Inspecting for better lives Random inspection report
Care homes for older people
Name: Address: Hinderton Mount Chester High Road Neston South Wirral Cheshire CH64 7TA The quality rating for this care home is: The rating was made on: two star good service 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 assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. 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: 1 3 0 1 2 0 0 9 Information about the care home
Name of care home: Address: Hinderton Mount Chester High Road Neston South Wirral Cheshire CH64 7TA 01513361019 01513531619 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Weatherstones House Care Ltd care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category 0 Over 65 26 Conditions of registration: This home is registered for a maximum of 26 service users to include: * Up to 26 service users in the category of OP (old age not falling within any other category) may be accommodated * Within the maximum of 26, one named service user in the category of LD (learning disability) may be accommodated Date of last inspection Brief description of the care home Hinderton Mount has been operating as a care home since 1985. Weatherstones House Care Limited has owned and run it since 1998. The home is a converted large house, providing 26 places for older people. It is situated on Chester High Road, a mile-and-ahalf from Neston town centre, and close to a pub and service station with a shop. The twenty-two single and two double bedrooms all have ensuite toilets and washbasins. There are two lounges - one with a large conservatory extension - and a separate dining room. The home has very pleasant and well-maintained gardens/grounds to the Care Homes for Older People Page 2 of 11 front and side, as well as adequate car parking. The fees range from £353.61 to £468.00 per week. Additional charges are made for hairdressing, chiropody, visiting entertainers and outings. The last inspection report is available from the manager on request. Care Homes for Older People Page 3 of 11 What we found:
We visited the home because we had received some concerns from relatives that medicines were not being given to residents properly.The visit was carried out by a pharmacist inspector. It lasted approximately 9 hours during which time we looked at medication and records about medicines and care plans for six people. We also talked to the manager and assistant manager. Detailed feedback was given to the manager and the group manager at the end of the inspection. Overall we found some poor practice when handling medicines that could seriously affect the health and wellbeing of people who live in the home. We found that the home was using an old fashioned system to administer medicines. The medicines for each dosage time are dispensed in a sealed bubble. This makes it difficult for staff to select individual tablets that need to be given outside the main times of medicines administration. In order to give a specific tablet the bubble needs to be opened and the remaining tablets must be put in a pot for administration at a later time. This is practice is unsafe as tablets can easily get muddled up if they are not kept in the original labelled packing supplied by the pharmacy. The staff who worked at night were not trained to give medicines, so day staff put doses of medicines in small pots for night staff to administer to residents during their shift. This practice is very unsafe as medicines could be given to the wrong people or not given at all. We made an immediate requirement that this practice of secondary dispensing must be stopped and that suitably trained staff must be available in the home at all times of day and night to ensure that medicines can be given safely. The staff were seen to be kind and thoughtful to residents when they gave medicines to them. Some people preferred to take their medicines in the privacy of their own room and we saw that medicines were taken to them in their rooms. Staff also made sure that people who chose to take their medicines later than other people were given their medicines at the time they preferred. Some people choose to look after their own medicines and we found that staff supported them to do this safely, however it is recommended that better records are kept of how they check that people are taking their medicines properly and any extra help they may need to stay safe. We looked at a sample of medication records and medicines held in the home for six people. We saw staff had signed the records to indicate that medicines had been administered but the stock levels showed that they had not been given. When medicines are not given as prescribed residents health could be placed at risk. We also found that some medicines had been given but no record had been made of them being administered. Records about creams were very poor and it was not possible to tell if they had been applied properly. When we looked at the medication administration records together with records of receipt and disposal not all medicines could be accounted for especially analgesics. When medicines are missing peoples health could be placed at risk from harm. Some medicines have special directions relating to how they should be given, for example some medicines can not be given at the same time as other medicines or Care Homes for Older People Page 4 of 11 should be given before food. We found that these special directions were not always followed. When directions are not followed properly the medicines may not be fully effective or serious side effects may be experienced. One resident was given medication which was out of date and we found some other medicine which had not been administered but was out of date. Residents health could be at risk if medicines are out of date. Some people did not have all their medication available in the home either because it had run out or had not been ordered. Health and wellbeing could be affected if medicines are unavailable to be