Inspection on 19/11/09 for West Abbey House

This inspection was carried out on 19th November 2009.

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

Other inspections for this house

West Abbey House 01/04/10

West Abbey House 21/01/10

West Abbey House 05/08/09

West Abbey House 30/01/08

West Abbey House 04/07/07

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Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Random inspection report Care homes for older people Name: Address: West Abbey House Stourton Way Yeovil Somerset BA21 3UA zero star poor service 06/08/2009 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: kathy McCluskey Date: 1 9 1 1 2 0 0 9 Information about the care home Name of care home: Address: West Abbey House Stourton Way Yeovil Somerset BA21 3UA 01935411136 01935420829 westabbey@barchester.net www.barchester.com 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) : Barchester Healthcare Homes Ltd care home 97 Number of places (if applicable): Under 65 Over 65 0 55 0 dementia old age, not falling within any other category physical disability Conditions of registration: 32 0 10 The maximum number of service users who can be accommodated is 97. The registered person may provide the following category of service: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Dementia (Code DE) maximum of 32 places Physical disability (Code PD) maximum of 10 places Old age, not falling within any other category ( Code OP ) maximum of 55 places Date of last inspection Brief description of the care home West Abbey is located in a residential area on the outskirts of Yeovil. It was purpose built as a nursing home in 1994. 0 6 0 8 2 0 0 9 Care Homes for Older People Page 2 of 16 Brief description of the care home In the main building is a 66-bedded unit for service users requiring general nursing care and this is located on two floors. There is one 13-person lift to the first floor. The corridors are wide and can accommodate people who mobilise using a wheelchair. The home has accessible and pleasant garden areas. The majority of the service users in the main wing are older people. The home is also registered to take up to 10 younger people (18-65). In a separate wing there is a single storey 28 bedded unit (Lyde) for older people with mental health needs. The Lyde unit has its own central courtyard garden. The homes current fees are £550 per week plus free nursing care,and for younger people fees are in line with their individual care needs assessment. Care Homes for Older People Page 3 of 16 What we found: This unannounced random inspection was conducted over one full day (6hrs) by regulation inspectors Kathy McCluskey and Jane Poole. The Commissions pharmacist inspector was also in attendance to look at the homes procedures for the management and administration of peoples medication. The purpose of this inspection was to follow up on some of the requirements raised at the homes last key inspection which was carried out in August 2009. Following the last key inspection, letters were received by the Commission from several relatives of people using the service praising the quality of care and the kindness and commitment of the staff. During this random inspection we were able to meet with two visitors who were both very positive about the care their relative received and of the kindness of the staff. Both indicated that if there was anything that the home could do better, it would be to have more staff available. The registered manager Beverley Davies was available throughout this inspection. We were given unrestricted access to all parts of the home and all records required for this inspection were made available to us. At the end of the inspection, feedback was given to the registered manager and the homes regional operations manager. At the time of this inspection, we were informed that 92 people were currently residing at the home. The home is made up of three units and we focused on the unit for people receiving nursing care for their dementia and on the upstairs unit for older people receiving general nursing care. All staff were welcoming and helpful and we would like to thank all those involved for their time and cooperation with the inspection process. HEALTH AND PERSONAL CARE On arrival at the upstairs unit at 1100hrs, for older people receiving general nursing care, we found 19 people being nursed in bed. We checked again at 1530hrs and 9 people were being nursed in bed. Diet/fluid intake charts and repositioning charts were seen in the majority of bedrooms. We found that diet/fluid intake charts did not contain sufficient information to allow staff to properly monitor what individuals had actually consumed during the day. Instead of staff recording the amount taken, they had recorded half a dinner, cup of tea. This was also the case on the Lyde Unit (for people with dementia). As required at the last inspection, we were able to see that fluids were available in peoples bedrooms. We noted that, on the upstairs unit, the majority of people in bed, had not been offered a hot drink during the day. This was brought to the attention of the registered manager at the time of the inspection. This needs to be investigated by the home to ensure that this was not due to staff not being able to assist people with a hot drink due to the high number of people in bed. Repositioning charts did not identify the frequency of turns required by each individual. Care plans examined were only found to contain reference to the individuals needing to be turned regularly. Charts examined did not demonstrate a consistent approach to care. We found a generic notice displayed at the nurses station on the upstairs unit instructing staff to turn people every four hours. Action needs to be taken to ensure that