Inspection on 17/12/09 for Gailey Lodge

This inspection was carried out on 17th December 2009.

CQC found this care home to be providing an Adequate 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Gailey Lodge 11/05/09

Gailey Lodge 01/05/08

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Random inspection report Care homes for adults (18-65 years) Name: Address: Gailey Lodge 32-33 Victoria Avenue Whitley Bay Tyne & Wear NE26 2AZ one star adequate service 11/05/2009 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: Michael Earnshaw Date: 1 7 1 2 2 0 0 9 Information about the care home Name of care home: Address: Gailey Lodge 32-33 Victoria Avenue Whitley Bay Tyne & Wear NE26 2AZ 01912970890 Telephone number: Fax number: Email address: Provider web address: gaileylodgeltd@aol.com Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Gailey Lodge Limited care home 19 Number of places (if applicable): Under 65 Over 65 0 physical disability Conditions of registration: 19 The maximum number of service users who can be accommodated is: 19 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 category: Physical disability Code PD, maximum number of places: 19 Date of last inspection Brief description of the care home Gailey Lodge provides personal care accommodation for up to 19 service users mainly with physical disabilities. The building is a large converted Victorian house. The home is located in a busy area of Whitley Bay, within walking distance of the local shops, library, post office churches and leisure facilities. The beach is also a short walk from the home. There is easy access to the town centre and public transport routes. All the bedrooms are single and seven rooms have en-suite facilities. There are two Care Homes for Adults (18-65 years) Page 2 of 11 1 1 0 5 2 0 0 9 Brief description of the care home lounge areas and a separate dining room. Service users also have access to a small kitchen area where they can prepare snacks and drinks. Fees for the home start at 414.00 per week. Information about the home and copies of inspection reports are available in the home. Care Homes for Adults (18-65 years) Page 3 of 11 What we found: The reason for the visit was to undertake a pharmacist inspection of the home to follow up concerns about medication practices reported to us over recent months. The visit lasted four hours and involved looking at the current medicine administration records (MARs), a sample of care plans, and the medication storage and handling arrangements within the home. Information about staff training, supervision and audit of the medication system was provided by the manager. During the visit we gave verbal feedback to the manager, Bridget Stephenson and a senior carer, Tanya Henderson. The outcome is as follows: Medicine records examined and practices observed during the visit suggest that people living in the home can expect to receive their prescribed medication correctly. Medicine administration was taking place when we arrived and generally followed good practice guidance, although the senior carer signed the MARs before the medicines had been given to the person. On one occasion the entry on the MAR had to be amended because the person refused the medication. A dose of a controlled drug, Morphine, had been administered that morning but there was no witness signature in the controlled drug register. The senior carer did not fully understand that the whole administration process should have been observed by a witness, and their signature entered in the register at the time of administration of the Morphine. Storage facilities for medication are inadequate to protect medication from theft and the environment. The treatment room is poorly furnished and decorated and the ceiling is not intact. The door of the treatment room is fitted with a digital lock rather than a key operated lock. A domestic fridge/freezer, which has no lock, is used to store medication requiring refrigeration. Medicines in monitored dose packs were stacked up on open shelving and not secured in a locked cupboard and medication documents were not well organised. There were multiple unopened containers of eye drops and eye ointments for two people living in the home which had been dispensed regularly over several months. Better communication between the surgery and the pharmacy would reduce this overstocking. A number of medicines with a limited use once opened did not have the date of first opening recorded on the container. In addition, some containers of eye drops and eye ointments that were labelled with the opening date, were still being used beyond the 28 day expiry period recommended by the manufacturer. One bottle of Chloramphenicol eye drops was labelled with a handwritten label rather than the original dispensing label prepared by the pharmacy. We were informed that the original label was no longer legible and staff in the home had replaced this with the handwritten label. Records of prescriptions ordered and medicines received into the home are not comprehensive and there is no clear audit trail to fully track the process of obtaining supplies of medication. Surplus medication at the end of the monthly cycle is fully recorded prior to disposal, but individual doses of medication, refused or dropped, are not documented in the home, and are place in another container for disposal via the pharmacy. Care Homes for Adults (18-65 years) Page 4 of 11 The controlled drug cupboard appears to meet safe custody requirements and there were no discrepancies between stocks of controlled drugs in the home and entries in the controlled drug register. All entries in the register were accurate and complete, apart from the one missing witness signature. No regular controlled drug stock checks are carried out. Some supplies of Morphine tablets had been removed from the their dispensed packs and placed in plastic cartons in the controlled drug cupboard. The dispensing labels on the original packs had been removed and placed on the lids of the plastic cartons. We were told that this was done to make storage in the controlled drug cupboard easier. One container had three dispensing labels stuck on the lid, one on top of another, and the top label was starting to peel away. The dose instructions were not identical on all three labels. There were no significant gaps in the administration records indicating that people can expect to be given their prescribed medicines correctly. Two persons missed some medication because they were out of the home on social leave. No arrangements appear to