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Inspection on 04/08/09 for Langdale Residential Home

Also see our care home review for Langdale Residential Home for more information

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The management consultant have overhauled the medication management system.

What the care home could do better:

To continue to improve and maintain the consistency in medication management to safeguard the health and safety of the people living in the service.

Random inspection report Care homes for older people Name: Address: Langdale Residential Home 6 Church Street Sapcote Leicestershire LE9 4FG zero star poor service 15/04/2009 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: Mathias Foundling-Miah Date: 0 4 0 8 2 0 0 9 Information about the care home Name of care home: Address: Langdale Residential Home 6 Church Street Sapcote Leicestershire LE9 4FG 01455274544 F/P01455274544 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) : Miss Neemat Kassam,Mrs Yasmin Nazir Kassam care home 27 Number of places (if applicable): Under 65 Over 65 5 5 27 7 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Conditions of registration: 0 0 0 0 No person in category PD(E) to be admitted to the home when there are 7 persons of that category already accommodated within the home. No person to be admitted to the home in categories MD(E) or DE(E) when 5 persons in total of these categories/combined categories are already accommodated in the home. Date of last inspection 0 3 0 3 2 0 0 9 Care Homes for Older People Page 2 of 14 Brief description of the care home Langdale Residential Home offers accommodation for 27 Older Persons, and is situated close to the centre of Sapcote, which offers local shops including a Post Office and local supermarket. Views from part of the home overlook the local Church and countryside. Langdale Residential Home offers two lounges and one dining area to the ground floor, with bedrooms being sited on the ground and first floor. Access to the first floor is via stairs, which has a chair lift and a passenger lift. The majority of bedrooms have ensuite facilities, which consist of a wash hand basin and toilet. Bathroom and showering facilities are located on both floors. A copy of the last inspection report was available at the home. Care Homes for Older People Page 3 of 14 What we found: Previous concerns were evidenced during a visit by Debbie Williams (Regulation Inspector) on a Key Inspection on 15th April 2009 and by Denise Clarke (Pharmacist Inspector) on a random Inspection on 17th July 2009. A code B was issued and evidence taken due to failings in regulation 13(2) in making arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. A statutory requirement notice has been issued to the home in breach of regulation 13(2). The reason for the pharmacist Inspection visit on 4th August 2009 was due to concerns raised regarding an incident involving the overdose of insulin adminstered by a care staff member. In addition to generally assess the medication management system was in place to safeguard the health and welfare of people living in the service. A code B was issued and evidence taken in view of the seriousness of this Insulin incident. Feedback was provided and the outcome of this inspection is as follows: The GP previously faxed a copy on 17th July 2009 of the changes to the insulin dosage (units) for a person living in the service and increased the morning Insulin dosage from 30 units to 32 units. The evening insulin dosage remains at 14 units. The GP informed the home, to contact the surgery if the blood sugar level exceeds a certain limit. The medicine chart stated as directed by your prescriber. On the 18th July 2009 the administration of the morning dosage was correct however the administration of the evening dosage was incorrect; the morning higher dosage (before the increased changes) was incorrectly adminstered and the incorrect dosage found recorded on the Insulin Administration Record (IAR) sheet. The next day a staff member noticed the error by the incorrect units entered on the IAR sheet, and immediately informed management of this incident accordingly. We found that this was a one off error as previous records indicated a consistency in adminstration of the correct dosages of insulin. However we found that there was no comprehensive insulin administration policy only a brief insulin policy for self medication was made available. The IAR sheets indicated occasional sudden increase in blood sugar levels. This was possibly due to poor hygiene practices which was also confirmed by the District Nurse on duty. Staff did not properly clean the hands of people living in the service before taking blood glucose samples.This policy did not provide staff guidance on this subject. The policy had no guidance on the recording of information from telephone, fax or mesages received from the GPs and other healthcare professionals with regards to any changes to medication and their dosages. We found inappropriate records. The corrections to units have been made by staff writing the changes in insulin dosages on the IAR sheet without detailed confirmation of which staff made this entry, the time, date and which GP had made this request. Staff regularly relied on this IAR sheet without consulting care plans or faxed information. Staff did not always put their policy into practice. Care plans indicated Staff do not always Care Homes for Older People Page 4 of 14 contact the surgery when the blood sugar level was beyond the agreed limit as requested by the GPs. There was gaps or lack of information in the