Random inspection report
Care homes for older people
Name: Address: Langton House Wharf Road Wroughton Swindon Wiltshire SN4 9LF two star good service 10/10/2008 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. 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: Sue Fuller Date: 1 5 0 9 2 0 1 0 Information about the care home
Name of care home: Address: Langton House Wharf Road Wroughton Swindon Wiltshire SN4 9LF 01793812661 01793845439 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Alice Jane Blackett Type of registration: Number of places registered: Conditions of registration: Category(ies) : Swindon Borough Council care home 40 Number of places (if applicable): Under 65 Over 65 40 old age, not falling within any other category Conditions of registration: 0 Intermediate care may only be provided for 11 people in the area known as the rehabilitation unit; 9 of which do not exceed 8 weeks and 2 of which do not exceed 16 weeks in any one episode. The Home may offer up to 2 places on a permanent basis at any one time if people receive intermediate care, short term or respite care. The Home may provide care and accommodation for up to 2 service users aged over 55 years and under 65 years at any one time, who are intermediate care, short term care or respite care. Date of last inspection 1 0 1 0 2 0 0 8 Care Homes for Older People Page 2 of 11 Brief description of the care home Langton House is a two-storey purpose built care home providing care and accommodation for up to 40 older people. Twelve of the places are within a rehabilitation unit that provides short-term care for people leaving hospital, to enable them to regain independent living skills and thus return home. The home is situated in the village of Wroughton, South of Swindon. There is some parking on site and in a nearby cul-de-sac, and public transport in the area is good. Local amenities include doctors surgeries, shops and a library. The home is one of a number owned and managed by Swindon Borough Council, and most residents are placed by that authority. Those living in the home have single bedrooms. Five of these have en-suite facilities, otherwise there are convenient toilets, all unisex, around the building. All bedrooms have wash hand basins. The two floors are connected by passenger lift. The home sits in large grounds and includes an enclosed courtyard that is easily accessed from one of the sitting areas. At the last inspection the weekly fee was £405. Care Homes for Older People Page 3 of 11 What we found:
The pharmacist inspector carried out this unannounced, random inspection to look at the handling of medicines in the home. During this inspection we (the Care Quality Commission) looked at both the residential and rehabilitation units. We spoke to staff on duty who were involved with giving medicines and someone living in the home. We looked at the arrangements and records kept for the ordering, administering and disposing of medicines. We found that two requirements made after an inspection in September 2009 had not been fully met. When medicines have been prescribed to be given when required there was no additional written information to help staff make decisions about when these should be given. Records are not kept of the disposal of some medicines, which are returned to the pharmacy in weekly boxes. Staff told us that most people living in the residential home are registered with a local doctor who visits the home every fortnight. Medicines are supplied by a local pharmacy using a weekly box system. The pharmacist makes regular visits to the home to check that medicines are looked after safely and we saw reports to confirm this. A doctor visits the rehabilitation unit to see people every week. Medicines are supplied in standard packs, initially from the hospital, with further prescriptions supplied by the local pharmacy as needed. Most medicines used in the residential unit are looked after and given by staff, who have received training about the safe handling of medicines. They also support people who wish to look after their own medicines. Lockable storage is provided in peoples bedrooms so that medicines can be kept safely. At the present time one person in the residential unit looks after some of their own medicines and told us that they very much like to keep this independence. We saw that this was documented in their care plan. Medicines are given a week at a time to improve safety. We recommended that staff discuss with their pharmacist, and the person involved, how they could avoid the need to transfer medicines each week. This would help reduce the risks of mistakes being made. In the rehabilitation unit care staff look after and give out medicines to people when they first arrive. They then make an assessment of whether people are able to look after their own medicines safely and work towards supporting them to do this whenever possible. There is no written procedure for this process. Both the residential and rehabilitation units use the same medicines policy. People using the rehabilitation unit, and the care staff looking after medicines here, would benefit from having a medicines policy specific to this unit. This would help to ensure that medicines are looked after consistently, following recommended good practice. We saw some medicines being given in the residential unit using safe practice. Staff told us that some recent changes made had meant that medicines were given at a more appropriate time in the morning. In the residential unit, the pharmacy provides printed medicines administration record sheets each month. We saw some handwritten records which had not been signed, dated
