This inspection was carried out on 30th September 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.
Random inspection report
Care homes for older people
Name: Address: Northfield Nursing Home 2a Roebuck Road Sheffield South Yorkshire S6 3GP 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: Steve Baker Date: 3 0 0 9 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 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 9 What we found:
The reason for this inspection visit was to follow up progress made against medication concerns identified at the last full inspection in August 2009. A pharmacist inspector spent eight hours in the home looking at medication storage and handling arrangements, the current months medication administration record charts (MARs), selected care files and the medication policy and procedure documents. He also observed and spoke to the two nurses who were giving medicines to people during the morning. Verbal feedback was given during the visit to the manager and deputy manager. The outcome is as follows. Multiple gaps and errors on the MARs together with discrepancies in the amount of medication held indicate that people living in the home may not always be given their prescribed medication correctly. Medication administration processes seen during the visit did not follow current professional best practice guidance. Medication storage and record keeping arrangements must be improved to ensure that staff know medicines are safe to use when needed. A total of 30 MARs were examined for completeness and accuracy. Six MARs contained entries lacking clear administration instructions and nine MARs contained significant gaps in the administration records. Six MARs failed to record the quantity of medication received or brought forward at the beginning of the month. Six MARs contained inadequate information about the use of prescribed skincare products and four MARs contained unclear information about nutritional supplement use. Five MARs contained a total of 12 hand written entries or amendments which lacked the necessary information for staff to be able to follow the changes safely. Very little information about when and why the changes were made could be found, for example, one persons record of warfarin dose was not always signed or dated nor did it make reference to the doctor authorising the change. Most of the hand written entries had been not checked for accuracy. Together, these gaps and errors in record keeping indicate that it is not possible to be sure that medication is always given correctly to people living in the home. The way medicines were seen to be given to people did not follow best practice guidance nor were good hygiene principles upheld. Nursing staff were reminded of this during the visit and agreed to change their practice to ensure medicines were given safely and records made in a timely and accurate way. People who wish to look after and take their own medicines are supported in doing this. The arrangements for how one person kept their own medicines was reviewed and changed during the visit to improve safety for others living in the home. The homes medication storage arrangements mean that medication trolleys are accessible in public areas of the home. Whilst not ideal, the design and use of space within the home mean this situation cannot easily be changed. We were told that consideration is now being given to identifying more secure storage areas for the medication trolleys. The temperature of the public areas is maintained for the comfort and wellbeing of people living in the home. The temperature inside the medication storage trolleys and cupboards should be monitored to ensure medication is kept at the temperature recommended by the manufacturer. All medication must be stored securely at the recommended temperature so that staff know it is safe to use when needed. As stated above, the quantity of medication brought forward from the previous month is not consistently recorded on the new MAR. This makes it difficult to know whether medicines are given correctly and whether the correct amounts remain each month. For example, eight containers of medication were checked to see whether the actual amount remaining tallied with the predicted amount calculated from the quantity received and number of
Care Homes for Older People Page 4 of 9 doses given according to the MARs. In five cases too many doses were left and in one other case too few. This indicates that medication may not always be given correctly and that record keeping in the home is not sufficiently accurate. The date when medication with a short in-use shelf life is first opened was missing from four of six liquid medicine containers and from all of the skincare products checked. If staff do not know when such products were first opened then they do not know that they are still safe to use. The homes medication policy and procedures documents had not been reviewed for some time. They should now be updated in line with current professional best practice guidance. This will help ensure all staff know exactly what is expected of them when handling and administering medication. 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 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 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 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 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. 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 1 9 Handwritten entries and changes to MAR charts should be accurately recorded and detailed. This makes sure that the correct information is recorded so that each person receives their medication as prescribed. Containers of skincare products and oral liquid medicines should be marked with the date they are first opened so staff know whether they are safe to use. The medication policy and procedures should be updated in line with current professional guidance so that staff understand exactly what is expected of them. 2 9 3 9 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!
