Random inspection report
Care homes for older people
Name: Address: Elmsfield House Limited Elmsfield House Limited Holme, near Milnthorpe Cumbria LA6 1RJ 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: Angela Branch Date: 0 9 1 0 2 0 0 9 Information about the care home
Name of care home: Address: Elmsfield House Limited Elmsfield House Limited Holme, near Milnthorpe Cumbria LA6 1RJ 01539563896 01539563896 chriselms1@btconnect.com 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) : Elmsfield House Limited care home 20 Number of places (if applicable): Under 65 Over 65 0 20 dementia old age, not falling within any other category Conditions of registration: 20 0 The registered person may provide the following category of service only: Care home only - Code PC 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, Dementia - Code DE The maximum number of service users who can be accommodated is: 20 Date of last inspection Brief description of the care home Elmsfield House is registered to provide care and accommodation for up to 20 older people some of whom may have dementia. Mr Christopher Wilson is the registered manager. Elmsfield House is set in a rural location close to the village of Holme and three miles from Milnthorpe. There are extensive views over the open countryside of the South Lake District. The home is a Georgian property that has been extended and
Care Homes for Older People Page 2 of 10 Brief description of the care home adapted for its present use as a care home. There are gardens on all sides of the property, part of which have been landscaped and provide a pleasant area for the residents to sit in during the summer months. Accommodation for residents is over two floors, the upper being served by a stair lift. There are eighteen single rooms and one double although currently all rooms are used for single occupancy. Some bedrooms have en-suite facilities. There are two lounges and a separate dining room, which give ample communal space for the residents to meet with visitors, enjoy activities or watch television. Information on fees are available from the service with extra charges for newspapers, magazines, hairdressing, chiropody and some personal toiletries. This service does not provide intermediate care. Care Homes for Older People Page 3 of 10 What we found:
The service was selected at random for a visit by the pharmacist inspector so that medicines handling could be assessed. The inspector looked at relevant documents, storage, and met with the manager Mr Chris Wilson and other staff. The inspection took just over six hours. Feedback was given during and at the end of the inspection to the manager and the assistant manager. Overall we found that there were a number of areas that required improvement to reduce risk to residents particularly around record keeping and medicines administration practices. Residents are protected by policies and procedures for managing medication. On the whole these were in order however those relating to the handling of medicines liable to misuse, called controlled drugs, needed to be up-dated to reflect new regulations regarding safe storage and record keeping. We looked at records for receipt, administration and disposal of medication. Although staff described a system of receipt of medication that included cross-checking against records to reduce errors the actual receipt of medication into the home was mostly unrecorded. This meant that we did not know how much was received and therefore how much should be in stock at any one time. Records for the administration of medication contained omissions that could place residents at risk from errors. We did not always know why medication had been omitted, and there were a significant number of records that were not signed for administration of medication and we could not tell if medication had been given or not. The majority of the administration records were supplied, pre-printed, by the pharmacy. However, we were told that the latest records were only received on 15th September which was the date they were meant to be started. This meant that they did not have them in time to start recording administration on the morning of 15th which was the first day of the record. The administration of morning medicines was therefore recorded at the end of the previous record but the records for the rest of the day were missing. We were also told that the medication, that was supplied in four-weekly cycles, was out of step with the records. The manager should discuss these issues with the supplying pharmacy to ensure that records and medication are received in time for the start of the new four-weekly cycle. Whilst most administration records were printed by the pharmacy a few were written in hand by staff at the home. Most of these records were completed correctly but occasional records contained errors such as inaccurate dosage instructions. These must be accurate to prevent errors in administration of medication. We watched the administration of medication and saw that it was given from plastic pots and not directly from the dispensed pack. The manager showed us the remaining medication that was waiting to be administered and this was found to be packed down from the original dispensed packaging into plastic pots, a couple of which had no lids. Staff said that these were packed down the night before. This practice is referred to as secondary dispensing and is a very high risk process that can result in harm. It is easy for tablets to get mixed up and it also means that the person administering the medication cannot identify what they are giving and do not have the dispensing label to
Care Homes for Older People Page 4 of 10 refer to at the time of administration. The manager said that they would immediately cease the administration of medication in this way. We discussed with staff the administration of a medication that had special instructions for it to be given safely and effectively. The staff showed good knowledge of this, describing exactly how it must be administered. During inspections we usually count up medication and compare it with records to check they tally. Unfortunately, as most records for receipt of medication were missing we were unable to do this for most medication. However, on the rare occasions where the receipt of medicines was recorded and the number of administrations could be counted we found that these tallied to show that medication was administered in the prescribed dose and could be accounted for. We saw very little use of sleeping tablets or when required sedatives. However, on one recent occasion when a when required sedative was administered the reason for this was not recorded so we did not know if it was given appropriately. We also checked care plans for managing when required medication and these contained little guidance for staff to follow to ensure that it was given only as needed in a safe and effective manner and with close monitoring of effect. We also saw a care plan for a resident who was noted to have frequent falls but this failed to describe how to manage this to reduce risk to the resident. Daily records also showed that this resident had recently fallen and had suffered an injury requiring hospital attention. The Care Homes Regulations require homes to report to us any serious injury however we did not receive a report of this incident. The manager told us that the staff on duty at the time had completed an internal Accident Investigation Report though this could not be found at the time of the inspection. Storage of medication was being addressed. The manager said that a new medicines trolley was being bought. The home did not have any medicines liable to misuse, called controlled drugs, at the time of the inspection. It did not have a controlled drugs cabinet or a bound register to record them should they be prescribed in the future. New regulations now require all care homes to have compliant storage for controlled drugs. Since this service does not have any such medicines there will be no requirement made as a result of this visit. However, the home must obtain a controlled drugs cabinet, that complies with the regulations, and a bound register and this will be checked at the next inspection. A requirement will be issued at the next visit if suitable storage has not been obtained. The manager was reviewing the training of staff in medication handling and had just purchased a training programme which he plans to deliver. A staff induction programme involving the safe administration of medication and assessment of competencies was in place for new staff. We did not see any evidence of regular checks, or audits, of medication and it is strongly recommended that the manager does this regularly so that issues relating to medication can be identified and managed without delay to keep residents safe. What the care home does well:
Although there were a number of concerns raised at this inspection regarding the safe handling of medication the manager was keen to follow these up and to manage them to reduce risk and improve safety of residents.
Care Homes for Older People Page 5 of 10 The manager had already addressed the issue of further training of staff in medication administration by accessing a training package and this was to be delivered to them shortly. He was also in the process of reviewing storage so that it is more secure. We saw little use of sleeping tablets and when required sedatives which is good as it means residents are not unnecessarily sedated. 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 6 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 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 9 13 The manager must ensure 09/11/2009 that all staff follow safe practices when administering medication. This is to prevent errors that could cause harm. 2 9 13 All records relating to medication including receipt and administration must be accurate at all times. This is to prevent errors that could cause harm. 09/11/2009 3 38 37 The manager must ensure 09/11/2009 that all incidents resulting in serious injury are reported to us. 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 It is highly recommended that care plans are more thorough and provide staff with clear guidance on
Page 8 of 10 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 managing residents with specific care needs and for the administration of when required medication so that residents are managed safely and effectively. 2 9 It is recommended that the manager introduce a system or regular checks, or audits, of medication so that risks are identiified and managed without delay to keep residents safe. It is recommended that the manager talk with the supplying pharmacy to make sure that new medicines administration records and medication are in step and are received in time to start giving them on the first day of the four-weekly cycle. 3 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!
