Care Home: Kington Court Health and Social Care Centre

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What the care home does well Because the focus of this inspection was to check some specific issues, we may not have identified some areas of good practice. The home is clean and tidy, and the people we spoke to told us that they were happy with the care that they receive at Kington Court. We saw staff providing support for people, and this was done with respect and in a caring manner. Care plans are detailed and are reviewed regularly. Medication is generally managed safely. What the care home could do better: Records of medication received into the home need to be improved, so that it is possible to account for all medication used in the home. The home needs to ensure that medical advice is sought whenever people have any significant unexplained weight changes. This will help to ensure that people`s healthcare needs are met. The home needs to make sure that staff know how to protect people from the risk of falling, by the use of up to date risk assessments and care plans. This will help to prevent the risk of injury to people from falls. We have made requirements about these issues, and the home must comply with them within the stated timescales. We will be checking to make sure that this has been done. Random inspection report Care homes for older people Name: Address: Kington Court Health and Social Care Centre Victoria Road Kington Herefordshire HR5 3BX two star good 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: Sarah Blake Date: 2 9 0 3 2 0 1 0 Information about the care home Name of care home: Address: Kington Court Health and Social Care Centre Victoria Road Kington Herefordshire HR5 3BX 01544232333 01453544218 suzanne.line@blanchworth.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Blanchworth Care Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 48 Number of places (if applicable): Under 65 Over 65 0 48 dementia old age, not falling within any other category Conditions of registration: Age: Dementia (DE) age 55 and above 6 0 The maximum number of service users who can be accommodated is: 48 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 (OP) 48 Dementia (DE) 6 Date of last inspection 1 3 0 1 2 0 0 9 Care Homes for Older People Page 2 of 10 Brief description of the care home Kington Court can provide personal care and accommodation for 16 older people, 12 intermediate care places, which includes two social services re-ablement beds, eight for older people and four for people under the age of 65, as well as 20 nursing places for older people. In total it is registered to accommodate 48 residents. The home is owned by Blanchworth Care Ltd and is located on the outskirts of the small market town of Kington. It is close to shops, and other amenities. The home was purpose built and opened in June 2003. It consists of a two-storey building, which was built to provide a Health and Social Care centre for the town and surrounding rural area. The homes facilities are entirely situated on the first floor of the building. They are divided into three units; Eardisley (personal care), Logan Jack (intermediate) and Staunton Wing (nursing). The home offers 46 single rooms and one double room, all with en-suite toilet and shower facilities. There is a passenger and a service lift provided. The home has gardens at the rear and to the side of the building that are accessible via the ground floor lounge/dining area or outside via an entrance off the car parking area. The home is accessible throughout by people with a physical disability who require the use of a wheelchair. A range of equipment is also provided for residents with physical disabilities. There is no information in the statement of purpose and service users guide about the range of fees charged by this service; fee levels are available on request. A copy of the homes statement of purpose and service users guide is on display in the home, including a copy of the most recent inspection report. Care Homes for Older People Page 3 of 10 What we found: This was an unannounced inspection so the owners and staff at the home were not expecting us. The inspection was done by two inspectors, including a pharmacist inspector. We arranged the inspection because we wanted to get an up to date picture of how people are being looked after at Kington Court. We also wanted to check some information about a recent incident at the home. We saw that the home was clean and fresh, and that some people were enjoying an activity session in one of the lounges. We looked at the care records for some of the people who live at the home. These were very detailed and there were care plans in place to tell staff how to care for each person. We saw that one person had been assessed as being at risk of not eating enough and that a dietary supplement had been prescribed for them. The staff were keeping detailed records of the persons food and fluid intake, and these had been fully completed. In spite of this, records showed that the person had lost a sigificant amount of weight. There was no evidence that any action had been taken to find out why the person had lost weight. When we spoke to the manager about this, she told us that she would contact the persons GP for advice. The day after the inspection, the manager contacted us to say that the GP had visited the person. It is concerning that the persons weight loss had not been reported to the GP earlier. We saw that one person had a history of falls, and had fallen on several occasions recently. There was a full and detailed risk assessment in place, which informed staff how they should support the person, and the equipment they should be using. Although the risk assessment was up to date, records showed that it had not been updated promptly following some of the falls. The person had previously suffered a serious injury from falling, so it is essential that staff have access to up to date information about strategies to prevent further falls. The pharmacist inspector visited the service to undertake a random inspection in order to check the management and control of medicines. We looked at medication storage on Logan Jack (Intermediate Care) and Eardisley (Personal