Care Home: Timberdine

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What the care home does well There was a welcoming and friendly atmosphere within the home. The home was clean and comfortable. A central garden was well maintained. People using the service are complimentary of the care provided in areas such as food and staff members. We saw staff treating people with respect and up holding their dignity throughout the time we were at the service. What the care home could do better: As a result of our findings the service accepted that improvement was needed in relation to a range of areas regarding the management and recording of medication. These improvements were needed to ensure that people can be confident that they will receive medication as prescribed or necessary. Random inspection report Care homes for older people Name: Address: Timberdine 1 Timberdine Close Worcester WR5 2DD two star good 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 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 1 0 6 2 0 1 0 Information about the care home Name of care home: Address: Timberdine 1 Timberdine Close Worcester WR5 2DD 01905361840 01905361854 Telephone number: Fax number: Email address: Provider web address: www.worcestershire.gov.uk Name of registered provider(s): Name of registered manager (if applicable) Mrs Ann Barry Type of registration: Number of places registered: Conditions of registration: Category(ies) : Worcestershire County Council Home Care Services (DCA) care home 27 Number of places (if applicable): Under 65 Over 65 0 27 dementia old age, not falling within any other category Conditions of registration: 27 0 The maximum number of service users who can be accommodated is: 27 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) 27 Dementia (DE) 27 Date of last inspection Brief description of the care home Timberdine is a large, purpose built, single storey building located in a mainly residential area near to the centre of Worcester. There is easy access to public Care Homes for Older People Page 2 of 12 Brief description of the care home transport and other local amenities. There are adequate car parking facilities at the front and side of the building. The premises are owned and operated by Worcestershire County Council. Originally, the premises were used to provide permanent residential care for older people. This service has been virtually phased out and the premises have been redesignated as a resource centre that is currently registered to provide care for a maximum of 27 older people. All the service users are accommodated in single bedrooms. Each unit has shared bathroom and toilet facilities, a combined lounge and dining area and the shared use of a small domestic kitchen. The centre provides eighteen places for people in receipt of intermediate care i.e. assessment and rehabilitation, eight places for people in receipt of respite care and one place for a service user in receipt of permanent residential care. The centre would also provide a rapid response i.e. a 72 hour placement, in one of the intermediate care places in appropriate circumstances. The fees ranged from nil to 368.00 pounds per week. A day care service is provided at the centre. However, this service did not form part of the inspection. Care Homes for Older People Page 3 of 12 What we found: This inspection was unannounced. Therefore nobody within the home knew that we were going to visit. This inspection was carried out by one compliance inspector over two days. The last key inspection at Timberdine Resource Centre was carried out during June and July 2007. The outcome of that inspection was that we rated the service as Good. Since our last key inspection we have written two Annual Service Reviews (ASR) about the service. An ASR is a document we produce taking into account information we have received about the service without carrying out a visit to the home. Prior to our visit we requested an Annual Quality Assurance Assessment (AQAA) from the service. The AQAA is an opportunity for providers of a service to tell us about areas where they are doing well and areas where they believe further development is needed. The AQAA was returned to us and gave us clear information. When we visited the service the manager was on sick leave. We reminded people that under Regulation 38 of The Care Homes Regulations we need to be informed of certain absences. During our visit we looked at some records such as care records, medication records and staff records. We had discussions with people working at the home as well as with both the team manager and the assistant provider services manager. We also had discussions with some people using the service and a relative. Within our previous report we wrote that people, who may prospectively use the service, are provided with relevant information about the centre. Within the AQAA the manager wrote that people are provided with a brochure prior to coming to the service. Furthermore, we were told, people are provided with a Welcome Pack. We saw copies of this pack within bedrooms when we had a look around the centre. A relative confirmed to us that she had seen information about the service. Although the pack itself contains out of date information in referencing the National Care Standards Commission the inserts provide people with a range of useful information. This information includes details about fees, meals, staff and complains. The pack states that the aim of the service is to provide all its service users with a comfortable and safe environment, in which they can receive appropriate care and support to maintain their independence. Information about the service can be translated in to other