Inspection on 17/12/08 for The Friendly Inn

This inspection was carried out on 17th December 2008.

CSCI 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 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Friendly Inn 29/10/09

The Friendly Inn 06/07/09

The Friendly Inn 19/02/09

The Friendly Inn 21/02/08

The Friendly Inn 31/05/07

The Friendly Inn 15/11/06

The Friendly Inn 26/06/06

The Friendly Inn 14/03/06

The Friendly Inn 16/08/05

The Friendly Inn 08/03/05

The Friendly Inn 24/09/04

The Friendly Inn 17/02/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Random inspection report Care homes for older people Name: Address: The Friendly Inn Gloucester Way Chelmsley Wood Birmingham West Midlands B37 5PE The quality rating for this care home is: The rating was made on: one star adequate service 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 assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. 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: Sue Scully Date: 1 7 1 2 2 0 0 8 Information about the care home Name of care home: Address: The Friendly Inn Gloucester Way Chelmsley Wood Birmingham West Midlands B37 5PE 01217795128 Telephone number: Fax number: Email address: Provider web address: TheFriendlyInnCH@aol.com Name of registered provider(s): Type of registration: Number of places registered: Mr Michael John Goss care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category 0 Over 65 30 Conditions of registration: Date of last inspection Brief description of the care home The Friendly Inn Care Home is a converted public house. There have been several major extensions to the home over a number of years. The home is registered to accept up to 30 residents in the category of old age requiring personal care. Accommodation is provided over two floors. The home has 30 single bedrooms, of which 29 have en-suite facilities. The Friendly Inn is located in Chelmsley Wood and is readily accessible to amenities such as shops, places of worship and public transport. The home has a number of aids and adaptations to assist any frail residents including, emergency call system, shaft lift, hand and grab rails, a mobile hoist and assisted toilet and bathing facilities. There is a well-maintained garden area at the rear of the building. Parking facilities are available at the front of the building and on-road parking is readily available outside of the home. The Acting Manager advised that the weekly Care Homes for Older People Page 2 of 17 fees for living in the home is £344, top up fees are no longer payable. Additional items such as the services of a hairdresser, newspapers and toiletries are paid for separately. Care Homes for Older People Page 3 of 17 What we found: A safeguarding meeting took place with social care and health on 16 December 2008 where the meeting identified areas of concerns about the care of the people living in the home. We completed a random inspection of the service on 17 December 2008. The senior care on duty was in charge of the home when we arrived. We asked for information about certain areas of people needs. For example people who had been ill, had pressure care needs, if the home had any concerns about peoples health, people who had been in hospital, any injuries people had sustained and any new admissions to the home recently. From the information given to us we were able to identify the peoples records that we would look at. We looked at three peoples care files, which included , risk assessment, admission assessment , care plans, daily records, medication records, accident records, dietary needs, other health care professional information including GP, district nurse information and medical conditions. Later the manager was able to assist us and answer questions. We found serious areas of concern that breach regulation from the records we sampled. For example one care plan showed us that the person had a large number of falls. There were no risks assessment in place to minimise the risks of falls for this person and no referral had been made to other health care professionals for assistance such as the falls clinic. The review that had been completed stated no change. The records showed us since May 2008 this person had 19 falls. On the day of the inspection the person had a cut above their eye having recently had a fall. Daily records stated the person had been found in bed with the injury, and no referral had been made to the falls clinic. The home keeps a falls registered, that records how many falls a person has had, but does not show the action taken. We asked the manager if a person had been referred to the falls clinic and we were told no. Information in the care plan said the person should wear an eye patch and glasses, when we spoke with the individual we observed the person was not wearing glasses or a patch. The senior care told us that the person would not wear them, when we asked where this was documented the senior care informed us that there was no record. Refusal to wear the glasses or eye patch could be part of the reason this person is falling and needs to be medically checked. The manual handling assessment for this person stated supervision and assistance to be given at all times, but did not say what assistance was required. An individuals dietary needs were recorded as not eating pork products as the person was allergic to pork. When we looked at the menu records of what the person had eaten over a period of time, these showed us that pork was often on the menu and on the 30/11/08 against this person name was written roast pork, on 2/12/08 sausages casserole and on 7/12/08 pork roast. We spoke with three staff and only one member of staff told us that the individual was allergic to pork yet it was clearly written in the persons care plan. Staff said the person did not eat pork for religious reasons. When we spoke with the cook we were told that when food was presented to the individual all pork products