Random inspection report
Care homes for older people
Name: Address: Heathlands Station Road Pershore Worcs WR10 1NG three star excellent 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: Morag Ross Date: 1 0 1 1 2 0 0 9 Information about the care home
Name of care home: Address: Heathlands Station Road Pershore Worcs WR10 1NG 01386562220 01386550409 heathlands@heart-of-england.co.uk www.heart-of-england.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Dawn Jeanette Hooper Type of registration: Number of places registered: Conditions of registration: Category(ies) : Heart of England Housing and Care Limited care home 60 Number of places (if applicable): Under 65 Over 65 0 60 0 dementia old age, not falling within any other category physical disability Conditions of registration: 60 0 60 The maximum number of service users who can be accommodated is: 60 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 (OP) 60 Dementia (DE) 60 Physical Disability (PD) 60 Date of last inspection 0 5 0 5 2 0 0 9 Care Homes for Older People Page 2 of 11 Brief description of the care home Heathlands is a purpose built home situated close to the town centre of Pershore. It is located within walking distance of the town centre where there are shops, restaurants, public houses, churches and good pubic transport. The home is built on two floors with a passenger lift to each floor and is arranged in units. All bedrooms are single and with en-suite toilets and showers. Adapted bathrooms are available on each floor and each unit has a communal lounge, dining and kitchenette facilities. The home is registered to provide a residential care and respite service for up to sixty older people who may have physical disabilities and/or mental health needs. A separate eight-bedded unit provides a service to older people with dementia type illnesses. A separate day care unit provides a service five days each week to older people living in the community The registered providers are Heart of England Housing and Care Ltd. The registered manager is Dawn Hooper. Information regarding the home is available in their Statement of Purpose and Service Users Guide. Copies of these and the inspection reports are available in the homes reception and on request. Alternative formats can also be provided. The current fees are available upon request from the home. Care Homes for Older People Page 3 of 11 What we found:
The pharmacist inspector visited the home on 10th November 2009 to undertake a random inspection to check the management and control of medicines within the service. A random unannounced inspection on 5th May 2009 had identified that medication management systems needed to be improved.We received an action plan from the service which stated that there would be a System in place and training completed by 31/10/09. The purpose of this inspection was to check compliance with the requirements relating to medication. We arrived at 10.45am and stayed until 2.30pm. We looked at medication storage on Bredon and Severn unit, some care records and medication administration records. We spoke to staff and the manager. The manager informed us that the medication management system had broken down but this was being looked at by two medication managers from another two Heart of England homes on 18th and 19th November 2009. We found that medication requiring special secure storage was stored in a cupboard that met the requirements of the Misuse of Drugs Act 1971, the Misuse of Drugs (Safe Custody) Regulations 1973. This had been a requirement at the inspection on 5th May 2009 and had been met. We found that the storage temperatures of medicines were not being monitored each day and medicines were not being stored at the correct temperature, which had also been identified at the previous inspection on 5th May 2009. For example, on Bredon and Severn unit staff were not monitoring the temperature of the room where medication was being stored on a daily basis. We saw temperature records for October 2009. There were nine temperature readings recorded and 21 gaps in the record with no temperature reading recorded. Medication should be stored below 25 degrees centigrade. Five out of the nine room temperature readings were above 25 degrees centigrade. There were no records available for November 2009. A member of staff informed us that the room did get very hot and stuffy. We looked at the temperature records available for the refrigerator on Bredon and Severn unit. There were 12 temperature readings recorded and 18 gaps in the record with no temperature reading recorded.There were three records documented for November 2009. Medication requiring refrigeration should be stored between two to eight degrees centigrade. The three temperature records for November were above the safe storage range for medication. No action had been taken to ensure the medication was stored correctly. This means that peoples medication was not stored correctly within the recommended temperature ranges and increases the risk of deterioration making the medicine ineffective and possibly harmful to the people they are being given to. We looked at the medication administration records (MAR) on Bredon and Severn unit. We found gaps on the medication charts where there were no signatures for administration of the prescribed medicine. This had also been identified at the previous inspection on 5th May 2009. For example, there were no signatures for four medicines which should have been given in the morning for an identified person on 4th November 2009. There were also no signatures for one of the medicines at bedtime on 3rd and 4th November 2009. It was not possible from the records to determine whether medication had been given or not. We checked the medication blister pack and saw that medication
