This inspection was carried out on 9th July 2009.
CQC found this care home to be providing an Good service.
The inspector found there to be outstanding requirements from the previous inspection
report. These are things the inspector asked to be changed, but found they had not done.
The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.
Random inspection report
Care homes for older people
Name: Address: Ladydale Residential Home 9 Fynney Street Leek Staffordshire ST13 5LF 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: Ian Henderson Date: 0 9 0 7 2 0 0 9 Information about the care home
Name of care home: Address: Ladydale Residential Home 9 Fynney Street Leek Staffordshire ST13 5LF 01538386442 01538385158 ladydale@arc-homes.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) : Aegis Residential Care Homes Limited care home 54 Number of places (if applicable): Under 65 Over 65 0 0 54 0 learning disability mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Conditions of registration: 3 10 0 54 The maximum number of service users who can be accommodated is: 54 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) 54 Mental Disorder, excluding learning disability or dementia (MD) 10 Learning disability (LD) 3 Physical disability (54) Date of last inspection Care Homes for Older People Page 2 of 11 Brief description of the care home Ladydale Residential Home is situated in a quiet, mature residential area in the historic market town of Leek. It is a well-established care home for the elderly that provides accommodation for up to fifty-four people. The main house has four floors. The majority of bedrooms are situated on the ground and first floors. A shaft lift and stair chair lift provide easy access to various levels in the home. The newer single-storey wing accommodates ten people and has its own communal lounge/dining area. Ladydale also has two small annexes, The Coach House with three semi-independent units and The Lodge with two semi-independent units. People who use the service are able to access all areas of the home as they choose. Ladydale is attractively decorated and furnished throughout to a high standard. Fifty of the bedrooms are single, two are double and 45 have en-suite facilities. Assisted bathing and shower facilities are situated throughout. The home has ample communal lounge and dining space. There are off-road parking facilities and attractive mature gardens surrounding the property with a very pleasant secluded patio area with seating. There is a comprehensive activities programme for people who use the service to access as and when they wish. Care Homes for Older People Page 3 of 11 What we found:
The reason for the visit was to check how the home was progressing in meeting the requirements made at the key inspection on the 21st May 2009. We found that the home was failing to record the receipt of all medication received into the home. We found that medication which had been carried over from previous months had not been accounted for in the records and therefore as a consequence the home did not know whether this medication was being used appropriately. When comparing the Medicine Administration Records (MDS) with the medication in the Monitored Dosage System (MDS) it appeared that this medication was being administered as prescribed. However due to the failings in the recoding of the receipt of medicines and a carrying forward system not being in place the auditing of the non MDS medicines was not possible. Therefore the home was not able to demonstrate that this medication was being administered as prescribed. We also found that where medication had not been administered the home was failing to use an appropriate abbreviation to identify the reason for the non-administration. We found that one person living in the home had been prescribed an inhalers which had the directions of two puffs to be inhaled when breathless coughing or wheezing. We found that the inhaler was being administered twice a day on regular basis but we found no written evidence that the inhaler was needed that frequently. The Deputy Manager said that the doctor had told the staff to administer it regularly twice a day but again there was no written evidence that the administration taking place had been clarified with the doctor. We found that the service had recently introduced a separate administration sheet to record the administration of creams and ointments by the care staff. The Manager said one of these sheets was kept in each persons room so that the carers could sign them when they had administered a cream or ointment. The Manager said that her senior carers had assured her that these record sheets were being completed properly. On examination of these records we found that they were not being completed indicating that the staff were not applying the creams and ointments as prescribed. We found that a moisturising cream had been prescribed to an individual living in the home and the directions on the label stated that it was to be applied twice a day. The administration sheet had only been signed once since the start of the sheet three days ago. We also found that another person had been prescribed a steroid cream which the Deputy Manager had said that it was for the District Nurse to use. We found this cream in an unlocked draw in the person room. We also found that the administration sheet had been signed once indicating that a member of staff had applied the cream. We also found that the staff member had signed the wrong day because we were examining this record at teatime yet the record had been signed for the night time of the day of the visit. We found overall that the care