Care Home: Latimer Grange

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What the care home does well Care plans contained good information, are reviewed and specialist assistance such as health and nursing staff are used in the planning of peoples care. Complaints have been documented and investigated appropriately. Safeguarding issues brought to our attention are currently under investigation Looking at a requirement from the last visit regarding staffing numbers. We saw these are adjusted to reflect peoples abilities and needs. There is a detailed medication profile held with the medication records for each person detailing what medication is currently prescribed and what it is taken for. What the care home could do better: Social care is not well documented and for what activities that do take place, little individual detail is recorded. Staff training is not up to date, with a number of courses having to be organised. Looking at the second requirement from the last visit regarding the Responsible Individual and how he oversaw the running of the home. There was little documentary evidence to back up any claims of regular visits to ensure peoples safety and has been again made in this report. Medicines must only be given to people in accordance with prescribed instructions, any variation to these instructions must only be with the prior agreement of the prescriber and a record made of this. Special instructions for the administration of medicines must be followed to ensure treatment is effective. Medicines must be stored under suitable environmental conditions and records kept to evidence this. Medicines must be locked away when not in use. Medicines controlled under the Misuse of Drugs Act 1971 must be stored in accordance with the Act and associated Regulations. Record made when medicines are given to people must be accurate and complete to demonstrate that they receive their medicines as prescribed. When people are prescribed medicines in variable doses or on a "when required" basis, there must be clear guidance for staff on the circumstances these are used and the correct dose to give to people to meet their needs. The record of medicines disposed of must be kept in the home to be able to account for all medicines in use. There must be adequate supplies of medicines kept in the home for the continued treatment of people. Staff authorised to administer medicines must be assessed as competent to do so. Hand-written changes or additions to the medication records should be signed and dated by the person making the change and checked for accuracy by a second person who should also sign the record. Random inspection report Care homes for older people Name: Address: Latimer Grange 119 Station Road Burton Latimer Northamptonshire NN15 5PA two star good service 06/02/2009 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: Keith Williamson Date: 2 0 0 8 2 0 1 0 Information about the care home Name of care home: Address: Latimer Grange 119 Station Road Burton Latimer Northamptonshire NN15 5PA 01536722456 01536725217 tonylampitt@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Rachael Elizabeth Sandell Type of registration: Number of places registered: Conditions of registration: Category(ies) : Latimer Grange Limited care home 27 Number of places (if applicable): Under 65 Over 65 27 27 dementia old age, not falling within any other category Conditions of registration: 27 0 The maximum number of service users who can be accommodated is 27. The registered persons 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 are within the following category: Old age, not falling within any other category - code OP. Dementia - Code DE and code DE(E). Date of last inspection Brief description of the care home Latimer Grange is a residential care home providing personal care for up to 27 older people over the age of 65 years, of which up to 10 can be older people with Dementia. Care Homes for Older People Page 2 of 12 0 6 0 2 2 0 0 9 Brief description of the care home Latimer Grange is situated close to the town centre of Burton Latimer. Accommodation consists of 19 single bedrooms, 14 of which have en-suite facilities, and 4 double bedrooms, two of which are en-suite. 5 of the single en-suite rooms were provided through a recent extension. The range of fees being charged at the time of this report are £356.99 to £568.43 per week. Continence products prescibed by the continence advisor or District Nurse are supplied free of charge. There are additional charges for continence wear supplied by the home , these are charged on an individual basis, with a further charged for disposal. Other services such as hairdressing, newspapers and private chiropody services are charged separately. Information is made available to service users and their relatives in the form of the service users guide. Other relevant leaflets and items of information (for example access to advocacy) are available in the hallway. Copies of Care Quality Commission reports are available from the Registered Manager. Care Homes for Older People Page 3 of 12 What we found: The reason for this inspection was to follow-up safeguarding issues about poor medication administration and comments received from an anonymous complaint, regarding a lack of hot water for the group of residents. We also looked for information to update requirements we set at the last visit. We visited the home on a weekday morning, and the visit lasted four hours. We had a tour of the home, and spoke to some residents, staff and the manager. We also had a specialist pharmacist inspector look at how medication was administered in the home. We looked at the training for staff to enable them to care for people safely, and how the Responsible Individual oversees the running of the home and how those visits are recorded. Care plans contained good information to help people attend to residents personal and health care. This was gathered prior to them coming into the home, and additional information added as necessary. Care plans are reviewed on a regular basis, and demonstrate peoples needs are being attended to. We saw that specialist help is used when staff need further information on peoples more complex needs. Although health and personal care are dealt with appropriately, social care is not well documented in plans. Staff record care information on a daily basis, and these daily records detail the work done with people and their day to day actions and personal events, however included little evidence of social care. We looked at the information recorded about complaints and the outcomes. Issues were brought to our attention about the hot water supply. Though this was not recorded as a complaint at the time, this has been investigated and the distribution problem is being acted on by the staff. There were three safeguarding issues brought to our attention. The one concerning medication has been dealt with by the specialist pharmacist inspector and forms part of this report. The other two were reported to the appropriate authority and are currently under investigation. Staff are aware how to respond to safeguarding issues. Staff spoke of the training they had done and gave information on courses about dementia care, medication, health and safety, moving and handling, and the prevention of abuse (known as poca or pova). These were also confirmed when looking at the staff training records, though staff training is not up to date and a programme of staff training needs to be developed to ensure people are safe. There were two requirements from the last visit. The first regarding the Responsible Individual and how he oversaw the running of the home. There was little documentary evidence to back up any claims of regular visits to ensure peoples safety, and therefore this requirement has been made again, and will be followed up at a later date to ensure compliance. The second was regarding staffing numbers, again to ensure peoples safety in the home. We looked at how the manager assessed peoples needs and were satisfied the staffing numbers were adjusted to reflect peoples abilities. We looked at the practices and procedures for the safe storage, use and recording of medicines. Most