Inspection on 11/11/09 for Ackworth House

This inspection was carried out on 11th November 2009.

CQC found this care home to be providing an Excellent 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ackworth House 14/05/07

Ackworth House 23/05/06

Ackworth House 04/01/06

Ackworth House 01/09/05

Ackworth House 04/11/04

Ackworth House 07/05/04

Ackworth House 22/01/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Random inspection report Care homes for older people Name: Address: Ackworth House The Beach Filey North Yorkshire YO14 9LA 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: Steve Baker Date: 1 1 1 1 2 0 0 9 Information about the care home Name of care home: Address: Ackworth House The Beach Filey North Yorkshire YO14 9LA 01723515888 01723515888 info@ackworth-house.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Susanne Ladyman Type of registration: Number of places registered: Conditions of registration: Category(ies) : Ackworth House Limited care home 43 Number of places (if applicable): Under 65 Over 65 43 0 old age, not falling within any other category physical disability Conditions of registration: 0 43 1. The registered person may provide the following category of service only: Care home with nursing: Code N, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other categories: Code OP, Physical disability: Code PD. 2. The maximum number of serviceusers who can be accommodated is 43. Date of last inspection Brief description of the care home Ackworth House provides general nursing, personal care and accommodation for up to 35 residents. Day and respite care is also provided. Care Homes for Older People Page 2 of 9 Brief description of the care home The home is situated on the seafront at Filey, North Yorkshire and is within easy reach of the local amenities and facilities of a seaside town. The home is registered to accommodate up to 35 older people and can accommodate 1 person within those numbers who is under 65 years with a physical disability. It is arranged over 4 floors with a passenger lift to all areas. The communal accommodation is on the ground floor with bedrooms to the upper three floors. There is ramped and level access to the home, a large veranda to the front and a small garden area at the side. Parking is limited to roadside parking opposite the home. Information about the services the home provides are made available to prospective clients and/or their representatives and to placing authorities though the provision of a written Statement of Purpose and Service Users Guide and through CSCI reports. The provider has declined to provide information about the scale of charges at this time. Additional charges may be made for hairdressing, newspapers, personal toiletries and clothing, dental treatment, chiropody and eye care where applicable. Care Homes for Older People Page 3 of 9 What we found: The reason for this inspection visit was to follow up information received about possible controlled drugs record keeping concerns. A pharmacist inspector spent 6.5 hours in the home looking at medication storage and handling arrangements (including those for controlled drugs), all of the current months medication administration record charts (MARs), selected care files and the medication policy and procedure documents. Verbal feedback was given during the visit to the manager and to the homes owner. The outcome is as follows. Four MARs indicated that some medicines had not been given exactly according to the prescribers instructions and two MARs indicated that people had received medicines from containers not supplied and labelled for them personally. For example, one persons MAR indicated that they had been given 12 doses of an antibiotic when only 10 doses had been supplied. Another person had been given a laxative as and when the nurses felt appropriate but no prescription had been written for this person. There were also inadequate records on 13 MARs for a total of 19 skin care products. Together, the above findings mean that people may not always receive their prescribed medication correctly. Nine MARs contained a total of 20 hand written entries or amendments which lacked the necessary information or checks for staff to be sure they could follow the changes safely. Most of the hand written entries had been not checked for accuracy. For example, the maximum permitted daily dose of pain killers given as and when needed was not always copied from the pharmacy label. Two MARs contained two entries for medicines originally prescribed to be given regularly which were being offered to people as and when needed but no amendments had been made on the MARs to show that the prescriber had agreed to this change. Such changes in peoples medication needs should be added to a personal medication care plan which would guide all staff when helping people with their medication. Three MARs contained adhesive labels supplied by the pharmacy. We were told that these had been stuck on to the MARs by staff in the home but there was no information about who had done this. Supplying loose medicine labels to a care home may lead to medication errors if the labels are accidentally stuck onto the wrong MAR. A clear procedure for all staff to follow each time should be put in place to reduce the risk of errors occurring. The homes medication storage arrangements are secure and well organised but the cupboards appeared to contain excessive supplies of some peoples medicines. A full check of all medicines