Care Home: St Johns Nursing Home

Similar services:

• The Lodge Nursing Home
• Bracken House
• Sunnycroft
• Field Farm House
• Edgeview Nursing Home
• Church Terrace Nursing & Residential Home
• The Forbury

What the care home does well Staff on duty were seen to be caring and showed residents respect. We saw staff up holding people`s dignity. What the care home could do better: Care plans and other written documents need to be an accurate reflect of people`s care needs. Recording systems need to be maintained in order to support staff in the meeting of people`s health care needs. The service needs to review the provision of person centred dementia care and provide meaningful activities and occupations. Staffing levels need to be reviewed to ensure that they are able to meet the complex care needs of people residing at St John`s. Systems in relation to the homes recruitment procedure need to be improved to ensure that the required checks are carried out on new employee prior to them commencing duties within the care home. Random inspection report Care homes for older people Name: Address: St Johns Nursing Home St Peters Walk Droitwich Worcestershire WR9 8EU two star good service 28/01/2010 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: Andrew Spearing-Brown Date: 1 9 0 5 2 0 1 0 Information about the care home Name of care home: Address: St Johns Nursing Home St Peters Walk Droitwich Worcestershire WR9 8EU 01905794506 01905798258 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Shaw healthcare (Homes) Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 43 Number of places (if applicable): Under 65 Over 65 0 0 dementia mental disorder, excluding learning disability or dementia Conditions of registration: 26 17 The maximum number of service users who can be accommodated is: 43 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Dementia - Code DE, maximum number of places 26, Mental Disorder, excluding learning disability or dementia - Code MD, maximum number of places 17. Date of last inspection 2 8 0 1 2 0 1 0 Care Homes for Older People Page 2 of 14 Brief description of the care home St Johns nursing home is currently registered for 43 residents. The home specialises in providing 24 hour nursing care for residents with a degree of mental illness and a dementia type illness. The home is registered to care for residents from the age of 55 years onwards. St Johns is part of the Shaw healthcare (Homes) Limited. The responsible individual is Mr P J Nixey. The registered managers post is currently vacant. St Johns moved into the home during October 2002. The home was then further extended in May 2003 to provide accommodation for an additional 17 residents. More recently 3 flats designed to rehabilitate people have been developed and added to the registration therefore making the current number of 43 places. The home is situated in Droitwich close to the town centre and public transport. Car parking spaces are available at both the side and rear of the home for staff and visitors. The home is spacious. All bedrooms are single occupancy with en-suite facilities of a toilet and shower. Communal areas include lounges, dining areas and specialist bathrooms. The home has enclosed gardens. Fees are available upon request. Care Homes for Older People Page 3 of 14 What we found: This inspection was unannounced. Therefore nobody within the home knew we would be visiting. This inspection was carried out during one day involving one compliance inspector and one pharmacy inspector. The last key inspection at this service was carried out during January 2010. The outcome of that inspection was that we assessed the service as Good. Following the key inspection and within our report we highlighted some areas where improvement was needed. We made two requirements regarding the management of medication. Since the inspection the service has appropriately informed us of some incidents within the home. In addition we were aware that the registered manager has left her employment at the home and the team leader on The Pines unit has also left. We have also received some information about the service which was of concern. We passed this information on to the provider to investigate. We also informed safeguarding within the local authority. The purpose of this inspection was therefore to assess compliance with the requirements as well as provide an opportunity to establish the latest position regarding some of the other areas mentioned above. During our inspection, which concentrated on the The Pines unit only, we viewed some documents such as medication records, care records and staffing records. We spoke to the area manager, trained nurses on duty and some other members of staff. We observed practices within the home throughout our time in the unit. At the time of this inspection The Pines unit was accommodating 23 long stay residents and 1 short stay (respite) resident. Therefore the unit had 2 vacancies. A new air conditioning unit had been installed in the medicine store room for The Pines unit. The room felt cool and we saw that temperature records for storage of medicines were documented daily below 25 degrees C. This means that peoples medicines were stored within the recommended manufacturers guidelines. Medication that would require special storage in a controlled drug cabinet was available and met the safe storage requirements following the Misuse of Drugs (Safe Custody) Regulations. We looked at the majority of medication administration record (MAR) charts and overall found that they were documented with a signature for administration or a reason was recorded if medication was not given. The times for administration of peoples medicines were clearly highlighted on the MAR charts. For example, one person was prescribed a medicine which requires regular blood monitoring. We saw that there were separate checks made on the medicine by two people to ensure that the correct dose was being given. We checked the MAR chart and the available records and found that the medicine had been given as directed. This means that the medicine was checked and being given safely. Care Homes for Older People Page 4 of 14 Medicines that were prescribed to be given on a when required or as needed basis were not always documented clearly and it was not always possible to check that the medicine had been given as directed. For example, we looked at one person who was prescribed seven medicines. We checked the records for each medicine and found that six of the checks were correct. However, one medicine was prescribed to be given when required for anxiety and agitation. There was no record of the receipt of the medicines on the current MAR chart or any balance forward from a previous MAR chart documented. We looked back over two months of MAR chart records but could not follow an audit trail due to the lack of up to date records. This means that it was not possible to check that the person had been given the medicine as prescribed. Medicines that were prescribed to be given as a variable dose, such as one or two tablets, did not have supporting information available for staff. For