Care Home: Bramble Lodge Care Home

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What the care home does well The home has some written information about the individuals placed and information is gathered from the person`s care manager and other health professionals to help staff working at the home meet their needs. Some of the people living at the home said that they liked it and that the care couldn`t be faulted. There are good visiting arrangements and visitors are able to visit the home at any time. Controlled drugs are well managed and regular audit of the medication system is carried out. Systems to manage people`s money are robust and regular audits are carried out. Maintenance records examined during the inspection were up to date. What has improved since the last inspection? Some staff have received training in safeguarding adults and further training has been booked for staff. What the care home could do better: Assessments and care plans need to contain more specific detail to ensure that all aspects of people`s health and personal care needs are met fully. The home needs to ensure that when people`s needs change that the assessments and care plans are updated. Where accidents and incidents occur, the home must ensure that appropriate investigation is conducted to minimize or prevent further risk. There were some gaps on the medication administration records and it was not always possible to confirm that medication had been given as prescribed. A complete medication audit trail is not maintained and there is insufficient secure storage space for medicines. The range and opportunities for social and recreational activities needs to be further developed and should include life history work. Menus should be reviewed. The complaints procedure should be updated so that people know who to go to should they want to make a complaint. Standards of hygiene and cleanliness must be improved upon within the home. Staff recruitment systems need to be reviewed and accurate records of recruitment and training must be maintained. Staff need to receive regular formal supervision. The quality assurance and management systems need to be reviewed and should be able to demonstrate that they are operating on the best interests of people living at the home. The health and safety policy should be reviewed and updated. Key inspection report Care homes for older people Name: Address: Bramble Lodge Care Home Delamere Road Park End Middlesbrough TS3 7EB     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Tanya Newton     Date: 2 7 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial 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. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Bramble Lodge Care Home Delamere Road Park End Middlesbrough TS3 7EB 01642322802 01642322803 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Bramble Care Homes Ltd Name of registered manager (if applicable) Mr Kenneth Walton Type of registration: Number of places registered: care home 41 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 41 The registered person may provide the followjng 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 categories: Dementia Code DE, maximum number of places: 23 Mental disorder, excluding learning disability or dementia - Code MD, maximum number of places: 23 Date of last inspection Brief description of the care home Bramble Lodge is a two storey purpose built 41 bedded care home with nursing which operates two separate units for different categories of care. One unit is for people with a mental disorder and the other unit is for people with dementia. All 41 bedrooms are single rooms with ensuite facilities containing a toilet and wash hand basin and the Care Homes for Older People Page 4 of 30 Over 65 0 0 23 18 0 7 0 7 2 0 0 9 Brief description of the care home rooms meet the required size. There are a number of bathrooms and showers as well as a variety of lounge areas. The home is set in its own grounds, with car parking. Bramble Lodge is located close to shops, public houses and transport. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is ** stars. this means that people who use this service experience ** quality outcomes. This inspection was a key inspection. As a key inspection, all of the key standards were looked at or discussed. This was to check that the home meets the standards that the Care Quality Commission (CQC) say are the most important for the people who use services, and that it does what the Care Standards regulations say it must. The visit was unannounced and carried out by two inspectors over 6.5 hours. In addition to this a pharmacist inspector from CQC also visited the service. During the inspection, a number of records were looked at, these included care records for people living at the home, staff recruitment and training records, policies and procedures and medication systems. Care Homes for Older People Page 6 of 30 Prior to the inspection the manager also completed an Annual Quality Assurance Assessment (AQAA), which provides the Commission with information about the service. Discussions took place with people living at Bramble Lodge, staff of varying grades and roles and both the manager and area manager. