Care Home: Branthwaite Nursing Home

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What the care home does well The manager had made improvements in the management of medication. Regular checks, or audits, of medication were being done that will help to identify areas for improvement to protect residents from errors. The manager has also started a programme of assessments of competences of staff in the safe administration of medicines to make sure they follow safe practices. What the care home could do better: Ordering procedures for medication must be improved to prevent medicines running out and to make sure residents always have the treatments they need. The manager must also ensure that staff who administer medication follow prescribed directions accurately so that residents receive safe and effective medication as intended by their doctors. Whilst work is being done to improve care plans there are still further improvements to be made to make sure that there is clear guidance for staff on the safe and appropriate management of medication. Random inspection report Care homes for older people Name: Address: Branthwaite Nursing Home Branthwaite Road Workington Cumbria CA14 4SS zero star poor service 16/03/2010 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: Angela Branch Date: 2 7 0 7 2 0 1 0 Information about the care home Name of care home: Address: Branthwaite Nursing Home Branthwaite Road Workington Cumbria CA14 4SS 0190067111 0190068339 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Margaret Rose Visick Type of registration: Number of places registered: Conditions of registration: Category(ies) : Aspenframe Ltd care home 57 Number of places (if applicable): Under 65 Over 65 0 0 57 0 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Conditions of registration: 57 57 0 57 The registered person may provide the following category of service only: Care home with nursing - Code N To people 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 - Code OP Physical disability - Code PD Mental disorder, excluding learning disability or dementia - Code MD Dementia - Code DE The maximum number of people who can be accommodated is: 57 Date of last inspection Care Homes for Older People 1 6 0 3 2 0 1 0 Page 2 of 14 Brief description of the care home Branthwaite Care Home is situated on the outskirts of Workington. The home is a care home that can provide nursing care for 57 people in the above categories. There are three distinct areas in the home - the general nursing unit, a memory care unit for people with dementia and the Harrington Unit that helps people who have complex mental health needs including challenging behaviour. All of the bedrooms are single occupancy and have en suite facilities. There are pleasant communal areas in all three units. Outside, there are raised gardens at the rear, and to the front and side of the home are paved areas. Information about the service is made available in a statement of purpose and service user guide that is on display in the foyer along with inspection reports. The fees currently charged by the services range from £398 to £945 per week and this does not include personal toiletries, personal newspapers, magazines and hairdressing. Care Homes for Older People Page 3 of 14 What we found: The pharmacist inspector examined the handling of medication by looking at relevant documents, storage and meeting with the manager Margaret Visick and other staff. The reason for the visit was to follow up requirements made at the last pharmacist inspection on 4 May 2010. The inspection took just over five hours. Feedback was given at the end of the inspection to the manager and senior staff, and by telephone to the Managing Director, and Responsible Individual, of the service. Overall we found that despite some improvements being seen in medicines handling there continued to be mistakes and other concerns that could affect the health and well-being of residents. Two of the requirements made at the last inspection remained unmet. We looked at records for receipt, administration and disposal of medication and these had improved. However, we still saw some errors such as gaps in the records, and records for a blood-thinning medicine were poor increasing the risk of administration errors that could be dangerous. We looked at the administration of a sample of medication and saw that some were not given in the correct dosage. For example, we saw courses of antibiotics that were not completed properly. We also saw a recent error in the administration of the bloodthinning medicine. This resulted in the resident receiving a dose when the doctor had instructed it to be missed because the blood was too thin. This would increase the risk of bleeding complications that could be serious. We also noted some medication had gone missing and could not be accounted for. On occasions the home did not have medication available to residents. Two residents did not have most of their regular medication on the first day of the current four-week cycle of medication received from the pharmacy. This included heart medication and stomach protecting medication. Staff told us that on the day of the inspection a resident was complaining of constipation yet their laxative had been allowed to run out for the second time in a month. We checked a sample of care plans. Staff were working to improve these but further work was still needed. We checked the care plans for a resident who had swallowing difficulties and who was at risk of food and fluids going down the wrong way. There had been much input from healthcare professionals that was documented. The medicines records for this resident said that one of their tablets should be dissolved in water. There was no care plan in place to show that this was being administered safely and following full discussion and agreement with healthcare professionals. We checked medicines liable to misuse, called controlled drugs, and these were stored and recorded properly. The manager did regular medication checks, or audits, that will assist in identifying concerns that need addressing to protect residents from medication errors. The manager was also in the process of doing assessments of competence of staff who administer medicines to make sure they follow best practice to keep residents safe. What the care home does well: Care Homes for Older People Page 4 of 14 The manager had made improvements in the management of medication. Regular checks, or audits, of medication were being done that will help to identify areas for improvement to protect residents from errors. The manager has also started a programme of assessments of competences of staff in the safe administration of medicines to make sure they follow safe practices. 