example, we saw that one person was prescribed a medicine to be given for night sedation. It was prescribed as one or two to be given at night when required. There was no guidance to inform staff how they decided whether to give the person one tablet or two. We saw a protocol dated 3/9/09 which stated the medicine was to be given to the person if unable to sleep and to document if takes one or two tabs but there was no further written information. This means that it was not possible to determine how many tablets needed to be given to the person to help them sleep. This means that medicines prescribed as a variable dose were being given without specific indications when to give one or two tablets and therefore this increases the risk of medication being given unnecessarily. Information and discussions with health care professionals about medicine requirements for people were not recorded in their care plans. For example, one person was prescribed a medicine to treat aggression and manic disorders. It was being used on a when required basis, however the medicine is not licensed to be given when required. We informed staff that the medicine was not being used according to its therapeutic indications and what discussions had taken place with the prescriber to ensure that the person was safe from harm. We were informed that the medicine was prescribed by a specialist. It was prescribed as Half to one tablet to be taken twice a day when required. We saw a protocol dated 3/9/09 which stated that the medicine was to be given when required for acute and chronic psychoses.... The MAR chart had sometimes been recorded with a code N, which was defined as offered PRN not required. We were concerned that a person was being offered a medicine to treat aggression and mania on a when required basis. It was not clear how a judgement was made on how much of the medicine should be given to the person. There was no written information to inform staff how many tablets to give and also under what specific circumstances this medicine should be given when required. We were informed by a member of staff that they decided whether to give a half tablet or one tablet based on their own knowledge of the person and their behaviour We know him and make that judgement. This was not recorded in the persons care plan. This means that there was a lack of supporting information and guidance on what was the best treatment for the person and therefore there was an increased risk that medication would not be given appropriately. Information relating to medication to be given when required was not always available. For example, we looked at the care plan for one person who was prescribed medication used to treat anxiety and agitation when required. We saw a protocol which was dated 4th June 2009, which stated that the medicine was to be given because the person can behave physically/verbally aggressive toward staff and service users. We saw records that documented that the medicine had been given on two occasions for increased Care Homes for Older People Page 5 of 14 agitation/aggression and aggression towards residents and staff. However, we saw that on one occasion the medicine had been given to the person for jerky movements. This indication was not documented on the protocol or in the persons care plan. We spoke to a member of staff who told us that the GP was aware of the jerky movements which had been getting worse. We were also told that a Duty GP had visited and said that the medicine could be given as necessary for jerky movements. This was not recorded in the persons care plan. This means that there was a lack of up to date protocols with regard to when required medication and people were at increased risk that medication would not be given appropriately. We found that there was a very high usage of medicines that may cause sedation prescribed for people on the Pines unit, which is a dedicated unit for people with severe end stage dementia. We found that 18 people were prescribed a medicine that could cause sedation. We were told by a member of staff that these medicines were necessary for this group of people to ensure they were safe from harm or from harming others and that all the medicines had been prescribed by a specialist. It is acknowledged that due to the nature of this disease that it is a specialised area that requires a dedicated team of staff to help and support people with dementia, however we were concerned that there was a high proportion of people prescribed sedating medicines without any supporting information or recorded discussions with healthcare professionals documented in peoples care plans. This means that people were prescribed medicines which can cause sedation and there was a lack of professional healthcare advice and support documented and therefore this may increase the risk of harm to people. As indicated above we viewed some care records alongside some of the MAR charts. The care records included care plans. A care plan is a document designed to give staff guidance in order that they are able to carry out the required care in a consistent way meeting identified care needs. Care plans contained a range of different headings such as personal hygiene, mobility, physical and verbal behaviours, cognitive impairment and nutrition. We saw that under many headings the plans were detailed. We also saw some temporary care plans in relation to short term care needs. We also saw risk assessments in place. We did nevertheless find some shortfalls where the information was insufficient or where we were unable to establish whether health care needs were suitably addressed. One care plan stated that a diet controlled diabetic should have their blood sugar checked every month. It was also recorded that the check should be carried out three times within a 24 hour period. The last check was done early February 2010. It was recorded that the individual concerned refused to have the lunch time check done. There was no other evidence to show that staff had attempted to carry out this check. The records of another person contained a short term care plan regarding an infected toe. This toe needed to be dressed however there was no record as to how frequently the dressing needed to be changed or when it was last done. From the records it was evident that one resident was having frequent falls. We found that the records did not always match regarding the falls and the risk assessment was not reviewed following the high number of incidents. On arriving at the home the person concerned was walking around the home without shoes or slippers. We were told that the individual frequently removed footwear. This could potentially be a factor regarding falls Care Homes for Older People Page 6 of 14 however this was not highlighted within the care plan or risk assessment. We saw gaps in other records regarding the use of creams and the taking of base line observations such as pulse and blood pressure. We were therefore unable to establish whether these health care needs where met or sufficiently monitored. We had a brief look around the home. The Pines unit is located on the ground and a lower