This inspection was carried out on 21st January 2010.
CQC found this care home to be providing an Good 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.
Random inspection report
Care homes for older people
Name: Address: Brooklands Nursing and Residential Home 44 Albany Road Old Swan Liverpool Merseyside L13 3BJ two star good 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: Stephanie West Date: 2 1 0 1 2 0 1 0 Information about the care home
Name of care home: Address: Brooklands Nursing and Residential Home 44 Albany Road Old Swan Liverpool Merseyside L13 3BJ 01512520080 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) : Rosewood Care Services Limited care home 49 Number of places (if applicable): Under 65 Over 65 49 old age, not falling within any other category Conditions of registration: 0 The registered person may provide the following category/ies 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 category - Code OP The maximum number of service users who can be accommodated is: 49 Date of last inspection Brief description of the care home Brooklands is a large home providing both personal and nursing care to older people over the age of 65 years and is located in the Old Swan district of Liverpool. Local amenities such as shops and churches can be found within a short walking distance and good transport links are available to local communities, nearby towns and Liverpool City centre. The home is purpose built with accommodation on two floors. A passenger lift provides full access to the upper floors of the home. There is wheelchair
Care Homes for Older People Page 2 of 10 Brief description of the care home access and parking at the front of the premises. A pleasant, private garden is located to the rear of the building. Fees range between GBP322.50 and GBP429 per week depending on the level of care required. Care Homes for Older People Page 3 of 10 What we found:
The purpose of this visit was to look at action taken to improve medicines handling in order to address weaknesses seen at our previous visit and to meet with current requirements. We looked at care documentation within the home and the medication systems that were in place. We spoke with nursing staff about the arrangements made for handling peoples medicines. At the end of the visit feedback was given to the nursein-charge. We were concerned to find that shortfalls in the way medicines were being handled remained to be addressed and continued to place the health and wellbeing of people at unnecessary risk. We looked at how medicines were administered. We were concerned to again find poor practice in the administration of medication. At our previous visit we saw that records were pre-signed as administered for times and dates into the future. At this visit we saw that several people had been administered their morning medicines without reference to their medicines administration records. Their records were later completed en masse, this reliance on memory increases the risk of making mistakes both when administering medicines and later completing the records. We again saw occasional examples where medicines had been pre-signed. In one case someones record had been completed to show they had refused a when required painkiller due several hours later on. As previously seen, we saw occasional examples where people could not be given prescribed medication because there were none left to give. It was also evident, from speaking with nursing staff and comparing a sample of medicines stocks and records, that doses of medication were not always administered from each persons own labelled supply. This poor practice again increases the risk of mistakes. Several people had chosen to self-administer some medicines. Since our previous visit, for most people, basic forms had been completed to show they self-administered some medication. But, there were no risk assessments or any written information about how safe self-administration was supported. This puts people at risk of not receiving any support they may need with their medicines. We looked at medicines record keeping and found several examples where records were poorly completed and did not support the safe administration of medication. Handwritten medication administration records were very poorly completed; many were not dated, other records were signed for dates into the future. We compared a sample of medicines stocks and records and found examples where more doses had gone from stock than shown as administered on the medicines record. We again saw that where medicines were prescribed e.g. one or two the actual dose given was not recorded and that where doses were missed the reason for this was not generally clearly shown. But, we saw two examples where people had missed several doses of their evening medicines because they were asleep. There was no evidence of advice being sought about the possible earlier administration of these medicines. We were concerned to find that on two occasions the controlled drugs register had not been completed, where the medicines administration records showed that a controlled drug had been given. It was not possible to tell whether or not the medication had been given correctly. It was of concern to again find that Warfarin was not managed in accordance with the advice to care services from the National Patient Safety Agency. One handwritten record incorrectly recorded the dose of Warfarin given. Medicines that were contained in the monitored dosage system
