Care Home: Good Neighbours House

What the care home does well The home manager facilitated a tour of the building. There is significant improvement in the physical environment since the last inspection. Hallway walls and bedroom doors have been decorated with brighter and lighter colours. New easy use toilets have been installed and there is a new assisted bathroom. At the last inspection we noticed that one of the hallway carpets was torn and thispresented a potential trip hazard and we issued a requirement for the tear to be repaired or the carpet replaced. Hallway carpets on the ground and first floors have all been replaced along with carpets in six of the bedrooms. The requirement is therefore met. There are new wall lights in the ground floor lounge and new curtains and sofas. An additional two sofas are to be delivered. Three new dining tables have been ordered for the dining room. There are two new tumble dryers and a new washing machine in the laundry room. The activities room is well stocked with lots of arts and crafts materials. One resident was enjoying doing a jigsaw when we toured the premises. The new toilets have a bidet function and the manager said that she hoped that this would make some of the residents more independent with their personal care. All 16 of the bedrooms have new net curtains and new worktops. Exposed wiring has been removed from a first-floor hallway wall, as required in the last inspection report. What the care home could do better: I looked at how medications were being handled in the home. Medication is stored securely in a staff office and, as required in the last inspection report, there is suitable storage for controlled drugs in place. A requirement made in this regard is therefore met. Prescribed medications are dispensed from a local pharmacy in blister packs. The pharmacy also supplies medication administration record. I looked at completed medication administration records for the month prior to this inspection visit. The medication records show that on some occasions residents have either not been administered their medication or staff have administered the medication but failed to maintain a record. There were a significant number of gaps in recording. For example, one resident is prescribed a nightly laxative but the record shows that on four days the medication was not administered and there is no record as to why. Records show that another resident has been refusing medication twice daily for a whole month but there is no record as to why or whether medical advice has been taken. One resident is prescribed an inhaler and the directions say that he should have one or two puffs every six hours as required, however on two days over the course of the month he was given doses only three hours apart and it is also unclear whether another of his medications is to be administered as required or daily. The directions appear to say that the medication should be given daily but staff are giving as required instead. There is information about contra indications in medications prescribed to another resident. Recorded directions say that the medication must not be administered within 1 to 2 hours of taking other medicines by mouth. However on 19 March the resident was given all of her medications at 9 AM. Records for one of these inhalers showed that the medication was not administered for five days this month. A dose of thiamine was missed on 19 April. A vitamin supplement was missed on the 16th and 25th of April. An analgesic was missed on the 15th and 19th of April. A medication to be administered four times each day via a nebuliser has not been administered at all for the entire month.The resident is also prescribed a controlled drug. I looked at the record of administration of controlled drugs and noted that a controlled drug had been administered on two occasions, the 29th and 30th of April 2010, with only one staff signature. The signature of the witness is missing. The directions the use of a topical cream say as directed and there is no record of the application of the cream or the entire month. The resident is prescribed a daily meal supplement although there is no record of any being administered. This was an issue at the previous inspection and a requirement was made. This requirement remains unmet. At the last inspection we recommended that quantities of medicines should be carried forward from one month to the next on medication administration records to better enable justified stock checking. This is not being done. The directions on some of the medication administration records say to be administered as directed. This does not provide staff with sufficient information about directions for use. Another resident is prescribed a topical cream to be applied twice each day. Records show that staff are routinely apply the ointment three times each day instead. One resident was prescribed a course of 21 antibiotic capsules. There are 26 entries on the administration record. This indicates that staff have carried on signing the record when the course of antibiotics had already finished. Medication administration records show gaps in recording and also show that medications are not being administered in accordance with the prescriber`s instructions. I saw that the manager had looked at the medication administration records at the end of the month and noted the gaps in recording. She had prepared a list of times and days to see who was on duty on those days so that she could ask them whether they had administered the medication and to sign the gaps in the medication administration records. Staff must be more vigilant and accurate in their recording and the systems in place to check whether medication is being administered correctly are inadequate. This places residents at risk. There has been a requirement in place for the registered person to establish and maintain a system for reviewing and improving the quality of care for the last two key inspections. A representative on behalf of the registered provider, an area manager, conducts monthly regulation 26 visit reports, copies of which are supplied to the home manager and kept in the home. During this inspection the home manager said that quality assurance had been improved and that surveys had been sent to residents and staff and that recommendations from the monthly regulation 26 reports are turned into action plans that must be submitted to the head office within five days.H Random inspection report Care homes for adults (18-65 years) Name: Address: Good Neighbours House 38, Mary Datchelor Close London SE5 7AX one star adequate service 22/05/2009 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: Sonia McKay Date: 1 0 0 5 2 0 1 0 Information about the care home Name of care home: Address: Good Neighbours House 38, Mary Datchelor Close London SE5 7AX 02077037451 02072527105 good.neighbours@scope.org.uk www.scope.