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Inspection on 22/12/09 for Northfield Nursing Home

Also see our care home review for Northfield Nursing Home for more information

This inspection was carried out on 22nd December 2009.

CQC found this care home to be providing an Adequate 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

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

The home remains able to support people who wish to look after and take their own medicines themselves.

What the care home could do better:

The steps we were told were being taken to improve medication storage, record-keeping and administration practice must be implemented fully and consistently. Sufficient qualified and competent staff must be on duty at all times to ensure people`s health and welfare needs can be met in a timely manner.

Random inspection report Care homes for older people Name: Address: Northfield Nursing Home 2a Roebuck Road Sheffield South Yorkshire S6 3GP one star adequate service 05/08/2009 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: Steve Baker Date: 2 2 1 2 2 0 0 9 Information about the care home Name of care home: Address: Northfield Nursing Home 2a Roebuck Road Sheffield South Yorkshire S6 3GP 01142687827 01142679591 northfield@palmsrow.co.uk www.palmsrow.co.uk 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) : Palms Row Health Care Limited care home 63 Number of places (if applicable): Under 65 Over 65 63 old age, not falling within any other category Conditions of registration: 0 The service may admit persons between the ages of 60 to 65 years. Date of last inspection Brief description of the care home Northfield is a care home providing personal and nursing care. Accommodation is provided for 63 people. The home is owned by Palms Row Health Care and is situated in the residential area of Crookesmoor. It is close to the main bus route and is a short walk away from the Upperthorpe shopping area. The home is purpose built with accommodation provided on two floors, which are accessed, by a lift. There is a garden area that is safe and private for people to enjoy. The grounds are accessible and well laid out, the garden sitting areas are attractive and well maintained. The manager confirmed that the weekly range of fees charged for accommodation and care was from £373-£649 Additional charges are made for services such as chiropody, newspapers and hairdressing. Further information about the home can be obtained by Care Homes for Older People Page 2 of 12 0 5 0 8 2 0 0 9 Brief description of the care home contacting the Manager. The inspection reports are available in the entrance to the home. Care Homes for Older People Page 3 of 12 What we found: The reason for carrying out this inspection visit was to assess the progress made against the medication requirements issued at the last pharmacist inspection on 30th September 2009. A pharmacist inspector spent 5.75 hours in the home looking at medication storage and handling arrangements, a sample of the current months medication administration record charts (MARs), a sample of care files and the draft updated medication policy and procedure documents. He also observed and spoke to the two nurses who were giving medicines to people during the day. In the managers absence, verbal feedback was given to the deputy manager in charge of the home. The outcome is as follows. None of three medication requirements were met at the time of this inspection. The morning medication round lasted until after 1pm on each floor as there appeared to be insufficient qualified staff on duty to deal with everyones health and welfare needs in a timely way. Discrepancies in the amount of remaining medication held along with recording gaps on the MARs indicate prescribed medicines may still not be given correctly. The temperature of most medication storage areas is still not checked so staff do not know whether medicines are being kept safely at temperatures recommended by the manufacturer. Some prescribed medicines and food supplements were left on open view in an unlocked store room accessible to unauthorised staff. Keeping medicines insecurely may lead to an increased risk of loss or diversion and means that staff may not be able to account for all medicines received into the home. As a result of these findings, the pharmacist inspector issued two immediate requirement notices at the end of the inspection visit. These notices require the home to take immediate steps to ensure firstly that medication administration and handling procedures are safe and secondly that sufficient qualified and competent staff are always available to meet peoples care needs in a timely way. Requirement 1 issued 30.9.09. Arrangements must be put in place to ensure that all medication is correctly administered according to the prescribers directions. Timescale for action - 30.10.09. Nine containers of medicines were checked to see whether the actual amount remaining would be the same as that predicted from the records of receipt and administration. Two were correct but seven showed discrepancies. For example, one person was supplied with 56 Adcal D3 tablets on 22.11.09 prescribed as one to be taken twice each day commencing 30.11.09. The MAR indicates that 37 tablets had been given, seven had been refused, there was one gap without explanation but there were still 35 remaining when there should only have been 18. Another person was supplied with 28 lansoprazole 15mg capsules on 22.11.09 prescribed as one to be taken when required as directed. the MAR indicates that four capsules were carried over making a total of 32 available. The same MAR shows that 18 capsules had been given between 30.11.09 and 21.12.09 but only seven remained when there should have been 14. Also, of the 22 MARs checked thoroughly, seven showed unexplained gaps in the administration record and one showed that simvastatin 20mg was unable to be given on four successive evenings as none was available in the home for this person. This same person was also unable to receive prescribed lactulose on four occasions between 19.12.09 and 21.12.09 as no personal supply was available. Finally, on arrival in the home, the pharmacist inspector was told that the morning medicines had begun to be given before 9am that day. He observed the nurses on duty still giving medicines due to be taken at breakfast time after 1pm. A further dose of some of these medicines would then have been due after Care Homes for Older People Page 4 of 12 lunchtime at about 1:30pm. Taking successive doses of the same medicine too close together may lead to an increased risk of unwanted side effects and may also reduce the expected benefits of the medicine. Together, these findings show that this medication requirement was not met at the time of this visit. Requirement 2 issued 30.9.09. All medication must be stored securely at the correct temperature recommended by the manufacture. Timescale for action 30.10.09. During the inspection we noted that the medication store room on each floor remained unlocked whilst the key-holding nurse was administering medication from the trolley. We were told by one nurse that the store room was accessed by unauthorised and agency staff who kept outdoor clothing and personal belongings there as no other secure storage space was available to them. The deputy manager insisted that all staff knew not to keep personal possessions in the medication store rooms. On entering the Red floor medication store room, we observed coats, shoes, bags and other personal possessions on