Care Home: Sir Jules Thorn Court and Mary Court

What the care home does well We saw that staff had been trained and given information to help them understand how to meet people`s individual needs. We found that the staff demonstrated an understanding of this and people were being supported. We saw that a lot of work had taken place to improve the quality of care for people living at the home. What the care home could do better: We found that medication storage, recording, ordering and administration was poor and this puts people at risk. We found that some people`s health needs were not properly identified or monitored and that they were at risk from this. Inspecting for better lives Random inspection report Care homes for older people Name: Address: Sir Jules Thorn Court and Mary Court 29-35 Prince Of Wales Drive Battersea London SW11 4SL 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: Sandy Patrick Date: 1 8 0 3 2 0 0 9 Information about the care home Name of care home: Address: Sir Jules Thorn Court and Mary Court 29-35 Prince Of Wales Drive Battersea London SW11 4SL 02077380280 Telephone number: Fax number: Email address: Provider web address: martin.lewis@servitehouses.org.uk Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Servite Houses care home 31 Number of places (if applicable): Under 65 Over 65 30 30 31 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Conditions of registration: 0 0 0 One named service user is to receive personal care only by one allocated member of staff. Variation of Registration Under the High Court judgement, the service shall be named Sir Jules Thorn Court and Mary Court. The variation is for such a time until the named service user assessed needs change or they leave the home. Date of last inspection Brief description of the care home Sir Jules Thorn provides nursing care for up to thirty people who have mental health needs or dementia. The home provides accommodation in single rooms with ensuite facilities. Mary Court adjoins Sir Jules Thorn and has one residential bed. Sir Jules Care Homes for Older People Page 2 of 19 Brief description of the care home Thorn has two floors, the home is divided into three units, known as clusters, which each have their own day room. The home has a large dining area and access to a small garden. The home is situated in Battersea, close to Battersea Park. There are accessible road and bus links to north and south London. Fees range from £444-48 to £827-12 per week. Care Homes for Older People Page 3 of 19 What we found: We visited the home on the 19/03/09. The visit was unannounced. The inspection team included a pharmacist inspector. The reason for this visit was: 1. To check compliance with the statutory requirement notices which we issued on the 17/02/09 following our key inspection. 2. For the pharmacy inspector to look in more detail at medication practices at the home. We met with the Area Manager, Deputy Manager, people living at the home, visitors and staff on duty. We found that action had been taken to address the requirements we made in the statutory requirement notice. We found that people were at risk from medication practices and procedures. The Area Manager told us that a new Manager had been appointed and was due to start work on 30.03.09. We saw that all the care staff had taken part in awareness training. We saw that this training took the form of workshops and aimed to give staff information and skills to work in a more person centred way. We saw evidence of some of the work that staff had undertaken in this training and their feedback on what they thought they had learnt. We also saw that other training had taken place, whereby the trainers worked alongside staff and then discussed their working practice and suggested ideas for change with them. We saw that the staff had been given written information about supporting people to make choices and how to observe whether people were well cared for and had their needs met. The Area Manager told us that he had seen changes in practice and staff seemed more aware of individual peoples needs. He said that staff had dressed people appropriately each day and made regular checks on their wellbeing. He also said that the staff had constructively challenged each other if they felt people were not getting the best support. The Area Manager told us that he had introduced a key working system to make sure people were listened to and their individual needs were met. The Area Manager told us that he had shown the staff that it was good practice to let people participate in different activities of their choice, such as household tasks. The Area Manager told us that people were now given choices at all mealtimes and that the majority of people ate in the dining room. He told us that food was now always served at the correct temperature and not left to go cold. Care Homes for Older People Page 4 of 19 We saw people being supported at lunchtime during our visit. The staff were kind and attentive and offered people choices. We saw that people were able to eat and drink what they wanted and that all food was served on an individual basis, which choices of condiments. We saw that staff took hot food to people who chose not to eat in the dining room and that they were supported to eat this while the food was still hot. We saw that people were dressed appropriately for the temperature. During our visit we saw staff talking to people who live at the home in a kind way and listening to them. We spoke to the activities officer and she told us that improvements had been made to organised activities and the care staff were now more involved in supporting people who do not want to join in the main organised activity. She told us that staff were now taking people for walks if they wanted to go out. We saw some people being supported to go for walks during our visit. We met two visitors who told us that they were happy with the care at the home. We looked at the recording of receipts, administration and disposal of medication and inspected storage and stocks of medicines. We noted that the clinical room was not very clean and also untidy. The Medicines policy was not available in the clinical room but the deputy manager did bring her own copy for us to see and we noticed that it was the corporate policy and was current. We looked at the medication administration records MAR and noticed that many of the medicines had not been received from the pharmacist in time for the first day of the current medication cycle. This means that many of the residents did not receive their heart tablets, medicines for their epilepsy and mood etc on the first day of the cycle. We noticed also that there were lots of omissions in recording on the MAR for the current cycle and the previous cycle, both for the recording of receipts and administration. Because staff were not removing medication systematically from the monitored dosage system we were not able to see if the medication was always given. We audited tablets in their original packs for several residents and found