Archived: Charlotte Rose House

The provider sent us an action plan to explain how they were going to address the concerns. We re-visited the service on 27 October 2014 to check if the provider had made any of the required improvements to the issues we had previously highlighted.

The following summary is based on a review of progress on the action plans sent to us in response to our last inspection, our observations during our visit and our discussions with people who used the service and the staff who supported them. We also looked at people's care records, management records and other documentation.

Two adult social care inspectors and a pharmacy inspector carried out this inspection. At the time of our inspection the home was without a registered manager. We spoke with a senior staff member about this and they told us they had submitted an application to become the registered manager for the service. Our records confirmed this.

Below is a summary which describes what we found. If you want to see the evidence supporting the summary please read the full report.

Is the service safe?

During this inspection our pharmacist inspector looked at how information in medication administration records and care notes for people living in the service supported the safe handling of their medicines. We found that medicine administration records did not accurately reflect what medicines people had received. For example not all medicines could be accounted for numerically and so we could not be assured people's medicines were being administered as intended by their prescribers.

People were at risk of infection because there was a lack of arrangements and guidance in place to prevent cross infection.

Is the service effective?

Risk assessments were in place for some areas of care such as skin care and moving and handling however we found other areas such as diet and nutrition had not been risk assessed

Is the service caring?

We saw that people's choices and preferences about how they wanted to be cared for were not respected or supported by staff.

Is the service responsive?

We saw where needed there people had access to external healthcare professionals . Records of visits were maintained to show

any actions agreed. However, we found although the service liaised with other agencies and services to make sure people received care in a joined up way, where changes to care needs had been identified, staff had not acted promptly to in order to respond to the changes needed.

Is the service well led?

There was no registered manager in post at the time of our inspection.

The provider had some quality assurance processes in place. Audits did not detail how and when changes would be made to ensure continuous improvement.

One person told us, 'I like the food here it is very good and the staff help me with my care. I would love a shower but I never get the help to get one.'

Previously we found no evidence of regular audits and quality reviews being undertaken. At this inspection we found questionnaires had been issued to people who lived at the home and their relatives but there was no system for ongoing quality monitoring and improvement.

During this inspection our pharmacist inspector looked at how information in medication administration records and care notes for people living in the service supported the safe handling of their medicines. We found that not all medicines could be accounted for numerically and so we could not be assured people's medicines were being administered as intended by their prescribers. We found there were failings and inaccuracies in records which could have led to people not receiving their medicines as intended by prescribers or led to them receiving incorrect medicines placing them at risk.

We re-visited the service on 29 July 2014 to check if the provider had made any of the required improvements to the issues we had previously highlighted.

The following summary is based on a review of the action plans sent to us in response to our last two inspections, our observations during our visit, our discussions with people who used the service and the staff who supported them. We also looked at people's care records, management records and other documentation.

Two adult social care inspectors and a pharmacy inspector carried out this inspection.

At the time of our inspection the home was without a registered manager. We spoke with a senior staff member about this and they told us they were in the process of making an application to become the registered manager for the service.

The focus of our inspection was to answer five key questions we always ask; is the service safe, effective, caring, responsive and well-led?

Below is a summary which describes what we found. If you want to see the evidence supporting the summary please read the full report.

Is the service safe?

During this inspection our pharmacist inspector looked at how information in medication administration records and care notes for people living in the service supported the safe handling of their medicines.

We found that not all medicines could be accounted for numerically and so we could not be assured people's medicines were being administered as intended by their prescribers. We found there were failings and inaccuracies in records which could have led to people not receiving their medicines as most recently intended by prescribers.

People were at risk of infection because there was a lack of arrangements in place to prevent cross infection.

Is the service effective?

Staff assessed potential risks together with people but did not take the right action to ensure risks to people's health and safety could be reduced.

Is the service caring?

We saw that people's choices and preferences about how they wanted to be cared for were not respected or supported by staff.

Is the service responsive?

We saw where needed there had been referrals to external health professionals such as doctors and community nurses so people could get support with any specific treatment needed by external health care professionals. Records of visits were maintained to show any actions agreed.

