Care Home: Alexandra Road Crisis Unit

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What the care home does well A valued service is provided to the local community providing short-term residence and support for mentally ill people at short notice for periods of crisis. There is effective communication with the local community mental health team and clients medication is arranged at a few days notice in preparation for admission to the home. Clients are assessed for their competence with medication and whenever possible they are supported to promote the self administration to facilitate independence when returning to their own home in the community. What the care home could do better: The draft policies and procedures for medication requires some updating before ratification by the local authority. Records kept of medication could be simplified as discussed to improve their effective use and the allergy status included for all clients. To promote the safe use of medication, purpose designed dosing aids should be used when clients are self administering their medicines. Cold storage facilities for medicines require monitoring to ensure correct temperatures are being maintained. Central storage of medicines is required to be secure. Attention is required to the accuracy and audit of medicines records to demonstrate administration is in accordance with the prescribers directions. Random inspection report Care homes for adults (18-65 years) Name: Address: Alexandra Road Crisis Unit 32 Alexandra Road Hornsey London N8 0PP two star good service 24/03/2009 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: Lawrie Allum Date: 1 9 1 0 2 0 0 9 Information about the care home Name of care home: Address: Alexandra Road Crisis Unit 32 Alexandra Road Hornsey London N8 0PP 02083657287 02088889829 yvonne.biasio@haringey.gov.uk 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) : London Borough of Haringey care home 8 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Conditions of registration: 8 The maximum number of service users who can be accommodated is: 8 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: Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home The Alexandra Road Crisis Unit is owned and run by London Borough of Haringey. The unit is unique in the borough as it only provides short-term emergency and respite services for up to eight people with mental health problems. Stays are typically from three days up to two weeks and may be an alternative to hospital admission. The unit is a three storey converted and extended domestic premises situated in a quiet residential street between Wood Green and Turnpike Lane. There are eight single Care Homes for Adults (18-65 years) Page 2 of 10 2 4 0 3 2 0 0 9 Brief description of the care home rooms, several bathrooms and shower rooms, a choice of two lounges, a staffed kitchen, a separate dining room with facilities to make drinks and snacks, an attractive conservatory that is used as an alternative place to relax and to do artwork and a private garden. Referrals to the unit come via the statutory and non-statutory mental health services. The unit has several aims: to provide good quality individualised support that is strengths and needs led; to facilitate personal development; to assist service users in development of alternative crisis responses and to foster appropriate coping strategies in order to return to their appropriate environment. Care Homes for Adults (18-65 years) Page 3 of 10 What we found: I am writing following the unannounced inspection of the service by a CQC pharmacist inspector. This inspection was requested by the homes CQC Regulatory Inspector, Susan Shamash, via CQC Local Area Manager, Hannah Hanley, following incidents in recent months involving medication errors. The manager of the service was not on duty at the time of the inspection and I was assisted by the homes deputy manager, Megan Laird. The services documented policies and procedures for medication were available for inspection in the office. Although the document was comprehensive it was in the form of a draft corporate policy produced by Haringey Council and dated 9 January 2009. The document therefore requires ratification with the contents section updated to reflect the correct page references and any procedures specific to the service entered. Clients using the service are admitted to the home for short periods of up to two weeks. Prior to a clients admission to the home, details of their medication is received in preparation from a healthcare professional representing the client. This is usually the Home Treatment Team based at St Anns Hospital and clients are from within their catchment area. Medication dispensed by a pharmacy is brought to the home with the client on their admission. Medication records included four forms showing the profile, receipt, administration and disposal/return, respectively. The service may benefit from simplifying this recording system to a single record sheet and this was demonstrated during the inspection. The allergy status of clients is to be entered, including when there are none known. For clarity and to reduce the risk of misinterpretation the directions for medication should avoid using Latin abbreviations and be written in full. The process of providing limited trials of medication to encourage clients independence in managing their medication should avoid the use of