Care Home: Wellington House

What the care home does well The home had maintained comprehensive records of all accidents and errors identified and also had accessible records of actions taken. The home`s management had overseen some elements of the first acting manager, and instructed a report of an accident in the car park was properly reported. This had been done. Senior management had also instigated medication reviews to respond to the deficits in the administration identified, and reported to us when errors had been identified. They had made arrangements for an alternative, experienced acting manager to cover the home following the position of the first acting manager becoming untenable. What the care home could do better: A full written pre admission assessment must be available for residents routinely admitted, to ensure that the home is confident it can meet residents needs prior to admission. Care plans must be fully completed and contain detailed comprehensive risk assessments within a short period of admission and must include all necessary elements. Sufficient staff must be on duty at all times to meet residents needs, and an accurate record of staffing provided must be kept. Medication audits undertaken by senior management are continuing and practices are improving; arrangements must be made to ensure people living at the home are administered their medication safely and as directed by the prescriber at all times, and eye drops should be dated when opened to ensure that they are not used past their expiry date. Inspecting for better lives Random inspection report Care homes for older people Name: Address: Wellington House Finborough Road Stowmarket Suffolk IP14 1PW one star adequate service 25/11/2008 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: Mary Jeffries Date: 1 0 0 2 2 0 0 9 Information about the care home Name of care home: Address: Wellington House Finborough Road Stowmarket Suffolk IP14 1PW 01449774633 01449775035 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Healthcare Homes Limited care home 21 Number of places (if applicable): Under 65 Over 65 0 21 dementia old age, not falling within any other category Conditions of registration: 5 0 The maximum number of service users who can be accomodated is: 21 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 - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Wellington House is a large converted and extended listed period house, situated on a main road near the centre of Stowmarket. It has been by owned by Healthcare Homes since June 2008 and provides care and support for up to 21 residents who are older people or who have dementia. The home has 11 single rooms and 5 double rooms; 7 rooms have en suite facilities. Resident accommodation is on two floors, the upper floor being accessible by stairs or stair lift. There is a communal area available to Care Homes for Older People Page 2 of 12 2 5 1 1 2 0 0 8 Brief description of the care home service users on the lower floor, with a dining area, also on the lower floor. There is currently extensive building work being undertaken as a two-storey extension is being built to the rear of the home. The home is situated within a 5-minute walk of the centre of Stowmarket, where there is a wide range of shops, pubs and public amenities, including library and post office facilities. Care Homes for Older People Page 3 of 12 What we found: During the period between 29th December 2008 and January 19th 2009, an acting manager had been looking after the home, following the resignation of the Registered Manager. We had received a number of concerns and complaints from members of staff. These were concerning staffing levels, medication practices, and the impact of a residents behavior towards other residents and staff at the home. During this period, no complaints had been made to us from residents or relatives. During the period there had been significant involvement from the senior management team, and it had been decided on 19th January 2009 that the position of the acting manager was not tenable. Senior management subsequently provided daily cover in the home for a week, following which a consultant was appointed to the acting manager position pending appointment of a permanent manager. We have not received any further concerns or complaints. The homes staffing compliment is one senior and two carers during the day and one senior and one carer at night. There had been some occasions on which the then acting manager had worked, during the day with only one other carer. On the occasion of the random inspection the home was fully staffed, and the previous two weeks roters showed that this had been the case on all but one occasion. The consultant currently holding the acting manager post was able to subsequently advise that a senior had covered the shift, when the planned worker had been sick. A significant number of shifts had been covered by agency seniors. Following the change in management and ownership a number of staff had left. The deputy manager had also been off work for a period; at the time of the inspection they had returned and staff spoken with advised that they were reassured by this. Records indicated that the agency seniors had received induction from a member of the management team, and that the organisation had received assurances that they had appropriate training and experience to cover the senior duties. There were not, however, any details of the content of the induction they had received available in the home. A person had been admitted into the home in January 2009, and there was no evidence on their file of a pre admission assessment having been undertaken. The previous acting manager had advised us that this had been conducted, when the person visited the home prior to admission. Since admission there had been