Care Home: The Alton Centre

What the care home does well The service strives to provide activities and leisure events to meet the needs of the people who use the service. To date, throughout the previous inspection activity that has occurred at the service, the feedback has been positive with people attending and engaging in activities of their choice. What the care home could do better: During this random inspection evidence was found that the service had failed to continue compliance with a number of requirements. There were reasonable grounds to believe that there may be evidence of a failure to sustain continued compliance with the requirements as stated. A Code B Notice was issued, in accordance with paragraph 6.7 of Code B of the Police and Criminal Evidence Act 1984. This was issued because the Commission for Social Care Inspection believes an offence may have been committed by virtue of (but not necessarily limited to) in breach of the regulations as stated under the Care Homes Regulations 2001, which are offences under the Care Standards Act 2000. In addition to this requirements have been made with regards to information in an individuals care plan being different to the information contained on the Medication Administration Record. A serious concerns letter was sent to the provider on the 27th November for compliance. A response was received within the time scales as specified. The care plan of the individual was reviewed. The food record showed gaps in the recordings of the blood sugar result. A further entry had been made on a separate recording tool, although all information was present it could cause confusion amongst staff as to where the record should be made, this lack of consistency has the potential to cause confusion and and therefore increase the risk of associated medication errors. Inspecting for better lives Random inspection report Care homes for adults (18-65 years) Name: Address: The Alton Centre Irchester Road Knuston Spinney Wellingborough Northants NN29 7EY zero star poor service 4th November 2008 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: Louise Bushell Date: 2 6 1 1 2 0 0 8 Information about the care home Name of care home: Address: The Alton Centre Irchester Road Knuston Spinney Wellingborough Northants NN29 7EY 01933413646 01933413664 altoncentre@activecarepartnerships.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Active Care Partnerships Ltd care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability 40 Over 65 0 Conditions of registration: 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 category: Physical disability - Code PD The maximum number of service users who can be accommodated is: 40 That Active Care Partnership employs Ms Cunningham forthwith as the manager of the home, with that appointment to last with the requirement that Active Care Partnership be required to submit an application for registration for Ms Cunningham forthwith, with the position thereafter to be discussed with CSCI. There will be two registered general nurses on duty at all times for six months There will be five care staff on the day shift and four on the night shift for six months. That the resident number will not increase beyond 19 for six months, but any increase or any variation will be discussed with CSCI. Care Homes for Adults (18-65 years) Page 2 of 20 That Mr White will attend the home two days per week for six months. But Lisa Lovett would attend the home two days per week for six months. That the division catering manager will attend the home every fortnight for six months: and The group quality assurance Manager will attend the home once a months for six months. Date of last inspection Brief description of the care home The home currently provides care for 19 physically disabled adults between the ages of 18 and 65 years. The home is situated in a small village, close to two local towns and their amenities. Transport is provided in the form of two mini-buses. Accommodation for the client group with Physical Disabilities is mainly provided over three floors and is in single rooms with ensuite facilities. Adaptations such as ceiling hoists and mobility aids are provided according to assessed needs. Inspection reports are available from the home or from the Commission for Social Care Inspection website. Information is available in the main entrance hallway in The Alton Centre. 0 4 1 1 2 0 0 8 Care Homes for Adults (18-65 years) Page 3 of 20 What we found: An unannounced random inspection was conducted on 26th November 2008 by Stephanie Vaughan, Louise Bushell and Mark Andrews who is a Pharmacist Inspector. The purpose of this random inspection was to review recent concerns that were brought to the attention of the Commission from Northamptonshire County Council regarding medication practices . In addition to this, a random review of the previous requirements occurred to monitor the services ability to sustain continued compliance for the best outcomes for the people who use the service. Since the last Key inspection conducted on the 4th November 2008, we have been informed on two separate occasions of circumstances regarding a variance in the imposed conditions of registration. Information was submitted by the provider on the 6th and 21st November 2008. This determined that Lisa Lovett, Training Manager would not attend the service for one day during the week of the 6th November 2008 and would not be attending the service for two days, week commencing the 10th November 2008, this was due to attendance on a manual handling diploma course. Alternative arrangements were put into place and Patrick Smith another company trainer would be attending the unit and would be providing first aid training for a number of staff. In addition to this we were notified on the 21st November 2008 that Lisa Lovett, Training Manager would not be attending the unit for one day due to illness. The provider stated that no alternative arrangements were able to be made due to the short