Care Home: Forest Hill Care Home

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What the care home does well Storage and handling arrangements for medicines, including for controlled drugs, are generally good. Planned admissions have a suitable admission assessment to determine their needs. What the care home could do better: Sufficient medicines must always be available to be given whenever needed. Prescribed medicines must always be given correctly and the home`s records must reflect this accurately. Each person must have a care plan that describes their health needs and how they need supporting. When people have unplanned admissions and transfers from hospital they must be assessed and their needs identified and recorded in a plan of care. Seizures must be properly monitored and recorded by trained and competent staff. Random inspection report Care homes for older people Name: Address: Forest Hill Care Home Forest Hill Park Worksop Nottinghamshire S81 0NZ two star good service 14/09/2009 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: Mary OLoughlin Date: 1 6 0 8 2 0 1 0 Information about the care home Name of care home: Address: Forest Hill Care Home Forest Hill Park Worksop Nottinghamshire S81 0NZ 01909530531 01909532239 foresthill@barchester.net www.barchester.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Josephine Mary Tuddenham Type of registration: Number of places registered: Conditions of registration: Category(ies) : Barchester Healthcare Homes Ltd care home 64 Number of places (if applicable): Under 65 Over 65 0 64 dementia old age, not falling within any other category Conditions of registration: 64 0 The maximum number of service users who can be accommodated is 64. 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 Dementia - Code DE Date of last inspection Brief description of the care home The home was previously part of Westminster Healthcare Ltd, as part of a reorganisation, the home transferred to an existing operations company called Care Homes for Older People Page 2 of 10 1 4 0 9 2 0 0 9 Brief description of the care home Barchester Healthcare Homes Ltd in January 2007. Forest Hill Care Home is a large, modern purpose built home on two floors. It provides 24 hour nursing care for up to 64 older people care. The home is situated in a quiet residential area north of Worksop town centre and close to Bassetlaw District Hospital. It has two units, one on each of the two floors, which can be accessed by a lift. There is ample communal space on each floor and all bedrooms are single with en-suite facilities. Landscaped garden, with seating, is available at the front and rear of the building and there is a car park to the rear. The building is wheelchair accessible, with wide corridors and doorways, and level access on each floor. The current weekly fees are £510.00 to £856.00. The Statement of Purpose and Service User Guide and are available in the main entrance area of the home and service users have a copy in their bedroom. Copies of previous inspection reports are available on request. Care Homes for Older People Page 3 of 10 What we found: Since we last inspected the service in November 2009 we have been notified of four separate medication errors that had resulted in people not receiving their prescribed medicines and the poor recording of health issues such as the recording of seizures for people suffering with epilepsy. We obtained reports from the Social Services safeguarding investigations team into the medicine errors and a report from the NHS Nottingham City care home monitoring team. We also looked at the action plans provided by the Registered Provider that told us the improvements they had made following the medicine errors. The focus of this inspection was on the management of medicines in the home and the assessment and care planning for the health needs of people who live there. A pharmacist inspector spent five hours looking at selected care files, the medication administration record charts (MARs) and the medicines ordering, receipt, storage and disposal arrangements in the home. We examined 20 recent MARs for accuracy and completeness and found 27 administration gaps on six MARs. Checks of medicines remaining could not always determine whether these doses had been given correctly. We also found evidence that six people had run out of some of their medicines during the last month. People living in the home may therefore not always have received their prescribed medicines correctly. Improved medicines checking systems are in place to identify gaps in the records and likely shortages in good time but staff have not always taken necessary or timely action to prevent shortages occurring. We also found poor records and systems in place for the use of prescribed skin care products which means people do not always receive the full benefit of these treatments. The home has systems in place to support people who choose to look after their own medicines but in one persons case, the records were incomplete meaning staff could not account for all of this persons medicines received by the home. Although medicines storage and handling arrangements in the home are generally good, we found some containers of liquid medicines in use without any evidence of when they were first opened. Such medicines can deteriorate or become contaminated during prolonged usage. Information from a recent safeguarding investigation told us that a person admitted for respite care had not received a full assessment of their needs and the care plan did not adequately identify their needs. We looked at 4 care plans and saw that each person had received a full assessment of their needs before they were admitted to the home. Each care plan was based on the activities of daily living and reviewed each month. We identified that one person had recently returned from hospital following a change in their health needs but staff had not assessed this person or written a plan of care to address their new health needs. When we spoke to staff they were aware of the persons needs but were not recording any information to monitor seizure activity. A second person did have a seizure record sheet within their file but staff spoken with were not aware of this record and were not keeping it up to date. Care Homes for Older People Page 4 of 10 The registered provider told us in their action plan of 20/04/10 that they were training staff in care planning and the management of seizure activity and how to record this. They also advised us that a specialist in Epilepsy would be attending the home to provide guidance to staff on the management of this condition The acting manager told us that staff had received training from the specialist nurse regarding the management of seizures and recording seizure activity. The 2 trained staff we spoke with could not confirm that they had received this refresher training because one had been employed as bank staff and the second person had just returned to work. The acting manager confirmed that all staff have planned dates for this training and we saw evidence of these dates displayed. 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 10 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 10 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 8 14 A full assessment must be undertaken for all new admissions and for people who are returning to the home from hospital. To make sure that staff are fully informed of the needs of each person and are able to support them safely and appropriately. 20/09/2010 2 8 13 Epileptic Seizures must be recorded and monitored. To make sure people are being supported appropriately and not put at risk. 20/09/2010 3 8 15 Plans of care must be in place for all health needs. This will ensure that peoples needs are met and they are protected. 20/09/2010 4 9 13 Arrangements must be made 20/09/2010 to ensure that all medicines, including skin care products, are administered correctly as Page 7 of 10 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 directed and that all medication records are maintained in an accurate and timely manner. This will help to make sure people receive the intended benefits of their medicines and that the home can account for all medicines received. 5 9 12 Effective systems must be put in place to ensure there are always sufficient quantities of medicines available in the home to be given whenever needed. 20/09/2010 This will help to make sure people can always receive their medicines as part of their planned care and treatment. 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 2 8 9 Daily handover sheets should be kept up to date with the revised needs of each person. All self-administration of medicines should be supported by suitable risk assessments, signed agreements and clear records. The home should carry out risk assessments on the storage arrangements for prescribed skin care products. Opening dates should always be marked on containers of products with a short shelf life once in use. Page 8 of 10 3 4 9 9 Care Homes for Older People 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 9 of 10 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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