Inspecting for better lives Random inspection report
Care homes for older people
Name: Address: Lakenham Residential Home Lakenham Hill Northam Bideford Devon EX39 1JJ 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: David Jones Date: 1 5 0 4 2 0 0 9 Information about the care home
Name of care home: Address: Lakenham Residential Home Lakenham Hill Northam Bideford Devon EX39 1JJ 01237473847 01237470790 cordelia.murphy@Hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Cordelia Wai-Yu Murphy,Mr Timothy Oliver Murphy,Mr Christopher Charles Hampton,Miss Siobhan Catr care home 28 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 28 old age, not falling within any other category Conditions of registration: Date of last inspection Brief description of the care home 0 Lakenham Residential Home is a care home registered for 28 beds, providing personal care for service users in the category of old age (OP). The building is a detached former residence of the Duchess of Manchester and is situated on a large corner plot in the Northam area of Bideford. The home is sited in extensive well-kept grounds and has glorious sea and coastal views. Accommodation is provided on four floors and the home is extremely spacious with several large communal, reception and meeting areas. The home also has a Chapel on the ground floor of the home. The majority of rooms are single and en-suite, although Care Homes for Older People
Page 2 of 14 Brief description of the care home two shared rooms are available if required. The home is accessible to all areas via a large, modern passenger lift. A copy of the previous CSCI inspection report was on the main notice board making it available to staff, residents, their relatives and any other visitors to the home. Fees charged range from 390.00 pounds to 525.00 pounds with additional charges being made for chiropody, hairdressing, newspapers and magazines and clothing. Care Homes for Older People Page 3 of 14 What we found:
We visited the home again to inspect arrangements and practices for dealing with medication to make sure that the Statutory Requirement Notice that was served on 23 February 2009 was met. We were therefore checking that there was a safe system in place to make sure of safe administration, safe recording and safe handling of medicines. We looked at some stocks and storage arrangements for medicines and various records about medication. We saw how staff administered some medicines to people living in the home. We spoke to two of the registered providers (one of whom is the registered manager) and a senior carer. We gave full feedback after the inspection to the registered providers about the medication issues we found. We judged that the issues about the handling of medicines for particular people included in the Statutory Requirement Notice had been sufficiently attended to. The registered manager showed us a new instruction sheet produced for staff to address some of these issues. The staff responsible for administering medication had signed to say they have read this. We explained to the registered providers that there were some further matters to address in order to provide improvement in the arrangements for medication in the home. There was also a medicine policy and procedures that had been reviewed in 2007. At the time of the inspection, except for one person who kept an inhaler, no people living in this home were assessed as able to self medicate and look after their medicines. People living in the home were therefore totally dependent on the staff for this part of their care. The registered manager explained that only three staff now administered medication as well as herself and the night staff. All had received some training through the pharmacy. The manager also explained that she shadows those staff giving out medication, then is in the vicinty when they start to administer medication on their own. We discussed the good practice of regularly assessing their competency in this important practice and keeping a record of this. The registered manager told us they do complete this through supervision and this was confirmed later by another member of staff. There were arrangements for keeping records about medication received and administered to each person in the home. Clear, complete and accurate records about medication are very important in a care home where there are a lot of different medicines in use and a number of different staff involved with medication. This is so that people are not at risk from mistakes, such as receiving their medicines incorrectly, and there is a full account of the medicines the home is responsible for on behalf of the people living here. Many of medicine records we looked at appeared to be in order so that there were clear records about the medicines people living in the home need and had taken. We did however have to point out to the registered manager that there were still a few examples of records that had not always been fully completed or that were not up to date. The allergy box on some medicine charts was not completed. We saw that records were in place for one person who takes a tablet where the dose is monitored by regular blood tests taken by the district nurse. The registered manager showed us the records kept for one person for creams applied to the skin. We discussed other possibly better ways of recording this information. Care Homes for Older People Page 4 of 14 Some medicines were prescribed to administer when required. It was clear that the registered manager and senior carer we spoke to understood about how these medicines were administered and that they were guided by each person about their needs but this was not written in the individual records. We discussed ways of recording this knowledge so that this is clear to all members of staff and that people in the home receive their medicines in a consistent way to meet their identified needs. We saw that for some of these medicines that were prescribed to administer every 