Care Home: Priscilla Wakefield House

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What the care home does well The home had made significant progress in improving the safe management ofmedication. We were satisfied that the new policies and procedures and training supported the safe management of medication and that audits and stock checks would identify shortfalls promptly and maintain a good standard. What the care home could do better: The home now needs to consolidate and maintain the good practices developed. They could carry out further work on care planning to ensure that the relevant medicines information and risk assessments were always easily located. They could also ensure that when a cream or topical medicine is prescribed that it is always clearly documented on the MAR where the area of application is to be. Random inspection report Care homes for older people Name: Address: Priscilla Wakefield House Priscilla Wakefield House Rangemoor Road Tottenham London N15 4PL zero star poor service 23/04/2010 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: Jane Shaw Date: 1 6 0 6 2 0 1 0 Information about the care home Name of care home: Address: Priscilla Wakefield House Priscilla Wakefield House Rangemoor Road Tottenham London N15 4PL 02088087196 02088852481 reception@precious-homes.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Magicare Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 112 Number of places (if applicable): Under 65 Over 65 112 112 112 dementia old age, not falling within any other category physical disability Conditions of registration: 112 0 112 The maximum number of service users who can be accommodated is :112 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: Physical disability - Code PD(E) (maximum number of places: 112) Dementia - Code DE (maximum number of places: 112) Dementia , over 65 years of age - Code DE(E) (maximum number of places: 112) Old Age, not falling within any other category Code OP (maximum number of places: 112) Date of last inspection Care Homes for Older People 2 3 0 4 2 0 1 0 Page 2 of 15 Brief description of the care home Priscilla Wakefield House is a large, newly built Nursing Home with 112 places for people with dementia (including early onset dementia) and physical disabilities. The majority of places are for Older People but younger people are also accomodated. There are four floors, which contain different specialist units. The building and environment have been built to an excellent standard and all bedrooms have en-suite facilities. There are a number of lounges and dining areas in each unit as well as outside terraces and gardens. The home has been very well designed. Priscilla Wakefield House has the equipment and facilities required to meet the needs of the people using the service. The stated aims of the home are, To help service users remain in control of their lives as far as possible and thus, to maintain their personhood through Person Centred Care. The home is situated in Tottenham, North London and although there is limited parking the home is near to local bus services and the Victoria Line Underground station. The range of fees are between five hundred and one thousand and five hundred pounds per week. Care Homes for Older People Page 3 of 15 What we found: This pharmacist inspection was to check compliance with a Statutory Compliance Notice issued on 4/5/2010 because of concerns over the safe handling of medication. The notice required the home by 14/06/2010 to:- Ensure the homes medicines policy adequately details procedures, to provide staff with sufficient guidance on all aspects related to the handling and management of service users medications, such as ordering medicines and managing anticoagulation. Ensure that all staff involved in the handling and management of medication within the home are trained in and adequately inducted into the revised medicines policy and procedures. Ensure that a system of robust auditing of medication is consistently and regularly carried out. We inspected the homes new medication policy and found it to be much improved. It was comprehensive and detailed all aspects of the homes activity including ordering procedures, managing those service users prescribed anticoagulants, and those service users who wished to self medicate. We saw that the medication policy was attached to each medication trolley and all the nurses and care workers were able to explain their understanding of it. We saw that there had been a training session and question and answer session, and all attendees had signed that they understood the homes procedures. We looked at the MAR charts (Medication Administration Records) in all the flats. We noticed that there were no gaps on the MAR for receipts or administration of medication. No medicines were recorded as out of stock. We saw that all variable doses were accurately recorded and that the GP was clearly indicating on the MAR when a new medicine was prescribed or a dose changed. The home was also keeping discharge letters from hospital, copies of prescriptions and anticoagulant books all accessible so that the currently prescribed dose could be checked . We checked the homes audits and stock checks in the flats and found all to be accurate. We counted several samples of medication including warfarin tablets, two anticonvulsants and a reducing dose of prednisolone, and noted that all were given as prescribed. We found that protocols for as required medicines had been expanded so that nurses and care workers knew why they were prescribed and how often to give them. We looked at a care plan for a service user with epilepsy who frequently refused medication. We saw the care management plan, the risk assessment and seizure chart. Overall we were satisfied with the progress made and that the Statutory Compliance Notice had been complied with. What the care home does well: The home had made significant progress in improving the safe management of Care Homes for Older People Page 4 of 15 medication. We were satisfied that the new policies and procedures and training supported the safe management of medication and that audits and stock checks would identify shortfalls promptly and maintain a good standard. 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 5 of 15 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 1 4 The Registered Person must 02/07/2010 ensure that clear information is available on the provision of respite care and how peoples needs will be met. There should be clear protocol for respite admissions. Prospective residents need information prior to moving into the home. 2 3 4 The Registered Person must 02/07/2010 ensure that the needs of people coming into the home on a short term basis are properly assessed. All prospective residents must have their needs fully assessed so that they can be confident that the home can meet these needs. 3 3 4 The Registered Manager must ensure that the provision of respite care is rewiewed to ensure that the home has the capacity to meet all residents needs. Residents need to be confident that the home can meet their needs. 