Care Home: Cardell House

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What the care home does well This inspection was to look at handling of medicines, other areas of care were not looked at. What the care home could do better: Improvements need to be made to the handling of medicines so that people living in the home can be confident that they will be given their medicines correctly. Action should be taken to ensure that all staff involved with giving medicines follow agreed good practice so that people can be confident that they will be given their medicines as they have been prescribed. Accurate records must be kept of the medicines which have been given by staff. If a medicine is not given the reason for this must be recorded. Action must be taken to ensure that medicines are given as prescribed by the doctor. Systems in place must allow the audit of all medicines to check that they have been given correctly. This is to protect people`s health. The registered manager must ensure that staff who administer medicines are competent to do this task safely. Random inspection report Care homes for adults (18-65 years) Name: Address: Cardell House 421-423 Speedwell Road Cardell House Kingswood Bristol BS15 1ER zero star poor service 20/04/2010 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: Sue Fuller Date: 0 1 0 9 2 0 1 0 Information about the care home Name of care home: Address: Cardell House 421-423 Speedwell Road Cardell House Kingswood Bristol BS15 1ER 01179674647 01179674647 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Diane Hull Type of registration: Number of places registered: Conditions of registration: Category(ies) : Ritzi Care Homes Limited care home 12 Number of places (if applicable): Under 65 Over 65 0 learning disability Conditions of registration: 12 The maximum number of service users who can be accommodated is 12. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection Brief description of the care home Cardell House is a registered care home, operated by Ritzi Care Homes Ltd with the day to day management cascaded to a recently employed new manager. The property consists of two domestic dwellings converted and adjoined to provide accommodation and personal care for up to twelve people. Accommodation is offered to both female Care Homes for Adults (18-65 years) Page 2 of 12 2 0 0 4 2 0 1 0 Brief description of the care home and males. There are nine single bedrooms and one double. The home is close to shops and bus routes, with other amenities within walking distance. The home aims to provide a high standard of accommodation and care in one group living unit and to enable all of the individuals to lead an ordinary life as possible. The range of fees is from £357.66 to £749.23 at the time of publishing this report. Care Homes for Adults (18-65 years) Page 3 of 12 What we found: The pharmacist inspector carried out this inspection to follow up concerns about the handling of medicines in the home, which were raised at a recent random inspection. We (the Care Quality Commission) talked to the registered manager and two members of staff involved with giving medicines and one person using the service. We looked at the arrangements for storing medicines and the records kept of the receipt, administration and disposal of medicines. The manager told us that people living in the home are registered with a local doctor. The home changed the way medicines are supplied to the home in May this year, to use a monthly blister pack system. This was to help improve the handling of medicines in the home. Staff look after and give medicines to people living in the home. One person living in the home is able to look after their own inhaler to help their breathing. This person told us that they were happy with this arrangement. The home has an assessment for selfmedication but this does not include any assessment about whether a person understands how to use their medicine correctly. A self-medication policy should be available which includes an assessment of whether the person is able to look after their medicine safely. Staff must record when they give a medicine to someone to look after themselves. This is so that there is a clear audit trail of the medicines received into the home. The pharmacy provided some medicines training the week before this inspection and also left training books for staff to complete. These books include an assessment of competency to check that staff are able to give medicines safely. The manager told us that she had not yet had the opportunity to be able to watch staff giving medicines. Action should be taken to ensure that staff who give medicines follow agreed good practice, so that people can be confident they will be given their medicines correctly. The pharmacy provides printed medicines administration record sheets each month for staff to complete when they give medicines. A new supply had been started three days before this inspection. We checked the monthly blister packs and saw that the medicines missing from the packs agreed with the administration records made by staff. Some medicines cannot be supplied using the blister pack system and are supplied in their original packs. The manager told us that these packs are started at the beginning of the month. Any medicines left at the end of the month are sent back to the pharmacy for disposal. We checked two packs of medicines with the administration records. One indicated that the medicine had been given as prescribed. The other had a discrepancy. This medicine was prescribed as two tablets twice daily. Ten tablets had been signed as given but only 7 were missing from this pack. This suggested that on at least one occasion one tablet had been given instead of two so the person had not been given the correct amount of medicine. We saw records of the receipt of medicines into the home and of the disposal of unwanted medicines. When we checked the disposal record we saw that a number of medicines had the reason for disposal recorded as expired or refused. These records Care Homes for Adults (18-65 years) Page 4 of 12 suggested that some medicines had not have been given as prescribed. We looked at the previous months medicines administration record sheets and checked them with the disposal record. We saw some examples which suggested that medicines had not been given as recorded. For example one