Care Home: Briarlea

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What the care home does well As reported above the service provides information for people and actively seeks people`s views regarding the service. People we spoke to were pleased with the service they receive. On surveys returned to us, people wrote `The staff are very caring` and `care is good`. Care plans are more detailed and are regularly reviewed. The home was clean and tidy. Improvements have taken place regarding the environment such as a new wet room. Photographs on display around the home show residents actively engaging in a range of occupational and social activities. What the care home could do better: Systems regarding the monitoring of health care need to be improved to ensure that the home has up to date knowledge regarding people. This is needed to ensure that the welfare of residents is maintained at all times. The management and recording of medication needs to be improved to ensure that they are not only accurate and up to date but also to ensure that people receive the medicines they are prescribed. Random inspection report Care homes for older people Name: Address: Briarlea Badsey Road Evesham Worcestershire WR11 7PA one star adequate service 10/07/2009 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: Andrew Spearing-Brown Date: 2 1 0 5 2 0 1 0 Information about the care home Name of care home: Address: Briarlea Badsey Road Evesham Worcestershire WR11 7PA 01386830214 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Briarlea Care and Supported Living Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 26 Number of places (if applicable): Under 65 Over 65 0 26 0 dementia old age, not falling within any other category physical disability Conditions of registration: 18 0 18 The maximum number of service users to be accommodated is 26. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category (OP) 26 Physical Disability (PD) 18 Dementia (DE) 18 Date of last inspection 1 1 0 2 2 0 1 0 Care Homes for Older People Page 2 of 11 Brief description of the care home Briarlea provides residential accommodation and care for older people who may have a physical disability and/or mental health needs associated with old age. It is owned by Briarlea Care and Supported Living Limited, which is a family owned company, both directors of which are actively involved in the running of the home. The home is situated just outside Evesham in a rural area with pleasant views over the local countryside. Apart from its road frontage the home is surrounded by a level garden and orchards. The premises consist of a two-storey house. There are twenty two single bedrooms and two double rooms. The majority of the single bedrooms have en suite toilets. A passenger lift links the two floors of the home. There are two communal lounges, a large sunlounge, a dining room, three communal bathrooms and communal toilets. Car parking is available at the side of the home. For up to date details on the fees charged the reader should contact the provider directly. Care Homes for Older People Page 3 of 11 What we found: This inspection was unannounced. Therefore nobody within the home knew we would be coming. The inspection was carried out over one day and involved one compliance inspector from the Care Quality Commission. The last key inspection at Briarlea was carried out during July 2009. The outcome of that inspection was that we rated the service as Adequate. Since our last key inspection we have carried out three random inspections. This inspection was carried out in order that we could assess the progress made since our earlier visits and check compliance against requirements we have made. During this inspection we spent a considerable amount of time assessing the management and administration of medication. In addition we had a look at some care documents and a look around the home. We spoke to a director of the company, the manager designate, the deputy manager, members of staff on duty and some people living in the care home. Prior to our visit we requested an Annual Quality Assurance Assessment (AQAA) from the service. This was completed and returned to us. The AQAA is a document within which services are able to demonstrate to us where they believe they are providing a quality service. In addition the AQAA is a means within which services are able to tell us about areas they believe they could improve in the future. Information about the service is available in the reception hall of the home. A copy of both the Service Users Guide and Statement of Purpose were given to us for reference. In addition we noted that information about the home is available within everybodys bedroom. We viewed a couple of care plans as part of this inspection. A care plan is a document designed to give staff guidance in order that they are able to carry out the required care in a consistent way meeting identified care needs. The details within the care plans and the risk assessments have significantly improved over recent inspection visits. Care plans are reviewed on a monthly basis as required to capture information for staff to assist them perform their caring duties. On looking over one persons care record we asked whether the individual is a diabetic. People were unable to answer our question. We saw that the initial assessment and information from the hospital indicated the person is a type two diabetic. Furthermore the medication described in the assessment included one prescribed to people in order to manage their diabetes. No mention of this condition was made within the care plan including the one on food and drink. We were informed that the resident, as a result of our query, reported that she was back on the medication despite her believing she had being taken off it. We saw a record that the community nurse had recently carried out a blood test but the result of this test was not known within the staff group. As a result of our inquiry the GP was contacted who, we are told, at that point discontinued the medication. Over recent inspections we have raised a number of concerns about the administration Care Homes for Older People Page 4 of 11 and management of medication. Within our last random inspection report (February 2010) we wrote that we had seen improvement in the management of medication and that as a result we did not plan to take further enforcement action. We did however, at that time, bring to the homes attention areas needing further attention. As part of this inspection we looked over a random number of MAR (Medication Administration Record) sheets appertaining to some people living at the home. We found that most of the MAR sheets were filled in completely and therefore in the vast majority of cases we did not study them in great detail. Within both the areas where the medication trolleys are stored we saw a thermometer. We were told that records are maintained in relation to the room temperatures. However we did not view these records as part of this inspection. The deputy manager was aware that the temperature of these storage areas must remain at 25 degrees Centigrade or below. In the room used to store medication on the ground floor we saw certificates given to staff following accredited medication training provided by a major High Street chemist. Seven of these certificates were dated May 2010. Medicines which were prescribed as one or two to be given were not always clearly recorded by staff. For example we saw records relating to one person prescribed painkillers on a variable dosage however the records did not document how many tablets were given each time. As a result we were unable to carry out an audit of this medicine to establish whether the balance remaining was correct. On another MAR sheet we were able to ascertain the dosage of the pain relief