STANDARD TO BE MET
A SERVICE USER PLAN OF CARE GENERATED FROM A COMPREHENSIVE ASSESSMENT IS DRAWN UP WITH EACH RESIDENT AND PROVIDES THE BASIS FOR THE CARE TO BE DELIVERED.

INSPECTORS CONCLUSIONS
THE ORGANISATIONS CARE PLAN DOCUMENTATION IN THE MAIN IDENTIFIES THOSE AREAS REQUIRED BY REGULATIONS, FOUR CARE PLANS WERE VIEWED AND CONTAINED SOME BUT NOT ALL THE INFORMATION, IN ONE PLAN THE RESIDENT HAD A PRESSURE RISK ASSESSMENT, WHICH IDENTIFIED NEEDS IN THIS AREA, HOWEVER THERE WAS NO CARE PLAN ENTRY IDENTIFYING WHAT ACTION THE HOME MUST TAKE, NEITHER DID THE CARE PLAN REFLECT CONTINENCE, NUTRITIONAL NEEDS FOR DEMENTIA. ANOTHER CARE PLAN HAD IDENTIFIED PRESSURE CARE NEEDS BUT NO INFORMATION REGARDING NUTRITIONAL OR HEALTH CARE NEEDS. IN THE CASE OF ANOTHER RESIDENT THERE WERE NO CARE PLAN ENTRIES IN RESPECT OF DIABETIC DIETARY NEEDS, THE HOME MUST INSURE THAT THE INDIVIDUAL NEEDS OF RESIDENTS ARE DETAILED FULLY TO REFLECT THE CARE REQUIRED. THE INSPECTOR NOTED THAT MANY OF THE RECORDS WERE EITHER NOT FULLY COMPLETED, UP TO DATE OR HAD A NUMBER OF GAPS IN THE INFORMATION, TWO OF THE CARE PLANS WERE FOR RESIDENTS WHO HAD BEEN IN THE HOME FOR A YEAR, ONE SHOWED A REVIEW IN JAN 04 WHILST THE OTHER SHOWED NO REVIEW SINCE ADMISSION. THERE WAS EVIDENCE THEY HAD APPROPRIATE EQUIPMENT USED WHEN REQUIRED. DISCUSSIONS WITH SERVICE USERS (3) AND RELATIVES (3) SHOWED THAT REGULAR HEALTH CHECKS ARE BEING UNDERTAKEN, THE INSPECTOR WAS NOT ABLE TO CONFIRM SUCH TREATMENT, IN MANY CASES FROM RECORDS VIEWED. THIS IS VITAL ESPECIALLY WHERE DIABETICS ECT REQUIRE REGULAR VISION AND FOOT-CARE. THE DIETARY NEEDS WERE NOT HOWEVER IDENTIFIED IN ONE CARE PLAN VIEWED, THIS IS ALSO TRUE OF RESIDENTS WITH EPILEPSY, WHERE THE HOME HAD NOT DETAILED ANY CARE PLAN TO MAINTAIN THEIR HEALTH.