notice provided. Mrs Deirdre Cunningham (proposed Registered Manager) was the person in charge at the time of this inspection. Tami Mokuolu, the services new Clinical Coordinator was on site throughout the inspection. Mr Stewart Whyte was on site at the commencement of the inspection. Mrs Sandra Bishop - Group Operations Manager, arrived on site towards the end of the inspection and Mr Micheal Keighley attended the feedback summary at the end of the inspection. Mrs Deirdre Cunningham is in the process of making her application to become Registered with the Commission. On the 29th October 2008 Mrs Deirdre Cunninghams Criminal Records Bureau (CRB) was returned and the Commission are still awaiting the completed application form. No further information has been received from the provider in relation to non compliance with the imposed conditions of registration as imposed by the Care Standards Tribunal. A limited tour of the premises was conducted. All areas were seen to be clean and hygienic and free from offensive odour. We have also received two Regulation 37 Notifications, one of which has implications for safeguarding and the appropriate referrals have been made. We are now awaiting the outcome. The second Regulation 37 Notification refers to care practice and appropriate action had been taken. Regulation 37 Notifications are being submitted in Care Homes for Adults (18-65 years) Page 4 of 20 a timely manner. The service continues to provide weekly progress reports to the Commission regarding actions and improvements that have been made. To date these have been received as required. A number of visits have been conducted at the service since the last key inspection in October 2007. A random inspection was conducted on the 6th and 7th August 2008, the 24th September 2008, 8th and 20th October. A further key inspection was conducted on the 4th November 2008 and a random inspection on the 26th November 2008. A number of requirements have been made throughout these inspections. This inspection focused on medication practices as we had received information in relation to possible poor practice. In addition to this a number of random checks were made on past requirements to assess the services ability to sustain continued compliance. During the random inspection conducted on the 26th November 2008 evidence was found that the service had failed to continue compliance with a number of requirements. There were reasonable grounds to believe that there may be evidence of a failure to sustain continued compliance with the requirements as stated. A Code B Notice was issued, in accordance with paragraph 6.7 of Code B of the Police and Criminal Evidence Act 1984. This was issued because the Commission for Social Care Inspection believes an offence may have been committed by virtue of (but not necessarily limited to) in breach of the regulations as stated under the Care Homes Regulations 2001, which are offences under the Care Standards Act 2000. Regulation 16, Standard 19. People who use the service must be offered adequate and regular fluids within a 24 hour period. To ensure adequate fluid intake for the people who use the service and to maintain their fluid balance and levels of hydration. This requirement made following the inspection conducted on the 24th September 2008. The requirement expiry date was the 19th October 2008. A compliance check occurred on the 20th October 2008 and it was found that the requirement was met. During the inspection conducted on the 26th November 2008 the requirement was not met and the service had failed to sustain compliance. In addition to this Regulation 16, Standard 19. Management must monitor and ensure the adequate fluid intake and output of vulnerable people who use the service. To ensure adequate fluid intake for the people who use the service and to maintain their fluid balance and levels of hydration. This requirement was made following the inspection conducted on the 24th September 2008. The requirement expiry date was the 19th October 2008. A compliance check occurred on the 20th October 2008 and it was found that the requirement was partially met. On the 4th November during the key inspection this requirement was found to be met. During the inspection conducted on the 26th November 2008 the requirement was not met and the service had failed to sustain compliance. Evidence gathered showed that the service has a policy and procedure in place for the appropriate hydration of individuals. The hydration for policy states that the care staff are responsible for offering fluids to service users as prescribed by the named nurse. It states that they are responsible for recording intake as required and reporting any changes to the person in charge. The person in charge is responsible for implementing this policy in the absence of the home manager. This person is also responsible for Care Homes for Adults (18-65 years) Page 5 of 20 monitoring service user intake for their span of duty. The home manager is responsible for implementing this policy, ensuring that staff understand the importance of good hydration and that systems are in place to achieve this. The policy continues to state that under normal circumstances an adult requires 1500- 2000 mls a day for adequate hydration. Offering a drink hourly, providing that it is consumed should satisfy this demand and that staff should note that this increases in hot weather. The individual assessment will identify the persons needs and preferences. The policy states for successful management of hydration it is important that an assessment of risk, hydration status, and effective care planing is conducted and evaluated on a daily basis. Fluid intake and output daily records for the 13th November 2008 details that one named persons intake was 750 mls intake in a 24 hour period. On the 17th November 2008 it detailed that the total intake for the named person was 800mls in 24 hour period. On 19th November 2008 records detailed 900mls intake in