This is the latest available inspection report for this service, carried out on 2nd April 2009.
CQC found this care home to be providing an Adequate service.
The inspector found there to be outstanding requirements from the previous inspection
report. These are things the inspector asked to be changed, but found they had not done.
The inspector also made 9 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: Lewis W Hammerson Memorial Home 50a The Bishops Avenue East Finchley London N2 0BE one star adequate service 11/11/2008 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 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: Jane Shaw Date: 0 2 0 4 2 0 0 9 Information about the care home
Name of care home: Address: Lewis W Hammerson Memorial Home 50a The Bishops Avenue East Finchley London N2 0BE 02084584523 02084582537 info@hammersonhouse.org.uk 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) : Lewis W Hammerson Memorial Home care home 68 Number of places (if applicable): Under 65 Over 65 68 old age, not falling within any other category Conditions of registration: 0 Limited to 68 adults of either gender over the age of 65 years, 15 of whom have nursing needs. Date of last inspection Brief description of the care home Hammerson House Memorial Home is registered to care for up to sixty eight people over the age of sixty five who are Jewish. The home is owned and operated by a charitable trust on behalf of the Hammerson family and has been registered since 1985. The home is situated in a residential area of North London and is served by public transport. The home is decorated to a high standard and well maintained. There are three floors, with the nursing unit on the ground floor. There is a lift to all floors. There are twenty- two sheltered housing units within the home and these are integrated within the residential home. The home has its own physiotherapy facilities and is run by qualified staff. The kitchen facilities have been contracted to a company Care Homes for Older People
Page 2 of 10 1 1 1 1 2 0 0 8 Brief description of the care home who also provide serving staff in the dining room. The aims of the home are That all service users shall live in a safe and clean environment and be treated with respect and sensitivity to their individual needs and abilities. Staff are responsive to the individual needs of service users and will provide the appropriate degree of care to ensure the highest possible quality of life within the home. The current cost of a weekly nursing and residential placements are between £890 - £1050 Following Inspecting for Better Lives the provider must make information available about the service, including inspection reports, to service users and other stakeholders. Care Homes for Older People Page 3 of 10 What we found:
We looked at the homes medication policy and procedure, the recording of medication and the storage of medication to see how safely it was handled. Overall we found systems confusing and complicated and spent a considerable time tracking care plans to locate evidence that residents were receiving their medication as prescribed. We found that the medication policy and procedures were outdated and incomplete. We were not able to audit medication because the records for receipts of medication were kept in several places and did not always seem to be available. Generally records for administration were accurate but we did notice gaps on the Medication Administration Records (MAR) for one resident who was refusing medication and for one who was prescribed a weekly enema. Nurses were using Tippex on the MAR when they were making mistakes and instructions on the MAR did not always correlate with what was being given. We noticed that a dosage change had not been re-written clearly and another for a morphine patch not deleted. By case tracking to the care plans we were reassured that the residents were receiving the correct doses. We were told that medicines were being returned to the community pharmacist instead of via the licensed waste carrier and no records had been made since January 2009. The home had no stock of senokot liquid for one resident but were recording it as given. For another resident they administered paracetamol but it was not prescribed and the home did not have a stock of household remedies. We did not know where either came from. We noticed that the name on a bottle of warfarin had been changed from a previous resident to a current resident. There were no instructions available for many of the creams supplied, and variable doses like take one or two were not always recorded accurately. We looked at the balances and storage of controlled drugs. These were accurate but we were concerned that the secondary MAR charts in place for recording administration were not clear and could cause confusion and error with the original printed MAR. We noticed for one resident that the dose of a medicine being given did not correlate with a hospital discharge letter and on case tracking noticed that two further increases in dosage had been made.The home investigated this after the inspection and confirmed that the dose was not increased as requested by the prescriber. We noticed that the home was using lancing devices designed for self testing, rather than those for professional use which are designed to prevent the risk of infection from blood borne diseases. We also noticed that there was plenty of storage in the home but that it could be better organised with first aid products separated from prescription items etc. Oxygen cylinders were not all secure. The home was recording the actual temperature of the three fridges but not the maximum and minimum as per Pharmaceutical Society recommendations. Several residents were able to take their own medicines and consent documents had been signed. These did not however assess risk such as dexterity or understanding. We met one resident who showed us the locked drawer where he kept his medicines but we noticed that they were not being taken at the right time. What the care home does well:
The service has done well in already identifying some of the issues and concerns raised above, and in taking action by employing an external pharmacist consultant to improve systems and provide training. We were pleased to see that so many residents Care Homes for Older People
Page 4 of 10 were able to take responsibility for some or all of their medication. We were also pleased that the home took steps to prevent errors in administration by highlighting residents with similar or the same name. The home was also keeping the results of the latest blood test for warfarin and the new dose with the Medication Administration Record. This prevents the risk of errors in administration. 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 10 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 17 Documentation in relation to 30/12/2008 wound care must be improved to provide clear records so that any wounds can be appropriately monitored and the plan of care assessed to ensure it is effective. This is so that there is a clear record of whether wounds are improving or if there is a need for the plan of care to be reviewed in order to improve outcome for the resident. 2 9 13 Medication must be given as perscribed so that residents receive the correct dosage. To ensure correct dosage is given as per prescribers instructions to ensure the safety and well-being of residents. 15/12/2008 Care Homes for Older People Page 6 of 10 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 That risk assessments for self-medication are expanded. This is to allow a more person centred assessment of physical and cognitive ability. 01/06/2009 2 9 13 That the home uses lancing devices for professional use when taking blood samples. This is to prevent the transmission of blood borne infections. 04/05/2009 3 9 13 That attention is given to the 04/05/2009 safe storage of medication in the clinical room. This includes the safe storage of oxygen cylinders and recording the minimum and maximum temperatures of the fridges. Well organised medication storage mimimises risk, prevents wastage and allows continuous supplies. 4 9 13 That the homes auditing 04/05/2009
Page 7 of 10 Care Homes for Older People 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 processes are carried out more robustly. This is to ensure that all medicines can be accounted for and that they are given as per the prescribers instructions. 5 9 13 That waste medicines are 04/05/2009 recorded and disposed of with the homes clinical waste and not returned to the community pharmacist. This is to ensure that the home complies with the Waste Regulations 6 9 13 That records are permanent records and tippex is not used. This is to ensure the accuracy of the records. 7 9 13 That there are robust records 04/05/2009 of receipts, administration and disposal of medication. This is to ensure that there is evidence of accurate administration and to ensure continuous supplies. 8 9 13 That the homes policies and 01/06/2009 procedures currently under review are updated and expanded in line with current best practice. This is to ensure the safe handling of medication in the home 20/04/2009 Care Homes for Older People Page 8 of 10 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 9 9 13 That instructions on the Medication Administration records correlate with labels and the prescription. This is to prevent error and to ensure that medication is administered as prescribed. 20/04/2009 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 That the home discusses with the GP and the pharmacist a household remedy policy so that a limited supply of some over the counter medicines are available in the home out of normal working hours. That the home works with the GP and the community pharmacist to ensure that all creams and ointments have directions for use and are not just prescribed as directed. That the home reviews the management of controlled drugs and uses the one original printed Medication Administration Record to record administration rather than the secondary handwritten one currently in use. That the home discusses with the community pharmacist the supply of printed MAR charts rather than adhesive labels which can be a cause of error. 2 9 3 9 4 9 Care Homes for Older People Page 9 of 10 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 10 of 10 - 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!