each individual receives personalized care in line with their assessed needs. Care Homes for Older People Page 4 of 16 We examined the care plan for an individual, who was being nurse in bed and did not have access to a call bell. Staff spoken with confirmed that the individual would not be able to use a call bell to summon assistance. Staff stated that the individual was checked regularly but we found no documented evidence to support this. No reference had been made in the plan of care. The outstanding requirement of the last inspection remains unmet. On the unit for people with dementia, we found one person being nursed in bed. On checking the individuals care plan, we noted an entry dated 9th October 2009 which stated that the individual was no longer mobile and would be nursed in bed until a safe chair is provided. The registered manager advised us that a chair was currently on order and they were awaiting delivery. The home need to consider a deprivation of liberties assessment as the individual is currently being restricted because of this. The registered manager informed us that the majority of people on this unit had recently been reviewed/assessed by their care managers and that no concerns had been raised regarding individuals plans of care to meet their dementia care needs. The home needs to ensure that mental capacity and best interests assessments are completed with appropriate parties. On the dementia unit, in peoples care plans we found letters which had be sent to relatives asking them what time they preferred their relative to go to bed and whether they minded their relative being dressed for bed following a bath in the afternoon. This impacts on peoples dignity and rights to make choices. The pharmacist inspector looked at the handling of medicines in the home. Two requirements concerning medicines had been made at the last inspection. The first concerned the application of creams and ointments. We checked this on Lyde unit and saw that a record is now kept of the application of creams and ointments on a separate record sheet. Many creams are applied by care staff and nursing staff need to ensure that there are clear dosage instructions for care staff to know how they are meant to be used. For example many said for dry skin, with no indication of which area of the body this meant. Staff told us that all the creams and ointments were kept in a medicines cupboard but that staff are intending to move these to lockable cupboards in peoples own rooms in the future. All the supplies we saw were labelled for individual people. The second requirement concerned monitoring the condition of people on medication and giving medicines prescribed when required in line with the prescribers guidelines. During this inspection we did not see evidence of medicines prescribed when required being given inappropriately. However we did see that several medicines prescribed when required or when necessary did not have clear dosage instructions or clear guidance for staff about when they should be used. This means that people cannot be sure that these medicines will be given appropriately and consistently, particularly if they are not able to express for themselves if they wish to have the medicine. People living in the home are registered with a number of different doctors practices. Medicines are supplied by a local pharmacy using a monthly blister pack system. The ordering system used means staff see a copy of the prescription when the medicines are delivered, so they cannot query any discrepancies before the medicines arrive. Staff told us that this sometimes means that they receive medicines that they have not ordered, which can result in overstocking. We saw some evidence of this. For example a medicine Care Homes for Older People Page 5 of 16 used daily for pain relief had supplies dispensed in May, August, September, October and November 2009 in the medicines cupboard. Staff told us that the person did not always want to have the medicine so they did not use the whole months supply. Action should be taken to ensure that excess medicines are not ordered and supplied. Staff on Lyde told us that sometimes medicines had been changed without informing the nursing staff so they were unaware of the change until they queried a discrepancy with the new monthly medicine supply. It is recommended that the ordering system enables staff to check the prescriptions before they are dispensed so that any discrepancies can be addressed. This should help ensure that the correct medicines are available but avoid waste caused by overstocking. The registered manager told us that they had asked their pharmacist to come and check the medicines on all three units. At the time of the inspection, one unit had been visited but the report had not yet been received. An annual check of medicines on each of the three units had also been carried out using the registered providers company format. Staff sent us a copy of this audit from one of the units. It was not clear from this document what action had been taken to address any shortfalls. In addition to these the registered manager does her own weekly checks with a sample of peoples medicines administration record sheets, we saw records of these. These checks should ensure that medicines are looked after and administered safely in the home. However despite this we saw a number of aspects of medicines handling that need to be improved to make sure that the health of people living in the home is better protected. The medicines we looked at during the inspection were all looked after and given by nursing staff. The home has a medicines policy which is available on each of the units in the home. People have their photo with their medicines administration record charts to help identify the correct