worktops and on the floor which made an already cluttered room very untidy. We also saw containers of prescribed medicines left in open view on top of a cupboard, unwanted medication awaiting disposal in a tub on the floor, and three open containers of prescribed nutritional supplements on the floor outside the store room door. This means that prescribed medication is visible and accessible to unauthorised staff and to people not working in the home. The medication store room on the Blue floor was similarly cluttered and untidy. Completed temperature monitoring records were seen for the medication fridge on Blue floor, but those for the medication fridge on Red floor were incomplete. A total of six records were made during October 2009, ten during November 2009 and only four during December, the most recent being dated 12th December 2009. There were no temperature monitoring records for either of the medication store rooms or for any of the individual medication trolleys. The deputy manager told us she had requested the purchase of four thermometers earlier on the day of the inspection as none were available in the home to check the temperature of medication storage areas. Together, these findings show that this medication requirement was not met at the time of this visit. Requirement 3 issued 30.9.09. Arrangements must be put in place to ensure that medication administration records are made and maintained in an accurate and timely manner. Timescale for action - 30.10.09. 22 MARs for the week commencing 30 November 2009 were checked for completeness and, where possible, for accuracy. The discrepancies found between actual and predicted amounts remaining described under Requirement 1 above indicate that seven MARs may contain inaccurate information. Similarly, seven of the 22 MARs checked showed unexplained gaps in the administration records. Incomplete records were seen for the use of prescribed skin care products on three MARs. For example, one persons MAR lacked any records at all for the use of 1 hydrocortisone cream; a second persons MAR contained a mixture of ticks and gaps for the use of Diprobase, Sudocrem and 2 clotrimazole cream; a third persons MAR lacked any records for E45 cream and showed only a range of ticks for Trimovate cream prescribed as directed. Some hand written entries were still incomplete. One MAR contained nine hand written entries all double signed but none of which state the quantity of medication received. The entry for aspirin 75mg daily lacked directions for dissolving in water and taking after food. The entry for paracetamol lacked the tablet strength and the usual safety warning about not taking other medicines containing paracetamol. The MARs of two people who both take daily digoxin indicated pulse measurements were recorded on only seven and four dates respectively of the 23 dates a dose was given to each person. The practice of the nurses Care Homes for Older People Page 5 of 12 involved may be in contravention of the Nursing and Midwifery Council Medicines Management Standards if the pulse was not taken on the occasions no records were made. Together, these findings show that this medication requirement was not met at the time of this visit. 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 12 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 9 13 Arrangements must be put in 30/10/2009 place to ensure that all medication is correctly admininistered according to the prescribers directions. This will help to make sure peoples health and well being are maintained through the use of prescribed medicines. 2 9 13 All medication must be 30/10/2009 stored securely at the correct temperature recommended by the manufacturer. Staff will then know medicines are safe to use when needed. 3 9 13 Arrangements must be put in 30/10/2009 place to ensure that medication administration records are made and maintained in an accurate and timely manner. This will help to show that all prescribed medication has been given correctly. 4 16 22 All complaints must be taken 04/12/2009 seriously and acted upon. Improvements made as a result of a complaint must be maintained. Page 7 of 12 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 To make sure peoples complaints are taken seriously and acted upon. 5 18 13 Staff must receive training in 04/12/2009 safeguarding adults. To make sure people using the service are protected from harm or abuse. 6 27 18 There must be sufficient 10/05/2008 numbers of competent and experienced staff on duty at all times. Previous time scale 01/07/07 not met 7 27 18 The use of agency staff must 04/12/2009 not prevent people using the service from receiving continuityof care. To make sure peoples needs are met. 8 27 18 There must be sufficient numbers of competent and experienced staff on duty at all times. To make sure peoples needs are met. 04/12/2009 9 30 18 Staff must receive refresher training appropriate to the work they are to perform. To make sure people are cared for and supported by staff trained and competent to do their job. 04/12/2009 Care Homes for Older People Page 8 of 12 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 10 38 18 All staff including night staff must receive fire instruction and take part in a fire drill. To make sure they know the action to take in the event of a fire. and to reduce the risk of harm to people. 04/12/2009 11 38 18 All substances hazardous to health including prescribed creams must be stored appropriately and securely. To make sure people are not placed at unnecessary risk to their health. 04/12/2009 Care Homes for Older People Page 9 of 12 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 1 9 13 Arrangements must be put in 23/12/2009 place immediately to ensure that all medicines are given according to the current directions, sufficient time elapses between each successive dose of the same medicine to ensure people receive the expected benefit of each medicine and that they are not exposed to an increased risk of unwanted side-effects, all medication administration records are made and maintained in an accurate and timely manner and all medication is stored securely at the correct temperature recommended by the manufacturer. This is to ensure people receive their prescribed medicines correctly and safely as directed. 2 9 18 Arrangements must be put in 23/12/2009 place immediately to ensure that suitably qualified, competent, and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users at all times. This is to ensure peoples health and welfare needs can be met at all times. Care Homes for Older People Page 10 of 12 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 12 Arrangements must be made 29/01/2010 to ensure an effective system is in place to request, obtain and retain adequate supplies of prescribed medicines. This is so that people can given their medicines as and when needed. 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 Handwritten entries and changes to MAR charts should be accurately recorded and detailed so that each person receives their medicine correctly as prescribed. Containers of all skincare products and oral medicines should be marked with the date they are first opened so that staff know whether thay are safe to use. The draft updated medication policy and procedures should be issued to all staff so that they know what is expected of them when administering and handling medicines. 2 9 3 9 Care Homes for Older People Page 11 of 12 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. 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