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: Sandra Bromige Date: 0 5 0 5 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): 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 60 60 60 dementia old age, not falling within any other category physical disability Conditions of registration: 0 0 0 The home may accommodate three named people under the age of 65. The property is not used for any purpose other than that of a care home, without appropriate consultation and agreement from the CSCI. Date of last inspection 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. Care Homes for Older People Page 2 of 11 Brief description of the care home 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 post is curently vacant. 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 quality rating for this service is three star excellent service. The rating was made following a key inspection carried out on 22nd August 2007. The quality rating will be reviewed at the next key inspection. We did this inspection as we had been told about three medication errors in the home in February and March 2009. We wanted to look at how the service are managing medication for people living in the home to make sure medication is being safely stored and administered correctly to people in the home. We looked at how the service manage medication on all four units of the home (Bredon, Severn, Allard and Cherry). What the care home does well:
The focus of this inspection was to look at the homes 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. Care Homes for Older People Page 4 of 11 What they 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 persons 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 homes 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 May
Care Homes for Older People Page 5 of 11 2009 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 records for an identified carer of any follow up after this incident. The senior carer told us it had not been followed up. None of the senior care staff spoken with were aware of the guidance referred to in the National Minimum Standards for Older People from the Royal Pharmaceutical Society of Great Britain and were unable to locate a copy of this guidance in the home. We showed the senior staff how to obtain this guidance from the Internet. We looked at the Heart of England Housing and Care medication policies and procedures. This was due for review in February 2009. The policy in use in the home was dated February 2007. 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 £ 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 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 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 2 9 13 Regulation 13.2 26/06/2009 To make 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. 3 9 13 Regulation 13.2 To make arrangements to ensure that medication is 08/07/2009 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 stored securely and at the correct temperature recommended by the manufacturer. To ensure medication does not deteriorate which can make the medication ineffective and possibly harmful to people living in the home. 4 9 13 Regulation 13.2 To make arrangements to ensure that controlled drugs are stored securely in accordance with the requirements of the Misuse of Drugs Act 1971, the Misuse of Drugs (Safe Custody) Regulations 1973 and in accordance with the guidelines from the Royal Pharmaceutical Society of Great Britain. To ensure controlled drugs are being stored safely and securely to prevent misuse. 5 38 13 Regulation 13.4 A risk 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. 26/06/2009 08/07/2009 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 1 9 The use of Homely Remedies for each person living in the home should be reviewed by the General Practitioner on an annual basis to ensure they remain safe to be given and does not place them at risk of harm. Risk assessments for the use of Warfarin should be reviewed regularly and following any medication incidents to ensure the safety of the people prescribed this medication. 2 9 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!
