Care Home: Kingsley Cottage

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What the care home does well The service was good at recording the receipt of medication on the MAR charts and had a good system for account for medication that was being used from the previous monthly medication cycle. The service was very keen to know where improvements were required. The service had a wonderful atmosphere and the people who used the service appear to enjoy living there. What the care home could do better: The service needs to ensure that the administration records can demonstrate that the people who are using the service are having their medicines administered as prescribed. The service needs to ensure that the care plans have information on how to administer when required medicines safely and effectively. The home must ensure that all medicines are stored at the correct temperature. The home must ensure that the administration practices do not place people at risk. The home must ensure that the staff administering medication to the people who use the service are safe and competent to do so. Random inspection report Care homes for older people Name: Address: Kingsley Cottage 40 Uxbridge Street Hednesford Cannock Staffordshire WS12 1DB 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: Ian Henderson Date: 0 9 0 7 2 0 0 9 Information about the care home Name of care home: Address: Kingsley Cottage 40 Uxbridge Street Hednesford Cannock Staffordshire WS12 1DB 01543422763 F/P01543422763 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Gurbaksh Kaur Rai,Mr Rughbir Singh Rai care home 17 Number of places (if applicable): Under 65 Over 65 3 17 dementia old age, not falling within any other category Conditions of registration: 0 0 The maximum number of service users who can be accommodated is: 17 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: Dementia - over 65 years of age (DE(E)) 3, Old age, not falling within any other category (OP) 17 Date of last inspection Brief description of the care home Kingsley Cottage is a well-established care home situated in the Hednesford area of Cannock. It is registered to provide personal care and accommodation for seventeen older people. The home is conveniently situated within the town being close to public Care Homes for Older People Page 2 of 12 Brief description of the care home and community services and with access to public transport which passes the door. There is also a railway station in Hednesford. Limited vehicle parking facilities are provided on site. Accommodation is provided on two floors and consists of fifteen bedrooms - two double and thirteen single, two have en-suite facilities and the shared rooms have privacy screening. There are two assisted bathrooms, a shower room/wet room and four separate toilets. There is a shaft lift to provide easy access to both floors. Aids to daily living are provided throughout the home to promote independence and health and safety. Communal areas consist of two lounges and a conservatory/dining room. There is a hairdressing salon situated in the `snug off the front lounge area. Externally there are attractive gardens with secluded patio and mature borders, trees, shrubs and flowerbeds. The service has a Statement of Purpose and Service User Guide which are available on request. The reader may wish to contact the service directly for up to date information on fees. Care Homes for Older People Page 3 of 12 What we found: The reason for the visit was to check how the service was progressing in meeting the requirements made at the key inspection on the 17th April 2009. We found that the service was recording the receipt of medicines entering the home. We found that the service had a carry forward system in place which meant that they were accounting for the presence of old stock in the new monthly medication cycle. This meant that the home had an accurate starting point for auditing the medication to see if it was being administered as prescribed. We examined a number of Medicine Administration Records (MAR) and found a number of anomalies with them which affected the accuracy and robustness of them. We found many signature gaps in the records for the regularly prescribed medicines indicating that they were not being administered as prescribed. It was expected that when a medicine was administered the MAR chart was signed to indicate that the medicine has been given. If the medicine was not administered it was expected that the reason for this will be indicated on the MAR chart and as a consequence there would be no gaps in the administration record for regularly prescribed medicines. The amount of gaps were particular prevalent with the administration of creams and ointments. We were told that where a gap appeared it was likely that the person concerned had refused the application. The service was told that the MAR charts therefore should reflect this by using abbreviations. There was some concern that the home did not appear to be trying to apply the creams and ointments as they had been prescribed. One example of this was with the administration of a combined steroid and antifungal cream which was to be applied two to three times a day. We found that the MAR chart was completely blank. The Deputy Manager said that the night staff were supposed to apply it but the records showed that they were not. There was no evidence that the service was attempting to apply the cream on any other occasion during the day. The Deputy Manager also checked with a member of the night staff who said that they sometimes applied it but was forgetting to sign the MAR chart. The audit process also identified that medication could not be accounted for. We found that a quantity of 28 tablets for a medicine that was being used to treat epilepsy on a when required basis had been carried forward from the previous month. There were no signatures on the MAR to indicate that this medicine had been administered yet on the day of the visit we only found 27 tablets. We found that 80 analgesic capsules had been carried forward from the previous month. The MAR chart indicated that two tablets had been administered so we expected to find 78 tablets remaining but we found 76 tablets. We also found evidence of where the MAR charts had been signed but the medication did not appear to have been administered. We found at the start of the current medication cycle that 36 sachets of a medicine that was used to treat constipation were present in the home. The MAR chart indicated that 6 sachets had been administered so we expected to find 30 sachets remaining but we found 31 sachets still present. We found at the start of the current medication cycle that 143 capsules of a medicine that was used to treat pain were present in the home. The MAR chart indicated that 37 capsules had been administered so we expected to