professional visitors record, medical notes and daily notes. The staff previously handling Insulin have undergone Administration of Insulin training and were also assessed by the Leicestershire County and Rutland NHS Primary Care Trust. We looked at the records of training and found that most of the staff were not due for review until 2010. However the record of training for one staff member involved in the Insulin overdose incident was found to be overdue. Their date of next review was in Sept 2007. No further documentation was provided by the home of their review or training or assessment that has been under taken to date. The Management consultancy have recently undertaken drug assessment of all the care staff. One staff member was found not washing their hands and had a tendency to rush with medication. They were reminded to take more time when adminstering medicines. All the care staff except one member of staff is not allowed to handle or adminster medicines or insulin in the care home. The management consultancy team have undertaken this role to safeguard the health and welfare of people living in the home. Regular checks of medication administration were not made by the home to ensure that people living in the service received medicines correctly. However we were informed that the Management Consultancy are installing a checking system to ensure that all the medicines are administered as prescribed at all times,to maintain the improved level of medicine management which has now been put in place. The sample audits undertaken indicated that the medicines are administered and staff followed instructions as the doctor prescribed. However there was gaps in the MAR chart for Insulin when staff and District nurses have not signed the MAR chart but the IAR chart has been signed and completed. The home had not contacted the GP when a person living in the service had refused there medication for more than a week. The home had not made reference to the care plan as stated in their policy, particularly if a medicine is not given to a person living in the service on a regular basis. The person had refused their calcium supplement for nine days in a row. We were informed that the GP is reviewing their medication and are now awaiting a response. One person living in the service was administered a food supplement. There was refusals and several entries stating that this was not available and none were recently supplied from the pharmacy. We queried this and were informed that the home ran out of this food supplement as this was for a short course. However the home had not contacted the GP to review whether another short course of food supplement was to be made or to confirm the end of this course.We were informed that they have gained weight and feeling better although no recent weight has been recorded. The Home has contacted the GP who was satsfied that the person living in the service was now eating well as the managment consultancy now assisted the person to eat rather than finger feed themselves. The GP has now reviewed the patient and re-issued this supplement for another month. The home has not put into practice their policy of reviewing medication every six months Care Homes for Older People Page 5 of 14 for each person living in the service. We were informed by the management consultancy that the main GP has agreed to provide a twice weekly check and also will be available when required. The medicine fridge inside the walk-in cupboard needed defrosting, however the current temperature was 8 degrees celsius. There was no monitoring of the external temperature in the walk-in cupboard. However the home had recently purchased a max-min thermometer which was installed during the inspection. There was bare central heating pipes running through the cupboard and the home later confirmed a reading of 27.7 degrees celsius which was unsuitable for storage of medicines. We were informed the home would action to insulate the pipes and make appropriate ventilation to enable the external temperature to be below 25 degrees celsius to store medicines safely. All external preparations for creams and ointments have been removed from bathrooms and other unsecured areas. The management consultancy have discarded all preparations that had been shared and which were applied to several people living in the service, or with no date of opening, or expired. All medicines for disposal have been documented, recorded and returned to the pharmacy. The home has not put into practice their policy of checking the completed prescriptions against what the home has ordered before sending them to the pharmacy to supply the home. The management consultant has informed us that she will personally book them in and has requested current medication records from the GPs for all the people living in the service. 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 14 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 3 14 People moving into the home 29/05/2009 must have their needs assessed and this assessment must be kept under review and revised at any time that this is necessary This is to ensure that people living at Langdale House have their needs met. 2 4 18 Staff must individually and collectively have the skills and experience to meet the specialist needs of people living at the home. This is to ensure that people with dementia or mental health have their specialist needs met. 26/06/2009 3 7 14 People living at Langdale House must have a plan of care based on a comprehensive needs assessment. The care plan must set out in detail the action which needs to be taken by staff to meet all aspects of health, personal and social care needs. This will ensure that people living at Langdale House 30/05/2009 Care Homes for Older People Page 7 of 14 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 have their needs met. 4 7 15 Care records must be reflective of peoples changing needs. A record must be kept of the wellbeing or otherwise, events of the day and care provided for people living at the home. This is to keep people living at the home safe from harm. 5 12 12 People must be given the opportunity for stimulation through recreational and social activities. Staff must receive the training they require to provide meaningful activity for people with dementia. This is to ensure people living at Langdale House have a fulfilled lifestyle. 