Care Homes for Older People Page 4 of 10 supplied by the community pharmacist were simpler to audit and our checks showed these were usually given correctly. As seen at our previous visit, the home did not have an effective in-house audit (written check) of medicines handling. This needs to be addressed to ensure any shortfalls in medicines handling can be promptly identified and addressed. We looked at care files to gather information about service users where concerns had been identified in relation to medications. One service user was found to have lost an excessive amount of weight over a period of four months but there was no evidence that advice from the GP or Dietician had been sought. The care plan that is necessary to identify the need for dietary supplements had not been completed. No dietary assessment had been completed. No dietary intake plan or intake records had been completed. An assessment of the service user had been undertaken in 2008 and a score given to indicate the risk presented by the service user. It was evident that this had been incorrectly completed at the original assessment had not been corrected at any of the monthly reviews carried out by the nurses. It was evident that nurses had not assessed the service users needs or risks and this has the potential for placing the service user at risk. One service user suffered from pressure sores but no detailed plan had been prepared to inform staff of the care needed to treat these. No moving and handling plan had been prepared and no information for staff regarding the specialist dietary and feeding needs. No nutritional assessment had been undertaken and no dietary intake chart had been prepared. No infection control plan was in place for this service user. The care file for one service user who had recently been admitted to the home was seen. The pre admission assessment form was undated and unsigned and so it was not possible to confirm that the assessment was undertaken by a suitably trained person. The assessment form contained little information about the care required and so the home could not provide evidence that they could meet the service users needs. No care plans had been completed for this service user and no risk assessments prepared. No information was provided for staff regarding the care they should provide or of how they could meet the service users needs. We also noted that one service user had suffered a fall in the home resulting in a head injury. The staff failed to take appropriate action at the time of the accident or subsequently when additional problems were identified. We found that service users were placed at risk through the failure of the nurses to complete detailed care plans, undertake effective assessments or provide the appropriate level of care. What the care home does well: What they could do better:
Care Homes for Older People Page 5 of 10 The way medicines are administered needs to improve with due consideration given to nurses own professional (NMC) guidance. Record keeping needs to improve to better support the safe administration of medication, and to enable the handling of all medicines to be accounted for (tracked). Written assessments need to be completed to help ensure people receive any support they may need to safely manage their own medicines. Effective medicines audits should be carried out to help ensure any shortfalls can be promptly identified and addressed. Detailed assessments need to be undertaken on service users to enable comprehensive and informative care plans to be prepared. Risk assessments need to be undertaken and risk management plans prepared to remove or reduce any risks to the service users. Audits of all care plans should be prepared to ensure that information held on care files is accurate, up to date and in line with service users abilities and preferences. 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 6 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 9 13(2) Where people self-administer 14/12/2009 medication written assessments must be completed to help ensure they receive any support they may need to do so safely. 2 9 13(2) Complete, clear and accurate 14/12/2009 records of medicines received, administered and of unwanted medicines sent for safe disposal must be maintained to support and evidence the safe handling of medication. 3 9 13(2) Medicines must be administered to people correctly as prescribed and sufficient stocks maintained to enable continuity of treatment. 14/12/2009 Care Homes for Older People Page 7 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 4 7 Detailed assessments of service users needs are required to be underaken and kept under review. To ensure that the needs and preferences of the service users are clearly identified. 05/03/2010 2 7 15 Comprehensive care plans 05/03/2010 are to be prepared for all service users and these plans kept under review. To inform staff of the individual needs and preferences of the service users to ensure that the appropriate level of care and support is provided. 3 8 13 Medicines must be safely administered with due consideration to the homes medicines policy and nurses own (NMC)professional guidance to reduce the risk of mistakes. 05/03/2010 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 1 7 Regular and clearly documented audits of care plans should be undertaken on a regular basis to ensure that the plans are kept accurate and up to date. There should be an effective system in place to audit medicines to make sure medicines are always handled safely in accordance with the homes policy and current good practice guidance. The monthly ordering procedures should be reviewed to reduce the risk of medicines running out. Prescriptions should be checked to give more time to follow-up any missing medicines before they are needed. 2 9 Care Homes for Older People Page 9 of 10 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. Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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!