6 to 8 hours when required the medicine charts were misleading as the times for administration were highlighted at 4 hour intervals. The records we looked at showed that the medicines had not in fact been given more frequently than the prescribed directions but the way the records were kept could risk staff administering at the wrong dose times. We pointed out a few examples of medicines that were not administered according to the directions printed on the label and medicine chart. The registered manager and staff explained why this was in some cases but there were two people where there was no clear reason why the last dose of eye drops due at 9.30pm each day were not signed as given. If people are asleep at this time then consideration must be given to revising times for medicines that fit in with each persons daily routine rather than missing doses that put people at risk because of insufficent treatment. On the day of the inspection one person had recently started a course of antibiotics. We were concerned that starting this was delayed partly because of the Easter break. When we looked into this it appears there were some communication problems between the surgery and the pharmacy as the doctor had not left the prescription in the home. This would have enabled staff to obtain the medicine within a very few hours from a more local pharmacy. Records we saw indicated the action the home had taken to resolve this. One person was having difficulty swallowing some tablets and we saw that the member of staff was careful to take time help this person with their medicines. We advised discussing this with the pharmacy and doctor as some of the medicines may be available in a form that is easier to swallow. The district nurse was now visiting each day to look after some aspects of treatment for a person with diabetes. The registered manager told us that in due course when this was stabilised the nurse may provide some training for staff to deal with some of this care. We emphasised that if this happens the recording of the training and delegation of this clinical responsibility is essential. We saw that medicines were stored safely and arrangements for keeping controlled medicines safely had been upgraded since the last inspection. The thermometer in the medicine fridge was not working and the fridge did not seem very cold perhaps as one of the vents on top was blocked. Some eye drops that should have been stored in the fridge were in fact on the medicine trolley. This was largely due to the fact that the pharmacy had labelled the drops incorrectly. This matter was taken up directly with the pharmacy. Eye drop containers had the date of opening noted so that they could be changed regularly and so avoid risks of contamination. This was not done for other medicines. We pointed out a container of capsules for example where the manufacturer states to use within six weeks of opening. Care Homes for Older People Page 5 of 14 What the care home does well: What they could do better:
There needs to be a better system in place to regularly check that there are always complete, accurate and up to date records about medicines administered to people living in the home and that any gaps in records or incomplete entries are quickly identified and sorted out. This includes always noting the actual dose given when a variable dose is prescribed (one or two tablets or 5 to 10ml for example). Written dose directions on medicine charts must be quite clear, for example which eye or ear the drops are to be instilled or where creams are applied. When handwritten entries are made on medicine charts these should be signed and dated by the person writing them with a signed check by a second trained member of staff that the information is correct. The registered manager must liase with the doctors to clarify and update some of the medicine dose directions on repeat prescriptions to make sure these are realistic, are up to date and accurately reflect the way the medicines are administered and the needs of individual people. Checking prescriptions in the home before they are sent to the pharmacy for dispensing would help with this. The registered manager must also liaise with the pharmacy to improve some information on the medicine administration records so that these accurately reflect the times when medicines are administered in the home and that medicines that are discontinued are no longer included on the records. The allergy box on all medicine charts needs completing with regular checking that the information is up to date even if this is noted as none known. This can indicate this important matter has been considered. The registered manager needs to consider if it is safe to highlight particular dose times for analgesic medicines that are prescribed to be used as required as this could lead staff to administer these at wrong intervals between doses. It may also lead staff to only offer this treatment at the highlighted times. The way analgesics should be used is that the person is able to choose to have this treament when they need it as long as this is in line with the doctors directions. For each medicine prescribed with a variable dose or with a direction to administer as required there needs to be specific written guidance for staff to describe what this means for each person and medicine. The medicine records for the person who is looking after an inhaler medicine need to indicate this and a written risk assessment carried out to address issues with self medication particularly as staff are administering some doses of the same medicine. Regular checks must be kept of the medicine fridge to make sure this is within the safe range of 2 to 8 degrees C. There needs to be a working thermometer in the fridge and the temperature recorded daily. We advise homes to write the date on any containers of medicines when they are first opened to use. This helps with good stock rotation in accordance with the Care Homes for Older People Page 6 of 14 manufacturers or good practice directions and with audit checks that the right amount of medicines are in stock. The supplying pharmacy should be able to provide advice about the recommended periods for using various medicines once the containers have been opened. The medicine policy and local procedures needed reviewing as some of the information was not up to date. Some of these issues could indicate that further training and competence assessment for dealing with medicines is needed for some staff. 