Care Homes for Older People Page 4 of 11 or checked by a second person. This increases the risk of mistakes being made, which could lead to medicines being given incorrectly. Two such mistakes have been reported to us. Action should be taken to address this. Generally we saw very few gaps in the administration records. Codes are used to record why a medicine has not been given. Records are made of the amount given if the dose is variable. However we saw that one cream prescribed to be used on alternate days had no record of it having been used. Staff said that this might have been because the cream was only used when it was needed. We saw no written information to support this. Action should be taken to ensure that clear information is available to staff about how this cream is to be used so that it is always used correctly. We saw that two people had been prescribed medicines with a dose of one or two be given when required. Staff explained what these medicines were for and when they would be given but there was no written information available about this. Action should be taken to ensure that there is always clear written direction for staff to ensure that these medicines are given appropriately and consistently. Separate records are kept of the use of creams and ointments kept in peoples own rooms and applied here. The rehabilitation unit uses hospital medicines administration record sheets. These last for a two week period and and are handwritten by staff, signed and checked. These had generally been fully completed. On both units we found that it was difficult to check whether medicines supplied in standard packs had been given as prescribed because there was no record of when a pack of medicine had been started. We recommended that action be taken so that staff can easily audit medicines to check if they have been given. Records are kept of the receipt and disposal of medicines. Improvements are needed to ensure that records include all medicines returned to the pharmacy. This must include medicines returned in the weekly boxes and other individual doses of medicines. This is so that there is a clear audit trail for all medicines which have been received into the home to show they have been used correctly. Medicines are stored securely in the home. A medicine trolley is used to transport medicines round the home safely. Suitable storage is provided for controlled drugs, which need additional security. We checked these medicines and saw that the records were correct and showed these medicines are looked after safely. What the care home does well: What they could do better:
All medicines administration record sheets that are handwritten by staff (including those copied from previous record sheets) must be signed, dated and checked by a second member of staff. This is to ensure that these records are accurate so that people receive
Care Homes for Older People Page 5 of 11 the correct medicines. Clear information must be available for staff about the use of medicines prescribed or used when required so that they are given appropriately and consistently. Records must be made of the disposal of all medicines. These records must include medicines returned to the pharmacy in the weekly Nomad boxes and other individual tablets that have not been taken. Systems should be put in place to allow the auditing of medicines supplied in standard packs so that staff can easily check that these medicines have been given correctly. It is recommended that a medicines policy specific to the procedures used in the rehabilitation unit should be available. This would help to ensure that medicines are looked after consistently, following recommended good practice. 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 6 of 11 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 8 12 Care plans must show how any specific medical conditions impact on a persons care needs, and how needs in respect of the condition are to be monitored. Care workers would benefit from knowing why, in the light of a condition, a person may have particular needs in how care should be provided, and how certain care needs are linked. 30/11/2008 2 9 13 When medication is 30/11/2008 prescribed for use when required, as directed or with a variable dose, make sure there is always clear written direction to staff on how to make decisions about administration for each person and medicine and in accordance with the Mental Capacity Act 2005. This will help to make sure there is some consistency for people to receive the correct levels of medication in accordance with their needs and planned action. 3 9 13 Keep complete and accurate 30/11/2008
Page 7 of 11 Care Homes for Older People 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 records for all medicines administered or leaving the home or disposed of. (This particularly relates to always recording the actual dose of medication administered where a variable dose is prescribed, to keeping records for the application of any prescribed medication that is applied topically and to keeping full records for any unwanted medicines that are disposed of.) This is to help make sure people receive the correct levels of medication and that all medicines can always be accounted for. Care Homes for Older People Page 8 of 11 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 Clear information must be available for staff about the use of medicines prescribed or used when required. So that these medicines are given appropriately and consistently. 13/10/2010 2 9 13 Complete and accurate 13/10/2010 records must be made of the disposal of all medicines. So that there is a clear audit trail to show that medicines received into the home have been used correctly 3 9 13 All medicines administration 13/10/2010 record sheets that are handwritten by staff must be signed, dated and checked by a second member of staff. This is to ensure that these records are accurate so that people receive the correct medicines. Care Homes for Older People Page 9 of 11 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 It is recommended that a medicines policy specific to the procedures used in the rehabilitation unit should be available. This would help to ensure that medicines are looked after consistently, following recommended good practice. Systems should be put in place to allow the auditing of medicines supplied in standard packs. So that staff can easily check that these medicines have been given correctly. 2 9 Care Homes for Older People Page 10 of 11 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission 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 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 11 of 11 - 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!