a number of incidents involving this person. The current acting manager had put an additional member of staff on duty at night when these incidents indicated a need. They advised that they were uncertain as to whether this was the most appropriate home for the person. The resident was thought not to have dementia, but they had experienced mood swings that affected their behavior. The acting manager had arranged for a consultation with the community mental health team (CMHT). Two CMHT workers attended the home to see the person on the day of the random inspection. The acting manager had also liaised with the family and the social worker for an early review. The home caters for up to five people with a diagnosis of dementia.The acting manager confirmed the record provided that staff had not received training in dementia, person centered care or challenging behavior. The acting manager had spoken with staff about how to approach the resident. One of the complainants had Care Homes for Older People Page 4 of 12 advised us that they had not known that they provide care for people with dementia; the registration certificate stating this was clearly displayed. An application had been made for five places for training in dementia care at a local college by the acting manager first appointed, and the current acting manager was planning to further this. The home had not yet met the single requirement made at the key inspection, that comprehensive care plans must be compiled with each individual resident detailing the actions the staff team must take to meet all of their personal, health and social care needs. It was due to be completed by 30th January 2009. The resident who had been the focus of concern in the home was diabetic, but there was no part of care plan on diet. A nutrition assessment was undertaken the day after their admission, but it included nothing about diabetes. The plan showed that staff had been very concerned when the resident had wanted to help themselves to a piece of cake; this is understandable given they had no written guidance in how to respond. A record of a night time accident the resident had indicated that a fall may have occurred because staff could not respond immediately to the residents call for assistance. In addition to an additional carer being put on duty immediately after this, the risk assessment identified the need for an alarm to alert staff if the resident rose from bed at night. Whist appropriate adjustments had been made to the environment, and to staffing, this did not provide for the need in the longer term, and was reactive rather than proactive. When staffing returned to two on duty at night, they could not respond immediately at all times, even if alerted to the need, and the resident had an upstairs room so risk of the resident falling on the stairs had not been fully eliminated. On the 10th February 2009 we looked at current medication charts and some peoples care notes, and considered staff training and competence in medication. We found that the home has been working to monitor and improve the homes medication practices. Care plans were in place for some peoples medication but for one person prescribed diazepam for administration at the discretion of staff there was as yet no written guidance available. The home is also planning medication reviews for all people receiving medicines. Where there had been changes to prescribed medicines these were clearly documented on medication charts. Risk assessments had recently been recorded for two people self-administering medicines at the home. For one person, however, the risk assessment did not establish if the person had a safe technique when handling and administering their inhaler. Overall systems in place for the administration and recording of medicines were satisfactory, however, we did note that some hand-written medication charts were being used unsafely by starting records towards the end of the charts and then continuing chronologically but at their start. This could lead to confusion and error. In addition, the charts would benefit from highlighting medicines that are not supplied in and administered from monitored dosage system (MDS) containers. This is to ensure these medicines are not missed by staff when medicines are being selected for administration. We found one container of paracetamol tablets for a person where there was no medication chart entry and we were unable to establish if this medicine was being administered or if it had been discontinued. We also noted containers of eye preparations that had not been dated on opening and two with an expiry time of 28 days that had been dated as opened 31st December 2008 and were in use beyond their expiry time. We found there to be some recent gaps in records for the administration of medicines where we could not determine from records if these medicines had been administered as prescribed. These were checked against MDS containers and medicines were found to have been Care Homes for Older People Page 5 of 12 removed as if given. Some omissions related to medicines prescribed for external use. We conducted audits on 12 medicines to establish if they could be accounted for and discussed with a senior manager and the acting manager three of these where we identified discrepancies. One related to a medicine in sachet form where there was a deficit of 2 sachets on the current medication record. The senior manager advised that they had identified at the start of the 28-day period that there were three sachets less than needed for the new period. Another related to a deficit discrepancy of two painkilling tablets. The acting manager investigated this and found that for two doses the record should have indicated that two tablets were administered and not one as implied from the records. There was a further discrepancy