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 14 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 3 14 A clear, written assessment 15/04/2009 identifying the needs of the person concerned must be completed before an offer of accommodation is made. From this assessment a clear, written care plan must be produced detailing the care the staff need to provide which is readily accessible by the staff. This will ensure that all staff are clear about what is required removing possible misunderstandings which may arise from verbal instructions. 2 7 15 A clear, written care plan 15/04/2009 must be produced for each person detailing the care the staff need to provide which is readily accessible by the staff. This will ensure that all staff are clear about what is required removing possible misunderstandingswhich may arise from verbal instructions. 3 30 18 New staff must have induction training that provides them with knowledge and skills about 15/04/2009 Care Homes for Older People Page 8 of 14 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 basic care principles, for example about feeding. This will ensure that staff follow best practice when caring for people. 4 36 18 Inexperienced staff must be supervised by appropriately qualified and experienced staff. To ensure that safe procedures are followed to that people receive the best care 5 38 37 The Commission must be 15/04/2009 notified without delay about the occurrence of; serious illness, serious injury or death of a person living in the home , an outbreak of any infectious disease, theft, burglary or accident or any event which adversely affects the well-being or safety of any service user; and any allegation of misconduct by the registered person or any person who works at the care home. This will demonstrate how incidents or events are being managed and enable the Commission to assess whether this effectively safeguards people living there. 6 38 13 Staff must have up to date training particularly with regard to manual handling. 15/04/2009 15/04/2009 Care Homes for Older People Page 9 of 14 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 To ensure that staff follow best practice when moving people to ensure this is done safely and avoids any risk of accident or injury to the person Care Homes for Older People Page 10 of 14 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, 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 Put in place arrangements to 10/06/2009 make sure that for all medicines prescribed with a direction when required or with a variable dose there is clear, up to date and detailed written guidance available to staff on how to reach decisions to administer the medicine and at a particular dose, taking into account the provisions of the Mental Capacity Act 2005. This will help to make sure that there is some consistency for people in the home to receive medication when necessary and in line with planned actions. Make arrangements to have regular recorded checks of the medicine fridge to make sure this is operating within the safe range for medicine storage of 2 to 8 degrees C and make sure that all medicines needing refrigerated storage are always stored at the correct 10/06/2009 2 9 13 Care Homes for Older People Page 11 of 14 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 temperature. This will help to make sure that people receive medicines of the right potency. 3 9 13 Put in place arrangements to 10/06/2009 make sure that there are always complete, accurate and up to date records about medicines to be administered to people living in the home and that there are always clear and accurate records about any medicines administered to people living in the home. This is to help to make sure people receive their prescribed medication correctly and to help reduce risks of mistakes. 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 Write the date on any containers of medicines when they are first opened to use. This helps with good stock rotation in accordance with the manufacturers or good practice directions and with audit checks that the right amount of medicines are in stock. Make sure that all staff who administer medication to people who live in this home are regularly assessed as still competent to safely carry out this task and that written records are kept of these assessments with action taken as a result of any shortfalls identified. Review and update the medicine policy and local
Page 12 of 14 2 9 3 9 Care Homes for Older People 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 procedures to make sure this is up to date and includes all aspects for the safe handling of medicines. This is so as to provide all staff with precise direction about the way medicines are safely managed and handled in this home. 4 5 9 9 Make arrangements so that the allergy box on medicine charts always contains a relvant entry. Make sure that when any handwritten entry is made on medicine charts this is signed and dated by the member of staff writing this with a second member of staff checking and signing as correct. Make arrangements to see and check prescriptions in the home before they are sent to the pharmacy for dispensing. This can help the home to monitor what and when medicines are ordered and that the directions are current. 6 9 Care Homes for Older People Page 13 of 14 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. 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 14 of 14 - 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!
