Random inspection report
Care homes for older people
Name: Address: Millview Nursing Home Bridgeman Street Bolton Lancashire BL3 6SA three star excellent 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: Stephanie West Date: 1 7 1 2 2 0 0 9 Information about the care home
Name of care home: Address: Millview Nursing Home Bridgeman Street Bolton Lancashire BL3 6SA 01204391211 01204363246 bebbingn@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 (CFHCare) Ltd care home 180 Number of places (if applicable): Under 65 Over 65 0 180 0 dementia old age, not falling within any other category physical disability Conditions of registration: 180 0 180 The registered person may provide the following category 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, Dementia - Code DE, Physical disability Code PD. The maximum number of service users who can be accommodated is: 180. Date of last inspection Brief description of the care home Millview is a Care Home providing nursing and personal care for mainly older people. It is situated in Great Lever about half a mile from Bolton town centre. It is close to main bus routes, the local railway station and the motorway network. The home is purposebuilt, single storey and comprises of six separate houses, each with 30 single
Care Homes for Older People Page 2 of 9 Brief description of the care home bedrooms. There is plenty of car parking to the front of the home and there are garden areas around each unit for residents to sit out in. All the houses allow level access for wheelchair users and people who have problems climbing steps. Each house has a large lounge, a designated smoking area and a dining room. The toilets and bathrooms have aids to assist any resident with a disability or mobility problem. The home is registered to provide care for up to 180 residents with a variety of nursing and residential needs. These include general nursing and physical disabilities, palliative care and dementia care. The fees at the time of this inspection ranged from £355.39 to £609.00. For further details please contact the home manager. Care Homes for Older People Page 3 of 9 What we found:
This visit was carried out to look at the arrangements for handling peoples medicines to look at action taken to meet the requirements of our previous (key inspection) visit. The visit involved discussing the handling of medication with the nurse or senior person-incharge of each house, examination of medicine records and storage arrangements. This visit focused on medicines handling, other areas were not examined on this occasion. At the end of the visit feedback was given to the manager. Overall, we found that suitable arrangements were in place for handling peoples medicines. But, care needs to be taken to ensure the homes medicines procedures are always followed throughout the service, to ensure people are best protected. We observed part of the morning medication round in one house. To help ensure medicines were administered as prescribed records were referred to and completed at the time of administration to each person. We found that staff spoken with knew that some medicines had special label instructions such as before food, but formal arrangements were not generally in place to ensure these instructions were always followed. This should be addressed to help ensure medicines are given at the best and right times. Where medicines were prescribed when required there was some written guidance for staff about when they may be needed and how this need may be communicated. But, in some cases this was quite brief and could be usefully expanded. This is particularly important when people may find it difficult to tell staff about their medicines needs. The home had made arrangements for the use of homely remedies to enable treatment for minor ailments to be given without needing a prescription. People wishing to manage their own medicines were supported to do so. One person spoken with was happy with the arrangements in place to support self-administration and confirmed that she always had the medicines she needed. But, her assessment had not been kept under review and so did not clearly describe the current arrangements. It is important that assessments of safe self-administration are kept up-to-date to help ensure people always receive any support they may need. Documents were in place to agree that two people living in the home could have their medication given covertly (e.g. in food). When we looked at the information in the care plan that instructed staff how to support each person with this, we found little information about how this was carried out in practise, or to show that the decision was kept under regular review. Decisions to administer medication covertly need to be kept under review to ensure peoples best interests are protected. We looked at the information kept about peoples medicines when they had PEG tubes (feeding tubes) in place. We saw that checks had been carried out to ensure that their medicines could be safely given this way, but there were no protocols in place describing how this was done in practice. This is recommended to help ensure there is consistency in the way these medicines are administered. We looked at medicines record keeping and found some areas that need to be addressed to help improve the clarity of these records. We found that records showing the receipt of the main monthly medicines deliveries into the home were generally clearly completed. But, it was not always possible to account for (track) the safe handling of medicines at the home because in most houses boxes and bottles were not dated on first opening, nor was the quantity of any medicines carried forward to the next month recorded. We also found that although arrangements were in place for the safe disposal of unwanted
Care Homes for Older People Page 4 of 9 medicines the records were not always completed. This makes it difficult for the home to audit (check) the handling of medication at the home and should be addressed. For example, we saw occasional examples were records impossibly showed that more doses had been given than had actually gone from stock. At this visit we found that records for the application of creams were not always signed by the person who actually applied them, this increases this risk of mistakes. We also found some overstocking of creams. But, the home was changing the way external preparations e.g. creams were handled. Staff had started a training course in the new arrangements for handling creams that once completed, should enable these concerns to be addressed. We found that generally sufficient stocks of medication were maintained to enable continuity of treatment. But, where the quantities in stock at the beginning of each monthly cycle were insufficient to last the month, there was a risk that doses may be missed because there were none left to give. Procedures for re-ordering medicines outside the normal monthly delivery should be reviewed to help ensure they are effective. We found some inconsistency in recording advice from healthcare professionals, in most houses records were clearly made and followed-up, helping to ensure any changes were promptly addressed, in other houses written records could not be found to support changes to peoples medicines. Similarly, there was inconsistency in the way records were completed when medicines were not given, with some but not all staff recording the reason in full. It is important that clear and accurate records are maintained to support and evidence the safe administration of medication. We found that all medicines including Controlled Drugs were safely locked away, this helps to ensure that they are not misused or mishandled. In-house audits of medication handling were completed but consideration should be given to developing these to help ensure consistent practice throughout the home. 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 5 of 9 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 6 of 9 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 Complete, clear and accurate 01/02/2010 records of medicines received, administered and those sent for safe disposal must be maintained to support and evidence the safe handling of medication. 2 9 13 Individual information about the administration of medicines must be regularly reviewed and kept up-todate to help ensure people receive the right and best support to take their medicines safely. 01/02/2010 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 Where medicines are administered through a PEG (feeding) tube a written protocol should be agreed to help ensure consistency in the way this is carried out. Arrangements should be made to ensure that any special Care Homes for Older People Page 7 of 9 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 instructions such as before food are followed so that medicines are given at the best and right times. Care Homes for Older People Page 8 of 9 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 9 of 9 - 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!