MY CONCLUSIONS
PAGE 24 STATES THAT I SERVICE USER HAD A PRESSURE SORE AND THIS INFORMATION HAS BEEN SOURCED FROM CARE NOTES, ONLY FIVE CARE PLANS INSPECTED FROM A TOTAL OF 65, YET IT IS STATED BY THE INSPECTOR THAT THIS INFORMATION HAS BEEN OBTAINED FROM A PRE INSPECTION QUESTIONNAIRE. IT IS STATED THAT THE RESIDENT WITH THE BEDSORE HAS THE APPROPRIATE EQUIPMENT, BEDSORES ARE THE RESULT OF NEGLECT AND TOTALLY PREVENTABLE BY MONITORING AND ENSURING THAT EQUIPMENT IS IN PLACE TO PREVENT BEDSORES DEVELOPING, IF THE CARE PLANS INSPECTED SHOWED NO PRESSURE RISK ACTION PLANS, THEN IT IS CONSISTENT WITH A LACK OF CARE IN THE FIRST PLACE, THERE IS NO POINT WHAT SO EVER IN PROVIDING SUCH EQUIPMENT AFTER A BED SORE HAS DEVELOPED OTHER THEN TO STOP FURTHER TISSUE LOSS.
BEDSORES ARE POTENTIALLY FATAL DUE TO INFECTION RISKS, AND IF YOU SAW AN AREA OF GANGRENOUS DEAD FLESH THAT CAN PENETRATE TO THE BONE, YOU MAYBE MORE LIKELY TO CONSIDER PREVENTION RATHER THAN CURE. WITH REGARD TO THE FALLS RISK ASSESSMENT THAT HAS BEEN STATED AS CARRIED OUT, THE NUMBER OF INCIDENTS RECORDED WHERE THE SERVICE USER HAS BEEN ADMITTED TO ACCIDENT AND EMERGENCY AS A RESULT IS LISTED AS 70, HOWEVER AFTER BUPA WERE QUESTIONED BY THE PRESS ON THIS EXTRAORDINARILY HIGH NUMBER, THE COMMISSION FOR SOCIAL CARE INSPECTION CHANGED THE NUMBER TO 26 CITING A TYPING ERROR, FOR THE ORIGINAL NUMBER!. AN INSPECTION OF THIS HOME WAS CARRIED OUT IN DECEMBER 03 UNDER REGULATION 37, " THE C.S.C.I MUST INSPECT CARE HOMES AT LEAST TWICE A YEAR AND MORE FREQUENT INSPECTIONS ARE CARRIED OUT WHERE THERE ARE CONCERNS ABOUT THE WELFARE OF RESIDENTS " ( SOURCE, STEPHEN LADYMAN, DEPARTMENT OF HEALTH, LETTER DATED 15/JUNE/04 ) THE DECEMBER REPORT STATES " THE HOME HAS HAD A NUMBER OF INCIDENTS AND ACCIDENTS OVER THE LAST FEW MONTHS. MANY HAVE OCCURRED AT NIGHT AND HAVE NOT BEEN WITNESSED, THE EARLY MORNING IS A VULNERABLE PART OF THE DAY AND COULD BE A CONTRIBUTORY FACTOR FOR THE HIGH NUMBER OF ACCIDENTS"

I WOULD THEREFORE SUGGEST THE FALL RISK ASSESSMENT BEING USED IS NOT EFFICIENT AND IN LIGHT OF ALL THE ABOVE, GRADE THIS STANDARD AS 1 MAJOR SHORTFALLS. STANDARD AWARDED 2- MINOR SHORTFALLS.

STANDARD TO BE MET
THE HOME ENSURES THAT THERE IS A POLICY AND STAFF ADHERE TO THE PROCEDURES FOR THE RECEIPT, RECORDING, STORAGE, HANDLING ADMINISTRATION AND DISPOSAL OF MEDICINES.

INSPECTORS CONCLUSIONS
THE HOME HAD GOOD RECORDS OF RECEIPT OF MEDICINES, ADMINISTRATION FOR REGULAR MEDICINES WERE GOOD, BUT NOT ALWAYS CLEAR FOR WHEN REQURIED (PRN) MEDICATIONS.

MY CONCLUSIONS
AS I REQUESTED A FULL COPY OF THIS REPORT INCLUDING THE SEVEN PAGES OF HOW THE PHARMACIST EVIDENCED HER FINDINGS, THESE SEVEN PAGES HAVE NOT BEEN FORTHCOMING, SO I HAVE USED EXTRACTS FROM A 24 PAGE DOCUMENT WHICH IS AVAILABLE ON REQUEST, TO SHOW THE OVERALL CONCERNS RAISED ON MEDICATION PRACTICES WITHIN THIS HOME.

RECOMMENDATIONS FROM SOCIAL SERVICES INQUIRY REPORT MADE WITH REGARD TO MEDICATION PRACTICES IN ISARD HOUSE, AS A RESULT OF ALLEGATIONS OF ABUSE AND DRUG MIS-USE BEING UPHELD, IN 1999.

8.5.1 THE MANAGEMENT MUST NOMINATE NAMED STAFF MEMBERS A MINIMUM OF TWO, WHO MUST BE RESPONSIBLE FOR CHECKING MEDICATION IN AND OUT OF THE HOME.

8.5.2 NEGOTIATIONS MUST NOT TAKE PLACE BETWEEN G.PS AND THE HOME REGARDING THE PRESCRIBING OF MEDICATION OVER THE PHONE, A PRESCRIPTION SHOULD BE WRITTEN AND OBTAINED BY STAFF FROM THE SURGERY.

8.5.3 MEDICATION MUST BE GIVEN ON TIME.

8.5.4 ONLY DESIGNATED CARERS SHOULD ADMINISTER MEDICATION TO RESIDENTS AND ALL DESIGNATED PERSONS MUST RECEIVE APPROPRIATE TRAINING

8.5.5 EVERY NIGHT BEFORE GOING OF DUTY THE ON CALL OFFICER SHOULD CHECK THAT ALL MEDICATION HAS BEEN GIVEN AND RECORDED. ANY GAPS IN RECORDING OR EXPLANATIONS WHY MEDICATION OMITTED SHOULD BE RECORDED.

