Inspection on 01/09/09 for Lyme Valley House Care Home

This inspection was carried out on 1st September 2009.

CQC found this care home to be providing an Adequate 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lyme Valley House Care Home 09/06/09

Lyme Valley House Care Home 27/11/08

Lyme Valley House Care Home 30/05/07

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Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Random inspection report Care homes for older people Name: Address: Lyme Valley House Care Home 115 London Road Newcastle under Lyme Staffordshire ST5 7HL one star adequate service 09/06/2009 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: Linda Clowes Date: 0 1 0 9 2 0 0 9 Information about the care home Name of care home: Address: Lyme Valley House Care Home 115 London Road Newcastle under Lyme Staffordshire ST5 7HL 01782633407 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ravinder Singh Thiara Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 26 Number of places (if applicable): Under 65 Over 65 0 26 0 dementia old age, not falling within any other category physical disability Conditions of registration: 26 0 26 Age: Dementia (DE) age 55 and above Physical Disability (PD) age 55 and above The maximum number of service users who can be accommodated is: 26 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) 26 Dementia (DE) 26 Physical disability (PD) 26 Date of last inspection 0 9 0 6 2 0 0 9 Care Homes for Older People Page 2 of 11 Brief description of the care home Lyme Valley House Care Home is a large, Victorian house that has been extended to provide accommodation for a total of 26 people who were elderly; ten may have physical disabilities of whom two may be a minimum of 55 years on admission; ten may have dementia care needs; two may have mental health needs and be a minimum of 60 years on admission. The home is situated on a corner plot, fronting the main A34 road. There are small gardens to the front and side of the property. To the rear there is a large secure, paved patio area with raised flowerbeds; there are also car-parking facilities on site. Lyme Valley House is situated on the A34 dual carriageway and close to the market town of Newcastle-under-Lyme with its wide range of amenities and communal facilities. The A34 road is a main public transport route with access to a wide area. Communal facilities consist of three lounges, a quiet lounge (used by some as a dining area), a large, attractive heated conservatory and dining room. There are three assisted bathrooms and nine separate toilets. There is a laundry, large kitchen and office on the ground floor. The upper floor is accessed via a shaft lift, stair chair lift and staircase. There is an additional staircase that is used by staff only. Gardens are well maintained with mature planting and patio area with garden furniture and parasols for the benefit of people who use the service and their visitors. It is recommended that anyone interested in the home should contact Lyme Valley directly to find out current fees and request a Service Users Guide. It is understood that where accommodation and care needs are publicly funded the home asks for a top up of fees and people will need to clarify this prior to admission. Care Homes for Older People Page 3 of 11 What we found: We carried out an unannounced Key Inspection visit on 9 June 2009 at which time we made requirements in relation to medication practices. The purpose of this Random Inspection visit was to monitor compliance with the requirements we made in the Key Inspection Report. We looked at the Medication Administration Record charts for the period starting 17/08/09 and discussed these fully with the Proprietor and Senior Care staff on duty. The records monitored failed to assure us that people received their medication and other medical treatments as prescribed by their General Practitioner. We looked at the Controlled Drugs Record. The record shows that three people are administered controlled drugs every day. For two of these people the prescription labels read one to be taken at night when required. We asked the senior on duty whether there was a protocol and/or risk assessment for each of these people to advise staff when it is appropriate to administer the controlled drugs and were told there was not. We have, therefore, asked the service to seek a review of the controlled drugs from each persons general practitioner. We identified that although all other medicines were administered by the service for one person we reviewed, the Medication Administration Record (MAR) showed they selfmedicated from two separate inhalers. We asked whether the person had the mental capacity to do so and were told they were confused and may not fully understand the procedure. We aked the senior whether there was a risk assessment in place to cover the practise of self-medication and were told there was not. We have asked for risk assessments to be carried out for all people who self-medicate to ensure that people are able to do so effectively. We identified that people may not be receiving pain relief as prescribed or as required. We looked at the MAR charts for two people administered pain relief. We were told that both people suffer confusion. We could not identify from the MAR whether they were being offered pain relief and being allowed to choose. We asked for the risk assessments/protocols for the prn (pro re nata - as and when) medication and were told there were no risk assessments in place regarding pain relief that was prescribed when required. In one instance the handwritten entry on the MAR chart read one/two to be taken 4 x daily. Max 1 p/dose. No more than 8 p/day. prn. The prescription label for this medication read Two to be taken when required for pain. The MAR showed in most instances for this person that tablets were being administered four times a day, although there were unexplained gaps in the record. The record did not identify the numbers of tablets administered on each occasion. Consequently, it was not possible to follow an audit trail for the medication. The record did not confirm that the medication was being administered as prescribed. The home seemed unclear about having pain relief removed from MAR charts when it was not being used for the original cause, for example pain relieve for arthritis, in