Care Home: Mahogany Care Home

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What the care home does well We found a pleasant friendly atmosphere was in place during our visit. Staff were observed going about their duties chatting to residents and other staff. The home has policies and procedures in place to promote the dignity and respect of the people who live there. The large notice board in entrance showed that the home are `Dignity in Care Champions.` Photographs of the staff involved, coordinator and the aims of the service were displayed. Dignity in care meetings are held with residents and relatives who wish to attend to discuss the activities, changes needed and any complaints. The residents are encouraged to speak freely. Meal times were seen to be relaxed and unhurried. Residents who needed help were provided with support in an unobtrusive manner by the staff. We spoke with a number of residents who commented: "I am settled here now, I can get up at any time and have breakfast in my room, I wash and dress myself. The food is good and I am very well cared for. I have clean clothes every day." " The girls do their best and everything here is nice." "Breakfast is belting." "I can dress myself but the girls are here for me when I need a bit of help." Relatives spoken with provided the following comments on the care and support provided: "We visited several homes to find one suitable for Mum and this one felt just right. It was like coming to an oasis. We have nothing but praise for the home and it`s staff for the way they care for Mum." "I can dress myself but the girls are here for me when I need a bit of help." What the care home could do better: Residents` plans of care must reflect all aspects of their individual current needs in respect of their health and welfare. Clear actions for staff must be recorded to show how their needs are to be met. Where possible the care plan must be drawn up with the resident/or representative and kept under review to reflect changing needs. In relation to specific health care needs identified, such as feeding regimes, wound care and exercise routines. Residents must have access to the appropriate care and treatment they need to keep them well. All care and treatment given must be recorded accurately to show the care provided. Residents` risk assessments should be accurate and kept up to date to show each residents specific care needs to ensure the health and safety of the residents. Residents` weight should be recorded regularly to enable the staff to monitor their health and well being. The manager agreed to conduct regular audits of staff recording systems to ensure the residents care needs are accurate and reflect the care and support they need. Overall we found shortfalls in the way that medicines were stored, administered and recorded that were placing the health and wellbeing of people living at the home at unnecessary risk of harm. In view of the above we strongly recommend that the manager should conduct regularly audits of residents` care files and staff competency to ensure safe systems of care are in place and up to date records are in place. Records of visits from health care professionals, other professionals and family should to be recorded accurately to show records of visits and access to health care services to help keep the residents well. Staff should receive training in the Mental Capacity Act and Deprivation of Liberty Safeguards so that they understand the needs of people who are unable to make their own decisions. Random inspection report Care homes for older people Name: Address: Mahogany Care Home Marsden Street Newtown Wigan Lancashire WN5 0TS three star excellent service 18/10/2007 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: Elaine Stoddart Date: 1 5 0 6 2 0 1 0 Information about the care home Name of care home: Address: Mahogany Care Home Marsden Street Newtown Wigan Lancashire WN5 0TS 01942820800 01942492111 Telephone number: Fax number: Email address: Provider web address: www.mimosahealthcare.com Name of registered provider(s): Name of registered manager (if applicable) Mrs Kathleen Barnett Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mimosa Healthcare (No4) Limited care home 51 Number of places (if applicable): Under 65 Over 65 51 old age, not falling within any other category Conditions of registration: 0 The maximum number of service users who can be accommodated is 51 The registered provider 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 category: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Mahogany Care Home is a purpose built, single storied building. It provides care with nursing for older people in a well maintained home. The majority of rooms are for single occupancy but there are also a small number of shared rooms. All the bedrooms Care Homes for Older People Page 2 of 15 2 6 1 1 2 0 0 9 Brief description of the care home have en-suite facilities. There is off road parking and pleasant gardens to sit in the better weather. The home is privately owned by Mimosa Healthcare Ltd. The company have homes located in other parts of the country. The manager is Kathleen Barnett. The home is ideally situated close to a shopping area and local transport links. Fees for accommodation at the time of the inspection 339.86 to 697.74 pounds per week. Care Homes for Older People Page 3 of 15 What we found: The Random inspection for Mahogany Care Home was conducted on 15th June 2010 by two inspectors, a compliance inspector and a pharmacy inspector. An expert by experience also attended the home as part of the inspection process for a period of approximately three hours. The Commission has different methods for collating information. An expert by experience is a person who has because of their shared experiences of using a service and/or ways of communicating, visits a service with an inspector. This is to help them to gain information as to what it is like to live or use the service. An expert by experience accompanied the inspector for this inspection and details of their findings have been included in the report. A site visit took place