a 24 hour period. On 22nd November 2008 records detailed that 800 mls intake in a 24 hour period. In addition to this evidence was gathered detailing records completed by the services physiotherapist, showing fluids consumed during physiotherapy sessions. The manager confirmed that these have been added to the fluid intake balance charts and are not in addition. The care plan for the individual person states to monitor fluid intake and to report any decline in fluid intake . It also states to monitor urinary output as far as reasonable possible. The individuals care plan also details information regarding a medication prescribed for a specific condition. This medication in question requires close management and monitoring of fluid intake and out put. Medication Administration Records (MAR) were reviewed to monitor that the medication prescribed was being administered. This was not evident on the MAR. This was brought to the attention of the proposed Registered Manager by the Pharmacist inspector. In addition to this the proposed Registered Manager signed a statement confirming that she would discuss this issue, as a matter of urgency with the individuals general practitioner and provide information to the Commission for Social Care Inspection. Following a review of evidence collected under Code B, a serious concerns letter was sent to the service, outlining that the service must provide the Commission for Social Care Inspection with information about whether the named individual is prescribed the medication as detailed in the care plan. The service provided satisfactory information to determine that the person was not prescribed the medication as detailed in the care plan. The service stated that the person was prescribed an alternative medication and that the care plan, although reviewed on the 13th November 2008 was incorrect. The manager confirmed in the letter that this had in fact now been changed and reviewed. Regulation 13, Standard 19. Risk assessments must be in place and sufficiently identify the control measures to reduce the risks. To ensure that the people who use the service are protected and supported at all times. This requirement was made on 24th September 2008. The requirement expiry date was the 19th October 2008. A compliance check occurred on the 20th October 2008 and it was found that the requirement was met. During the inspection conducted on the 26th November 2008 the requirement was not met and the service had failed to sustain compliance. Evidence gathered showed that the accident record for one named person using the Care Homes for Adults (18-65 years) Page 6 of 20 service had been completed, detailing a fall from the toilet to floor on the 20th November 2008. The record also indicates that a body check occurred on the 20th and 23rd November 2008 and no bruising was observed. The individuals moving and handling risk assessment was reviewed on the 6th November. No entry and or review was observed following the fall. The Falls risk assessment shows that a review occurred on the 6th November 2008 but no evidence of a review following the fall. The falls risk assessment tool had not been accurately completed and showed that upon review the record stated that the person had not had any falls in the last year. This affects the total score. Although the individual would remain in the high risk category. A new manual handling risk assessment has been produced but there is no date of commencement and this is not signed. The record details information regarding the individual previously fractured the left hip. The date of the fracture is unknown, although the falls risk assessment stated that the individual did not have fracture within the last two years. A care plan was commenced on 5th October 2008 surrounding risk of falls due to partial weight bearing. This document refers to the persons requiring assistance for all transfers with two staff however does refer to him making attempts to transfer unaided. The care plan states that it should be re enforced with him to seek assistance to prevent accidents and that the service must monitor for any accidents and incident and to report them. Our evidence shows that they have reported the accident on the accidents and incident report form but have failed to include this in their own moving and handling risk assessment, falls risk assessment review, service user manual handling risk assessment tool, and the action taken box on the accident and incident report form has not been completed at all. The care plan evaluation for care plan relating to risk of falls due to partial weight bearing was reviewed on 6th November 2008 and states continues to be assisted with all transfers and no accidents or falls reported in this period. The daily records entry for the 20th October 2008 does state that found sitting on the floor in the toilet in his room, was examined for any obvious injuries, none noted, although he said he banged his head. Obs done BP 122 over 88, P 88, R 16. Was hoisted onto his wheelchair. Nurse in charge informed. There is no reference to the second check made on as signed on the accident records by Deidre Cunningham in the daily information of the 23rd October 2008. There is also no reference made in the records with regards to the bang on the head and any further medical checks or support that was sort. The falls prevention policy states the home manager is responsible for implementing this policy within the Care Centre. The manager is also responsible for ensuring that staff undertaking risk assessments and care planning for falls are competent to do so, and that all staff receive training in falls prevention according to their level of responsibilities. The policy further adds that staff should carry out risk assessment of the service users room and communal areas to identify and act upon specific falls and risks. In addition to this the policy also states that the service users moving and handling assessment should be re assessed and