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 14 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 7 15 Individual care plans must 28/05/2010 reflect the needs and wishes of the individual and contain guidance for staff about nursing and care interventions and personal preferences and wishes. This must be done to comply with Regulation 15 of the Care Standards Act 2000 and to ensure that people get the highest possible standards of care. 2 8 12 The registered person must 28/05/2010 ensure that individual health and nursing care needs are met at all times. This must be done to comply with Regulation 12 of the Care Standards Act 2000 and to ensure that good health care planning is in place. This should include nutritional planning, pressure and wound care and behaviour managment to ensure people receive high standards of physical and mental health care. 3 9 13 Ordering procedures for 01/06/2010 medication must be reviewed to prevent medicines from Page 6 of 14 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 running out. This will ensure that residents always have the treatment they need. 4 9 13 All records for administration 01/06/2010 of medication must be accurate and free from errors. This will protect residents from mistakes that could cause harm to their health and well-being. 5 9 13 Medicines must be given in the prescribed dosage. This will ensure that residents receive safe and effective treatment. 6 12 16 A programme of social and 28/05/2010 therapeutic activities must be developed for people with organic mental health problems and for people with functional mental health issues. This should take into account ability and any special needs or requirements. Where necessary individual programmes must be drawn up. This requirement had an original end date of 12/03/2010 and has been extended. This must be done to comply with Regulation 16 of the Care Homes for Older People Page 7 of 14 01/06/2010 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 Care Standards Act 2000 and to combat lack of stimulation, disorientation and challenging behaviours in vulnerable people. 7 18 13 It is required that, through training or by other means, all staff understand their responsibilities and job role in relation to safeguarding vulnerable adults. This requirement had an original end date of 12/03/2010 and has been extended. This must be done to comply with Regulation 13 of the Care Standards Act 2000 and so that staff understand what is abusive and so that they also understand how to report, or where appropriate, manage any safeguarding issues. 8 19 23 IT is required that the 28/05/2010 planned improvements to different areas of the building are completed in a timely fashion and a completion report sent to the Care Quality Commission. This must be done to comply with Regulation 23 of the Care Standards Act and so that people live in a well maintained and comfortable home that has access to outside areas. 28/05/2010 Care Homes for Older People Page 8 of 14 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 9 26 23 IT is required that suitable 28/05/2010 measures are put in place so that all areas of the home are clean and hygienic at all times. This must be done to comply with Regulation 23 of the Care Standards Act 2000 and so that peoples health and well being are not compromised and so that staff understand their responsibilities to maintain good hygiene levels when undertaking housekeeping and care tasks. 10 27 18 It is required that there are sufficient staff on each shift who have the skills and knowledge required to meet the needs of residents. This must be done to comply with Regulation 18 of the Care Standards Act 2000 and to ensure that eacg shift has workers on duty who know how to deliver appropriate care and services. 28/05/2010 11 29 19 IT is required that any new 28/05/2010 member of staff has two references - ideally with one being the last employer;is checked against the Protection of Vulnerable Adults List and has a Criminal Records Bureau check before they start to work directly with vulnerable people. Care Homes for Older People Page 9 of 14 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 The registered person must do this to comply with Regulation 19 of the Care Standards Act 2000 and to ensure that people in the home are protected from potential harm or abuse. 12 30 18 It is required that all staff 28/05/2010 attend the basic training programme that is set out by the company. This must be done to comply with Regulation 18 of the Care Standards Act 2000 and to ensure that staff are suitably skilled and knowledgeable for the work they perform. 13 36 18 It is required that all staff receive formal supervision and also have their practice observed. This needs to be done to comply with Regulation 18 of the Care Standards Act and to ensure that staff have the opportunity to discuss concerns, training needs and to reflect on practice. Staff competencies need to be checked through observation and formal supervision. 14 37 17 IT is required that a review is 28/05/2010 held on the way records are maintained in all areas of the service. This must be done to comply Care Homes for Older People Page 10 of 14 28/05/2010 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 with Regulation 17 of the Care Standards Act 2000 and to ensure that clear and concise information is available that will help the home to function efficiently. 15 38 37 It is required that the 28/05/2010 registered person ensures that the kitchen is kept in a clean and orderly fashion; that food safety rules are applied; that staff understand how to handle hazardous substances and that records are kept of food temperatures. You must do this to comply with regulation 16 of the Care Standards Act 2000 and to ensure that safe working practices are in place for food safety so that food is stored and prepared correctly in order to lessen the risk to service users. 16 38 13 It is required that all staff attend updates to manual handling training and that their competence in this is checked by persons trained to do so. This outstanding requirment has been extended. This must be done to comply with Regulation 13 of the Care Standards Act 2000 and to ensure that safe manual handling is carried out and that both staff and residents are kept as safe as possible. Care Homes for Older People Page 11 of 14 28/05/2010 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 Care Homes for Older People Page 12 of 14 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 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 9 It is highly recommended that care plans are more thorough to provide staff with clear guidance on managing residents with specific care needs so that they receive safe and effective treatment. Care Homes for Older People Page 13 of 14 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. 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