Random inspection report
Care homes for older people
Name: Address: Nether Place Nursing Home Chestnut Hill Keswick Cumbria CA12 4LS 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: Maggy Howells Date: 2 9 0 6 2 0 0 9 Information about the care home
Name of care home: Address: Nether Place Nursing Home Chestnut Hill Keswick Cumbria CA12 4LS 01768773269 F/P01768773269 nether-place@supanet.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) : Hometrust Care Limited care home 32 Number of places (if applicable): Under 65 Over 65 32 old age, not falling within any other category Conditions of registration: 0 The registered person may provide the following categories of service only. Care home with Nursing - code N, to people 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 people who can be accommodated is: 32 Date of last inspection Brief description of the care home Homecare Trust Ltd purchased Nether Place in July 2007. Mrs Jane Clarke is the registered manager. The home is registered to provide nursing care for up to 32 older people. Nether Place is a traditional stone building which retains many of its period features alonside a a newer extension. It is situated in a residential area on the outskirts of Keswick. Although the home is registered for 32 people, occupancy is generally lower, as most of the double rooms are let singly. Accommodation is over two floors, served
Care Homes for Older People Page 2 of 8 Brief description of the care home by one passenger lift. There are three lounges and a conservatory for shared use as well as seating areas within the large entrance hall. There is a well-kept garden with spectacular views over the Lakeland fells. Bedrooms are varied in size and shape, with the majority having ensuite facilities. There are assisted bathing facilities and an on site laundry and kitchen. There is an informative enquiry pack available from the home for anyone interested. The weekly fees at the time of this visit ranged from £396.00 to £635.00 including the government registered nursing care contribution payment. Fees were dependant on care needs and the bedroom occupied. Care Homes for Older People Page 3 of 8 What we found:
We visited the home because we had been told about a mistake that had happened when recording medicines. A pharmacist inspector carried out the visit. It lasted for four hours and involved speaking with the manager and a senior nurse. We checked the medicines storage area, a sample of medicines stocks and medicines records. We gave detailed feedback to the manager throughout the visit and at the end of the visit. Overall, we found that whilst most medicines were given correctly, some aspects of recording medicines did not fully protect the health and wellbeing of people who live in the home. There were policies and procedures covering all areas of handling and recording medicines. These documents help staff to know what to do in order to carry out their duties safely. Most medicines were supplied by the pharmacy in blister packs, although some were in traditional boxes and bottles. We looked at a sample of records and stock and we found we could account for most blistered medicines easily. This meant that we could be sure they had been given to people correctly. It was not possible to account for medicines that were not in blister packs, so we could not be sure that these were always given correctly. The health and well-being of people may be at risk if medicines cannot be accounted for. Of the medicines supplied in bottles and boxes, we found some that did not add up correctly, showing that they had been missed or not signed for. For example, one person had missed two antibiotic capsules, but these had been signed for as though they had been given. Another person had records showing that all their senna laxative tablets had been given, but some were still left in the blister pack. A third person was prescribed painkillers, but it was not possible to see how many had been given. Missing medicines can seriously affect a persons health and wellbeing. The use of creams and ointments had not always been recorded so it was not possible to see whether these had been used properly. When the administration of medicines is not accurately recorded, people are at risk of being given the wrong amount of medicine (too much or too little). Some people were prescribed medicines to be taken only when required, for example painkillers. There was no formal system for recording detailed information about how and when these medicines were to be given. Having clear written information helps to ensure that people are given their medicines consistently and correctly. We looked at the storage of medicines and found that the service had appropriate medication cupboards and a trolley available. These were kept in a locked room and the keys were kept by the nurse on duty. People are better protected when only authorised staff have access to the medication. A separate fridge was used for medicines needing cold storage, but staff had not checked the temperatures of this regularly. Checking and recording the maximum and minimum temperature of the fridge each day ensures that medicines are kept at the correct temperature so that they do not spoil. Care Homes for Older People Page 4 of 8 We checked how controlled drugs (medicines that can be misused) were handled. A suitable cabinet for storage was used and a special register accurately recorded the stocks and administration of these medicines. Having good arrangements for the handling of controlled drugs helps prevent them being mishandled and misused. The manager told us that no formal audits (checks) of the medicines handling system, other than the recording of controlled drugs were carried out at the moment. This meant that mistakes were not always found and acted upon to help prevent them happening again. For example, the manager said that staff knew to sign the medication administration record charts immediately after giving each person their medicines, however, some gaps were seen on the charts that had not been noticed. Having a good audit system can help to maintain and improve standards. We looked at training and found that only qualified nurses were authorised to handle and record medication. There was also a formal system for checking and recording the competence of these staff in carrying out these tasks. Checking the competence of staff ensures that staff are safe to carry out their duties without supervision. 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 8 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 8 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 There must be complete and 31/08/2009 accurate records of all medication received, administered and leaving the service in order to account for all medicines. 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 There should be clear written instructions informing staff how to give any medicines that are prescribed to be taken only when required so that people are given these medicines safely and consistently. There should be a system for regularly auditing (checking) the standard of handling and recording medication within the service so that standards can be monitored and improved where necessary. The maximum and minimum temperature of the medication fridge should be recorded daily to ensure that medicines are kept at the correct temperature. Care Homes for Older People Page 7 of 8 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 8 of 8 - 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!
