Care Home: Arden House

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What the care home does well The manager was keen to improve the medicine management and care plans to support the people further. All healthcare professional visits had been documented together with the outcome. It was possible to see why one medicine had been discontinued and another one started for example. The care assistant spoken with had a good knowledge of the medicines she handled enabling her to support the clinical conditions of the people. What the care home could do better: The home must ensure that the medicine management improves to a safe standard and all the requirements left at this inspection are met to ensure the health and well being of the people that use the service. Random inspection report Care homes for older people Name: Address: Arden House 18-20 Clarendon Square Leamington Spa Warwickshire CV32 5QT one star adequate service 16/04/2009 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: Debby Railton Date: 1 0 1 2 2 0 0 9 Information about the care home Name of care home: Address: Arden House 18-20 Clarendon Square Leamington Spa Warwickshire CV32 5QT 01926423695 01926315769 arden@greensleeves.org.uk www.greensleeves.org.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) : Greensleeves Homes Trust care home 33 Number of places (if applicable): Under 65 Over 65 33 old age, not falling within any other category Conditions of registration: 0 The maximum number of service users who can be accommodated is: 33 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) 33 Date of last inspection Brief description of the care home Arden House is a Regency property which was originally three terraced houses forming part of a square with a small central park. The home is at the northern edge of the town centre with local shops nearby. Leamington Spas main shopping centre is within walking distance or a five-minute bus journey. A car park is located to the front of the home. It is managed by Greensleeves Homes Trust, a not-for-profit charitable organisation Care Homes for Older People Page 2 of 10 1 6 0 4 2 0 0 9 Brief description of the care home who also manage a further 16 homes in England. Arden House is registered as a care home providing personal care for 33 older people although only 32 places are presently used due to the discontinuation some time ago of double bedrooms. The home is constructed on five floors and the first and second floors are also accessible by stair lifts. Each bedroom has a TV point, wash-hand basin and shaving socket. 28 of the rooms have ensuite facilities and there is an assisted bath on all floors and a wet room shower on the third floor. Although a passenger lift is provided as well as chair lifts, some areas of the home are only accessible via a small number of steps. There is level access to the building for wheelchair users and people with mobility difficulties via a separate entrance to the main entrance which has ramp. The dining room is situated on a lower ground floor next to the kitchen. There is a large lounge on the ground floor which has a small conservatory leading off this that overlooks an attractive and well maintained garden. The fees for a room at the time of this inspection were quoted by the manager to be £465 to £635.00 per week. Extra charges are made for hairdressing, chiropody, incontinence pads (if not assessed as needing them in which case they are free of charge). Variable charges are made for newspapers, activities, transport, care assistant escorts to hospital or appointments and social trips. Care Homes for Older People Page 3 of 10 What we found: The pharmacist inspection lasted two hours. Six peoples medicines were looked at together with their Medicine Administration Record (MAR) chart and care plans. One care assistant was spoken with and all feedback was given to the manager at the end of the inspection. The medicine management must improve to safeguard the health and well being of the people who live in the home. All the medicines were kept in a locked medicine trolley chained to the dining room wall when not in use. Surplus medicines and controlled drugs were stored in a separate cabinet. There was an inadequate system to check the prescriptions and the medicines and MAR charts received into the home, but the quantity of all medicines received had been recorded enabling audits to take place. An improved system had been installed to ensure that they do not run out of prescribed medicines. Audits indicated that not all the medicines had been administered as prescribed. Some medicines had been signed as administered when they had not been. Some medicines were unaccounted for. Hand written MAR charts were poor. They did not always contain relevant information for example the date. Without such information the records would be meaningless in the future. One person had two MAR charts for the same medicine and staff had recorded on both they had administered the medicine. This indicates that staff do not always refer to the MAR chart before the administration and signed exactly what has occurred directly afterwards. Inhalers had been recorded as administered when they had not been. Staff had secondary dispensed one medicine from one pharmacist labelled box to another, increasing the risk of potential error. This is considered poor practice as all medicines should be administered from the original pharmacist dispensed and labelled box. The care plans did not always record the clinical condition of the people in the home. One person was on night time sedation but no reference was made in the care plans other than the time to go to bed. other care plans were better in content and recorded the clinical conditions of the people. This information would enable staff to support their clinical needs. People were encouraged to self administer their own medicines and a risk assessment was undertaken but no compliance checks had been documented to check if they do so correctly as the doctor intended. One lady self administered her own inhalers but the care plan gave conflicting information as she had poor manual dexterity and was confused at times. We the commission were assured she could use her inhalers as prescribed but there was no evidence to suggest that she actually could. Care Homes for Older People Page 4 of 10 All controlled drug balances were correct and records reflected practice 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 3 14 Prospective residents should have a detailed assessment of their needs completed prior to their admission. This is so needs can be clearly identified and the home can assess if these can be effectively met. 18/05/2009 2 7 12 Care plans must be developed where wounds or pressure areas to the skin are identified. This is to ensure these are managed effectively by staff to promote healing. 18/05/2009 3 7 12 Care plan reviews need to identify changes in health and make clear what aspect of the care need has been reviewed. This is to ensure appropriate staff support is provided to the resident in meeting their needs. 18/05/2009 4 18 13 Systems for managing 15/05/2009 allegations of abuse must be followed consistently. Staff need to be clear on their responsibilities in regards to reporting any allegations made. Page 6 of 10 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 This is to ensure residents are sufficiently protected and do not come to harm. 5 27 18 A review of staffing 29/05/2009 arrangements should be undertaken to ensure these remain effective consistently. This is to ensure residents receive consistent good care to meet their needs. Care Homes for Older People 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 9 13 A system must be installed to check the prescription prior to dispensing and to check the dispensed medicine and MAR charts against the prescription for accuracy. All discrepancies must be addressed with the health care professional. This is to ensure that all medicines are administered as prescribed at all times 22/01/2010 2 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 staff practice is assessed on a regular basis and appropriate action is taken if audits indicate that staff do not administer the 22/01/2010 Care Homes for Older People Page 8 of 10 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 medicines as prescribed. 3 9 13 The medicine chart must 22/01/2010 record 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 right medicine is administered to the right service user at the right time and at the right dose as prescribed and records must reflect practice 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 2 9 9 It is advised that all hand written MAR charts are checked by a second member of staff for accuracy. It is advised that compliance checks are undertaken and documented to check that service users that self adminsiter their medicines as the doctor prescribed. 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. 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. 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