02/07/2010 Care Homes for Older People Page 6 of 15 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 4 7 12 The Registered Person must 02/07/2010 ensure that care plans are up to date, comprehensive and reflect peoples needs. Residents needs must be met 5 8 24 The Registered Person must 02/07/2010 undertake a complete review of how it meets the food and drink needs of residents. This should broadly cover any factors that could impact on meeting peoples needs and include a clear action plan for improvement. This review should form of an wider review of care in the home. A copy must be provided to CQC. Residents basic needs must be met 6 8 12 The Registered Person must 14/06/2010 undertake a complete review of how it meets the food and drink needs of residents. The review should include a clear actions plan for improvement. This should form part of a wider review of the care and management of the home, detailed in the Management section of this report. Residents basic need must be met 7 9 13 The Registered Person must 14/06/2010 ensure the homes medicines policy adequately details Page 7 of 15 Care Homes for Older People 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 procedures to provide staff with sufficient guidance on all aspects related to the handling and management of service users medications, such as ordering medications and the management of anticoagulant therapy within the service. Statutory Enforcement action is being taken. To maintain the health of the residents. 8 9 13 The Registered Person must 12/05/2010 ensure there is an efficient ordering and receipt of medication system in place so as to ensure service users prescribed treatments are consistently available to them. Statutory Enforcement action is being taken. To maintain the health of the residents. 9 9 13 The Registered Person must 14/06/2010 ensure that all staff involved in the handling and management of medication within the home are trained in and adequately inducted into the revised medication policy and procedures. To ensure that there are safe systems for managing medication in the home. 10 9 13 The Registered Person must 14/06/2010 ensure that a system of robust auditing of medication Page 8 of 15 Care Homes for Older People 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 is consistently and regularly undertaken. To provide evidence of safe administration of medication. 11 16 17 The Registered Manager 02/07/2010 must ensure that all complaints are acknowledged, investigated, outcomes and actions taken communicated and recorded. Complaints policies and procedures must be adhered to. 12 18 18 The Registered Manager 31/08/2010 must ensure that all staff receive advanced safeguarding training so they understand the links between safeguarding and good care practice. Residents need to be protected from poor care practice. 13 27 18 The Registered Person must review its handover system to improve communication about peoples needs. Staffing need sufficient time to communicate about residents needs. 14 27 18 The Registered Person must 30/06/2010 put in place a system to keep staffing levels and the competancy and experience of staff under review to meet the complex and changing Page 9 of 15 02/07/2010 Care Homes for Older People 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 level of residents needs. Suitably qualified, competant and experienced staff in sufficient numbers must be working in the home at all times. 15 30 18 The Registered Person must ensure that care staff are trained in best practice dementia care. Staff must be trained and competant to do their jobs. 16 30 18 The Registered Person must 31/08/2010 ensure that staff recieve ongoing training in the areas of specialist care that the home offers. Staff need to keep up to date with care practice. 17 30 18 The Registered Person must 31/08/2010 ensure that all care staff receive core training relevant to their roles. Staff must be trained and competant to do their jobs. 18 33 24 The Registered Person must 27/08/2010 commission a full and thorough review of all aspects of the service, the quality of care, the homes aims and objectives, management and staffing, and an investigation into why the problems identified in this report have come about. This review should be Page 10 of 15 31/08/2010 Care Homes for Older People 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 comprehensive (not piecemeal) and independent. It should include an action plan. A copy must be provided to CQC. The home should review the quality of care and the running of the home to improve practice and management. 19 35 13 The registered person must 27/08/2010 ensure there is a clear record for each resident of how they manage their personal finances and that where support is needed systems must be in place that have been agreed with the most appropriate care professional. Any risk management issues must be discussed with care professionals as needed and a plan agreed. This requirement is repeated. Previous due date 01/05/2009 This is to ensure that residents at the home are protected from possible financial abuse 20 35 13 The Registered Person should 27/08/2010 ensure that residents who are unable to manage their money or do not have nominated person, should have their own accounts. Care Homes for Older People Page 11 of 15 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 Residents money should be protected. 21 36 18 The Registered Person must 02/07/2010 ensure that all staff, including management staff, receive regular, comprehensive, individual supervision. This should be properly recorded. The management and practice of supervision helps to improve peoples care and staff and supported. 22 36 18 The Registered Person must 02/07/2010 ensure that staff who provide supervision must be trained to do so. The management and understanding of supervision helps to improve the residents care. 23 37 37 The Registered Person must ensure that CQC is kept informed of all matters covered by Regulation 37. The home must notify CQC of all serious matters affecting the home. 24 38 23 The Registered Person must ensure that all staff are trained in fire procedures. The home must ensure the safety of people in the home in the case of fire. 25 38 23 The Registered Person must ensure that at least four fire 31/05/2010 31/05/2010 31/05/2010 Care Homes for Older People Page 12 of 15 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 drills per year are undertaken and recorded and actions arising from the drills are noted and addressed. The home must ensure that people working and, where far as practicable, people living in the home have the opportunity to become familiar with fire procedures. Care Homes for Older People Page 13 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 8 13 That the home continues to robustly audit medication and maintain the improvements made to safely handle medication This is to ensure that the health and welfare of services users is maintained. 01/07/2010 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 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. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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