Inspecting for better lives Random inspection report
Care homes for older people
Name: Address: Marsden Grange 239 Barkerhouse Road Nelson Lancashire BB9 9NL The quality rating for this care home is: The rating was made on: three star excellent service 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 assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. 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: Simon Hill Date: 1 9 0 1 2 0 0 9 Information about the care home
Name of care home: Address: Marsden Grange 239 Barkerhouse Road Nelson Lancashire BB9 9NL 01282618226 01282613382 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Eileen Frances Littlewood care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category 0 Over 65 40 Conditions of registration: 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 - Code OP The maximum number of Service Users who can be accommodated is: 40 Date of last inspection Brief description of the care home Marsden Grange is located in Nelson, set back off the main road in its own grounds. There is a bus stop outside the home, on route to the town centre. Accommodation is offered for twenty-four people in single and double rooms in the main house. The upper floor is accessed via stair lifts. There are aids and adaptations provided to assist people to maintain their independence. All rooms have a call system for residents to summon staff assistance. There is a purpose built extension to the rear of the home that accommodates sixteen people. Bedrooms in this extension are single and have en Care Homes for Older People Page 2 of 10 suite facilities. There is car parking space to the front and rear of the home. Information about the service is available from the home for potential residents in a Statement of purpose and Service User Guide. Weekly charges for personal care and accommodation range between £373:50 and £423:50. Residents are responsible for purchasing optional extras such as hairdressing, and private chiropody. Care Homes for Older People Page 3 of 10 What we found:
We visited the home because some concerns had been raised about the way medicines were being handled. The visit was carried out by a pharmacist inspector. It lasted nine hours (over two days) and involved speaking with the manager, the deputy manager, two carers and one resident. We checked a sample of medicines stocks, medicines records and checked how medicines were being stored. We gave detailed feedback to the manager at the end of the visit. Overall we found some out dated practices when handling medicines that could seriously affect the health and wellbeing of people who live in the home. When we arrived at the home we found some medicines insecurely stored. The deputy manager said that most of these were medicines awaiting disposal and had been left out over the weekend. Storing medicines insecurely can lead to medicines being mishandled and misused. We checked a sample of records and medicines stock and found it very difficult to fully account for all medicines as there was no clear system of stock control because stock was not properly carried forward at the beginning of each month. We found some medicines kept in packets and bottles had been put together in one container to make storage simpler, this is not recommended as mistakes can happen if medicines are taken out of their original containers. We also found some records of medicines received into the home were not complete and sometimes inaccurate, which made it difficult to show that medicines were being given to people correctly. We looked at the times medicines were given and found the records did not always state the correct time to take them in relation to food intake. The manager said that medicines that needed to be given before food were given correctly but the records did not show this, which could result in some staff giving them at the wrong time. We later found a current antibiotic being given after food instead of before, this was confirmed by a carer. Giving medicines at the wrong time can stop them working properly. We checked how controlled drugs (medicines that can be misused) were handled. A suitable cupboard was used for storage but this was not properly attached to the wall so it was not fully secure. A special register was used for record keeping but this was not always completed correctly. We found several recording mistakes and found not all entries in the register were correctly witnessed. Controlled drugs can be mishandled and misused if they are not stored and recorded properly. We looked at how medicines were checked and found no recorded audits (medicines checks). The manager said medicines were checked when they were received into the home but we found mistakes that showed that this was not always carried out correctly. We gave some advice to the manager on how to carry out and record audits because mistakes were not being found and acted upon to help prevent them happening again. We looked at how staff were trained to handle medicines safely. The manager said all staff have attended formal medicines handling training sessions and we saw some evidence of this. The manager said all staff were watched and supervised until they Care Homes for Older People Page 4 of 10 were deemed competent but we saw no formal records of this. Regular recorded competency checks on staff help make sure they have the necessary skills to handle medicines safely. We revisited the home on 26th January 2009 for three hours to carry out further checks on the medicines stock and records and to check that some improvements had been made. We found all stock to be securely stored and the manager told us about plans to improve the storage of medicines stock and controlled drugs. Storing medicines securely helps prevent them being misused. We found a serious mistake when staff had forgotten to replace a strong pain relief patch even though some of the records showed it had been given. The manager agreed that it had been missed and said she would take immediate action to help prevent it happening again. Going without prescribed medicines can seriously affect a persons health and wellbeing. We saw some general improvements in the way medicines were adminstered and recorded and we discussed plans with the manager about how to improve the stock control of medicines so that all medicines can be fully accounted for. We looked at how people were supported to look after their own medicines and found suitable procedures and paperwork in place. We spoke with one person that was looking after their own medicines and they said they felt fully supported by staff to do this. Looking after their own medicines helps people retain some of their independence. We looked at how when required medicines were being handled. We discussed with the manager and gave advice about how care plans should have detailed information about when required medicines, this helps make sure they are given to people correctly.` What the care home does well: What they could do better:
Accurate records of medicines received into the home and accurate records of medicines stock must be kept so that all medicines can be fully accounted for. Suitable arrangements should be put in place for checking medicines and staff competence to help make sure medicines are handled safely. Medicines must always be given as prescribed because receiving medicines at the wrong dose, wrong time or not at all can seriously affect a persons health and wellbeing. Controlled drugs must be stored in a secure, legally compliant cupboard to help prevent them being misused or mishandled. Care Homes for Older People
Page 5 of 10 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 10 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set.
No. Standard Regulation Requirement Timescale for action 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, Care Homes 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 24 Suitable arrangements 27/02/2009 should be put in place for checking medicines and staff competence. This will help make sure staff have the necessary skills and will help make sure medicines are handled safely. 2 9 13 Controlled drugs must be stored in a secure, legally compliant cupboard. This will help prevent misuse. 28/04/2009 3 9 13 Accurate records of medicines received into the home and accurate records of medicines stock must be kept. This will help make sure all medicines can be fully accounted for. 27/02/2009 4 9 13 Medicines must always be given as prescribed. Because receiving medicines at the wrong time, wrong 27/02/2009 Care Homes for Older People Page 8 of 10 dose or not at all can seriously affect a persons health and wellbeing. 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 Care Homes for Older People Page 9 of 10 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI 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: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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!
