Inspection on 17/02/10 for The Garden House

This inspection was carried out on 17th February 2010.

CQC found this care home to be providing an Good 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Garden House 21/12/09

The Garden House 02/06/09

The Garden House 11/05/07

The Garden House 14/06/06

The Garden House 27/02/06

The Garden House 09/11/05

The Garden House 20/10/04

The Garden House 08/06/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 16/05/2010.

Random inspection report Care homes for older people Name: Address: The Garden House 24 Humberston Avenue Cleethorpes North East Lincs DN36 4SP two star good service 02/06/2009 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: Rob Padwick Date: 1 9 0 2 2 0 1 0 Information about the care home Name of care home: Address: The Garden House 24 Humberston Avenue Cleethorpes North East Lincs DN36 4SP 01472813256 01472812337 worcestergarden@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Worcester Garden (No 2) Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 44 Number of places (if applicable): Under 65 Over 65 20 44 0 dementia old age, not falling within any other category physical disability Conditions of registration: Date of last inspection Brief description of the care home 0 0 10 0 2 0 6 2 0 0 9 The Garden House is a 44-bedded care home set in an exclusive area of Humberston, near the towns of Grimsby and Cleethorpes. The main house is in the style of an old manor house and retains many of its original features. The previous owner added a sympathetically designed extension in the grounds. There is ample car parking space and a well-designed and colourful garden. Care Homes for Older People Page 2 of 21 Brief description of the care home The home provides care for those with problems of old age and will take permanent, respite and emergency admissions. Some rooms have en-suite facilities, but there is ample bathroom and toilet facilities positioned around the home. There are several sitting rooms and a large dining room. All areas, including the gardens are accessible for wheelchair users. The home charges third party top-up fees. The amount payable is dependent upon the level of the fee paid by the responsible local authority (where applicable) and/or whether the resident occupies a shared, single or ensuite bedroom. In addition to this residents are expected to pay for hairdressing, private chiropody treatment, toiletries and newspapers/magazines. Details of current fees payable are available from the home. Care Homes for Older People Page 3 of 21 What we found: This random inspection was carried out on 17th February 2010 and the 19th February 2010 and was undertaken by Mr Steve Baker Specialist Pharmacist Inspector for The Care Quality Commission and two Regulatory Inspectors Mr Rob Padwick and Theresa Bryson. The reason for the inspection visit was to check compliance with requirements made at the inspection visit to The Garden House on 21st December 2009, and progress made following a warning letter issued on 27th January 2010. Health and personal care: At our last visit to the home we made requirements that care plans and risk assessments are reviewed and kept up to date to ensure staff have up to date information about the care people need and that people using in the service are kept safe from potential harm. On our visit on 19th February 2010 we found that whilst progress had been made to ensure the daily records belonging to people living in the home are kept up to date, there was evidence that care plans and risk assessments had not been updated as needed and did not reflect changes in the needs of people living in the home. We looked at the care records for three people living in the home and none of the associated care plans, or risk assessments for these people had been updated to reflect changes identified in their daily notes. The daily notes of one person recorded her mobility to be Poor, unsteady and unpredictable on her feet, however their care plan had not been updated since 12/5/08 and recorded I can walk with a trike. The night reports (14/2/10) for this person indicated they had been Found on the floor and a Red area noticed on right upper back and Cream applied, however we were unable to find a record of this in the accident book . The medication records for this person failed to record that creams had been applied and the risk assessment for them had not been updated since 4/10/10 when changes were recorded due to a Fractured wrist. Similarly whilst the skin viability (Waterlow assessment) recorded them to be at High risk, this had not been updated since 4/10/10. The accident records for another individual indicated they had had an unwitnessed accident on 14/12/09 (which we had previously been told about) and which resulted in them going to hospital. A care plan for this person recorded I need everyone to ensure my safety when I mobilise was last updated 12/5/08 and whilst an overview review for them recorded them to be High dependency (2/10/09), the manual handling assessments had not been updated since 2/10/09 when no changes were reported. The care records we inspected for a third person living in the home indicated their care plan had not been reviewed since 18/9/09 and that risk assessments relating to manual handling and their skin viability had similarly not been reviewed or updated since 18/9/09. This means people living in the home may be potentially placed at risk of harm, as a Care Homes for Older People Page 4 of 21 result of staff not having sufficient information to know how to meet their needs properly. The previous requirements in respect of these matters to ensure care plans are regularly reviewed and brought up to date and that assessments about the management of known risks to people living in the home are kept up to date and regularly reviewed are therefore repeated. Medication: A pharmacist inspector spent 6.25 hours in the home looking at the medication ordering, storage, handling and disposal arrangements, and examining medication administration record charts (MARs) and speaking to staff. The outcome is as follows. We found no direct evidence of incorrect administration of medicines but