kept in the home should be carried out regularly so that appropriate quantities of medicines actually needed are ordered each month. The temperature of all medication storage areas should be checked so that staff are sure that medication is always kept at the temperature recommended by the manufacturer. Some creams and eye drops intended to be kept at room temperature were found stored incorrectly in the medication fridge. All medication must be stored securely at the recommended temperature so that staff know it is safe to use when needed. The opening date was missing from containers of oral liquids and creams. Containers of medication with a short in-use shelf life such as eye preparations, skin care products and oral liquids, should be marked with the date they are first opened. If staff do not know when such products were first opened then they can not be sure that they are still safe to use. Arrangements should be put in place to enable staff in the home to see the monthly prescriptions before the medicines are delivered by the pharmacy. This will also provide an opportunity to check if any new medicines or dose changes have been added. Care Homes for Older People Page 4 of 9 Problems with prescriptions can be addressed at this point rather than after the supply has been made. The prescription is the authority for the staff to administer medication to each person. The checking of prescriptions is an important part of the management of medication. There were no new discrepancies found between the controlled drugs held in the home and the relevant entries in the controlled drug register. Administration entries were accurately recorded and earlier entries had been witnessed for accuracy. We were told that advice had been received recently which caused the home to alter their practice so that some newer entries lacked a witness signature. A second check of all controlled drugs details is needed each time by staff trained in this process to make sure that accurate records of all supplies of controlled drugs received into the home are made. The homes owner has ordered new controlled drugs storage units which will enable all controlled drugs kept in the home to be stored safely according to current regulations. The homes medication policy and procedures indicate they were last revised in 2005 so they do not take account of current professional guidance issued by the Care Quality Commission or the Royal Pharmaceutical Society of Great Britain. They should now be updated to reflect current best practice. This will help to ensure all staff understand exactly what is expected of them when handling and administering medication. 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 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 19 23(2) Assurances must be given 30/06/2007 that additional bathing facilities at the home will be provided by the agreed date of 31/12/07. This will ensure people have access to sufficient facilities and their dignity is preserved at all times. A copy of the fixed wiring 30/06/2007 certificate must be forwarded to the Commission for Social Care Inspection when received. This will provide evidence that the installation is safe. 2 37 13(4(a) 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 13 Arrangements must be put in 31/12/2009 place to ensure that medication administration records are made and maintained in an accurate and timely manner. This will help to show that all prescribed medication has been given correctly. 2 9 13 All medication must be 31/12/2009 stored securely at the correct temperature recommended by the manufacturer. Staff will then know medicines are safe to use when needed. 3 9 13 Arrangements must be put in 31/12/2009 place to ensure that all medication is correctly admininistered according to the prescribers directions. This will help to make sure peoples health and well being are maintained through the use of prescribed medicines. Care Homes for Older People Page 7 of 9 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 The medication policy should be updated in line with current professional guidance so that staff understand exactly what is expected of them. Safe practice procedures should be developed for all mediction tasks and activities. Handwritten entries and changes to MAR charts should be accurately recorded and detailed. This makes sure that the correct information is recorded so that each person receives their medication as prescribed. When nurses delegate the task of applying creams to care workers, then the whole of the task should be delegated. Arrangements should be made for the care worker responsible to sign the record of administration in line with current professional best practice guidance. Containers of skincare products and oral liquid medicines should be marked with the date they are first opened so staff know whether they are safe to use. Individual medication care plans should be developed and agreed which reflect the personal preferences and needs of people living in the home. These care plans should be regularly reviewed in line with changes in peoples medication, health and wellbeing. Regular, monthly prescriptions should be seen before sending to the pharmacy. This makes sure a check can be made of any changes, that all the medicines required have been listed and prevents people from being without their medicines. 2 9 3 9 4 9 5 9 6 9 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. 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