Random inspection report
Care homes for older people
Name: Address: Hillcrest Care Home Wear Street Jarrow Tyne And Wear NE32 3JN 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: Michael Earnshaw Date: 2 4 0 8 2 0 1 0 Information about the care home
Name of care home: Address: Hillcrest Care Home Wear Street Jarrow Tyne And Wear NE32 3JN 01914890200 01914286343 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Jaqueline Karen Wallace Type of registration: Number of places registered: Conditions of registration: Category(ies) : Hillcrest Care Homes Limited care home 49 Number of places (if applicable): Under 65 Over 65 0 49 dementia old age, not falling within any other category Conditions of registration: 49 0 The maximum number of service users who can be accommodated is: 49 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 - maximum number of places 49 Dementia Code DE, maximum number of places 49 Date of last inspection Care Homes for Older People Page 2 of 9 Brief description of the care home Hillcrest Care Home is a purpose built three-storey building located within the busy town centre of Jarrow. The building has 49 single bedrooms all of which have an ensuite bathroom. Access around the building is made easier by a passenger lift or there are two staircases, which are located at either end of the building. There are a number of communal areas, such as lounges, dining rooms and quiet areas. A fireplace with surround and easy chairs is located in the corridors of both the first and second floor and provides a popular place where service users can choose to spend their time. A staff call system, which is accessible to the service users, is provided in all parts of the home. The laundry and staffroom are located on the second floor of the home. There is a garden to the rear of the home and parking facilities are available for the convenience of visitors. The home is registered to provide care to 26 people who have varying degrees of dementia and 23 people who are elderly. Fees for the home vary further information is available from the home. Additional charges are made for toiletries, newspapers magazines, and hairdressing. Items, which are included in the cost, are listed in the home s terms and conditions. Care Homes for Older People Page 3 of 9 What we found:
The reason for this inspection was to check compliance with two Statutory Requirement Notices issued to the provider on 23 July 2010 which related to the handling of medicines within the service. A Statutory Requirement Notice is a legal notice which is served on the provider when there has been a breach of regulations. The notice describes which regulations have been broken and what the provider must do to put right the breach; it also gives the date by which it must be done. We must then follow up the notice by visiting the service to make sure that actions have been taken to meet the requirements and regulations. The requirements made in these notices were made to make sure that residents health was not at risk from poor management of medicines. The service was required by 9 August 2010 to: Put in place effective arrangements to ensure that all medication is safely administered to service users in accordance with the prescribers directions. Put in place effective arrangements to ensure that clear and accurate records for all medicines received into the home and administered to the service users are maintained, including reasons for non-administration. Put in place effective arrangements to ensure that all medications are stored correctly and are organised so that staff can find them and administer them in accordance with the prescribers directions. Put in place effective arrangements to ensure sufficient stocks of medicines are kept in the home so that medication is administered to service users in accordance with the prescribers directions. A pharmacist inspector spent seven hours in the home and the inspection involved looking at medication ordering, storage and disposal arrangements, examining the current and previous months Medication Administration Records (MARs), and speaking to the acting manager and senior care staff. We counted a sample of medicines on both floors of the service and checked them against receipt and administration records to check that medicines were being given correctly as prescribed. We also considered systems put in place by the service provider and the services own internal medication audit process for evidence of compliance with these notices. We looked at a sample of current MARs for the period 16 August to 12 September 2010 and the previous MARs for the period 19 July to 15 August 2010. The home has put in place a system to frequently monitor the running balances of medicines that are not supplied in monitored dose system packs. In addition, a check of all MARs has been introduced as part of the handover procedure when staff change shift, although we saw that this was not yet fully operational at every handover. We found that all medicines administered from monitored dose system packs had been
Care Homes for Older People Page 4 of 9 correctly selected and recorded, and where medicines had not been given we found there were appropriate records indicating why they had not been administered. Codes used to record non-administration were clearly recorded. There were records for the quantities of any medication carried forward from the previous month and no omissions in records for the receipt of medicines. We found no discrepancies in any of the medicine counts when compared to the quantities received and administered. These findings indicate that people living in the home are getting their medicines as prescribed. We found written guidance for staff of the timing of medicines administration in relation to food within each MAR file. MAR files were clearly labelled with any special administration requirements. A separate early morning administration round is now undertaken to administer any medication which needs to be taken before food at breakfast time. We observed, on arrival at the home, that medication prescribed in this way had already been administered that morning and recorded in line with the prescribers instructions. We did find some small discrepancies between the quantities of some nutritional supplements and the administration records but it was not possible to confirm these because the pharmacy had not labelled all individual containers with the persons name. We found no evidence of any medicines being out of stock although a supply of Paracetamol tablets for one person had been returned to the pharmacy for repacking and was not available to administer, if required, for the morning of the first day of the current monthly cycle. The supply had been returned in time for a teatime dose to be given. We noticed one gap on the MARs where a single early morning dose of medication to reduce gastro intestinal irritation had not been administered on the day of the inspection, and a count of the remaining stock confirmed this. We also found one dose of a water tablet had been recorded as not being available to administer despite a supply being continuously available in the medicines trolley. The acting manager was aware of this non- administration and had taken appropriate action to prevent any recurrence. Some MARs were not secure within the ring file because no holes had been punched in the MARs or the holes were damaged. If all the MARs for a person are not held together securely there is a risk that some medication may be overlooked, particularly if staff are not familiar with people living in the home. We also found one MAR without a photograph of the service user attached which can increase the risk of medicines being given to the wrong person. A small number of handwritten entries on MARs had not been signed and dated by a witness to confirm that the entries were accurate and complete. All medicines, including those requiring refrigeration, were stored securely and within the temperature range recommended by the manufacturer. The medicines fridge, although in a secure room, was not locked at the time of the inspection because the lock was faulty. The acting manager was aware of this and arrangements were in hand to replace the lock. Medicine cupboards and trolleys were tidy and well organised which helps improve stock control and when locating medicines for administration. Care Homes for Older People Page 5 of 9 When we discussed the findings of our inspection with the acting manager we asked how the improvements that had taken place to date would be maintained. She responded by telling us that the level of medication audit currently in place would continue whilst additional permanent nursing staff were being recruited, and the programme of additional medication training and assessment of competence had been completed for all staff handling and administering medicines. In view of the improvements we found the Commission does not intend to take further action in relation to the statutory requirement notices on medication at this time. What the care home does well: 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 6 of 9 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 9 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 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 Confirmation should be obtained from the local police controlled drugs and chemicals inspector that the current controlled drugs cabinet meets legal requirements. The pharmacy should be requested to label individual containers of nutritional supplements to assist when checking administration records. Staff should sign and date each handwritten entry they make on the MAR. Each entry should be checked and countersigned by a second competent person to ensure that it is complete and accurate. A uniform practice should be adopted by all staff when recording the disposal of medicines which have been refused. A photograph of each service user should be kept with the persons MAR to assist in identification. 2 9 3 9 4 9 5 9 Care Homes for Older People Page 8 of 9 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 9 of 9 - 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!