were removed, however this was not recorded in any of the records seen on the day of the visit, and records were not produced to confirm this. Care Homes for Older People Page 4 of 17 The nutritional assessment for this person said the person was at minimum risk, but did not say what the risk was. This person has a soft diet and is allergic to pork this highlights that there are risks and there should be a clear risk assessment for this. The assessment also said to review monthly and take action. This was not being completed as the last entry recorded was on 30/07/2008. The daily records gave very little information of how the same person was cared for on a daily basis for example 13/10/08 assisted by staff, son came to visit took him out for a few hours. There were no daily records for the 14/10/08, 15/10/08 and on 16/10/08 the person was admitted to hospital with a chest infection there had been no indication the person had been ill and was admitted to hospital On 6/12/08 the daily records said the person had had four falls and had a slight graze to shoulder and knee. There was only two accident records completed which both said no injuries. There were only two entries on the falls registered, and again both said no injuries. The doctors visiting record had no entry for the 6/12/08 and the last recorded entry was 28/8/08. The doctors visit sheet does not cross reference with the visit made on the 16/10/08 that had been recorded in daily records when the person was admitted to hospital. Records do not identify what the service did about the injuries found on the 6/12/08 and the accident records do not correspond to the amount of falls the person had on the 6/12/08 and contradict the daily record. Another care plan stated the person was nursed in bed due to ill health. The information received from the manager and senior care stated that this person was no longer eating or drinking very well and the person needs had changed. We looked at the last review completed on 14/12/08 which stated this person enjoys their food but can only manage small amounts and is unable to feed themselves and needs a soft or pureed food. The review also stated that turn charts, a diet and fluid chart were in place. The home was able to produce the fluid and diet charts but not the turn charts. The turn charts were particularly important as this person was at high risk of pressure sores. The home was not able to produce these documents when asked at 10.45am or by 6.30pm when we left. The manager and senior care informed us that the person was no longer being turned to relief pressure as instructed by the district nurse team. We spoke with the nursing team who attend the home and were informed that the instructions were to turn every two hours and not as previously stated by the manager and the senior care. The home must start a turning regime as advised and seek further guidance from the district nursing team. There was no risk assessment in place for pressure care, turning to relief pressure, or care plan in place for the person current needs. The last recorded entry in daily records about turning this person to relief pressure was on 4/12/08. Records relating to skin management stated on 4/12/08 the person required 2 hourly turns. Daily record did not show that from this date this had been completed. We looked at the dietary records for the individual and found fluids were being given through a syringe and no diet was being taken. There was some confusion on the charts referring to the intake of fluids and the out put of fluids as the record showed there was quite a high output of fluids which could indicate the person may be becoming dehydrated. For example on 12/12/08 the intake of fluids indicted a small amount four sips of juice, 6 sips of juice and this carried over a period of the day from Care Homes for Older People Page 5 of 17 4.15am to 10.30pm the out put total for this period came to approx 5000mls out put. When we spoke with the senior care she informed us that this was not the output of fluids but what was contained in the catheter bag. The information recorded must be very clear and accurate and identify if this is the actually amount or if this is contained in the catheter bag as this would ensure the appropriate action was taken if required. Records stated the person was diabetic and was insulin dependent. This person had a blank nutritional assessment and also stated that they did not require any special diet. The persons pre admission assessment stated that the person required a specific diet. The information had not been transferred into a plan of care and no dietician had been contacted. The food record seen for this person showed us that they had bacon sausage beans tomatoes and bread most days for breakfast and lunch. The person was cared for in bed due to having an amputation and also a weakened shoulder. We spoke with the individual who said that most days he would have a fry up and enjoyed his meals. The individual stated that staff lift him up the bed and in and out of bed and dont use a hoist as it is better this way. The person stated the staff has great difficulty in moving him this way. The risk assessment said staff are never to transfer alone and must use a manual handling belt with two care staff in conjunction with a hoist. The risk assessment was not signed or dated so we were unable to establish when the risk assessment had been completed and if it was still current. When we spoke with staff they informed us that they would not use the hoist as it was more comfortable for the individual. This means staff are not following the risk assessment and may place the individual or themselves at risk of injury. On the 25/11/08, 27/11/08, and 29/11/08 the individual had fallen out of bed, there was no explanation of how staff had assisted the person back into bed and there was no risk assessment for the falls sustained. The pharmacist inspection took place at the same time