This inspection was carried out on 15th October 2008.
CSCI 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 10 statutory requirements (actions the home must comply with) as a result of this inspection.
Inspecting for better lives Random inspection report
Care homes for older people
Name: Address: The Grange Nursing & Residential Home Smeeton Road Saddington Leicester Leicestershire LE8 0QT The quality rating for this care home is: The rating was made on: two star good service 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: Mark Andrews Date: 1 5 1 0 2 0 0 8 Information about the care home
Name of care home: Address: The Grange Nursing & Residential Home Smeeton Road Saddington Leicester Leicestershire LE8 0QT 01162402264 01162404888 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Banesh Laxmilall Bhatoolall care home 52 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability 14 0 12 Over 65 14 52 52 Conditions of registration: No person under the age of 55 falling within category PD (physical Disability) may be admitted to The Grange Nursing and Residential Care Home. No one falling within category OP may be admitted into The Grange Nursing and Residential Care Home where there are 52 persons of category OP already accommodated within this home. No one falling within category PD(E) may be admitted into The Grange Nursing and Residential Care Home where there are 52 persons of category PD(E) already accommodated within this home. No one falling within category PD may be admitted into The Grange Nursing and Residential Care Home where there are 12 persons of category PD already accommodated within this home. Care Homes for Older People
Page 2 of 12 No person to be admitted to The Grange Nursing and Residential Care Home in categories OP, PD, PD(E) or DE(E) when 52 persons in total of these categories/combined categories are already accommodated in this home. No one falling within category DE(E) may be admitted into The Grange Nursing and Residential Care Home where there are 14 persons of category DE(E) already accommodated within this home. Date of last inspection Brief description of the care home The Grange Nursing and Residential Home is registered to accommodate up to fiftytwo older people, within the categories of older persons and physical disability. The home is located in the village of Saddington, Leicestershire and is approximately 12 miles from Leicester City centre. It is accessible by public or private transport and there is car parking at the home. The home is a large, traditional style house with bedrooms on two floors. The upper floor is accessible by stairs, stair lift or the passenger lifts. The home has 38 single rooms and 7 double rooms. Bathrooms and toilet facilities are located close to the bedrooms and the communal areas. There are two large comfortable lounges and the dining area is situated off the main lounge. All areas of the home are accessible to people using mobility support, aids and equipment. Information about the service is provided to prospective and current residents in the `service user guide?. The monthly fees are #327 to #441, which was provided by the Registered Person. There are additional charges for hairdresser, chiropodist and escort fees. The CSCI published inspection report is available at the home. Care Homes for Older People Page 3 of 12 What we found:
When we arrived for inspection, we found that the medicine round was still underway. The registered nurse on duty said that there were still four people who had so far not received their medicines. However, we found that no records had been completed for any medicines administered the morning of inspection and that the nurse had not followed safe medicine administration procedures. The nurse confirmed that she routinely tries to get the medicines out first before completing records. We also noted the medicine trolley was not in use for the morning round and there were plastic vessels on top of the medicine trolley one containing medicines. The medicine trolleys and storage cabinets were not locked when we arrived and medicines were not secured. We observed the final part of the medicine round and saw some medicines being given to people that did not belong to them. The morning medicine round was not completed until 11.50. The nurse on duty then arrived to start the next medicine round at 13.00 hrs. We were concerned that some medicines were being given to people later than intended by prescribers and there had been inadequate intervals between doses of some medicines. We discussed this with the nurse who was not aware of the need to leave intervals of four hours between doses of paracetamolcontaining painkillers. There were identifying photographs alongside medication charts for some but not all people to assist in ensuring medicines are safely selected for administration. Medicine refrigerator temperature records indicated that on each day since 05/10/08, medicines requiring refrigeration had been stored below the accepted temperature range. We asked the assistant manager to urgently consider if these medicines should be replaced. We asked to see records for both the receipt and disposal of medicines. The home could not provide records for the receipt of medicines into the home on behalf of people living there. When we looked at records for the disposal of medicines we noted that since the key inspection three pages of records had been completed by a nurse at the home. We asked Mr Bhatoolall where these medicines were located. Mr Bhatoolall said they were in his office but when we looked they were not there. Mr Bhatoolall then said the medicines had been collected by the supplying pharmacy. We checked this with the manager at the pharmacy who confirmed that no medicines had been either received or collected from the home. During feedback, on discussion, Mr Bhatoolall was unable to account for these medicines. During the inspection we conducted an audit of some medicines available for administration and current and some previous medication chart records. We found there to be some gaps in records for the administration of medicines where we could not determine if medicines had been given to people living at the home as prescribed. We also found that some records for medicines prescribed with variable doses were not complete as they did not indicate the doses administered and so these could not be accounted for. In the absence of records for the reciept of medicines, we attempted to undertake audit trails of medicines to account for them by assuming quantities of medicines on the labels were available at the start of the current medication charts Care Homes for Older People Page 4 of 12 (starting 13/10/08). We found there to be a significant number of discrepancies where medicines could not be accounted for and records did not demonstrate they