that we could not reconcile balances. We were therefore concerned that residents were not always receiving their medication as prescribed. We looked at the homes audits and these were just for checking MAR charts and had ceased on 18.02.09. We noticed on these audits that no check had been carried out on 9 and 10 February 2009 and that there were lots of gaps on the MAR for these dates. We inspected the controlled drugs CD and they were stored securely and balances were correct. There were injections still in the cupboard for a resident who was deceased in 2008. Daily checks for CD seemed to have stopped 07.09.08 in a record book and 07.01.09 in the register. Some tightening up on recording is needed particularly around witness signatures. We looked at the fridge and noticed that it contained liquid medicines which were out of date 12.01.09 and 09.03.09. These were mixed up with the current medicines and could be given in error. The fridge temperature had only been recorded 6 times in the Care Homes for Older People Page 5 of 19 18 days of March and was not the minimum and maximum temperature. We looked at the waste medicines and could not see any records. Some medicines were being returned to the community pharmacist and the home had no disposal kit to destroy controlled drugs. We looked at lancets for checking blood glucose and noticed that they were not of the professional type to prevent the risk of blood borne infections. We looked at three care plans and noticed that there was no information on how to manage seizures in a resident who was epileptic. There was no evidence of review for this resident or seizure charts and we were concerned because sometimes medicines were not recorded as given. Another resident was prescribed painkillers four times a day and we could find no care plan for pain management or why this resident was in pain.The medication chart showed that painkillers were only given or offered three times a day and there were lots of gaps. Another resident was prescribed a high dose of an antipsychotic and we were able to track this to a hospital admission and discharge information. We not able though to find a care plan or behavioural chart on how to manage this residents behaviour. Overall therefore we were disappointed in the poor systems in place for ensuring the safe management of medication. We left an immediate requirement notice and took copies of evidence to discuss whether further action would be required. 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 6 of 19 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 7 15 The Registered Person must 31/03/2009 make sure: Care plans record individual wishes, choices and preferences where these are known. People have a copy of their own care plan so that they know what is written about them. Care plans must be accurate. Care plans should include information about peoples lives before they moved to the home so that the staff have a better understanding about each individual and not just their care needs. Care plans should contain a photograph of the person they are about. Care plans must not reflect the opinions of the staff writing them they should be unbiased and there must not be an expectation that the person they are about should think or do things a certain way. Care plans did not describe individual wishes, likes or interests. Some care plans contained the opinions of staff and some were inaccurate. 2 7 13 The Registered Person must make sure risk assessments 31/03/2009 Care Homes for Older People Page 7 of 19 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 record how people can be supported to take risks. Risk assessments did not record how people would be supported to take risks. 3 9 13 The Registered Person must 20/02/2009 make sure: All medication received at the home is checked and recorded. Medication administration records are completed accurately at all times. Peoples allergies are recorded on their administration records. There is a record of all medication held at the home so that this can be used to help audit medication administration. Medication awaiting disposal must be stored separately to medication in use and there must be a record of this. All medication must be stored at the correct temperature. The way in which some medication was stored and recorded put people at risk. 4 10 13 The Registered Person must 20/02/2009 make sure staff remove protective clothing when they have finished supporting people and only wear protective clothing which is appropriate to the situation. Some staff did not remove protective clothing when they had finished supporting people with personal care or Care Homes for Older People Page 8 of 19 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 wore protective clothing at other times. 5 10 12 The Registered Person make 02/03/2009 sure that suitable arrangements are in place to ensure that the care home is conducted in a manner that respects the dignity of service users by ensuring that:- (i) staff talk to service users and explain what they are doing when they interact with service users. (ii) staff do not talk to the service users in an aggressive or patronising way. (iii) staff take service users to the toilet as and when asked by any service user. Enforcement action is being considered. Some staff did not show respect to the people they were caring for. 6 10 12 The Registered Person must 02/03/2009 make sure that suitable arrangements are in place to ensure that every service user, giving consideration to their individual choice, is dressed appropriately for the weather and that staff are responsive and aware when someone may be too cold or too hot. The Registered Person make sure that suitable arrangements are in place to ensure that service users are given prompt support to change from stained or dirty clothing. Care Homes for Older People Page 9 of 19 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 Enforcement action is being considered. Some people were not dressed appropriately. 7 12 16 The Registered Person must 30/04/2009 make sure each person living at the home is supported to pursue individual interests that they choose. Their interests and likes should be recorded and these should be reflected in the care and support they are given. People should be supported to follow their own interests and hobbies. 8 12 16 The Registered Person must make sure there is a varied programme of organised activities, which is well advertised, accurate and reflects the likes and interests of people living at the home. The Registered Person must make sure records of activity participation and enjoyment are used to plan new activities. People should be given the opportunity to particiate in a variety of different organised activities. 9 14 12 The Registered Person must 20/02/2009 make sure people living at the home are free to express themselves, to make choices and to move around their 30/04/2009 Care Homes for Older People Page 10 of 19 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 home as they wish, supporting them to be safe wherever needed. People should be supported to make choices and live the life they chose. 