the lack of detailed medication receipt, administration and disposal records means it is not possible to be certain that everyone living in the home always receive their prescribed medicines exactly as directed. Medication management processes in the home still do not follow best practice and we found a lack of awareness of current professional guidance. When we examined the 31 current MARs for accuracy and completeness we found difficulties in being sure everyone had received all their prescribed medicines correctly. For example, 11 MARs contained a total of 70 administration gaps without any explanation given, the MARs and care files lacked sufficient information to show that two people were taking their own medicines safely and correctly, five MARs contained inadequate records of the use of prescribed skin care products and nine MARs contained insufficient information about medicines prescribed to be taken when required or as directed. There was inconsistency in the use of omission codes by staff and where administration gaps or omission codes were seen on the MARs, insufficient additional information was found explaining why these doses hadnt been given. We found little additional information about when and how people living in the home prefer to receive their medicines or about how to give medicines prescribed when required. Such information helps staff to give medicines consistently and correctly and also helps to reduce the risk of refusals or omissions. Five MARs contained 12 new hand written entries which had not been signed, dated or witnessed, some of which lacked essential information to guide staff. Hand written entries and changes to MARs must be clear, detailed and complete and safe arrangements must be made to ensure staff know the reasons for the changes. A second person should always check these entries for accuracy so that all staff follow the changes on the MARs correctly. We found that the medication store room was cramped, disorganised, very untidy and was insecure as unauthorised staff needed to access other materials and facilities kept in this room. The controlled drugs cupboard does not meet current safe custody requirements and it was not attached to the wall of the store room. The controlled drugs register contained inaccurate records of controlled drugs handling as staff seem unaware of the correct procedure for recording the disposal of controlled drugs. No thermometer was available for staff to check the temperature of the store room or medication fridge. The medication fridge was not fitted with a lock and is kept in an unlocked office accessible by unauthorised staff. We found four containers of medicines in the fridge which should be stored at room temperature and one opened food supplement container provided to the home some four months ago. All medicines must be stored securely at temperatures recommended by the manufacturer. This will help staff to know medicines Care Homes for Older People Page 5 of 21 are safe to use when needed. We were told about plans to provide secure restricted storage for medication in another location in the home but we also learnt that some uncertainty still exists as to how and when this urgently needed improvement will happen. On checking the arrangements for one person who looks after and gives their own medicines, we found that the medicines were kept insecurely in an unlocked drawer in an unlocked bedroom and we found a container of medicines no longer prescribed which had been stopped by the doctor. We could find no evidence of staff having checked that the medicines were being taken regularly and correctly or that they were following safe practice guidance. So that all staff know exactly what is expected of them, the homes medication policy and procedures should be updated in line with professional best practice guidance published by the Royal Pharmaceutical Society and the Care Quality Commission. We were told that a new pharmacy supplier was now working with the home and that a programme of medication safety and systems update training had commenced. Having well trained up to date staff all of whom follow best practice guidance helps to reduce the risk of medication errors. Complaints and Protection: When we visited the service on 21st December 2009, we made requirements that the complaints policy is updated with our details and that an auditable record of all concerns received by the service is available, together with a record of actions taken to resolve these to ensure people using the service can be assured any concerns about the home will be taken. We observed a copy of the complaints policy to be on display by the front door of the home that had been appropriately updated with our details as required and whilst we were unable to find a copy of the complaints log for the service, the provider told us an electronic computer record of these is available in the home. On 21st December 2009 we made a requirement that all staff receive refresher safeguarding training to ensure they are able to recognise issues of potential abuse and know how to refer them appropriately to the Local Authority for investigation. Since our last visit to the service, the manager had worked well with the Local Authority to ensure this requirement was met and we saw records that over 50 of the staff team had now completed this training and that plans were in place to ensure the remaining staff receive this training in the near future and received confirmation of this from the Local Authority. Whilst the service has a safeguarding policy and procedure, no details were included that staff must inform the Care Quality Commission of safeguarding incidents, and further clarification was needed about reporting such incidents, when the alleged perpetrator is a staff member. Recommendations are made in these respects. Staffing: A requirement was previously made that an up to date record of training provided to staff must be made available to the Care Quality Commission. As previously indicated the new management team had worked closely with the Local Authority to ensure this requirement was met and we saw evidence of plans to develop the staff training programme accordingly. In addition to safeguarding training already noted, we saw evidence of infection Control training and plans for other mandatory courses to be delivered and this was confirmed by the Local Authority. Care Homes for Older People Page 6 of 21 Management: A fire plan for the building was on display by the front door of the home and we saw evidence of weekly checks of the fire alarm and a periodic electrical wiring certificate for the building had been now obtained as we previously required. There was evidence that notifications about significant events in the home were now being appropriately reported to us and whilst tests of some fire fighting equipment, such as extinguishers, fire blankets and hose reels were not up to date at the time of our visit, we saw evidence a firm of health and safety maintenance specialists had been engaged by the provider to assist with this. 