Care) including some care records and medication administration records. We spoke to two members of staff and gave feedback to the Manager. Medication was stored within locked cupboards and a medicine trolley on each unit was used to store peoples medicines.The medicine trolleys were neat and tidy, which made it easy to locate peoples medicines.We saw that medication was available to give to people as prescribed. This means that there was provision for the safe storage of peoples medication. Controlled drug medication, which requires special storage, was not always stored according to the legal requirements of the Misuse of Drugs Act 1971 and the Misuse of Drugs (Safe Custody) Regulations 1973. We saw some medication stored in the medicine Care Homes for Older People Page 4 of 10 trolley on Eardisley that should be stored in a controlled drug (CD) cabinet. We discussed this with a member of staff who agreed it should have been stored in the controlled drug cabinet and put the medicine into the CD cabinet immediately to meet the legal storage requirements. As there was no CD cabinet available on the unit the member of staff had to take the medicine to the CD cabinet located on the nursing unit. We discussed this issue with the member of staff who siad that it would be helpful to have another CD cabinet located in Eardisley to save time and also ensure staff did not need to leave the unit. We discussed these issues with the manager. We looked at the medication administration record (MAR) charts. Logan Jack used an NHS Trust MAR chart which was documented and signed by a Doctor. The other two units used MAR charts, which were printed by the pharmacy and overall found that they were well documented with a signature for administration or a reason was recorded if medication was not given. This ensured that staff knew when to give medicines. We found that medication records were generally available and kept up to date. However, the receipt of some peoples medicines were not always documented. In particular we found that there was no record for the receipt of medicines that were individually prescribed for people on Logan Jack unit. We discussed this with the manager who agreed to ensure that there was a record documented. This meant that it was not always possible to ensure there was a clear audit trail of peoples medicines arriving into the home. One person was prescribed an anticoagulant to thin the blood.This medication requires blood checks to ensure the correct dose is prescribed, which can vary depending on the result. We saw that two different strengths of the tablet were available in order that the correct prescribed dose could be given. We saw that two staff had checked and signed the MAR chart for accuracy. We looked at the prescribed dose, which was available in the yellow Anticoagulant booklet and also a printed copy of the prescribed doses from the GP surgery. The doses were clearly recorded onto the MAR chart so that staff were able to give the correct amount of the medicine. We checked the amount of tablets available in order to check the records for accuracy. We were not able to do the check because there was no accurate balances of the medicines available. For example, we counted 25 tablets for one of the medicines, however the available records documented a total of 0. This means that although the records were clear and easy to follow it was not possible to check that the medicines had been given as prescribed. Information about peoples medicines were generally recorded in their care plans. For example we looked at the care plan for one person who was looking after their own medicines. We saw that the home had recorded the receipt of the medicines and had clearly documented on the MAR chart that the person was self administering their own medicines. We also saw that there was a document called a Medicine Administration Choice and Capacity form dated 26/2/10 which included information about the risks and abilities of the person to look after their own medicines. This ensured that there was clear information available about how the person looked after their medicines and ensured the person was safe from harm. We saw that medicines were given to people safely. For example, during lunchtime we witnessed a member of staff administering medicines. The member of staff took medicine from the medicine trolly, locked it and then checked the MAR chart again before taking the medicine in a pot to the person. The member of staff signed the MAR chart after the Care Homes for Older People Page 5 of 10 medicine had been taken. This procedure was repeated for each person. This means that medicines were checked and handled safely before being given to the person. 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 6 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 7 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 13 (4) Falls risk assessments must be reviewed in cases where the person has experienced a fall since the risk was previously considered. This will assist the home in reviewing whether there is any further preventative action they can take following each fall. 14/05/2010 2 8 12 (1) You must put an effective 14/05/2010 system in place to ensure that concerns about peoples health and well being are referred to health care professionals in a timely manner. This is to ensure that peoples health needs are met. 3 9 13 (2) You must make 14/05/2010 arrangements to ensure that records are kept of all medicines received into the home. Care Homes for Older People Page 8 of 10 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 This is to ensure that the care service maintains accurate records of medicines. 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 The service should make arrangements to ensure that controlled drugs are stored securely on Eardisley Unit in accordance with the requirements of the Misuse of drugs Act 1971, the Misuse of Drugs (Safe Custody) Regulations 1973 and in accordance with the guidelines from the Royal Pharmaceutical Society of Great Britain. This is in order to ensure that controlled drugs are stored safely to prevent misuse. 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. 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