Care Home: Hertha House

What the care home does well During this inspection other areas of care were not looked at. We received an improvement plan (dated 3rd December 2009) detailing the action taken to meet the requirements made on 22nd October 2009. These requirements were not looked at as part of this inspection so they remain in the report. What the care home could do better: We found that improvements need to be made to the handling of medicines in the home so that people living here can be confident they they will always be given their medicines correctly. Information about medicines to be given "when required" must be available and accessible for staff to ensure that these medicines are given appropriately and consistently. Accurate records must be kept of feeds given to one person via a PEG tube. Action should be taken to ensure it is always clear which medicines on the medicines administration record are in correct use and should be given. Random inspection report Care homes for adults (18-65 years) Name: Address: Hertha House 14a St Michael`s Square Gloucester GL1 1HX 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: Sue Fuller Date: 2 5 0 8 2 0 1 0 Information about the care home Name of care home: Address: Hertha House 14a St Michael`s Square Gloucester GL1 1HX 01452313113 Telephone number: Fax number: Email address: Provider web address: admin@aspectsandmilestones.org.uk Name of registered provider(s): Name of registered manager (if applicable) Megan Beatrice Fields Type of registration: Number of places registered: Conditions of registration: Category(ies) : Aspects and Milestones Trust care home 11 Number of places (if applicable): Under 65 Over 65 0 physical disability Conditions of registration: 11 The maximum number of service users who can be accommodated is 11. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Physical Disability - (Code PD) Date of last inspection Brief description of the care home Hertha House is a modern fully equipped Care Home which opened in early 2001 to provide accommodation for 11 service users with a physical disability. Some people living at the home also have a learning disability. It is located in a residential area very close to the centre of Gloucester. There are three self-contained flats on the first floor that fall under a supported living scheme. Care being provided by other domiciliary care providers. Aspects and Milestones Ltd are the registered providers for the home. Care Homes for Adults (18-65 years) Page 2 of 12 Brief description of the care home They have had delegated responsibility for managing the home since 2005. Gloucestershire Housing Association owns the building. Single en suite accommodation is provided on two floors with access to the upper floor via a shaft lift. Hertha House has a sensory room, an assisted bathroom with a hydro-massage bath and spacious communal facilities. There is also a small garden and upper balcony. The home has a mini-bus that is accessible to people who use wheelchairs. Base fee levels at Hertha House begin at GBP1200 per week. Additional charges are made for day care, travel, holidays, chiropody and hairdressing. Each person living at the home has a copy of the Statement of Purpose and Service User Guide. Further copies are available in the office, where a copy of inspection reports can also be found. Care Homes for Adults (18-65 years) Page 3 of 12 What we found: The pharmacist inspector carried out this unannounced inspection following concerns raised about the handling of medicines in the home. We (the Care Quality Commission) talked to four staff involved with giving medicines in the home and to one person living in the home. We looked at the arrangements for ordering, storing, administering and disposing of medicines in the home. The registered manager was not available on the day of this inspection but we spoke to her by telephone to discuss our findings. A requirement made at the last inspection, for all staff who dispense medication to have the skills, knowledge and competency to do this, had been partly met . When we arrived at Hertha House, the front door was partly open and we were able to enter the house and walk around the ground floor without being challenged. Staff told us that there had been a problem with the front door not closing properly and that they had taken action to address this. Staff must ensure that the door shuts properly, to safeguard the people living here. At the present time all the medicines used in the home are looked after and given by staff. Staff told us that they had recently had some medicines training arranged by their pharmacy. They had left a training book for staff to complete. We also saw a book for assessing staff competency to give medicines safely. We were told that the manager had started to carry out these checks. However when we spoke to her, she told us that she was using the books for group discussion rather than to assess individuals competence. The manager told us that she would carry out individual assessments within the next two months to ensure that all staff are able to give medicine safely. Staff told us that they had received training for giving emergency rescue medicine prescribed for one person, so that there would always be a suitably qualified person on duty. They had also had training for giving a particular feed to another person. We were not able to see the training records during the inspection. Most people living in the home are registered with a nearby doctors surgery. The manager told us that some people have stayed with their original family doctor if this was requested and agreed by that doctor. Staff request medicines via a local pharmacy. It is good practice for staff to see and check the prescription to ensure that the correct medicines are always supplied. We saw medicines prepared to be given to one person. We spoke to one person who told us that they were happy with how their medicines were looked after. The pharmacy provides printed medicines administration record (mar) sheets each month for staff to complete. We saw that in many cases these included medicines that staff told us had been discontinued. It was not always clear which medicines were in current use. This increases the risk that medicines will not be given correctly and action should be taken to address this. Staff told us that they have a meeting arranged with their pharmacy to discuss this. We saw that systems are in place to allow medicines to be audited to check that they Care Homes for Adults (18-65 years) Page 4 of 12 have been given correctly.We checked medicines for three people and they all appeared to have been given as recorded. We saw that bottles of liquid medicines are dated on opening. Some people are prescribed medicines to be given when required but we saw no protocols for the use of these medicines to ensure that staff gave them appropriately and consistently.Staff told us that these had been available in the past but they did not know where to find them. When we spoke to the manager she told us that these had been reviewed and were now kept with peoples health action plans. Action is needed to ensure that staff can easily access and use these protocols. We saw that some records had a code of D meaning social leave. It was not clear whether this meant that the person had been given their medicine or not. Staff told us that often the medicine was taken with the person out of the home and either given by a member of staff or family. If