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 Care Homes for Older People Page 7 of 21 following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 8 of 21 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 7 15 To regularly review the care 15/02/2010 plans and bring up to date as needs change. To ensure that staff have up to date information about the care people need. To regularly review the care 15/02/2010 plans and bring up to date as needs change. To ensure that staff have up to date information about the care people need. 2 7 15 3 8 13 The Registered Person must ensure assessments about the management of known risks to people living in the home are kept up to date and regularly reviewed. This is to ensure they are helpt safe from potential harm. The Registered Person must ensure assessments about the management of known risks to people living in the home are kept up to date and regularly reviewed. This is to ensure they are kept safe from potential harm. 15/01/2010 4 8 13 15/01/2010 Care Homes for Older People Page 9 of 21 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 5 9 13 The relevant code must be recorded when a person has refused their medication. To ensure accurate records are maintained. 31/01/2010 6 9 13 The relevant code must be recorded when a person has refused their medication. To ensure accurate records are maintained 31/01/2010 7 9 13 The Registered Person must 31/01/2010 ensure medication administered to people living in the home is given as prescribed and that arrangements are in place for the ordering, safekeeping and safe administration of medicines, with accurate and timely records for these maintained.This is to ensure the Health and welfare of people living in the home are promotedand they are protected from harm. The Registered Person must 31/01/2010 ensure medication administered to people living in the home is given as prescribed and that arrangements are in place for the ordering, safekeeping and safe administration of medicines, with accurate and timely records for these maintained. This is to ensure the Health 8 9 13 Care Homes for Older People Page 10 of 21 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 and welfare of people living in the home are promoted and they are protected from harm. 9 16 17 The Registered Person must 15/01/2010 ensure there is an up todate and auditable record of all concerns received by the service together with actions taken to resolve these. This is to ensure people using the service can be assured any concerns about the service will be taken seriously and that actions taken about these are transparent and clear. The Registered Person must 15/01/2010 ensure there is an up to date and auditable record of all concerns received by the service together with actions taken to resolve these. This is to ensure people using the service can be assured any concerns about the service will be taken seriously and that actions taken about these are transparent and clear. 11 16 22 The Registered Person must 15/01/2010 ensure the complaints policy is updated with details of how to contact the Care Quality Commission. This is to ensure the concerns of people using the service can be addressed. Care Homes for Older People Page 11 of 21 10 16 17 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 12 16 22 The Registered Person must 15/01/2010 ensure the complaints policy is updated with details of how to contact the Care Quailty Commission. This is to ensure the concerns of people using the service can be addressed. The Registered Person must 15/02/2010 ensure all staff receive refresher safeguarding training and ensure they are able to recognise issues of potential abuse and know how to refer these appropriately to the Local Authority for investigation. This is to ensure the health and welfare of people living in the is protected and they are safeguarded from potential abuse. The Registered Person must 15/02/2010 ensure all staff receive refresher safeguarding training and ensure they are able to recognise issues of potential abuse and know how to refer these appropriately to the Local Authority for investigation. This is to ensure the health and welfare of people living in the is protected and they are safeguarded from potential abuse. 13 18 13 14 18 13 15 19 23 The Registered Person must ensure that an up to date 30/01/2010 Care Homes for Older People Page 12 of 21 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 periodic electrical wiring certificate for the home is obtained. This is to ensure the health, safety and welfare of people living in the home is promoted and protected. 16 19 23 The Registered Person must monitor the temperature in the home. This is to ensure appropriate action is taken to promote and protect the health and welfare of people living in the home. 17 19 23 The Registered Person must 30/01/2010 ensure that an up to date periodic electrical wiring certificate for the home is obtained. This is to ensure the health, safety and welfare of people living in the home is promoted and protected. The Registered Person must 29/01/2010 monitor the temperature in the home. This is to ensure appropriate action is taken to promote and protect the health and welfare of people living in the home. The Registered Person must 15/02/2010 provide an up to date record of training provided to staff to the Commission. This is to ensure staff have the Page 13 of 21 29/01/2010 18 19 23 19 30 18 Care Homes for Older People 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 appropriate skills to do their jobs and ensure the health and welfare of people using the service are promoted and protected. 