Random inspection report
Care homes for older people
Name: Address: Springdene 55 Oakleigh Park North Whetstone London N20 9AT 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: Jane Shaw Date: 0 1 0 6 2 0 0 9 Information about the care home
Name of care home: Address: Springdene 55 Oakleigh Park North Whetstone London N20 9AT 02084462117 02084462110 gaye.summers@btconnect.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) : Springdene Nursing & Care Homes Limited care home 56 Number of places (if applicable): Under 65 Over 65 0 56 dementia old age, not falling within any other category Conditions of registration: 56 0 The maximum number of service users who can be accommodated is: 56 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 Date of last inspection Brief description of the care home Springdene is a purpose built care home registered to provide nursing care for 56 elderly people, some of whom may also have dementia. A short stay rehabilitation service for people between hospital and home is also provided. The stated aim of the home is to provide a service that is safe, sociable, comfortable and healthy to live
Care Homes for Older People Page 2 of 10 Brief description of the care home in. The home is owned by a company called Springdene Nursing and Care Homes Ltd. The company also has three other care homes in London. The company is led by a board of directors. The home is built on four levels and there are two shaft lifts. On the lower floor there is the kitchen and laundry as well as some bedrooms overlooking the garden. On the ground floor there is the main lounge area and bedrooms. The first floor has a small lounge and the main dining area. The second floor provides a designated service to people who have a higher range of needs and includes a lounge and dining area for these service users. The top floor provides a large activity room and hairdressing room. There are 55 single bedrooms and these all have en suite shower rooms. There are also four assisted bathrooms. The staff team consists of a manager, two deputy managers, nursing staff and a team of carers. There is a team of ancillary staff including catering staff, laundry assistant, cleaning staff a handyman and reception staff. The current scale of charges are £895 -£995 per week. Care Homes for Older People Page 3 of 10 What we found:
This was a focussed pharmacist inspection to see how medication was handled in the home and to follow up on concerns raised at the key inspection of 30/3/09. We inspected the Medication Administration Records (MAR) and noticed that the recording of receipts of medication in the home were overall complete. There were records of balances when medicines were carried over from one cycle to the next. We noticed some gaps on the MAR particularly on the second floor. Lactulose was prescribed twice a day for one resident but nurses were not recording the evening dose. We noticed an omission for amisulpiride on 29/5 but the dose was not in the monitored dosage system so we assumed it was given. When we audited a course of flucloxacillin though, there was one too many capsules left which means that one dose was not given but signed as given. There were several gaps for co-codamol, a medicine for pain relief and nurses were not recording the reason why. Other audits carried out of medication on this floor were accurate. We noticed that when variable doses were prescribed eg 1 or 2 paracetamol or 1 or 2 puffs that the actual dose administered was not recorded. We noticed on the other floors an omission for lactulose and in recording adcal on 28/5. We counted the tablets and noted that the tablets were not given and the reason not stated. Otherwise there was good recording and we were able to reconcile quantities against the signatures for administration. There was good practice of keeping the anticoagulant book with the MAR for a resident prescribed warfarin and we were able to check the accuracy of recording and the stock of tablets. We were concerned that the clinical room was very hot. The thermometer was reading 29 degrees centigrade at the time of the inspection. Medicines need storing at room temperature which is generally considered as under 25 degrees, to preserve the potency. We checked the controlled drugs and noticed that they were not stored in a cupboard meeting the requirements of the Misuse of Drugs Act. Most of the schedule 2 CD were transferred to the inner CD cupboard at the time of the inspection, but there was not enough room for them all. Balances were not all correct. There were 10 too many fentanyl 50 patches. These were subsequently identified as being entered on the wrong page of the register and the evidence was sent to the pharmacist after the inspection. Further tightening up in the CD register is required, as one page stated the residents name but no drug or dosage, so we did not know what was being recorded. Further consideration needs to be given to storage as prescription medicines were stored on open shelves, not in lockable medicines cupboard as described in the homes medication policy. The fridge was unlocked in the main office and only the actual temperature was recorded rather than the minimum and maximum. We noticed that the lancets in the home,used for testing blood glucose, were not of the professional type, to prevent the risk of cross infection from blood borne infections. Dates of opening were written on liquids and eye drops with a short expiry date so that they were not used past their shelf life. We noticed that one resident was prescribed oxygen and she told us that staff looked after her very well and that she was very happy in the home. The oxygen is a prescribed medicine albeit by a different method and should be documented on the MAR. We looked at the care plan of the resident prescribed co-codamol and noticed that there was no care plan/risk assessment/pain chart . We looked at the records for disposing of waste and noticed that there was no entry since the last return to the community pharmacist in April 2009. The manager faxed through to us the contract with the new waste disposal company after the inspection and staff
Care Homes for Older People Page 4 of 10 confirmed the new arrangements. We looked at the home medicine policy written in 2002 and noticed also the draft operational policy from 2009. We noticed that the new policy did not cover the disposal of medication, the management of leave medicines and the management of medication errors. We visited the rehab unit. There were no local procedures on how medication should be managed in this unit-which was quite different from the rest of the home. Residents had their medicines stored in original packs in locked medicines cupboards in their room. The home did have a self-medication procedure but no residents were able to self administer at the time of the inspection. A medication prescription/administration record was used. We were not able to audit medication because stock had not been carried forward from the previous chart but records were complete. There were no gaps and receipts were entered on the previous MAR and in a separate ordering and receipt book. We noticed that a resident was prescribed warfarin and the result faxed through from the private laboratory. We discussed improving practice of recording the telephone conversation with the GP re the dosage and/or signing the MAR to maintain the audit trail. We looked at the care plans in this unit and noticed the very good record keeping of the physiotherapist and records of GP and consultant visits. We noticed a defibrillator in the Rehab unit and were told that nurses were trained in its use on an annual basis. It had not been used yet but would be subject to individual resuscitation wishes. We did not see any reference to resuscitation in the four care plans reviewed. We asked to see the audits but the manager was not on site the day of the inspection .These were sent after the inspection and the manager told us that she carried out an audit every Thursday. What the care home does well: What they could do better:
There was still concern over the safe storage and recording of controlled drugs. The accurate recording of variable doses such as one or two had not been fully addressed.The prescriber needs to know exactly what dose is administered in order to carry out an appropriate review of effectiveness. Auditing processes could be further developed so that gaps and inappropriate recording are promptly identified and addressed. The home needs to keep abreast of current guidance such as the use of professional lancets to sample blood glucose. Care plans still need to be expanded with regard to management of pain and end of life care such as the use of the defibrillator.
Care Homes for Older People Page 5 of 10 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 £ 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 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 That controlled drugs are 01/07/2009 stored in a cupboard meeting the requirements of the Misuse of Drugs Act and recorded appropriately This is to meet the current legislation on controlled drugs 2 9 13 That care planning includes assessments for pain and monitoring of analgesia. So that residents have their needs met. 01/07/2009 3 9 13 That medication audits are expanded and are more robust and are available for inspection. This is to ensure that no medication is missed and recording including variable doses and oxygen are accurate. 01/07/2009 4 9 13 That lancets of a professional 01/07/2009 type are used when taking blood samples for testing
Page 8 of 10 Care Homes for Older People 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 blood glucose. This is to prevent the transmission of blood borne infections. 5 9 13 That the home expands its 01/08/2009 new medication policy to include the new procedures for disposal of medication,the management of medicines when residents take social leave and how the home manages and reports any medication errors. This is so that there are clear procedures for all nurses to follow to ensure that medication is managed safely to protect the residents. 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 That attention is given to storage of medication including the fridge, at the right temperature and in a professional secure manner. 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!