10 14 12 The Registered Person must make sure the staff offer people choices and communicate clearly with them when they are supporting them. Staff need to communicate clearly so that people can make informed decisions about their own lives. 11 15 12 The Registered Person must 28/02/2009 make sure people are offered fresh fruit, snacks and drinks throughout the day and whenever these are requested. People should be able to eat and drink whenever they wish throughout the day. People may not be able to ask or may feel they are not entitled to extra food and drinks therefore the staff must be proactive and offer these. 12 15 16 The Registered Person must 20/02/2009 make sure people are offered choices at meal times, are given information about the meals offered and are served fresh and hot food. 20/02/2009 Care Homes for Older People Page 11 of 19 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 People should be able to chose from a variety of well prepared, freshly served and hot food. 13 16 22 The Registered Person must 28/02/2009 make sure there are accurate and detailed records of all complaints, including the investigation and outcome so that these can be audited. Records of complaints were not organised and some information needed to audit each complaint was not available. 14 18 13 The Registered Personmust 30/04/2009 offer the staff further training and support so that they have a better understanding of safeguarding issues. Because people are at risk if the staff can not recognise when they are not being protected or allowed to express themselves or make choices. 15 19 24 The Registered Person must make sure fire exits are unblocked and accessible at all times. People should be safe and be able to escape in event of a fire. 16 19 23 The Registered Person must make sure the building is decorated and furnished in an attractive and homely way. Broken furniture and 30/06/2009 20/02/2009 Care Homes for Older People Page 12 of 19 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 equipment must be repaired. People should live in an attractive and well maintained environment. 17 19 23 (2) (b) The registered person must 30/08/2008 ensure that communal areas are redecorated to enhance the environment for residents. 18 19 23 The Registered Person must decorate and furnish the home in a way which meets the needs of people living at the home and supports better orientation. People should live in an environment which meets their specific needs. 30/06/2009 19 26 23 The Registered Person must 20/02/2009 make sure all areas are dust free and that old Christmas decorations are removed in a timely fashion. Because people should live in a clean and well mainatained environment. 20 26 13 The Registered Person must make sure all WCs are equipped with liquid soap and paper towels. This reduces the risk of infection spreading. 20/02/2009 21 27 12 The Registered Person must review staffing levels and 31/03/2009 Care Homes for Older People Page 13 of 19 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 deployment to make sure these are appropriate to meet the needs of people living at the home. People living at the home should be involved in choosing the staff who support them. 22 31 8 The Registered Person must 31/03/2009 recruit a permanent manager for the service and this person must apply to be registered with the Commission for Social Care Inspection. The service should be managed by a suitably fit person. 23 33 12 The Registered Person must 31/07/2009 think about ways to monitor customer satisfaction and gather the opinions of people who live at the home and other stakeholders to help them improve the service. People living at the home should have a say in how it is run. 24 33 26 The Registered Person must send the reports of the monthly quality inspections of the home to the CSCI. Because we need to see evidence that the home is being regularly monitored and improvements are taking place. Care Homes for Older People Page 14 of 19 28/02/2009 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 25 34 25 The Registered Person must make sure the home has appropriate insurance and that the certificate for this is displayed. The organisation must show evidence that they are appropriately insured. 28/02/2009 26 35 13 The Registered Person must 20/02/2009 make sure money held on behalf of people living at the home is stored in an appropriate place, balances are recorded and are accurate and that checks on these are thorough. People should be safeguarded by the homes procedures. Care Homes for Older People Page 15 of 19 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 The Registered Person must: 25/03/2009 1.ensure that medicines are recorded accurately when received into the home, when administered and when disposed of. 2.Ensure that medication is administered as prescribed. 3. Ensure that there is robust auditing of medication. 4. Ensure that the clinical room is cleaned and tidied. Because people are at risk. 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 The Registered Person must 31/03/2009 make sure care plans are expanded when residents have pain, epilepsy or other long term medical conditions which require regular review. The Registered Person must 25/03/2009 make sure there are robust auditing processes in place to ensure the safe handling of medication. 2 9 13 Care Homes for Older People Page 16 of 19 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 9 13 The Registered Person must 30/04/2009 make sure the nurses have training to update their skills in managing medication safely. The Registered Person must 31/03/2009 make sure the home uses lancets when sampling blood which are of the professional type-to prevent the transmission of blood borne infections. The Regsitered Person must 25/03/2009 make sure waste medicines including controlled drugs are recorded and disposed of according to the Waste Regulations. The Registered Person must 17/04/2009 make sure the ordering process of medication is reviewed with the community pharmacist and GP to ensure that medication is administered as required. The Registered Person must 25/03/2009 make sure there are systems in place to ensure the safe storage, administration and management of medicines in the home. 4 9 13 5 9 13 6 9 13 7 9 13 Care Homes for Older People Page 17 of 19 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 It is recommended that the registered person requests the pharmacist to attach labels to the actual containers so that when the carton is thrown away the instructions are still visible. It is recommended that the registered person request the pharmacist to ensure that MAR charts are correctly aligned so that the home can record accurately. 2 9 Care Homes for Older People Page 18 of 19 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 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 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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