Care Home: Avon Court

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What the care home does well There was a relaxed atmosphere within the home. People have access to a local General Practitioner. The communal lounges are comfortable. The rear garden is well maintained and provides a pleasant place to enjoy the warmer weather. What the care home could do better: The management and administration of medication needs to be improved to ensure that systems are safe and that people always receive their medication as prescribed. Improvements in the documentation and processes regarding staff recruitment are needed to ensure that safeguards are fully in place to prevent unsuitable people gaining employment caring for people. A review of training staff have attended needs to be undertaken to establish any gaps in this area. Following this review an action plan should be devised. Management systems need to be improved in areas such as staff supervision and fire records. Random inspection report Care homes for older people Name: Address: Avon Court All Saints Road Warwick Warwickshire CV34 5NP two star good service 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: Andrew Spearing-Brown Date: 2 1 0 6 2 0 1 0 Information about the care home Name of care home: Address: Avon Court All Saints Road Warwick Warwickshire CV34 5NP 01926401324 01926401324 Telephone number: Fax number: Email address: Provider web address: info@prime-life.co.ukwww.prime-life.co.uk Name of registered provider(s): Name of registered manager (if applicable) Miss Claire Wright Type of registration: Number of places registered: Conditions of registration: Category(ies) : Prime Life Ltd care home 34 Number of places (if applicable): Under 65 Over 65 0 34 dementia old age, not falling within any other category Conditions of registration: Restrictions at age 65 no longer apply. 34 0 The maximum number of service users who can be accommodated is: 34 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: Dementia (DE) 34, Old age, not falling within any other category (OP) 34 Date of last inspection 0 9 0 6 2 0 0 9 Care Homes for Older People Page 2 of 12 Brief description of the care home Avon Court is a care home providing personal care and accommodation for up to 34 service users over the age of 65 years. Accommodation consists of all single bedrooms, over two floors. Two types of service are provided at the home, dementia care and transitional care. There are 5 permanent dementia care places, 5 short stay dementia care places ands 24 transitional care places. Avon Court does not take any privately funded service users. Referrals for the transitional places are through the hospital social work team. Copies of the last inspection report are available at the home. Care Homes for Older People Page 3 of 12 What we found: This inspection was unannounced. Therefore nobody within the home knew that we were going to visit. This inspection was carried out by one compliance inspector over one day. The last key inspection at Avon Court was carried out during January 2008. The outcome of that inspection was that we rated the service as Good. Since our last key inspection we have carried out two random inspections. The first of these random visits was during August 2008. The most recent was carried out during June 2009. That inspection was carried out by a pharmacy inspector who made one requirement in relation to differing shortfalls regarding the management and administration of medication. Prior to our visit we requested an Annual Quality Assurance Assessment (AQAA) from the service. The AQAA is an opportunity for providers of a service to tell us about areas where they are doing well and areas where they believe further development is needed. When we visited the service the manager was on a day off. Therefore we referred to the senior carer, who was on duty at the time, throughout our visit. In addition were two carers, a domestic and a cook. The home was accommodating six people when we visited one of whom was due to return home that day following a respite stay. The home had two people who were long stay residents. Within our previous report we wrote that information about the home is given to people by the hospital social work team or ward when they are referred to the service. The AQAA stated the service works in conjunction with social services and Warwick hospital to provide short team accommodation until such time that people are able to return home or move into permanent care. We asked for a copy of the Service Users Guide but unfortunately one could not be found within the home. We were told within the AQAA that the service was to introduce a Meet and Greet checklist as a means to ensure that people receive a positive reception into the home. We did not see these on file and therefore we asked whether they are used. Although a blank template was found on the computer nothing else was known about this document. We saw information supplied by Warwickshire County Council held within peoples files. Assessments were carried out by the service which contained brief details of peoples care needs. These were not dated or signed by the person who had carried out the assessment. Care plans were in place covering areas of care needs. We asked about a care plan in relation to the use of a prescribed cream. We were told that one did not exist because it appeared on the medication records. We could not find any reference to this ointment within any other documents within the home other than the medication sheets. Some information on care plans was incorrect such as the use of food supplements. Other records were held such as daily records, a communication book and a GPs book. We have previously reported that people are temporarily registered with a local GP service. During our visit a GP attended the home due to staff having concerns about a residents dietary intake. We were informed that a review was scheduled to take place involving a social worker in relation to another resident. Risk assessments are carried out. The falls Care Homes for Older People Page 4 of 12 assessment on one person had the wrong name upon it. We were however assured that it was an accurate reflection of the person intended. We assessed the management, storage and administration of medication. Medication is stored in suitable