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 4 0 7 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 11 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 11 What we found:
The reason for this visit was to check the progress made against the medication requirements issued following the last key inspection on 6 May 2010 and the subsequent Warning Letter sent following that inspection. These requirements, and the Warning Letter, 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 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. A pharmacist spent 8 hours in the home and the inspection involved looking at medicines storage, medication administration records (MARs), procedures for stock control, medication audit arrangements within the home and discussion with the manager and staff handling medication. During the visit we gave feedback to the manager and the interim compliance manager. The outcome is as follows: Some significant improvements have been made to the handling of medication in the home since the last inspection. Audit of medication processes in the home has been introduced and additional medication training is currently being provided to staff handling medicines. However, further improvement is required to make sure that all medication records are accurately maintained and that all medication is given correctly as prescribed. A further inspection will be carried out to make sure that this has been achieved. Initial audits of the medication processes in the home have been completed by the manger and the pharmacist supplying medicines to the home. Weekly checks on the MARs are now carried out by the manager and detailed medication audit will take place monthly. This will help identify any medication discrepancies promptly and will help confirm that staff are closely following the homes medicines policy. Records for the receipt and disposal of medicines were not fully completed and it was not always clear what checks had been made to ensure that all monthly medication had been received in full and confirmed against the original prescriptions. Photocopies of all prescriptions were not kept in the home to help with these checks and disposal records did not identify when medication had been removed from the home. All medicines were stored securely and appropriately, and within the correct temperature range recommended by the manufacturer. The controlled drug cupboard appeared to meet the safe custody regulations and all entries in the controlled drug register were accurate and fully completed. There was no record of regular stock checks on controlled drugs, the last one being undertaken on 16 April 2010. We looked at a sample of current MARs and a number of medicines were counted and checked against the administration records to confirm that they matched. This helps to show that people are getting there medicines as prescribed. We found several discrepancies and gaps on the MARs where administration had not been recorded or a
Care Homes for Older People Page 4 of 11 non-administration code entered on the MAR. In some cases medicines had not been recorded but were no longer in the monitored dose pack, indicating that they had probably been given. We also found some MARs where medication had been recorded as given but the actual doses still remained in the monitored dose pack. For example, a morning dose of Furosemide was recorded as not given on the morning of the inspection, because no supply was available. We later located the remaining supply of this medication in the medicines trolley and informed the nurse who subsequently completed the administration. Putting the names of service users on trolley shelves may help staff locate medication more easily. Records for the administration of Warfarin to one person were poor and it was not possible to determine exactly how each daily dose had been given and the strength and number of tablets used to make up the daily dose. The manager showed us a new form which was about to be introduced to make sure that full details of Warfarin administration were recorded. Some people were prescribed medicines to be given when required but there was no guidance with the MARs, or in the care plans, to help staff determine when administration was appropriate. Not all handwritten entries on MARs had been checked and countersigned by a second person to confirm that they were accurate and complete. Allergies to medicines were not recorded on MARs or on the photograph profile for each person. Allergies to medicines, or the words none known should be recorded on all MARs and photograph profile sheets so that staff know what medication must be avoided for a particular service user. The manager told us that the GP had recently been contacted to provide a list of known allergies and this would be forwarded to the pharmacy once received into the home and recorded. Medication which was carried forward from the previous month was not always recorded on the MAR. This means that there is not a complete record of medication in the home and makes it difficult to check that medicines are being given correctly as prescribed. Not all MARs included a current photograph of the service user. Having a named photograph for each service user with the MAR reduces the risk of giving medication to the wrong person, particularly when new or agency staff are handling medicines. Some MARs also contained a medication profile form listing the medicines and doses for that service user. However, we found that for one service user the profile was inaccurate and did not fully reflect current prescribed medication. Medication profiles in use must be kept up to date to prevent errors when ordering or communicating prescription details. We found a bottle of Quetiapine suspension that was still being used despite the fact that it had expired three weeks earlier. We pointed this out to the nurse who immediately replaced it with a fresh bottle that was still in date and safe to use. Other requirements made following the last key inspection have not been included in this report. Care Homes for Older People Page 5 of 11 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 11 Are there any outstanding requirements from the last inspection? Yes £ No R 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 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 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 deadline of 01/07/2010 not met. 2 9 13 Ensure that all medication is administered as directed by the prescriber to the service user it was prescribed, 29/07/2010 Care Homes for Older People Page 8 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 labelled and supplied for. This is to make sure that residents healthcare needs are met. Previous deadline of 25/06/10 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. 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 2 3 4 5 9 9 9 9 9 Medication profiles must be kept up to date and reflect each persons current prescribed medication. Allergies to medication, or non known should be recorded on all MARs for all service users. Where a dose of medication is variable, the actual dose given should be recorded on the MAR. A current edition of the British National Formulary should be readily available to staff on each floor of the home. All medication received into the home, or carried forward from the previous month, should be recorded on the MAR, and the entry dated and signed.
Page 9 of 11 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 6 7 9 9 A photograph of each service user should be kept with the persons MAR to assist in identification. Staff should sign and date each hand written entry they make on the MAR. Each entry should be checked and countersigned by a second competent person to reduce the risk of error when copying information. Stocks of controlled drugs should be regularly checked, and a record of this check made in the controlled drugs register. 8 9 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. © 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 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!