However, we found although the service liaised with other agencies and services to make sure people received care in a joined up way, where changes to care needs had been identified, staff had not acted promptly to in order to respond to the changes needed.

Is the service well led?

There was no registered manager in post at the time of our inspection.

The provider had a quality assurance system and process in place. Records indicated any shortfalls identified would be addressed in the right way. However, there was not enough information available to confirm the systems and processes would enable the provider to sustain the improvements they had made.

Whilst care plans had been updated in a new format in May 2013 and gone some way to identify people's current needs they had not been reviewed since this date. This meant it was not clear if care was still relevant or not.

During this inspection our pharmacist inspector looked at information in medication administration records and care notes. We found that not all medicines could be accounted for numerically. We could not be assured people's medicines were being

administered as intended by their prescribers.

Previously we found no evidence of regular audits being undertaken. At this inspection we found questionnaires had been issued to people living at the home and their relatives but there was no system for ongoing quality monitoring and improvement.

At our last inspection we identified that some carpets were not fitted correctly. We observed this had not been rectified and still posed a risk of falls to people.

We looked at the statement of purpose and found this had not been updated and did not reflect the current service provision.

We reviewed procedures for infection control and found these did not meet national guidance.

Whilst care plans had been updated in a new, clear format in May 2013 and gone some way to identify people's current needs they had not been reviewed. This meant it was not clear if care was still relevant or not.

During this inspection our pharmacist inspector looked at information in medication administration records and care notes. We found that not all medicines could be accounted for numerically and so we could not be assured people's medicines were being administered as intended by their prescribers.

Previously we found no evidence of regular audits being undertaken. At this inspection we found a questionnaire had been issued to people living at the home and their relatives in the month prior to our inspection. Comments included, 'I think the care is good here' and 'The staff look after me well.'

At our last inspection we identified concerns that several carpets were not fitted correctly at the entrance to some of the bedrooms. At this inspection we observed this had not been rectified and still posed a risk of falls to people.

One person told us she stayed in her bedroom most of the time through her own choice. She said she did not have to wait very long for members of staff to attend to her and that staff, 'pop in and check you'. She also told us, 'Staff are very good at night.'

We looked at the staff rotas for May, June and July.

We found there were always two members of care staff on duty at any one time. In addition there was a cook and housekeeper. Members of staff we spoke with told us there was often more staff on duty since the registered manager lived on the premises and the deputy manager would always be there past their regular hours.

During this visit we looked at a range of records within the home such as care plans, staff files and infection control documentation. We also undertook a tour of the home.

A selection of staff and people living in the home were spoken with. People who lived in the home reported that they were happy living there.

We saw the provider had made improvements in all of the areas we highlighted in the warning notices. They demonstrated they were compliant with Regulation 23. However we judged that there were still some aspects of Regulations 9 and 12 with which the provider was not fully compliant.

With reference to the improvements made by the provider we decided to issue additional compliance actions for Regulations 9 and 12 to ensure full compliance with the Regulations was achieved.

During our previous visit to the home on 09 January 2013 we also judged the provider was not compliant with Regulations 10, 13 and 20. We said the provider needed to make improvements in all of these areas. We did not look at the provider's progress with these improvements during this visit but we will do so at future visits.

At our last inspection in May 2012 we issued five compliance actions. We were concerned staff were not receiving appropriate support to enable them to carry out their role and people were not receiving care and support that met their needs as care plans were not updated. We were also concerned people who used the service were not protected against the risk of abuse.

We also found the provider did not have an effective system in place to regularly assess and monitor the quality of the service.

During this visit we spoke with the registered manager and a staff member. We checked a range of documentation. We found the provider was not compliant with four of the outcomes previously inspected.

We saw improvements had been made in one area and people were now protected against the risk of abuse.

During this inspection our pharmacist inspector looked at how medication administration records and care notes for people supported the safe handling of their medicines. We found that not all medicines could be accounted for numerically and so we could not be assured people's medicines were administered as intended. Records for the administration of medicines were sometimes inaccurate.

We also looked at the cleanliness of the home and the systems which protect people from the risk of infections. We found there were not any systems and processes in place to protect people from the risk of infection.