Care Home: Breme

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What the care home does well We looked at the care of two people who use the service. We saw they had care plans in place. The quality of the care plans varied. Both care plans were person centred and contained a satisfactory standard of information within them about the care needs of the people so that staff know what care these people need. We spoke to staff about these two people and they had a very good knowledge of the care needs of both people and were able to `fill in the gaps` of care information which was not in the care plan. This ensured the people whose care we tracked were receiving good outcomes of care. We saw one person was falling frequently and the staff were monitoring the falls each time they happened, to enable them to see if there is a reason or common theme emerging why this person is falling, so that the home can put any measures into place to reduce the number of falls. We saw one person had developed a small pressure sore and other skin injuries. We saw that the home had taken immediate action to ensure equipment was obtained to use for this person on their bed and chair to reduce the pressure on their skin when sitting or lying in bed. We saw the staff had contacted the Distict Nurse who was coming into the home to assess and treat the skin problems. We spoke to the person using the service who told us they were happy with the care they received. We saw that they had a specialist mattress and cushion they were using to reduce and prevent any further damage to their skin when sitting in their chair or lying in bed. We could see from the daily records that the people were receiving the personal care as agreed in their care plan. We saw the people who use the service had agreed to their care plans. We saw that the people we case tracked had been helped to look their best by staff, for example, people had clean clothes and their hair and nails were well looked after. We saw the staff had contacted the Doctor when the people were showing signs of being unwell and had carried out the Doctors instructions about their care. We found that there was good documentation and recording of all medicine records. We looked at the majority of medication administration record (MAR) charts and overall found that they were well documented with a signature for administration or a reasonwas recorded if medication was not given. We saw that the times of administering medicines were clearly highlighted on the MAR charts. We saw directions recorded for the application of any external preparations such as creams or ointments, however it was not always clear where the cream or ointment was to be applied. Overall, there were arrangements in place to ensure that medication is administered as directed by the prescriber to the person it was prescribed, labelled and supplied for. Medicines were not always stored at the recommended room temperatures. We looked at the three storage rooms used for medicines. The temperature of the room on the first floor was recorded daily at 25 degrees C and one reading was 26 degrees C. We were shown a new storage room for medicines on the ground floor. We saw the daily temperature records were documented between 19 to 21 degrees C. Medicines should be stored at a temperature of 25 degrees or below to ensure their safety. We were informed that new air conditioning units were due to be installed in two of the medicine store rooms the following week thus ensuring the medication will be stored within the temperatures recommended by the manufacturer. Medication that required special storage in controlled drug cabinets were stored safely following the Misuse of Drugs (Safe Custody) Regulations. Information about peoples medicines were generally recorded in their care plans and any medicine that was prescribed on a when required or as needed basis was detailed in each persons care plan to ensure the person was safe from harm. Overall, we saw improvements in the control and handling of peoples medicines. We saw that the relevant staff had received updated training and support about the writing of care plans and the management of medication to ensure people received good outcomes of care and are not placed at risk of harm. We look at how the home wash foul laundry. We saw staff put foul laundry into special red bags. The laundry staff told us they wash foul laundry at 75 degrees Celsius as this ensures there is no risk of cross infection. We looked at the content of the reports of the monthly visits carried out by a representative of the organisation to see if they were in line with the Regulation, enabling them to monitor the quality of the service. We saw these reports were now very comprehensive. The reports showed the senior manager looks at care plans, medication management, the environment and seeks the views of the people who use the service and staff to give them an overview of the quality of the service being provided. Any shortfalls in the standards are reported to the manager and an action plan is made to address these shortfalls. Any shortfalls identified the previous month are followed up by the senior manager to ensure they have been addressed. The manager told us the visits are now all unannounced. What the care home could do better: The following are examples of areas where further improvement could be made to the care records to ensure they contain full and accurate information about each person`s care needs and will reduce the risk of people not receiving a consistent standard of care.Care plans for the care of the person`s skin should be updated and reviewed if there are any changes identified to their skin condition to show what action the home have taken to address the problems. Information from risk assessments relating to the risk of a person developing a pressure sore should be incorporated into the care plan. Risk assessments for nutrition and pressure sores need to reviewed at least once a month and more often if there is any identified concern in any of these areas. Risk assessments for the management of behaviour and mood of people who use the service should be reviewed if there are any incidents of this nature. The service need to ensure