8.71 THE HEAD OF CARE AT ISARD HOUSE MUST CARRY OUT A CARE AUDIT EVERY THREE MONTHS, CHECKING MEDICATION, CARE PLANS KARDEX REPORTING, TO MAKE SURE THE INDIVIDUAL NEEDS OF RESIDENTS ARE BEING KEPT AND RECORDED.

8.73 RISK ASSESSMENT SHOULD BE CARRIED OUT ON ALL RESIDENTS AND THE FINDINGS NOTED IN ALL CARE PLANS, THE ASSESSMENT SHOULD BE CARRIED OUT AND CARE PLANS UPDATED EVERY THREE MONTHS.

ISARD HOUSE DRUG AUDIT REPORT MAY 2002 WHICH RESULTED IN A STANDARD OF 4, COMMENDABLE AWARD.

" WHEN VARIABLE DOSES ( PRN ) WERE PRESCRIBED THE AMOUNT ACTUALLY GIVEN WAS NOT ALWAYS RECORDED, THE STRENGTH AND QUANTITY OF MEDICATION RETURNED TO PHARMACY WAS NOT RECORDED"

THE REPORT CONCLUDES THAT THE HOME SHOULD BE COMENDED FOR THE DRUG AUDIT CARRIED OUT WAS IN ORDER.

LETTER FROM E. CHUBB TO INSPECTION PHARMACIST DATED 6TH OF MARCH,

" HOW CAN YOU COMMEND A CARE HOME, WHEN IT IS SIMPLY NOT POSSIBLE TO CARRY OUT A DRUG AUDIT WITHOUT KNOWING WHAT DRUGS WERE CHECKED IN AND OUT OF THE HOME?"

LETTER FROM INSPECTION PHARMACIST TO E. CHUBB, DATED 2ND OF MAY.

" IN TERMS OF DOING A COMPLETE AUDIT TRAIL OF MEDICATION IN THE HOME, THIS WAS, AS YOU QUITE RIGHTLY SAY, IMPOSSIBLE BECAUSE THERE WERE INCOMPLETE RECORDS OF MEDICATION DISPOSED OF "

ISARD HOUSE INSPECTION REPORT APRIL 03, STANDARD 2 MINOR SHORTFALLS, RECOMMENDATIONS MADE,

" THE HOME MUST ENSURE A WRITTEN PLAN IS PREPARED, MONITORED AND REGULARLY UPDATED AS TO HOW THE SERVICE USERS HEALTH AND WELFARE ARE TO BE MET"

" LOCAL PROCEDURES FOR ORDERING, RECEIPT, STORAGE, ADMINISTRATION, DISPOSAL OF MEDICINES, SELF ADMINISTRATION, SUPPLY'S FOR DAY LEAVE, DRUG ERRORS, ADVERSE REACTIONS, CHANGES TO THE MONITORED DOSAGE SYSTEM ARE DEVELOPED IN LINE WITH ROYAL PHARMACEUTICAL GUIDELINES"

" STAFF RECEIVE DOCUMENTED TRAINING ON THE HOMES POLICIES AND PROCEDURES ON MEDICINES, HANDLING AND RECORDS, STAFF ADHERENCE TO THESE POLICIES IS MONITORED"

THE HOME SHALL MAKE SUITABLE ARRANGEMENTS BY TRAINING STAFF TO PREVENT SERVICE USERS BEING PLACED AT RISK OF HARM OR ABUSE"

FIVE YEARS AFTER THE ORIGINAL RECOMMENDATIONS, THE INQUIRY REPORT FROM APRIL 2004, LIST THESE RECOMMENDATIONS AGAIN AND ALSO A FURTHER FORTY FIVE SHORTFALLS AND GIVES YET ANOTHER EXTENSION ON THE TIME PERIOD FOR THEM TO BE MET, I QUOTE FROM THE REPORT PAGE 38, WHICH STATES THE LEGAL ENFORCEMENT METHODS THAT WILL NOW BE USED TO ENSURE COMPLIANCE, " THE INSPECTOR RAISED THESE CONCERNS WITH THE BUPA OPERATIONS MANAGER AND HOME MANAGER AND THERE IS A SHARED UNDERSTANDING THAT THESE AREAS MUST BE DEALT WITH OVER THE NEXT YEAR"

OF THE 5 STANDARDS INSPECTED, 5 WERE PARTIALLY MET, MINOR SHORTFALLS ONLY.