with the homes manager and it lasted approximately nine hours. The purpose of the inspection was to follow up on a number of requirements from the last Random inspection, which was conducted on 26th November 2009. The inspection focused on two outcome areas. These were Health and Personal Care and Complaints and Protection. We found that all the requirements from the last Random Inspection on 26/11/09 had been met. During the visit we case tracked three residents care files (their files were examined to help ensure staff were providing the care and support they needed). This included one resident who had recently been admitted to the home and was placed on the residential unit and two other residents on the nursing unit. There were forty six people accommodated and the home was well staffed on the day of the site visit. People accommodated at the home like to be called residents and this term is used in this report as a mark of respect to them. Time was spent meeting with staff, residents and relatives to enable us to gain their opinions of the overall service. The last Key inspection was excellent on 18/10/07. The Annual Quality Assurance Assessment (AQAA) from the previous inspection was used as this was still within date and up to date information was obtained from the manager during the visit.The AQAA is a quality assurance assessment, which was sent to us by the service and is completed once a year by the provider. The AQAA provides us with statistical information about the service and trends and patterns in social care. Outcome Area - Health and Personal Care. We looked at three care files. We found that initial assessments of the residents care needs had been completed, which showed their care needs on admission to the home. This formed the basis of their initial care plan. Records showed that staff had conducted a review of their care needs and had dated and signed to show their needs had not changed. We found that care plans failed to provide up to date, accurate information on the individual care needs of the residents. A full care plan review had not taken place since the residents initial admission to the home. This was particularly noted for on resident who has high level care needs. Daily records showed that the residents care needs had changed recently, however the plan of care in place failed to reflect his current needs. These were in relation to feeding, daily exercise routines, specific health care needs and turning (as cared for in bed). Records failed to show that where needs had changed these had been clearly identified and a new plan of care drawn up. Records showed that the resident required further input and supervision from staff to manage the Care Homes for Older People Page 4 of 15 residents care. Up to date care needs were not recorded in the plan of care to reflect this as the monthly review recorded Care plan remains valid. When care plans reviews take place staff should ensure that all changes are reflected in an up to date plan of care. Care plans failed to provide clear actions to be undertaken by staff to meet residents individual care needs so that they are able to provide the care and support required to keep them safe and healthy. Records of visits from health care professionals, other professionals and family failed to be recorded in the correct place within the residents care files. Thus failed to show an accurate records of visits and access to health care services to help keep the residents well. We looked at wound care records and found that these failed to be up to date and accurate in a residents care file. We looked at risk assessments and found that these were not up to date to show the residents specific care needs. The above issues raised were discussed in detail with manager in view of the high level needs of one resident. A review of this residents care assessment was requested at the time of the visit and agreed by the manager. The manager agreed to conduct a review of all care plans to reflect changes in need and provide up to dare accurate records. This will ensure that the residents are provided with the care they need to support them. The manager agreed to conduct regular audits of staff recording systems to ensure the residents care needs are accurate and reflect the care and support they need. We observed residents having their lunch in a relaxed environment. Residents who needed help were seated at the same table, their carers sat unobtrusively beside them and were gently persuasive and encouraging throughout the meal. Thus ensuring the residents dignity and respect at this time. We spoke with a number of residents, staff and visitors and their comments were positive regarding the care and support provided. Their comments are included in the section What the service does well. The home operates a key worker system, where nominated staff are responsible for certain residents to ensure their care needs are met and their wishes respected. Staff were seen to treat residents with dignity and respect during visit. They talked with them using their preferred name, knocked on doors prior to entering. All personal care was given in the privacy of own rooms. Residents stayed in rooms if they wished or went into the lounge or dining area to have their meals. The laundry was seen to be well organised with named clothing and individual baskets to avoid losses. Assessments of need and care plans viewed recorded the residents social history and their likes and dislikes. So the staff are aware of what they like to do. An activity organiser provides activities to stimulate the residents. They can choose if they wish to attend or not. The activities include: bingo, barge trips, weekly church visits, pub visits, and walking days. Relatives spoke highly of the activities in place. Part of this visit was carried out by a Pharmacist Inspector. Their role was to check how medicines were being managed. Overall we found shortfalls in the way that medicines were stored, administered and recorded that were placing the health and wellbeing of Care Homes for Older People Page 5 of 15 people living at the home