Latest Inspection
This is the latest available inspection report for this service, carried out on 23rd September 2010. CQC found this care home to be providing an Adequate service.
The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.
For extracts, read the latest CQC inspection for Charlotte Rose House.
What the care home does well During this inspection we noted that the service has met only one requirement in relation to medicine management of those set at previous inspections. Improvement to date in this area is not sufficient to safeguard the health and welfare of people living at the service. Records are now maintained in sufficient detail to show that meals provided at the home are nutritious, well balanced and specific to the needs of the service users with specialist diets. As a result of environmental risk assessment all the locks on the bathroom doors, have been replaced to ensure staff access in an emergency situation. Furthermore the registered manager provided us with a service certificate which showed that the homes passenger lift was in good working order. What the care home could do better: During this inspection we continued to identify significant failings in the way the service manages medicines and meets the health and care needs for people living at the service. Further developments are required in relation to service uses care planning documentation and the recording of support provided to service users. The registered manager could not demonstrate that a robust recruitment procedures had been followed. Random inspection report
Care homes for older people
Name: Address: Charlotte Rose House 1 Norwood Road Skegness Lincs PE25 3AD one star adequate service 13/07/2009 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: Mark Andrews Date: 2 3 0 9 2 0 1 0 Information about the care home
Name of care home: Address: Charlotte Rose House 1 Norwood Road Skegness Lincs PE25 3AD 01754762119 Telephone number: Fax number: Email address: Provider web address: pcoulson@chaucerhouse102.wanadoo.co.uk Name of registered provider(s): Name of registered manager (if applicable) Mrs P D Coulson Type of registration: Number of places registered: Conditions of registration: Category(ies) : Lonrush Ltd care home 20 Number of places (if applicable): Under 65 Over 65 19 0 old age, not falling within any other category physical disability Conditions of registration: Date of last inspection Brief description of the care home 0 1 2 0 0 7 2 0 1 0 Charlotte Rose House formerly known as Chaucer House is a home providing personal care to people who are over the age of sixty-five. It is situated in a residential area of Skegness within a short car ride of the town centre. Local services are within walking distance of the home and include a hotel-restaurant, post office and shops. The home is a detached three-storey building with accommodation for people who use the service on both ground and first floor levels. There is a passenger shaft lift and stair lift for access to the upper floors. There are fifteen bedrooms, five of which are shared occupancy, although at present no one shares a bedroom. To the front of the premises
Care Homes for Older People Page 2 of 14 Brief description of the care home there is a patio area for sitting out and a small lawn and seating area to the rear. There are no on-site parking facilities for cars although on-street parking is available at the front and side of the home. The home is registered to provide personal care for up to twenty people, nineteen older and one younger physically disabled person. Eight people were living in the home at the time of the inspection. The current fees for the home range from £360 to £446 per week with additional charges made for hairdressing, dry cleaning, social transport and personal effects. Information about the day-to-day operation of the home and fees, as well as a copy of the last inspection report, is available in the main entrance hall of the home. Care Homes for Older People Page 3 of 14 What we found:
This inspection was conducted by Steve Keeling and the Commissions pharmacist inspector Mark Andrews who followed up on issues raised during the previous random inspections of 20 July 2010 and 23 August 2010 in relation to the homes management of medicines for people living at the service. During the inspection we looked at some peoples care records, talked to some people living at the service and to staff, looked at recruitment records, how medicines are being stored and administered and medication records. We discussed our findings with the manager and senior carer at the time of the visit. On arrival for inspection a senior carer on duty took the pharmacist inspector to the medicine trolley which was at the time located in the room used for the storage and management of medicines. The medicine trolley and door to the room were locked and keys were being held by the senior carer so medicines were secure. A senior carer informed us that the cabinet for the storage of controlled drugs that had been obtained would be fitted to the wall and used from later during the same day. A senior carer on duty said that she, another senior and the manager were the only members of staff currently handling and administering medicines at the service. On arrival, we were told that all medicines scheduled for morning administration had been given. However, we noted a medicine where a record of its administration had not been completed and so where records did not demonstrate that the medicine had been given. We did not observe medicines being administered during this inspection but we noted an open and unlabelled pot in the medicine trolley containing one white tablet. When we discussed this with the senior carer as unsafe practice she confirmed that this tablet related to a dose change from two tablets in the morning and one at lunchtime to one tablet to be taken three times daily and where the morning monitored dosage container with two tablets was still in use. The carer described how one tablet is dispensed in the morning from the container and the other is placed in the pot to administer later in the day. This dose change was identified at the previous inspection as having not been put in place and by the time of this inspection the dose change had not been safely and satisfactorily resolved. We undertook an audit of medicines against current medication records. We confirmed the arrangements the home had put in place to account for medicines but again we found a significant number of numerical discrepancies both in surplus and in deficit. We