person. We saw some lunchtime medicines being given on one unit, using safe practice. We looked at medication administration record sheets on each of the floors and at the storage arrangements in place. The pharmacy provides printed administration record sheets each month for staff to complete. We saw that some people living in the home had a large number of administration record sheets, for example one person had six sheets and another ten, with staff having to find the current medicines amongst the items included on the sheets. In both these examples some of the same medicines had been listed more than once. In some cases it was not clear whether medicines, particularly creams and ointments, were being used or not. Another record sheet included both solid and liquid forms of Senna prescribed to treat constipation. This increases the risk of mistakes being made with discontinued medicines given in error or medicines being given more than once. Staff need to discuss with the pharmacy how this can be resolved to help safeguard peoples health. On one unit we saw that one person regularly misses one dose of medicine when they are not in the home. We discussed with staff the need to have arrangements in place so that this person can take their medicines at the prescribed time or to check with the persons doctor that missing the dose will not be harmful to the individual. On this unit we also saw a bottle of Paracetamol with a dose of two 5mls spoonfuls to be given four times a day. However we saw from the administration record that codes were Care Homes for Older People Page 6 of 16 used to record that, 10mls, 15mls and 20mls are given at various times. 15 and 20mls are both larger doses that that prescribed. Staff said that in the past the dose had been two to four 5mls spoonfuls and that the prescription needed to be amended. Medicines must be given as prescribed and any discrepancies discussed and changes agreed with the prescriber before the medicine is given. On one unit we saw that one person had been prescribed two different medicines to help them sleep, one with a variable dose. Staff told us that the person would not be able to express a preference and it was not clear how staff would know which medicine to give or the dose to give. The person was also prescribed another liquid medicine to be given in the morning when required but would not be able to say whether they needed it. The member of staff we asked was not sure of how they would know when this medicine was needed. Two separate bottles of the liquid medicine had been opened and were in the medicine trolley, one started on 10th August and one on the 20th August 2009. The label stated that this medicine should be used within one month of opening but both bottles were still in the medicine trolley at the time of the inspection in November and need to be disposed of. On this unit we also saw that one person had a different dose of medicine on the administration record sheet o that on the label. The box had been opened in August 2008 and no record had been made of the quantity carried over into the current month so it was not possible to check what dose had been given. Two people on Lyde had medicines prescribed when necessary with no information available about how often they may be given and limited information in place about when they should be used. Action should be taken to make sure that clear directions are available for medicines prescribed to be given when required so that the dosage instructions and the reason for their being given are clear to staff. This is to make sure that these medicines are given appropriately and consistently by staff. Staff told us that they add one persons medicines to a drink so that the person is able to take them. The medicines are crushed and a capsules opened before being added to the drink. Staff told us that this had been agreed with the doctor and the pharmacy but we saw that one medicine label instructed staff to add the contents of the capsule to water rather than to the drink they are using. Staff must ensure that they have confirmed with the pharmacist that it is suitable to give all the medicines in this way. This is to make sure that none of the medicines is altered by mixing with the drink before taking, which could effect their effectiveness. Codes are used so that staff can record a reason that a medicine has not been given. On some occasions a code meaning offered prn, not required has been used suggesting that the person has been offered the medicine and not wanted to take it. Staff however said they used this code to mean that they had assessed that the medicine was not required. One persons administration record stated that they were allergic to a particular group of medicines but we saw that this person was receiving a medicine from this group every day. The nurse told us that they had checked this with the doctor and that the allergy was actually to one specific medicine so they were safe taking the prescribed medicine. Staff must ensure that information recorded about medicine allergies are accurate. This is to make sure that people are not harmed by being given a medicine that they are allergic to. Care Homes for Older People Page 7 of 16 We checked some sample blister packed medicines and these showed that the medicines had been given as recorded by staff. Bottles of liquid medicines had been dated when opened so that the staff could check that the correct amount had been given over a period of time. However it was not possible to check some medicines supplied in standard packs because there was no record of when the pack had been started or of the amount carried forward from the previous month. Action should be taken to ensure that all medicines can be checked. Suitable secure storage is