Care Homes for Older People Page 4 of 11 had been removed from the container on 3rd and 4th November. This means that due to a lack of records it was not always clear if people had been given their medicines as prescribed. We saw that some medication administration records were handwritten, however there was no checking system in place to ensure that the record was accurate. For example, we saw a handwritten record for a prescribed cream, however it had not been signed or double checked to ensure it was accurate.We saw a second MAR chart for the same person, which had been printed by the supplying pharmacy. This MAR chart also had the same prescribed cream printed on it. This means that there were two MAR charts for the prescribed cream for the same person. We saw that staff had signed both charts but at random and we saw gaps in the records. It was not clear which record was being used. We spoke to a member of staff who had not been aware of the two records and agreed that it was not clear. This means that there is an increased risk of a medication error and poor records. We found that information for the use of medication prescribed to be given when required was not up to date. This had been identified at the previous inspection on 5th May 2009. For example, we saw that some people were prescribed medicine to help control their behaviour, which was to be given on a when required basis, however there was not enough information about why and when the medication should be given. We saw that one person was prescribed a tablet to be given three times a day when required for anxiety. We saw that the MAR chart was signed for administration three times a day on a regular basis.There were no written procedures for staff to follow to ensure that the medication was given according to a behaviour management plan. We saw the persons care plan for behaviour dated 22/11/08 and reviewed 08/09/09, which stated Has no behaviour issues. We spoke to a member of staff who informed us that the person does get anxious in the morning and the medication calms them down. There was no written record available to show why the tablet was being administered on a regular basis. We found that the homely remedies list of medication had been reveiwed by the General Practitioner. For example, we saw that one person had a review of their homely remedies on 26/05/09. This means that medication required for a minor ailment had been recently reviewed and agreed with the General Practitioner. We asked to look at how oxygen was stored and handled within the service because this had been a requirement made at the previous inspection on 5th May 2009. We were informed by the manager that there was no oxygen stored in the service. We found that three out of the four requirements for medication under Regulation 13(2) had not been met. We discussed the possible outcomes with the manager during the inspection. What the care home does well: What they could do better:
The service needs to ensure that staff accurately record the administration of medication
Care Homes for Older People Page 5 of 11 to people living in the service. This is in order to ensure that medication records accurately reflect what medication has been administered to people. The service needs to ensure that care plans document any new prescribed medication or any changes made to peoples medication including reasons to give any when required or as needed medication to ensure staff can follow clear directions. The service needs to ensure that medication is stored at the correct temperature to prevent deterioration. Medication stored at the wrong temperature may make it ineffective. The service needs to ensure that any handwritten medication administration records are double checked in order to ensure the record is accurate. The service needs to ensure that medication is always handled and administered in accordance with the medication policy and follow good practice guidance so that people receive medication as prescribed and are protected from 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 Regulation 13.2 To make 26/06/2009 arrangements to ensure that care plans include detailed information and instructions for staff in respect of the administration and management of medicines, including the reasons to give medicines on a when required basis and what constitutes needed for a named person. To ensure staff know when and how to give the medication. 2 9 13 Regulation 13.2 To make arrangements to ensure the administration of all prescribed medication is recorded on the medication records. To ensure people living in the home are receiving the medication as prescribed. 26/06/2009 3 9 13 Regulation 13.2 To make 08/07/2009 arrangements to ensure that medication is stored securely and at the correct temperature recommended by the manufacturer. To ensure medication does Care Homes for Older People Page 7 of 11 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 not deteriorate which can make the medication ineffective and possibly harmful to people living in the home. 4 38 13 Regulation 13.4 A risk 26/06/2009 assessment must be done to assess the safety of the storage of oxygen in peoples bedrooms when in use and take action according to the outcome of the risk assessment. To ensure the safety of the staff and people living in the home. Care Homes for Older People Page 8 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 Regulation 13.2 To make arrangements to ensure the administration of all prescribed medication is recorded on the medication records. To ensure people living in the home are receiving the medication as prescribed. 11/12/2009 2 9 13 Regulation 13.2 To make 11/12/2009 arrangements to ensure that medication is stored securely and at the correct temperature recommended by the manufacturer. To ensure medication does not deteriorate which can make the medication ineffective and possible harmful to people living in the home. 3 9 13 Regulation 13.2 to make 11/12/2009 arrangements to ensure that care plans include detailed information and instructions for staff in respect of the administration and
Page 9 of 11 Care Homes for Older People 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 management of medication, including the reasons to give medicines on a when required basis and what constitutes needed for a named person. To ensure staff know when and how to give medication. 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!
