We carried out an unannounced comprehensive inspection of this service on 3 and 6 October 2014. A breach of the legal requirements was found and we issued a compliance action for a breach in relation to the safe management of medicines. The provider sent us an action plan saying they would have made the required improvements by 2 April 2015.
As a result we undertook an unannounced focused inspection on 12 May 2015 to follow up on whether action had been taken to meet the legal requirements. You can read a summary of our findings from both of these inspections below.
Comprehensive inspection 3 and 6 October 2014
This inspection took place on 3 and 6 October 2014 and was unannounced.
The Firs Care home provides accommodation for up to 22 older people who are physically frail or may be living with dementia. At the time of our inspection there were 20 people living at the home. The home provides long term care, respite care and day care. It does not provide nursing care. Most people needed assistance with managing daily routines such as personal care. A small number of people routinely needed support with eating or support with moving and positioning. The home is located in a residential area of Locks Heath. There is a small car park located at the front and there are accessible gardens. The accommodation is arranged over two floors and there is a lift available for accessing the first floor. There are 16 single rooms and three shared rooms. All of the rooms have en-suite facilities.
The Firs has a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
There were systems and processes in place for managing people’s medicines, for example staff had received appropriate training. However the systems were not effective in ensuring that medicines were administered, stored and disposed of correctly.
Risks to people’s safety were identified and managed effectively. However some risk assessments contained conflicting or out of date information. Some risk assessments needed to be more detailed about the actions staff needed to take to ensure that people were protected from harm.
There were some quality assurance systems in place to monitor and review the quality of the home. However these needed to be more robust to ensure that they were an effective tool in identifying any shortfalls or areas for improvement.
There were sufficient numbers of suitably qualified staff. Some staff told us that at times they felt that care could be enhanced further by having some additional staff on duty. Three people told us that at times, there could be a slight delay in staff being able to assist them as they were busy supporting other people. New staff had been recruited to ensure that staffing levels remained responsive to the needs of people using the service.
Safe recruitment practices were followed which made sure that only suitable staff were employed to care for people in the home.
People told us that they felt safe and we saw that there were systems and processes in place to protect them from harm. Staff were trained in how to recognise and respond to abuse and understood their responsibility to report any concerns to their management team. Staff were aware of the importance of disclosing concerns about poor practice or abuse and were informed about the organisations whistleblowing policy
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager understood when an application should be made and how to submit one and was aware of a recent Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty.
Staff understood how the Mental Capacity Act (MCA) 2005 was applied. Mental capacity assessments had been undertaken which were decision specific. Where people were deemed to lack capacity, appropriate consultation had been undertaken with relevant people such as GP’s and relatives to ensure that decisions were being made in the person’s best interests.
People told us that their staff members provided them with the support they needed. Staff told us that the registered manager supported them to develop their skills and knowledge by providing a programme of training which helped them to carry out their roles and responsibilities effectively. Staff received regular supervision which considered their development and training needs.
Staff worked effectively with healthcare professionals, for example, links had been developed with the continence service to help ensure that staff were following best practice guidance. People were supported to see healthcare professionals such as GP’s, chiropodists, community nurses and opticians.
People were positive about their care and the support they received from staff. Interactions between staff and people which were kind and respectful. Staff were aware of how they should respect people’s dignity and privacy when providing care.
Staff were aware of what people needed help with and what they were able to do for themselves. They supported and encouraged people to remain as independent as possible.
People’s preferences, likes and dislikes had been recorded and we saw that support was provided in accordance with people’s wishes. People were involved, where able, in decisions about their care which helped them to retain choice and control over how their care and support was delivered.
People knew how to make a complaint and information about the complaints procedure was included in the service user guide, including how to raise concerns with the Care Quality Commission. People were confident that any complaints would be taken seriously and action taken by the registered manager.
There was a programme of activities in place which people seemed to enjoy, although some health and social care professionals told us that they felt the activities offered could be more diverse.
The registered manager who actively sought feedback from people and staff in order that improvements could be made to the home. The registered manager told us that the provider visited the home frequently and was supportive of the management team which included provided the resources needed to effectively meet people’s needs.
We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.
Focused inspection 12 May 2015
At our inspection in October 2014, we identified that the service was failing to ensure that medicines were stored appropriately, that an accurate record of the medicines administered was maintained and that medicines were disposed of safely. We issued a compliance action in relation to Regulation 13 relating to the management of medicines. We were sent an action plan which described the improvements the provider planned to make in order to comply with the above Regulation. This plan stated that the provider would have made the required improvements by 2 April 2015.
On the 12 May 2015 we conducted a focused inspection. This inspection found that the required improvements had not been made. The provider had failed to remedy the breach of regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. In addition we found a number of new concerns in relation to how medicines were managed within the service.
We reviewed a number of medication administration records (MAR’s) and found that many of these contained gaps in recording with no reason noted as to why. Information about allergies was incomplete or potentially incorrect. For example, one person was prescribed an Epipen. There were no protocols in place to guide staff on the circumstances in which they might need to use ‘as required’ or ‘PRN’ medicines.
Medicine audits were not being effectively used to drive improvements and to ensure that medicines were being managed safely. None of the concerns we found during the inspection had been identified by the provider. Therefore we could not be assured that the medicines administration systems were monitored effectively to ensure that people received their medicines as prescribed.
This was a breach of Regulation 12 (2)(g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment. You can see what action we told the provider to take at the back of the full version of the report.
The service had made improvements to way in which medicines were stored. The service now had a dedicated medicines fridge and the temperature of this was being monitored on a daily basis. All medicines viewed were within their use by date which meant that they were safe to use.