available for medicines. Each unit has a medicine fridge and records show that these are kept at suitable temperatures for safe storage of medicines. Special cupboards are available for storing controlled drugs, which need additional security. Staff must ensure that suitable size cupboards are available for all controlled drugs to be stored appropriately, as required by the Misuse of Drugs Act (safe custody) Regulations 1973. Records for these medicines had been completed as required. Two small Oxygen cylinders were seen in medicines storage areas. Staff must ensure that these are secured so that they cannot fall over, causing injury. Warning notices in these areas need to include the statutory warnings about the risk of fire. Records are kept of the receipt of medicines into the home and of their disposal, however staff need to ensure that records show when the medicines are removed from the home. At the last inspection it was required that the home take appropriate action to ensure that the privacy and dignity of people is respected. This related to screening in shared bedrooms and blinds on the glass panels in bedroom doors on the Lyde unit. During this inspection we were able to see that the home had taken action to address this. DAILY LIFE AND SOCIAL ACTIVITIES At the last inspection concerns were raised regarding the meal time experience for people on the Lyde Unit. During this inspection we were able to observe lunch being served on this unit. We noted a good staff presence and observed people being assisted in an appropriate manner. The atmosphere was relaxed and unhurried. We did note that tables had been laid for lunch by 12 mid day, many people were observed sitting at the dining tables although lunch was not served until 1310hrs. Given that this may be confusing for people with dementia, we have made a good practice recommendation that the home reviews this routine on the unit for people with dementia. During this inspection we saw activity coordinators on each unit throughout the day. One to one activities were being offered to people including those being nursed in bed. ENVIRONMENT We found all areas of the home to be clean and free from malodours. We also found that the home had taken steps to address the requirement raised at the last inspection relating to appropriate signage being made available in the dementia care unit. With the assistance of peoples relatives, memory boxes have been made available on the majority of peoples bedroom doors. This assists people to orientate themselves to their own rooms. Signage was also seen to be in place to orientate people to the lounge. STAFFING We examined recruitment files for the two most recently employed staff and we were able to see evidence that the requirement of the last inspection had been addressed. We were able to see that the home had obtained two references prior to employment and that gaps in employment history had been explored and reasons Care Homes for Older People Page 8 of 16 documented. An outstanding requirement of the last inspection was that the home reviews staffing levels to ensure that the needs of people living at the home are met. This was not fully assessed at this inspection as the home have been requested by 4th December 2009 to provide the Commission with details regarding the dependency levels of people currently using the service. MANAGEMENT AND ADMINISTRATION We followed up on the two requirements raised at the last inspection which related to the home informing the Commission of all significant events and ensuring that foot plates are in place when transporting people in wheelchairs. We have been receiving notifications of significant events from the home. What the care home does well: What they could do better: The home need to ensure that diet/fluid intake charts contain sufficient information to allow staff to fully monitor an individuals intake. The home home need to ensure that people are offered hot drinks throughout the day and that sufficient staff are available to assist people where required. This relates particularly to the upstairs unit. Where people are assessed as requiring staff assistance to change position, the home need to ensure that the frequency of turns is recorded in the plan of care and on the repositioning charts. This is to ensure that people receive care in line with their assessed needs. At the last inspection it was required that the home have a recorded system of appropriate supervision in place to support people to summon assistance when needed. This requirement has not been met as we found no risk assessment, care plan or documented evidence of regular checks had been raised for one individual who was nursed in bed and who was unable to use a call bell. The home needs to ensure that where required, deprivation of liberties/best interests assessments are completed. During this inspection we found that one individual on the unit for people with dementia, had been nursed in bed for the last one and a half months because an appropriate chair was not available. We were advised that an appropriate chair was on order and the delay was due to the supplier. On the unit for people with dementia, the home needs to ensure that people are supported to make choices about their lives. Where required, the home must involve appropriate parties in the completion of mental capacity assessments and best interest assessments. The home should consider revising its policy on the unit for people with dementia regarding the times that tables are laid for lunch. We observed people sat at dining tables which had been laid for lunch for over an hour before the meal was served. This may be Care Homes for Older People Page 9 of 16 confusing for people with dementia. Action is needed to ensure that clear dosage instructions