20 30 18 The Registered Person must 15/02/2010 provide an up to date record of training provided to staff to the Commission. This is to ensure staff have the appropriate skills to do their jobs and ensure the health and welfare of people using the service are promoted and protected. 21 38 23 A record of weekly checks of 01/03/2010 fire systems must be kept to ensure fire systesm are maintained in full working order. To ensure that fire systems are maintained in full working order. The Registered Person must 22/01/2010 ensure significant events are reported promptly to the Commision. This is to ensure the welfare of people using the service can be protected and promoted. A record of weekly checks of 01/03/2010 fire systems must be kept to ensure fire systems are maintained in full working order. To ensure that fire systems 22 38 37 23 38 23 Care Homes for Older People Page 14 of 21 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 are maintained in full working order. 24 38 37 The Registered Person must 22/01/2010 ensure significant events are reported promptly to the Commision. This is to ensure the welfare of people using the service can be protected and promoted. Care Homes for Older People Page 15 of 21 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 7 15 The Registered Person is required to ensure that care plans are regularly reviewed and brought up to date as needs change. This is to ensure staff have up to date information about the care people need. This is to ensure staff have up to date information about the care people need. This is a previous requirement that was not met at this visit and remains outstanding. This requirement is the subject of a Statutory Requirement Notice that the provider will receive separately. 21/05/2010 2 8 13 The Registered Person must ensure assessments about the management of known risks to people living in the home are kept up to date and regularly reviewed. This is to ensure they are 21/05/2010 Care Homes for Older People Page 16 of 21 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 kept safe from potential harm. This is a previous requirement that was not met at this visit and remains outstanding. 3 9 13 The Registered Person must 21/05/2010 ensure controlled drugs must be stored securely and records of receipt, administration and return must be made in accordance with current regulations and guidelines. This will provide the necessary additional protection against loss or diversion of these medicines. This requirement is the subject of a Statutory Requirement Notice that the provider will receive separately. 4 9 18 The Registered Person must 21/05/2010 ensure all staff authorised to handle and give medicines have received relevant update training and that their practice is then checked regularly. This will make sure staff are suitably qualified and competent to give medicines safely. This requirement is the subject of a Statutory Requirement Notice that the Care Homes for Older People Page 17 of 21 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 provider will receive separately. 5 9 13 The Registered Person must 21/05/2010 ensure medication records are accurately completed and maintained in a timely manner including those for all medicines received, administered and leaving the home. This will help to show that medicines are being used correctly as directed. This requirement is the subject of a Statutory Requirement Notice that the provider will receive separately. 6 9 13 The Registered Person must ensure medicines are stored securely at temperatures recommended by the manufacturer. This will help staff to know that medicines are safe to use when needed. This requirement is the subject of a Statutory Requirement Notice that the provider will receive separately. 7 9 13 The Registered Person must 21/05/2010 ensure medication administered to people living in the home is given as prescribed and that arrangements are in place Page 18 of 21 21/05/2010 Care Homes for Older People 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 for the ordering, safekeeping and safe administration of medicines, with accurate and timely records for these maintained. This is to ensure the health and welfare of people living in the home are promoted and they are protected from harm. This requirement is the subject of a Statutory Requirement Notice that the provider will receive separately. 8 9 13 The Registered Person must 21/05/2010 ensure that all medicines are administered as directed and that care plans include relevant instructions for staff in this respect. This will help to make sure that staff administer all prescribed medicines correctly as and when needed. This requirement is the subject of a Statutory Requirement Notice that the provider will receive separately. Care Homes for Older People Page 19 of 21 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 Hand written MAR entries and changes should be checked for completeness and accuracy. Regular checks of medicines kept in the home, medication record keeping and staff practice should be made and recorded. The medication policy and procedure documents should be updated to reflect current best practice. Peoples own choices about when and how they prefer to receive their medicines should be recorded and reviewed regularly. The Safeguarding policy and procedure should include details that staff must report safeguarding incidents to the Care Quality Commission. The Safeguarding policy and procedure should include clarification about what actions staff must take when reporting safeguarding incidents, when the alleged perpetrator is a member of staff. 3 4 9 9 5 18 6 18 Care Homes for Older People Page 20 of 21 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. © 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 Older People Page 21 of 21 - 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!