confirmed these with the senior carer or manager who could not explain the discrepancies. We noted that where medicines had been prescribed with variable doses, records did not accurately indicate what doses had been administered. We noted that for a significant number of medicines carried forward figures had not been transferred onto the current medication chart at the start of the 28-day medication chart cycle and these medicines could not be accounted for. We also again noted inaccuracies with records for the receipt of medicines. We again identified ongoing issues around medicine stock control. We noted that for one person recently admiited to the home for a period of respite a second container of two of their prescribed medicines was located in the medicine trolley. For each of these medicines there were no records for receipt of the second container and there were discrepancies for them suggesting there had been confusion because of the presence of the secondary container. The senior carer described
Care Homes for Older People Page 4 of 14 the internal audit as a simple medicine count without reconciliation of the records. We discussed how this audit was inadequate and would not identify medicine discrepancies arising. We looked at the controlled drug register and found that for a person no longer living at the home, their painkilling patches had been recorded by a visiting pharmacist as disposed of on 2nd September, however, the senior carer told us that the patches had been returned with the person when they left. We advised of the need to ensure care staff record when this happens and involve a witness signatory. We were told that there was a programme of prescriber reviews of peoples medicines underway. We found there to be some records of recent prescriber interventions in relation to changes in peoples medicines, however, for one person there had been a change of dose indicated in hand-writing on the medication chart of one tablet to be administered on alternate days. This differed from the printed instruction of two tablets to be administered on alternate days. The senior carer confirmed this change had been authorised by the prescriber but when we looked at care records we saw no documentary evidence of this intervention. We found a newly prescribed medicine in a pharmacy bag within the medicine trolley intended for administration three times daily. The senior carer confirmed that the medicine had been received the day before inspection but we noted that the medication chart was still in the bag and none of the medicine had so far been removed for administration. For another person, during the previous inspection we identified a pain-relieving gel that was prescribed for three times daily application but medicine administration chart records indicated it was being administered each morning only. We noted during this inspection that no change had been made and this issue was still unresolved. Another similar painrelieving gel was previously prescribed and written on the medication chart. At the time of this inspection, the gel had been deleted from the chart but when we checked the persons care notes we found there to be no records confirming this had been authorised by the prescriber. We noted that since the previous random inspections, there has been no change to the non-security of medicines held in peoples rooms for their self-administration. When we asked, the senior carer confirmed that such medicines are still not being kept securely within peoples rooms. In addition we noted no improvement to risk assessments conducted in relation to their ability to safely manage their medicines. For example, for a person self-administering eye drops there had been no assessment of their ability to continue to safely handle and properly administer eye drops and store them securely. We established that at the time of inspection all medicines were available for administration as scheduled and there was no recorded evidence that since the previous inspection any medicines had not been available and therefore not given as had been identified at the time of the previous inspection. At the last key inspection performed on 13th July 2009 we had concerns in relation to the quality of peoples care plans and the process used to record how care and support is given as the numbering system used at that time did not show clearly the care and support given to service users. A requirement was made to ensure that Care plans are reviewed to make sure they reflect accurately peoples needs, and how they are to be met. At the time of our last key inspection the manager agreed to review ways in which
Care Homes for Older People Page 5 of 14 information is recorded to show clearly the care provided and how it is delivered. At our unannounced random inspection we spoke to the registered manager and examined a service users care plan. The registered manager informed us that although training in person centred care planning is being sought from an accredited training agency the review process has not been undertaken. Records showed and the registered manager confirmed that staff continue to record whether care plans are met through the previously mentioned numerical system therefore they did not clearly show the care and support provided to the service users. At the last key inspection performed on 13th July 2009 we had concerns as records were not kept in sufficient detail to show that meals provided at the home were nutritious and well balanced. We made a requirement which stated that Records of meals must be kept in sufficient detail to show the full range of meals provided. It was shown that the service has responded appropriately to our requirement and initiated a procedure to record all meal provision within the home and it could be demonstrated that the meals provided are well balanced and nutritious. The service has also initiated a procedure for the recording of peoples specialist dietary needs and it was confirmed by a service user that her specialist diet is provided, she stated, The meals here are very nice, I have no concerns whatsoever. The home provides me with my specialist diet, they even cook me little gluten free cakes which are lovely. At the last key inspection performed on 13th July 2009 we had concerns in relation to recruitment practices, a requirement was set which stated; A thorough recruitment procedure must be followed for all staff, which makes sure they are employed only after all necessary checks have been completed. At our random inspection on the 23rd September 2010 it was established that