and reasons for use are available for medicines prescribed to be given when required or when necessary. This is to make sure that these medicines are given appropriately and consistently by staff. Action is needed to ensure that medicines are given as prescribed. Improvements are needed in the administration record sheets to make sure that they accurately reflect the medicines people are currently using. This will ensure that people receive the treatment they need. Storage arrangements for controlled drugs, which need additional security, must be improved on one of the units. This is so that these medicines can all be stored in a suitable cupboard as described by the Misuse of Drugs Act (safe custody) regulations 1973. It is recommended that the ordering system in place, enables staff to check the prescriptions before they are dispensed so that any discrepancies can be addressed. This should help ensure that the correct medicines are available but avoid waste caused by overstocking. Action should be taken to ensure that staff can audit all medicines not supplied in the monthly monitored dosage system. This is so that staff can check that these medicines have been given correctly. 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 10 of 16 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 8 16(2)(i)(4)12 Fluids must be available to (4)(a)(b)17(1 those who can manage )(a)Sch.3 (l) independently at all times when sitting in their rooms or when in bed. THIS HAS BEEN MET Call bells must be accessible at all times and must be placed within reach after care interventions / changes of position. THIS HAS BEEN MET A recorded system of appropriate supervision is required to be implemented to support people to summon assistance when needed. THIS HAS NOT BEEN MET. 21/04/2008 2 14 12 The management must 16/09/2009 ensure that people living at the home are offered choices in all areas including meals, times of bathing and how to spend thier day. This was not fully met at this random inspection. To ensure that people have an influence on thier lives Care Homes for Older People Page 11 of 16 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 3 22 23(2)(l) Designated storage must be used rather than communal bathrooms for equipment that is not in use. NOT ASSESSED 21/04/2008 4 27 18 (1) It is required that the 21/04/2008 manager reviews the numbers of staff available to ensure that the needs of the people living at the home are met. Previously required by 19/9/07. THIS WAS NOT FULLY ASSESSED. Care Homes for Older People Page 12 of 16 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 8 12 (1) The registered person 11/12/2009 must ensure that a recorded system of appropriate supervision is implemented to support people to summon assistance when needed. This is to ensure the health, safety and well-being of people who are unable to use a nurse call bell 2 9 13 The registered manager 23/12/2009 must ensure that clear dosage instructions and reasons for use are available for medicines prescribed to be given when required or when necessary. This is to make sure that these medicines are given appropiately and consistently by staff. The registered mananger must ensure that medicines are given as prescribed and that the administration record sheets accurately 15/01/2010 3 9 13 Care Homes for Older People Page 13 of 16 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 reflect the medicines people are currently using. This is to make sure that people receive the treatment they need. 4 9 13 Controlled drugs must be 19/01/2010 stored in a suitable cupboard as described by the Misuse of Drugs Act (safe custody) regulations 1973. To make sure that these medicines are stored securely. 5 14 12 (3) The registered person must ensure that people are offered choices about their lives including the times for retiring to bed, bathing and times of changing into nightclothes. Consideration must be given to the use of mental capacity and best interest assessments where required. This is to ensure that people are supported to make decisions about their lives. 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 23/12/2009 1 8 The home need to ensure that care plans and repositioning charts provide clear information on the frequency of turns required by an individual. The use of generic frequencies Page 14 of 16 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 should be replaced by a more person centred approach to care. 2 8 The home should ensure that diet and fluid intake charts contain more detailed information about the amount an individual has actually taken. This will enable staff to properly review/monitor the individual. Action should be taken to ensure that staff can audit all medicines not supplied in the monthly monitored dosage system. This is so that staff can check that these medicines have been given correctly. It is recommended that the ordering system in place, enables staff to check the prescriptions before they are dispensed so that any discrepancies can be addressed. This should help ensure that the correct medicines are available but avoid waste caused by overstocking. The home should ensure deprivation of liberties and best interest assessments are completed where required. This related to an individual who was being nursed in bed as the specialised equipment required was not available. To alleviate any confusion for people with dementia, the home should review the current practice of laying tables for lunch over an hour before the meal is served. As appropriate, people should be supported to help to lay tables just prior to the meal being served. 3 9 4 9 5 12 6 15 Care Homes for Older People Page 15 of 16 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. 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