6 12 12 Routines of daily living must be made flexible in order to meet individual needs and preferences. This is to ensure that are able to make decisions about the care they receive. 7 12 12 People living at langdale House must be given opportunities to excersise choice. This is to ensure that choice and autonmy are promoted. 15/05/2009 22/05/2009 05/06/2009 20/03/2009 Care Homes for Older People Page 8 of 14 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 8 18 13 National and local 29/05/2009 safeguarding policies and procedures must be adhered to and staff must receive training in this area. This is to protect people living at Langdale House from harm. 9 18 13 Staff must receive training in 29/05/2009 caring for people with dementia and safe management of challenging behaviour. This is to ensure that people living at Langdale House are protected form harm. 10 18 13 Staff must respond 20/03/2009 appropriately to any incident of suspected abuse and must follow safeguarding adults policies and procedures. This is to protect people living at the home from harm. 11 22 13 Specialist equipment must be 22/05/2009 fit for use and properly risk assessed. This is to promote safety for people living at Langdale House 12 27 18 Staff must be trained and 31/03/2009 competent in order to meet peoples needs. In particular, caring for people with dementia and challenging behaviour. Moving and Page 9 of 14 Care Homes for Older People 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 handling and safeguarding vulnerable adults. This is to ensure that people living at the home have their needs met and are kept safe from harm. 13 31 18 People working at the home 20/03/2009 must be appropriately supervised to ensure that care practice adheres to safe policies and procedures This is to ensure that people living at the home receive the care that meets their needs and are kept safe from harm. 14 31 8 A manager must be appointed to manage the home effectively. Langdale House must be managed in the best interests of people living there. 15 38 13 People living at the home 20/03/2009 must have their moving and handling needs risk assessed by a person trained to do so. Staff must use appropriate and safe moving and handling techniques. This is to keep people living at the home safe from harm. 26/06/2009 Care Homes for Older People Page 10 of 14 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 18 The Registered Manager 08/09/2009 must ensure staff responsible for medicines administration including invasive techniques and external preparations have the necessary skills and training. In house training schemes must have a body of up to date knowledge in the subject of medicines. To safeguard the health and welfare of people living in the home 2 9 13 A quality assurance system 08/09/2009 must be installed to assess staff competence in their handling of medicines. Appropriate action must be taken when these indicate that medicines are not administered as prescribe and records do not reflect practice, to ensure that all medicines are administered as prescribed and this can be demonstrated. To safeguard the health and welfare of people living in the Care Homes for Older People Page 11 of 14 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 home 3 9 13 A system must be installed 08/09/2009 to check the prescriptions prior to dispensing by the pharmacy. The home must check the dispensed medications and the medicine charts against the prescription for accuracy. All stocks of medicines and discrepancies must be addressed with the healthcare professional before each cycle of medication is received into the home. To safeguard the health and welfare of people living in the home 4 9 13 The Registered Manager 08/09/2009 must ensure that the home has a procedure to communicate and record clearly. This includes making a careful record of who took the telephone call, the time of call, the name of person who called and the change(s) made. To safeguard the health and welfare of people living in the home Care Homes for Older People Page 12 of 14 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 To action that staff monitor and record daily the external temperature. Staff are made aware of the acceptable temperature range of medicines to be stored at room temperature. The policies and procedures relating to the handling of medication should be reviewed and updated in line with the guidance from the Royal Pharmaceutical Society document The Handling of medicines in Social Care settings published 2007. To action that the walk-in cupboard does not exceed above the acceptable external temperature range of 25 degrees celsius to appropriately store medicines 2 9 3 9 Care Homes for Older People Page 13 of 14 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 14 of 14 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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