only one member of staff had been recruited. We examined the recruitment records relating to this person, the records showed that the member of staff was last employed at a domiciliary care agency as a carer but the registered manager had not requested a reference from the domiciliary care agency and it was not documented why the member of staff had left her previous employment, therefore we continue to have concerns as the registered manager could not show that a robust recruitment procedures is in place. At the last key inspection performed on 13th July 2009 we had concerns in relation to the lack of environmental risk assessments in relation to the locks on bathroom doors, as the locks could not facilitate staff access to the bathrooms in an emergency. In addition the registered manager was unable to provide us with an up to date certificate to show when the homes passenger lift was last serviced. At our unannounced random inspection it was shown that all the locks on the bathroom doors, following a risk assessment, have been replaced to ensure staff access in an emergency situation. Furthermore the registered manager provided us with a service certificate which showed that the homes passenger lift was in good working order. What the care home does well:
During this inspection we noted that the service has met only one requirement in relation to medicine management of those set at previous inspections. Improvement to date in
Care Homes for Older People Page 6 of 14 this area is not sufficient to safeguard the health and welfare of people living at the service. Records are now maintained in sufficient detail to show that meals provided at the home are nutritious, well balanced and specific to the needs of the service users with specialist diets. As a result of environmental risk assessment all the locks on the bathroom doors, have been replaced to ensure staff access in an emergency situation. Furthermore the registered manager provided us with a service certificate which showed that the homes passenger lift was in good working order. 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 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 12 Daily records must accurately reflect how peoples care needs are being met. This is so that the home can demonstrate that people are receiving the care they need. 17/09/2010 2 7 15 Care plans must be reviewed 30/09/2009 to make sure they reflect accurately peoples needs and how they are to be met. This is to make sure peoples needs and wishes are fully identified and known. 3 7 12 Care plans must accurately 17/09/2010 reflect service users needs and how they are to be met. This is so that people are assured they will receive the care that they need. 4 9 13 Medicines no longer 06/08/2010 prescribed for use must be safely and promptly removed for disposal To ensure peoples health and welfare is protected at all times 5 9 12 Effective arrangements must 10/09/2010 be made to ensure medicines
Page 8 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 are available at all times to administer as scheduled by prescribers To ensure treatment is continuous and promote and safeguard the health and welfare of people prescribed medicines 6 9 13 Records must be completed 06/08/2010 for contact received from prescribers about changes to medicine regimens To ensure accurate documentation is kept and the health and welfare of people is protected 7 9 13 Regular and thorough risk assessments must be completed and documented when people chose to selfadminister their own medicines. To ensure peoples health and welfare is protected at all times 8 9 13 Controlled drugs must be kept in a cabinet compliant with the Misuse of Drugs (Safe Custody) Regulations To provide an appropriate additional level of security for controlled drugs 9 9 13 Medicines must be administered to people as instructed by prescribers. This must be evidenced by 06/08/2010 22/10/2010 06/08/2010 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 accurate record keeping practices To ensure peoples health and welfare is protected at all times 10 9 13 Medicines must be 06/08/2010 administered to people by staff who follow safe medicine administration procedures and in line with the homes policy at all times To ensure the health and welfare of people is protected 11 9 13 Medicines kept in peoples 06/08/2010 rooms must be kept securely To ensure the safety of people living at the service 12 11 16 Menus must show peoples needs for specialist diets. This is so that the home can demonstrate they are providing appropriate meals for people. 13 15 22 Complaint records must be clearly dated This is so that people are assured that their complaints are dealt with in a timely manner. 14 16 22 The complaints procedure must be reviewed to make sure that it contains clear and accurate information about how we can be 06/11/2009 17/09/2010 17/09/2010 Care Homes for Older People Page 10 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 contacted. Records of any complaints raised must be kept to show details of any investigations and any action taken. This is to make sure that people are clear about how to raise any matters and they can feel confident their concerns will be taken seriously, listened to and acted upon. 15 29 19 A thorough recruitment procedure must be followed for all staff This is so that people living at the home are kept safe. 16 29 19 A thorough recruitment 24/09/2009 procedure must be followed for all staff, which makes sure they are employed only after all necessary checked have been completed including obtaining satisfactory POVA and CRB checks. Staff must not be employed prior to a CRB check being received unless there are exceptional circumstances, which put the health, safety and welfare of people who use the service at risk, in which case CQC must be notified. This is to make sure people who live in the home are well protected. 17 29 18 Rotas must accurately 17/09/2010
Page 11 of 14 17/09/2010 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 demonstrate that there are sufficient staff are on duty at all times. This is so the home can show that there are enough staff to meet peoples needs. 18 38 13 Risk assessments must be in 17/09/2010 place for all environmental needs. This is to make sure that people living in the home are kept safe. 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 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. 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. Care Homes for Older People Page 14 of 14 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
