Inspection on 19/06/09 for St Georges Hall & Lodge

This inspection was carried out on 19th June 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Georges Hall & Lodge 16/03/09

St Georges Hall & Lodge 09/03/09

St Georges Hall & Lodge 04/03/08

St Georges Hall & Lodge 11/10/06

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Random inspection report Care homes for older people Name: Address: St Georges Hall & Lodge Middleton St George Hospital Site Middleton St George Darlington Co. Durham DL2 1TS The quality rating for this care home is: The rating was made on: Zero star poor service 09/03/2009 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. Care Homes for Older People Page 1 of 14 Lead Inspector: Sue Lowther Date: 1 9 0 6 2 0 0 9 Care Homes for Older People Page 2 of 14 Information about the care home Name of care home: Address: St Georges Hall & Lodge Middleton St George Hospital Site Middleton St George Darlington Co. Durham DL2 1TS Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : dementia old age, not falling within any other category Number of places (if applicable): Under 65 62 0 Over 65 0 21 08456032558 01325335487 stgeorgeshall@try-care.co.uk www.orchardcarehomes.com Orchard Care Homes.Com Limited Alison Pemberton Care Home 83 Additional conditions: The registered person may provide the following category of service user only: Care home with nursing-Code N To service users of then following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia-Code DE, maximum number of places: 62 Old age, not falling within any other category- Code OP, maximum number of places: 21 Care Homes for Older People Page 3 of 14 Date of last inspection: Brief description of the care home: 2 1 0 4 2 0 0 9 St Georges Hall and Lodge is a residential care home with nursing, newly built in 2006. The layout of the building is split into three units which run with distinct staff teams but share some facilities such as kitchen, laundry and garden areas. There are 83 individual rooms each with en suite bathroom including shower. All rooms are equipped with T.V and DVD player. The home also has assisted bathing facilities in communal bathrooms. There are several communal lounges and dining areas. There is a landscaped garden at the rear of the building for people to use and an outside summer house for people who smoke to shelter from the elements. The home itself is no smoking. The home is situated near the Durham Tees Valley airport site and is not in easy reach of community facilities such as shops, banks, leisure facilities and pubs. However there is a hotel nearby. Care Homes for Older People Page 4 of 14 What we found: A key inspection was carried out in February and March 2009 where several statutory requirements were made. A random inspection was then carried out on the 21 April 2009 to check the progress the home had made in respect of meeting some of those requirements. Of those requirements assessed it was identified that several remained outstanding. Due to the serious nature of the concerns enforcement action was commenced and Statutory Requirement Notices in relation to care planning and medication arrangements were issued on 19 May 2009. The purpose of this random inspection visit on 19 June was to assess compliance with the statutory requirement notice dated 19 May 2009 with regard to service users care plans. This statutory requirement notice describes poor care planning which failed to clearly identify how service user needs would be met in terms of health and welfare. In addition care plans were not kept under review and revised to reflect service users changing health and welfare needs. We found that the registered manager was not available and staff were being supported and supervised by Debbie Campey who is a support manager and acting manager at the home. We looked in detail at the care records of people and spoke with staff. The statutory requirement notice asked the home to ensure that service user plans clearly identified how their needs in respect of health and welfare were to be met. Also to ensure that care plans were kept under review and where appropriate and, unless impracticable after consultation with the service user or a representative of his, revised to reflect the service users changing health and welfare needs. With regard to care records, those seen at the random inspection in April 2009 were reviewed and re examined. An additional random sample was reviewed at this visit. We found that peoples nutritional needs are still not being properly assessed and that their care plans are not being kept under review and revised to reflect their changing health and welfare needs. In one care plan seen by the inspectors in April 2009 it was identified that reference to nutritional supplements in the nutritional risk assessment was incorrect. However at this inspection the inspector found that the nutritional risk assessment was unchanged and still indicated that the same nutritional supplement was being used. Another care plan referred to food and fluid charts having commenced but staff were unable to locate these when the inspector asked to see them. Monthly care plan reviews had not been carried out in May for a person who was clearly becoming increasingly unwell with a changing condition. This person had been weighed in April and when weighed in June was found to have suffered significant weight loss. One risk assessment with regard to the use of bedrails indicated that the person was at low risk of injury due to falling out of bed, yet bedrails were still in use. Another care plan indicated that one person was being restrained using a lap strap, however there was no risk assessment in place to demonstrate that this was appropriate. In another care plan the inspector saw a good description of the management of a pressure sore but no evidence of its exact location, size, shape or grade. There were no March or April 2009 care plan evaluations for one person with regard to continence despite the fact that daily entries indicated their needs had changed. Care Homes for Older People Page 5 of 14 In another set of records it was clear that the contact details required by the home for the next of kin had changed. However the records had not been updated and could therefore cause confusion for staff and distress for relatives. Some duplication was seen in