This is the latest available inspection report for this service, carried out on 14th October 2008.
CSCI found this care home to be providing an Good service.
The inspector found no outstanding requirements from the previous inspection report,
but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.
Inspecting for better lives Random inspection report
Care homes for older people
Name: Address: Harker Grange Nursing Home Harker Carlisle Cumbria CA6 4HY 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 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: Angela Branch Date: 1 4 1 0 2 0 0 8 Information about the care home
Name of care home: Address: Harker Grange Nursing Home Harker Carlisle Cumbria CA6 4HY 01228523753 01228540344 kmacfin@aol.com 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) : Mrs Wendy McNaughton care home 26 Number of places (if applicable): Under 65 Over 65 0 26 dementia old age, not falling within any other category Conditions of registration: 26 0 The registered person may provide the following category of service only: Care home with nursing - Code N 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 The maximum number of service users who can be accommodated is: 26 Date of last inspection Brief description of the care home Harker Grange is an adapted Victorian House set in extensive grounds close to the M6 and Carlisle. Nursing care is provided for up to 26 service users within the category of Older Persons. The home has a large and a small lounge for residents communal use. Bedrooms may be single or the option to share may be given, subject to availability. There was access to the first floor via stairs, a passenger lift or a chair lift. Movement and access around the home is difficult in places due to the Victorian nature of the Care Homes for Older People
Page 2 of 8 Brief description of the care home building. The Committee of Friends continues to support the home and holds regular fund raising activities as well as volunteering to escort residents when going on trips. The weekly fees at the time of this inspection ranged from £385.00 to £542.00 plus any registered nursing care contribution entitlement from the primary care trust. Information for prospective residents and their families could be gained from the home, in the form of a service users handbook. Care Homes for Older People Page 3 of 8 What we found:
The home was selected for a random check of the way that medication was handled. The pharmacist inspector assessed this through inspection of relevant documents, storage and meeting with the owner and manager Wendy McNaughton. The inspection took five and a half hours. Feedback was given at the end of the inspection to the manager. Overall we found that medicines were adequately managed but there is still room for improvement to ensure that peoples health and wellbeing are fully protected. We found records for receipt, administration and disposal of medicines that were well maintained except on rare occasions. This means that with these rare exceptions it was clear the medication people had received. The manager was well informed of peoples medication and was observant of any medication changes. A sample of medicines were counted and compared with records. The majority of medicines were in order and could be accounted for. This also showed that people received medication as prescribed to provide safe and effective treatment. However on rare occasions discrepencies were found showing that in these cases the dosage received by people was not as prescribed. For example, in one case a five day course of steroids was administered for three and a half days only. The medication was commenced towards the end of the month and the information was not transferred to a new administration record at the start of the next month so that it was missed and the course was not completed. This means that the person was at risk from ineffective treatment. In another case an antibiotic that was prescribed three times a day was administered four times a day on two days. We noted some people who received paracetamol for minor pain who were not prescribed any painkillers. We were told that in these cases staff gave them their own tablets. It is recommended that the home introduces a policy for the administration of nonprescribed medication and a supply for the purpose so that minor conditions can be treated promptly and appropriately. We looked at a sample of care plans for people taking complicated and when required medication and for those who self medicated. These care plans were mostly inadequate and did not provide enough instruction for staff to follow to ensure that people received safe and effective treatment in a consistent manner. For example, a care plan for a when required sedative did not give enough information for staff to follow to make sure it was administered only when needed to prevent inappropriate use that could affect the persons health. Daily records however were also checked and each time the sedative was administered a record was made that justified its use. Care plans were checked for people who received medication through a tube into the stomach. In these cases capsules were emptied and tablets crushed. We also observed the preparation of medication that involved mixing different medicines. The preparation of medication in this way was not supported by care plans and there was no evidence to show that these techniques had been checked for safety and effectiveness. The home assumed responsibility for the storage and administration of most medicines on behalf of the people who lived there. However on occasions people were able to Care Homes for Older People Page 4 of 8 look after and take their own medicines if they wanted and this helped them remain independent. The care plan for one person who took their own when required medication was checked but did not contain any evidence that risks had been assessed or managed properly to keep them safe. The person who was spoken to was very glad to be able to look after their own medication as this meant that they could take it promptly when they needed it so that they could get immediate relief of symptoms. The home did not have any medicines liable to misuse, called Controlled Drugs, at the time of the inspection. We looked at the bound register for Controlled Drugs and found that this was incomplete when medicines were disposed of. Although records were kept of disposal in a separate book the register was not kept up to date with this information. Storage of medication was good so that people received good quality medicines. However we saw some medication that was no longer prescribed and this should be disposed of to reduce the risk of it being administered by mistake. There were no regular audits of medication performed and it is recommended that these be done on a regular basis to ensure monitoring and improvment of the quality of medicines handling. What the care home does well: What they could do better: 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 5 of 8 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 6 of 8 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, Care Homes 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 All medication must be and 24/11/2008 administered as prescribed and medication records must be accurately transferred from month to month so that people receive safe and effective treatment. 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 1 9 Care plans relating to medicines such as complicated or when required medicines and for people who self-medicate should contain clear detail of how they are managed to ensure people receive safe and consistent treatment. The Controlled drugs register should be up to date for disposed medication. It is recommended that a homely remedy policy be introduced to enable prompt treatment of minor ailments It is recommended that medicines that are no longer required are disposed of to prevent administration by mistake. Regular audits of medication should be done to monitor the management of medicines and to keep people safe. 2 3 4 9 9 9 5 9 Care Homes for Older People Page 7 of 8 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: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 8 of 8 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
