Inspecting for better lives Random inspection report
Care homes for older people
Name: Address: Stone House 55-57 Cheyney Road Chester Cheshire CH1 4BR 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 assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. 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: Elaine Bray Date: 1 2 1 1 2 0 0 8 Information about the care home
Name of care home: Address: Stone House 55-57 Cheyney Road Chester Cheshire CH1 4BR 01244375015 01244375734 lisawilford@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) : Mr Harry Gerard Keyzor,Mrs Jill Keyzor care home 33 Number of places (if applicable): Under 65 Over 65 33 old age, not falling within any other category Conditions of registration: 0 The registered person may provide the following category of service only: Care home only - Code PC 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 The maximum number of service users who can be accommodated is: 33 Date of last inspection Brief description of the care home Stone House is a residential care home providing personal care and accommodation for up to thirty-three older people. It is a family run private business that opened in 1987. The home is located in a residential area near to the centre of Chester, and has been converted from three houses. Many community facilities and shops, pubs and post office are within walking distance. Service user accommodation is on two floors and access between floors is via a passenger lift or the stairs. Care Homes for Older People Page 2 of 10 Brief description of the care home The home provides accommodation for a total of thirty-three service users in single rooms, all of which benefit from en-suite toilet facilities. A number of extensions have improved physical standards in the home. An outside garden/courtyard area is available for service users. There are car parking facilities available at the side of the property. The car park is accessible from Garden Lane. The fees at Stone House are between 367.54 pounds and 482.00 pounds per week. Optional extras include hairdressing, chiropody, bingo and newspapers. Care Homes for Older People Page 3 of 10 What we found:
This inspection was part of a random programme of inspections to see if medicines were handled safely. The inspection took about four hours and involved looking at residents medicines, medicine records and talking to the manager and deputy manager. We found some aspects of medicine management were good but there were examples of poor practice that could put residents at risk from harm. We found that medicines were stored securely. The controlled drug cupboard (for medicines that are liable to abuse) contained other valuables. It was agreed that these would be moved so that the cupboard is only opened for medicines. Secure storage ensures that only authorised people can get to the medicines, which reduces the risk of mishandling. The probe in the medicines fridge was not working. It was agreed that a fridge thermometer would be obtained and the temperature recorded daily. This means that residents health is protected by having medicines that are fit for use. We looked at how medicines were handled. The medicines supplied in a monitored dose pack (a pack containing a months supply, in compartments that show the day and time the dose should be given) were managed well. This system makes it is easy to see how many doses are left. The doses that have gone can be accounted for using the records. There was no system to do this with medicines supplied in conventional containers. This is important as this prevents mishandling and ensures that residents are safe. We found some tablets that had been dispensed more than a year ago. A small fresh supply should be obtained if they are still needed. There were some medicines for a resident who died in March 2008. Some medicines, that have a limited open shelf life (eg. eye drops that are sterilised), were not marked with the date of breaking the seal to be sure that they are fit for use. We were informed that a new pack is started at the beginning of each month. This is a good safeguard but it does not allow staff who give eye drops mid-month to be absolutely sure they are in-date. Some eye drops that are supplied in very small amounts in tiny bottles would not easily fit this system. All medicines should be checked at least monthly. Medicines that are not required nor fit for use removed. Good medicine handling ensures residents health is protected by having safe medicines. We looked at how medicines were recorded. A printed sheet listing the medicines to be given is supplied by the pharmacy. If this is not supplied or there are dose changes staff hand write the record. Sometimes changes were not explained and the record was not always signed and dated. Medicine receipt was not always recorded. The records of giving medicines had been made in exceptional detail and had no unexplained gaps. A residents preferred flavour of food supplement was recorded showing staff are aware of residents needs. The printed record uses omit codes (letters to describe why medicines are not given eg A= refused). The code F is left blank for staff to add a reason not already included. Code G refers to a full Care Homes for Older People Page 4 of 10 explanation on the reverse of the sheet. These were used a lot. The deputy manager explained that G was used to show when medicines had not been given at the printed time, for example, bedtime medicines for a resident wishing to go to bed early, medicines for prevention of osteoporosis that are needed very early in the morning. This is excellent and shows that staff are aware of residents individual needs. This also included doses that were not given on time because staff had other duties to attend to. This a particular problem in the mornings. The codes are explained given after breakfast/late. Some were medicines that should be given on an empty stomach. Entries on the back of one residents record were as above, referring to the first record made on the sheet. A few other records were made using the omit code letters F and G. No explanation had been added so it was not clear if the medicines had been given or by whom. The F code was mainly used for external creams and lotions. These are most frequently applied by care staff but are sometimes recorded by senior care staff or the deputy manager. Only the staff applying the cream must make the record to be sure that the record is accurate. For example, a resident developed a sore sweat rash. An urgent prescription for an antibiotic cream was supplied. The cream was only recorded used for forty-eight hours, the following records were all F. We were told that the cream would probably have been used for longer, but not recorded. The quantity of a cream received was recorded as 1 -the strength of medication it contains. Some other creams were not recorded used as frequently as the doctor prescribed. Staff did not always record the dose given when a variable dose had been prescribed. One of these was a sedative liquid to be given at night when required. Additional doses had been recorded on the back of the sheet. Staff had interpreted the directions when required incorrectly. There were records of a resident having doses of homely remedy paracetamol from 24/10/08 to 10/11/08. Homely remedies should only be given for a day or two without asking for medical advice. One resident was recorded to have had 11 doses from a course of 10 antibiotics. Staff had not asked for clarification when the printed record caused doubt. For example, an eye drop, printed to be used in the morning, the patient information leaflet said to use in the evening. Also, the dose of a laxative liquid was printed Two 5ml spoonfuls but the entry in the time box was 15ml. Controlled drug records were not made in a printed controlled drug book, now required due to recent changes in the law. Some records had been made correctly. When controlled drugs were sent to the pharmacy for safe disposal this was not recorded in the controlled drug record. The running balance (that should have been zero) showed misleading records of residual stocks. Records of returning other medicines to pharmacy for disposal were well done. Sometimes the date the medicines were returned had been missed. We were told that staff working between 22:00 hours and 07:00 hours were not medicines trained. A senior member of staff was on call. Some residents inhalers and a supply of paracetamol were kept in the office. Residents health is at risk if medicines are given by staff who are not trained and competent. Regular audits of the records are carried out. The audit process does not include all aspects of medicine management. There was a notice in the office about the next medicine refresher course for staff. Care Homes for Older People
Page 5 of 10 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 10 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set.
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, Care Homes 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 Ensure that all medicines are 10/04/2009 given to the doctors directions taking into consideration any special directions included on the label or patient information leaflet. So that residents get the maximum benefit from their medicines. 2 9 13 Ensure that all medicines are 10/04/2009 checked at least once a month to be sure that they have not date expired, are fit for use and are held in reasonable quantities for the residents needs. So that residents health is protected by ensuring their medicines are fit for use. 3 9 13 Ensure that clear, complete and accurate records of medicines received into the home and administered to residents are maintained. So that medicines can be fully accounted for to show that they are being given 10/04/2009 Care Homes for Older People Page 8 of 10 correctly and to prevent mishandling. 4 9 13 Ensure there is a system to account for every dose of medicines by auditing amounts with records. Residents are safe from mishandling of medicines 5 27 18 Ensure that at all times medicines are given by suitably trained and competent staff. So that residents health is protected from the risks of medicine errors made by staff that are not trained and competent. 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 10/04/2009 10/04/2009 Care Homes for Older People Page 9 of 10 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI 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 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI 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!
