Random inspection report
Care homes for older people
Name: Address: Haylands 93 Crofts Bank Road Urmston Manchester M41 0US 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: Avril Frankl Date: 2 6 0 8 2 0 0 9 Information about the care home
Name of care home: Address: Haylands 93 Crofts Bank Road Urmston Manchester M41 0US 01617483185 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) : Urmston Housing Society care home 24 Number of places (if applicable): Under 65 Over 65 24 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 only - Code PC. To service users of the following gender: Male. 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: 24. Date of last inspection Brief description of the care home Haylands home for retired gentlemen is registered to accommodate a maximum of twenty-four service users who require personal care by reason of old age. The home is situated within walking distance of Urmston town centre with public transport routes close by. The building is a large detached Victorian house with well-maintained enclosed gardens. There is off road parking at the front of the property. There are fourteen single rooms and five twin bedded rooms. Two of the single rooms have ensuite facilities and there are toilets and bathrooms on each floor. A stairlift provides
Care Homes for Older People Page 2 of 11 Brief description of the care home access to all floors and there are additional toilet facilities on the ground floor with disabled access. The fees for accommodation are 250 pounds per week and the fees include all meals, laundry, domiciliary chiropody and entertainment. Additional costs include hairdressing, dry cleaning and telephone calls. Care Homes for Older People Page 3 of 11 What we found:
We visited the home because at the previous two inspections we had found some concerns in the way medicines were handled. This visit was to make sure that improvements had been made so that service users health was not at risk from poor medication practices. The visit was carried out by a specialist pharmacist inspector. The visit lasted about three and a half hours during which time we looked at medication together with records about medicines for several service users. We spoke to the registered manager about medicines handling as she was administering medicines during our visit and we gave her full detailed feedback at the end of the inspection We found that little improvement had been made since our last inspection in June 2009. Sample signatures of the staff had been updated so that it was possible to tell who had administered the medicines. Also a system of recording the date on which medication was started and what it was used for had been put in place. This was good information which explained to all staff why the service users were prescribed their medication. At the last inspection we found that the medication administration records contained a number of signature omissions or gaps, so it was not possible to tell if service users had been given their medicines as prescribed. During this inspection we found some improvement in that the number of gaps had been reduced. At the last inspection it was noted that handwritten records did not contain two signatures to confirm the administration details were correct, during this visit we also found that some of the second signatures were missing. If handwritten information is not double checked, errors which may have been made in copying out the information on the dispensing labels may go unnoticed and service users will not be given their medicines properly. At this inspection we found that some of the medication administration records were inaccurate and when compared with the stock of medicines for service users we found that some medication had been signed for but had not been given. Some records could not show that all medicines could be accounted for. At the last inspection we found that medicines were not always recorded when they arrived in the home, making it difficult to keep track of medication. During this inspection we found that no record had been made of any medicines which had been received into the home for a new service user. There was also no record of any medication which had been given to this gentleman since his arrival in the home the previous day. It is very important that accurate records about medicines are kept so that it is possible to tell exactly what medication has been given to service users in order to avoid doses of medicines being missed or given too often. It is also important that the records show that all medicines can be accounted for to show that they have not been mishandled. We looked at the way medicines were supplied to the home in. Most medicines were supplied in a monitored dose system; however the system in use was not the best design for use in a care home. The easiest system to use is one where each tablet is