medicines are stored securely for the protection of residents but we found that the fridge used to store medicines was not locked and was in an accessible area, we also found some medicines in the office which is not always locked when not in use. This could mean that people can gain access to medicines not prescribed for them Care Homes for Older People Page 4 of 12 and that they could be used by unauthorised people. The temperature of the area where medicines are stored is not monitored and recorded regularly. Although it was acceptable at the time of this inspection, it was at the upper limit of the acceptable level. We also saw that the temperature of the fridge used to store medicines had been recorded outside the recommended range without any action taken to investigate its performance or the quality of medicines stored there. Medicines must be stored at the correct temperature as this could put people at risk of receiving medicines that are ineffective. The cupboard used to store controlled drugs is not of the right construction or fixed to the wall in the way required by the Regulations, although there were no controlled drugs in use at the time of the inspection. We looked at the medication records for several people in the home and found a number of problems with these records. We found a number of gaps in the records made when medicines are given to people giving no indication whether medicines had been given or not. We also found that when people were not given their medicines the reason why was not always recorded. The records were sometimes inaccurate as they had been signed to indicate medication had been given but the corresponding dose remained in the packs. When medicines are given in variable doses e.g. one or two tablets, the records did not always indicate the quantity given and this could result in people receiving to much or too little medication and makes it difficult to account for all medicines in use. We also saw that some people were not given medicines in line with the prescribers instructions and that special instructions for medicines e.g. to be given before meals, were not being followed. In some cases the date that medicines were given to people was not clearly recorded. Hand-written changes or additions to the medication record are not signed and dated by the person making the change or checked for accuracy by a second person. The manager told us that regular checks have been started to assess the quality and accuracy of medication records, and some of the problems described above had been picked up, but not all. We therefore left an immediate requirement notice to ensure medicines are given correctly and records are accurate and complete. When people are given medicines in variable doses and on a when required basis e.g. to treat pain or control behaviour, we could not find any guidance for care staff on the circumstances these are given and no information for staff to follow to ensure medicines are given appropriately to meet peoples needs. We saw that a number of people had not received their medicines as supplies had run out; for one person this meant that they had not received any pain killers for 4 days. The records made when medicines are received into the home were of a good standard but the records made when medicines are disposed of were not available as it had been removed from the home. It was therefore difficult to account for all medicines in use. Medicines are only given to people by authorised staff who have received training. We were told that some further training was planned for the following week. However, there is no assessment that people are competent to administer medicines to people. What the care home does well: Care Homes for Older People Page 5 of 12 Care plans contained good information, are reviewed and specialist assistance such as health and nursing staff are used in the planning of peoples care. Complaints have been documented and investigated appropriately. Safeguarding issues brought to our attention are currently under investigation Looking at a requirement from the last visit regarding staffing numbers. We saw these are adjusted to reflect peoples abilities and needs. There is a detailed medication profile held with the medication records for each person detailing what medication is currently prescribed and what it is taken for. 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 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 27 18 (1)(a) That sufficient staff 28/02/2009 are on duty at all times to cope with the dependency of the residents. This has been required at a previous inspection. That the residents should receive appropriate care and protection at all times. 2 37 26 (4)(c)(5)That the registered 28/02/2009 provider completes a written record of his inspection of the home. To make sure that the home is running within the standards required. Care Homes for Older People Page 7 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 1 9 13 Records made when 22/08/2010 medicines are given to people must be accurate and complete. This will demonstrate that people receive their medicines as prescribed. 2 9 13 Special instructions for the administration of medicines must be followed. This will ensure people receive treatment that is effective. 22/08/2010 3 9 13 Medicines must only be given 22/08/2010 to people in accordance with prescribed instructions. This will ensure people receive the correct treatment. 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 There must be adequate 30/09/2010 supplies of medicines kept in the home for the continued treatment of people. This will ensure people receive their medicines as prescribed. Care Homes for Older People Page 8 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 2 9 18 Staff authorised to 31/10/2010 administer medicines must be assessed as competent to do so. This will protect people from harm and ensure medicines are given safely and appropriately. 3 9 13 Medicines must be locked away when not in use. This will ensure that medicines are not accessible to unauthorised people and people they are not prescribed for. 15/09/2010 4 9 13 Medicines controlled under 31/10/2010 the Misuse of Drugs Act 1971 must be stored in accordance with the Act and associated Regulations. This will ensure compliance with the law and prevent unauthorised access to these medicines. 5 9 15 When people are prescribed 30/09/2010 medicines in variable doses or on a when required basis, there must be clear guidance for staff on the circumstances these are used and the correct dose to give to people to meet their needs. This will protect people from harm and ensure medicines are not used inappropriately. 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 6 9 13 Medicines must be stored 30/09/2010 under suitable environmental conditions and records kept to evidence this. This will ensure medicines are of suitable quality. 7 30 18 The registered person shall, 08/10/2010 having regard to the size of the care home, the statement of purpose and the number and needs of service users This will ensure people are cared for by competent carers. 8 36 26 Where the registered 09/11/2010 provider is an organisation or partnership, the care home shall be visited in accordance with this regulation by (a) the responsible individual or one of the partners, as the case may be; (b) another of the directors or other persons responsible for the management of the organisation or partnership; or (c) an employee of the organisation or the partnership who is not directly concerned with the conduct of the care home. This is to ensure the safety of people in the home Care Homes for Older People Page 10 of 12 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 Hand-written changes or additions to the medication records should be signed and dated by the person making the change and checked for accuracy by a second person who should also sign the record. Social care could be expanded in peoples plans of care, this would enable staff to engage people with activities suited to their abilities and previous lifestyle. 2 12 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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