Random inspection report
Care homes for older people
Name: Address: Brockshill Woodlands Briar Walk Oadby Leicestershire LE2 5UF one star adequate 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: Vashti Maharaj Date: 0 4 0 3 2 0 1 0 Information about the care home
Name of care home: Address: Brockshill Woodlands Briar Walk Oadby Leicestershire LE2 5UF 01162716014 01162716014 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) : Prime Life Ltd care home 30 Number of places (if applicable): Under 65 Over 65 27 5 30 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Conditions of registration: 0 0 0 Brockshill Woodlands care home is registered to provide personal care to male and female service users who fall within the following categories: Old age, not falling within any other category (OP) 30. No one falling within category MD(E) should be accommodated at Brockshill Woodlands when there are already five persons of the category MD(E) accommodated in the home. No one falling within the category of DE(E) should be accommodated in Brockshill Woodlands when there are already 27 persons accommodated under the category of DE(E). No persons should be accommodated in the double-bedded bungalow situated in the grounds of Brockshill Woodlands unless they are an established co-habiting couple, or
Care Homes for Older People Page 2 of 14 have an established friendship/relationship, prior to being accommodated in the bungalow. Only persons falling within the category OP should be accommodated in the two single bedroom bungalows situated in the grounds of Brockshill Woodlands. Persons should only be accommodated in the double-bedded bungalow situated in the grounds of Brockshill Woodlands under categories OP, and DE(E). A maximum of one person falling within the category DE(E) should be accommodated at any one time. The maximum number of persons to be accommodated at Brockshill Woodlands is 30. Date of last inspection Brief description of the care home Brockshill Woodlands is a care home providing personal care and accommodation for up to thirty older persons who may have additional needs, which may include Mental Disorder or Dementia. Accommodation comprises of the main care home and three self-contained bungalows; bedrooms are both single and shared. Parking for visitors can be found to the front of the home. Brockshill Woodlands is located in a residential area of Oadby. Communal areas consist of a dining room and three lounges, and are located on the ground floor, with access to the garden from the lounge to the rear of the home. Bedroom and bathing facilities are located on the ground and first floor. Information is located on site detailing the range of services offered, which includes the Statement of Purpose and Service User Guide. Copies of the Care Quality Commissions Inspections Inspection Reports are available by request at Brockshill Woodlands. Information regarding the weekly fees at Brockshill Woodlands can be obtained from the registered provider. Care Homes for Older People Page 3 of 14 What we found:
This report is from a Commission Pharmacist Inspector, who visited the service on 4th March 2010 to carry out an inspection of medicines management following on from a referral by the Lead Inspector for the service. We inspected the current records of medicines received, used and returned for all people at the home, we also inspected medicines storage areas, medicines stock, controlled drugs storage, stock and records. We checked whether staff handling medicines have had appropriate training, inspected older records of medicines prescribed and used from October 2009 onwards for 9 people to see whether medicines could be acounted for and checked how the service was managing changes to peoples medicines. We also spoke with the person temporarily managing the service in the absence of the Registered Manager and one member of staff with responsibilities for medicines. Staff were open during discussions and facilitated the inspection by providing all the documents requested, and also offered possible explanations for issues found. We found that the service has a number of serious issues with the way it manages peoples medicines which could put peoples health and safety at risk. There are three main risk areas. The first is the reconciliation of medicines kept on behalf of people living at the home. There were discrepancies between the quantities of medicines received, used, and returned for a number of sedating medicines used for agitation as staff have not always recorded whether medicines have been returned or carried forward, and for one person, have not recorded the dose given. For example, during the past ten days, for one sedating medicine, there was 50ml unaccounted for, the equivalent of 5 doses. For the period between November 2009 to now, for the same medicine, records show that 250ml in total was unaccounted for. There were also 3 other sedating medicines with quantities unaccounted for. There was no evidence to explain why there were discrepancies. One explanation for this, offered by the Acting Manager, could be that staff have not recorded accurately when these are used or returned. The Care Homes Regulations 2001 require the service to keep accurate records of medicines received, used, and returned so that it can account for all medicines kept for people at the home, to prevent misuse and also to show that medicines have been used as prescribed. A requirement has been made that the Registered Provider ensures that accurate records of medicines received, used and returned are kept to ensure the safety of people at the home. The second area of risk is that some changes on the medication record do not tally with the GPs notes e.g. the record of health visits says that the GP made a change to