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Assessments and care plans need to contain more specific detail to ensure that all aspects of peoples health and personal care needs are met fully. The home needs to ensure that when peoples needs change that the assessments and care plans are updated. Where accidents and incidents occur, the home must ensure that appropriate investigation is conducted to minimize or prevent further risk. There were some gaps on the medication administration records and it was not always possible to confirm that medication had been given as prescribed. A complete medication audit trail is not maintained and there is insufficient secure storage space for medicines. The range and opportunities for social and recreational activities needs to be further developed and should include life history work. Menus should be reviewed. The complaints procedure should be updated so that people know who to go to should they want to make a complaint. Standards of hygiene and cleanliness must be improved upon within the home. Staff recruitment systems need to be reviewed and accurate records of recruitment and training must be maintained. Staff need to receive regular formal supervision. The quality assurance and management systems need to be reviewed and should be able to demonstrate that they are operating on the best interests of people living at Care Homes for Older People Page 8 of 30 the home. The health and safety policy should be reviewed and updated. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Assessments are provided so that the home can ensure it can meet peoples needs before a service is offered. Evidence: Each person living at Bramble Lodge has a basic admission assessment in place. Assessments are provided so that the home can ensure it can meet peoples needs before a service is offered. The pre admission assessment would benefit from including more specific information about peoples individual needs. Files also contained other information gathered from the persons care manager and other health professionals. The AQAA returned to CQC detailed the pre-admission process. The home does not admit people who require intermediate care. Care Homes for Older People Page 11 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are not always appropriately recorded or evaluated. The principles of respect, dignity and privacy are not always reflected in practice. Improvements are needed in the management of medication. Evidence: Every person at Bramble Lodge has a care plan which in the main identified how peoples needs should be met. Four care plans were looked at during the inspection. The standard of recording in care plans was not specific enough and the majority of those looked at contained limited information. Care plans need to be further developed to include more person centred information. Although care plans were being evaluated, they did not reflect any specific detail and just stated no change. Not all needs which have been identified within the assessment process are then formulated into specific care plans. An example of this was a person whose assessment of needs specify that they are on Section 17 leave, their mental health assessment includes bi polar, anxiety, bizarre thoughts, overdose, depression, alcoholism, drug addictions, yet the only mental health care plan in place is for anxiety. Some of the daily records detail, tearful, weepy, reoccurring thoughts, Care Homes for Older People Page 12 of 30 Evidence: reassurance, but this again has not triggered a care plan. Another persons plan states, Plans in place for going to Mind, but the actual arrangements for this are not specified. Further records indicate has got dinner time medication with her, cocodamol 2 tablets. There is no risk assessment or medication management plan in place regarding this. Other care plans viewed did not contain up to date information following a change in needs or an evaluation. Although an evaluation had been carried out, the information had not then been carried forward into the care plan. On the day of the visit when touring the home a staff member confirmed that a resident was asleep in another residents bed as this was easier. This does not uphold the principles of maintaining peoples dignity. A number of issues had also been raised from the local authority about peoples clothes being dirty and their personal care needs not being fully maintained. The home must ensure that peoples dignity is maintained at all times. Accident records and audits were looked at. Although there is monthly analysis in place, the home need to question the effectiveness of this. There is no information showing what action the home are taking as a result of any analysis. It may be more beneficial for the home to be broken down into individual units. The home should separate out incidents and accidents and where necessary there should be further investigation for example, 9/1/10 Resident punched carer in mouth, there is nothing to indicate what action was taken, investigation etc. Two gentleman who were sat in the ground floor dining room, having chocolates and crisps said, It is great here, cant fault it another person said, The care here is alright, better than I expected it to be. The pharmacist inspector looked at the arrangements in the home for managing medication. There is insufficient secure storage space within the home for medication. Some medicines cupboards in the treatment rooms contained disposable medical items such as syringes and needles, and there was evidence of some overstocking of medication. In addition, a new system of medication packaging and supply has been introduced increasing the demand for secure and organised storage facilities. Some medication packs were on open benches or in cupboards with no locks fitted, and medicine fridges were not locked. Prescriptions for dispensing are not first sent to the pharmacy for checking and there was evidence that this had led to inaccurate or incomplete medication administration Care Homes for Older People Page 13 of 30 Evidence: records (MARs) being printed by the pharmacy, and to excessive stock of medication being dispensed, or dispensed when adequate supplies already remained in the home. In addition, because there are no detailed records of when prescriptions are ordered, dispensed and medication received, or photocopies of prescriptions