people`s weight is checked and recorded at least monthly to ensure they are maintaining a healthy weight for their age and build. All care plans need to be reviewed at least monthly to identify if the care being given is what the person needs to ensure their health and welfare is met at all times. If people have diabetes, there should be a care plan in place telling staff the specific care which is needed to ensure this person`s condition is managed well. The care plan needs to inform staff how to recognise if the person`s blood sugar levels are high or low and what action to take if this occurs to ensure staff take prompt and correct action to rectify the blood sugar levels. The home need to ensure all communal linen is being washed at temperatures above 65 degrees Celsius to prevent cross infection. Medicines were not always given to people at the prescribed time. For example, we saw that the morning administration of peoples medicines did not finish until 11.50am on the first floor. We were informed by the Lead Care that this was partly due to the amount of medicines to be given to people in the morning. The Lead Care told us that people who were due painkillers were given their prescribed medicines first to ensure they were not in pain and also so that there was a space between the morning dose and the lunchtime dose. We discussed these issues with the manager who agreed that the morning medicines can take a bit longer and that this issue would be looked at. Random inspection report Care homes for older people Name: Address: Breme 46 Providence Road Bromsgrove Worcestershire B61 8EF one star adequate service 18/12/2009 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: Sandra Bromige Date: 2 0 0 4 2 0 1 0 Information about the care home Name of care home: Address: Breme 46 Providence Road Bromsgrove Worcestershire B61 8EF 01527571320 01527882218 breme@orbit.org.uk www.heart-of-england.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Karen Keen Type of registration: Number of places registered: Conditions of registration: Category(ies) : Heart of England Housing and Care Limited care home 60 Number of places (if applicable): Under 65 Over 65 0 0 60 0 dementia learning disability old age, not falling within any other category physical disability Conditions of registration: 60 60 0 60 The maximum number of service users who can be accommodated is: 60 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) 60, Learning disability (LD) 60, Old age, not falling within any other category (OP) 60, Physical disability (PD) 60 Care Homes for Older People Page 2 of 9 Date of last inspection Brief description of the care home 1 8 1 2 2 0 0 9 Breme House is a purpose built 60 bedded home in a residential area of Bromsgrove, which is close to the town centre and is on a bus route. The home offers a service for 60 older people who may have a physical disability and mental health needs associated with older age. Additionally the home is registered for 2 people over the age of 65 who have a learning disability and has a separate 8bedded unit for people who have dementia. The home is on three floors and all the bedrooms are single and en-suite with toilets and showers. The upstairs rooms can be accessed by passenger lift and there are handrails throughout the building. Separate toilets and bathrooms are adapted for people with physical disabilities. Communal lounge, dining facilities and kitchenettes are provided on all floors and there is an attractive garden. The registered providers for the home are Heart of England Housing and Care Ltd for whom Ms. Michelle Shawcross is the responsible individual. Mrs Karen Keen is the homes registered manager. Up-to-date information relating to the fees charged for the service is available on request from the home. Care Homes for Older People Page 3 of 9 What we found: This was an unannounced inspection which took place over one day and was carried out by one Inspector and a Pharmacist Inspector. The reason for the visit was to see if the service had complied with the seven requirements made at the key inspection in December 2009. We found good outcomes of care for the people whose care we tracked and due to this made a judgement that the service have complied with all seven requirements, which relate to the health, safety and welfare of the people who use the service. What the care home does well: We looked at the care of two people who use the service. We saw they had care plans in place. The quality of the care plans varied. Both care plans were person centred and contained a satisfactory standard of information within them about the care needs of the people so that staff know what care these people need. We spoke to staff about these two people and they had a very good knowledge of the care needs of both people and were able to fill in the gaps of care information which was not in the care plan. This ensured the people whose care we tracked were receiving good outcomes of care. We saw one person was falling frequently and the staff were monitoring the falls each time they happened, to enable them to see if there is a reason or common theme emerging why this person is falling, so that the home can put any measures into place to reduce the number of falls. We saw one person had developed a small pressure sore and other skin injuries. We saw that the home had taken immediate action to ensure equipment was obtained to use for this person on their bed and chair to reduce the pressure on their skin when sitting or lying in bed. We saw the staff had contacted the Distict Nurse who was coming into the home to assess and treat the skin problems. We spoke to the person using the service who told us they were happy with the care they received. We saw that they had a specialist mattress and cushion they were using to reduce and prevent any further damage to their skin when sitting in their chair or lying in bed. We could see from the daily records that the people were receiving the personal care as agreed in their care plan. We saw the people who use the service had agreed to their care plans. We saw that the people we case tracked had been helped to look their best by staff, for example, people had clean clothes and their hair