Inspecting for better lives Random inspection report
Care homes for older people
Name: Address: Milbanke HFE Station Road Kirkham Lancashire PR4 2HA The quality rating for this care home is: The rating was made on: one star adequate 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: 2 0 1 0 2 0 0 8 Information about the care home
Name of care home: Address: Milbanke HFE Station Road Kirkham Lancashire PR4 2HA 01772684836 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Lancashire County Care Services care home 44 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability 15 1 0 7 Over 65 0 0 21 0 Conditions of registration: The home is registered for a maximum of 44 service users to Include:-: upto 21 service users in the category OP (Old Age not falling into any other category) upto 7 service users in the category PD (Physical Disability) upto 15 service users in the category DE (Dementia) up to 1 service user in the category MD (Mental Disorder) Service users in the physical disability category may only be accommodated in the 7 bedded rehabilitation unit, which must not accommodate any service user under the age of 55 years. Date of last inspection Brief description of the care home Care Homes for Older People Page 2 of 10 Milbanke Care Home provides high quality accommodation for a range of people with different needs and requirements. The home is separated into four different self contained units two of which provide accommodation for older people, one unit is for people assessed as requiring specialist dementia care and the fourth unit is a designated seven bed intermediate care unit. This facility, that can accommodate residents over the age of 55 years, provides time limited accommodation and support to people with a view to enabling them to return to their home environment. In addition, the building houses a designated, separately run day care centre and office accommodation. Milbanke Care Home is located in a convenient location close to the main shopping centre of the town and local amenities. The accommodation is purpose built, arranged over two floors and offers individual bedroom accommodation to all residents some of which are provided with an en-suite facility. Each individual unit also has a large lounge/dining room that is bright, airy and comfortable and a smaller quiet lounge. Newly refurbished bathroom/shower and toilet facilities are conveniently located and provided with aids to promote independence. A passenger lift is provided for ease of access throughout the home. Care Homes for Older People Page 3 of 10 What we found:
We visited the home because a previous inspection had found some serious shortfalls in the way medicines were handled. The visit was made by a pharmacist inspector and lasted four hours. We spoke with the acting manager, the area manager, four care staff and two residents. We gave detailed feedback to the managers at the end of the visit. Overall we continued to find some shortfalls in medicines handling that need to be addressed to make sure medicines are handled safely. We found some general improvements in the way medicines records and stock were organised. However, on the day of our visit it was the first day of a new medicines cycle and it was evident that the new supplies of medicines had not been properly organised so not all medicines were available when staff were trying to give them. This meant that some medicines were not given at the right time and some were completely missed. We pointed this out to staff on at least three occasions who agreed that they had missed giving them. One persons medicine was used on someone else because there was no stock available. Another persons medicines record was signed as given but our stock checks showed one of their medicines had been missed, this was confirmed by the carer involved. Missing medicines can seriously affect a persons health and wellbeing. Records of medicines given were not always complete because a clear record was not always made when people were not given their medicines, for example, if they were asleep or refused them. We also found a siginificant number of gaps on the records for the previous weekend because staff had not signed them when giving the medicines out. The manager said that when she checked the records on a weekly basis if there were any gaps she would ask staff to sign them. This is not good practice as it is not a true record because staff would not always be able to confirm whether they have given the medicine. On the day of the visit one medicine had not been signed as given so the carer on duty tried to give it, fortunately, another carer stopped her because she had seen the medicine given by a different carer. This shows that poor record keeping can lead to serious mistakes when giving medicines. Records of medicines receipt and disposal showed some improvement. However we continued to find it difficult to account for medicines contained in traditional packets and bottles because there was no clear system of stock control. The manager said that she had asked a senior staff member to record stock carried over from the previous month but this had not been done, which made it impossible to check current stocks to show medicines were being given to people correctly. We looked at the times medicines were given and although we found improvements in the