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Inspection on 27/07/09 for Warneford House Care Centre

Also see our care home review for Warneford House Care Centre for more information

This inspection was carried out on 27th July 2009.

CQC found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Administration practices in the home follow best practice guidance which means that people are likely to accept and take their medicines regularly. Monthly prescriptions are checked before medicines are supplied to ensure all items needed have been listed correctly.

What the care home could do better:

Individual medication acre plans for medicines prescribed as required should be put in place to reflect peoples needs and preferences. Storage arrnagements and conditions should be improved to make sure all medicines are stored securely at temperatures recommended by the manufacturer and to reduce the risk of loss or diversion.

Random inspection report Care homes for older people Name: Address: Warneford House Care Centre Warneford House Tenter Balk Lane Woodlands Doncaster South Yorkshire DN6 7EE one star adequate service 28/04/2009 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: Steve Baker Date: 2 7 0 7 2 0 0 9 Information about the care home Name of care home: Address: Warneford House Care Centre Warneford House Tenter Balk Lane Woodlands Doncaster South Yorkshire DN6 7EE 01302337111 01302337113 warneford.house@ashbourne-homes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ashbourne Homes Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 40 Number of places (if applicable): Under 65 Over 65 0 25 dementia old age, not falling within any other category Conditions of registration: 15 0 The maximum number of service users who can be accommodated is: 40 The registered person may provide the following category of service only: Care Home with Nursing - Code N, To service users of the following gender: Either, Whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category - Code OP, maximum number of places 25, Dementia - Code DE, maximum number of places 15 Date of last inspection 2 8 0 4 2 0 0 9 Care Homes for Older People Page 2 of 12 Brief description of the care home Warneford house is a care home situated in a residential area of Adwick-Le-Street and is within a short distance of shops, library and churches. The home comprises of two units. They are Warneford suite and Adwick suite. The Warneford suite provides personal and nursing care for up to 25 older people, whilst Adwick suite provides personal and nursing care for up to 15 people with dementia. The home is a horse shoe shaped single storey building with easy access to the patio and garden areas. The fees at the time of this site visit ranged from 390 to 578 GBP per week and did not include costs for hairdressing, chiropody, toiletries and personal transport. A service user guide was available to the visitors to the home which provided information about services on offer at the home and the most recent Commission for Social Care Inspection report was displayed at the reception area for the visitors to read. Care Homes for Older People Page 3 of 12 What we found: The reason for this visit was to undertake a pharmacist inspection of the service to follow up concerns about medication administration and record keeping brought to our attention. The visit lasted six hours and involved looking at a sample of care files, the current medication administration record charts (MARs) and the medication storage and handling arrangements in the home. Medication administration was observed during the breakfast and lunchtime periods. We also sought information about staff training and supervision. During the visit we gave verbal feedback to the Project Manager in charge of the running of the home pending the appointment of the new manager. The outcome is as follows. The medication records we examined and the administration practices we observed suggest that people living in the home can expect to receive their prescribed medicines correctly as intended. Improvements have been made since the last key inspection and some of the recommendations made during an external medication audit visit from the supplying pharmacy have been put in place. Further changes in medication care planning, storage arrangements and record keeping would help to maintain peoples health and wellbeing through the safe and effective use of prescribed medicines. For example, some medicines and sip feeds were kept insecurely under inappropriate conditions. The temperature of one storage area is not checked regularly to make sure medicines are being stored at the correct temperature. Monthly prescriptions are checked before the medicines are delivered. This good practice helps to make sure that any changes are acted upon and that all requested medicines are correctly supplied each month. The opening date of medicines with a limited use once opened is clearly recorded. The reduces the risk that medicines of being used when the quality has deteriorated. Controlled drugs are stored securely and regular checks of controlled drugs usage are made by senior staff. Two nurses were observed giving medicines to people at breakfast and lunchtime. Good practice was seen which encouraged people to accept and take their prescribed medicines in a way they chose and preferred. This helps to reduce the possibility of medicines being refused or of doses being missed. This good practice should be built on by developing medication care plans which ensure the correct and consistent use of those medicines prescribed to be taken only as and when needed or as directed. The MARs of two people indicate that some of these medicines were being given at regular intervals without any explanation. Medication care plans will guide staff in giving these medicines in accordance with agreed directions and circumstances. There are very few gaps in the medication records meaning that medicines are being given correctly and can be easily accounted for. However, eight MARs displayed unclear and incomplete entries for the use of prescribed skin creams. On questioning the nurses, we were told that carers would use the creams, not make