trolleys. We viewed the medication held within the trolleys on both the ground and first floor. Due to the service provided the majority of people have their medicines dispensed from the original container rather than using a monitored dosage system. We therefore viewed the boxed medication, currently in use, for most people living at the home. The date of opening was not recorded upon boxed or bottled medication which can made the auditing of medicines easier and therefore demonstrating that people have received items as prescribed. We looked at the current months Medication Administration Record (MAR) sheets. Although overall we found MAR sheets to be completed satisfactorily we did nevertheless need to seek clarification about some areas in relation to most people. We saw that some staff were printing their initials on the MAR sheet to indicate that they had administered medication rather than a signature. MAR sheets are handwritten by a member of staff. These entries are not checked for accuracy by another member of staff. We saw one entry whereby the dosage on the MAR sheet was half the strength of the medication held within the trolley. We viewed the previous MAR sheet and found the same discrepancy. A list of medication supplied by the hospital at the time of discharge showed that the dosage which staff were administering to be correct. However if a medical professional had viewed the MAR sheet without referencing any other document they would have obtained incorrect information about the persons medication. It was of concern that not only was the dosage written down on two MAR sheets incorrectly but staff had not noticed this error as medication should be checked against the MAR sheet prior to administering. We audited one persons painkillers over a period of two months MAR sheets. A carry forward was shown on the second sheet and this balanced with the drugs remaining. However we could not balance the month beforehand to establish how the carry forward figure was established. We carried out further audits. Some of these balanced however others did not. In cases where they did not balance we checked our findings with the senior carer who agreed with them but was unable to account for our findings. We saw a small number of gaps on MAR sheets whereby staff had not signed the sheet to indicate medication given or enter a code to explain why medication was omitted. We audited some of these to establish whether the medication was given. We found that the medication balanced assuming medication was not given as prescribed. We asked whether any explanation could be given or any record made as to why it appeared some people had not received some of their medication. The senior carer was not aware of any reason and no written record why this had occurred could be found. As a result of the above findings we issued an immediate requirement in relation to the management and recording of medication. This requirement was followed up by a letter to the provider. A copy of the letter was also sent to the manager. Prior to preparing this report we had discussions with these people on the telephone and received a written response regarding the actions to be taken within the home in order to meet our requirement. Care Homes for Older People Page 5 of 12 A dedicated fridge is provided for any item requiring special storage. This piece of equipment was not in use at the time of our inspection. We saw the storage facilities for medication known as controlled. The cabinet was empty as the home had nobody requiring such medicine at the time of the inspection. We viewed the controlled drugs register (CDR). Pages within the CRD were turned in on themselves to demonstrate that the item recorded was no longer in use. We saw two entries within the register showing medication to be still in the home however as reported above the cabinet was empty. On viewing a book recording items returned to the pharmacy we found these items. On our survey sent to residents before the inspection the answer to our question upon whether activities are provided were mixed. When asked what the service Could do better one person replied More activities. During our visit we did not see any social activities taking place. We saw staff on a number of occasions sat outside on garden furniture having a drink or in some cases a cigarette. A notice was on display saying that activities take place between 3.00pm and 4.00pm on Mondays, Wednesdays and Fridays. A rota of activities was also on display showing events such as bingo, quiz, painting and snakes and ladders. Photographs were on display of residents during a recent outing to the butterfly farm at Stratford Upon Avon. A poster showed dates when outings were scheduled to take place. During this visit we had a brief look around the home. Avon Court consists of 34 single bedrooms on two floors. Two bedrooms have en suite facilities. One of these bedrooms is used by the manager in the event of her needing to stay overnight. As the home was only accommodating a small number of residents at the time of our visit some parts of the home were not been used. The home has two lounges on each floor. These were comfortably furnished. One of the lounges upstairs contains kitchenette facilities which can be used to assess people who may be returning to their own home. An electric organ in this room had a label on it showing that it failed a portable appliance test in 2004. The plug had been removed from this item to prevent anyone using it. The carpet near to the dining room was stained. Communal toilets and bathrooms are functional in appearance and in need of refurbishment. We saw a thermometer in a bathroom to test bath water however this information is not recorded. One bath was last serviced during December 2009 therefore due another service. We were told that contractors attended when due. The boxing in around the outlet pipe in one toilet was rotten. Sluice rooms were not locked, although a sign on the door says they should be. These areas did not however contain any hazardous chemicals as these are held elsewhere. The senior carer informed us that she would record a potential trip hazard and a faulty light within the homes maintenance book. The bedrooms of people not on respite care were personalised. Freestanding wardrobes are not secured to prevent accidental