kept in the home, there is no complete audit trail for the medication supply process. Disposal of surplus medication is recorded but no record is made when this medication is removed from the home by the waste contractor. Medication records for the current and previous month were looked at on both floors of the home. A number of gaps were noted where medication had not been recorded or a non administration code entered. Some medication dispensed in boxes had been carried forward from the previous month but the quantities had not been recorded on the MARs. This means that there is no complete record of medication in the home, it is difficult to check that all medicines have been given correctly as prescribed, and can lead to overstocking of medication. Some handwritten entries on MARs were not signed and dated by the person making the entry and medication entries had sometimes not been signed by a second person to confirm accuracy. The quantities of some creams and eye drops dispensed by the pharmacy had not been printed on some MARs or recorded by staff in the home, and the MARs have no designated area to record any known medication allergies. The controlled drugs cupboard appears to meet safe custody regulations and there were no discrepancies between the quantities of controlled drugs in stock and the records in the controlled drug register. There was no evidence of any regular controlled drug stock checks being carried out. Care Homes for Older People Page 14 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home needs to support people in making more choices and decisions and to reflect these within individual care plans. Activities need to be more structured around the needs, likes and dislikes of people living at the home. Evidence: The home employs two activities co-ordinators who both work three days per week. Activities in the home are very ad-hoc and there was very little in terms of a social assessment for each individual. The home does have a proforma to look at life histories but these had not been completed. Any activites that do take place are recorded in a daily diary. The activities co-ordinator who was spoken to during the inspection said that occasionally there were opportunites for people to go on trips out and that local trips to the shops could be accomodated as and when people wanted to go. It may be beneficial for the home to look at a more structured programme of activites, based on peoples likes and dislikes. One staff member said, In the way of activities more could be done, ground floor people go out a lot, its more difficult with the people upstairs, they are taken outside when the weather is better. Meals are of good quality. Care Homes for Older People Page 15 of 30 Evidence: During a tour of the home, which took place following lunch, some people were observed to be sat in the upstairs lounge. Both the TV and stereo were on, although the TV had been muted. There was no evidence seen of any social stimulation and a staff member on duty said that most people chose not to participate in any activities. Visiting arrangements are open and people were seen coming in and out of the home throughout the day. People are able to see their visitors in either the communal areas or in private and there are a number of areas in the home for this to happen. There are also tea and coffee making facilities so that visitors can make themselves a drink. The menus were looked at, which were four week rotational menus. There were choices available at all mealtimes. One person said, Food is not too good, not really much of a choice, you can take it or leave it. Menus may need to be reviewed. Care Homes for Older People Page 16 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home needs to ensure that people are supported in raising any concerns and that its policies for doing so, clearly signpost people in the right direction of who to contact. Evidence: The complaints procedure was available within reception, although it was not particularly visible. It needs to be amended as it signposts potential complainants to CQC rather than the Local Authorities or PCTs, it also signposts people to the Ombudsmen before the Local Authority. Some concerns had been raised with the Commission prior to the inspection, this related predominantly to medication, standards of hygiene and infection control and care planning. One person said, any problem I would tell my social worker, although I dont see them very often. I wouldnt tell the staff in here. The home has appropriate policies and procedures in place for safeguarding adults. Training in safeguarding vulnerable adults is booked. Care Homes for Older People Page 17 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards of hygiene and cleanliness need to be improved upon. Evidence: Bramble lodge Care home provides care for people with dementia and mental health needs across two units. It is a spacious home with a good amount of communal rooms, located throughout the home. These include a coffee lounge and sensory room. There was evidence of personalisation of peoples own rooms, with people having photographs displayed alongside other personal belongings. The garden is accesible to people who want to use it and it is a safe environment. A number of concerns about standards of hygiene and cleanliness were previously shared with the Commission following a visit by the local authority. On the day of the inspection some further concerns were raised regarding standards of hygiene within the home. During a tour of the home some of the bedding was seen to be stained. Some rooms smelt unpleasant and required additional cleaning. Some of the bathrooms and toilets required cleaning. Shower 1 was locked, it smelt musty and the floor seal needs replacing as it is coming away from the wall. Some