Care Homes for Older People Page 4 of 14 someones medicine used for agitation on 11th December 2009 however there is no evidence from on the medication record that the change was made. There are also 2 cases where sedating medicines have been changed from night to morning administration but staff have not signed and dated the medication record so it is not clear who made the change and when. A requirement has been made that the Registered Provider ensures that there is written evidence for all changes to peoples medicines, and written evidence that changes have been implemented. The third area of risk is on the use of controlled drugs.The entries in the controlled drugs register do not tally with the temazepam tablets in the blister for two people, e.g. for one person, the entry in the controlled drug register says that temazepam was given on Sunday 28th Feb 2010 however the tablet was still in the sealed blister pack for that day.The entry in the controlled drug register says that temazepam was not given on Saturday 27th February 2010 however the tablet was missing from that date. For another person, the entries in the controlled drug register say that temazepam was given on Monday 22nd February, Tuesday 23rd February and Wednesday 3rd March 2010, but the tablets are still in the blister for these days. The overall number in stock tallies with the records, however staff have been using the tablets from the incorrect blister. This is unsafe practice. There is no date of return for some controlled drug injections so it is not possible to say when these were returned. There is also a note in the controlled drug register that 31 tablets of a controlled drug were given to the family when a person left the home, however the person making this entry has not signed and dated the register so it isnt obvious who has made this entry. There are 3 members of staff who are trained to give medicines, however there were an additional 7 members of staff who are not authorised to give medicines who are witnessing the administration of controlled drugs. A requirement has been made that the Registered Provider ensures that controlled drugs are given and recorded accurately by trained and competent staff, so that there is evidence that these have been given as prescribed and can all be accounted for. Details of the issues were fed back to the Acting Manager on the day of the inspection, and followed up in writing the next day to ensure that the service addresses these issues for the safety of people at the home. There are also a number of other issues with medication, these are listed under What the service could do better. What the care home does well: What they could do better:
Care Homes for Older People Page 5 of 14 There are a number of other issues on the current medication usage records: For one person, the medication record lists a pain relieving medicine, but there were none in stock. There is a note on the back of the medication record which says that it was returned to the pharmacy, but staff have not recorded the date and quantity returned, or the date the medicine was stopped. Protocols are needed for all medicines given on as as required basis, these give staff information on when these should be used, how much should be given, how often, and the maximum amount in 24 hours to ensure these are not overused or misused. These protocols are especially important for sedating medicines used for agitation. For one person, the PRN protocol is for diazepam 2mg/5ml, but the medicine in stock is 10mg/5ml so if staff followed the instructions on the PRN protocol, the person would receive too much. For another person on diazepam tablets, there is no PRN protocol, so there is no clear guidance for staff on when this should be used. Two people have missed doses of medicines over the past 10 days which could have affected their health. For one person, one of their medicines was out of stock for between 1 and 3 days in the past ten days, but it was not clear from the medication record how long for. For another person, a medicine has only been given 2 days out of the last 9 days, but there is no explanation on the medication record why this has not been given. There is no record of use for creams for two people. One person keeps this in their bungalow and applies it themselves, the medicines record should say this, otherwise it looks as though it is not being used. For one person, 4 medicines were not given on one morning in the past 10 days as the person was asleep. As these are medicines given once a day only, they should be offered again later in the morning when the person is awake. The community nurse comes in every 3 months to give an injection to one person. It would be good practice to record the date this injection is due on the current medicination record to ensure it is given on time. One person is on an inhaler, prescribed for regular use twice a day. Staff have added PRN, as required, by hand. If a medicine is changed to as required use, staff must ensure that the GP amends the prescription so that the labeled medicine and medication record are changed to reflect what is being used. For one person, their medicine is being crushed and added to yoghurt before they take it. Advice must be sought from the GP or Pharmacist before any medicines are crushed and added to food as crushing medicines is outside of the product licence and may affect the properties. There are no instructions on the medication record for one persons antibiotic. It is being given four times a day. There must be full instructions for use for all prescribed medicines. A number of requrements have been made with short compliance dates to ensure that medicines handling and recording is improved for the safety of people at the home.
