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Inspection on 11/03/08 for Abbey Grange

Also see our care home review for Abbey Grange for more information

This inspection was carried out on 11th March 2008.

CSCI found this care home to be providing an Poor service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Inspecting for better lives Random inspection report Care homes for older people Name: Address: Abbey Grange 47 Venns Lane Hereford Herefordshire HR1 1DT zero star poor service 02/10/2008 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 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: Morag Ross Date: 1 1 0 3 2 0 0 9 Information about the care home Name of care home: Address: Abbey Grange 47 Venns Lane Hereford Herefordshire HR1 1DT 01432271519 01432271519 ubheedave@yahoo.co.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) : Mrs Aileen Ubhee,Mr Bissessur Ubhee care home 29 Number of places (if applicable): Under 65 Over 65 29 29 29 0 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Conditions of registration: 29 29 0 29 All residents must be at least 50 years of age on admission. That Mr Ubhee works a minimum of 30 hours a week at Abbey Grange in order to fulfil his responsibilities as the Care Manager. Date of last inspection Brief description of the care home Abbey Grange is situated in a residential area on the outskirts of Hereford city. There is a drive-in parking area at the front of the home and local buses pass within easy reach. The original part of the premises has been adapted for its current use. It carries Care Homes for Older People Page 2 of 10 0 2 1 0 2 0 0 8 Brief description of the care home a listed building status. This places some restriction for making desired alterations. The original building has been extended to provide additional, purpose-built accommodation. The home is registered to provide care to 29 people who are over 50 years of age and who have needs arising from old age, dementia or mental disorder. Information about the service is displayed in the main entrance hall of the home. A copy of the most recent inspection report is also displayed. A schedule of fees is available from the home. Additional charges are made for hairdressing, transport, escort, chiropody, toiletries and newspapers. Care Homes for Older People Page 3 of 10 What we found: A Pharmacist Inspector undertook inspection of the control and management of medication within the service on 11th March 2009. A basic medication policy was available, however it was not dated or signed and there was no evidence to show if trained staff had seen and read the policy to ensure that the residents were safeguarded. The manager informed us that staff had undertaken medication training on 13th November 2008. It was not clear whether the training course covered all aspects of safe handling of medication. We saw no evidence of any checks on competencies of staff who administer medication and therefore to ensure the safe handling of medication within the service. The majority of medication we saw was stored in locked cupboards and also within a locked medicine trolley. However, some medication was not secure. For example, the medicine trolley, although locked, was not secured to the wall, which was also in an open accessible area and could therefore be moved. The keys to open the medication refrigerator were stored in an unlocked drawer in the same open area. We saw several residents, members of staff and visitors walk through this area and therefore this increased the risk of safety to the residents. The area used to store the medication felt very warm. There were no temperature checks to ensure that medication was stored at the correct temperature. We saw a digital clock on the wall, which displayed a temperature of 29 degrees C. This is above the 25 degrees C safe storage temperature for medication. On moving the clock to the medicine trolley the temperature came down to 27 degrees C, which is still above the safe storage temperature. This means that medication was not stored at the correct temperature, which could affect the stability of the medication administered to residents. The majority of the medicine records seen were documented with staff initials to record that medication had been administered to a resident, however there was no list of staff initials available in order to identify who had signed the record. There was no system in place to record what quantities of medication were available in the service. For example, one resident was prescribed two different painkillers on the medication record chart. The records seen showed that the quantity was zero for both and that there were no painkillers available to administer. However, we saw a box of painkillers labelled for the resident stored in the medicine trolley dated September 2008. This means that records were not complete and increases the risk of a medication error. Some of the medicine records were not clear or accurate. For example, one medication administration record chart we saw had been handwritten by somebody in the service, however, it was not dated with a month or year and there was no staff signature or checking system in place to ensure for accuracy. There was also no system in place to check the accuracy of any changes made to medication on the medication record Care Homes for Older People Page 4 of 10 charts. For example, a medication had been altered from a tablet to a liquid, however the change had not been signed, dated or checked for accuracy. This means that due to the incomplete medicine records there is an increased risk of a medication error and therefore increased risk of harm to the residents. The service did not ensure that medication no longer required was disposed of safely. For example, we saw an opened tube of an antibiotic eye preparation in the medicine trolley labelled for a resident, which was 6 days past the 28 day expiry. The medication record chart was seen and there was no antibiotic eye preparation documented. This demonstrated that there was no system in place to ensure the safe disposal of medication no longer required and therefore increased the risk of harm to the residents. Three residents care plans were looked at together with their medication administration records. We were concerned by the lack of information linking their healthcare needs with medication. For example two residents were prescribed medication for behaviour control to be administered, when required. There was no protocol in place to inform staff under what circumstances the medication should be administered. One resident had had no GP review prior to the medication being started. We spoke to a member of staff who informed us that the medication would be administered when X keeps asking everyone to leave and kicks off. We were also informed that social services had completed a review for the resident but this was not documented in the records available. The medication records for a second resident documented that the medication for behaviour control had been administered. However, the daily contact sheet for one of the dates stated that Y has been fine today, with no record of any mental health issues. A third resident was prescribed three painkillers. Two of the painkillers were to be given, when required, but there was no documentation available to inform staff what the painkillers were for or when they should be administered. It was of concern that the medication care plan did not document that the resident was in pain and there was no healthcare plan available for the management of pain. We spoke to a member of staff who informed us that the resident was crippled with arthritis. There was no documented record of this in the care plan. We spoke to the manager who informed us that the resident can tell staff what is required. This was not documented in the healthcare plan. This means that the residents healthcare and medication care records were not person specific and did not document a plan for staff to follow to ensure the well being of the residents. 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 10 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 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 The service must make 30/04/2009 arrangements to ensure that there are records for medicines documenting what medication is stored and available within the service, including receipt, administration and disposal records. This is in order to ensure that the residents medication needs are being safeguraded. 2 9 13 The service must make 30/04/2009 arrangements to ensure that medication is stored securely at the correct temperature recommended by the manufacturer. This is in order to ensure the safety of residents within the service and to protect them from harm. 3 9 13 The service must make 30/04/2009 arrangements to ensure that medication administration records are accurately maintained. 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 This is to prevent a medication error that may cause harm to a resident. 4 9 13 The service must make 30/04/2009 arrangements to ensure that care plans include detailed information and instructions for staff in respect of the administration and management of medicines, including the reasons to give medicines on an as and when required basis and what constitutes needed for the named person. This is in order to ensure that residents are safeguarded from harm. 5 9 13 The service must ensure that 30/04/2009 staff are suitably qualified, experienced and competent to safely administer medication before they administer medication to residents. This is in order to ensure that medication administration is undertaken by trained and competent staff. 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 Staff should read and sign to agree to the mediaction policy Care Homes for Older People Page 8 of 10 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 to ensure they are kept up to date with current medication procedures. 2 3 9 9 The medication policy should be reviewed regularly,signed and dated to ensure good practice is kept up to date. The service should ensure that there is an available and up to date list of staff initials exactly as they sign the medication record charts. 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). 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