as the random inspection. It lasted four and a half hours. Nine residents medicines were looked at together with the medicine charts and care plans. One senior care assistant was spoken with and a medication round observed. All feedback was given to the owner and the registered manager. The morning medicine round did not start until 10 oclock and took two hours. Poor practice was observed. The trolley was taken to a residents room and left opened whilst the care assistant prepared the medicines and took them throughout the home to the residents. The trolley was left unattended during this process and many people came into the room and had full access to the contents within. The care assistant also prepared two residents medication into pots which she then stacked up and took to the two residents. These could easily be muddled up, which may result in the resident receiving the wrong medicines. Due to the late start there was insufficient time between the morning and lunchtime rounds. At least four hours should elapse to reduce the risk of potential overdose. Two tablets were found in a pot in the trolley that had been prepared by the day staff the previous day for the night staff to give. This is very poor practice. They were controlled drugs which have to be administered and witnessed by a second member of staff in a separate register. This had been signed and witnessed by two members of staff even though the tablets had not been given. Following an investigation the two night staff had prepared their own medicines and not used the pre-prepared medicines, so these were to be discarded following the inspection. Care Homes for Older People Page 6 of 17 The senior care assistant did not get the administration of the controlled drug she administered, witnessed and the register was left blank. On closer inspection not all the witness signatures on the medicine chart matched the signatures in the register. This indicates that the staff are not following the correct procedures to safeguard the administration of controlled drugs. One controlled drug tablet was missing at the time of the inspection. The staff see all prescriptions before they are dispensed and use these to check the medicines into the home. All quantities had been recorded so audits were easy to do, to demonstrate whether the medicines had been administered as prescribed. Two medicines had not been ordered in time resulting in the resident not receiving their prescribed medication for up to four days whilst a new supply was sought. Records indicated that the majority of medicines had been administered as prescribed. A few discrepancies were found where the medicines had been signed as administered when they had not been. Two medicines had been administered but had not been recorded on the medicine chart. One of these had been recorded under a different medicine so records did not reflect actual practice. There was no quality assurance system installed in the home so the manager did not routinely assess individual staff practice. Residents are encouraged to self administer their own medicines but there were inadequate risk assessments and no compliance checks to confirm that they do so safely. Medicines prescribed for occasional use had no supporting protocols to ensure that care staff administers them as the doctor intended. One medicine was to treat an angina attack. The care assistant described very brief, subjective symptoms that would warrant the administration of a spray to prevent an angina attack. All staff should be correctly trained to be able to recognise life threatening conditions and act appropriately and have clear guidelines to follow. One resident refused to take her medication and staff were crushing the tablets and hiding them in a biscuit. Covert administration can only be done following discussion with a multi-disciplinary team and must comply with the Mental Capacity Act 2005. This had not been followed. The storage of medicines was good except during the actual medicine round. All medicines requiring refrigeration were kept in a dedicated refrigerator. The temperature was not monitored daily but at the time of the inspection was within the correct range. All controlled drugs (CD) were stored in a CD cabinet and excess medicines were stored in individual baskets in the medication cupboard. The trolley albeit full was clean and well ordered enabling safer handling of medicines Staff have received training in the safe handling of medicines but they did not put into practice the information they had learnt. Knowledge of the medicines they handle was poor. All staff should be aware of what the medicines are for and their common side effects to be able to fully support the residents they look after. Care Homes for Older People Page 7 of 17 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 17 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 15 13(3) Residents meals must not be 28/02/2008 cooked so far in advance of the planned mealtime so that the food is left standing for a long period before it is ready to be served. This will help to prevent the risk of infection due to the contamination of food. All light fittings must be 28/02/2008 checked to ensure that light bulbs are safely fitted in residents bedrooms and the lampshade used is appropriate for use. This will protect residents from the risk of harm. The standards of health and 28/02/2008 safety management within the home must be improved. This must include: Disinfectant and washing products must be stored in a locked cupboard/room. 2 25 13 3 38 13 4 38 13 The flooring in the kitchen 31/05/2008 and laundry must be reviewed and risk assessed to ensure it does not present a health and safety risk to staff working in there or residents who may enter the kitchen. Page 9 of 17 Care Homes for Older People 5 38 13(5) Safe care practices related to 28/02/2008 moving and handling must be used at all times. This includes: Residents must be transferred in wheelchairs safely. Footplates must be fitted to wheelchairs. Risk assessments should be completed for residents who request not use footplates when using a wheelchair. These practices could result in injury to residents if not carried out appropriately and safely. 