Care Home: The Firs

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What the care home does well There was a friendly atmosphere within the home. The home was clean and comfortable with well maintained gardens. The service has made improvements in relation to aspects of care planning, many aspects regarding the management of medication, the use of bed rails and staff recruitment. What the care home could do better: The service needs to ensure that prescribed medicines are available within the home at all times. Care records need to be improved in order that they give a clear explanation as to why medication is required and when it is no longer needed. Consultations with health care professionals such as GP`s also need to be clearly recorded in order that the service is able to demonstrate that health care needs are met. Cleaning materials need to be held securely at all times in order to prevent potential misuse. Suitable action is needed to ensure that people are not at risk of accidental or deliberate falling from windows. Random inspection report Care homes for older people Name: Address: The Firs 141 Malvern Road Worcester Worcestershire WR2 4LN one star adequate service 30/11/2009 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: 2 4 0 5 2 0 1 0 Information about the care home Name of care home: Address: The Firs 141 Malvern Road Worcester Worcestershire WR2 4LN 01905426194 F/P01905426194 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Sandra Lynne Ghalamkari Type of registration: Number of places registered: Conditions of registration: Category(ies) : Eldahurst Limited care home 15 Number of places (if applicable): Under 65 Over 65 0 15 0 dementia old age, not falling within any other category physical disability Conditions of registration: 15 0 15 The maximum number of service users who can be accommodated is: 15 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: Old age, not falling within any other category (OP) 15 Dementia (DE) 15 Physical Disability (PD) 15 Date of last inspection 3 0 1 1 2 0 0 9 Care Homes for Older People Page 2 of 11 Brief description of the care home The Firs provides care for fifteen people. 14 and 16 Margaret Road (known as Fern House) are now registed as a separate service. The properties are divided by their joint back gardens. The Firs is located in the St Johns area of Worcester. The property is adapted to provide a comfortable domestic environment for older people. The registered proprietor is the company Eldahurst Limited. The responsible individual and the registered manager is Mrs Sandra Lynne Ghalamkari. We did not obtain details on the current fees charged therefore the reader should contact the service directly. Previously we were told that the standard fee does not include hairdressing, chiropody, newspapers or having own telephone in bedroom. Care Homes for Older People Page 3 of 11 What we found: This inspection was unannounced. Therefore nobody within the home knew we would be visiting. This inspection was carried out during part of one day involving one compliance inspector and one pharmacy inspector. The last key inspection at this service was carried out during November 2009. The outcome of that inspection was that we assessed the service as Adequate. During that inspection we identified shortfalls regarding care planning, risk assessments in relation to bed rails, ensuring that medication records were accurate, staff recruitment and notification of certain events. Since our key inspection we have carried out one previous random inspection. This inspection was carried out in order that we could assess the progress made since our earlier visits and check compliance regarding the requirements we have made. We looked at the 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. We saw that the times of administering medicines were clearly highlighted on the MAR charts. We saw that a separate medicine record was used to document application of any external preparations such as creams or ointments. This ensured that staff knew when to give medicines. Medicines were not always available to give to people as prescribed, which had been a previous requirement made at the last inspection. We found two examples where medication was not available to give. One person had been prescribed a painkiller which had run out. We were informed by the manager that the person had a painful shoulder and the doctor prescribed a small amount of painkillers. The person was no longer in pain and therefore no more had been ordered, however the MAR chart record had been documented as none available. We looked at the care plan for the person, however it had no record of the persons painful shoulder or that a doctor had prescribed some painkillers. A second person had run out of a prescribed medicine for two days to treat constipation. Staff had not informed the manager that there was none available and therefore it had not been ordered. On informing the manager it was agreed that the medicine would be ordered immediately to ensure the person had their prescribed medicine. We discussed these issues with the manager and highlighted the importance of ensuring that a clear system for ordering medicines was discussed with trained staff. Medication that required special storage in controlled drug cabinets were stored safely following the Misuse of Drugs (Safe Custody) Regulations. However, we found some money for a named person stored inside the CD cabinet. This means that there could be an increased risk of unnecessary access to a secure medicine cabinet and peoples valuables and money were not stored appropriately. We discussed this finding with the manager who agreed to move the money to another secure location. As mentioned above we looked at written records, known as care plans, regarding some of the residents. 