand written entries on Mars are now mostly completed correctly and new Mars are being annotated with any remaining medication quantities carried forward. Accurate and complete record keeping can help to prevent medication errors. We found that medicines are stored securely and at correct temperatures. This helps to make sure that staff know they are safe to use when needed. However, we also found that unwanted medicines were being returned to the supplying pharmacy for disposal instead of to a licensed special waste contractor. Arrangements for medication disposal which are in line with current environmental waste regulations must be put in place to ensure such waste is disposed of safely and lawfully. The homes medication procedures should be updated so that all aspects of medication administration and handling are brought in line with current professional best practice guidance. Care Homes for Older People Page 4 of 12 Inspectors also checked the management of medication on two further units. Staff were making a general fridge temperature recording on one of the units each day as, 8-2 degrees. The staff need to record the actual temperature of the fridge not the maximum and minimum it should be. We also noted that staff were destroying medication that had been administered to residents but declined, in different ways. Some staff flushed them down the sluice, some returned them in the box used for the disposal of sharps, some put them in the de-naturising kit specifically for controlled drugs and some returned them in black bags to the pharmacy. The importance of correct disposal of medicines is highlighted above. We found that staff were not adhering to policies and procedures regarding administration of medication. For example, one person was observed to receive their medication after the MAR had been signed. Staff also had to be reminded to check the MAR prior to administration of a controlled drug and they were observed to sign the MAR and CD register prior to administration. On one unit staff had given six residents their medication but had omitted to sign the MAR each time. The inspector reminded the staff and the charts were signed. Two residents had been prescribed eye drops for a set period of time and although the end of the course had passed they were still receiving the drops. Three residents were not administered their morning medication on the day of the inspection. Staff reported this was because they were asleep but they had not returned when the person was awake to administer them. It was noted that one resident regularly missed an evening dose of calcium medication because they were asleep. This means that people are not receiving their medication as prescribed and staff should report back to the GP to see if an alternative time can be arranged. Some of the handwritten instructions on the MAR were incorrect or gave confusing instructions. For example, there were three sets of differing instructions for one persons pain-killing medication. Another MAR stated a medicine was required weekly and staff had circled the dates it was due throughout the month. However the circle was only six days after the first dose had been given so all the markers were incorrect. Another MAR stated a specific cream had to be applied but did not state how often. Staff had been applying it every morning but there were two occasions when it was also applied in the afternoon as well. It is important that staff have clear instructions about when to administer medicines so mistakes will not be made. There were protocols in place for medicines that were prescribed, as and when required. This is good practice and an improvement since the last inspection. To improve, the protocols need more information especially for people with dementia and communication difficulties. For example the protocol for a behaviour modifying medication stated it was for agitation. It was not specific in how the persons agitation presented itself, nor at what point or level of the agitation the medication was given. There were other recording issues and these were mentioned to the manager to address. Medication audits were carried out weekly but they need to more thorough in order to pick up the issues identified in this report. There was a medication error recently when a resident was given medicines meant for another resident. This was initially a pharmacy error but should have been picked up when the prescription arrived and was checked by staff.
Care Homes for Older People Page 5 of 12 Throughout the day we also checked to see that other requirements issued at the last inspection had been met. One was to ensure that care staff followed instructions in plans of care that were written to meet peoples assessed needs. We found this requirement had been met. A second was to ensure accurate recording when pressure relieving tasks were completed. The monitoring charts had improved, and the evidence satisfied us that this requirement was met. To improve further the staff could comment on the condition of the residents skin, when possible, at each pressure relieving task and continence check. This would enable a clear trail of when any sore area first developed and prompt a quick response. A third requirement was to ensure a behaviour management plan was produced for a specific resident to enable a consistent approach to managing their care. The plan had been produced and the requirement met. A fourth requirement was to ensure that advice and equipment provided by health professionals was followed and used. This referred to the use of convenes, hip protectors, pressure relieving aids and completion of exercises. We found that this requirement had been met. A fifth requirement was to ensure sufficient numbers of nurses working the day time shifts in the lodges providing nursing care. Since the last inspection one of the lodges has closed and the remaining patients transferred to Coniston Lodge in a phased way. Some nursing and care staff transferred with them and others were dispersed throughout the home. Coniston Lodge had twenty-nine people living there with one vacancy. Rotas for Coniston lodge were examined, which indicated that most days there were 2 nurses and 4-5 carers during the day and one nurse and 2-3 carers at night. This was sufficient to meet the current needs of the people living there. Nursing staff also had protected medication rounds to enable them to administer medicines without interuption. This was set up after the last key inspection when it was noted the medication rounds were constantly interupted with telephone calls. A sixth requirement was to ensure that residents were supported to the toilet in a more timely manner. There were no comments about this throughout the day and the requirement has been met. One remaining requirement regarding improving practice following complaints management, will be assessed at the next full key inspection. We have not received any complaints about care issues to date. What the care home does well:
The manager always responds positively to any suggestions and completed a detailed and comprehensive improvement plan after the last inspection. Regular monthly prescriptions are checked for any changes and to ensure everything had been listed. Care Homes for Older People Page 6 of 12 Medicines are stored securely to reduce the risk of loss or diversion. Protocols were produced for, as and when required medication to give staff further information. Nursing staff on Coniston Lodge had protected medication rounds to enable them to administer medicines without interuption. 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 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(2) Revised Requirement. The registered person must ensure that the home does not run out of prescribed items. This will ensure that service users receive the medication as instructed by their GP. Previous timescales of 22/08/2008 and 31/8/2009 not met. We will be issuing a Statutory Requirement Notice for this breach of regulation. 15/01/2010 2 9 13(2) The registered person must ensure that medication is administered to people as per their prescriptions. This will ensure the health, safety and wellbeing of people is protected. Previous timescales of 22/08/2008 and 31/08/2009 not met. We will be issuing a Statutory Requirement Notice for this breach of regulation. 15/01/2010 3 9 13 Adequate arrangements 15/01/2010 must be put in place for the correct storage and handling
Page 8 of 12 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 of medicines and for the timely and accurate recording of all medicines recieved and administered. This will help to ensure that medicines are always available when needed so that they can be given correctly in order to protect peoples health and wellbeing. Previous timescale of 04/09/2009 not met. We will be issuing a Statutory Requirement Notice for this breach of regulation. 4 18 12 The lessons learned from 11/09/2009 investigations into complaints and safeguarding of adults referrals should be implemented and monitored via quality assurance processes, documentation, staff supervision and training, and observations of practice. This will help to ensure poor practice continues to decrease and the welbeing of residents continues to increase. Not assessed at this inspection but will be checked at the next key unnanounced inspection. Care Homes for Older People Page 9 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 8 18 Staff must receive training 15/01/2010 and be assessed as competent to apply precribed topical products. This will help to ensure the products are applied correctly. 2 9 12 The registered person must ensure that the home does not run out of prescribed items. This will ensure that service users receive the medication as instructed by their GP. This requirement is repeated as it affects regulation 12 (health and welfare) as well as regulation 13 (2) (medication) Previous timescales of 22/08/2008 and 31/8/2009 not met. We will be issuing a Statutory Requirement Notice for this breach of regulation. 15/01/2010 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 9 Handwritten entries onto the medication administration records should be accurately recorded and witnessed. This will help to prevent mistakes being made. There should be effective audit systems of medication to ensure all medication is accounted for and a clear audit trail is available. This will help to ensure better management of medication. Unwanted medicines should be disposed of safely according to current waste management regulations. 2 9 3 9 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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!
