Care Home: Maxey House

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What the care home does well This area was not assessed on this occasion. What the care home could do better: There is work in progress to ensure that the pre-admission process is improved to ensure that people admitted to the home have their needs fully assessed to ensure that the home can meet these needs and that the quality of the records provide robust evidence of such assessments. There is work in progress to improve the current standard of record keeping to include risk assessments and care planning. This is to ensure people are protected by accurate records. We have made a requirement so that people with diabetes mellitus have their condition monitored to ensure that they are receiving the right medical care and treatment. Staff must remain vigilant to ensure medication is not accessible to people it is not prescribed for. We found that the recorded balance of one controlled drug did not agree with the amount of stock in the cupboard as a new supply had not been added to the register. We expect this to be managed by the home to ensure that there is a clear audit trail of medication coming into the home. Random inspection report Care homes for older people Name: Address: Maxey House Lincoln Road Deeping Gate, Peterborough PE6 9BA one star adequate service 03/11/2009 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: Elaine Boismier Date: 1 1 0 5 2 0 1 0 Information about the care home Name of care home: Address: Maxey House Lincoln Road Deeping Gate, Peterborough PE6 9BA 01778342244 01778345850 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Jacqueline Watson Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Laura Louise Levin care home 31 Number of places (if applicable): Under 65 Over 65 0 31 dementia old age, not falling within any other category Conditions of registration: Date of last inspection Brief description of the care home 1 0 0 3 1 1 2 0 0 9 Maxey House is a large Georgian country residence standing in three acres of grounds. The home is within half a mile of the town of Market Deeping and approximately five miles from Peterborough city centre. The home consists of a main house with a modern single storey extension. Residential accommodation is provided in twentyseven single and three double bedrooms. Twelve bedrooms have en-suite facilities. A lounge, dining room with quiet area, and conservatory form the communal areas of the home. Residents have access to the gardens. Information about fees, including any additional costs, can be obtained from the home. Copies of CQC reports are made available on request or from our website at www.cqc.org.uk Care Homes for Older People Page 2 of 11 Care Homes for Older People Page 3 of 11 What we found: We, the Care Quality Commission, carried out this random unannounced inspection, by two Inspectors between 10:05 and 13:05, taking three hours to complete. The purpose of this inspection was to assess what progress had been made in some of the areas following our last key unannounced inspection of the 3rd November 2009 and what action the home had taken in response to a safeguarding meeting held in April 2010 and which was reconvened in May 2010. Before this inspection we looked at some of the information we had about the home. At the inspection we looked at some of the peoples records and visited some of the areas of the home. We spoke with some of the staff, including a visiting hairdresser, the Registered Manager and the Registered Owner. We looked at pre-admission assessments of three of the people and we found that information provided by external agencies, such as care managers and hospital workers, was made available to the home, before the person moved in. These included the persons assessed health and social care needs. We also examined the homes preadmission assessments to assess what progress had been made since our last inspection. These assessments were carried out before the person moved into the home although the assessments were brief in detail, and were not always in line with information found elsewhere within the persons records. For example we saw that one of the people was assessed, by the referring agency, as having dementia. They were also noted to have a previous and on-going history of depression and their current medication administration records indicated that the person was prescribed and currently taking medication for this condition. The homes pre-admission assessment for communication said that this was good and that the persons mental health and cognition was also good although this assessment did not take into account the persons medical history of having a diagnosis of dementia and did not account for the persons medical history and ongoing treatment for their depression. As part of a safeguarding investigation, led by the local authority, it was noted that the pre-admission assessment of a resident was brief in detail and it became clear (at this inspection) from reading other pre-admission documentation, provided by the referring agency, that significant information had not been recorded within the homes preadmission assessment. Information provided to us, before this inspection, told us that the home was now no longer a suitable place for this person, as the home was unable to meet the persons pre-existing and current mental health needs. This tells us, and the Registered Owner agreed, that the pre-admission process of the home is to be improved to ensure that people admitted to the home have their needs fully assessed and the quality of the records provide robust evidence of such assessments. We examined three peoples care records to assess what progress had been made since the last two safeguarding meetings. We noted that for one person their care plan, for the management of their diabetes, had been updated to include the expected healthy ranges of the persons blood sugar. Care Homes for Older People Page 4 of 11 We saw, from our examination of another persons care records, that these had been reviewed, since the reconvened safeguarding meeting held on the 7th May 2010. The details within the persons care records demonstrated that full risk assessments had been carried out, to include those for nutrition, moving and handling and the development of pressure sores. The information also referred to a history of a fall, during 2009, and this assisted in formulating the risk assessment for falls. We noted that the persons likes, dislikes, choices and interests were also recorded and the care plans were developed based on these areas. This tells us that the persons care needs were planned in a person centred way and that the person was valued as a unique individual. We looked at a care plan and the medication administration records for another person. We found that they were prescribed medication for depression although we could find no care plan for the monitoring of the persons mental health and wellbeing. We also noted that the person was prescribed medication for pain and it was recorded that the person was taking pain-relief medication every day. Their moving and handling risk assessment recorded that they had pain in their back and legs and their daily records noted on a number of occasions, for example on the 5th, 19th, 23rd, 25th and 26th March 2010, that they had experienced pain in their back and legs. We could find no assessment of their pain, how this affected their activities of daily living and no plan of care in how the staff were to assess and monitor and provide care for this person, during these episodes when they were experiencing their pain. The medication