case they Care Homes for Older People Page 4 of 11 needed to provide pain relief if the person has a headache. It is recommended that the home introduces a Homely Remedy Policy to cover these occasional needs for pain relief and that they discuss and receive authorisation from each persons general practitioner to administer homely remedies occasionally as and when required. There were instances where the MAR showed prn (mainly handwritten) when it was not prescribed as required (prn) by the General Practitioner. One person was prescribed creams. The MAR did not contain any record of this having been administered. Discussions with the senior identified that care assistants are administering prescribed creams when they are dressing/undressing people. There was no record completed by the person who had administered the prescribed cream. We were unable to confirm that care staff administering creams had received training or were being monitored to confirm their competence to administer prescribed creams. It was identified that creams were stored in peoples bedrooms. We asked to see the risk assessments for prescribed creams and were told there were none. The service will need to carry out risk assessments regarding the administration, recording and storage of prescribed creams, bearing in mind that they may be accessible to other people when stored in bedrooms. One prescription label read Apply as directed by the doctor. Spread thinly. There were no written instructions for staff on how or where they are to administer the cream. At the last inspection we identified that there was little formal monitoring by the service of the MAR charts and medication practices. The senior showed us an Evening Medication Check form that had recently been introduced. It was not possible from this form to identify where gaps may have been identified as the names/initials were not recorded. We checked this form against the gaps in the MAR chart we found for one person on the 23 and 26 August 2009. The Evening Medication Check showed all correct. This is an indication that staff are not being thorough when monitoring the homes medication records. One persons medication is administered weekly and was administered three days early in the last week. The senior stated that the General Practitioner had been consulted and that he had confirmed it was acceptable to leave the next dose until the next planned administration date ten days later. The senior could find no record of this incident in the care plan or on the homes daily record/handover notes. What the care home does well: What they could do better: The service will need to demonstrate that it has robust and reliable processes in place to protect people who use the service in relation to the recording, handling, safe keeping, safe administration and disposal of prescribed medicines and treatments. We have made two requirements and six recommendations in this Random Inspection Care Homes for Older People Page 5 of 11 report as a result of this visit. 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) & 13(2). 17/07/2009 The service must ensure that all medicines are administered as prescribed. This will assure people who use the service that they will receive their medicines as prescribed. 2 30 18 Regulation 18(1)(a). The 17/07/2009 service must ensure that staff who administer medication are competent to do so. This will assure people who use the service that they are in safe hands. 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 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 12 Regulation 12(1)(a)The 09/10/2009 registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. This will assure people that they are in safe hands. 2 9 12 Regulation 12(1)(a) & 13(2). 09/10/2009 The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. This will assure people who use the service that their health and welfare is promoted and that they will receive their medicines as prescribed. 3 30 18 Regulation 18(1)(a) 30/10/2009 The service must ensure that all staff who administer prescribed medication are Page 8 of 11 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 competent to do so. This will assure people who use the service that they are in safe hands 4 37 17 Regulation 17(1) 30/10/2009 Accurate records, risk assessments and written protocols must be in place to cover all areas of medication practice, including selfadministration. This will promote the health and welfare of people using the service. 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 It is recommended that the services Evening Medication Check records include full details of any errors and omissions found, together with the name of the person who uses the service who is involved, and that the record clearly demonstrates what has been done to correct this. It is recommended that each and every time there is a change to instructions printed on the Medication Administration Record charts, this should be signed and dated and an explanation entered into the persons care plan. This will ensure that there is a clear record regarding changes to the Medication Administration Record that will identify the instructions given by the persons general practitioner and provide a clear audit trail for the medication/treatment. The home should introduce a Homely Remedies Policy and maintain a supply of homely remedies in order to provide occasional medication to people for example who have a Page 9 of 11 2 9 3 9 Care Homes for Older People 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 headache. Discussions should take place with the persons General Practitioner in all instances to ensure that he agrees with the occasional administration of homely remedies for each person. A protocol should be introduced for each person who uses the service. 4 30 All care staff responsible for administration of medication should receive robust medication training to enable them to appropriately administer the medical treatments the home asked them to carry out. The service should have robust monitoring procedures in place for all areas of practice, including medication, in order to ensure that the health and welfare of people who use the service are protected by good working practices. 5 38 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. 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