Care Homes for Older People Page 6 of 14 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 7 of 14 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 4 18 All care staff should receive 12/01/2009 training in caring for people with dementia and mental health needs. This is to ensure that all staff have the skills to meet the needs of people living in the home. (Original Time Scale 30/11/08) 2 7 14 Care plans must be in place for all assessed needs. care plans and risk assessments must be updated on at least a monthly basis. This is to ensure that people have their needs met and are protected from harm. 12/02/2010 3 8 13 People living at the home must have their risk of malnutrition assessed and their weight recorded and monitored. This is to ensure that people at risk of malnutrition are identified and referred to the appropriate healthcare professional to receive the appropriate treatment. People living at Brockshill Woodlands must be given 15/02/2009 4 12 12 26/02/2010 Care Homes for Older People Page 8 of 14 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 opportunities to participate in recreational and social activities that are meaningful to them. In particular, people with more advanced cognitive impairment must be given these opportunities. This is to ensure that people experience a fulfilled lifestyle that matches their expectations. 5 15 12 Staff must ensure that appropriate assistance is given when required during mealtimes. advice should be sought from appropriate health care professionals such as dietitians or occupational therapists. This is to ensure that people receive a nutritional diet that meets their preferences and are assisted in an appropriate and sensitive manner. 6 18 13 People living at Brockshill 10/02/2010 Woodlands must be protected from abuse. Robust procedures for responding to suspicion or evidence of abuse or neglect must be in place and followed by all staff members. This is to protect people from harm. 7 30 18 All staff must receive the the 26/03/2010 training they require to meet
Page 9 of 14 08/02/2010 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 the needs of people living at the home. This must include training for caring for people with dementia and mental health needs. All mandatory health and safety training must be updated on an annual basis. This is to ensure that people living at Brockshill Woodlands have their needs met and are protected from harm. Care Homes for Older People Page 10 of 14 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 Registered Provider must 18/03/2010 ensure that there are full and clear instructions for all prescribed medicines, in particular medicines prescribed on as as required basis. To ensure medicines are used appropriately and not overused to protect the health and safety of people. 2 9 13 The Registered Provider must 18/03/2010 ensure that there is a robust system to order medicines. To ensure that medicines do not run out and people receive their medicines as prescribed to protect their health. 3 9 13 The Registered Provider must 18/03/2010 ensure that controlled drugs are given and recorded accurately by trained and competent staff. To ensure there is evidence that these have been given Care Homes for Older People Page 11 of 14 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 as prescribed and can all be accounted for, for the safety of residents. 4 9 13 The Registered Provider must 18/03/2010 ensure that there is written evidence for all changes to peoples medicines, and written evidence that changes have been implemented. To ensure medicines have been used as prescribed. 5 9 13 The Registered Provider must 18/03/2010 ensure that complete and accurate records of medicines received, used and returned are kept. To ensure that medicines are used as prescribed and that all medicines can be accounted for to protect the health and safety of people at the home. 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 Registered Provider should ensure that there is a record of when the next dose is due for medicines given by community nurses e.g. injections. The Registered Provider should ensure that there is a risk
Page 12 of 14 2 9 Care Homes for Older People 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 assessment for all medicines which are kept in peoples rooms including creams. Care Homes for Older People Page 13 of 14 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 14 of 14 - 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!