languages if people require this service. A Customer Service Excellence Continues Compliance Report, covering three resource centres, dated March 11th 2010 states that access to the service is by referral. The report continues that the service builds in prior visiting before admission, but that this cannot happen for hospital discharges. Information was displayed within the office regarding the people who are able to make referrals to the home such as trusted assessors within the community or hospital. During our visit we heard a member of staff informing another professional that the centre could not admit a potential resident until a suitable mattress was provided. Care plans were in place covering areas of care needs. The information within these was Care Homes for Older People Page 4 of 12 generally sufficient to provide staff with the details needed to ensure consistency in care provision. We saw risk assessments to be in place regarding areas such as mobility, skin viability and moving and handling. A nurse works 30 hours per week on the intermediate care unit. At other times the local community nursing services are used. Within a care plan, of a resident on respite care, we saw that staff had contacted the community nurse about a concern. Written instructions about using cream were in place following an initial visit from a nurse. The care plan reflected the regime recommended for using a barrier cream. The carer on duty was aware of these instructions and had signed a sheet to indicate the treatment carried out. However, we noted some gaps in this record whereby it was not possible to evidence that the cream was applied on certain occasions. We assessed the storage, administration and management of medication. The vast majority of medication is stored within lockable cabinets within each persons bedroom. Some medication is however stored in a room off the main office. We discovered some areas of concern during this part of the visit and involved managers within the home with our findings at the time. We looked at the records and storage arrangements for medication regarded as controlled. Within the controlled drugs cabinet we found medication which was not recorded within the controlled drugs register (CDR). The CDR did however still contain details of another persons medication which we established was returned to the person concerned on leaving the service. We found some pain relieving patches within the cabinet which were not recorded within the CDR. It was of concern that upon checking these we discovered that the resident concerned should have had a patch applied 2 days prior to our inspection. This had not happened and nobody within the service had realized this omission had happened. Reference was made to this patch within the persons care plan describing it as wears for pain. Upon highlighting the omission action was taken by people at the home including contacting the persons doctor. The arrangements for the holding of the controlled drugs key was not sufficiently robust to ensure that the service could account for who had gained access to these medicines. The service was holding two separate supplies of homely remedies. We were told that one supply was for day time use while the other was for night time use. These items did not have the date of opening recorded upon them which means we were unable to carry out a full audit to establish that they were dispensed correctly. It was of concern that some tablets used to remedy constipation were out of date by over 7 months. We also found a bottle of medicine to relive the symptoms of indigestion which had also passed its expiry date. The records regarding the administering of homely remedies were inadequate however they suggested that the tablets to remedy constipation were used after their expiry date. We became aware that one person had medication viewed as controlled within the monitored dosage system stored within their own bedroom. As staff members were administering this medication it needed to be stored more securely within the controlled Care Homes for Older People Page 5 of 12 drugs cabinet. A fridge is provided to store medication requiring such facilities. Records were maintained which showed that the temperature was generally below 8 degrees Centigrade. We did however see one entry for 10 degrees, where no follow up action was recorded. The service was not monitoring the temperature of the room holding medication or within peoples bedrooms. Medication should be stored at or below 25 degrees Centigrade. We looked at the medication in some peoples bedrooms. We found that boxed medication was not dated. One person had received medication from two different pharmacies. In relation to one drug the instructions as to when a once weekly dose was to be administered differed between the two. This mixed information could have potentially caused confusion. There was however no evidence to suggest that this had happened. We were assured that action would be taken immediately to address the shortfalls and we were supplied with an action plan. Since the inspection we have received further up dates regarding the action plan. During this visit we had a brief look around the home. Timberdine Resource Centre consists of 27 bedrooms all of which are on the ground floor therefore making the service accessible to people in wheelchairs. All the bedrooms are single occupancy, four have en suite facilities. The respite unit is able to accommodate 7 people on a short stay basis in addition to 1 person who is a permanent resident. The intermediate care unit is able to provide accommodation for 18 people plus 1 person on respite care. The home provides comfortable lounge and dining areas. Kitchenette