administration records indicated that, from 26th April up to 11th May 2010, the person continued to take medication for pain control. Continuing with the examination of this persons care records we noted that, before their admission to the home on the 22nd February 2010, they were newly diagnosed as having diabetes mellitus. Their medication administration records noted that the person was taking medication for this condition. We noted, in addition, that the person was prescribed medication, a steroid, that has a potential side effect of increasing blood sugar in some people, which can lead on to them developing diabetes mellitus and can alter the blood sugars in people who have already acquired diabetes mellitus. The Registered Manager informed us that the persons doctor had visited the person that morning and it was suspected the person had developed an infection. Infections in people with the condition of diabetes mellitus, can affect their blood sugars, in a harmful way. Although we found a care plan for nutrition with a goal To ensure (their) diabetes is catered for we could find no evidence that the persons blood sugars were monitored, either by the home or by an external health care professional. Within this persons daily records we saw a record, dated 23rd March 2010, telling us that the person had sustained a skin tear. The records said that the staff attended to this, at the time, although we do not know how the persons wound was subsequently monitored by the home or what action was taken to ensure that the persons skin tear healed and was without any signs of infection. People with the condition of diabetes mellitus have a higher risk of developing infections compared with people who do not have this medical condition. We saw that people had been actively consulted about their care plans and had signed their consent to receive their planned care. Care Homes for Older People Page 5 of 11 We looked at how the home had developed a risk assessment, to safeguard one of the people. Our records told us that the home was to complete a risk assessment, and, during a telephone conversation from us to the Registered Manager on the 1st April 2010, they confirmed that they had completed the risk assessment that day. During this inspection we looked at the risk assessment and spoke with the Registered Manager. The completed risk assessment was dated 19th March 2010 and was signed by the Registered Manager. They confirmed that they had written this assessment, dated it and signed it. According to the Registered Provider the homes diary indicated that the Registered Manager was on leave on the 19th March 2010 and returned to their work on the 22nd March 2010. The Registered Manager explained that they had dated the risk assessment as that of the date of the untoward incident of the resident although our records told us that the risk assessment was not active until the 1st April 2010. The Registered Owner informed us that there is ongoing training for all of the staff in record keeping. At the key inspection of 3rd November 2009 we found that some prescribed creams and dressings were unsecure and openly accessible to people that they were not prescribed for. On this inspection we looked around the home and did not find any prescribed items in communal areas. However in one persons room we found some medicines which were not locked away. The room was unoccupied and the door to the room was unlocked. We brought this to the attention of the Registered Manager although no spontaneous action was taken by them, to make sure the medication was locked away, until we requested that this was done. We were assured by the Registered Manager that this was an isolated occurrence. However, staff must remain vigilant to ensure medication is not accessible to people it is not prescribed for. We found that medicines needing cold storage were stored in a locked cash-box in a domestic refrigerator in the kitchen. This is an unacceptable level of security and it is necessary to ensure dedicated refrigerated storage is provided. We were assured by the Registered Manager that such a refrigerator had been ordered so we have not made a requirement about this. On the last inspection we found that there was no record of controlled drugs stored in the controlled drugs cupboard. We expected this to be managed by the home. On this inspection we found that the recorded balance of one controlled drug did not agree with the amount of stock in the cupboard as a new supply had not been added to the register. We expect this to be managed by the home. At the inspection on 3rd November 2009 we made a requirement that there must be clear records of all medicines in the home, including that date and quantity received and when medication is given to people. On this inspection we looked at the medication and medication records for several people and found that these had improved and the date of receipt and quantity received were recorded. However, we found that the record for one persons medication, which had special instructions for when it was to be taken, was inaccurate and the time the medication was recorded as given was also inaccurate. Staff had not been provided with clear instructions from the pharmacy supplier, so taking a proportionate view, we consider the requirement has been met. We also made a requirement that risk assessments must be completed where people look after and take their own medication. On this inspection we found that the risk assessments had improved and assessed the risk to the person themselves, but there was no assessment of the risks posed to other people. However, given the improvement, Care Homes for Older People Page 6 of 11 we expect this to be managed by the home rather than repeat the requirement. Information provided by the safeguarding meeting of the 8th April 2010 and at a follow up meeting held on the 7th May 2010, proved that the home failed to protect a resident from the risk of harm. It was also concluded that the home had not followed correct safeguarding reporting procedures and had not reported the untoward incident, as per regulation 37 of the Care Homes Regulations 2001. We requested for this to be formally reported to us and the home appropriately responded to our request. Representatives of Maxey House acknowledged, at the reconvened safeguarding meeting held on the 7th May 2010, that the staff had followed the homes policy and procedure for missing persons, at the time of an untoward incident, although this policy and procedure document has since been updated, and there is work in progress to improve this revised document, to ensure that there is accurate and clear guidance for the staff in what to do should any person go out of the home by themselves and assessed to be unsafe to do so. According to the Registered Owner arrangements have been made for staff to attend training in caring for people with dementia and refresher training in safeguarding. We saw a notice of these dates for these training events, displayed on a notice board, when we visited the staff room. 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 7 of 11 Care Homes for Older People Page 8 of 11 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 9 of 11 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 People with the condition of diabetes mellitus must have their condition monitored. This is to ensure that they are receiving the right medical care and treatment. 20/05/2010 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 Care Homes for Older People Page 10 of 11 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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