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Scope Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 16 Number of places (if applicable): Under 65 Over 65 0 physical disability Conditions of registration: 16 The maximum number of service users who can be accommodated is: 16 The registered person may provide the following category of service only: Care Home Only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Physical disability - Code PD Date of last inspection Brief description of the care home Good Neighbours House is a purpose built care home which provides care and accommodation for up to sixteen adults who have a physical disability. The home is fully accessible to people who use wheel chairs. Each resident has his or her own room. The home has three floors, access to the upper floors is by stairs or the two passenger lifts. None of the bedrooms on the top floor of the home are currently in use. Care Homes for Adults (18-65 years) Page 2 of 11 2 2 0 5 2 0 0 9 Brief description of the care home Three residents live in accommodation which is used to develop independent living skills and, as appropriate, to facilitate a move to independent living in the community. The home is located close to the centre of Camberwell where there is a busy shopping centre, banks, restaurants and pubs. Public transport routes are close by. The charges for the current residents are between 2,000 pounds and 6,000 pounds per month. There have not been changes in the ownership, management or service registration details in the last 12 months. Care Homes for Adults (18-65 years) Page 3 of 11 What we found: This inspection was carried out to check on compliance with requirements made in the last key inspection report. New admissions were not looked at during this random inspection visit. At the last inspection we issued requirements for additional information about the size of the bedrooms and the complaints procedure to be added to the homes statement of purpose and service users guide documents. The home manager has added additional information to the service users guide and statement of purpose. The requirements made in this regard are therefore met. At the key inspection we noted that a previous requirement to ensure that residents care plans contained details of their cultural needs was not met and the requirement was reissued. At this inspection the manager showed me some of the care plans that had been prepared in regards to planning to meet peoples cultural needs. There is basic information available and the requirement is therefore met. However we recommend that staff continue to develop their skills in understanding and planning for peoples cultural needs as part of person centred planning. Residents were observed to be in the lounge or dining room. Some were watching television and looking at magazines. During the afternoon four residents and a member of staff were engaged in arts and crafts at a dining room table. In March 2010 a member of the visiting multidisciplinary health team sent the home manager a letter of concern after a visit to one of the residents during which the visiting health professionals made a number of observations of poor care. The home manager recognised that some of the issues raised should be looked at under the safeguarding of vulnerable adults protocols and she contacted the local authority safeguarding team who are currently investigating the issues raised. The manager has produced an action plan in response to each of the concerns raised in the therapists letter. I looked at the record of complaints and noticed that one of the residents had complained about the way that member of staff had talked to her. The record says that the member of staff apologised to the resident and was informed that this event will be recorded. However, when I queried whether this had been recorded in the staff members file the manager said that she did not think this had been. Standards in relation to staffing were not looked at during this inspection. What the care home does well: The home manager facilitated a tour of the building. There is significant improvement in the physical environment since the last inspection. Hallway walls and bedroom doors have been decorated with brighter and lighter colours. New easy use toilets have been installed and there is a new assisted bathroom. At the last inspection we noticed that one of the hallway carpets was torn and this Care Homes for Adults (18-65 years) Page 4 of 11 presented a potential trip hazard and we issued a requirement for the tear to be repaired or the carpet replaced. Hallway carpets on the ground and first floors have all been replaced along with carpets in six of the bedrooms. The requirement is therefore met. There are new wall lights in the ground floor lounge and new curtains and sofas. An additional two sofas are to be delivered. Three new dining tables have been ordered for the dining room. There are two new tumble dryers and a new washing machine in the laundry room. The activities room is well stocked with lots of arts and crafts materials. One resident was enjoying doing a jigsaw when we toured the premises. The new toilets have a bidet function and the manager said that she hoped that this would make some of the residents more independent with their personal care. All 16 of the bedrooms have new net curtains and new worktops. Exposed wiring has been removed from a first-floor hallway wall, as required in the last inspection report. What they could do better: I looked at how medications were being handled in the home. Medication is stored securely in a staff office and, as required in the last inspection report, there is suitable storage for controlled drugs in place. A requirement made in this regard is therefore met. Prescribed medications are dispensed from a local pharmacy in blister packs. The pharmacy also supplies medication administration record. I looked at completed medication administration records for the month prior to this inspection visit. The medication records show that on some occasions residents have either not been administered their medication or staff have administered the medication but failed to maintain a record. There were a significant number of gaps in recording. For example, one resident is prescribed a nightly laxative but the record