Random inspection report
Care homes for older people
Name: Address: Lyons Court Care Home Stones End Evenwood Bishop Auckland County Durham DL14 9RE two star good service 30/01/2009 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: Michael Earnshaw Date: 1 1 0 8 2 0 1 0 Information about the care home
Name of care home: Address: Lyons Court Care Home Stones End Evenwood Bishop Auckland County Durham DL14 9RE 01388834516 01388832327 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Durham Careline Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 50 Number of places (if applicable): Under 65 Over 65 0 50 dementia old age, not falling within any other category Conditions of registration: 50 0 The maximum number of service users who can be accommodated is: 50 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 50 Dementia Code DE, maximum number of places 50 Date of last inspection 3 0 0 1 2 0 0 9 Care Homes for Older People Page 2 of 10 Brief description of the care home The home is well designed and has pleasantly landscaped surroundings. It shares a site with its sister home, Bowes Court. There is ample parking space and views of the surrounding countryside. The home has three floors and all are accessible by lift. The home has very generous communal and circulatory space and it has been designed to enhance the experience of the service users and to make operation easier for the staff. There is a generous amount of storage space in the home. This design and build is an example of good practice. There is a good standard of equipment such as mobile and fixed hoists, and specialist beds. A suitable call system has been installed. The scale of charges is between 454.71 and 476.44 Pounds per week depending on whether nursing care is required or not. Care Homes for Older People Page 3 of 10 What we found:
The reason for this visit was to check progress made against the medication requirements issued following the last random pharmacist inspection completed on 14 July 2010. These requirements related to our concerns about the recording and safe handling of medicines in the care 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 the service 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. A pharmacist spent 5 hours in the home and the inspection involved looking at medication administration records (MARs) and discussion with the manager and staff handling medication. During the visit we gave feedback to the manager of the home and compliance managers. The outcome is as follows: Improvements have been made regarding the completion of medication administration records and to make sure that medication is administered as directed by the prescriber. Care plans now include detailed guidance for staff on when it is appropriate to offer people living in the home medication prescribed to be taken as required. We looked at a sample of current MARs and a number of medicines were counted and checked against the administration records to confirm they matched. We found no significant discrepancies where administration had not been recorded or a nonadministration code added. This helps to show that people are getting their medicines as prescribed. Medication which was carried forward from the previous month was recorded on the MAR. This means that there is a complete record of medication in the home and helps when checking that medicines have been given correctly as prescribed. The stock control of nutritional supplements could be improved to make sure that supplies are maintained for each person they are prescribed for. We found that one person prescribed Fortisip nutritional supplement twice daily had not received this for eight days because no supply was available. We were informed that a further supply had been requested but not yet received and the manager agreed to follow this up immediately. Handwritten entries on the MARs had been checked and signed by a second person to make sure that they were accurate and complete. A sheet in the front of the MAR file on each floor recorded the known allergies to medication for all people living in the home, and appropriate entries had also been made on the individual MARs. This means that staff know which medicines must be avoided for a particular service user. Some MARs were not held securely in the ring file.This means that the complete
Care Homes for Older People Page 4 of 10 medication records may not remain together and increases the risk of medications not being administered. We found a bottle of Tears Naturelle eye drops which was being used beyond the one month shelf life after opening and informed the manager. Medicines with a short use after opening must be used within the timescale recommended by the manufacturer to make sure that they remain safe to use. We also found a bottle of Fludrocortisone tablets stored in the medicines trolley, and not in the fridge at directed on the dispensing label. A programme of additional training on the safe handling of medication has been provided to staff handling medicines in the care home. In addition, results of the regular medication audits are shared with staff to support and encourage good medication practices. Copies of the homes newly written medicines policy were located in each treatment room along with a recent edition of the British National Formulary. 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 10 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 8 13 Ensure that individual service 09/08/2010 users risk assessments are in place and are reviewed and updated to reflect their changing needs. (This is an outstanding requirement from the last inspection.) This is to ensure service users are protected from risk of harm. 2 9 13 Ensure that medication 29/07/2010 administration records are accurately maintained; that the reasons for nonadministration of medication are recorded by the timely entry of an appropriate code or entry on the medication administration 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 service user at the time of administration. This is to make sure that there are arrangements in place to ensure the recording and safe administration of medication. Previous Care Homes for Older People Page 6 of 10 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 deadline of 01/07/2010 not met. 3 9 13 Care plans must include 10/08/2010 detailed information and instructions for staff in respect of the administration of medicines, including the reasons to give medicines prescribed as required and how to decide if administration is appropriate. This will make sure that medicines are given in the way intended by the prescriber. 4 9 13 Ensure that all medication is administered as directed by the prescriber to the service user it was prescribed, labelled and supplied for. This is to make sure that residents healthcare needs are met. Previous deadline of 25/06/10 not met. 29/07/2010 Care Homes for Older People Page 7 of 10 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 Effective arrangements must 14/09/2010 be in place to request, obtain and retain adequate supplies of prescribed medicines, including nutritional supplements, for service users. This will make sure that all medicines are available to administer as and when required. 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 MARs should be held securely in the ring file so that the administration records remain complete and intact for each person living in the home. Guidance on the expiry date of medicines with a short shelf life once opened should be available to staff and included in the homes medicines policy. The pharmacy should be requested to print standard cautions on the MAR sheets so that staff know about any special administration requirements, such as take half to
Page 8 of 10 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 one hour before food, where appropriate. Care Homes for Older People Page 9 of 10 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 10 of 10 - 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!
