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Inspection on 22/02/10 for Millfield Care Centre

Also see our care home review for Millfield Care Centre for more information

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Certain areas of medication handling were done well. Records were clear when medicines were omitted and the reasons for the omission were recorded. Medication was stored in a secure environment and medicines which need to be kept cool were properly stored.

What the care home could do better:

Medication must be given to residents as prescribed and staff must ensure they follow the directions fully at all times. Further improvements must be made the clarity and accuracy of record keeping about medication particularly when residents come into the home or have changes to their medication. Careful checks must be made to confirm exactly what medicines are currently prescribed for residents. Medication which is prescribed by doctors , especially emergency doctors, must be obtained without delay, to ensure residents` health is not placed at risk from harm.

Random inspection report Care homes for older people Name: Address: Millfield Care Centre Bury New Road Heywood Rochdale Lancashire OL10 4RF zero star poor service 19/11/2009 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: Avril Frankl Date: 2 2 0 2 2 0 1 0 Information about the care home Name of care home: Address: Millfield Care Centre Bury New Road Heywood Rochdale Lancashire OL10 4RF 01706621222 01706627688 mcnallyh@bupa.com www.bupa.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Emma Elizabeth Fitzgerald Type of registration: Number of places registered: Conditions of registration: Category(ies) : BUPA Care Homes (AKW) Ltd care home 92 Number of places (if applicable): Under 65 Over 65 0 52 0 dementia old age, not falling within any other category physical disability Conditions of registration: 24 0 15 The maximum number of service users who can be accommodated is: 92 The registered person may provide the following category/ies 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: 52) Dementia - Code DE (maximum number of places: 24) Physical disability - Code PD (maximum number of places: 15) Date of last inspection Care Homes for Older People 1 9 1 1 2 0 0 9 Page 2 of 13 Brief description of the care home Milfield Care Centre is a two- storey purpose built home situated close to the town centre of Heywood. Access to public transport and the motorway network is good and there is ample parking to the front and rear of the home. The home is registered to provide nursing and personal care in four distinct units up to a total of 92 residents. On the ground floor one unit provides nursing care for residents in the dementia category, and in separate accommodation nursing care is provided for up to 15 Physically Disabled residents (18 - 65 years). The upstairs unit provides nursing and personal care for 52 Older People. The home is suitably adapted for disabled access and the majority of rooms have en suite facilities. The previous Commission for Social Care Inspection report is available on request. The home weekly charges range from 370.00 pounds to 515.00 pounds per week. This is dependant on the individuals assessed needs. Care Homes for Older People Page 3 of 13 What we found: The reason for this inspection visit was check that the requirements made in the Statutory Requirement Notice, dated 29th December 2009 and the requirements made following our key inspection on 18th and 19th November 2009 had been complied with and you were no longer in breach of the regulations. A Statutory Requirement Notice is a legal notice, which is served on the provider when there has been a breach of regulations. The notice describes which regulations have been broken and what the provider must do to put right the breach; it also gives the date by which this must be done. We then follow up the notice by visiting the service to make sure that actions have been taken to meet the requirements and regulations. The requirements in this notice were made to make sure that residents health was not at risk from poor medication practices. The pharmacist inspector looked at medication together with records about medicines for seven residents. We spoke to, Emma Fitzgerald the homes manager and Ruth Yates, the regional manager. We also spoke to three nurses and a senior care assistant who had responsibility for administering medicines. Full detailed feedback was given to the manager and regional manager at the end of the inspection. The Statutory Requirement Notice made four requirements that had to be complied with, met, by 17th January 2010. 1. Make arrangements to ensure that all medication is administered exactly as directed by the prescriber to the service user it was prescribed, labelled and supplied for. 2. Make arrangements to ensure that medication records are accurately maintained; that the reasons for non administration are recorded by the timely entry of an appropriate code or explanation on the administration record; that the meaning of any such codes is clearly explained in each record; and that the person administering the medication completes the medication administration record in respect of each individual service user at the time of administration. 3. Ensure that all medication records regarding receipt, administration and disposal are completed accurately. 4. Put in place effective systems for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Put in place effective arrangements to ensure that secondary dispensing is not carried out and that service users are administered their medication straight from the containers received from the pharmacy. The report contained a number of requirements, which were not in the notice, some had been outstanding since September 2009 and others had to be met by 31st December 2009. 