Random inspection report
Care homes for adults (18-65 years)
Name: Address: The Firs Nursing Home 745 Alcester Road South Kings Heath Birmingham West Midlands B14 5EY one star adequate 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: Debby Railton Date: 0 1 0 4 2 0 1 0 Information about the care home
Name of care home: Address: The Firs Nursing Home 745 Alcester Road South Kings Heath Birmingham West Midlands B14 5EY 01214303990 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Janet Alice Murrell Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 25 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Conditions of registration: 25 Age: Mental disorder, excluding learning disability or dementia (MD) - age 40 and above. The maximum number of service users who can be accommodated is: 25 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: Mental disorder, excluding learning disability or dementia (MD) 25 Date of last inspection Care Homes for Adults (18-65 years) Page 2 of 9 Brief description of the care home The Firs is a care home, which provides nursing care and support to 25 adults with enduring mental ill health. The home is located close to the Maypole area of Kings Heath. It is close to local shops, post office, banks, and leisure facilities. It is located on a major trunk road into Birmingham, which also has good motorway connections. A regular bus service passes the home enabling easy access to Kings Heath and the city centre. The home was first registered in 1987. The Firs consists of the original house, and a newer extension. The home offers accommodation over three floors and has both single and shared bedrooms. No rooms have en-suite facilities. The home has a passenger lift enabling access to all floors. The home has an attractive rear garden. Copies of previous inspection reports are available in the home for people to read if they wish to. The service user guide did not record the range of fees to live at the home, it said fees are per individual contract. The range of fees should be included in the guide. Additional charges are made for chiropody and hair-dressing. Care Homes for Adults (18-65 years) Page 3 of 9 What we found:
The pharmacist inspection lasted two hours. Five peoples medicines were looked at, together with their Medicine Administration Record (MAR) charts and care plans. The reason for the pharmacist inspection was to check compliance with the seven requirements regarding medicines left at the last inspection on 9th February 2010, due to the poor medicine management seen. Four requirements remained outstanding and had not been met. This is of serious concern and following the commissions enforcement pathway further enforcement action may be taken. Continued failure to comply with the the regulations may result in prosecution. The manager had responded to the last pharmacist inspection with an action plan detailing improved systems and practices within the home. The manager had introduced a lengthy auditing system to identify medicine errors. Whilst this had certainly improved the medicine management, serious errors were still found during this inspection. Nursing staff are still failing to adhere to their ethics regarding the safe administration of medicines. Nursing staff had failed to record the correct quantity of medicines received into the home at all times. Despite the action plan stating that two nurses now check the medicines into the home to ensure there are no errors in this practice. Audits were therefore difficult to undertake to demonstrate that medicines had been administered as prescribed. Medicines had been signed as administered when they had not been. Gaps were seen on the MAR chart. Nurses had failed to record they had administered one dose of medicine. This is of serious concern as a second dose may be administered as staff may believe that the dose had not been administered. There were discrepancies between the auditing system and the actual practice. Medicines had been recorded as administered on the MAR chart but the audit sheets indicated differently. One medicine had been administered at twice the prescribed dose on at least three occasions. The manager assured the commission that this was acceptable but there was no evidence to confirm this was what the doctor intended. The prescription and the label on the medicine clearly recorded that one tablet was to be given when required and not two as nursing staff had recorded as administered on three separate occasions. This is of very serious concern. One MAR chart was not dated so the information recorded would be meaningless in the future. Again this had occurred despite assurances in the action plan that two nurses now check in the medicines into the home on the MAR chart. Relevant information had not been recorded in all instances. Duplicate MAR charts were seen for one person and it was not possible to demonstrate exactly what had occurred. Care Homes for Adults (18-65 years) Page 4 of 9 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 Adults (18-65 years) Page 5 of 9 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(4) Improvements are needed to 21/11/2009 the homes risk assessment procedures. So that people can take risks in their lives but be as safe as possible. 2 20 13 All nursing staff must be 09/03/2010 further trained in the indications and side effects of the medicines they handle. This is to ensure that they can fully support the service users clinical needs. 3 20 13 All dose regimes must be clearly written on the medicine chart and checked by a second nurse for accuracy. This is to ensure that the nursing staff have clear directions to follow. 09/03/2010 4 20 13 The quantity of all medicines 09/03/2010 received and any balances carried over from previous cycles must be recorded. This is to enable audits to take place to demonstrate the medicines are Care Homes for Adults (18-65 years) Page 6 of 9 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 administered as prescribed 5 20 13 The medicine chart must 09/03/2010 record the current drug regime as prescribed by the clinician. It must be referred to before the preparation of the service users medicines and be signed directly after the transaction and accurately record what has occurred. This is to ensure that the right medicine is administered to the right service user at the right time and at the right dose as prescribed and records reflect practice 6 23 13(6) Where there are suspicions of abuse or an allegation of abuse is made this must be notified to the Local Authority and the Commission under safeguarding procedures. This will help protect people from abuse. 7 34 19 The required recruitment records must be available in the home. So that the home can demonstrate that a robust recruitment procedure has been followed. 21/11/2009 21/10/2009 Care Homes for Adults (18-65 years) Page 7 of 9 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 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 Adults (18-65 years) Page 8 of 9 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 Adults (18-65 years) 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 Adults (18-65 years) Page 9 of 9 - 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!