and nails were well looked after. We saw the staff had contacted the Doctor when the people were showing signs of being unwell and had carried out the Doctors instructions about their care. We found that there was good documentation and recording of all medicine records. We looked at the majority of medication administration record (MAR) charts and overall found that they were well documented with a signature for administration or a reason Care Homes for Older People Page 4 of 9 was recorded if medication was not given. We saw that the times of administering medicines were clearly highlighted on the MAR charts. We saw directions recorded for the application of any external preparations such as creams or ointments, however it was not always clear where the cream or ointment was to be applied. Overall, there were arrangements in place to ensure that medication is administered as directed by the prescriber to the person it was prescribed, labelled and supplied for. Medicines were not always stored at the recommended room temperatures. We looked at the three storage rooms used for medicines. The temperature of the room on the first floor was recorded daily at 25 degrees C and one reading was 26 degrees C. We were shown a new storage room for medicines on the ground floor. We saw the daily temperature records were documented between 19 to 21 degrees C. Medicines should be stored at a temperature of 25 degrees or below to ensure their safety. We were informed that new air conditioning units were due to be installed in two of the medicine store rooms the following week thus ensuring the medication will be stored within the temperatures recommended by the manufacturer. Medication that required special storage in controlled drug cabinets were stored safely following the Misuse of Drugs (Safe Custody) Regulations. Information about peoples medicines were generally recorded in their care plans and any medicine that was prescribed on a when required or as needed basis was detailed in each persons care plan to ensure the person was safe from harm. Overall, we saw improvements in the control and handling of peoples medicines. We saw that the relevant staff had received updated training and support about the writing of care plans and the management of medication to ensure people received good outcomes of care and are not placed at risk of harm. We look at how the home wash foul laundry. We saw staff put foul laundry into special red bags. The laundry staff told us they wash foul laundry at 75 degrees Celsius as this ensures there is no risk of cross infection. We looked at the content of the reports of the monthly visits carried out by a representative of the organisation to see if they were in line with the Regulation, enabling them to monitor the quality of the service. We saw these reports were now very comprehensive. The reports showed the senior manager looks at care plans, medication management, the environment and seeks the views of the people who use the service and staff to give them an overview of the quality of the service being provided. Any shortfalls in the standards are reported to the manager and an action plan is made to address these shortfalls. Any shortfalls identified the previous month are followed up by the senior manager to ensure they have been addressed. The manager told us the visits are now all unannounced. What they could do better: The following are examples of areas where further improvement could be made to the care records to ensure they contain full and accurate information about each persons care needs and will reduce the risk of people not receiving a consistent standard of care. Care Homes for Older People Page 5 of 9 Care plans for the care of the persons skin should be updated and reviewed if there are any changes identified to their skin condition to show what action the home have taken to address the problems. Information from risk assessments relating to the risk of a person developing a pressure sore should be incorporated into the care plan. Risk assessments for nutrition and pressure sores need to reviewed at least once a month and more often if there is any identified concern in any of these areas. Risk assessments for the management of behaviour and mood of people who use the service should be reviewed if there are any incidents of this nature. The service need to ensure peoples weight is checked and recorded at least monthly to ensure they are maintaining a healthy weight for their age and build. All care plans need to be reviewed at least monthly to identify if the care being given is what the person needs to ensure their health and welfare is met at all times. If people have diabetes, there should be a care plan in place telling staff the specific care which is needed to ensure this persons condition is managed well. The care plan needs to inform staff how to recognise if the persons blood sugar levels are high or low and what action to take if this occurs to ensure staff take prompt and correct action to rectify the blood sugar levels. The home need to ensure all communal linen is being washed at temperatures above 65 degrees Celsius to prevent cross infection. Medicines were not always given to people at the prescribed time. For example, we saw that the morning administration of peoples medicines did not finish until 11.50am on the first floor. We were informed by the Lead Care that this was partly due to the amount of medicines to be given to people in the morning. The Lead Care told us that people who were due painkillers were given their prescribed medicines first to ensure they were not in pain and also so that there was a space between the morning dose and the lunchtime dose. We discussed these issues with the manager who agreed that the morning medicines can take a bit longer and that this issue would be looked at. 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 6 of 9 Are there any outstanding requirements from the last inspection? Yes £ No R 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 7 of 9 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 Care Homes for Older People Page 8 of 9 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. 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