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 Care Homes for Older People Page 4 of 11 needs. Overall the details within care plans have significantly improved since our last inspection. We saw that care plans are generally reviewed on a regular basis in order to capture information about changing needs. However, as mentioned earlier within this report we were unable to find any written guidance regarding a health care need. We could not find any written information about why the medication was needed, the regime for using medication, whether the pain was subsiding and an assessment as to whether further medication was required. We also saw within somebodys daily records indications that an individual needs gentle persuasion to go to bed. However this, if an identified need, was not reflected in a care plan in order to provide staff with guidance. A risk assessment was on each file in relation to areas such as pressure care and nutrition. However, the risk assessment on each file was a photocopy of the same assessment and made no reference to individuals or specific areas of risk which could effect the outcome of the assessment and therefore the steps needed to reduce risk. We have previously raised concerns about the risk assessment process in relation to bed rails. At the time of this inspection only one resident was using bed rails. We had a brief look at the bumpers and found that they were fitted in such a way as to prevent an accident. The home is now keeping detailed records of daily checks which are taking place to ensure that the gap between the equipment and the head board is within a safe range. We did however read a record within the daily notes which we asked the manager to look regarding pillows and the resident concerned slipping down the mattress. It is important that following any incident involving the bed rails the risk assessment and care plan are reviewed to minimise the risk of future incidents. The service is currently working alongside the local authority in relation to safeguarding and Deprivation of Liberty safeguards. The service are recording any incidents that happen however the care plans did not provide staff with any strategy in order to manage any further incidents. We have previously reported upon improvement in relation to the service obtaining a CRB (Criminal Records Bureau) disclosure and references prior to a new employee commencing work at the home. At the time of our previous random inspection we did however have concerns about references. Since the last visit no new employees have started work at the home however we were shown the documents held to date in relation to a member of staff who has not yet commenced duties. We saw that the home has a new application form and noted that the required checks were available. Having these checks helps to reduce the risk of someone who is unsuitable gaining employment within the home. During this inspection we had a brief look around the home. We mainly looked at the areas where we have previously brought certain matters to the attention of the manager. We found that improvements had taken place in the majority of areas. A suitable curtain track is now fitted in the double bedroom on the first floor, which will enable people to be afforded privacy safely. A pedestal on a wash hand basin was found to be secured to prevent toppling and the boiler in a bathroom is now guarded to prevent accidental scalding. During recent inspections we have seen some bars of soap within the newly fitted wet room. We have highlighted that having bars of soap within communal areas are a concern Care Homes for Older People Page 5 of 11 due to infection control procedures. Although we did not see any soap within the wet room we did nevertheless see a bar within a communal toilet. The liquid soap hand dispenser near to the front door was, as previously mentioned, empty however a bottle of hand gel was available. During our last random inspection we found some cleaning materials within an unlocked cupboard. We highlighted within the previous report the potential hazard of having such items at hand. On this visit we found the cupboard door to be open and immediately saw a bottle of bleach on the floor. Due to the potential hazard if this was handled incorrectly we removed this item and handed it to the most senior person within the home at that time. Since our previous inspection a different property which was included within the registration of The Firs but operating under a different company has become registered as a separate care home. We have previously recommended that further advice be sought from a food safety officer from Worcester City Council Environmental Health regarding the transporting of food from The Firs to Fern House. The manager informed us that she has requested a further visit in order to gain advice but that this has not as yet happened. A visit from health and safety concluded that a review of training to ensure that staff receive all that is appropriate to their responsibility be undertaken. This visit took place during a period of warm weather. We saw that some of the first floor windows were open. Although restrictors were fitted to windows they were able to be open well in excess of the amount advised by the Health and Safety Executive. We brought this to the attention of the manager who informed us that she had noted this herself and was planning to take action to address this concern. What the care home does well: What they could do better: The service needs to ensure that prescribed medicines are available within the home at all times. Care records need to be improved in order that they give a clear explanation as to why medication is required and when it is no longer needed. Consultations with health care professionals such as GPs also need to be clearly recorded in order that the service is able to demonstrate that health care needs are met. Cleaning materials need to be held securely at all times in order to prevent potential misuse. Suitable action is needed to ensure that people are not at risk of accidental or deliberate falling from windows. Care Homes for Older People Page 6 of 11 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 7 of 11 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 8 of 11 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 38 13 Regulation 13 (4). Risk assessments must be in place regarding window restrictors and suitable and appropriate action must be taken to reduce risks to people and their safety and welfare This is to ensure that risks to people are minimised as far as reasonably practical. 25/06/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 7 8 9 A system needs to be in place to ensure that care plans are up to date and fully reflect people identified care needs. Risk assessments should be individual to each person living within the home. The service needs to ensure that items such as residents personal belongings or money are not held within the controled drugs cabinet. A system needs to be in place to ensure that medication is Page 9 of 11 4 9 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations ordered on time to ensure that people have medicines available to them. 5 26 A system needs to be in place to ensure that infection control procedures are maintained and that bars of soap are not used within communal facilities. A system should be in place within the home to ensure that all cleaning materials are locked away to ensure that people using the service are not able to access them. The home should make further contact with environmental health in relation to the transportation of food to Fern House. 6 38 7 38 Care Homes for Older People Page 10 of 11 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. 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