1. All medication must be stored securely and at the correct temperatures. Care Homes for Older People Page 4 of 13 2. There must be effective systems in place to ensure that staff who handle medication are competent to do so safely. 3. Risk assessments must be made to assess the safely of residents if medicines are stored in their rooms. 4. Effective auditing must be put in place so that managers are confident that medicines are being handled safely. 5. Supplies of medicines must be obtained in a timely manner so that residents do not go without their prescribed medication. We found that systems had been put into place and staff had worked hard to ensure that requirements contained within the notice and report were met. Some improvements had been made in most areas of mediation handling and we found that most of the requirements were met or partially met. However we found that some residents health and wellbeing was at risk from harm because they had not been given their medication as prescribed particularly when medication had been changed by the prescriber or had been newly prescribed. Residents also experienced delays in being given their new medication. The records about such medication were not always accurate. We found the same concerns at the previous inspection. The first requirement was to make arrangements to ensure that all medication is administered exactly as directed by the prescriber to the service user it was prescribed, labelled and supplied for. This requirement was not met. We looked at the records about medication together with the stock of medicines held in the home for seven residents. We found that most residents were given most of their medication as prescribed. We looked at medication and records for four of the seven residents in depth. These residents had either recently been discharged from hospital, recently come to live at Millfield or had been seen by their consultant or doctor and changes had been made to their medication. At the last inspection we found that sometimes staff failed to follow the directions of the doctors. We found these failures were repeated at this inspection. Three of the residents were not given some of their prescribed medication because staff had not transferred the information from one set of documents to the next. Three residents had not been given some of their medication as prescribed because staff failed to follow the prescribers directions properly. One resident had been prescribed two new medicines for diabetes on 19th February 2010; no record of the medication had been made of its receipt. The medication was available in the home on the day of this visit but neither tablet had been given because staff said they were waiting for clearer directions for one of the tablets. The manager could not explain why the other one had not been administered. If people are not given all their medication as directed their health could be at risk. We also saw that medication which had arrived in the home, unexpectedly, for a resident had been administered. The medication was for a resident who had recently come to live Care Homes for Older People Page 5 of 13 at Millfield, there was no information on admission that these tablets were prescribed. Nurses had failed to check that they should administer the medication before doing so. Another resident was in pain and the emergency doctor was contacted who advised that Paracetamol should be given, from the homes stock of homely remedies. Records show that this advice was not followed and no pain relief was administered. The staff were sufficiently concerned about this resident to contact the emergency doctor later in the day. The resident was prescribed some antibiotics and Paracetamol; records showed that he was not given any pain relief or antibiotics for almost 24 hours after the doctor had visited. No explanation of this delay could be given. The second requirement was to make arrangements to ensure that medication records are accurately maintained; that the reasons for non administration are recorded by the timely entry of an appropriate code or explanation on the administration record; that the meaning of any such codes is clearly explained in each record; and that the person administering the medication completes the medication administration record in respect of each individual service user at the time of administration. This requirement was met. We found clear and accurate records were made when medication was not given as prescribed to residents. For example one person was not given their laxative medication because they had loose bowels. This clearly explained the reason for none administration. The codes used on the medication administration sheets were used properly and when an explanation was required staff recorded it clearly. During the inspection we observed that medication was signed for at the time of administration to individual residents. The third requirement was to ensure that all medication records regarding receipt, administration and disposal are completed accurately. This requirement was not met. The vast majority of medication which was received into the home for the seven residents was properly recorded, with the exception of the medication for residents as outlined in the paragraph regarding the first requirement. However, when medication was received outside the normal monthly cycle the records did not always record the quantity of mediation which arrived. One lady was prescribed an antibiotic liquid and the quantity received was not recorded so it was not possible to tell from the records if this medication had been given properly. The records of receipt for one resident were so confusing it was impossible to tell if the correct dose had been given. The manager and two nurses tried to understand the records and they too found them confusing. The records regarding administration regularly prescribed medication were mainly accurate. We looked at the records for seven