updated as necessary. It also comments that the service user care plan, daily information record, relatives communication record, should be updated as necessary. Care Homes for Adults (18-65 years) Page 7 of 20 A statement from the named individual confirms that there is not enough room to get his wheelchair beside the toilet in the en-suite of his new room. He added that he tried to reach for the wheelchair. He has asked staff if he can use the main toilet but has been told to use the toilet in his old bedroom as he can get wheelchair in there but will not be able to do so when his old room is again occupied. He confirmed that he does not know what will happen when old room is occupied and staff have not made any suggestions. The care plan regarding his risk of falls due to partial weight bearing states The service must ensure environment is hazard free. No evidence was found on the individuals plan of care to determine that a risk assessment had been carried out of the persons room and or communal areas to identify and act upon specific falls and risks as per the services own policy. The Service User Care Following An Accident Or Fall Policy states that the actions to be taken where there is no apparent injury include hourly observations. No records were evidence to reflect this. During an interview with a member of staff who was in charge of the shift on the 20th October 2008, recollected the accident and she stated that an agency nurse completed the accident report as I was working with her too. The nurse said he was found on the floor so not sure if he fell. He did not complain of pain but I have managed to book him appointment with the orthopaedic consultant on 10th December 2008 to check his hip. He has always had problems with his hip since he had a fracture. Regulation 12, Standard 6. Care plans must be regularly reviewed and guidance within them implemented to ensure the health and welfare of the people living in the home. The requirement was originally made on the 6th and 7th August 2008 and was given a compliance date of the 19th October 2008. The requirement expiry date was the 19th October 2008. A compliance check occurred on the 20th October 2008 and it was found that the requirement was met. During the inspection conducted on the 26th November 2008 the requirement was not met and the service had failed to sustain compliance. Evidence gathered during the inspection shows that the service policy Transition to a care centre determines that Care Planning is central to supporting the transition process. It should focus on the Service Users strengths. Methods of reducing perceived losses on coming in to care, usual daily living patterns, usual coping methods, personal resources and strengths and the development of new coping skills. Relatives and other supporters should be involved in the care planning processes according to the wishes of the service user. The services policy for Record Keeping and the service user care file states that each service users care file is maintained in good order and that all documents are kept in a clean and tidy condition. It adds that In accordance with service user Care File audit policy, the home manager will regularly audit a random sample of service user care files to ensure that, a. All information is recorded in a professional manner. b. The records show accurately the details of the individualised care provided to the service user. c. The details recorded accurately reflect the service users current condition. d. The service user care file documentation is maintained accurately and in good order. One care plan file determines that a care plan was re written and in place from the 21st September 2008. The Care Plan Index is showing that a total of fourteen care plan are in place. The document indicates that they were implemented on the 21st Care Homes for Adults (18-65 years) Page 8 of 20 September 2008. Eleven of the fourteen care plans were reviewed on the 13th November 2008 following implementation on the 21st September 2008. This equates to the care plans having not been reviewed for a total of fifty three days. One care plan had not been reviewed since its implementation of the 21st September 2008. The pressure sore care plan number fourteen was implemented on the 13th November 2008 and states closely monitor area for further deterioration and refer to GP DN sooner if required. The on going wound assessment document shows an entry made on the 21st November 2008. This is following the visit by the District Nurse visit on the 19th November 2008. The Record Keeping and the Service User Care File policy states that the home manager will delegate a Named Nurse / Team Leader to co ordinate the various aspects of care to be provided to the service user. The Named Nurse and Key worker list gathered as evidence displays who is allocated to each individual. The care review matrix planner details the scheduled internal reviews for the individuals currently residing at the service. The services risk assessment policy states that Named Nurse / Team Leader is responsible for assessing individuals service user risks and completing a service user care plan. A witness statement was gathered from a senior staff member stated that I can confirm that it is the procedure of the Alton Centre to review care plans on a monthly basis or sooner as required. My understanding is that the policy referring to this is in the policy file for service users. My role and responsibility surrounding care planning is to make sure that they are up dated and monitor the care plans. I also monitor the implementation of the new care plans as per changes in client care or condition. I review the care plans also and these are now divided between the named nurses who are primarily responsible. A Second statement was gathered from a Registered Nurse My role and responsibility for care planing is to ensure that they are updated every now and again, if a member of staff is off sick or on annual leave we