tablet was returned as expired but 56 tablets had been received and 56 doses signed as given. There were no gaps in the administration record and no occasions recorded of the person not taking the tablet. One medicine, given twice daily, is supplied as a pack of 60 each month. This means that four capsules would be wasted at the end of 28 days. The returns record showed that six capsules had expired but there were no gaps in the record and no record of any doses having been refused. Recent disposal records also showed that on one occasion 63 tablets prescribed for one person were returned as expired. On another occasion 28 tablets of the same medicine were returned as refused. This medicine is given in a dose of two tablets twice daily. Staff we spoke to did not know why these tablets were left at the end of the month. Staff who had completed the disposal record told us that they did not investigate why medicines were left at the end of the month. If medicines are supplied as a months supply but some are left at the end of this period it suggests that these medicines have not been given as prescribed. This could put peoples health at serious risk and action must be taken to ensure that medicines are given as prescribed. Accurate records must be kept of the medicines given by staff. If a medicine prescribed to be given regularly is not given, the reason for this must be recorded. A system should be in place to allow audit of medicines supplied in standard packs so that it is quickly clear if a medicine has not been given or the incorrect dose has been given. If medicines have been given incorrectly, appropriate action must be taken to make sure that the person is safe and to prevent further mistakes. We saw a handwritten addition to an administration record sheet that had not been signed or dated by the person writing the entry. The entry had not been checked by a second person to make sure that it was correct and it was not clear which month the record had been made and the tablets given. Handwritten additions should always be signed, dated and checked to reduce the risk of mistakes being made. Suitable secure storage is available for medicines. The medicine trolley must be kept secured when it is not in use. Suitable storage is available for controlled drugs, which need additional security. We saw some medicines that are no longer used and need to be returned to the pharmacy. Some cream dispensed in January 2009 for one person had the name on the medicine label crossed out and changed to another person living in the home. Medicines prescribed for one person are their property and must only be used for that person. What the care home does well: This inspection was to look at handling of medicines, other areas of care were not looked at. Care Homes for Adults (18-65 years) Page 5 of 12 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 Adults (18-65 years) Page 6 of 12 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 13 16 Arrangements must be made 31/07/2010 for the people living in the home to have access to the local community and leisure activities. This will help people to be part of their local community and to engage in appropriate activities. 2 20 37 Notify us when the people 27/08/2010 living in the home have been subject to a medication error. So that we know what action has been taken to monitor medication errors and keep people safe. 3 20 13 Keep a record on Medication Administration Record of when an individuals medication is administered and with dosage. So that staff support people with their medication consistently and safely. 27/08/2010 4 20 13 Keep a record of when people are given medication and for staff to sign in the appropriate space. Ensure individuals medication is given from the appropriate 27/08/2010 Care Homes for Adults (18-65 years) Page 7 of 12 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 time slot in the blister pack. So that people are protected and supported safely. 5 23 13 The manager and staff working in the home must attend training in safeguarding. This will help to prevent the people living in the home being placed at risk of harm or abuse. 6 23 13 Keep a record of the 27/08/2010 valuables and property belonging to the people living in the home. So that peoples property is safeguarded. 7 33 18 Review staffing arrangements. So that the the individual and collective social and leisure needs of the people living in the home are met. So that staff are not working excessive hours without the required breaks in between. 8 34 19 Ensure all recruitment 27/08/2010 documentation is available including agreed working visas for staff empolyed from overseas, applications and evidence of staffs identity. So that the people living in the home are kept safe. 27/08/2010 30/06/2010 Care Homes for Adults (18-65 years) Page 8 of 12 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 35 18 (1) (c) (i) To ensure that staff have adequate training in health and safety and keeping this up to date and current including first aid, fire and food hygiene. Ensuring individuals are supported by competent staff. 30/09/2009 10 36 18 Staff working in the home must receive appropriate supervision. So that staffs work performance is monitored to help ensure the needs of the people living in the home are met. 31/07/2010 Care Homes for Adults (18-65 years) Page 9 of 12 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 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 9 13 The registered manager must ensure that staff who administer medicines are competent to do this task safely. To ensure that medicines are given correctly. 30/09/2010 2 9 13 Systems in place must allow 30/09/2010 the accurate audit of all medicines to check that they have been given correctly. To protect peoples health 3 9 13 The registered manager 23/09/2010 must ensure that medicines are given as prescribed. Accurate records must be kept of the medicines which have been given by staff. If a medicine is not given a reason must be recorded. So that people can be confident that they will be given the correct medicines. Care Homes for Adults (18-65 years) Page 10 of 12 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 Adults (18-65 years) Page 11 of 12 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) 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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