given and we were able to successfully audit the medication and found it to balance. We found that the date of opening was recorded on most boxed and bottled medicines. On the occasions when this had not happened it made our auditing difficult. We looked at some MAR sheets containing details of recent courses of antibiotic medication and discovered some concerns. Although some MAR sheets showed the correct number of signatures for the amount of medicine, others did not. One MAR sheet had a code M recorded on three evenings. The deputy manager confirmed that M means make available. It was concluded that the three capsules were returned to the pharmacy in error. As a result the person concerned did not receive her full course of antibiotic medication. This could have resulted in a poor outcome for the individual concerned. We saw some other MAR sheets relating to one resident and some recent antibiotic medication. It was difficult to establish from the MAR sheets and the daily records the exact regime prescribed and the actions taken by the home. It did nevertheless appear that a course of antibiotics was interrupted for a few days as staff did not realize that a further bottle of medicine remained within the fridge. We were unable to establish the reasons why one blister pack had too many tablets removed from it according to the MAR sheet. We pointed out to the manager and deputy manager that the label printed by the supplying pharmacy was dated March 2010 and not in line with the current months supply. No body within the home had noticed this. One MAR sheet showed that the home was out of stock of a tablet for one person at the time of our inspection. The manager designate believed that a Doctor may discontinue Care Homes for Older People Page 5 of 11 the medicine concerned but a medical opinion had not been obtained at that time and therefore medication should be available. Staff had signed for medication then over scored on top of the original signature with a code. In one case staff had signed that medication was given then recorded M (make available). On the reverse of the MAR sheet we saw that medication arrived at a later date, therefore staff could not have administered medication that was originally signed as given. We viewed the records and checked the stock of medication which needs to be stored as controlled. Within the CRD (Controlled Drugs Register) staff had failed to sign for a drug the evening before this inspection. The MAR sheet was signed and assuming the medication was given the stock held balanced. We noted that on the MAR sheet of another resident a member of staff appeared to have crossed her initial out. Nobody on duty could explain the crossing out. We spent a considerable amount of time trying to understand the records regarding some liquid medication which was stored as controlled. The balance held was clearly incorrect. A number of people tried to resolve how certain balances were reached over the last two months by looking at factors such as the date when medication was dispensed, the date when a bottle was opened and when medication was returned. This exploratory work led to further confusion and people having to make a number of assumptions to try and arrive at an explanation of the current situation. It was evident that records were insufficient in detail in order to provide an accurate audit trail. On arriving at the home some people were having their breakfast in the sun lounge. We spoke to two people both of whom told us that the food is good and that staff are kind. Menu cards were on the tables within the dining room giving details of the current weeks menu. The days menu was also written on a white board near to the main lounge. Briarlea has a four star Very Good rating from the local district council environmental service in relation to food hygiene. We were told of plans to refurbish the kitchen in the near future. The refurbishment will include the fitting of a dishwasher. We had a brief look around the home and noted a number of improvements since our previous inspection. The walls around the home contained some large modern art which brighten these areas up. In addition we saw many picture frames each containing a number of photographs of residents engaged in activities such as baking, playing cards, folding washing and during a time when an organisation brought some reptiles into the home. Some bedroom doors now have a brass name plate showing the name of the resident occupying the room. A list detailing improvements since the last key inspection was given to us. This included redecoration and new carpeting in some bedrooms, the provision of new sanitary ware in some en-suites and a new large flat screen television with a Wii console in the sun lounge. We have previously commented upon an unused bathroom on the first floor. Since our last visit this has been converted into a practical and attractive looking wet room which should be of benefit to people using the service. Care Homes for Older People Page 6 of 11 The homes complaints procedure was on display near to the front door. We also saw the procedure within the Service Users Guide. The procedure needs some minor amendments as it current has the wrong name for the commission and it needs to reflect our Newcastle address. Briarlea does not, currently, have a registered manager. The manager designate informed us that she is awaiting the return of her CRB (Criminal Records Bureau) disclosure in order that she can continue with her application to the commission for registration. Photographs were on display of the residents involved in the residents committee. During our inspection we saw a wheelchair on the first floor without any footrests in place. We later saw the deputy manager putting wheelchairs away including the one previously seen. One wheelchair had both footrests in place while another had one missing. The deputy manager told us that it must have fallen off. We highlighted that it can be potentially dangerous to residents if wheelchairs are used without appropriate footrests fitted. We have previously highlighted some areas needing attention in order to reduce the risk of injury to people. We checked a small number of wardrobes within bedrooms currently occupied and found them to be secured to the wall to prevent accidental toppling. We did not view records regarding the management of hot water during this visit. 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 7 of 11 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 8 of 11 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 Regulation 12 (1). The 11/06/2010 service must ensure that the medical care needs of residents are met and that records are kept up to date regarding the actions taken. This is to ensure that peoples well being is maintained. 2 9 13 The service must ensure that 04/06/2010 people residing within the care home receive their medication as prescribed by a medical practitioner. Medication Administration Records must be accurate and up to date with the necessary signature or code in place. This is to ensure that people health care needs are maintained and that records reflect what medicines have been given to people. 3 9 13 Regulation 13 (2) The service 04/06/2010 must ensure that medication which needs to be treated as Page 9 of 11 Care Homes for Older People 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 controlled has accurate records maintained as required by the Misuse of Drugs Regulations (Safe Custody 1973), the Misuse of Drugs Act 1971 and as in guidance issued by the Royal Pharmaceutical Society of Great Britain. This is to ensure that systems within the home are safe. 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 10 of 11 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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