This inspection was carried out on 9th February 2010.
CQC found this care home to be providing an Adequate service.
The inspector found there to be outstanding requirements from the previous inspection
report. These are things the inspector asked to be changed, but found they had not done.
The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.
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 9 0 2 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): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Ms Janet Alice Murrell 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 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
Care Homes for Adults (18-65 years) Page 2 of 10 Brief description of the care home 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 10 What we found:
The pharmacist inspection lasted two and a half hours. Five peoples medicines were looked at together with their Medicine Administration Record (MAR) charts, care plans and other records. One senior nurse was present during the inspection and all feedback was given to the manager at the end of the inspection. The reason for the inspection was to check the medicine management in the home as some medicines had been reported missing. The home stored all the medicines in a dedicated trolley used to take the medicines to the people in the home. Surplus medicines were kept in a separate cupboard, but this was un locked when we arrived in the medication room. The nurses see all the prescriptions before they are dispensed and then takes a copy of them to check the medicines and the MAR charts dispensed by the community pharmacy. Nurses had taken steps to ensure the persons doctor prescribed some medicines for the individual person, as some were bulk dispensed together for up to four different people instead of individually. The nurses then had to secondary dispense them for the individual people. One medicine was unlabelled and the nurses had not requested for the pharmacist to label it correctly. All medicines must be administered from pharmacist labelled container to ensure that they are administered to the correct person and at the correct dose. Not all the quantities of medicines received had been recorded on the MAR chart or balances carried over from previous cycles. Audits were difficult to undertake to confirm that the nurses had administered the medicines as prescribed and records reflected practice. Handwritten MAR charts did not always record the correct dose. In one instance the dose was written ambiguously as 2 weekly when it was to be administered fortnightly. This was misleading and may increase the risk of mal-administration. Variable doses had not been recorded so it was not possible to evidence whether the person had been administered one or two doses. One medicine had been signed as given for 9 doses at either a dose of 5ml or 10ml, but on inspection the bottle had not been opened and the seal remained intact. Nine doses had therefore been signed as administered when they could not have been. Gaps were seen on the MAR chart and it could not be demonstrated exactly what had occurred, whether the medicine had been administered and not recorded or not administered and the reason for non-administration not recorded. The nurse on duty offered no explanation for any of these omissions. The nurse on duty during the inspection had signed that he had administered one medicine on the 10th February 2010, when it was only the 9th February. This was because a nurse had already signed she had administered the medicine on the 9th so he signed for the following day. This is very poor practice and against the nurses code of conduct. In addition 52 tablets had been signed as administered when they had not been. This is of serious concern as they were prescribed to prevent epileptic fits.
Care Homes for Adults (18-65 years) Page 4 of 10 Medicines had been signed as administered when they had not been and reasons for non administration had not been recorded. The nurse on duty had a poor knowledge of the medicines he handled. Without such information he would not be able to fully support the peoples clinical needs. The care plans recorded the persons mental health issues but not all their underlying clinical conditions, for example, if they had a heart condition or asthma. A list of medicines together with their side effects had been recorded though. External health care professional visits had been recorded but not all visits had been fully documented. One medicine had been discontinued and a new medicine prescribed. The nurse responsible for writing and keeping the persons care plan up to date admitted that she had failed to up date the information and record all the visits correctly. It was seen in the external healthcare professional visits record that one medicine should have been prescribed but it had not been and none were available to administer. No explanation was offered and the nurse responsible for the persons care agreed to contact the doctor to confirm whether it needed to be prescribed. This means that the nurses are not following though the doctors instructions, to ensure that the persons clinical needs are fully met. 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 10 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 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. 21/10/2009 3 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 Care Homes for Adults (18-65 years) Page 6 of 10 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 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 administered as prescribed 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. All medicines must be administered from a pharmacy labelled container This is to ensure that service users are administered their own prescribed medication at the correct dose 09/03/2010 2 20 13 3 20 13 09/03/2010 4 20 13 All nursing staff must be further trained in the 09/03/2010 Care Homes for Adults (18-65 years) Page 7 of 10 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 indications and side effects of the medicines they handle. This is to ensure that they can fully support the service users clinical needs. 5 20 13 A quality assurance system must be installed to assess nursing staff competence in their handling of medicines. Appropriate action must be taken when these indicate that medicines are not administered as prescribed and records do not reflect practice. This is to ensure that individual nursing staff practice is assessed on a regular basis and appropriate action is taken if audits indicate that they do not administer the medicines as prescribed. 6 20 13 All medicines must be held in 09/03/2010 a locked facility at all times This is to ensure that all medicines are securely held on the premise to prevent any mis-handling 7 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
Page 8 of 10 09/03/2010 Care Homes for Adults (18-65 years) 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 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 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 9 of 10 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. 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 Adults (18-65 years) Page 10 of 10 - 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!