find 106 capsules remaining but we found 108 capsules still present. We found that when a medicine had been prescribed with a variable dose the home was not indicating what quantity had been administered. At the last inspection the home had been asked to ensure that the times of administration were clearly identified for medication that required specific time intervals. Care Homes for Older People Page 4 of 12 We found that this system had not been put into place yet. We found that the service had worked hard in reducing the number of medicines that had been prescribed with the instruction of as directed. We found overall that the care plans were poor for containing information about the administration of medicines. In particular we found little or no information about how and when medicines prescribed on a when required basis should be administered. We found no evidence that clarification had been sought with the prescriber about medicines that had been prescribed with a variable dose. We found very little information about the reasons for the administration of the medication and where appropriate the length of treatment in particular the administration of medicated creams. We found that medicines were not being stored at the correct temperatures. The maximum and minimum temperatures of the fridge were not being recorded on a daily basis and therefore it could not be guaranteed that the fridge was being maintained at between 2 and 8 degrees centigrade. The staff however were measuring and recording the ambient temperature on a daily basis and from these records it could be seen that the fridge temperature was not being maintained at between 2 and 8 degrees centigrade. On the day of the inspection the maximum and minimum temperatures were recorded at 24 degrees centigrade and minus 1 degree centigrade respectively. The service was advised that as a consequence the contents of the fridge should be discarded and new supplies sought. The service was also informed that they must also ensure that the temperature of the fridge is maintained at between 2 and 8 degrees centigrade so that the risk to medication loosing its potency or becoming contaminated is reduced. We observed a number of administrations of medication during the day. We observed that the medication was being prepared in the office and then the open medication pot containing the medication was being transported around the home on a tray. The walking around the home with medication not secure could lead to other people living in the home and visitors especially children obtaining the medication in these pots. We also found that the MAR charts remained in the office and the staff member had to return to the office to sign them. This practice could be one of the factors for the many gaps on the MAR charts. We found that none of the staff had undergone any assessments to establish whether they were able to administer medication safely and in accordance with good administration practices. In light of some of the issues identified during the inspection the assessment of the care staffs competency to administer medication safely must be carried out as soon as possible. What the care home does well: What they could do better: Care Homes for Older People Page 5 of 12 The service needs to ensure that the administration records can demonstrate that the people who are using the service are having their medicines administered as prescribed. The service needs to ensure that the care plans have information on how to administer when required medicines safely and effectively. The home must ensure that all medicines are stored at the correct temperature. The home must ensure that the administration practices do not place people at risk. The home must ensure that the staff administering medication to the people who use the service are safe and competent to do so. 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 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 9 12 Reg. 12(a)(a) & 13(2). The home must promote and make proper provision for the health and welfare of people who use the service and make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. The administration times of medication that is time critical and in this instance paracetamol, should be recorded so that the Medication Administration Record clearly identifies that there is an appropriate interval between administration of each dose. 22/05/2009 2 38 12 12(1)(a) & 13(5) Moving and 22/05/2009 handling training must be provided by a suitably trained person to all care staff deployed in the home who assist people who use the service. This will ensure that the health and welfare of people who use the service and staff are promoted and protected. Care Homes for Older People 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 3 38 12 12(1)(a) Risk assessment 29/05/2009 procedures that include input from appropriate healthcare professionals, must be carried out in all instances where bedguards are fixed. Records of the maintenance arrangements for bedguards must also be in place. This will ensure that the health and welfare of people who use the service are promoted. Care Homes for Older People Page 8 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 Regulation 13(2) The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Staff who handle medication must be competent and their practice must follow current written policies and procedures to ensure that individuals receive their medication safely and correctly. 13/09/2009 2 9 13 Regulation 13(2) The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Appropriate information relating to medication must 13/09/2009 Care Homes for Older People Page 9 of 12 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 be kept, for example, in risk assessments and care plans to ensure that staff know how to use and monitor all medication including when required medication so that all medication is administered safely correctly and as intended by the prescriber to meet individual health needs. 3 9 13 Regulation 13(2) The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Medicine records for the receipt administration and disposal of medication must be clear and accurate showing that people using the service have received medication as prescribed in order to ensure that these people are safeguarded. 4 9 13 Regulation 13(2) The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. The service must ensure that medication is stored at the Care Homes for Older People Page 10 of 12 13/09/2009 13/09/2009 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 correct temperature recommended by the manufacturer. 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 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 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. 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