have to update their care plans also. Also if there is any changes of circumstances we have to up date the care plan. We evaluate them every month but we up date them every time something happens, for example if some one attends the dentist we up date the oral hygiene care plan or if some one has a panic attack or a seizure we up date the care plan. I have done the company care planning training with our companys clinical co coordinator two weeks ago. The individual continued to state that . Our policy says review monthly but like I have been explaining if any thing happens we have to up date the care plan. For example if some is deteriorating we must update the care plan to reflect their needs at that moment in time. A third statement was gathered from another Registered General Nurse who stated that Care plans are reviewed on a monthly basis I have three clients allocated to me and I review their care plan monthly. There is a chart in place which tells us when it is needed to be done by. If there are any changes I hand it over to the shift, up date the progress notes, I would also add to the hand over sheet so it cant be missed. A fourth statement was gathered from the proposed Registered Manager Mrs D. Cunningham who confirmed That it is the policy of Southern Cross Active Care Care Homes for Adults (18-65 years) Page 9 of 20 Partnerships that care plans are reviewed monthly or sooner as required. To the best of my knowledge all the care plan are reviewed, are accurate and up to date. An immediate requirement was made on the 6th August 2008 which states that the Registered Person must ensure that the time that the identified service users blood sugars are taken is recorded accurately. This is to ensure consistent monitoring and management of the service users diabetes.We conducted random inspections on the 24th September, 8th and 20th October. A further key inspection was conducted on the 4th November 2008 and a further random inspection on the 26th November 2008. Compliance with this requirement was assessed at the inspection dated 24th September 2008, Mrs D Cunningham stated that the food diary had been expanded to include the blood sugar result, that this is taken after the meal and before the insulin is given to show an audit trail. This requirement had therefore been met. This was again reviewed on the 26th November 2008 to assess the ability of the service to sustain improvements and compliance. The care plan of the individual was reviewed the food record showed gaps in the recordings of the blood sugar result. In particular for the 18:00 hrs check on the 22nd November 2008, in this case the blood sugar recording had been made on the Insulin body map record and one other occasion the record of the Blood sugar level had been recorded in the daily notes. Mrs D Cunningham proposed Registered Manager confirmed that it is company policy for the staff to record blood sugar levels on the insulin record. However there appears to be confusion amongst staff as to where the record should be made, this lack of consistency has the potential to cause confusion and and therefore increase the risk of associated medication errors. Regulation 13, Standard 20. having an effective system in place for ordering medication to ensure there are sufficient quantities of medication so that people receive their medication. In addition to this that systems must be sufficient to identify when errors in recording have been made and action taken on this. Audits must be under taken to identify inaccuracies when medication stock do not reconcile with medication stocks. This requirement made following the inspection conducted on the 6th August 2008. The requirement expiry date was the 7th August 2008. A compliance check occurred on the 7th August 2008 and it was found that the requirement was met. During the inspection conducted on the 26th November 2008 the requirement was not met and the service had failed to sustain compliance. Regulation 19, Standard 12 that the identified service user receives her insulin at the times prescribed by her medical practitioner. This is to ensure consistent monitoring and management of the service users diabetes. This requirement made following the inspection conducted on the 6th August 2008. The requirement expiry date was the 7th August 2008. A compliance check occurred on the 7th August 2008 and it was found that the requirement was met. During the inspection conducted on the 26th November 2008 the requirement was not met and the service had failed to sustain compliance. We looked at the homes medicine management practices by examination of current and previous medication charts made available to us and medicines available in the medicine storage room for administration. We also observed a small part of the lunch time medicine round and we looked at medicine refrigerator records. Care Homes for Adults (18-65 years) Page 10 of 20 The medicine refrigerator is located in the ground floor office adjacent to the dining room. We noted that the refrigerator was locked and indicated that the temperature was within the correct temperature range but we noted that daily temperature records were omitted on 5 days to date during the month of November 2008. Medicines are stored in a medicine storage room on the second floor. The room temperature of the room is being monitored on a daily basis. A fan and cooling unit are in place to keep room temperatures within the accepted temperature range. The two medicine trolleys are located in this room when not in use. We noted that back up stocks of medicines including oral medicines are stored on open shelves within the room and the door to the room has a lock which is not self locking when the door to the room is closed. During the afternoon of the inspection we noted that the door to the room was not locked leaving medicines on shelves not secured and potentially accessible by unauthorised persons or people living at the home. We brought this to the attention of the