This inspection was carried out on 24th August 2009.
CQC found this care home to be providing an Good service.
The inspector found there to be outstanding requirements from the previous inspection
report. These are things the inspector asked to be changed, but found they had not done.
The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.
Random inspection report
Care homes for older people
Name: Address: Millfield Care Centre Bury New Road Heywood Rochdale Lancashire OL10 4RF two star good 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: Avril Frankl Date: 2 4 0 8 2 0 0 9 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): 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 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) The maximum number of service users who can be accommodated is: 92 Date of last inspection Care Homes for Older People Page 2 of 10 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 #339.90p to an upper limit that is dependant on the individuals assessed needs. Care Homes for Older People Page 3 of 10 What we found:
We visited the home because we had received some concerns from social services that medicines were not being given to people properly. We had also received a number of notifications from the home that there had been errors in medicines handling .The visit was carried out by a specialist pharmacist inspector. It lasted approximately six hours during which time we looked at medication and records about medicines for several people living in the home. During our visit we talked to the three nurses who were in charge of their units on the day of the inspection. We gave the manager detailed feedback during and at the end of our inspection visit. At the start of our visit the manager explained the circumstances surrounding the notifications we received about five incidences of poor medicines handling. Four of the five errors had been made by nurses and as a result this inspection visit concentrated on the units which were staffed by the nurses. She explained to us the range actions which had been taken to help make sure the errors did not happen again. The manager told us that some of the nurses involved in the incidents were no longer working in the home the other nurses have received updated medication handling training and have had their competency assessed to make sure they were able to handle medication safely. We were also told that the managers of the nursing and dementia units had been in post for 3 months and the home had recruited new nurses which had resulted in a more stable and consistent team. The manager also told us that medication was audited, checked, on a weekly basis and improvements had been made in the way medicines were handled. When errors were found the manager told us the staff were given specific instructions, action plans, to prevent errors happening again in the future. We looked at the way medicines were handled on the younger persons unit and found some very good practice. The records were clear and accurate and enabled medication to be tracked and accounted for. The records could also show if medication had been given properly. We saw that staff had developed mini care plans to explain how to give medicines, such as laxatives and analgesics, which were prescribed on a when required basis. Clear instructions of where to apply creams and dressings was recorded, which made sure that they were applied to the correct area of the body. We saw good records made when the prescriber changed the doses of medication and the date on which they were changed. Clear records make sure that people are given their prescribed medication properly and their health is protected. We also saw that some residents liked to take some of their medicines in a certain way and this preference was recorded and their wishes were listened to. On the day of our visit the nurses on this unit had discovered a dispensing error made by the pharmacy who supplied the medicines. Their careful checking of the medicines prevented a resident being given too much medication. We looked at the way medication was handled on the dementia unit and found some examples of very poor practice. On the day of our visit we found that nurses had not given some medication to some residents although the Medication Administration Record Sheets (MARS) had been signed by the nurse to say that these medicines had been given. We also found records about unwanted medicines were poor and incomplete. Other records about the amount of medicines in the home were poor and confusing. It is important that all medicines can be accounted for and that the records are accurate and can show exactly what medicines have and have not been administered to residents. If
Care Homes for Older People Page 4 of 10 medication records are poor and incomplete peoples health can be placed at risk from harm. We found that some residents were not given their medication as prescribed because nurses failed to follow the instructions carefully. Some medicines had special instructions, such as antibiotics, which must be given before food. We saw that nurses ignored this instruction and gave the medication with food. If special instructions are ignored then medicines may not work properly and residents health may be placed at risk from harm. Other people could not be given some of their medication because there was none available in the home for them because it had run out. Some residents had been without their prescribed medication for four days. Some residents were given medicines when their health indicated that these medicines should not be given. One resident was prescribed three different laxatives, records for this resident showed that one of the laxatives had been withheld for two days because of loose stools. However the same nurse had administered the other two laxatives on those days. Some residents with swallowing