ground floor. A passenger lift is provided to afford people access between floors. Signage and colour coded doors are provided to assist people with a dementia type illness find their way around. The unit has a large lounge on the ground floor which is split into two parts. A central area known as the garden room is used by a number of residents. A dining room is also provided on the ground floor. On the lower level an activities room is provided however we did not see this room being used during this inspection. The decoration within the large lounge is showing signs of wear and tear as the paint work is damaged. Within our previous report we made reference to plans to add a conservatory. This is now in place although not yet furnished. A ramp is needed in order that people are able to get to the garden from the conservatory. Within the last report we made reference to the fact that wardrobes were not secured to a wall in order to prevent accidental toppling. Wardrobes remain to be freestanding. We read information in a care plan regarding a resident who was kicking doors therefore the risk of pulling over the wardrobe appeared high. The nurse on duty undertook to take appropriate action to secure this item of furniture. During this inspection we were informed by the area manager that Shaw healthcare are currently seeking to appoint a suitably qualified and experienced manager to replace the former manager who left earlier this year. We were also informed that the company have appointed a new team leader for the older peoples unit but awaiting the return of the persons CRB (Criminal Records Bureau) disclosure before this person can commence work. We are aware that the service currently has staff vacancies. We were told that due to the number of vacancies for the qualified nursing staff 7 nights per fortnight are having to be covered by agency staff. The service has however appointed some bank (relief) staff and await CRBs for other staff. Despite this the service is still carrying 113 hours for qualified staff and 171 for support workers. At the time of our visit the unit had 2 qualified nurses and 6 support workers on duty. Throughout our visit staff were clearly very busy and the majority of time was taken up meeting basic care needs. At one point we noticed 11 out of 14 people in the lounge were either sleeping or had their eyes shut. At the same time only 1 person out of 7 people in the garden room where more was going on was sleeping. At lunch time staff were busy feeding or assisting residents with their meal. Staff were carrying out this role showing dignity however it was evident that other residents were waiting for attention. Although staff were busy as already stated staff were very caring towards people. We saw a situation in the lounge which required 4 members of staff to intervene. Staff remained calm and patient and ensured that the persons dignity was upheld and Care Homes for Older People Page 7 of 14 respected. Throughout our time in the unit we did not see any residents engaging in any meaningful occupational tasks such as helping lay the tables or doing some dusting. We viewed the files of two recently appointed members of staff. We were informed that no new member of staff is able to commence duties until sanctioned by the companys human resources section. We were able to view application forms and references. Neither persons CRB had returned furthermore we saw no evidence that an ISA (Independent Safeguarding Authority) first check had arrived. We were assured by the area manager that neither of the carers were carrying out personal care duties unsupervised. It is important that references and a CRB check are undertaken as they reduce the risk of someone who is unsuitable gaining employment within the home. 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 8 of 14 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 9 13 Regulation 13 (2) The service 15/03/2010 must make arrangements to ensure that medication administration records are accurately maintained that the reasons for non administration of medication are recorded by the timely entry on the medication administration record. To ensure that medication is managed safely Care Homes for Older People Page 9 of 14 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 12 Regulation 12 (1). The service must ensure that systems are reviewed to ensure that peoples health care needs are recorded. This is to ensure that peoples health care needs are monitored. 31/07/2010 2 9 13 Regulation 13 (2)The service 31/07/2010 must make arrangements to ensure that care plans include detailed information and instructions for staff in respect of administration and management of medicines. This must include the reasons to give medicines when required with a variable dose and what constitutes needed for the named person. This is to ensure that there are clear directions for care staff to give medicines prescribed when required. Care Homes for Older People Page 10 of 14 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 Regulation 13 (2) The service must make arrangements to ensure that clear up to date records are kept of all medicines received, administered and leaving the home or disposed of. This is to ensure that the care service maintains accurate records of peoples medicines. 25/06/2010 4 9 13 Regulation 13 (2) The service must make arrangements to ensure that medication administration records are accurately maintained. The reasons for non-administration of medication are recorded by the timely entry of an appropriate code or entry on the medication administration record; that the meaning of any such codes are clearly explained on each record; and that the person administering the medication completes the medication administration record in respect of each individual person at the time of administration. This is to ensure that the care service maintains accurate records of medicines administered to people including reasons for non 25/06/2010 Care Homes for Older People Page 11 of 14 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 administration of prescribed medicines. This is to ensure that the care service maintains accurate records of medicines administered to people. 5 12 12 A review of the arrangements to provide dementia care in a person centred way needs to take place. This is to ensure that meaningful activities are provided. 6 27 18 Regulation 18 (1) A review of staffing levels must be undertaken to ensure that people receive the care required in a timely way. This is to ensure that identified care needs are met. 7 29 19 A review of the recruitment 31/07/2010 process must take place to ensure that staff have the required checks carried out prior to them commencing duties and evidence of this is available for inspection. This is to ensure that only suitable people gain employment within the service. 31/07/2010 31/07/2010 Care Homes for Older People Page 12 of 14 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 13 of 14 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. Care Homes for Older People Page 14 of 14 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!