toppling. Bedroom doors are lockable. We were informed that nobody held a key. However the locks appeared to be ones whereby people could potentially lock themselves into their own room. Families and friends of people who are receiving short term care at Avon Court are requested, where possible, to do most of the personal laundry for residents. Items such as sheets and towels are laundered by an external company off the premises. Care Homes for Older People Page 6 of 12 We saw hand gel within bedrooms and around the care home. In addition we saw an ample supply of personal protective equipment such as gloves and aprons. The senior on duty was unable to find complaints records within the home. Upon the AQAA we were informed that the service has received 3 complaints during the 12 months up until November 2009 none of which were up held. Information was displayed within the hallway about complaints however they made reference to the former regulator (CSCI) and one referred to our office in Leamington Spa which closed a number of years ago. We saw a display of cards outside the dining room complementing the service for the care they had given to people. We looked at the file on a member of staff recruited since our last inspection. The application form was signed but not dated. We saw one written reference on file. A verbal reference was recorded however this was dated over 5 months after the person had commenced employment. A section for recording when a CRB (Criminal Records Bureau) was received at head office was blank. The member of staff concerned confirmed that a CRB was obtained prior to employment starting. We were unable to view any records regarding staff supervision. One person told us that they could not recall the last supervision session they had received. We viewed the training records of some members of staff. Many of those we viewed showed that they undertook training on fire safety, controlled of substances, moving and handling and food hygiene on the 18th February 2010. Records showed that some night staff last received training in moving and handling and hoisting during 2006. During our visit we were informed that 4 out of 17 people hold an NVQ (National Vocational Qualification). As this equals 24 percent of the staff it falls well below the associated National Minimum Standard. People are able to have money and other valuables held in safe keeping for them. As the key to gain access to these items was held by the manager who was not on duty we were unable to check the money held against the records. We were informed that audits are performed by personnel from Prime Life to ensure that they are accurate. We were not able to view any recent documents in relation to quality assurance such a reports following Regulation 26 visit. We saw a quality assurance document in the hallway however this was dated September 2006. We were given a blank copy of a Friends, relatives and visitors satisfaction questionnaire. The results from this survey are not yet known. We were informed that the fire alarm is tested on Friday. However on checking the dates this is not the case. The records following the testing were not up to date and showed a number of gaps. The last recorded test was on a Tuesday almost three weeks before our visit. During May the alarm was tested twice which was also the case during April. During March 2010 it was once while in January no tests are recorded. The testing is not done in sequential order. We could not find evidence that the home has tested one break glass point since September 2007. Care Homes for Older People Page 7 of 12 We saw a care assistant park a wheelchair without footrests fitted under the stairs well. In this area was another wheelchair also without footrests. A cardboard box was also in this area full of footrests. We asked whether the wheelchair had just been used and this was confirmed. The senior carer instructed that footrests be fitted. We later saw the same wheelchair with a resident sat within it. The chair had one footrest fitted at this time. We were told that the other one could not be found. Using wheelchairs without having the correct footrests in place can be potentially dangerous to people in relation to possible accidents happening. The passenger lift was serviced in early November 2009. We saw a document saying that a thorough examination needs to be carried out within an interval of 6 months therefore the service was due early May 2010. While we were in the home a service was carried out. However this was 7 weeks later than needed. 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 8 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 9 13 The Medicine Administration Record (MAR) chart must record all the prescribed medication and staff must ensure that all medication is administered as prescribed at all times. All external preparations must be recorded when they are applied. This is to ensure there is a record of all prescribed medicines and their administration/ application to demonstrate they have been given as prescribed. 09/07/2009 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 1 9 13 Regulation 13(2) 23/06/2010 The service must ensure that the prescribed dose on medication records is correct and matches the medicine held. This is to ensure that people receive the correct medication. 2 9 13 Regulation 13 (2). 23/06/2010 The service must ensure that records regarding medication carried forward are correct and that the balance of medication held is correct This is to ensure that people receive the correct medication. 3 9 13 Regulation 13(2) 23/06/2010 The service must ensure that people received their medication as prescribed and that medication records are completed accurately. This is to ensure that peoples health care needs are met Care Homes for Older People Page 10 of 12 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 38 13 Regulation 13 (4). 16/07/2010 The service must ensure that footrest are in place on wheelchairs. To safeguarding people using the service from unnecessary risk. 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 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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. Re-publishing this information is in breach of the terms of use of that website. 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