residents and found that records about food thickeners were not accurate and they could not demonstrate that these thickeners were being properly used. Records of administration for another resident were so poor that they showed that medication had been given two weeks before it had been prescribed. Nurses had signed these records for eight days failing to notice the dates were incorrect. From the records it appeared that one medication had been administered twice on a number of days. Another resident had had their dose of medication increased by their Care Homes for Older People Page 6 of 13 doctor, the nurse told us she had given the increased dose but the records did not reflect this. Records regarding the disposal of medication, on the nursing units, were mainly clear and showed that all medication could be accounted for. The staff on the residential unit told us that they did not make any record of medication sent for disposal and it was not possible to track medication which had been sent for destruction. The fourth requirement was to put in place effective arrangements to ensure that secondary dispensing is not carried out and that service users are administered their medication straight from the containers received from the pharmacy. This requirement was met. We found no evidence that medication was given from containers other than those supplied by the pharmacy. The following requirements were made in the report following our key inspection on 18th and 19th November 2009. 1. All medication must be stored securely and at the correct temperatures. This requirement was met. We found no evidence that medication was not stored securely or at incorrect temperatures. 2. There must be effective systems in place to ensure that staff who handle medication are competent to do so safely. This requirement was met. During feedback the homes manager and the area manager told us they had assessed the staff and found that they were competent in administering medication. 3. Risk assessments must be made to assess the safely of residents if medicines are stored in their rooms. This requirement was met. We saw evidence that a full risk assessment had been made regarding creams being kept in a residents bedroom. 4. Effective auditing must be put in place so that managers are confident that medicines are being handled safely. This requirement was met. During feedback the homes manager and the regional manager told us they had formally audited medication on an ongoing basis. The improvements in medicines handling observed at the inspection visit could not have been made without careful monitoring and auditing. 5.Supplies of medicines must be obtained in a timely manner so that residents do not go without their prescribed medication. This requirement was not fully met. We found no evidence that medication had run out. However the emergency doctor was Care Homes for Older People Page 7 of 13 called out to one resident and antibiotics and pain relief were prescribed. The medication was not given to the resident for almost 24 hours after it was prescribed. The manager could not explain why a there was such a long delay other than by explaining the system for obtaining medication outside the normal monthly cycle. This delay could have placed the residents health at serious risk of harm. 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 8 of 13 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 7 12 The Provider must ensure that where action has been identified on the nutritional risk assessments this is addressed. Ensuring that the health and well being of people is not affected. 30/01/2010 2 9 13 The Provider must ensure that supplies of medicines are obtained in a timely fashion To make sure that residents do not go without their prescribed medication. This remains OUTSTANDING. 30/12/2009 3 9 13 Medicines must be given to residents as prescribed. Because receiving medicines at the wrong dose, wrong time or not at all can seriously affect their health and wellbeing. This remains OUTSTANDING and was repeated in the Stautory Notice and remains unmet. 03/09/2009 4 9 13 Clear and accurate records of 03/09/2009 medicines received into, Page 9 of 13 Care Homes for Older People 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 administered and disposed of by the home must be maintained. So that medicines can be fully accounted for to prevent mishandling and to show that they are being given correctly and service users health is not at risk form harm. This remains OUTSTANDING and was repeated in the Stautory Notice and remains unmet. 5 15 15 The manager must ensure 30/01/2010 that all staff are aware of the nite bite provisions available so that people have something to eat when they want ensuring their nutritional needs are met . 6 27 18 Sufficient staffing must be provided at all times so that peoples needs are met and they are able to access staff when they need. So that peoples needs are met and they are able to access staff when they need. 7 30 18 Effective arrangements need 30/01/2010 to be made to ensure that agency and bank staff rotad to cover shifts have received a detailed handover so that they are aware of the particular needs of people and are able to support them Page 10 of 13 30/01/2010 Care Homes for Older People 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 safely. Evidence of this should be provided. So that they are aware of the particular needs of people and are able to support them safely. 8 30 18 Training should be provided in the specific health needs of people, such as dementia care and nutrition. So that peoples health and well being is maintained. 30/01/2010 Care Homes for Older People Page 11 of 13 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 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 12 of 13 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. 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