Inspection on 10/06/09 for Lyttleton House

This inspection was carried out on 10th June 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lyttleton House 03/07/08

Lyttleton House 27/11/07

Lyttleton House 18/05/07

Lyttleton House 04/09/06

Lyttleton House 01/03/06

Lyttleton House 12/09/05

Lyttleton House 24/03/05

Lyttleton House 25/08/04

Lyttleton House 04/03/04

Lyttleton House 09/09/03

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Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Random inspection report Care homes for older people Name: Address: Lyttleton House 1 Ormond Road Frankley Birmingham B45 0JD one star adequate service 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: Debby Railton Date: 1 0 0 6 2 0 0 9 Information about the care home Name of care home: Address: Lyttleton House 1 Ormond Road Frankley Birmingham B45 0JD 01214601150 01214577302 Telephone number: Fax number: Email address: Provider web address: Notknown Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Birmingham City Council (S) care home 30 Number of places (if applicable): Under 65 Over 65 30 old age, not falling within any other category Conditions of registration: 0 The maximum number of service users who can be accommodated is: 30 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) 30 Date of last inspection Brief description of the care home Lyttleton House is owned and managed by Birmingham City Council and is registered to provide care for 30 older adults who may have mild dementia. The building is a bungalow construction and divided into three separate units, each with their own dining area, kitchen and lounge. Facilities briefly include 30 single bedrooms, the majority of which are less than 10 square metres and therefore cannot Care Homes for Older People Page 2 of 12 Brief description of the care home contain all the items of furniture specified in the standards. Each bedroom has a call system. There are a number of communal areas equipped with televisions, videos and music systems where people living at the home can socialise. The home is situated on a corner plot in a cul-de-sac. It has an open plan frontage with lawn, shrubs and flowers. There is level access to the front door and parking to the front and side of the property. Lyttleton House is located close to local shops and facilities, including public transport. Fees at the home are based on the financial assessment carried out by the social worker. Care Homes for Older People Page 3 of 12 What we found: The reason for this pharmacist inspection was to assess the medicine management within the home due to a reported loss of a controlled drug (CD). Six peoples medication was looked at together with their Medicine Administration Record (MAR) charts, care plans and daily records. All the controlled drugs kept in the home were looked at together with the controlled drug register, where staff should record all the controlled drug transactions. The actual medication, that had been reported missing was not legally a controlled drug but due to the nature of the drug it could be misused. The manager, Kathleen Roberts, decided to treat it as a controlled drug by storing it in a special cabinet and recording all entries in the CD register. The controlled drugs originally reported to the Commission as lost were found but the manager had failed to inform the Commission. However on inspection of the records it was apparent that one tablet was still unaccounted for. Staff had also recorded that two doses of medication had been administered to the resident in the CD register but the MAR charts recorded that they had not been as the resident was asleep. There was no record stating that they had been destroyed. These two tablets were therefore also unaccounted for. Other entries in the CD register were incorrect. In one instance the name of the medicine had not been recorded so it was an incomplete record. Evidence of secondary dispensing was seen. Staff had put the contents of two or three boxes into one box. This box then held medication with different batch numbers, which increases the risk of potential error if this had not been done correctly. All medicines should be administered from the original pharmacist dispensed box. This did not occur for two medicines. Ms Roberts was keen to address these issues and we, the Commission, were assured that a full audit of all the controlled drugs would occur after the inspection and any discrepancies acted upon. All the medication was stored in a locked room. This room was very hot and the temperature inside the room and medication trolleys was 26C. This is outside the range to safely store medication in line with their product licenses. This high temperature may affect the medicines stability and they may not work as intended. All medicines stored in the dedicated medication refrigerator were correctly stored at the right temperature and this was monitored daily. Two medicines requiring refrigeration were not stored correctly as they were not stored in the refrigerator, which may again have an impact on their stability. Not all the medicines had been held in a locked cabinet. Medicines delivered to the home and those awaiting return to the pharmacy were kept in either an bag or an open box. Anyone gaining access to the medication room would have full access to these medicines. This may increase the risk of harm to the people who live in the home. Care Homes for Older People Page 4 of 12 The home has its own homely remedy policy. This was poor in content and no homely remedies were actually kept in the home. The policy was to be removed. A box of antibiotics was found in one cabinet. This had been dispensed in May 2009. Further information indicated that it should only of been administered following a urine sample test for an infection. Staff had tried to obtain an sample but failed so the medication was not given as they felt the residents health had improved. This antibiotic had not been returned to the pharmacy for destruction. The system originally set up to check the prescriptions prior to dispensing had not been followed. This meant staff did not check the prescriptions for accuracy before they were dispensed or checked the dispensed medication received into the home. One medicine had not been supplied and it was not possible to check whether this had been discontinued or just not ordered and