Inspection on 23/03/10 for Lakeside House

This inspection was carried out on 23rd March 2010.

CQC found this care home to be providing an Poor 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lakeside House 28/04/10

Lakeside House 28/01/10

Lakeside House 12/05/09

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Mendip House

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Ann Charlton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 16/05/2010.

Random inspection report Care homes for older people Name: Address: Lakeside House Lakeside Lakeside House Darlington County Durham DL1 5TH zero star poor service 02/02/2010 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 3 0 3 2 0 1 0 Information about the care home Name of care home: Address: Lakeside House Lakeside Lakeside House Darlington County Durham DL1 5TH 01325286000 01325361253 lakeside.darlington@schealthcare.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) : Southern Cross OPCO Ltd care home 67 Number of places (if applicable): Under 65 Over 65 0 67 0 dementia old age, not falling within any other category physical disability Conditions of registration: 67 0 12 the maximum number of users who can be accommodates is 67 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, 67 Dementia - Code DE, maximum number of places, 67 Physical disability - Code PD, maximum number of places 12 Date of last inspection 0 2 0 2 2 0 1 0 Care Homes for Older People Page 2 of 12 Brief description of the care home Lakeside House is a purpose built care home which is able to provide both nursing and residential care to people with dementia. The home also has a unit for younger people with physical disabilities. All bedrooms have en-suite facilities and each unit has its own dining room and lounge areas. There is a private car park for visitors to use. Fees range from £490 - £503.70 for private clients and £428 for clients funded by the Local Authority. Care Homes for Older People Page 3 of 12 What we found: The reason for carrying out this inspection was to check progress made against the medication requirements issued at the key inspection on 28 January 2010 and against the contents of the subsequent Warning Letter sent following that inspection. These requirements concerned the recording, handling and safe administration of medicines in the home. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk or harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Two inspectors, one being a pharmacist inspector, spent 6 hours at the home and the inspection involved looking at medication administration records (MARs), procedures for the stock control of medication, medication audit arrangements within the service and discussion with the acting manager of the home. We found that: A new stock control procedure has recently been introduced into the home to record all stages of the ordering and receipt of medication. This record is comprehensive and enables staff working in the home to track all stages of medication supply and to confirm that all medication has been ordered correctly and received in full. The last delivery of monthly medication had not been fully documented and we were informed by the acting manager that this was the result of the senior carer involved not being familiar with the new system. A programme of additional medication training and staff supervision is underway in the home and will address these new medication procedures. The current MARs where examined and a number of medicines were counted and checked against the medication administration records. No significant discrepancies were identified although we noted occasional gaps on the MARs where medication administration had not been recorded or a non administration code added. For example, one person was prescribed a once weekly dose of Alendronic Acid but this had not been recorded on one occasion, although the medication was no longer in the monitored dose pack. For a second person a night time dose of Dorzolamide eye drops had not been recorded for 10 days since the start of the new treatment cycle, although for the whole of the previous month administration had been fully recorded by the same nursing staff. We were unable to confirm if the night time doses had not been administered, or had been administered but had not been recorded. Some entries on the MARs had been amended and a non administration code, indicating that the person refused treatment, had been added. This indicates that some staff are signing the medication record to indicate that medicines have been given, before this has been completed. This may contribute to medication error and lead to an inaccurate record of medication administration. A number of medications had been carried forward from the previous month but no record of the quantity transferred had been recorded. This means it is difficult to have a complete record of all medication in the home and to check if medication is being Care Homes for Older People Page 4 of 12 administered correctly. Two people were prescribed medication to be taken when required to help with agitation. There was no additional guidance with the MARs, or in the care plans, to assist staff in deciding when it might be appropriate to offer medication. We noted that another person was prescribed Ventolin by inhalation but only required an occasional dose. No supply was available for the first 3 days of the supply cycle although the stock control records indicated that an inhaler from the previous month had been carried forward to the current month. We were informed by the nurse on the unit that she had identified the problem and obtained a replacement inhaler, and indicated that the previous inhaler may have been discarded in error. Audit of the medication process is regularly carried out and we looked at the results of the last medication audit. This had identified a small number of discrepancies between the amount of medication received into the home, the number of doses recorded as administered, and the number of doses remaining in stock. We noted that action had been taken by the acting manager to address these issues, including weekly medication counts and the issue of written guidance to staff outlining additional checks and recording to be carried out. This should ensure that any medication discrepancies are identified and resolved promptly. 