Care Home: Elm House

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What the care home does well Medicines are given to people at the right and best time. This helps make sure they work properly. What the care home could do better: Records of medicines received into the home and given to people need to further improve so that all medicines can be fully accounted for. Random inspection report Care homes for older people Name: Address: Elm House 43 Cambridge Road Southport Merseyside PR9 9PR one star adequate 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: Simon Hill Date: 2 7 0 7 2 0 1 0 Information about the care home Name of care home: Address: Elm House 43 Cambridge Road Southport Merseyside PR9 9PR 01704228688 01704231940 elmhouse43@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Zena Carol Stretch Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Peter John Berry care home 30 Number of places (if applicable): Under 65 Over 65 30 old age, not falling within any other category Conditions of registration: 0 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 - Code OP The maximum number of service users who can be accommodated is: 30 Date of last inspection Brief description of the care home Elm House is a privately owned care home that provides 30 single places for older people with nursing or personal care needs. Elm House is situated close to Southport town centre, local amenities and Hesketh Park. The home has 4 floors with a passenger lift to all areas. Extensive work has been carried out to improve the Care Homes for Older People Page 2 of 9 Brief description of the care home accommodation. There are now two lounges and all bedrooms have an ensuite facility. Wheelchair access is available at the main front entrance. The home has car parking space and a landscaped garden at the rear. Baths and a shower are suitably adapted to assist those who are less able and residents are provided with a call bell system. Elm House is privately owned by Mr Berry and the manager is Ms Zena Carol Stretch. The weekly rate for accommodation is five hundred and ten pounds to six hundred and thirty five pounds. Care Homes for Older People Page 3 of 9 What we found: This visit was carried out to look at how medicines were being handled because we found some shortfalls on our last inspection. A specialist pharmacist inspector carried out the visit who looked at medicines stocks, medicines records and spoke with two nursing staff and two residents. Overall we found some improvements are still needed to help make sure medicines are always given and recorded safely. We found some good improvements in the times medicines were given to people because a new before food medicines round had been organised that helped make sure these medicines were given at the best time. Medicines stock and records were generally well organised making it usually simple to account for them. Records of medicines received into the home had improved since our last visit, however, we found some mid month supplies had not been properly recorded. Records of medicines administered to people were usually signed and up to date but we found some recording mistakes that showed nursing staff were not always checking the records carefully enough. One medicine that was used for anxiety was signed as given twice in the last month but the stock levels showed that none had been given. An inhaler used for breathing problems was also wrongly signed for three times a day instead of the prescribed twice a day for over a week. We also found the records unclear when medicines were not given to people, for example, if they refused, were asleep or did not need them. Having accurate records is important to help prevent mistakes when giving people their medicines. Our checks of the current stocks and records found medicines were now usually given to people correctly. However, we found some discrepancies that showed some occasional doses had been missed. One person had missed two doses of their epilepsy medicine in the last three weeks and another person missed their nutritional food supplement on several occasions because staff had not checked the records carefully when giving them out. We looked at how people were supported to look after their own medicines and found safe procedures were in place. One person who was using their own inhaler had good paperwork that highlighted the risks involved and the support staff needed to give to help them manage it safely. We spoke with this person who said they received the right amount of help from staff. Helping people to manage their medicines safely is important because it helps them retain some of their independence. The records for people who were prescribed external medicines, such as creams, had improved since our last visit. Creams charts were kept in peoples bedrooms and these were usually signed by the care staff that applied them. However, we found the main central records, which also listed the creams, were also signed by nurses that had not applied them so this made some of the records confusing. We also found some cream charts were not always signed so we could not be sure they had always been applied properly. Several people were prescribed medicines to take when required. When we checked their care plans and supporting paperwork we found little or no information about how and when to use them. Two people that were prescribed medicines that are used for severe agitation had no information about when to give them and several people that Care Homes for Older People Page 4 of 9 were prescribed pain killers had no clear information about when and for what type of pain they were to be used for. We gave some advice about how to improve this because having detailed care plans about medicines helps make sure they are given to people correctly and only when they need them. We looked at how controlled drugs were handled and found the cupboards used to store them were now secure because they had been properly attached to the wall. Records were made in a suitable register and current stocks were correct when we checked them. Although all records of controlled drugs were witnessed we found best practice was not always being followed because staff did not fully witness these medicines being given. This was confirmed by speaking with staff and one resident who received regular controlled drugs. A recent mistake also showed staff did not always follow the right procedures because a controlled drug had been administered but no record was made in the register. Having properly witnessed records is important because they help prevent misuse and mishandling. We checked how the managers made sure staff were competent and made sure medicines were being handled safely. We saw the last recorded audit but this had not found the types of mistakes that we had identified because it was not detailed enough. We gave some advice about how to improve this so that recording and administration mistakes are found and action is taken to prevent them happening again. We were told, and we saw the paperwork, that formal assessments of staff competence were being carried out on all nursing staff and these were to be completed within the next few weeks. Having regular effective audits and thorough assessments of staff competency help make sure medicines are handled safely by suitably skilled staff. 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 9 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 8 12 The residents risk 07/05/2010 assessments must accurately record current risk in respect of falls and hazards to their safety. This is to help ensure the protection of the resident by identifying the risk and as far as possible eliminate. 2 9 13 Records of medicines 06/05/2010 received into the home, given to people and disposed of must be clear, accurate and complete. This will help make sure all medicines can be fully accounted for. 3 35 16 Financial records and receipts must be kept on behalf of the residents when staff are dealing with their monies. This will help to protect the residents financial interests. 08/05/2010 4 37 17 Residents daily care records 07/05/2010 must be kept up to date. This is especially important following an incident, such as a fall where the resident has subsequently suffered an ill effect. Page 6 of 9 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 This will help to protect the residents and to ensure that the staff have the information they need to provide care and support according to individual need. 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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