so not dispensed. Another medicine to treat angina was missing despite the order slip stating that it should have been prescribed. This is of concern as staff are failing to identify these anomalies and address any discrepancies found. It could not be ascertained whether the doctor had discontinued it or staff had failed to order it. This is of serious concern. The quantities of all medicines received into the home had been recorded. This enabled full audits to be undertaken to demonstrate whether the medicines had been administered as prescribed and records reflected practice. Whilst the majority had, a few errors were seen and the homes internal auditing system had not always identified them. Some medicines had been recorded as administered when they had not been. Other medicines were unaccounted for. Care staff could not tell the Commission why some were missing. Medicines were available but not recorded on the MAR chart so it could not be demonstrated if they had been administered or not. Cream management was poor. Staff had recorded when they applied creams. These records were incomplete and records indicated that had not been applied as prescribed by the doctor. Some medication was administered by the distrust nurse. Records were incomplete and often information recorded in at least two different places. Staff would not be able to easily identify if the district nurse had not come in. Some of the written records just recorded the health care professionals visit and whether an injection had been administered. Information surrounding what the medication actually was, was difficult to find. The care plans were poor. They lacked details of the clinical conditions of the people who lived in the home. Without such information it would be harder for care staff to fully support their health needs. Information from the hospital or clinics were not always acted upon. This resulted in one medicine being available to administer but no record that it actually had been. One resident was discharged from hospital with MRSA and there was no supporting care plan detailing procedures to be followed to prevent infection of other residents or to fully support the residents condition. No protocols detailing when a medicine was to be administered on a when required basis had been recorded. As there was little or no information surrounding the persons clinical needs, staff would struggle to actually administer these medicines appropriately. One person was encouraged to self administer their own medication. There was no risk Care Homes for Older People Page 5 of 12 assessment undertaken to document that she could safely do so and no compliance checks to record that she did safely do so. New residents to the home did not have their medication they brought in checked with their doctor. It was not possible to check that the resident was administered all their current prescribed medicines. Ms Roberts said the assessment sheets completed by the social workers were often incomplete but staff had failed to undertake their own assessments and written complete care plans despite one resident being in the home for the last 5 days. 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 12 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 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 8 12 The care plans must record the clinical indications of the service user. This is to enable care staff to fully support their health care needs. 10/07/2009 2 9 13 A system must be installed 10/07/2009 to check the prescription prior to dispensing and to check the dispensed medication and the medicine charts against the prescription for accuracy. All discrepancies must be addressed with the healthcare professional. This is to ensure that all medicines are administered as prescribed at all times 3 9 13 The medicine chart must 10/07/2009 record the current drug regime as prescribed by the clinician. It must be referred Page 8 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 before the preparation of the service users medicines and be signed directly after the transaction and accurately record what has occurred. This is to ensure that the right medicine is administered to the right service user at the right time and at the right dose as prescribed and records must reflect practice 4 9 13 All medication must be held 10/07/2009 in a locked cabinet within the medication room. This includes items awaiting return to the pharmacy or those delivered This is to ensure that there is limited, authorized access to the medicines kept on the premise 5 9 13 All medicines that are 10/07/2009 administered must be stored correctly in accordance with their product licenses and from a pharmacist dispensed container. The practice of secondary dispensing two or three boxes into one must cease immediately. This is to ensure that the correct medicine is administered to the right service user and their stability is not compromised. Care Homes for Older People Page 9 of 12 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 6 9 13 A system must be installed to check all new service users medication with their doctor at the earliest oppurtunity This is to ensure that they are administrated their current drug regime 11/07/2009 7 9 13 All service users must be risk 10/07/2009 assessed as able to self administer their own medication and regular compliance checks undertaken and documented. This is to ensure that they can handle their medication safely 8 9 13 A quality assurance system 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 prescribed and records do not reflect practice. This is to ensure that individual nursing staff practice is assessed on a regular basis and appropriate action is taken if audits indicate that nurses do not administer the medicines as prescribed. 10/07/2009 Care Homes for Older People Page 10 of 12 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 advised that all medicines prescribed on a when required basis have supporting protocols detailing exactly when they should be administered. It is recommended that all external preparations have their own MAR charts for staff to complete directly after the application. 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. If you would like a summary in a different format or language please contact our helpline or go to our website. 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