clinical coordinator to take urgent action to ensure the medicines were secured. We also noted that the cabinet used to store controlled drugs is not secured to the wall of the medicine storage room by a minimum of two bolts in line with the Misuse of Drugs (Safe Custody) Regulations. The senior Registered Nurse on duty administering medicines told us that there were no medicines stored in the rooms of people living at the home. Medicines were being self-administered by one person but these were being stored in the central storage room. With the nurses permission we observed the latter part of the lunch time medicine round. We saw that procedures followed by the nurse were satisfactory. We discussed with the nurse blood glucose monitoring for a person with diabetes living at the home. When asked what the danger blood glucose levels were for this person the nurse described both the upper and lower limits. The nurse then showed us a laminated card which she said is made available for agency nurses working at the home. The upper blood glucose level stated was higher than that stated by the registered nurse. Also when we looked at the persons medication charts we found that on 8th November 2008 insulin prescribed for this person was not administered because the blood glucose level was too low. However, we noted that this recorded level was higher than that stated as the lower limit. We examined the records of a person living at the home who has recently been prescribed a series of antibiotic courses. We found that for the current course of antibiotics there was a deficit discrepancy of one tablet. We checked this finding with the manager and Clinical coordinator who agreed there was a discrepancy. On another recent course we found that an error had been made by staff where the morning dose scheduled for 20th November 2008 had been missed. The GP was contacted and a double dose was authorised for the 17.00 dose. This was confirmed on both the reverse of the medication chart and the persons care notes. Whilst the home has a system in place which enables medicine quantities to be audited, we found other audit discrepancies of medicines for this person and other people at the home. These were checked with the proposed Registered Manager and Clinical Coordinator during the inspection who were able to explain some discrepancies where we had found a deficit of one tablet. The explanations highlighted the fact that staff were frequently recording A equating to medicine not administered because it was refused but actually disposing of the medicines. The coding system on the homes medication charts makes provision for medicines refused and wasted by code E but Care Homes for Adults (18-65 years) Page 11 of 20 this code was seldom not being used. Where there were other numerical discrepancies of medicines identified these were checked and discussed with the proposed Registered Manager and Clinical Coordinator during the inspection. Some of these discrepancies could not be identified exactly because full and accurate records were not being completed when medicines are prescribed with variable doses (for example, Co-codamol 30/500mg tablets 1-2 tablets x4 daily). The manager told us the home was routinely conducting its own internal audit of medicines and had found no discrepancies, however, she also said that the home was currently being staffed with approximately 75 percent agency staff. We also found that for one person at the home there were two container types of the same medicine available in the medicine trolley. When we looked at records there were nine tablets more than expected. The manager said that this does not make sense and agreed that the presence of the second container was unsafe and could lead to confusion and error. During the inspection we found on examination of current and previous medication records that there had been a number of situations where medicines had not been available to administer to people as scheduled placing their health and welfare at risk. These medicines included phenytoin suspension usually prescribed for the prevention of epileptic seizures omitted 26th and 27th October 2008 and painkillers including paracetamol tablets that were not available previously and during the week leading up to the time of inspection. What the care home does well: What they could do better: During this random inspection evidence was found that the service had failed to continue compliance with a number of requirements. There were reasonable grounds to believe that there may be evidence of a failure to sustain continued compliance with the requirements as stated. A Code B Notice was issued, in accordance with paragraph 6.7 of Code B of the Police and Criminal Evidence Act 1984. This was issued because the Commission for Social Care Inspection believes an offence may have been committed by virtue of (but not necessarily limited to) in breach of the regulations as stated under the Care Homes Regulations 2001, which are offences under the Care Standards Act 2000. In addition to this requirements have been made with regards to information in an individuals care plan being different to the information contained on the Medication Administration Record. A serious concerns letter was sent to the provider on the 27th November for compliance. A response was received within the time scales as specified. The care plan of the individual was reviewed. The food record showed gaps in the recordings of the blood sugar result. A further entry had been made on a separate recording tool, although all information was present it could cause confusion amongst staff as to where the record should be made, this lack of consistency has the potential Care Homes for Adults (18-65 years) Page 12 of 20 to cause confusion and and therefore increase the risk of associated medication errors. 