medicines are taken out of the home to be given later a record must be made of this. We saw that records for the feeds given to one person through a special tube are made on a food diary. These were not always completed accurately so there was no evidence that this person was given their feed correctly. Action must be taken to ensure that complete and accurate records are kept of the feeds given. This is to make sure that this person receives their feeds correctly. Records are kept of the disposal of medicines. The disposal record had only been completed since August. Staff told us that they had not returned any medicines since changing to a new pharmacy several month ago. Records are kept of the medicines received into the home. We saw that the record for one medicine did not appear to be accurate as 120 tablets had been recorded as received but it appeared that only 112 tablets were actually supplied. This needs to be checked with the pharmacy. Staff must ensure that they sign for the amount of medicine actually received into the home. Any discrepancies must be checked with the pharmacy. We looked at two peoples care records to see what information was available to help staff give medicines correctly. One person had a number of when required medicines in the cupboard. Staff were able to explain when they would use these and the person involved was able to say which medicine for pain they wanted to take. However we saw no information in the care plans about the use of these medicines and one had been supplied some time previously for an injury which has since healed. One persons care notes had a list of their current medicines. This did not include inhalers they had been prescribed for breathing problems, although there was a record of this person being wheezy and the doctor prescribing inhalers. There was no information about a change in the medicine used for pain relief. There was no information about the use of an inhaler prescribed when required for wheezing. This means that medicines may not be given appropriately and consistently. Storage is available for medicines on each floor of the home. The arrangements in place on one floor for storing controlled drugs, which need additional security, do not meet the Care Homes for Adults (18-65 years) Page 5 of 12 requirements of the Misuse of Drugs (Safe Custody) Regulations 1973. None of these medicines are currently used in this area but consideration should be given to having a suitable cupboard in place, in case this is needed at a later date. Staff upstairs told us that there had been discussion about having medicines cupboards in peoples own rooms rather than keeping them centrally. But no action had been taken yet. We saw some excess stock which had accumulated over a period of time. Action is needed to ensure that only those medicines that are needed are ordered each month to avoid overstocking and waste of medicines. We saw some empty medicine containers in the office. Staff told us that this was because they washed them and returned them to the pharmacy for disposal. 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 Adults (18-65 years) Page 6 of 12 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 6 15 The registered person must 31/12/2009 make sure that each person has a care plan reflecting their assessed needs which is accessible to them and to staff. This is to that their individual needs can be met. 2 6 15 Care plans must be put in 30/11/2009 place for new people who have moved into the home so that their individual needs can be met. (The timescale for this requirement was not met.) 3 9 13 The registered person must 31/12/2009 make sure that any hazards people face are assessed and regularly reviewed. This is to safeguard people from possible harm. 4 9 13(4) Risk assessments must be 30/11/2009 put in place to minimize hazards for new people living in the home. Where a new risk assessment is needed as a Care Homes for Adults (18-65 years) Page 7 of 12 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 result of an incident this must be put in place as soon as possible. This is to safeguard people from further harm. (The timescale for this requirement was not met.) 5 19 12 The registered person must make sure that recommendations from health professionals are implemented. This is to promote the safety and wellbeing of people living in the home. 31/12/2009 6 19 12 The registered person must 30/11/2009 make sure that any treatment undertaken by people in their care is done in their best interests and that this is evidenced after discussion with the appropriate social and health care professionals. The registered person must make sure that all staff who dispense medication have the skills, knowledge and competency to do this. This is to protect people from possible harm. 30/11/2009 7 20 18 8 22 17 The registered person must 31/12/2009 Page 8 of 12 Care Homes for Adults (18-65 years) 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 make sure that a record of all complaints made by people or their representatives are kept in the home. This is to provide us with evidence that the homes complaints procedure is open and transparent. 9 23 37 The registered person must 30/11/2009 inform us if physical intervention is used to prevent people from possible harm, this includes switching an electric wheelchair into manual mode. This is to safeguard people from possible harm. 10 23 17 The registered person must keep a record of any limitations agreed with people in respect of their liberty of movement. This relates to switching an electric wheelchair to manual. This is to safeguard people from possible harm or abuse. 30/11/2009 11 34 19 The registered person must make sure that agency staff have the necessary records in place and have a satisfactory CRB. This is to safeguard people 30/11/2009 Care Homes for Adults (18-65 years) Page 9 of 12 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 from possible abuse. 12 34 19 Sch 4 The registered person must keep copies of all records required by us in the home for newly appointed staff. This is to safeguard people from possible harm. 30/11/2009 13 39 24 The registered person must maintain the quality assurance system which reviews the service at appropriate intervals. This is to make sure people living in the home are involved in and informed about improvements and developments in the home. 31/03/2010 14 42 23 The registered person must 30/11/2009 make sure that fire exits are kept clear and that rubbish under stairwells is removed as this is a fire risk. This is to safeguard people from harm due to the risk of fire. Care Homes for Adults (18-65 years) Page 10 of 12 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 9 13 Information about medicines 29/09/2010 to be given when required must be available and accessible for staff to ensure that these medicines are given appropriately and consistently 2 9 13 Accurate records must be kept of feeds given to one person via a PEG tube To ensure that these are given according to the prescribed regime 29/09/2010 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 Action should be taken to ensure information on the medicines administration record sheet makes it clear which medicines are in current use and need to be given. This is to make sure the correct medicines are always given. Care Homes for Adults (18-65 years) Page 11 of 12 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. 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