Random inspection report
Care homes for older people
Name: Address: Grace Lodge Nursing Home Grace Road Walton Liverpool L9 2DB zero star poor service 03/02/2009 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: Patricia Thomas Date: 2 4 0 8 2 0 0 9 Information about the care home
Name of care home: Address: Grace Lodge Nursing Home Grace Road Walton Liverpool L9 2DB 01515237202 01515237203 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Kim Alison Truscott Type of registration: Number of places registered: Conditions of registration: Category(ies) : Ocean Cross Ltd care home 65 Number of places (if applicable): Under 65 Over 65 65 old age, not falling within any other category Conditions of registration: 0 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 category - Code OP. The maximum number of service users who can be accommodated is: 65 Date of last inspection Brief description of the care home Grace Lodge provides nursing and residential care and support for up to sixty-five people. The home is purpose built and is situated off a busy residential and shopping area of Walton Vale Liverpool. The home is well served by public transport (bus and rail) and a motorway network is approximately ten minutes away by car. The home is
Care Homes for Older People Page 2 of 12 0 3 0 2 2 0 0 9 Brief description of the care home built on two levels, is centrally heated and well maintained. A passenger lift and stairways access the first floor. There is a well maintained garden to the rear of the home. The home is staffed twenty-four hours each day with both trained nurses and care staff. A representative of the owner visits at least monthly to report on the running of the home. Care Homes for Older People Page 3 of 12 What we found:
We carried out an unannounced site visit to Grace Lodge on 24th August 2009 and were there for a period of five hours. The purpose of our visit was to look at how staff manage medication for the people living there. Whilst we were at the home we spoke with five members of staff and with four of the people living there about medication. We also looked at training records for staff and examined in detail the management of medications for eight people living in the home. Care plans for peoples medication management are not in place. The manager advised that she is aware of this and intends to put into place individual medication plans for everyone living there. These would not only provide clear guidance for staff on how the person prefers to take their medication they would also provide guidance on how and when to give medication that is prescribed for as required and would help to ensure that staff are fully aware of the reasons the person is taking their medication and any specific requirements around it. Since our last inspection at Grace Lodge on 24th June 09, air conditioning units have been fitted to the medications rooms on both floors of the home. However these are regularly recording temperatures of over 25 degrees. As many medications state they should be stored at below 25 degrees this may mean the medication is not as effective as it should be. The manager was aware of this issue and explained they were waiting for the unit to be refitted. The home provides fridges for the storage of some medications and records showed that these are consistently at the right temperature. However some medications stored in the fridge, including eye drops and ear drops did not state that they needed to be stored at such a low temperature. They could be uncomfortable for people to use and may not be as effective as they should be if stored correctly. Several boxes of dressings were stored in the home that appeared to have had the label removed. In addition a box contained single packets of several different dressings. As these cannot be used by any person other that the person prescribed for, they should be destroyed. This will lessen the risk of a dressing being applied to the wrong person. We looked in detail at medication administration records (MAR sheets) for eight people living at Grace Lodge. We found that clear records are kept where a person is prescribed medication that changes frequently depending on medical tests. We checked records for one person and found that instructions from the hospital were readily available and the MAR sheets had been clearly updated to reflect these. We checked the medication against the records and found that these tallied. We also found clear records kept of people refusing or taking pain relief medication. This helps to provide a clear picture of the persons pain levels so that any changes can be quickly noted and advice sought. Some people have been prescribed once a week patches for pain relief. Records were clear as to when these were to be applied which helps to lessen the risk of an error occurring. Staff were able to explain that they change the site of the patch each week as
Care Homes for Older People Page 4 of 12 recommended, however this is not recorded on the MAR sheet, or elsewhere. A simple recording of the site used each week would ensure that this practice is being consistently followed. One MAR sheet we looked at contained a number of entries for creams and an inhaler that were not signed for. Staff explained that these were no longer in use but were still printed on the MAR. This could lead to medications or creams being used that are no longer prescribed. The home receives most medications in blister packs from the pharmacist. However medication we looked at for one person had been received from the hospital in boxes. Neither the medication nor the box had the persons name on. Again this could lead to errors occurring. A check of this persons medication also found that they had not been given one medication for several days. This was due to the medication from the hospital running out before the next months medication was received. A clear audit of the medication received, and check of dates the next prescription was due would have highlighted this in time for staff to take action. If people do not receive their prescribed medication regularly this could have a negative impact on their health. A system is in place for ordering new medication for the following month. We discussed this with a member of staff who explained that they use the existing MAR sheets to fill in a form that goes to the pharmacist. This is then sent to the GP who writes the prescription and sends it to the home. Once this is checked the prescriptions are forwarded to the pharmacist who dispenses them. On arrival at the home they check the medication received with the new MAR sheet. However one persons current MAR sheet that we looked at did not tally with their last MAR sheet. They had been prescribed and been taking 6mg of a medication split between a 4mg and 2mg tablet. The new MAR sheet only recorded a 2mg tablet. However the medication delivered in the blister pack was a 4 mg tablet. Staff had signed for this over the previous weekend. A senior member of staff had noted the error on the day of our visit and was in the process of liaising with the GP and pharmacist to resolve this. However the checking system in use in the home had not noted the error which had led to the person not getting all of their medication and could impact upon their health. A second person also had their medication in boxes. We checked two of these against the amount the home had received and the amount signed for as given. We found that for one medication the home had received twenty two tablets and given five. However there were eighteen tablets remaining rather