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 13 of 20 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Adults (18-65 years) Page 14 of 20 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 1 4 01/01/2009 The Statement of Purpose and Service User Guide must be reviewed to ensure that it reflects the imposed conditions of registration. To ensure that people have accessible, accurate and up to date information. This requirement was made on the 4th November 2008 at the Key Inspection. 2 19 12 Risk assessments must be conducted in situations where peoples rights to choose conflict with current best practice. To ensure that peoples rights are balanced with the potential risk and that action is taken to manage these risks. This requirement was made on the 4th November 2008 at the Key Inspection. 01/01/2009 3 19 17 Records for the recording of 30/12/2008 blood sugar levels, fluids and food intake must be clear, in Care Homes for Adults (18-65 years) Page 15 of 20 order for an audit trail to occur and for staff to following without confusion. To ensure that all records are completed as required and that staff are provided with clear unambiguous guidance. 4 20 13 Medicines must be kept secure at all times. To ensure that people are adequately protected from potential risks. Systems in place for the administration of medicines must be safe at all times. Second containers of medicines no longer in use must be promptly removed to avoid the potential for confusion and error. To ensure that the people who use the service are protected from unnecessary risks. 6 20 13 Medicines must be stored under appropriate environmental conditions in compliance with their product licence to maintain their stability. To ensure the quality of medications in use and to protect people in the service from harm. This requirement was made on the 4th November 2008 at the Key Inspection 7 20 13 The storage of controlled 01/01/2009 medication must be reviewed to ensure that the arrangements are in compliance with the guidance issued by the Royal British Page 16 of 20 10/12/2008 5 20 13 10/12/2008 01/01/2009 Care Homes for Adults (18-65 years) Pharmaceutical Society. To ensure the safe storage of controlled medication. This requirement was made on the 4th November 2008 at the Key Inspection. 8 20 12 Medication must be administered as prescribed and care plans accurate and up to date to reflect the correct medication for the person using the service To ensure that the people who use the service receive all medicines as prescribed and that their individual care plans are reflective of their needs. This requirement was made on the 27th November 2008 following the random inspection conducted on the 26th November 2008. A Compliance date was issued for the 27th November 2008 at 17:00 Hours. 9 24 23 Action must be taken to ensure that appropriate fixtures and fittings are provided in the individuals accommodation. To ensure that a persons privacy and dignity is respected at all times. This requirement was made on the 4th November 2008 at the Key Inspection. 10 34 19 Recruitment practices must 10/12/2008 demonstrate compliance with Schedule 2 of the National Minimum Standards. 01/01/2009 08/12/2008 Care Homes for Adults (18-65 years) Page 17 of 20 To ensure that people who use the service are in safe hands at all times. This requirement was made on the 4th November at the Key Inspection. 11 39 13 The arrangements for storing 01/01/2009 and recording money stored for the people who use the service must be reviewed to ensure that it complies with the guidance issued with the Commission for Social Care Inspection - Managing money for people who use services. To ensure that people who use the service are protected from abuse. This requirement was made on the 4th November 2008 at the Key Inspection. 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 5 People who use the service and or their representatives should be involved in the care planning and review process to ensure that care plans are individual and person centred. This recommendations was made on the 4th November at the Key Inspection. 2 5 Contracts should be reviewed to ensure that they contain the criteria listed in Standard 5 of the National Minimum Standards. This recommendations was made on the 4th November at the Key Inspection. 3 7 People who use the service and or their representatives should be informed and supported to access advocacy services if they wish to do so. Care Homes for Adults (18-65 years) Page 18 of 20 This recommendations was made on the 4th November at the Key Inspection. 4 16 Information gatherered during the assessment process should be reflected in the current care plan to ensure that people are supported to achieve their personal preferences. This recommendations was made on the 4th November at the Key Inspection. 5 6 20 20 The homes system of auditing should be reviewed to enhance its accuracy. The security of medicines stored in the medicine storage room should be reviewed considering locked storage for back up supplies of medicines and the door lock type. The application form should reference the raltionship of the referee to the applicant. This recommendations was made on the 4th November at the Key Inspection. 8 35 Staff files should evidence that a comprehensive induction training programme has been provided to new employees. This recommendations was made on the 4th November at the Key Inspection. 9 38 Formal processess should be developed to ensure that people who use the service are able to voice their opinions and become involved in the running of the service. This recommendations was made on the 4th November at the Key Inspection. 10 42 Polices and procedures should be reviewed on an annual basis to ensure that they comply with current best practice and are applicable to the needs of the people who use the service. This recommendations was made on the 4th November at the Key Inspection. 7 34 Care Homes for Adults (18-65 years) Page 19 of 20 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. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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