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Inspection on 13/01/10 for Stamford Nursing Centre

Also see our care home review for Stamford Nursing Centre for more information

This inspection was carried out on 13th January 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides a service to some very dependent people requiring high levels of care. The management and staff at the home work very hard to meet peoples` needs. There are systems in place to enable residents and their families to have a say in how the home is run and to ensure that peoples` rights are respected. The service also takes into account the cultural and religious needs of residents at the home. In the main medication is stored and administered in accordance with the prescribers` directions and records are clearly maintained to indicate this.

What the care home could do better:

The home requires some refurbishment and decoration to ensure a pleasant and safe environment is maintained. Attention is required to keep to the required time for administration of medicines and to ensure that all records for the administration of medicines are accurately entered. Accountability is needed on occasions to accurately record the cold storage temperatures for medicines and those medicines with a limited expiry when in-use.

Random inspection report Care homes for older people Name: Address: Stamford Nursing Centre 21 Watermill Lane Edmonton London N18 1SU two star good service 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: David Hastings Date: 1 3 0 1 2 0 1 0 Information about the care home Name of care home: Address: Stamford Nursing Centre 21 Watermill Lane Edmonton London N18 1SU 02088074111 02088079479 moriarth@bupa.com www.bupacarehomes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) BUPA Care Homes (ANS) Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 90 Number of places (if applicable): Under 65 Over 65 0 43 0 dementia old age, not falling within any other category physical disability Conditions of registration: 33 0 14 The maximum number of service users who can be accommodated is: 90 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: Dementia Code DE (of the following age range: 50 years and over) (maximum number of places: 33) Old age, not falling within any other category - Code OP (of the following age range: 65 years and over) (maximum number of places: 43) Physical disablity - Code PD (maximum number of places: 14) Date of last inspection Care Homes for Older People Page 2 of 12 Brief description of the care home Stamford Nursing Centre is a care home registered to provide nursing care for older adults and a specified number of younger adults with physical disabilities. The home was previously owned by ANS Homes Limited. BUPA purchased the home in October 2005. BUPA is a national organisation and owns other care homes across the country. The home aims to provide a high quality of nursing care to adults convalescing after surgery or illness, older people who require nursing care, adults aged over fifty with physical disabilities and those requiring palliative care. The home is a large modern purpose built three storey building. The kitchen, laundry, reception and administrative offices are all located on the ground floor. The bedrooms are located on all three floors. All bedrooms have en-suite facilities. Floors are connected by stairways and a passenger lift. Each floor has a lounge and separate dining room. There are two additional smaller lounges. Fourteen younger adults are accommodated in a separate wing on the first floor. The home is located close to the North Middlesex Hospital and along the North Circular Road. It is within walking distance of shops; restaurants and transport facilities located the High Street in Edmonton. The fees charged by the home range from Seven hundred and thirty five pounds to Nine hundred and twenty nine pounds per week. The provider must make information about the service available (including reports) to service users and other stakeholders. Care Homes for Older People Page 3 of 12 What we found: We carried this unannounced random inspection of Stamford Nursing Centre on Wednesday 13th January 2010. The registered manager resigned from her post and currently the service is being managed by a support manager from BUPA. The inspection lasted five hours and we were assisted throughout the inspection by the support manager and the quality consultant for BUPA who is also supporting the service until a new manager is in post. The reason for this visit was to check compliance with the requirements we made at the last key inspection in July 2008. There have also been a number of safeguarding issues recently and we wanted to make sure the service was dealing with these issues properly to ensure the continued safety of people who use the service. A CQC pharmacist inspector visited the home on 22nd January to inspect the medication procedures at the home. Their findings are also included in this report. We spoke with fourteen residents, eight staff and one visitor. We observed the interactions between staff and residents. We inspected the building and examined various care records as well as a number of policies and procedures. At the last key inspection we issued two requirements and five good practice recommendations. The two requirements related to the replacement of worn carpets and increasing the lighting in the corridors in the home. We saw that the lighting of corridors has improved and corridors were much brighter. Of the three floors, carpet has only been replaced on the second floor. The carpet on the ground and first floor remain frayed and worn. Duct tape has been used to seal any frayed carpet, however this can only be a temporary measure the carpet on both floors needs replacing. In fact the decoration of the whole home needs some attention. Corridors still appear tired and gloomy. Some of the lounges and residents rooms need redecorating. The support manager agreed that the home was overdue for refurbishment and told us that this was hopefully taking place sometime this year. It is a real shame that the homes interior does not reflect the hard working staff team or the expectations