care plans with regard to pain and medication and in one instance there were two care plans for the same identified need. This duplication is time wasting and can lead to confusion and missed communications especially where agency staff are being used. At the previous key inspection a problem was noted with the flooring and drainage system in the en suite facilities. It was noted at the inspection in April that this had been addressed in part. The acting manager said that the showers in the bedrooms where this problem had occurred had been disabled, but that there were separate showers available in some parts of the home. However one care plan stated that the person preferred a shower, but would sometimes have a bath. When discussed with the member of staff in the unit where this person resides it appeared that the person was not being offered the choice of being taken to another part of the home for a shower. During the course of this inspection it was identified that accident records were not being kept in sufficient detail for inspectors to assess whether they were being managed appropriately. It was noted that in June 2009 one person had fallen but the inspector was told that it was unwitnessed. The accident report was extremely brief, but indicated that the person had been found on the floor complaining of pain in the left hip and with a small cut and bruising above the left eyebrow. The daily communication sheet was also brief and contained reference to the fact that the person was assisted to their bedroom in a chair. There was no mention in the record of when the person was last seen and by whom. There was no record to confirm this accident was unwitnessed. There was no name or statement of the member of staff who was first on the scene and what they found, saw or were told. There was no written evidence to confirm that a full nursing assessment of the actual or potential injuries had been carried out prior to the decision to move the person. There was no clarity as to why and how the person was moved in a wheelchair to the bedroom, whether immediate first aid had been administered, or how the transfer to the bed had taken place. Similar concerns were identified with the management of another person who had fallen in May 2009. In addition it was found during the inspection that some people had been without medication for several days. One person had not been given pain relief since 16 June 2009, despite it being prescribed on a regular basis and this was recorded as out of stock. The medication was prescribed as 30mg to 60 mg four times daily but recent entries on the administration records failed to identify how much had been given. A second medication had been out of stock since the 15 June 2009 and was still out of stock on 19 June 2009. Following the inspectors’ intervention on 19 June 2009 Debbie Campey advised the inspectors that the pain relief had not yet been obtained, but that the practice manager had promised to address this as a matter of urgency. She confirmed that the second medication had arrived before the inspectors left the home. Janet Long, Pharmacist Inspector, and Steve Baker, Regional Lead Pharmacist, visited the home on 15 June 2009. The purpose of this random inspection visit was to assess compliance with the statutory requirement notice dated 19 May 2009 which described poor medication practices. During the visit they examined the current months medication administration records (MARs) on all units, reviewed medication ordering, Care Homes for Older People Page 6 of 14 receipt, storage and handling arrangements in the home and spoke to the senior staff on duty in each unit. In the absence of the manager, the inspectors gave verbal feedback to Debbie Campey, the nurses and senior carers on each unit. The medication statutory requirement notice asked the home to carry out a full audit and review of the systems used for the recording, handling and safe administration of medicines. We found that although checks had been carried out regularly by the manager and had identified, for example, missing signatures on MARs, no records were found of any subsequent action taken. The checks were repetitive and failed to target those areas of practice needing urgent changes. As a result, some improvements had been made, but these were not consistently seen across all units. The home was also asked to put in place effective arrangements to ensure that any omissions or variations in the administration of prescribed medication, and the reasons for these, were clearly, legibly and promptly recorded. Also to put in place effective arrangements to ensure that accurate records of all medicines administered at the home were maintained. We found that record keeping is now much better on the two ground floor units and examples of clear explanations for omissions or refusals were seen. In contrast, we found that records in the two first floor units are still in need of improvement. Gaps seen on MARs mean that it is still not possible to know whether all medicines have been given correctly. For instance, the MARs of three people indicated that one medicine for each person was out of stock at some point during June 2009. We also found many gaps in the records for the use of prescribed skin creams which could not be explained. The notice required the home to put in place effective arrangements to ensure that accurate administration of medication was carried out in accordance with the directions of the prescriber. We found that this had been achieved on the two ground floor units but records on the first floor show some incorrect use of prescribed skin creams. The MARs of two people prescribed anticoagulant medicines indicate that not all doses were given and that once again, no explanation was recorded. We also found that the guidance about giving medicines prescribed when required was insufficiently clear to ensure such medicines would be given as intended. The home was expected to put in place a system to check expiry dates of medicines and to add the date of opening where necessary. We found that this had been achieved on the ground floor. However, we found six opened skin products on the first floor which had been supplied more than six months previously and which were still being used. The home was also required to put in place a system to make sure that medicines