given as prescribed. The manager told us that she had audited medication about three months previously, but she had not made a formal record of the checks she had made or the actions she had taken. It is important that the results of audits and the actions taken as a result are recorded to help reduce risk of the same concerns happening in the future. We also looked at care plans and professional notes to check if medicines were reflected properly in them. We found that there was no formal system to record how to give medicines which are prescribed on a when required basis or how to record medication when residents were away from the home. If this information is clearly written in the care plans then it helps make sure that people are given medicines when they are needed. However we did find some very good records in the professional visit notes which detailed the doctors directions and the reasons why certain medicines were needed. This information helped make sure that everyone looking after those residents could do so consistently. We checked how controlled drugs ( powerful medicines which could be misused) were handled. We found that the cupboard used for storage of these drugs did not meet current legislation however the records about these drugs were clear and accurate and showed that the drugs could be accounted for. We looked at the storage arrangements for other medicines and found that they were stored in an organised way and the storage facilities were clean and tidy.However the room double as a hairdressing salon and recommended that the medicines should be stored in a separate place. We found that when medicines needed to be stored in a fridge the staff room fridge was used, this is not an appropriate place to store medicines and such medicines must be stored in a lockable dedicated medicines fridge. We asked when staff had last received formal medicines training. We did not see formal training records but the manager and assistant manager confirmed that training had been attended about a year ago and that no formal competency assessments had been done to make sure staff could handle medicines safely. We saw some poor and outdated practices during our inspection and staff would benefit from updated training and regular competency checks on staff to make sure that have the skills to handle medicines safely. Throughout the inspection we found the manager to be open with us and she accepted that some aspects of medicines handling were poor and must be improved. During the inspection the manager acted promptly to try and address some of the concerns we highlighted. She arranged for the pharmacist who supplied the home with medicines to Care Homes for Older People Page 5 of 11 visit , during the inspection, so that they could discuss the implementation of a new medication system and to arrange medication training for all staff. The manager told us that the new system would be in use within the next 4-6 weeks and staff would receive training on this new system and further generalised medicines training. 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 11 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set.
No. Standard Regulation Requirement Timescale for action 1 9 13 Residents must receive their medicines as prescribed; stocks of medicines must be adequate and the medicines are offered later (if possible depending on a particular medicine) if a resident is asleep. 14/12/2007 2 12 16(2)(n) Suitable activities to keep 14/01/2008 residents active and stimulated must be provided regularly. (Timescale 28/02/07 not met) An application for the manager to be registered must be made to CSCI. 14/03/2008 3 30 8(1) & (2) 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 1 9 18 You must ensure there are 23/01/2009 suitably trained and qualified staff on duty at all times specifically staff that are trained in medication handling. To ensure the health and wellbeing of people who live in the home is protected. 2 9 13 Records of administration must be signed by the person administering the medicines at the time they are given. To make sure the records accurately show who gave medication to the resident. 23/01/2009 3 9 13 You must cease secondary dispensing. To ensure that residents health is not placed at risk from harm 23/01/2009 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 Staff must be trained to 23/01/2009 administer medication safely and be assessed as competent to do so. This will ensure that Care Homes for Older People Page 8 of 11 residents are given their medicines properly and their health and wellbeing is not put at risk. 2 9 13 All medicines must be stored 23/01/2009 safely and securely and that controlled drugs are stored in a cabinet with meets current legislation. This is to help ensure that medicines are not mishandled or misused. 3 9 13 Records about medicines must be accurate. This will help show that medicnes are administered properly and that medicines can be accounted for. 4 9 13 A formal auditing and 23/01/2009 checking system must be put in place. This will ensure that medicnes are handled safely and that staff have the necessary skills to do so safely. 5 9 13 Medicines must be given to residents as prescribed. When medicines are not given at the right time, in the right dose or at all residents health could be seriously affected. 6 9 13 Medicines must be in date 23/01/2009 when they are administered. To prevent residents health being put at risk of harm Recommendations These recommendations are taken from the best practice described in the National 23/01/2009 23/01/2009 Care Homes for Older People Page 9 of 11 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 CSCI 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: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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) Commission for Social Care Inspection (CSCI). 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 CSCI 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!