of residents. The requirement relating to carpeting corridors has been amended to include general refurbishment and is restated. The homes Statement of Purpose now contains information about how the home will meet the cultural and religious needs of people who use the service. The document was written in quite small print and a large print version would be of benefit to those people with sight problems. A new recommendation has been issued. Care Homes for Older People Page 4 of 12 It was good to see that the menus for the home reflect the cultural diversity of the residents. Four care plans were examined. These plans gave clear information to staff about how best to support the individual. Plans also included information about how to maintain peoples dignity, privacy, choice and independence. There is also a section within each plan that looks at relatives expectations of the service. Service users weight is being monitored on a regular basis and recorded in each persons care plan. We noted that a referral had been made to the local authority in relation to an assessment of a resident under the Mental Capacity Act. This should ensure that the rights and safety of people who use the service are respected and assured. Risk assessments were seen in all care plans examined. These assessments outlined the perceived risk and detailed action that staff need to take to minimise these risks. Both care plans and risk assessments were being reviewed monthly and updated where peoples needs or risks had changed. People we spoke with told us they were satisfied with the care and support they receive at the home. One resident told us that she would soon tell staff if she was not happy with the care. Another resident told us that a staff member had been rude to him but he could not identify the staff member. The support manager was aware of this matter and was dealing with it by discussing customer care and respect in general staff meetings. A large number of residents have quite complex needs and we saw staff working very hard to attend to residents needs. We noted that a large number of residents stayed in their rooms for most of the day. The support manager said this appeared to be a long standing culture of the home and that she was trying hard to encourage residents to go to the lounge and dining rooms where possible. As previously mentioned, lounges could be better designed and more welcoming. The support manager told us she was trying to address this issue by rearranging furniture in the lounges to make them more homely. At the present time there are two safeguarding issues that are being investigated by the local safeguarding team in Enfield. Both these investigations are ongoing. It was clear from discussions with the support manager that the service is dealing with these issues in a professional manner and in line with relevant policies and procedures. The staff we spoke with told us that things were going well at the home. They also told us Care Homes for Older People Page 5 of 12 that both the support manager and the quality consultant were very helpful and supportive. Dementia training has been provided for most staff as well as training in the Mental Capacity Act. We saw the training schedule for 2010 and where concerned that dementia training did not appear to be included for this year. It is important that follow up dementia training is provided for those staff who did not attend the training last year. A good practice recommendation has been issued. Two staff files were examined. Of the four written references only one did not contain a company stamp or letter headed paper to further confirm the authenticity of the references. The support manager told us that it was now a policy of the organisation to request this information when references are sent out. The support manager and quality consultant told us that a number of people in the organisation have been trained in Dementia Mapping. This is a way of assessing the quality of care provided to those people with dementia. We were informed that this will now be used regularly to monitor the well being of residents at the home. Minutes of residents and relatives meetings provided evidence that residents have a say in how the home is being run. There are a significant number of residents that do not attend these meetings. It may be useful for staff to talk to residents who do not wish to attend meetings and obtain any agenda items, questions or concerns about the service so these can be discussed at the meetings. Minutes of these meetings are then given to all residents at the home. This practice would ensure that more people have a say in how the home is run. A new good practice recommendation has been issued. We saw a number of visitors to the home throughout the inspection. One visitor we spoke with told us they were happy with the home and were made welcome by staff. As previously mentioned in this report the CQC pharmacist visited the home on 22nd January 2010. An account of their inspection is detailed below. The acting manager was on leave at the time of this inspection. During the acting managers leave, management was being provided by a manager of the nearby BUPA Highgate care home, and who arrived at the home during this inspection. At 11:30am the inspector accompanied the staff-nurse on Broomfield unit who was in the process of conducting the morning medicines administration round which took a further 10 minutes to complete. When the lateness of the round was questioned the cause was said to be due to staff failing to arrive for duty that morning. Poor punctuality in administering medicines may affect a medicines therapeutic effect. Broomfield unit included some of the homes most dependent residents who are physically disabled as well as 7 residents unable to receive medicines orally and requiring administration by tube directly into the stomach from their abdomen (PEG). Care Homes for Older People Page 6 of 12 Where medication required administration to these 7 residents outside the conditions of a medicines product license the medical practitioners written authorisation was obtained. However, where medicines were being similarly administered by PEG to 2 