are stored at temperatures recommended by the manufacturer. Room temperatures had been monitored and records indicated that temperatures of more than 25 degrees Centigrade had occurred in all units. This suggests that the home should explore and introduce methods of cooling all the clinic/store rooms where medicines are kept. All the fridge temperatures are being monitored but the records indicate that staff do not understand how to use the integral digital fridge thermometers or what to do when recording temperatures outside the required range. This was confirmed by questioning staff on duty in each unit. Finally, the home was asked to put in place a system to check that medications received at the home are those that are prescribed. Evidence from both the first floor units indicated some discrepancies in checking received medicines. This means that incorrectly supplied medicines and/or MAR charts are still available and in use. For instance, the carton of one medicine contained 10 tablets fewer than the quantity Care Homes for Older People Page 7 of 14 printed on the label. Another persons antibiotic cream and dosage directions had been changed by the doctor but these changes had not been made on the printed MAR. The evidence described above demonstrates that the home has not complied with the requirements of the statutory notice issued on 19 May 2009. When asked, Debbie Campey stated that the reasons for the lack of compliance with requirements were ‘changes in management arrangements’ and ‘the continuing need to use agency staff in the first floor units’. 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 Older People Page 8 of 14 Are there any outstanding requirements from the last inspection? Yes Outstanding Statutory Requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random 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 No 1. 7 15(1) and (2) Ensure that care plans are Enforcement kept under review and where action in appropriate and, unless it is progress. impracticable after consultation with the service user or a representative of his, revised to reflect the service users changing health and welfare needs. Outstanding from inspection 9 March 2009 (date revised). 2 7 15(1) and (2) Ensure that service user plans clearly identify how their needs in respect of health and welfare are to be met. Outstanding from inspection 9 March 2009 (date revised). Enforcement action in progress. 3 9 13(2) Put in place a system to check that medications received at the home are those that are prescribed. Outstanding from inspection 27 April 2009. Enforcement action in progress. 4 9 13(2) Put in place a system that makes sure that medicines are stored at temperatures recommended by the manufacturer. Outstanding from inspection 27 April 2009. Enforcement action in progress. 5 9 13(2) Put in place a system to check expiry dates of Enforcement action in Page 9 of 14 Care Homes for Older People medicines and to add the date of opening where necessary. Outstanding from inspection 27 April 2009. 6 9 13(2) progress. Put in place effective Enforcement arrangements to ensure that action in accurate administration of progress. medication, in accordance with the directions of the prescriber, is carried out. Outstanding from inspection 27 April 2009. 7 9 13(2) Put in place effective Enforcement arrangements to ensure that action in accurate records of all progress. medicines administered at the home are maintained. Outstanding from inspection 27 April 2009. 8 9 13(2) Put in place effective Enforcement arrangements at the home action in to ensure that any omissions progress. or variations in the administration of prescribed medication and the reasons for these are clearly, legibly and promptly recorded. Outstanding from inspection 27 April 2009. 9 9 13(2) Carry out an audit and review of the systems used for the recording, handling and safe administration of medicines. Outstanding from inspection 27 April 2009. Enforcement action in progress. 10 15 16 Arrangements must be put in 30/06/2009 place to ensure that staff support and assist all service users with their food intake, so that they receive a nutritious and where required a fortified diet that is appropriate to their individual assessed needs. Page 10 of 14 Care Homes for Older People Not assessed at this inspection. 11 30 18 Staff must receive training 17/04/2009 that will provide them with the knowledge and skills they need to care for people in the home. This must include safe working practices, the conditions and needs of the service user groups and elderly nutrition to include the specific needs of dementia sufferers. This will make sure that people are being cared for by staff who know what they are doing. Not assessed at this inspection. 12 37 17(Schedule 4) Records of food provided for 30/06/2009 service users must be maintained and include sufficient detail to demonstrate whether the diet is satisfactory. Not assessed at this inspection. Care Homes for Older People Page 11 of 14 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 38 12(1)(a) and (b) Ensure that all staff adhere to safe and appropriate accident management and emergency first aid procedures. 31/07/2009 2 37 17(1)(a) Schedule 3 Maintain adequate records of 31/07/2009 any service user accident and a record of falls and treatment provided to service users as detailed in paragraphs (j) and (o) of Schedule 3 of the Care Homes Regulations 2001. Put in place effective 31/07/2009 arrangements for requesting, obtaining and retaining adequate supplies of prescribed medication. 3 9 12(1)(b) 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 2 9 9 Accurate and timely records of all medicines received and administered should be kept on all units. All unwanted medication should be disposed of to prevent inappropriate use. Page 12 of 14 Care Homes for Older People 3 9 Room temperatures should be monitored regularly to ensure they dont exceed 25 degrees centigrade. Medication fridge thermometers should be checked and used correctly to ensure meaningful records are kept of storage conditions. Management checks of medicines records should show what action is taken and recurrent problems should be actioned. 4 9 Care Homes for Older People Page 13 of 14 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 14 of 14 - 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!