have been made to take the medication with them, in line with the homes medicines policy. Some handwritten entries on MARs were not fully completed to include the signature of the person making the entry, the date, or a witness signature to confirm accuracy. In addition, the quantity of medication received in to the home, or carried over from the previous month, is not always recorded on the MAR. This makes it difficult to have a complete record of all medication within the home and to check if medication is being administered correctly. There is no space on the new style MAR to document any allergies to medication. One person was receiving treatment with Warfarin but the anticoagulant book, containing up to date information on the dose to be given, was not kept with that persons MAR. The medicines policy is up to date and provides guidance for staff on most areas of medication practice. The British National Formulary in the treatment room was a 2002 edition. Staff undertake a short course of medication training, supervision and assessment of competency before handling medicines on their own, although a written record of these competencies is not kept. The senior carer responsible for giving out medication on the morning of the visit had a very limited knowledge of the medicines she was handling. She was also unclear about procedures for witnessing the administration of controlled drugs and disposal of medication. No audit of the medication system is undertaken. Regular audit helps identify any medication issues promptly and helps to confirm that staff are closely following the homes medicines policy. What the care home does well: What they could do better: Care Homes for Adults (18-65 years) Page 5 of 11 Medication storage facilities are poor. Medicines with a short life once opened are not used in line with manufacturers instructions. Audit of the medication system is not undertaken. Additional medication training should be provided so that staff have a good understanding of the medicines they handle and the relevant procedures to be followed. Handwritten entries on MARs are not always complete and checked by a witness. Records of medicines ordered, received and disposed of could be improved. 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 Adults (18-65 years) Page 6 of 11 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 20 13 There must be appropriate arrangements in place for the recording, handling and safe administration of medicines received. To protect the health and welfare of service users. 15/05/2009 2 30 13 A new kitchen cleaning schedule must be implemented to make suitable arrangements for maintaining satisfactory standards of hygiene. To promote the health and welfare of the service users. 15/05/2009 Care Homes for Adults (18-65 years) Page 7 of 11 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 20 18 To ensure that staff are suitably qualified, experienced and competent to safely administer medication before they administer medication to people in the home To safeguard the health and welfare of people living in the home 17/03/2010 2 20 13 To make arrangements to 17/01/2010 ensure that records are kept of all medicines received into the home, administered and leaving the home or disposed of. To safeguard the health and welfare of people living in the home 3 20 13 Medicines must only be 17/01/2010 administered from containers supplied and labelled by the pharmacy and must not be used beyond the date recommended by the manufacturer. Care Homes for Adults (18-65 years) Page 8 of 11 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 To protect people from medication error and to make sure that medicines are safe to administer. 4 20 13 To make arrangements to 17/03/2010 ensure that medication is stored securely at the correct temperature recommended by the manufacturer. To safeguard the health and welfare of people living in 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 20 Staff should sign and date handwritten entries they make on MARs. Each entry should be checked and countersigned by a second person to reduce the risk of error when copying information. Advice should be obtained from the supplying pharmacy and the date of first opening should be recorded on the containers of those medicines which have a limited use once opened. A system should be in place to record all medicines kept in the home and carried over from the previous month. This helps to confirm that medication is being given as prescribed and assists in checking stock levels. A current edition of the British National Formulary, together with professional guidance on the handling of medicines in social care, should be available for staff. A more comprehensive audit trail should be maintained for the ordering of prescriptions, the receipt of medication and all medication subsequently disposed of. The pharmacy should be contacted to request that any Page 9 of 11 2 20 3 20 4 20 5 20 6 20 Care Homes for Adults (18-65 years) 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 known allergies to medicines are documented on each persons MAR. 7 20 When a controlled drug is administered the person acting as the witness must be fully involved in the administration process and sign the controlled drug register at the time the medicine is given. Regular audit of the medication system should be carried out to help identify any medication problems promptly and to help confirm that staff are following the homes medicines policy. The competency of staff to handle medication safely should be documented in personal files. A lockable medicines fridge with integral temperature monitoring should be obtained to replace the current domestic fridge/freezer. The homes medicines policy should be followed when people go out on social leave so that their medical treatment is not interrupted. The written provided by the anticoagulant clinic should be kept attached to the MAR of people receiving anticoagulant treatment. This makes sure that staff have access to up to date guidance on the dose of anticoagulant to administer. The treatment room should be refurbished and a key operated lock fitted to the entrance door. Additional medicine storage cupboards for medicines in monitored dose packs should be considered. 8 20 9 10 20 20 11 20 12 20 13 20 Care Homes for Adults (18-65 years) Page 10 of 11 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 Adults (18-65 years) 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 Adults (18-65 years) Page 11 of 11 - 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!