residents in Oakwood unit, there was no such written authorisation. Two residents on Broomfield unit were prescribed aqueous cream for regular application. During the current four-week medicines administration cycle, started on 18th January, there was one medicine administration record (MAR) chart entry left blank for each resident. When querying these omissions the nurse stated that application was not required on these occasions but was unable to account for entry being omitted. When asked why application was not required the reason was given that the resident refused. One administration entry for the once daily dose of Bumetanide 1mg tablets was omitted for a resident in Oakwood unit. The monitored dosage pack indicated the dose as being given. The staff nurse stated this omission had come to her notice earlier that day and she would be addressing the entry with the nurse responsible for the administration. On 2 occasions ink eradicating fluid had been used to make corrections on medication administration record charts for residents in Woodside unit. For clarity any written errors made on documents must be clearly identified without obliteration. When recording the administration of a painkilling medicine prescribed with a dosage choice of 1 or 2 tablets, for a resident on Broomfield unit, the dose given was not recorded to indicate the number of tablets administered. Audit was therefore not possible to reconcile the quantity of the medicine with the medicine administration records to ensure that administration was in accordance with the prescribers direction. An audit of codeine 30mg tablets prescribed for a resident in Oakwood unit at a dosage of one tablet to be given four times a day when required indicated a surplus of 5 tablets. One possible reason for this could be staff recording administration when doses are not given. It was therefore not possible to reconcile that administration was in accordance with the prescribers direction. Attention is required to the stock control of Fentanyl patches prescribed for 2 residents in Broomfield unit where there were 22 and 26 patches in stock representing 66 and 78 days treatment, respectively. This excess stock may result in wastage due to expiry being reached or decease of the resident before administration. The label on a 500ml bottle of Oramorph solution indicated that usage should not exceed 90 days from first opening and provides for the entry of the first date of opening, however, this was not entered. The nurse pointed out that a date was entered elsewhere on the container of 4/11/09, stating this was the first date of opening. According to the infrequent usage of this medicine being administered to treat breakthrough pain, some of the solution would remain after 90 days and run the risk of administration after expiry unless there was awareness of the opening date. The medicines fridge on Broomfield unit measured the temperature using a maximum/minimum thermometer. However, the maximum temperature was 40.70C and Care Homes for Older People Page 7 of 12 the minimum, minus 2.30C, which is contrary to the requirement of 2 to 80C. The daily record of the temperatures indicated the minimum as plus 2.30C and the maximum apparently being read as the current temperature at the time of recording. The daily current temperatures recorded were within the required range, however, staff were unaware of the correct operation of the thermometer or the need and process for resetting the thermometer after recording to ensure the readings pertained to the current period of recording. An insulin pen containing insulin currently in use was stored in the medicines fridge on Oakwood unit. This is contrary to the storage directions printed on the container requiring storage at room temperature when in use. The thermometer for monitoring the temperature of the medicines fridge in Woodside unit did not provide record of the maximum/minimum temperatures. This would therefore not indicate if temperatures went outside the required range other that at the time of reading the thermometer. The most recent copy of the BNF, which is published each 6 months for medicines reference, that was found on all 3 of the homes units was September 2008. In view of the nursing care provided it would be advisable for a more recent edition to be available. 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 12 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 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 19 23 The registered person must 01/07/2010 ensure that the home is refurbished and redecorated where required. This also includes replacing frayed and worn carpets. This should ensure that the environment is both pleasant and safe for residents. 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 1 The registered person should ensure that the Service User Guide is provided in large print so that it is assessable to all people interested in receiving a service. To ensure the time indicated for medicines administration is being kept to ensure therapy meets the prescribers requirements. To maintain stock control of all medicines to ensure usage is within expiry date and to avoid wastage. To ensure a recent edition of the BNF is available as an effective source of information on medicines. 2 9 3 4 9 9 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 5 9 To ensure the accuracy of medicines administration records to reconcile audit as an indicator of meeting the prescribers directions. To maintain an accurate record of the medicine fridges maximum, minimum and current temperatures to ensure that it is functioning correctly within the licensed range for medicines storage. There should be ongoing dementia training for all staff at the home so all staff have the confidence and knowledge needed to support people with dementia. The registered person should ensure that all residents at the home are asked about any agenda items, concerns or questions they may have before each residents meeting takes place. This should ensure that more people at the home have a say in how the home is run. 6 9 7 30 8 33 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. 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