of paracetamol tablets. We looked at recent Regulation 37 reports and saw two recent medicine administration errors which we discussed. These were said to have arisen from agency staff employed at the home. Helen Hill showed a recent audit of medication that she had conducted. We discussed the frequency of the audit needed to until there are no longer errors arising. The homes complaints book did not contain a reference to a complaint which was received in December 2008 regarding the previous management, nor did it contain any reference to concerns and complaints raided by staff with management. We had, however received a copy of a reply sent by a senior manager regarding the complaint sent to the home in December 2008, and we are aware that medication audits by senior management had commenced in the home. This indicates that senor management have responded to concerns and complaints received, but does not demon state this has been done comprehensively. We found that the change in ownership followed by a change in management was a significant event for the staff group who had enjoyed a ling period without change. Some staff were unhappy about the changes in the home and what they saw as a lack of response to the shortcomings of the acting manager initially appointed to look after the home. We found that senior management had taken action to respond to problems identified, but that staff had not been confident in this. Some staff thought that communication could be improved, and that they had not been kept fully informed about the steps senior management were taking, other than at one staff meeting. The home, however, generally had an open culture, the visitors book showed that large numbers of relatives regularly visit the home. What the care home does well: What they could do better: A full written pre admission assessment must be available for residents routinely admitted, to ensure that the home is confident it can meet residents needs prior to admission. Care plans must be fully completed and contain detailed comprehensive Care Homes for Older People Page 6 of 12 risk assessments within a short period of admission and must include all necessary elements. Sufficient staff must be on duty at all times to meet residents needs, and an accurate record of staffing provided must be kept. Medication audits undertaken by senior management are continuing and practices are improving; arrangements must be made to ensure people living at the home are administered their medication safely and as directed by the prescriber at all times, and eye drops should be dated when opened to ensure that they are not used past their expiry date. 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 12 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered person must 30/01/2009 prepare a written plan detailing how the individual residents needs are to be met in respect of their health and welfare. A comprehensive care plan must be compiled with each individual resident detailing the actions the staff team must take to meet all of their personal, health and social care needs. Care Homes for Older People Page 8 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 1 7 13 A risk assessment must be 16/03/2009 undertaken to assess the homes ability to manage the care and protect the safety of a resident who had fallen at all times of the day and night , and appropriate remedial action taken. This is to ensure that the homes ability to meet their needs is viewed in the light of other demands on staff. 2 7 15 The registered person must 16/03/2009 prepare a written plan detailing how the individual residents needs are to be met in respect of their health and welfare. A comprehensive care plan must be compiled with each individual resident detailing the actions the staff team must take to meet all of their personal, health and social care needs. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Medicines prescribed for ophthalmic administration must be safely handled in a way that ensures that they 17/03/2009 Care Homes for Older People Page 9 of 12 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 are not used following their expiry times. This is to prevent unnecessary infection occurring. 2 9 13 Arrangements must be made 17/03/2009 to ensure people living at the home are administered their medication safely and as directed by the prescriber at all times. This is to safeguard residents health. 3 30 18 Training in dementia and person centered care must be delivered at an appropriate level to all staff. This is to equip staff to meet the needs of residents that the home cares for. 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 30/06/2009 1 9 It is recommended that risk assessments undertaken when people living at the home handle their own inhaled medicines include an assessment of their ability to safely handle the inhaler devices and that effective monitoring is in place. It is recommended that arrangements are made to ensure medication charts are safely used at all times by starting new entries when their period of use is exceeded and by highlighting medicine entries for medicines not supplied in MDS containers 2 9 Care Homes for Older People Page 10 of 12 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 3 9 It is recommended that the competence of care staff authorised to handle and administer medicines at the home is regularly assessed and recorded. Staff who have not undertaken recent training should have this provided. A record of all complaints should must be maintained in the home, to ensure that all are aware of complaints under investigation and to demonstrate that the policy has been properly applied. 4 16 Care Homes for Older People Page 11 of 12 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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