Care Home: Oakfield

What the care home does well Medication was in continuous supply at the home. Ensured that the required consents for the administration of medicines , first aid and homely remedies were obtained from people who use this service. Carried out risk assessments for the self-administration of prescribed medicines by individuals. What the care home could do better: The mar sheets should accurately reflect what medicines and the quantity, is in the home for a person who uses the service. There should be a carried forward balance of medicines especially when this was dispensed in a previous cycle and is still being offered as a currently prescribed medicine. All medicines at the home should be accurately accounted for. All oral medicines and prescribed creams/ointments must be given according to the prescriber`s instructions. A pharmacist approved system should be used when prescribed medicines are to be administered to people who are on leave from the home. Any issues with medicines that will run out before the new supply is in the home must be addressed . Any medicine that is refused or spoiled must be accounted for. The home must discuss with the dispensing pharmacy how long it shall retain "when required" medicines after the actual dispensing date. If the case is unclear if medicines are still in date they should order a fresh supply from the GP. A homely remedy policy should be reviewed by a healthcare professional. This is so they can assess the appropriateness of the choices of the remedies against prescribed medication and certain medical conditions. The home should stored medication at 25`C or below. Medicines that require cold storage ( temperature range 2-8`C) should be stored in an appropriate fridge. Regular monitoring of the maximum and minimum temperature of this facility should be carried out. Inspecting for better lives Random inspection report Care homes for adults (18-65 years) Name: Address: Oakfield Oakfield Easton Maudit Wellingborough Northants NN29 7NR zero star poor 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 assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. 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: Naveeda Knopp Date: 0 9 1 2 2 0 0 8 Information about the care home Name of care home: Address: Oakfield Oakfield Easton Maudit Wellingborough Northants NN29 7NR 01933664222 01933664333 rm.oakfieldltd@btconnect.com 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) : Oakfield (Easton Maudit) Limited care home 18 Number of places (if applicable): Under 65 Over 65 0 0 learning disability mental disorder, excluding learning disability or dementia Conditions of registration: 18 8 No one falling within category MD may be admitted into the home where there are eight persons of category MD already accommodated within the home. Date of last inspection Brief description of the care home Oakfield is situated on the outskirts of the village of Easton Maudit. The home is registered to provide care for 18 service users with a learning disability, up to 8 of whom may have additional mental health needs. All accommodation is in single bedrooms spread over two floors. The home has a minibus, a people carrier and a car at its disposal. People living at the home can attend day care services provided in the same building. The home is set in a rural location, on the outskirts of Easton Maudit. Within the grounds there is land on which service users look after animals that belong to the home, with support from the staff. There is a pleasant outdoors seating area Care Homes for Adults (18-65 years) Page 2 of 13 Brief description of the care home overlooking the open countryside. The home is owned by Oakfield, and is a registered charity. A board of trustees and directors provide oversight of its operation. The basic fee, which includes access to the day care service, is £947. However there are additional individual charges, which are agreed at the time of the initial assessment, dependent on the specific care needs of prospective service users. These are not detailed in the Service Users Guide as they are arranged individually. This information was current at the time of the inspection. Information about the home in the form of the Service Users Guide and Statement of Purpose is available from the home. Both documents need reviewing to ensure that all the information required as stated in the National Minimum standard for younger adults is available in the documents. It was stated at the last key inspection that these documents were being updated but this had still not been done. The home has developed limited user friendly information for current and prospective service users. The most recent published inspection report is available from the home or on the Internet. Care Homes for Adults (18-65 years) Page 3 of 13 What we found: Most of the medication arrives into the home in a monitored dosage system from Boots The Chemists in Wellingborough. Reviewing the medication administration sheets(mars) we identified a few unexplained gaps. A person was prescribed Lorazepam 1mg tablets prn , current mar states none supplied but there are currently 30 tablets in stock. Another person who uses the service is prescribed Haloperidol capsules 500mcg, dose 1 or 2 every six hours if needed for agitation. On the mar none supplied was printed but currently have 36 capsules in stock at the home for this person. Fusidic acid and Hydrocortisone cream and also Miconazole/ Hydrocortisone cream at a frequency of three times a day was prescribed to a person. The corresponding mar indicates that these two creams are only being applied /offered twice daily. The room used to store medicines was feeling a little warm with it being small and an area where there are various electrical equipment and wiring was situated. The room temperature reading was taken after two hours from the start of the inspection and was 25C. All medication was in stock for service users on the downstairs unit and there was no over stocks of the medicines in the cupboards. For three people their blister packs showed that doses had been removed from the blister at the end of the medication cycle. There was no documentation available to explain why this had happened. The staff and the manager were also unsure why medication had been removed in this way. A supply of Promazine tablets which was originally dispensed in May 2007 was found in with current medicines. The current mar for this person had not got this medicine listed. A clinical fridge is not being used to store medicines that require cold storage. The home is using a fridge that is more suitable for keeping drinks cold. A thermometer is being stored in the fridge. The temperature was 8C. The staff follow a homely remedy policy when treating certain minor ailments but it had not been approved by a GP or any other health care professional. A senior carer on duty stated that they would redispense medicines in to a dossett box and keep documents for people who need to take their prescribed medication while away from the home, for example on social leave. A deputy manager would carry out medication audits. Care Homes for Adults (18-65 years) Page 4 of 13 The manager was not aware of the guidance Handling medicines in the social care setting. 