carpets were stained and needed Care Homes for Older People Page 18 of 30 Evidence: to be cleaned or replaced, these were mainly corridors on the first floor, however the dining room on the ground floor required deep cleaning due to food remnants and heavily stained areas. The home is in the process of developing a new smoking room on the first floor for residents. Although the home employs domestic and laundry staff, there are no laundry staff on duty during the weekend. This puts additional pressure on domestic staff working in the home. One of the staff said, always sufficient aprons and gloves etc. Care Homes for Older People Page 19 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The current, recruitment, induction and training for staff does not protect people. More robust systems need to be in place and accurate records must be available. Evidence: Six staff recruitment files were looked at during the inspection. Although the files in place did have two references, these were not always from the previous employer. It was concerning to note that a number of references looked like they had been completed in the same handwriting. We queried whether this was due to them being telephone references, however even if they were, then they should still not be signed by member of staff. There were no letters on individual files showing who the referee is and references received were not on letterhead so it is hard to evidence where they have come from. Not all the application forms viewed had up to date information regarding peoples previous working history, some of the contracts of employment had not been completed. One person had been employed for bank work. They are employed in one of the other homes in the company. There was no recruitment information available, no orientation or induction. Training records were looked at. A lever arch file was made available which contained individual training sheets and training certificates. The individual training sheets had not been completed, they were blank. A training matrix was in place, which was not up to date, there were a significant number of blanks. Some of the training files Care Homes for Older People Page 20 of 30 Evidence: looked at had no record of induction and there was no record of any training which had been provided. Up to date NMC records were not available for the qualified staff. These were obtained during the inspection. There was no evidence of Mental Capacity Act (MCA) training or Deprivation of Liberty (DOLS) which is significant particularly with the client group accommodated at the home. The area manager confirmed that this would be taking place. Some of the staff working at the home were asked about the recruitment process, one person said, I was interviewed and during interview process was told about the fire procedure, fire points and bath chairs. No actual induction. In terms of training they said they had covered some fire and health and safety - hand washing. They had not received training in safeguarding adults, despite working alone on a one to one basis with them. Care Homes for Older People Page 21 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health, safety and welfare of people who live at the home and staff is promoted and protected. Evidence: The manager of Bramble Lodge is a Registered Mental Nurse, who has the relevant experience and qualifications to manage a home. He has been in post for a number of years. However, as identified throughout this report, management systems have not been good enough and have not ensured that the service has been operating in the best interests of people living there. Quality assurance systems were looked at. Regulation 26 visits are carried out by a nominated company individual on a monthly basis. Questionnaires are available in the home but the manager said that they have a very poor return rate. These had recently been sent out to relatives. Although meetings were held for relatives and people living at the home, the attendance rate was poor. Care Homes for Older People Page 22 of 30 Evidence: The home need to look at alternative ways to gain feedback on the service being provided. Following a number of issues raised from the local authority and the issues identified within this inspection report, the home needs to ensure that its own internal quality assurance processes identify any issues of concern and that appropriate action is taken to address any shortfalls in the service. Accidents/incidents are not always followed up or investigated and as such, do not contain the detail needed in terms of an effective management tool, which again would identify issues and prompt appropriate action. A sample audit of monies held by the home on behalf of the people that live there found no discrepancies between amounts recorded and money held. Money is held in individual wallets. These are audited by an internal company representative on a monthly basis. People were asked about supervision, comments include, Supervision - no actual formal supervision but Ken and Mike are approachable. When we looked at records of supervision it was clear that these were not all up to date. All staff should receive a minimum of six supervision sessions each year. The health and safety file was looked at, the actual health and safety policy statement is dated 19/10/07 and has JF as the operations director, she is no longer working for the organisation. The actual H&S procedures are dated December 2007, with no evidence of review or updating. During feedback the area manager confirmed that all of the H&S policies/procedure were currently being reviewed. Maintenance records looked at during the inspection were up to date. As identified earlier in this report, staff are not up to date with all of the required training. Care Homes for Older People Page 23 of 30 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 The registered person must 31/08/2009 ensure staff follow the policies and procedures in relation to the administration of medications. To promote the safety and welbeing of the people living at the home Care Homes for Older People Page 24 of 30 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, Care Homes 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 7 15 Care plans must contain specific information about the individual and their needs. They must be reguarly evaluated and updated. Care plans must provide staff with the information they need to meet peoples needs. 