Care Homes for Older People Page 4 of 11 packaged in its own blister so that it is possible to identify the individual tablets. In the current system more than one tablet was supplied in each blister without any means of identifying each tablet or capsule. When medication doses were changed or stopped, the blisters had to be opened by staff and tablets removed or added and resealed using sticky tape. The package in which the pharmacist supplies medication must not be tampered with by care staff as they do not have the skill or qualifications to re package, dispense, medication. We found that staff had placed 7 unwanted tablets of the same medication in one blister; this is seen to be dangerous practice as the medication could have been administered in error. It is important that the way medicines are supplied to the home is looked into urgently so that service users health is not placed at risk We also found a number of tablets placed in a small tablet dosette box which was unlabelled and the manager could not explain why they were in the dosette or to whom they belonged. All medication must be accounted for to ensure it is not misadministered. The arrangements for storage for some drugs were poor. We found tablets which needed to be stored in a fridge had been stored at room temperature. There was no lockable medication fridge for such medication to be stored in. Although there were no controlled drugs, powerful drugs, which need special secure storage, in the home during our inspection there were no facilities to store them should they be prescribed. All care homes must have a special controlled drugs cabinet which meets current legislation. Some service users were not given their medicines properly because staff failed to follow the directions printed on the labels. Some medication had special directions to administer before food, during this inspection we saw such medicines had been administered with food. This was also a concern at previous inspections. If directions on how to give medicines are not followed carefully the service users health may be at risk, as the medication may not work well. At the previous inspection it was identified that arrangements needed to be put in place to make sure that staff who have responsibility for administering prescribed medicines are competent, able, to do so safely. However the manager told us that staff had not had their competency assessed. If staff are not competent in handling all aspects of medication the health and well being of service users could be at risk. The manager told us all staff who handled medication did medication training after the inspection in June 2008. The manager also told us that she had not undertaken formal audits, checks, to ensure that service users were being given their medicines properly or that all medication could be accounted for. As a result of failing to do formal audits the quality of medication handling could not be assessed and service users health may be at risk What the care home does well: What they could do better:
The standard of record keeping must be improved so that records can show exactly what medicines have been administered to service users. The records must also be able to
Care Homes for Older People Page 5 of 11 show that all medication can be accounted for. Medicines must be stored properly; if medicines are not stored at the correct temperatures they may not work properly. Staff must not tamper with the packing in which medication is supplied in by the pharmacy by adding or removing medication. This activity is called secondary dispensing and is considered a high risk activity: to avoid this it is important that a different packing system is urgently looked at. All medicines should be given as prescribed and this includes carefully following the additional instructions printed on the dispensing labels. Staff who administer medication must be assessed as competent in doing so. The manager must put in place an efficient auditing system to ensure that service users health is not placed at risk form harm. 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 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 9 13 (2) The registered manager 31/07/2008 must make sure that medication administration procedures are carried out in a safe and appropriate manner thereby ensuring that service users receive the right medication. The registered person must make sure that the building complies with fire safety regulations at all times and cease wedging doors open. In order to minimse the risk of smoke inhalation and the spread of fire in the event of a fire emergency. 23/07/2009 2 19 23 Care Homes for Older People 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 9 13 There must be effective systems in place to ensure staff that handle medicines are competent to do so safely. To help make sure that people who live in the home are kept safe There must be effective systems in place to audit medication. To help make sure that medicines are handled safely and to make sure that people who live in the home are kept safe. 14/09/2009 2 9 13 14/09/2009 3 9 13 All medicines must be stored 01/09/2009 safely and securely. Medicines must be stored safely and at the correct temperatures so they can not be mishandled and so that they work properly. Provision for the storage of medicines
Care Homes for Older People 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 under the in accordance with the Misuse of Drugs (Safe Custody regulations) must be made. 4 9 13 Secondary dispensing must cease. 01/09/2009 This is a high risk activity and service users health and well being may be put at risk. 5 9 13 Clear and accurate records of 01/09/2009 medicines received into, administered and disposed of by the home must be maintained. So that medicines can be fully accounted for to prevent mishandling and to show that they are being given correctly so service users health is not at risk form harm 6 9 13 Medicines must be given to service users as prescribed. 01/09/2009 Because receiving medicines at the wrong dose, wrong time or not at all can seriously affect their health and wellbeing. Care Homes for Older People Page 9 of 11 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 Care Homes for Older People 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 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 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!