facilities whereby people are encouraged to make themselves a drink are provided. These facilities are found to be beneficial in preparation for pre assessments prior to people returning to their own accommodation. A therapy room is provided within the intermediate unit. One person told us that staff encourage her to do as much as possible for herself. A small hairdressing room is provided. We saw the newly extended laundry which is staffed seven mornings per week. We were informed that the laundry is now able to provide a better service than in the past. During our visit we asked people about their experience of this part of the service. Their comments were complimentary. Following a local flood a number of years ago work has taken place around the home to improve future defenses. The central garden is well maintained with a pond and raised flower beds. Other areas of the garden require further attention once the flood defense work is completed. We saw a member of staff serving lunch to people in the respite unit. The meal was plated up from a heated trolley and appeared appetizing. People were complimentary about the food provided. Within surveys returned to us prior to our visit one person wrote very good food while somebody else wrote The food has been plentiful and varied and played an important part in my stay. A record from the quality focus group comprising of people using the service in February 2010 contained positive comments about food. We saw a booklet within the Welcome Pack called compliments comments and complaints making your views known. This leaflet makes reference to the Councils Care Homes for Older People Page 6 of 12 complaints procedures for adult social care. Under the section about what people can do if still not satisfied it gives details of the local government ombudsman and advocacy service. There was no mention of CQC. We did however see other copies of this leaflet with a sticky label on them which did refer to CQC. Information was on display within the home regarding contacting the commission. Another sheet within the Welcome pack contained full details of the homes complaints procedure and how to contact us. We looked at the file on a member of staff recruited since our last inspection. This file showed that the service operates a recruitment process which makes sure that the required checks are undertaken prior to a new member of staff starting work. We saw that a CRB (Criminal Records Bureau) check and references are in place. Having these checks helps to reduce the risk of someone who is unsuitable gaining employment within the centre. Staff informed us that they receive regular training. One person told us that moving and handling training was scheduled to take place in the near future. People receive induction training when they first start employment within the centre. Staff who work within the intermediate care unit are called support workers and have received additional training in order for them to carry out rehabilitation. Within the AQAA we were informed that over 93 percent of care staff have achieved a level 2 NVQ (National Vocational Qualification). People using the service described the staff as very approachableand pleasant. People are able to have money and other valuables held in safe keeping for them. We checked the balances held in relation to a small number of people and found them to be in order. The service has a range of methods to assess the quality of service provided. Up until recently the service was using the National Minimum Standards as a benchmark for their own assessment of quality. The service is now using the new Essential Standards of Quality and Safety which are due to be introduced in October 2010 and some case studies to ensure compliance with these new quality outcomes. The service generally informs us of incidents which have occurred within the centre as necessary under Regulation 37. We did however find a document within a file regarding an incident of which we were not aware. We briefly viewed some safety records such as water temperatures and fire and found them to be in order. What the care home does well: What they could do better: Care Homes for Older People Page 7 of 12 As a result of our findings the service accepted that improvement was needed in relation to a range of areas regarding the management and recording of medication. These improvements were needed to ensure that people can be confident that they will receive medication as prescribed or necessary. 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 12 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 9 of 12 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 13 Regulation 13 (2) Ensure that systems are in place to check expiry dates of medication within the home. To ensure that people are protected from harm and have their health care needs meet. 16/07/2010 2 9 13 Regulation 13 (2) Ensure that people receive their medication as prescribed To ensure peoples health care needs are met. 16/07/2010 3 9 13 Regulation 13 (2) 16/07/2010 Medication which needs to be treated as controlled received into the care home must be booked in and held securely at all times as required by the Misuse of Drugs Regulations (Safe Custody 1973), the Misuse of Drugs Act 1971 and as in guidance issued by the Royal Pharmaceutical Society of Page 10 of 12 Care Homes for Older People 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 Great Britain. To ensure that systems are in place to securely hold medication and protect people from harm 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 11 of 12 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. 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