transferring medication into envelopes and instead use dosing aids, as discussed. For accountability the transfer of medication must be documented and where possible involve the client to promote their understanding. A dedicated lockable fridge is available for medication requiring cold storage. There was currently no medication requiring cold storage and the recently acquired fridge had not been used. It is recommended to ensure the fridge is operating correctly and to record the maximum, minimum and current temperatures as a record of this and to indicate if any remedial attention to its functioning is required. Clients were assessed for their competence with medication and to determine if it is safe for them to have custody of their medication. Those clients with custody keep their medication stored in a locked drawer in their room with keys held by both the client and the home. When it is not considered safe for clients to have custody, then their medication is stored centrally in the homes office. This central storage includes a bank of locked small filing drawers, one for each client, and a small purpose-built medicines cupboard that can store larger medicine containers. However, both of these storage facilities were free standing and require attaching to the wall. Provision for Controlled Drugs (CD) includes a CD cupboard meeting the Misuse of Drugs Regulations 1973 and a Care Homes for Adults (18-65 years) Page 4 of 10 CD record book. No CDs were currently stored in the home. Of the medication stored centrally, 6 items were audited, 3 for each of 2 clients. Of these, one item indicated a deficit of one tablet, being mirtazapine 15mg tablets, one at night. Records indicated that 5 tablets were received, however, administration was recorded on 6 occasions and none remained. Possible reasons for this could be: incorrect record of the quantity received or, administration recorded in error when the dose was omitted. Records are required to be accurate to indicate that medication is being administered in accordance with the prescribers directions. 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 Adults (18-65 years) 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 20 13 The registered person must 29/06/2009 ensure that the temperature of the medication storage area is monitored and recorded. This is to ensure that medication being held on behalf of clients is being stored at the correct temperature. 2 20 13 The registered person must 29/06/2009 ensure that all medicines are being stored in accordance with the relevant professional guidance. This is to make sure that all medicines held on behalf of clients is being stored securely. 3 22 23 The registered person must 31/07/2009 ensure that a improvement plan is developed and sent to the Commission giving timesales when redecoration of the communal areas will take place as well as timescales for replacement of old or broken furniture is to be replaced. This is to ensure that clients stay in a comfortable and Care Homes for Adults (18-65 years) 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 homely environment. 4 24 23 The registered person must 31/07/2009 ensure that a improvement plan is developed and sent to the Commission giving timesales when redecoration of the communal areas will take place as well as timescales for replacement of old or broken furniture is to be replaced. This is to ensure that clients stay in a comfortable and homely environment. 5 35 18 The registered person must ensure that all staff at the home undertake training in supporting people who have a personality disorder. This is to ensure that all staff at the home have the appropriate training in order to support the people who use the service. 31/07/2009 Care Homes for Adults (18-65 years) Page 7 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 20 13 Medication storage is required to be fixed to the wall. For security and to meet legal requirements 19/12/2009 2 20 13 The draft policies and 19/12/2009 procedures for medication in the home are required to be ratified and include any procedures not included that are practiced in the home. To provide effective guidance on the safe use of medicines. 3 20 13 Medicine administration records are required to be accurate and complete with full information provided. For accountability that medicines are handled safely and administered to the homes service users, as prescribed. 19/11/2009 Care Homes for Adults (18-65 years) Page 8 of 10 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 20 To maintain a record of the medicine fridges maximum, minimum and current temperatures to ensure that it is functioning correctly within the licensed range for medicines storage. To incorporate the information currently provided on four forms into a single form, thereby avoiding duplication of information, reduce the risk of transcribing error, facilitate ease of retrieving full information from archived records and providing easier audit and accountability. To use labelled dosing aid containers instead of envelopes to provide medication for short trial periods to encourage clients independence. 2 20 3 20 Care Homes for Adults (18-65 years) 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 Adults (18-65 years) 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 Adults (18-65 years) 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. 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