Inspection on 11/02/09 for The Perry Tree Centre

This inspection was carried out on 11th February 2009.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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.

Other inspections for this house

The Perry Tree Centre 18/12/08

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Random inspection report Care homes for older people Name: Address: The Perry Tree Centre Dovedale Road Kingstanding Birmingham B23 5BX new service which has yet to be given a quality rating 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 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: Debby Railton Date: 1 1 0 2 2 0 0 9 Information about the care home Name of care home: Address: The Perry Tree Centre Dovedale Road Kingstanding Birmingham B23 5BX 01216755571 01216755573 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) : Social Care and Health care home 32 Number of places (if applicable): Under 65 Over 65 0 0 0 32 0 0 dementia learning disability mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability sensory impairment Conditions of registration: 32 32 32 0 32 32 The maximum number of service users to be accommodated is 32. The registered person may provide the following category of service only: Care Home Only (Code PC) 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) 32 Dementia (DE) 32 Mental Disorder (MD) 32 Sensory Impairment (SI) 32 Learning Disability (LD) 32 Physical Disability (PD) 32 Date of last inspection Care Homes for Older People Page 2 of 13 Brief description of the care home The Perry Tree Centre is a new two-storey building of Brick and tile construction. The centre has been designed and built to a high standard with input from the Sterling University regarding dementia design. The residential unit is accessed through a security door to which passes can be set to varying access levels, to exit a push button system is in operation. The accommodation consists of thirty-two single occupancy bedrooms all with en-suite facilities, on the ground floor, which include a walk in shower and an adjustable sink for wheelchair users. The accommodation is divided into units of eight with their own lounge/dinning areas, staff work stations for the location of files and medication. All bedrooms have communication systems, which, include pull cords and voice communication, which can only be cancelled at the point of call. The system can be extended to included other assistive technologies. All bedrooms exceed current NMS about personal space. All rooms have access for wheelchair users. Bedrooms have TV and telephone points; the site has Wi-Fi for computer access. The centre has two gardens, which have been equipped to a high standard with sensory facilities. There is kitchen that caters for the whole building and a laundry sited outside of the unit. There is some parking in a designated car park at the front of the building. Fees charged at the home are assessed by placing social workers. Care Homes for Older People Page 3 of 13 What we found: The pharmacist inspection lasted four hours. Six residents medicines were looked at together with their medicine administration record (MAR) chart and care plans. The team leader was in charge of the home at the time and assisted during the inspection. All feedback was given to her and a care assistant responsible for ordering the medication each month. The medicine management in the home was poor. Due to an outstanding requirement regarding medication the issuing of a statutory requirement notice was being considered. The home has a dedicated medication room. This was fairly hot during the inspection but the temperature was not monitored on a daily basis to confirm that the temperature did not exceed 25C, to ensure that the medication is safely stored within. Two medication trolleys are used to store and transport the medicines to the residents in the home. The team leader prepared the medicines after referral to the MAR chart, offered the medication to the resident and then signed the chart. She treated residents with respect throughout the procedure. The home sees the prescription prior to dispensing and photocopies some of them only. Without copying all prescriptions the medicines cannot be properly checked in. Hand written MAR charts were poor. They did not record relevant information such as the date, any allergies, the dose or the quantities received or carried over in all instances. One medicine had the incorrect dose recorded on the MAR chart. The pharmacist had dispensed it to be administered at night but the home had written that it could be administered three times a day. It is the responsibility of the care assistants in the home to administer the medicines as the doctor prescribes. Whilst the quantities received had been recorded in a separate book these entries were not totally inclusive. Recording the same information in two different places may lead to further errors. Two MAR charts for one medication were seen and staff had recorded that the cream was in the residents room twice. Staff are not adequately checking the MAR charts to ensure that any duplicate entries printed by the pharmacy are crossed out. This may lead to a medicine being administered twice. Audits indicated that not all the medicines had been administered as prescribed. Some medicines had been signed as administered when they had not been. Gaps were seen on the MAR chart. In some instances medicines had been administered but not recorded as such. In others it was not possible to tell exactly what had occurred. The MAR chart should be an exact record of what had occurred in the home. Reasons for non-administration were recorded. Staff do not always record the exact reason for non-administration resulting in some medicines unaccounted for. Variable doses had not always been recorded, so it was not possible to tell exactly what dose had been administered at what time in all instances. The manager had installed an auditing system whereby the staff count the medicines at the end of each day. Staff had failed to act when the audits indicated that a Care Homes for Older People Page 4 of 13 medicine had not been administered even though it was signed as such. A further auditing system was to be installed where all medicines were counted and recorded at the end of each shift. This would be a time consuming system that may result in staff not actually counting the tablets due to the time taken. Only one member of staff is on duty at each shift responsible for medication and this time consuming system will take them away from more important duties. A more robust system to randomly assess individual staff practice would be beneficial to the staff and residents. One out of date medicine had been administered for the last three doses. No new supply was available to administer. Another medicine was not available to administer for the last seven days. This was used to treat a heart condition. We, the commission were assured that the remaining supply had not been delivered by the pharmacy. On closer inspection of the records it showed that the last receipt was in November 2008 for 14 days supply only and none since until 20th January 2009 again for a 14 day supply only. The pharmacy confirmed that it had supplied an additional 14 day supply on 2nd January 2009. No record for this in the home was seen. A supply available to adminsiter was not dispensed to adminsiter for at least one week. Care staff are not checking the prescription to ensure that enough is prescribed and dispensed to adminster resulting in a break of administration. This would be detrimental to the residents health and well-being. Another medicine was found in the medicine trolley and not the medication refrigerator, so had not been stored correctly to maintain its stability. In addition