records of these medicines, on the day of our visit we found several medicines were not given at the correct time in relation to food intake. We saw at least three medicines wrongly given with food instead of before. Records showed that some medicines were not given in the morning because people were still asleep, however, staff did not return to give them later when they had got up so this meant important medicines were regularly missed. Giving medicines at the wrong time or missing them can seriously affect a persons health and wellbeing. Care Homes for Older People Page 4 of 10 We looked at a sample of care plans and records and found some improvements about how when required medicines were to be given. We saw this with medicines used for anxiety and pain relief. Having clear written plans helps make sure people get their medicines when they need them. We looked at how a person was supported when they looked after their own medicines. The paperwork was not detailed enough. No formal risk assessment had been carried out and a care plan had not been written, which could result in this person not getting the right amount of support to handle their medicines safely. We checked how controlled drugs (medicines that can be misused) were stored and recorded. The manager said the community pharmacist was supplying a new cupboard and this was to be delivered soon. A suitable special register was used for record keeping although nobody was prescribed any controlled drugs at the time of our visit. We looked at how medicines were checked and audited. The manager said some informal checks were carried out throughout the month and we saw a formal recorded audit carried out the week before. Although these checks had found some recording mistakes they had not found the mistakes that we had found because medicines stock was not checked in detail. The manager said that formal competency checks on staff were planned and we saw the paperwork to support this. Efficient recorded checks of the medicines and competency checks on staff help make sure medicines are handled safely and make sure staff have the neccessary skills. We saw that written policies and procedures had been better presented for staff to read. A new policy and paperwork about the Mental Capacity Act had been written, which helps make sure peoples rights are protected. What the care home does well: What they could do better:
Medicines must be given to people correctly because receiving medicines at the wrong dose, wrong time or not at all can seriously affect their health and wellbeing. (This was highlighted as a concern following the last pharmacist inspection) There should be an effective system in place to audit medicines and staff competence to make sure medicines are always handled safely. (This was highlighted as a concern following the last pharmacist inspection) Records of medicines given to people must be accurate so that all medicines can be fully accounted for and to make sure they are safely handled. (This was highlighted as a concern following the last pharmacist inspection) A legally compliant controlled drug (medicines that can be misused) cupboard must be available in the home to store controlled drugs to help keep them safe. (This was highlighted as a concern following the last pharmacist inspection) For people that look after their own medicines a written risk assessment must be carried out and a care plan developed to make sure they receive the right amount of Care Homes for Older People
Page 5 of 10 support from staff and to make sure their medicines are handled safely. 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 R No £ 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 1 1 4(1)(2) The Statement of Purpose 30/09/2008 must be revised and updated and made available to all interested parties. (Not assessed at this inspection) 2 7 15 All residents must have an accurate, holistic and up to date plan of care that is regularly reviewed and amended as required. (Not assessed at this visit previous timescale 31/08/08). 09/09/2008 3 9 13(2) Records of medicines 21/11/2008 received into the home, given to people and disposed of must be accurate so that all medicines can be fully accounted. (Partially met, previous timescale 12/10/08) 4 9 24(1) There should be an effective 21/11/2008 system in place to audit medicines and staff competence to make sure medicines are always handled safely. (Not met previous timescale 12/10/08) A legally compliant controlled 12/12/2008
Page 7 of 10 5 9 13(2) Care Homes for Older People drug (medicines that can be misused) cupboard must be available in the home to store controlled drugs to help keep them safe. 6 9 13(2) Medicines must be given to 21/11/2008 people correctly because receiving medicines at the wrong dose, wrong time or not at all can seriously affect their health and wellbeing. (Not met previous timescale 12/10/08) Care Homes for Older People Page 8 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 13 For people that look after 21/11/2008 their own medicines a written risk assessment must be carried out and a care plan developed. This will help make sure they receive the right amount of support from staff and help make sure their medicines are handled safely. 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 © (2008) 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!