at unnecessary risk of harm. We looked at one of the medication storage rooms and found it to be dirty and in need of new flooring. We found supplies of medicines that were unlabelled and some that were out of date. Medicines are at risk of being misused and people are at risk of harm if medicines are not stored hygienically and disposed of appropriately. We found several gaps on the current medicines records and other mistakes that meant the records were not accurate. We saw that some medicines were not given at the correct time with regard to food and drink intake because staff had not followed the written instructions. We found that staff had handwritten some entries onto the medicines charts when medicines had been received from hospital or in the middle of the medicines cycle. These entries did not include all the warnings necessary to give these medicines safely and they had not been checked and signed by two members of staff. We found that clear explanations had not been recorded when medicines were not given, for example, if they were refused. Inaccurate records can lead to serious mistakes that can place peoples health and wellbeing at risk of harm. We found that the medicines fridge was not keeping medicines within the correct temperature range (2-8C) and staff did not record the temperatures accurately. We saw no evidence of any action taken when the fridge became too warm or too cold. Medicines are likely to spoil and may be dangerous to use if they are not kept correctly. We looked at how controlled drugs (medicines that can be misused) were being handled. We found that records in the Controlled Drugs Register had not always been signed for by two staff and we also saw that on one occasion medication had been signed for as administered when it had not been. Accurate and complete records are essential for ensuring that these powerful medicines are used correctly. We carried out detailed checks of some stocks and records and found that whilst medicines supplied by the pharmacy in special blister packs were usually given correctly, medicines contained in traditional bottles and packets could not always be accounted for. We saw evidence that some medicines had been signed for, but not actually given, whilst others could not be accounted for. In some cases it was not possible to tell whether or not the medicines had been given correctly. The instructions for administering medication and feeds via PEG tubes (tubes going directly into the stomach) were unclear or missing as were instructions for giving medicines that were prescribed to be taken only when required. The health and well being of people living in the home is at serious risk of harm if staff do not have clear instructions to follow and if medicines are not given as prescribed. We looked at the way medicines and staff competency were audited (checked). There was no evidence that staff had been formally observed giving and recording medicines and given some of the mistakes found at the visit it was evident that some staff still need to have their competency formally assessed to make sure they have the necessary skills to handle medicines safely. Whilst some audits had been completed, they had not been effective as they had failed to identify a number of areas of concern. This meant that problems had not been found and rectified by the manager. Requirements and recommendations regarding the above findings are contained in this report and in the section What they could do better. We spent some time with the manager at the end of the visit to discuss our findings and actions required by the home Care Homes for Older People Page 6 of 15 to improve the health and welfare of the residents. Outcome Area - Complaints and protection. Two complaints had been received by the Commission since the last visit and these were forwarded to Wigan Social Services who agreed to undertake investigations into the complaints and let the Commission know their findings. We looked at the complaints policy and procedure, which outlines that all complaints will be investigated fully by the manager and responded to within 28 days. A copy of how to make a complaint is available in the service user guide and statement of purpose. We spoke with a number of residents and no concerns were raised. We also spoke with visiting relatives who were satisfied with the care and support provided. A relative spoken with commented: I am very happy with the care and support. I looked at other homes prior to making a decision for my wife to be admitted here. I wouldnt hesitate to tell the manager if I wasnt happy. The home always notify me of anything regarding the care of my wife. One safeguarding investigation is taking place and is under investigated by the Wigan Safeguarding Team. The manager followed the correct procedures to notify the authorities of the incident. Thus ensuring the people they care for are safe from harm. We looked at policies and procedures in place on abuse and found that copies of the local safeguarding procedures were available so that staff are aware of how to raise an alert. A copy of the staff training plan was seen and showed that fifteen of the thirty one staff had received training in abuse 33 . Further training on safeguarding was seen to be arranged for staff in June 2010. Staff spoken with showed an understanding of what action to taken should they witness any abuse. Their comments include: I know what to do should I witness any abuse. I wouldnt hesitate to report it. We looked at policies and procedures in place for dealing with residents finances. The administrator is responsible for maintaining records of residents personal allowances. All records of transactions are maintained. These are signed by the administrator and countersigned by the manager. Monthly audits are completed and all receipts and balances countersigned. The head office conducts monthly audits within their monthly visits. These systems help protect the residents from financial abuse. All records are securely stored. Information was available on the Mental Capacity Act and Deprivation of Liberty Safeguards. The manager