the MAR chart recorded that only 100ml had been received but 200ml was available in the medication trolley. One new resident to the home had brought in one paracetamol tablet only. It was agreed with him to give it to him at teatime for one day only while a new supply was sought. Staff had contacted the doctor for a new prescription but no more tablets had been received by the end of the inspection. We, the commission were assured that it would be delivered by the end of the day and they had immediately sought a new supply from the doctor. No record was found for this communication with the doctor. The pharmacy had not been contacted to explore the possibility of an emergency supply dispensed or homely remedies being purchased. One medicine for one resident had been changed from a strong to a moderate pain relieving tablet. There was no record as to why, and the stronger pain relieving tablet was still available in the trolley to give as well as the new medication. This may lead to potential errors in the future as it had not been removed. For another medication two bottles had been dispensed and received separately but both were in use in the trolley at the same time, again increasing the risk of errors. From calculation 450ml had been received and 300ml administered during that period of time therefore 150ml should have been left, but each bottle contained approximately 50ml each. 50ml was unaccounted for. The care plans were poor. They contained limited information about the clinical condition of the residents. Without such information it would be difficult to fully support their clinical needs. Information regarding external healthcare professional visits though were well written including the outcome of the visits. Verbal communication with professionals was not always documented. For example, the home had queried why one resident, on return from hospital, was no longer on one Care Homes for Older People Page 5 of 13 medicine. It was recorded to be followed up but no record was found. We, the commission were assured by the team leader that it was followed up and the doctor was spoken with, who decided not to restart the medication. No documentation existed for this communication. One resident constantly refused her medication, so the majority of it, prescribed in liquid form is taken in a beaker of orange squash. We, the commission were assured that she finished the glass of squash containing the medication over a period of time. Alternative formulations had not been explored, even though it was known she did not like the taste of some of the liquid medicines. Previously this resident had been administered the medication covertly but now she is told that it in the squash. Sometimes she takes it, others she does not. This was clearly documented on the MAR chart when she actually did take her medication. The care plan did not support this method of administration. Placing medicines in orange squash may make the medication more palatable but may alter the medicine especially over a period of time and if the squash is not finished an unknown quantity of medicine is administered only. All controlled drug balances were correct and the entries on the MAR chart matched those in the register. They were stored in a locked cabinet but it was not fixed to anything and it could easily be removed. 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 6 of 13 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 Care plans (ISS) must be updated as changes in need oocur. Ths will ensure that the staff will know what the current needs of the people living in the home are. 01/02/2009 2 7 15 There must be a written plan 31/03/2009 that describes how the needs of the people living in the home are to met. This will ensure that the staff know the needs of the people living in the home and they can be met in a person centred way. 3 8 13 There must be a risk assessment and management plan in place for all identified risks. This will ensure that the staff know how any risks can be safely managed and the people living in the home is safeguarded. 28/02/2009 4 8 13 A tissue viability assessment 01/02/2009 and management plan must in place for people at risk of developing pressure ulcers. This will ensure that a plan is Care Homes for Older People Page 7 of 13 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 in place that will minise the risks of individuals developing pressure ulcers. 5 9 13 The medication 31/01/2009 administration system must ensure that the people living in the home get their medicines as prescribed. This will ensure that the people living in the home can be assured that their health needs are being met. 6 12 12 Any decisions made to 28/02/2009 override an individuals decision must be recorded with details of why the decision has been made, by whom and whether it is in line with the mental capacity act. This will enable the people living in the home toremain in control of decisions affecting their lives unless it has been determined that it is in their best interest. 7 22 23 The emergency call system 31/01/2009 must meet the requirements of the home. This will ensure that the people living in the home get help when they need it. 8 32 26 The providers representative 31/01/2009 must visit on a monthly basis and provide a report of the visit. This will ensure that any Care Homes for Older People Page 8 of 13 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 problems arising can be addressed and the provider can be assured that the home is being run in the manner required. Care Homes for Older People Page 9 of 13 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 A system must be installed 13/03/2009 to check the prescription prior to dispensing and to check the dispensed medication and the MAR charts against the prescription for accuracy. All discrepancies must be addressed with the healthcare professional. The quantities of all medicines received and any balances carried over from previous cycles must be recorded to enable audits to take place to demonstrate the medicines are administered as prescribed. This is to ensure that the audit trail for all medicines is seen and all medicines are adminsitered as prescribed at all times. 2 9 13 All hand written dose 13/03/2009 regimes must be clearly written on the MAR chart and checked by a second member of staff for Care Homes for Older People Page 10 of 13 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 accuracy. This is to ensure that the staff have clear directions to follow. 3 9 13 All prescribed medicines 13/03/2009 must be available for administration, be in date and stored in accordance with their product licenses. This is to ensure that the medicines are safely administered and its stability is not compromised. All medication polices must 13/03/2009 be reviewed and reflect good practice. Staff must be trained to adhere to them. This is to ensure that all staff have clear information to handle medication safely. 5 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 care staff practice is assessed on a regular basis and appropriate action is taken if audits indicate that care staff do not administer the medicines as prescribed. 13/03/2009 4 9 13 Care Homes for Older People Page 11 of 13 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 6 9 13 The MAR chart must record 13/03/2009 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 correct medicine is administered to the correct service user at the correct dose and time and records reflect practice The controlled drug cabinet 13/03/2009 must be securely fixed to the wall. This is to ensure there is no mishandling of controlled drugs 7 9 13 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 12 of 13 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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