shows that on four days the medication was not administered and there is no record as to why. Records show that another resident has been refusing medication twice daily for a whole month but there is no record as to why or whether medical advice has been taken. One resident is prescribed an inhaler and the directions say that he should have one or two puffs every six hours as required, however on two days over the course of the month he was given doses only three hours apart and it is also unclear whether another of his medications is to be administered as required or daily. The directions appear to say that the medication should be given daily but staff are giving as required instead. There is information about contra indications in medications prescribed to another resident. Recorded directions say that the medication must not be administered within 1 to 2 hours of taking other medicines by mouth. However on 19 March the resident was given all of her medications at 9 AM. Records for one of these inhalers showed that the medication was not administered for five days this month. A dose of thiamine was missed on 19 April. A vitamin supplement was missed on the 16th and 25th of April. An analgesic was missed on the 15th and 19th of April. A medication to be administered four times each day via a nebuliser has not been administered at all for the entire month. Care Homes for Adults (18-65 years) Page 5 of 11 The resident is also prescribed a controlled drug. I looked at the record of administration of controlled drugs and noted that a controlled drug had been administered on two occasions, the 29th and 30th of April 2010, with only one staff signature. The signature of the witness is missing. The directions the use of a topical cream say as directed and there is no record of the application of the cream or the entire month. The resident is prescribed a daily meal supplement although there is no record of any being administered. This was an issue at the previous inspection and a requirement was made. This requirement remains unmet. At the last inspection we recommended that quantities of medicines should be carried forward from one month to the next on medication administration records to better enable justified stock checking. This is not being done. The directions on some of the medication administration records say to be administered as directed. This does not provide staff with sufficient information about directions for use. Another resident is prescribed a topical cream to be applied twice each day. Records show that staff are routinely apply the ointment three times each day instead. One resident was prescribed a course of 21 antibiotic capsules. There are 26 entries on the administration record. This indicates that staff have carried on signing the record when the course of antibiotics had already finished. Medication administration records show gaps in recording and also show that medications are not being administered in accordance with the prescribers instructions. I saw that the manager had looked at the medication administration records at the end of the month and noted the gaps in recording. She had prepared a list of times and days to see who was on duty on those days so that she could ask them whether they had administered the medication and to sign the gaps in the medication administration records. Staff must be more vigilant and accurate in their recording and the systems in place to check whether medication is being administered correctly are inadequate. This places residents at risk. There has been a requirement in place for the registered person to establish and maintain a system for reviewing and improving the quality of care for the last two key inspections. A representative on behalf of the registered provider, an area manager, conducts monthly regulation 26 visit reports, copies of which are supplied to the home manager and kept in the home. During this inspection the home manager said that quality assurance had been improved and that surveys had been sent to residents and staff and that recommendations from the monthly regulation 26 reports are turned into action plans that must be submitted to the head office within five days. Care Homes for Adults (18-65 years) Page 6 of 11 However, evidence seen during this inspection indicates that there has been inadequate monitoring of the quality of health care in regards to residents receiving their prescribed medicines and this must be better monitored in future. There are monthly residents meetings and next month a joint meeting between residents and staff is planned and there are plans to encourage greater involvement from relatives. At the last inspection and we issued a requirement because of poor odour control in one of the bedrooms. The manager said they had replaced the carpet but there is still a bad odour emanating from the bedroom. The requirement is therefore not met and further work must be undertaken to ensure good odour control. 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 7 of 11 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 20 17 Staff must keep a record of 31/07/2009 when prescribed medications are administered Staff are not currently recording the administration of each administration of topical creams and food supplements 2 30 16 The registered person must 28/08/2009 ensure that all parts of the home are free from offensive odours. The registered person must 28/10/2009 establish and maintain a system for reviewing and improving the quality of care. 3 39 24 (1) Care Homes for Adults (18-65 years) Page 8 of 11 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 20 13 The registered person must make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Medication administration records show that residents do not receive their medications as prescribed and that doses are missed. The controlled drugs register shows that a controlled drug was administered and signed for by only one member of staff on two occasions. The arrangements in place to monitor the safety of medication administration are also inadequate. This places residents at risk. 04/07/2010 Care Homes for Adults (18-65 years) Page 9 of 11 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 6 22 Staff should continue to develop plans to meet the resident cultural needs. Substantiated complaints about staff conduct should be added to the staff personnel records. Care Homes for Adults (18-65 years) Page 10 of 11 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. 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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