than the seventeen there should have been. The home had received twenty five of the second medication and signed for five. However there were twenty one tablets remaining rather than the twenty that records indicated there should have been. This indicates that on one occasion medication had been signed for but not given to the person. A senior member of staff explained that when medication is in boxes rather than blister packs, these are usually returned when the next months medication is received. As the home records monthly on the MAR sheet the amount of each medication received, this should provide a clear audit trail. However we noted that one person had received four pain relief patches but had seven in stock. A record of the amount of medication brought forward from the previous month would help establish a clear audit trail to ensure people are receiving their medication correctly. Care Homes for Older People Page 5 of 12 The manager explained that she has not carried out a full audit of medication for a while, although she has been working with the local, PCT on medication management within the home and systems of ordering within the area. A regular audit of medication would help to quickly identify or predict any issues that may arise so that action to resolve these could be taken. For example whilst most MAR sheets we looked at had been correctly signed for medication given, we noted some gaps where medication appeared to have been given but not signed for. Over a period of time this makes it difficult to carry out a full audit of medication to ensure it is being given correctly. We checked the training records to make sure staff who give out medication have the skills to do this properly and safely. We found that training in safe handling of medication has been given for twenty two care and nursing staff since May 2009. This medication course includes modules on legislation, safe practice, handling and storing of medication, different forms and routes of medication, receiving, storing, disposal and expiry of medication, record keeping, the rules around the administration of medication, identifying and working from MAR sheets, over doses and guidelines on best practice. To complete the course, staff are observed giving medication to the satisfaction of the instructor from the training agency. In addition the records showed us a course on medication handling competence has been completed by five members of staff. Care staff have completed, or are working toward, National Vocational Qualifications 2 and 3 in care. Thirty eight staff have completed safeguarding training and fifteen have done a course on care planning. The manager has started observations of nursing staff giving out medication to check their competence, and one person on duty confirmed their competency observation had been done. Senior care staff give out medication in the residential unit and registered general nurses on the nursing unit. A member of bank staff working on the nursing unit said she had not received training updates in medication recently although she does give out medication. She told us she was new to the home and getting to know the people who live there and their names. A senior care assistant on the residential unit said she had been observed giving out medication by the training instructor, but has not done the training course yet. She said she gives out medication one day a week. All staff who give out medication should receive the training first and regular updates, to ensure people are given their medication safely and will not be placed at risk. Although two of the nurses on duty told us they have experience in palliative care, none of the staff in the home had experience of chemotherapy drugs. The manager has arranged for a course on this medication to take place so that they will have the knowledge and skills to support people living in the home who may be having this treatment. Also, for staff guidance, a medication information file has been started. When completed this will give details of every drug prescribed for people who live in the home and the possible side effects. The manager has taken action to ensure that when peoples doctors are changed as they move in to the home, permission is obtained in writing, and their new doctors details clearly stated on their care plan. This is to avoid communication break down when for example, people are admitted to hospital and their doctor needs to be contacted. What the care home does well:
Care Homes for Older People Page 6 of 12 We spoke with four of the people whose medication was tracked and they expressed no concerns about how their medication is managed by staff. They said they were not rushed when taking their medication and were given a drink to take with it. One person said pain killers are always on time and brought to the bedroom. Another said the medication is given at the same time every day and diabetes is well controlled. There are clear records of all training carried out in Grace Lodge, including medication training. It was evident in the records that a lot of progress in training has been made recently which should improve staff competence and skills. 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 7 of 12 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 8 of 12 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 Medication carried over to the next month should be recorded. This will provide an audit trail to ensure people are given medication as prescribed. 30/09/2009 2 9 13 Staff should check with the 30/09/2009 pharmacy that all medication stored in the refrigerator is being stored safely and correctly. To ensure that peoples medication is effective and they are getting it as prescribed. 3 9 13 An audit of medication and medication management should be carred out at regular intervals. This will help to ensure that any issues will be identified and dealt with without delay. 30/09/2009 4 9 13 A system must be put into place and audited to ensure that when medications are 30/09/2009 Care Homes for Older People Page 9 of 12 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 received they are checked with the persons prescription and MAR sheet. This will help to lessen the risk of errors are occuring and ensure people are getting their medication as prescribed. 5 9 13 A system must be put into place and audited to ensure that when new medications are prescribed there are sufficient stocks to last until the next delivery. This will ensure that people are getting their medication as prescribed. 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 30/09/2009 1 9 A stock check should be carried out on dressing held in the home. Where they are no longer in use or not labelled they must be returned. Staff should liaise with the pharmacist to ensure that MAR sheets do not record medications no longer in use. Staff should liaise with the hospital to ensure medications sent to take home are labelled with the persons name. This will lessen the risk of errors which could impact on peoples health and wellbeing. All staff who give out medication should have training and observation to ensure they are competent to do this safely. A record of where pain relief patches are sited should be maintained. This is to ensure they are not put on the same place and are given in accordance with pharmacy
Page 10 of 12 2 3 9 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 instructions. Care Homes for Older People Page 11 of 12 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 12 of 12 - 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!