had been given to people in line with presrcribed instructions. For a person recently admitted to the home for respite care we found that for two medicines the medication chart entries did not indicate the dose to be taken in line with the medicine container labels. We also found recent recorded evidence of some medicines not being available for administration to people prescribed them for ongoing regular administration placing their health and welfare at risk. For a person, previously administered painkiller paracetamol tablets from stock we noted that none were recorded as given to the person since the recent key inspection. Records indicated that the home had received authority from healthcare professionals to administer this medicine the day before this inspection but they had so far not been obtained. When asked, Mr Bhatoolall confirmed that he would ensure this medicine was obtained later during the day of inspection. When we asked the assistant manager if there were people at the home who selfadminister medicines and she said there were not, however, the medication chart for a person indicated they were self-administering three eye drop preparations. The assistant manager confirmed there had been no risk assessment undertaken for this person to establish the safety of this and ensuring the person is able to properly handle and administer the eye drops. The home were unable to account for medicines recorded for disposal since the key inspection of 09/10/08 (see above). We also found medicines that were being retained at the home including a container of dioralyte sachets with pharmacy label partremoved and a container of painkiller co-codamol 8/500mg tablets in a drawer in the medicine storage room with the persons name who they were prescribed for deleted. Another persons name was overwritten on the label. We noted a container of nighttime sedative zopiclone 3.75mg tablets in the same drawer that could not be accounted for by records. There were some medicines that were not labelled including a container of timolol 0.25 eye drops. The nurse on duty said these were for a resident currently at the home prescribed them. There was also no date of opening on the container and so no system in use to ensure this medicine is not used following its 28-day expiry time. What the care home does well: What they could do better:
We found there to be widespread concerns in the way the home manages medicines for people living there. We discussed matters arising with Mr Bhatoolall via verbal feedback in the company of his appointed pharmacist, a person appinted to take notes, Nicky Kaur (Assistant Manager) and Carol Bilvere (registered nurse on duty). Care Homes for Older People Page 5 of 12 We issued Mr Bhatoolall a Code B Notice under the Police and Criminal Evidence Act 1984 and took copies of some records away from the home during the inspection. We provided a letter stating the documents taken. 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 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 1 29 19 Staff must have Criminal 18/12/2007 Record Bureau Checks (CRB?s) in place before they commence employment. Such checks show that staff are recruited properly, and that the registered provider makes sure checks are carried out so that he can be confident that staff are safe to work with clients. Care Homes for Older People Page 7 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 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 12 The non-availability of prescribed medicines must be avoided. Medicines must be promptly obtained to enable them to be administered at scheduled times To safeguard the health and welfare of people living at the home 07/11/2008 2 9 13 Recorded risk assessments 07/11/2008 must be undertaken for people wishing to selfadminister their medicines. These must ensure people are able to safely handle and administer their own medicines To safeguard the health and welfare of people wishing to self-administer their medicines 3 9 13 Medicines must be given to 07/11/2008 people prescribed them in line with prescribed instructions. This must be demonstrated by recordkeeping practices that enable all medicines to be accounted Care Homes for Older People Page 8 of 12 for To safeguard the health and welfare of people 4 9 13 Full and accurate records must be provided on medication charts against which medicines can be safely selected for administration in line with their current prescribed instructions To safeguard the health and welfare of people living at the home 5 9 13 Arrangements must be made 07/11/2008 for the safe and appropriate disposal of medicines. Medicines no longer in use must not be retained at the home To safeguard the health and welfare of people living at the home 6 9 13 Records for the administration of medicines must be completed immediately following their administration. Full and accurate records of medicines prescribed with variable doses must be completed at all times To safeguard the health and welfare of people living at the home 7 9 13 Medicines requiring refrigeration must be stored within the accepted temperature range To safeguard the health and welfare of people living at the home 07/11/2008 07/11/2008 07/11/2008 Care Homes for Older People Page 9 of 12 8 9 13 Records for the receipt of medicines into the home must be completed and available at the home To safeguard the health and welfare of people living at the home 07/11/2008 9 9 13 Medicines must be stored 07/11/2008 securely. Steps must be taken to ensure the medicine storage room, cabinets and medicine trolleys are locked when unattended To safeguard the health and welfare of people living at the home 10 9 13 Medicines must be administered by staff who follow safe procedures. Medicines must be given to people at scheduled and prescribed times and when clinically appropriate To safeguard the health and welfare of people living at the home 07/11/2008 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 Regular and frequent audits of medicines and records should be undertaken to promptly identify and resolve discrepancies arising Action should be taken to ensure members of staff writing medication chart medicine entries do so safely and accurately. Entries written should be checked by a second competent person Identifying photographs should be obtained for all people prescribed medicines and placed alongside their medication charts to assist in ensuring medicines are safely administered
Page 10 of 12 2 9 3 9 Care Homes for Older People Care Homes for Older People Page 11 of 12 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: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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 © (2008) 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 12 of 12 - 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!
