Random inspection report
Care homes for older people
Name: Address: Nazareth House 162 East End Road East Finchley London N2 0RU three star excellent 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 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: Ffion Simmons Date: 0 5 0 8 2 0 1 0 Information about the care home
Name of care home: Address: Nazareth House 162 East End Road East Finchley London N2 0RU 02088831104 02084443691 anne.fenlon@nazarethcare.com www.sistersofnazareth.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Anne Fenlon Type of registration: Number of places registered: Conditions of registration: Category(ies) : The Congregation of the Sisters of Nazareth care home 84 Number of places (if applicable): Under 65 Over 65 84 old age, not falling within any other category Conditions of registration: 0 Fifteen specified service users who have dementia may remain accommodated in the home. The home must advise the regulating authority at such times as any of the specified service users vacate the home. Date of last inspection Brief description of the care home Nazareth House is a long established residential care home providing a home for eighty-nine people over the age of 65. It is owned and operated by a Roman Catholic order of nuns, The Congregation of the Sisters of Nazareth who are the registered providers. There is a very strong Catholic ethos in the home, including a chapel where
Care Homes for Older People Page 2 of 9 1 0 0 6 2 0 1 0 Brief description of the care home Mass is celebrated daily. People from other religious and cultural groups are also accommodated and assisted with religious observance and to maintain contact with their community groups. Nazareth House is a large home split into a number of annexes named after Saints. There are a number of bedrooms with en-suite facilities, but those bedrooms without en-suite facilities have communal facilities close by. The home, with its spacious grounds, offers peace and tranquillity and it is ideally situated close to shops, post office and local transport. The home is light and airy with spacious corridors and has appropriate adaptations and equipment for people with mobility problems. The staff are allocated to work on the same unit so that the residents receive consistent care from the same staff. Each unit has a separate dining area and lounge. The cost of placements is £620 to £682 per week. Additional cost are for hairdressing, chiropody and nail care. Inspection reports produced by the Commission of Social Care Inspection (CSCI) are available upon request from the registered manager/provider. 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 9 What we found:
The random inspection took place over 4 hours on the 5th August 2010. This random inspection focused on the homes management of medication and focused on actions taken by the home to comply with a Statutory Requirement Notice issued following our visit to the home on the 10th June 2010. During the visit we audited the medication and talked to staff. The medication administration records (MAR) of twelve residents were checked during this visit. The Statutory Requirement Notice required the home to put a system in place to ensure medication records (MAR) accurately reflect whether medication was administered, refused, or refused and destroyed and if there was non administration of medication for any other reason, the reason for the non administration to be recorded. During this inspection we found that there were improvements in the recording of medication given to residents with no gaps appearing in their records. We could see that where medication had not been administered, the appropriate endorsements had been used to indicate why the medication was not administered. This means that the records now show more clearly, that residents are receiving their medication as prescribed and where the medication was not given, the reasons why. We were told that a new system has been introduced to record medication coming into the home and leaving the home including medication received mid-cycle, which is providing greater clarity and an audit trail of the medication in the home. We could also evidence that staff were taking greater care to check that the amount of medication coming in matched the amount indicated on the MAR chart, which was helpful to identify any discrepancies when auditing loose medication. The home was required also as part of the Statutory Requirement Notice to ensure that only staff that are suitably skilled and competent handle medication. Since our last inspection, staff have received training by the homes Pharmacist during which staff were reminded about the importance of signing and administering medication at all times. Further training has been undertaken by a member of the Nazareth House Clinical governance team. Staff spoken with confirmed that they had received this training and had found it beneficial. Another requirement of the Statutory Requirement Notice was to ensure that a safe system of administering medication was used and for the practice of secondary dispensing to cease and for medication to be given as prescribed. We evidenced during this inspection that the practice of secondary dispensing medication into dosset boxes, which had been identified at the last inspection, has been stopped. We checked the medication and found that they had been put in blister packs. This means that there is now a safer system in place, reducing the risk of errors and mix-ups, which allows the carers to check medication against the original label. During the inspection, we found much improvement in the management of medication. The home has introduced a system for auditing loose medication, which is effective in identifying any discrepancies in the administration of medication. A weekly audit is undertaken by the home Manager and senior staff are also auditing in between these weekly audits. This has been effective in reducing the amount of discrepancies in the administration of medication. We noted a big improvement in the safe administration of medication and could evidence that residents were mostly receiving their medication as prescribed. Some discrepancies were still noted however in five medications sampled during the inspection, in which we noted that there were 1 or 2 medicines too many or on one occasion there was one tablet short. The
Care Homes for Older People Page 4 of 9 medication had been signed as given. The medication included pain relief drugs (CoDydramol and Paracetamol) and Calcium supplements. The home had identified these errors as part of their self-auditing processes. Since the last inspection, the home has worked hard to ensure that a recent picture of each resident is placed with their MAR chart and their blister pack to promote the safe identification of each resident. We noted that some allergies had been noted on the residents MAR charts although there were gaps in this section on 6 of the 12 MAR chart checked. Allergies must be noted on the MAR chart, where no allergies are known, this should be recorded on the MAR chart as per the homes medication policy. During the visit, we were told that staff were covertly administering medication to one resident. Whilst there was a signed consent form by the next of kin and evidence that a review had been carried out by the Psychogeriatrician, there was no documentary evidence that an assessment of capacity had been undertaken although the Manager confirmed that this had been undertaken by the Psychogeriatrician. There was no care plan in place for staff to follow. 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 9 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 6 of 9 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 15 A clear audit trail for 19/08/2010 recording the decisions to administer medication to one service user covertly must be in place and include evidence that an assessment of their mental capacity has been completed. To ensure that the best interests and well-being of the service user is promoted. 2 9 13 Steps must be taken to 02/09/2010 ensure that the registered person maintains the system for auditing of medication so that service users are administered their medication as prescribed. To ensure that service users health and well-being is promoted. 3 37 17 The Registered Manager 19/08/2010 must ensure that a care plan is in place for the covert administration of medication, which must be regularly reviewed and updated.
Page 7 of 9 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 To ensure that the best interests and well-being of the service user is promoted. 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 Allergies should be noted on the MAR chart, where no allergies are known, this should be recorded on the MAR chart as per the homes medication policy. Care Homes for Older People Page 8 of 9 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 9 of 9 - 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!