20/06/2010 2 8 12 In the event of 20/06/2010 accidents/incidents, effective measures must be in place to reveiw, follow up and investigate any matters where necessary. This will ensure proper provision for the health and welfare of people. 3 9 13 All medication must be 28/05/2010 stored securely and in a way which supports good stock control, and medicines cupboards should be used Care Homes for Older People Page 25 of 30 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 exclusively for the storage of medicines. This will protect medicines from being tampered with and will assist in effective stock control. 4 9 13 Accurate records must be kept of all medicines received, administered and leaving the home, including the quantities of any medication carried forward from the previous month. 28/05/2010 This will provide a full audit trail for all medication. 5 9 13 Medication records must be 28/05/2010 accurately maintained; the reasons for nonadministration must be recorded by the timely entry of an appropriate code or entry on the medication record; the meaning of any such codes must be clearly explained on each record; and the person administering the medication must complete the Medication Administration Record at the time of administration This will ensure that an accurate record of Care Homes for Older People Page 26 of 30 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 medication administered is maintained. 6 10 12 Suitable arrangements must 28/05/2010 be made to ensure the care home is conducted in a manner that ensures respect and dignity of people living at the home, To ensure that people are treated at all times with dignity and respect. 7 19 23 Standards of cleanliness and 28/05/2010 hygiene throughout the home must be improved upon. To ensure the health, safety and well being of service users and staff living at the home. 8 29 18 The registered person must 20/06/2010 operate a thorough recruitment procedure. Appropriate references must be sought. To ensure the protection of people living at the home. 9 30 18 All staff must be provided with with appropriate training for the work they are to perform. 20/06/2010 Care Homes for Older People Page 27 of 30 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 To ensure that people living at the home are cared for by suitably skilled and trained staff. 10 33 24 A review of the quality assurance systems must be made to ensure that they are effective. To demonstrate that the home is ran in the best interests of the people living there. 11 38 18 All staff must receive appropriate training for the work they are to perform. To ensure staff have the specific knowledge, skills and experience to carry out their roles effectively. 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 20/06/2010 20/06/2010 1 2 3 9 Assessments should contain more specific information about how a persons needs should be met. Removal of medicines for disposal should be recorded on the appropriate page of the medicines disposal record book. A current copy of the British National Formulary and other relevant guidance on the handling of medicines in social care, and a copy of the providers medicines policy should 3 9 Care Homes for Older People Page 28 of 30 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 be available within each treatment room. 4 9 Handwritten entries on MARs should be signed and dated by the person making the entry and checked and signed by a second person to confirm accuracy. Prescriptions should come to the home first for checking prior to being dispensed and full records maintained for each stage of the ordering process, including keeping a photocopy of each persons prescriptions in the home. Oral syringes should be used for the administration of liquid medicines. The pharmacy should be requested to print any medication allergies onto each persons MAR wherever there are know medication allergies. Regular controlled drug checks should be carried out and recorded in the controlled drug register. Medicines storage should be reviewed on both floors, and additional medicine cupboards obtained, to accommodate all medication. This should include an audit of all medication held in the home and action to reduce further overstocking of medication. Activities need to be more structured around the needs, likes and dislikes of people living at the home. The home needs to support people in making more choices and decisions and to reflect these within individual care plans. The complaints procedure needs to be updated to reflect the appropriate contacts if a complaint is made. The home should consider employing additional laundry staff on a weekend. Management systems and practices should be reviewed to make sure that it is effective and that the home is being ran in the best interests of service users. All staff should be provided with a minimum of six supervision sessions each year. The Health and safety policy should be reviewed and updated. 5 9 6 7 9 9 8 9 9 9 10 11 12 14 12 13 14 16 26 31 15 16 36 38 Care Homes for Older People Page 29 of 30 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. 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