confirmed she had attended training on this and that future plans are in place for staff to have access for this training. The Mental Capacity Act and Deprivation of Liberty Safeguards are to help protect people who cannot make their own decisions about their care home or treatment, because they do not have the capacity to do so. A recommendation is made in this report for staff to be trained in this area. This is also referred to in the section What they could do better. We looked at three residents assessments and found that the home takes into account Care Homes for Older People Page 7 of 15 residents mental capacity and if they are able to make decisions for themselves. We looked at notifications, which are sent to us to inform us of any incidents at the home which effect the health and welfare of the residents. We found that the home has been notifying us of these events on a regular basis. This was a requirement made at the last Random inspection on 26/11/09 and has been met. A requirement was also made for the AQAA to be returned to the Commission within the correct time scale. This too was found have been met at this visit. What the care home does well: We found a pleasant friendly atmosphere was in place during our visit. Staff were observed going about their duties chatting to residents and other staff. The home has policies and procedures in place to promote the dignity and respect of the people who live there. The large notice board in entrance showed that the home are Dignity in Care Champions. Photographs of the staff involved, coordinator and the aims of the service were displayed. Dignity in care meetings are held with residents and relatives who wish to attend to discuss the activities, changes needed and any complaints. The residents are encouraged to speak freely. Meal times were seen to be relaxed and unhurried. Residents who needed help were provided with support in an unobtrusive manner by the staff. We spoke with a number of residents who commented: I am settled here now, I can get up at any time and have breakfast in my room, I wash and dress myself. The food is good and I am very well cared for. I have clean clothes every day. The girls do their best and everything here is nice. Breakfast is belting. I can dress myself but the girls are here for me when I need a bit of help. Relatives spoken with provided the following comments on the care and support provided: We visited several homes to find one suitable for Mum and this one felt just right. It was like coming to an oasis. We have nothing but praise for the home and its staff for the way they care for Mum. I can dress myself but the girls are here for me when I need a bit of help. Care Homes for Older People Page 8 of 15 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 9 of 15 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 10 of 15 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 7 15 Residents plans of care must 29/10/2010 reflect all aspects of their individual current needs in respect of their health and welfare. Clear actions for staff must be recorded to show how their needs are to be met. Where possible the care plan must be drawn up with the resident/or representative and kept under review to reflect changing needs. This provides a basis for the inclusion, monitoring, planning and evaluation of care. It helps to ensure that a clear pathway can be established and the person concerned is involved. 2 8 13 Residents risk assessments should be accurate and kept up to date to show each residents specific care needs. This will ensure the health and safety of the residents. 29/10/2010 Care Homes for Older People Page 11 of 15 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 3 8 12 Residents must have access 29/10/2010 to the appropriate care and treatment they need to keep them well. All care and treatment given must be recorded accurately to show the care provided. This promotes and maintains the residents health and ensures access to health care services to meet their needs. 4 9 13 Medication must be stored at 31/07/2010 the correct temperature at all times. so that it does not spoil and remains safe to use. So that it does not spoil and remains safe to use. 5 9 13 There must be an effective 31/07/2010 system of auditing (checking) all aspects of handling and recording medicines within the service. So that areas of weakness are identified and action taken to improve and ensure the health and well being of people living in the home is maintained. 6 9 13 There must be an effective 31/07/2010 system for training and testing the competency of all staff (including carers who apply creams) who handle, administer and/or record medicines. Page 12 of 15 Care Homes for Older People 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 staff are competent to perform their duties safely. 7 9 13 Accurate records of all 31/07/2010 medicines (including Controlled Drugs) received into the home, given to people and disposed of must be kept. To make sure all medicines can be fully accounted for. 8 9 13 Medicines must be given to 31/07/2010 people as prescribed Because receiving medicines at the wrong dose, wrong time or not at all can seriously affect their health and wellbeing. 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 7 The manager should conduct regular audits of care plans to ensure the residents care needs are accurate and reflect the care and support they need. Residents weight should be recorded regularly to enable the staff to monitor their health and well being. All handwritten entries on medication administration records should be checked and signed by a second member of staff to reduce the risk of mistakes. Staff should receive training in the Mental Capacity Act and Page 13 of 15 2 3 8 9 4 18 Care Homes for Older People 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 Deprivation of Liberty Safeguards so that they understand the needs of people who are unable to make their own decisions. Care Homes for Older People Page 14 of 15 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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