difficulties were prescribed a special powder to thicken their drinks and other fluids, in order to prevent then from choking. There was no record made that those residents who were prescribed this powder, were having their drinks thickened properly, on either the residential or nursing units. There was information in files about how to thick drinks their drinks should be but this information was not available to care staff , who were making the drinks. If information is not available, staff can not be sure thay are making the drinks properly and residents health could be placed at serious risk form harm. We found that some aspects of storage was poor ,for instance creams were not stored safely because they were stored in residents rooms without assessing, checking, if it was safe to do so. Medication which should be stored in a fridge was stored at room temperature, if medicines are not stored at the correct temperatures they may not work properly. We looked at the way medication was handled on the nursing unit and again found some examples of very poor practice. We also found that some of the poor practice found on the dementia unit was repeated on this unit. We found that some of the records about medicines were poor, in that nurses were signing for medicines which, when the stock was counted showed that these medicines may not have been given. We saw that staff had signed that one medicine had been given twice in one day, despite being only prescribed once. However when the stock and records were checked against each other it was clear that a double dose of medication had not been given. Some records had been altered which made it difficult to tell what dose of medication was given each day. We also found that a number of records about medicines received into the home were poor or incomplete so it was not possible to track the medication nor was it possible to tell if these medicines had been given as prescribed. We looked at medication held for one resident together with the records about their medicines. The records showed that some medication must be withheld for seven days. Our visit was on day five of this period and the records showed that it had been withheld up to date. However the stock showed that the tablet had been removed from its packing
Care Homes for Older People Page 5 of 10 on one of the days during this period. The nurse on duty assured us that it had not been administered however there was no record of this medication being removed in error or of its destruction. If this medication had been given the residents health may be placed at serious risk from harm. This was discussed with the manger at feedback so the matter could be investigated and the residents health could be protected. On the day of our inspection visit the morning medicines on this unit were still being administered at midday and lunch time medicines were then given at 2:30 pm. It is possible some residents had their doses of medication too close together or had a long gap between their bed time medicines and the ones they took in the morning. Residents who were prescribed regular analgesia or antibiotics may have had their health placed at risk from harm due to the times of the medication administration. We looked at the records for two residents on the residential unit and found that the records showed some poor practice. The dates on one of the records had been altered making it difficult to tell exactly what date medicines had been given. During our visit we also observed a member of care staff enter the medication room take some pain relief tablets out of the blister packing and sign that they had been given, before she had done so. When inaccurate records are made residents may not get their medicines as prescribed and their health may be at risk. In light of some of our findings the manner in which staff handle medication shows that they do not all do it well and are not all competent to manage medication safely. It is essential that the home ensures that only well trained and competent staff handle medicines, to ensure the health and wellbeing of residents 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 10 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 18 13 The registered person must 30/01/2009 ensure, by training staff or by other measures that service users are protected from harm or suffering abuse or being placed at risk of harm This so that people can feel safe while they are at Millfield Care Home. And so staff understand fully the effects of abuse and the actions they must take to protect people. 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, 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 Medicines must be given to residents as prescribed. 03/09/2009 Because receiving medicines at the wrong dose, wrong time or not at all can seriously affect their health and wellbeing. 2 9 13 There must be effective systems in place to ensure staff that handle medicines are competent to do so safely. 03/09/2009 To help make sure that people who live in the home are kept safe. 3 9 13 All medicines must be stored 03/09/2009 safely, securely and at the correct temperatures. Medicines must be stored safely to make sure they can not be mishandled and at the correct temperatures to
Care Homes for Older People Page 8 of 10 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 ensure that they work properly. 4 9 13 Clear and accurate records of 03/09/2009 medicines received into, administered and disposed of by the home must be maintained. Risk assessments must be done to assess the safety of residents if medicines are stored in their rooms 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 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 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. Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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!