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 Adults (18-65 years) Page 5 of 13 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set. No. Standard Regulation Requirement Timescale for action 1 5 5 The contract must be amended to reflect that people will only be asked to pay the cost of a meal that exceeds what they have already paid for food included in their fees. So people can better understand their rights and responsibilities of their stay, in addition it also needs to explain who pays for meals for users when they dont have a meal in the home, and they have to eat out as part of the activity provided by the home. 30/11/2008 2 5 12 Notice to leave must only be 30/11/2008 given to people in accordance with the terms of their agreement and when demonstrated through appropriate assessment that the home is not able to meet their needs. This is to ensure people are treated fairly and their rights protected 3 5 5 Each service user must have 30/06/2008 an individual written contract with the home so they are aware of their rights and conditions of their stay. Care Homes for Adults (18-65 years) Page 6 of 13 4 6 12 Written records maintained 30/11/2008 about the people living in the home must be recorded in a way that is respectful and maintains the persons dignity. This is to maintain the persons dignity 5 6 15 The care plan must state 30/07/2008 how the service users aspirations and goals will be achieved and describes any restrictions on choice and freedom; the plan should be drawn up with the involvement of the service user and their representative or an advocate. The risk assessments need 30/06/2008 reviewing to ensure that the five steps to assessing risks are recorded to minimise potential risk and hazards to service users. A planned varied programme 30/07/2008 of activities must be developed to meet the needs, capabilities and wishes of all service users to engage them in fulfilling activities. The people using the day service from the community must be provided with a seperate entrace to the day care service This is to maintain the privacy and dignity of the permanent people living at the home 30/11/2008 6 9 13 7 12 12,16 8 15 12 9 19 13 The risk assessments for seizures must be detailed to 30/11/2008 Care Homes for Adults (18-65 years) Page 7 of 13 address the peoples safety at all times This is to ensure that the people are kept safe 10 19 13 Provide staff guidelines in 30/11/2008 how to manage a person who is having a seizure This is to help meet the needs of the people and keep them safe 11 20 13 (2) Medication must be administered safely and meet the requirements set out in the `Handling of medicines in social care? guidance To be inspected by the CSCI Pharmacist. 12 22 22 The complaints policy needs 30/05/2008 reviewing to meet the standard, and it needs to be clear and easy to understand The registered provider must 30/05/2008 follow the complaints procedure for any complaints made. All service users must have their own accounts in their own name for their personal money. 30/05/2008 30/05/2008 13 22 22 14 23 20 15 23 17The financial records (2)Schedule 4 maintained for residents are not robust, there is no clear audit trail, leaving people using the service open to financial abuse An Immediate requirement was issued on the day of the 07/05/2008 Care Homes for Adults (18-65 years) Page 8 of 13 inspection for an action plan to be submitted to CSCI by 7th of May 08 to inform CSCI as to how the home would meet the regulation. 16 24 13 The handrail should be 30/11/2008 replaced by one of a different style that will not cause injury to people using it This is to ensure that people living in the home are kept safe 17 24 13 A risk assessment needs to be undertaken for the fire exit door in the upstairs dinning area This is to minimize the risk to people using the service and keep then safe 30/11/2008 18 33 18 The staffing rota must be 30/06/2008 reviewed to ensure that there are adequate numbers of staff on duty to meet the needs of service users. Staff working times must be recorded with the role and names of all staff in full, the rota must be individualised to the home All staff must have employment contracts when working at the home This is to ensure that they know what their rights and responsibilities of working at the home 30/06/2008 19 33 18 20 34 17 30/11/2008 21 37 21 Robust monitoring systems must be in place to ensure that the service users are 30/06/2008 Care Homes for Adults (18-65 years) Page 9 of 13 receiving a high standard of care and they are being safeguarded. 22 39 24 Introduce quality assurance systems as specifies by this standard and regulation to measure the quality of care provided at the home. Ensure that the homes policies and procedures are specific to the home, up to date, signed and regularly reviewed. A risk assessment must be undertaken for taking hot meals to the first floor dinning room This is to ensure that the people carrying the food are kept safe 30/07/2008 23 40 17 30/07/2008 24 42 13 30/11/2008 25 42 13 The radiators in the home must be covered up so the people living in the home do not hurt them selves To protect people from hurting themselves 30/11/2008 Care Homes for Adults (18-65 years) Page 10 of 13 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, Care Homes 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 20 13 A homely remedy policy 20/02/2009 should be used at the home that has been approved my a healthcare professional. To safeguard the health and welfare of people. 2 20 13 All medicines must be accurately accounted for at the home. Carried forward balances must be used for stocks of medicines still in the home but that have not been re-issued in the proceeding month. To safeguard the health and welfare of people. 20/02/2009 3 20 13 Medication that requires cold 20/02/2009 storage (2-8C) must be stored in appropriate facility. The maximum and minimum temperature must be regularly monitored To ensure medicines are stored in an environment that prevents a decline in their effectivness 4 20 13 The system used to ensure medicines are administered 20/02/2009 Care Homes for Adults (18-65 years) Page 11 of 13 while on leave must be agreed by a pharamcist. The practise redispensing in to a dossett box must be stopped. To safeguard the health and welfare of people. 5 20 13 All prescribed medication must be administered or applied in accordance to the prescribers instructions. To safeguard the health and welfare of 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 20/02/2009 1 20 Photographic identification along with a brief medication profile is kept along with the medication administration sheets. This may be valuble when a person is on a when requiredmedicine. All when required medicines should have a date placed on the label (can be agreed by the dispensing pharamcy) as to when to remove the product from current stocks for a person. Regular and frequent documented medication audits should be carried out to identify any discrepancies in medication administration sheets or in the competency level of staff. 2 20 3 20 Care Homes for Adults (18-65 years) Page 12 of 13 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI 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 Adults (18-65 years) 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: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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