6 38 13(3) The standards of health and 28/02/2008 safety management within the home must be improved. This must include: Dirty laundry must not be put on the laundry floor or placed in inappropriate areas around the home. Appropriate bins with lids should be used in the laundry and kitchen areas of the home to prevent the risk of infection from contaminated material. Suitable kitchen equipment, utensils and crockery must be available for use by residents to prevent the risk of cross infection. Utensils and crockery used in the kitchen must be appropriately stored to prevent the risk of cross infection. All areas of the home must be kept clean. Areas to be Care Homes for Older People Page 10 of 17 addressed include the kitchen and laundry areas of the home. This will ensure that people who use the services live in a clean home and have their health, safety and welfare protected. Care Homes for Older People Page 11 of 17 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 7 15 There must be additional 16/02/2009 care plans in place when a person health needs change including other health care professional that are involved This will ensure end of life care provides dignity and choice. 2 7 15 Care plans must be updated as the needs of the people living in the home change. This will ensure staff know the current needs of the people living in the home. 16/02/2009 3 7 13 (4)(B) The service must 16/02/2009 ensure that other professionals are involved in the prevent of falls for people who use the service where required. This will ensure all reasonable steps have been taken to minumise the risks to the individual. 4 7 13 The serivce must ensure risk 16/02/2009 assessemnts are completed for pressure sore care. Page 12 of 17 Care Homes for Older People This will ensure peoples pressure care is monitored and reviewed 5 7 13 The service will must ensure 16/02/2009 accurate records are maintained when other health professionals attend the home such as General Practitioner, district nurses and other health care professional that are involved in the persons health and welfare. This will ensure people needs are known and can be met safely. 6 8 13 The serivce must ensure 16/02/2009 manaul handling risk assessement are completed and staff follow the guidance supplied in the risk assessements. This will prevent injuries to the person using the serivce. 7 9 13 All controlled drugs must be administered by one trained member of staff and witnessed by another. This is to ensure that all controlled drugs are safely handled in compliance with current regulations. 8 9 13 All service users must be risk 16/02/2009 assessed as able to self administer their own medication and regular compliance checks undertaken and documented. This is to ensure that they can handle their medication safely 16/02/2009 Care Homes for Older People Page 13 of 17 9 9 13 All staff must be trained to 16/02/2009 adhere to the medication policies and procedures and also the indications and side effects of the medicines they handle This is to ensure that all staff can fully support the clinical needs of the service users they look after 10 9 13 All medicines must be available for administration at all times and their receipt and administration accurately recorded on the medicine chart. This is to ensure that the service users receive the medication as prescribed. 16/02/2009 11 9 13 A quality assurance system must be installed to assess 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 all medicines are administered as prescribed and this can be demonstrated. 16/02/2009 12 9 13 All covert administration must cease. The Mental Capacity Act 2005 must be adhered to at all times This is to ensure that the service users rights are respected. 16/02/2009 Care Homes for Older People Page 14 of 17 13 9 13 Staff must transport 16/02/2009 medicines throughout the home in a safe manner and all medicines must be able to be securely held in a locked facility in the event of an emergency. The practices of leaving the trolley open in a service users bedroom during the medication round must cease. The practice of preparing more than one service users medication at once must cease. This is to ensure that all safety of all medicines at all times Staff must transport medicines throughout the home in a safe manner and all medicines must be able to be securely held in a locked facility in the event of an emergency. The practices of leaving the trolley open in a service users bedroom during the medication round must cease. The practice of preparing more than one service users medication at once must cease. This is to ensure that all safety of all medicines at all times The service must ensure where dietary needs require specific input from other professionals this is sought. This will ensure people using the service are provided with suitable wholesome food that takes into account their dietary needs. 16/02/2009 14 15 16 Recommendations Care Homes for Older People Page 15 of 17 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 At least four hours should elapse between medication rounds to reduce the risk of potential overdose. It is advised that all medicines prescribed for occasional use have supporting protocols detailing their use and staff are trained to use them correctly. Care Homes for Older People Page 16 of 17 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI 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: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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) Commission for Social Care Inspection (CSCI). 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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