Inspection on 05/05/09 for Heathlands
Also see our care home review for Heathlands for more information
This inspection was carried out on 5th May 2009.
CQC found this care home to be providing an Excellent service.
The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.
Other inspections for this house
What follows are excerpts from this inspection report. For more information read the full report on the next tab.
What the care home does well
The focus of this inspection was to look at the home`s policies and procedures for the management of medication. Because of this we did not look at all aspects of the service and may therefore not have identified other positive things about the home. The medication trolleys on all of the units were clean and well organised. Medicines prescribed by the General Practitioners are obtained from a local pharmacy every four weeks. We looked at the medication administration records for four people living in the home, one from each unit. We saw that the staff record the amount of medication they receive from the pharmacy on the medication chart and also record how much of each medication they have in stock. This enables the staff to check to see if the medication is being given to people as prescribed by the General Practitioners. The medication charts were all printed by the pharmacy and clearly stated each persons name and personal details including any allergies they may have. Photographs were seen for all four peoples medication we looked at so that staff can make sure they are giving the medication to the correct person. Each unit had a list of staff signatures with the medication charts so the staff initials on the medication charts can be identified. The keys for the medication trolleys and cupboards are held by the Lead Carer for each unit at all times to make sure medication cannot be accessed by people who are not authorised to do so. The medication trolleys on Bredon, Severn and Cherry units were all seen to be secured to the wall when not in use to prevent people who are not authorised taking the medication trolley out of the units. Eye preparations, creams and ointments were being stored correctly when in use and dated when they are opened to make sure they are are renewed according to medication guidance, for example eye drops should be renewed 28 days after opening. Medication needing to be stored in a refrigerator was seen being stored in a locked refrigerator. Monthly audits are done by two Lead Care staff to enable them to monitor the management of medication stock, administration of all medication in particular any controlled drugs in use and medication for anti coagulation treatment to prevent blood clots.
What the care home could do better:
We found the remaining stock for Fybogel prescribed for one person was incorrect. There was one less sachet of the medication than there should have been which indicates a sachet may have been used for another person living in the home. One person living in the home was applying a prescribed cream intermittently themselves, but there was no risk assessment in the care records to indicate this person was self administering this cream. One person was using oxygen. The staff told us this was prescribed by the General Practitioner although it was not on the medication chart for this person. We saw the oxygen in the person`s room. There was no prescription label on the oxygen cylinder and it was not secured in a stand to ensure it can be transported around the room and to prevent the metal cylinder falling over and injuring staff or the person using it. This was not in line with the home`s medication policy. The risk assessment for the use of oxygen for this person had been reviewed on 26/02/09 but the Lead Carer when asked said she was not sure if the stated action plan had been put into place as there was no documentary evidence showing it had been actioned. We found gaps on the medication charts where there were no signatures for administration of the prescribed medication. For example, there were no signatures for six items which should have been given at bedtime for an identified person on 1st May 2009. We saw the medication was not left in the packaging, which indicates it was given to the person but had not been signed for by the carer following administration to the person it was prescribed for. An identified person was prescribed a specialist hair shampoo, Cavilon and E45 cream. There were no signatures on the medication chart to show if it had been applied as prescribed. We found the information for the use of medication prescribed to be given `when required` was inaccurate and did not give enough information about why and when the medication should be given to ensure it is given consistently by staff when required. For example, a person was prescribed Tramadol 50mg `when required`, which is used for the relief of pain. There was no written guidance for the use of this medication and no care plan or risk assessment. We saw a written protocol form for an identified person for Paracetamol tablets `when required`, although the Lead Carer told us this person was not taking these tablets anymore as it had been changed to Paracetamol suspension to be given on a regular basis four times each day. The information had not been reviewed and updated to show the changes made by the General Practitioner. We found the `homely remedies` list of medication for one person had not been reviewed by the General Practitioner since 05/10/06. We found the medication trolley on the dementia unit was not secured to the wall when not in use and the room was left unlocked when not in use. We found the storage temperature of medicines was not being monitored each day and medicines were not being stored at the correct temperature. For example, staff were not monitoring the temperature of the rooms where medication was being stored. The records of the refrigerated medicines were seen. There were gaps in the records. On Bredon and Severn unit there were daily temperatures recorded for 2nd and 3rd May09 only and the records for April 2009 were blank for 1st - 27th April and 31st April 2009. The recorded minimum temperature for 2nd and 3rd May 2009 were 5.1 degrees Celsius and maximum temperature of 27.6 degrees Celsius, which is outside the range it should be stored at (two to eight degrees Celsius). The medicine refrigerator on Cherry unit was not in use as the recorded temperature for 4th May 2009 was minus three degrees Celsius. We were unable to locate any records of the fridge temperatures for February, March and April 2009, although the records for identified dates in January 2009 showed the temperature ranged between minus four to minus eight degrees Celsius which is outside the range it should be stored at. If medicines are not stored at the correct temperature as recommended by the manufacturer they can deteriorate making the medicine ineffective and possibly harmful to the people they are being given too. We found the storage of controlled drugs was not secure. For example, the controlled drug cabinets were not secured to a solid wall and they were screwed to the wall and not secured according to the manufacturers instructions. We found the risk assessment for the use of Warfarin for an identified person was due for review in April 2009 and this had not been undertaken. We were told of a recent Warfarin medication error for this person, the risk assessment had not been reviewed following the medication error. We looked at what action the home had taken following the three medication errors in February and March 2009 to prevent a recurrence and to ensure the safety of the people living in the home. We could not find any reco