plans were poor for containing information about the administration of medicines. In particular we found little or no information about how and when medicines prescribed on a when required basis should be administered. We found very little information about the reasons for the administration of the medication and where appropriate the length of treatment, in particular the administration of medicated creams. Care Homes for Older People Page 4 of 11 We found that a number of people who were using the service were holding and administering part of their own medication. We found that there was no documented assessment of the risks to either the people themselves or other people in the home associated with this activity. We also found that there was no monitoring programme in place to ensure that the people were administering the medication as prescribed by the doctor. We found that following the key inspection the carers had received training on the application of creams and ointments by a nurse from one of the local medical practices. The service had also arranged for further training to be undertaken by the carers. We found that none of the staff had undergone any assessments to establish whether they were able to administer medication safely and in accordance with good administration practices. In light of some of the issues identified during the inspection the assessment of the care staffs competency to administer medication safely must be carried out as soon as possible. We found that the service was measuring and recording the maximum and minimum temperatures on a daily basis. We found on the day of the visit that the maximum and minimum temperatures were within the accepted range of between 2 and 8 degrees centigrade. However on the previous five days the minimum temperature had been measured and recorded at 1 degree centigrade. The home was advised that as a consequence of the low temperature the contents of the fridge should be discarded and new supplies sought. The home was also informed that they must also ensure that the temperature of the fridge is maintained at between 2 and 8 degrees centigrade so that the risk to medication loosing its potency or becoming contaminated is reduced. We also found it concerning that neither the Manager nor the Deputy Manager had been informed about the fridge temperature being outside of the accepted temperature range. On examination of the contents of the fridge we found a liquid medicine that was out of date. This liquid medicine had not been opened and we were informed that the current bottle being used was being stored in the trolley. This lead us to go and examine the trolley and we found that the bottle in use had expired on the 20th May 2009. We also found that some antibiotic eye drops that required storage conditions of the fridge had not been stored in the fridge at all. We also found two medicines in the trolley that after six weeks of opening had to be discarded. We found that the home had not identified when these medicines had been opened and with the dispensing dates being the beginning of May potentially these medicines could also have been out of date. What the care home does well: What they could do better: Care Homes for Older People Page 5 of 11 The service needs to ensure that the administration records can demonstrate that the people who are using the service are having their medicines administered as prescribed. The service needs to ensure that the care plans have detailed information about the administration of medicines. The service must ensure that all medicines are in date and are stored at the correct temperature. The service must ensure that the staff administering medication to the people who use the service are safe and competent to do so. 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 12 Regulation 12(1)(a) & 14/09/2009 18(1)(c)(i). All staff responsible for the administration of medicines, including creams and drops, must receive training and be assessed as competent to do so. This will ensure that people who use the service are supported by trained and competent staff. 2 9 12 Requirement 12(1)(a) & 13(3). The service must ensure that arrangements are in place for the safe storage of all prescribed medicines including creams and liquid medicines. This will ensure that prescribed medicines are only accessible to persons for whom they are prescribed. 14/09/2009 3 9 12 Requirement 12(1)(a) & 14/09/2009 13(2). Arrangements must be in place for the recording, handling and safe administration of all prescribed medicines in the care home. This will ensure that people 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 who use the service receive their medicines as prescribed. 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) The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Appropriate information relating to medication must be kept, for example, in risk assessments and care plans to ensure that staff know how to use and monitor all medication including when required as directed and self administered medication so that all medication is administered safely correctly and as intended by the prescriber to meet individual health needs. 14/09/2009 2 9 13 Regulation 13(2) The registered person shall make arrangements for the recording, handling, safekeeping, safe 14/09/2009 Care Homes for Older People Page 9 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 administration and disposal of medicines received into the care home. The service must ensure that all medication is in date and is stored at the correct temperature recommended by the manufacturer. 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!
