This inspection was carried out on 1st June 2010.
CQC found this care home to be providing an Poor 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.
Random inspection report
Care homes for older people
Name: Address: The Green Nursing Home Wharf Road Kings Norton Birmingham West Midlands B30 3LN zero star poor service 09/03/2010 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 6 2 0 1 0 Information about the care home
Name of care home: Address: The Green Nursing Home Wharf Road Kings Norton Birmingham West Midlands B30 3LN 01214513002 01214863360 flintvaleltd@btconnect.com Flintvaleltd@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Flintvale Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 59 Number of places (if applicable): Under 65 Over 65 0 59 dementia old age, not falling within any other category Conditions of registration: 59 0 The maximum number of service users who can be accommodated is: 59 The registered person may provide the following category of service only: Care Home with Nursing (N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 59 Dementia (DE) 59 Date of last inspection 0 9 0 3 2 0 1 0 Care Homes for Older People Page 2 of 10 Brief description of the care home The Green is a purpose built facility, which offers nursing care for up to 59 older adults, who may also have dementia care needs. There is off road parking to the front of the property, which is sufficient for the home. The home is situated close to bus links to the centre of Birmingham. There are a range of local shops and community facilities nearby. The home has a mixture of shared and single bedrooms, some of which have en-suite facilities, spread over the ground and first floors of the building. There are communal bathing, shower and toilet facilities on both floors to meet the needs of the people who live there. The building has basic adaptations for people with limited mobility, including two passenger lifts. Communal lounges are situated on the ground floor and the lounge doors open onto an enclosed garden with a water feature, which has wheelchair access. Laundry and kitchen services are located on the ground floor, as are the dining rooms. Fee rates for the home vary depending if the person is privately funded or funded by Social Care and Health. Charges vary, on the assessed banding and type of room chosen and a top up fee is payable. Current fee rates are available on request from the home. Hairdressing, chiropody, opticians and dentists visit the home, and are available for additional fees. Previous inspection reports and articles of interest are available inside the reception area of the home, for anyone who wishes to read them. Care Homes for Older People Page 3 of 10 What we found:
The pharmacist inspection lasted three hours. The reason for the inspection was to check compliance with the statutory requirement notice issued on 5th May 2010, due to serious concerns regarding the safe handling of medicines seen at the last two pharmacist inspections on 7th November 2009 and the 9th March 2010. The home was required to comply with the statutory requirement notice by 22nd May 2010. The home was required to 1 Make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. 2 Ensure that medication prescribed for people using the service is available in the home at all times so that it can be administered to them as prescribed by their G.P. The statutory requirement notice had not been met and only two of the six requirements left at the last two inspections had been met. The home had a new manager who had started on the day of the inspection. She was aware of the problems in the home and keen to address them. All the medicines were kept in a dedicated medicine room which was held at the correct temperature to store medicines. Three medicine trolleys were used to store and transport medicines to the people in the home. These were clean, tidy and well organised so it was easy to find individual peoples medicines reducing the risk of potential error. The nursing staff saw the prescriptions prior to dispensing and took a copy of them to use to check the medicines and Medicines Administration Record (MAR) chart received into the home. The quantity of all medicines received and any balances carried over were recorded enabling audits to take place. These indicated that the medicines dispensed in a Monitored Dosage System (MDS), where one dose was dispensed in a separate blister for each day of the 28 day cycle, had been administered as prescribed and records reflected practice. Errors were seen in the medicines dispensed in traditional boxes and bottles. Medicines had been recorded as administered when they could not have been. Medicines were unaccounted for. Gaps were also seen and it was not possible to ascertain in all instances exactly whether the medicine had been administered and not signed as such or not administered and the reason for administration not recorded. Concern was raised when it was identified that two people had not received two medicines for a week as nursing staff had failed to obtain a further supply in time to ensure a continuous supply. The reasons were poor. One agency nurse did not know where the book was to record that they needed to be ordered. The other nurse said another medicine had not been ordered as the doctor had already been in for that week and they were waiting for him to come in the following week to obtain a prescription. Cream management was poor. Some were unlabeled and left in communal areas. This
Care Homes for Older People Page 4 of 10 increased the risk of cross infection and also they may not be applied to the person they were originally prescribed too. One medicine was found that was unlabeled. There was no record of the medicine on the MAR chart or the care plans. It could not be ascertained who this prescription only medicine belonged to. This is of serious concern. The care plans did include many of the clinical conditions the people had. Nursing staff though did not always follow the care plans and so did not fully support the peoples clinical needs. Directions clearly written on a discharge summary record from hospital had not been adhered to. No care plan had been written and the nurse admitted that she had not read or followed the hospitals instructions. Not all the doctors visits had been recorded and many were incomplete so it was not possible to ascertain the exact outcome of the visit. The home had recently installed a quality assurance system following an audit that had identified errors in the handling of medicines. Nurses were expected to record the quantity of boxed medicines left in the trolley following administration. This had reduced the number of errors but on the day of the inspection, one medicine audit had not been completed. The nurse had administered only half the prescribed dose. Had the system been adhered to, she would have recognised this error. 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 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 7 12 Care plans must be written and provide staff with current information. So that staff know how to assist people to meet their assessed needs. 04/05/2010 2 8 12 Individual risk assessments must be completed. So that staff have guidance about how to assist people to manage risks and minimise potential of harm. 16/04/2010 3 9 13 All medicines must be stored 08/01/2010 in compliance with their product licences. This is to ensure their stability 4 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 individual nursing staff 08/01/2010 Care Homes for Older People Page 6 of 10 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 practice is assessed on a regular basis and appropriate action is taken if audits indicate that nurses do not administer the medicines as prescribed. 5 9 13 The medicine administration record chart 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 9 12 All prescribed medicines must be available for administration This is to ensure that the service users is administered their prescribed medication as the doctor intended. 7 12 16 Provision of indoor and oudoor activities must be reviewed. So that people can continue to have an interesting and stuimulating lifestyle. 8 26 23 Remedial work must be 30/04/2010 completed in the kitchen sink area.
Page 7 of 10 09/04/2010 09/04/2010 31/05/2010 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 To ensure a safe and clean environment. 9 26 23 Infection control procedures must be reviewed and acted upon. So that people live in a safe and clean environment. 10 33 24 Systems must be in place to monitor the quality of the service provided. So that the home provides a quality service and acts upon peoples opinions. 11 37 17 Records must be available for inspection at the home. So that people can see that information and checks for health and safety are up to date. 12 38 23 All safe to participate in fire drills. To ensure they know how to keep people safe. 11/03/2010 23/04/2010 07/05/2010 16/04/2010 Care Homes for Older People Page 8 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 9 13 All medicines on the premise 23/06/2010 must be labeled by a pharmacist. Any unlabeled medicine must be removed and destroyed. This is to ensure that all prescribed medicines are administered to the service user they are prescribed to only and at the correct dose. 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 Older People 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 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 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!