any records of this but would then let the nurse on duty know that this had happened. Such practice is against current professional guidance and should be changed to make sure that whoever applies a skin cream makes a full record of this at the time. Not all hand written changes and entries on the MARs were sufficiently detailed or were checked to ensure all information was correctly copied. A check of each hand written entry would help to make sure that all essential information had been copied accurately. Seven MARs listed a total of 14 medicines which were no longer in use. The home should advise the GP and pharmacy of discontinued medicines so that up to date MARs of provided. This will reduce the risk of people being given medicines they do not need. Care Homes for Older People Page 4 of 12 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 12 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 The care plans must be kept 30/06/2009 under review and they must reflect the changing needs of the people. Therefore people are able to receive appropriate care. Some examples are Barrier nursing of a person, Statements of peoples wish to get up and get ready in the morning, mouth care to those receiving artificial feeds. 2 8 16 People must be provided with 30/06/2009 chairs which are fit for purpose. This will enable mobility and also help the person access the communal areas and enjoy social activities. 3 12 16 The activity programme for 03/06/2008 people in both units must be improved so it is suitable and specific to individuals needs. At mealtimes there must be 26/06/2009 an adequate number of staff available. Therefore people who need help will receive the correct 4 15 18 Care Homes for Older People Page 6 of 12 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 level of support. Therefore people are able to receive good nutrition. 5 16 22 A record must be kept of all complaints made including details of investigation and any action taken by the management of the home. So that the people using the service and the people working at the home are protected from harm. Furthermore people could be confident that the management of the home took all complaints seriously, carried out investigations and took appropriate action. 6 18 13 All staff must be trained and deemed competent when dealing with abuse, neglect and discrimination of those whom they care for. Staff must know whether they have had training on protection of vulnerable adults and know what needed to be done if there was to be an incident of abuse, neglect or discrimination . 7 27 18 Staffing numbers must 26/06/2009 reflect the dependency levels and therefore the needs of the people living at the home. Additional staff must be on duty at the peak times of activities. 26/06/2009 26/06/2009 Care Homes for Older People Page 7 of 12 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 people are receiving the appropriate care in a timely manner. 8 27 18 The staffing levels in both 03/06/2008 the Warneford and Adwick suite must be sufficient to meet the needs of the people living at the home. Previous requirement: 15/07/07 All staff must be competent 26/06/2009 to do their jobs. The standard of care at the home must reflect the homes aims and objectives. The staff training needs to be competency based so that they are able to carry out their duties appropriately. 10 33 24 An effective QA assurance with quality monitoring system must be in place. So that the management will be able to findout how best they are meeting the aims, objectives and statement of purpose of the home. 11 36 18 Staff must be appropriately supervised and there must be records kept of the supervision. The staff supervision helps the staff to feel supported and provides an opportunity to make career progress. It helps the management when Care Homes for Older People Page 8 of 12 9 30 12 26/06/2009 26/06/2009 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 auditing the staff skills, development needs and practices. 12 38 12 The window restrainers must 26/06/2009 be fitted to the areas of the home where people with dementia have access to. Therefore preventing people putting themselves at risk. Care Homes for Older People Page 9 of 12 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 must be stored 28/08/2009 securely at temperatures recommended by the manufacturer. This will help staff know that all medicines are safe to use when needed. 2 9 13 Medication, including all skin 28/08/2009 preparations, must be given as prescribed and a record must be made at that time. This will help to make sure that people receive their medicines correctly and that an accurate record of medication usage is maintained. 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 9 The supplying pharmacy should be advised of all medication no longer in use so that they provide up to date MARs. This helps to reduce the chance of someone being Page 10 of 12 Care Homes for Older People 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 given a discontinued medicine they no longer need. 2 9 Hand written entries and changes to MARs should be accurately recorded, detailed, signed and checked. This makes sure the correct information is recorded. When nurses delegate the task to carers of applying skin creams then the whole of the task should be delegated. Arrangements should be made for the carer responsible to make and sign a record each time a skin product is used. The prescriber or supplying pharmacist should be asked to provide addtional informationto guide staff when medicines are prescribed to be given when required or as directed. This make sure the medicine is given correctly as intended. Individual medication care plans, including for medicines prescribed when required, should be developed and agreed which reflect the personal preferences and needs of people living in the home. These care plans should be reviewed regularly in line with changes in peoples medication, health and wellbeing. 3 9 4 9 5 9 Care Homes for Older People Page 11 of 12 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 12 of 12 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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