Care Home: Cherry Trees Care Home

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What the care home does well The medicine management had improved significantly since the last inspection to a safe standard. What the care home could do better: The home must ensure that the three recommendations left at the last inspection and repeated at this inspection are fully met and also the recommendation left at this inspection. Random inspection report Care homes for older people Name: Address: Cherry Trees Care Home Stratford Road Oversley Green Alcester Stratford Upon Avon B49 6LN two star good service 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: Debby Railton Date: 1 8 0 3 2 0 1 0 Information about the care home Name of care home: Address: Cherry Trees Care Home Stratford Road Oversley Green Alcester Stratford Upon Avon B49 6LN 01789764022 01789764024 cherrytrees@barchester.com www.barchester.com/oulton Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Claire Hardcastle Type of registration: Number of places registered: Conditions of registration: Category(ies) : Barchester Healthcare Homes Ltd care home 81 Number of places (if applicable): Under 65 Over 65 0 81 0 dementia old age, not falling within any other category physical disability Conditions of registration: 67 0 14 The maximum number of service users who can be accommodated is: 81 The registered person may provide the following category of service only: Care Home with Nursing (Code N); 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) 81 Dementia (DE) 67 Physical Disability (PD) 14 Date of last inspection 0 3 1 2 2 0 0 9 Care Homes for Older People Page 2 of 8 Brief description of the care home Cherry Trees Care Home is situated approximately half a mile from Alcester town centre along the main road through Oversley Green. Barchester Healthcare Ltd owns the home. The area is very rural with infrequent public transport and the nearest shops are half a mile away. The care home can accommodate up to 81 people. The registration of the care home includes older people, older people with dementia and younger people with physical disabilities. The home is divided into dedicated living units for each client group. The homes decor, furniture and furnishings are generally of a high standard, however some areas are beginning to show signs of wear and tear. The accommodation is provided on two floors with access to these via a passenger lift or stairs. It must be noted that in order to move between the two floors of the physical disability unit, staff must either use the lift, the stairs in the dementia unit of the home or go outside as there are no stairs connecting the two floors within the unit itself. All of the accommodation is single room with en suite facilities. The gardens are well maintained, being accessible to all of the current residents. There are a number of seating areas, which are well used in good weather. There is a vehicle at the home to transport the residents on trips and for appointments. Information about the home is given to prospective residents and their families via the `Statement of Purpose? and other information brochures. Information about the fees is not included in the Service User Guide but is available on request to the manager. Fees should be checked at the time of deciding to use this service as the range of fees differ on each of the three units. Additional charges are made for hairdressing, chiropody, toiletries and sundries such as newspapers. Residents also contribute to external activities. Care Homes for Older People Page 3 of 8 What we found: The pharmacist inspection lasted three hours. Nine peoples medicines were looked at, together with their Medicine Administration Record (MAR) charts and care plans. Three nurses were spoken with and all feedback was given to the regional support nurse and the manager. The reason for the pharmacist inspection was to check compliance with the six requirements left at the last inspection on 3rd December 2009. regarding medicine management and care planning. All six requirements were met at this inspection and this was commended. The three recommendations regarding medicines remained outstanding and have been repeated as a result. One new recommendation was also left. The home now sees all the prescriptions prior to dispensing enabling them to check them and to take a copy to use to check the dispensed medicines and MAR charts received into the home for accuracy. The quantities of all medicines received and any balances carried over from previous MAR charts were recorded enabling audits to take place, to demonstrate whether medicines had been administered as prescribed and records reflect practice. These indicated that the majority had been. A few mistakes were seen, where mainly the reasons for non administration had been incorrectly recorded. In one instance nursing staff had recorded they had administered two tablets but in fact had only administered one. The regional support nurse was keen to address these issues. Overall though the standard had significantly improved to a safe level. The home had installed a competency assessment that nurses must pass before they are allowed to handle medicines in the home. This had raised the standard of medicine management seen and the regional support nurse assured the commission, that a more robust quality assurance system to assess individual nursing staff competencies in the safe handling of medicines would be introduced to reduce the risk of errors further. Concern was raised again that there were many people prescribed antipsychotics even though they had no underlying psychotic behaviour. Of a total of 31 people living on the memory lane unit as many as two thirds had been prescribed antipsychotics or hypnotics (sleeping tablets) or a combination of both. In line with current thinking, people diagnosed with dementia should not be prescribed these potent medicines with sedating side effects, unless absolutely necessary. The manager assured the commission that she had tried to address this issue with both the consultant and doctors, to no avail. The three nurses spoken with had a good understanding of the medicines they administered. The high use of antipsychotic medicines were not questioned though. The care plans were well written and it was possible for staff to understand and meet the peoples clinical needs. To date, there were no supporting protocols regarding the use of medicines prescribed on a when required basis. This had not been addressed since the last inspection despite being recommended by the Commission. Without clear protocols these medicines may be given routinely or not as the doctor intended. The morning medicine round finished late. This meant that only two and a half hours Care Homes for Older People Page 4 of 8 would elapse between the morning and lunchtime rounds. This may increase the risk of potential overdose. The regional support manager was to address this issue. This was a recommendation from the last inspection and again had not been suitably addressed. All controlled drugs were stored in compliance with the current regulations and records reflected practice. 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 5 of 8 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 6 of 8 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 advised that medication reviews are undertaken to reduce the reliance on antipsychotic medicines and hypnotics It is advised that all medicines prescribed on a when required basis have supporting protocols for staff to follow to reduce the trend of regularly administering medicines prescribed for occasional use only. It is advised that there are at least four hours between medicine rounds to reduce the risk of potential overdose It is advised that the quality assurance system is improved to include a way to assess individual nursing staff competencies in their handling of medicines 2 9 3 4 9 9 Care Homes for Older People Page 7 of 8 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. 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