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 5 of 12 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 7 15 Service users and or their 31/03/2010 representatives must be consulted about how their health and welfare needs will be met by the home. The results of this consultation must be reflected in a written care plan. This will ensure that the service user or their representative is happy and in agreement with how their health and welfare needs will be met. 2 9 13 Arrangements must be in 28/02/2010 place to ensure that medication is given as prescribed and a record must be made at the time that it is given. This will make sure that people receive their medications correctly and the treatment of their medical condition is not affected. 3 16 17 A record must be kept of all complaints made in the home. This will ensure that an accurate record of complaints is kept and can be used to 31/03/2010 Care Homes for Older People Page 6 of 12 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 identify trends and areas for imporvement. 4 30 18 New staff must receive a 30/04/2010 structured induction programme when they commence employment with the home. This will ensure that staff know what is expected of them and enable further training needs to be identified without delay. 5 30 18 Regular staff training must 30/04/2010 be provided that equips people with the skills and knowledge that they need to meet the needs of the people they care for. This will ensure that staff skills and knowledge are kept up to date and service users are not put at risk through ignorance or poor practices. 6 30 18 Training in the administration 30/04/2010 of medication must be provided to all staff who are administering medication. This will ensure that staff giving medication know how to do it safely. 7 30 18 Infection Control training and 30/04/2010 techniques must be implemented and monitored for all staff. This will ensure that good infection control measures Care Homes for Older People Page 7 of 12 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 are in place and the risk of cross infection is reduced. 8 31 39 The Care Quality Commission 31/03/2010 must be notified of any changes to the management arrangements of the home. This will ensure that the Care Quality Commission know who is responsible for the day to day management of the home 9 33 26 Provider visit reports must be produced and a copy provided to the manager of the home. This will ensure that the manager of the home is aware of areas that need improvement and that a copy of the report can be made readily available for inspection purposes. 10 33 24 The quality of the services provided by the home must be monitored and take into account the views of service users and their representatives. This will ensure that the service provided remains acceptable to the people who use the service and their representatives. It will also highlight areas that may need to be developed to meet peoples expectations about the service provided. 31/03/2010 31/03/2010 Care Homes for Older People Page 8 of 12 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 11 36 18 Regular staff supervision 31/03/2010 sessions must take place and records kept of the outcome. This will ensure that staff receive regular feedback on their performance and are given the opportunity to raise any concerns that they may have. Care Homes for Older People Page 9 of 12 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 To make arrangements to 30/04/2010 ensure that medication administration records are accurately maintained; that the reasons for nonadministration of medication are recorded by the timely entry on the medication record; that the meaning of any such codes are clearly explained on each record; and that the person administering the medication completes the Medication Administration Record in respect of each individual service user at the time of administration. This is to ensure that people living in the home receive their medication correctly and the treatment of their medical condition is not affected. 2 9 13 To record all medication 30/04/2010 received into the home, including the quantity of any medication carried forward from the previous month Page 10 of 12 Care Homes for Older People 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 To ensure that a complete record of medication in the home is maintained. 3 9 13 Make arrangements to 30/04/2010 ensure that all 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 an as and when basis and what constitutes needed for the named person To ensure that people living in the home get their medication as intended by the prescriber. 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 Staff should check the MARs when first received to ensure that the correct dates have been printed and request a replacement from the pharmacy where any discrepancy is found. The pharmacy should be requested to print all known medication allergies on the relevant MAR sheets for each monthly cycle. 2 9 Care Homes for Older People Page 11 of 12 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. 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