Inspection on 10/02/10 for The Priory

This inspection was carried out on 10th February 2010.

CQC found this care home to be providing an Poor 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Priory 02/02/10

The Priory 20/10/09

The Priory 30/06/09

The Priory 02/12/08

The Priory 21/10/08

The Priory 08/07/08

The Priory 31/07/07

The Priory 02/03/07

The Priory 11/12/06

The Priory 06/10/06

The Priory 08/05/06

The Priory 14/11/05

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 11/04/2010.

Random inspection report Care homes for older people Name: Address: The Priory Springhill Wellington Telford Shropshire TF1 3NA zero star poor service 22/10/2009 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: Debby Railton Date: 1 0 0 2 2 0 1 0 Information about the care home Name of care home: Address: The Priory Springhill Wellington Telford Shropshire TF1 3NA 01952242535 01952641577 thepriory.home@yahoo.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Wellcare Management Ltd The registered provider is responsible for running the service care home 37 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 37 old age, not falling within any other category Conditions of registration: 0 The maximum number of service users who can be accommodated is: 37 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 (OP) 37 Date of last inspection Brief description of the care home The date of the last key Inspection was 22 October 2009. The Priory is care home for older people and also provides nursing care for individuals with complex nursing needs Care Homes for Older People Page 2 of 15 2 2 1 0 2 0 0 9 Brief description of the care home due to their physical health condition. The home is located in residential area and is accessible via public transport and is nearby to local amenities, such as shops and pubs. The two storey property is situated within its own grounds, offering single bedrooms on both the ground and first floor. The majority of bedrooms are equipped with en suite. Bathrooms and toilets are provided on each floor and are nearby to communal areas. A lounge, dining room, kitchen and laundry is situated on the ground floor and are accessible to people who live there. Equipment and adaptations are in place for people with restricted mobility. These include a passenger lift, grab rails and lifting appliances. Staffing is provided throughout the day and night. People do not have access to previous inspection reports. Access to these reports should enable people to find out about the quality of service provided and peoples experiences of living there. The fees charged for the service provided at The Priory was not made available to us. The reader is advised to contact the service direct for this information. Care Homes for Older People Page 3 of 15 What we found: The pharmacist inspection lasted five hours. The reason for the inspection was to check compliance of the three requirements regarding the safe handling of medicines left at the last inspection on 22nd October 2009. Eleven peoples medicines were looked at together with their Medicine Administration Record (MAR) charts and care plans. Two nurses were spoken with and one person who lived in the home. All feedback was given to the manager at the end of the inspection. Two of the three requirements left at the last inspection regarding the safe handling of medicines had not been met. Further enforcement action will be taken in line with the Commissions policy. All the medicines were kept in three medicine trolleys and the manager was considering moving these to a dedicated medication room, which could be suitably locked when not in use. One nurse took full responsibility for ordering medicines and problems occurred if she was on holiday as nobody else knew the system. All the prescriptions were seen prior to dispensing and a copy was taken, but not all the nurses knew how to use these to check the dispensed medicines and MAR charts received into the home. The majority of medicines were dispensed in a monitored dosage system (MDS) where one dose was in a separate blister per day. The remaining medicines were dispensed in traditional bottles and boxes. Not all the relevant information had been recorded on the MAR chart, for example, the date or the quantity of medicines received. Without this information it was difficult to demonstrate that all medicines had been administered as prescribed. Where this information had been recorded these indicated that many medicines had been recorded as administered when they had not been. Some medicines were not available to actually administer so some people did not receive their prescribed medication. Whilst the nurses had recognized that these had not been dispensed and some action had been taken, this was inconsistent and resulted in, for example, one person going without one medicine for 12 days to treat dementia. This is of serious concern. Nurses had signed that some medicines had been administered when they had not been and had failed to record the correct reason for non administration. It could not be demonstrated why they had not been administered on some particular dates even though the medicines were seen in the MDS for those dates. Some medicines were available to administer but not recorded on the MAR charts. Concern was raised that one medicine contained paracetamol and it could not be demonstrated whether these had been administered or not as there was no record of these on the MAR chart but some had certainly been administered from the dispensed pack. Staff had recorded they had administered other paracetamol tablets. This may increase the risk of possible overdose of paracetamol if they had administered both. Medicines were found in the medicine trolley that were unlabelled. All medicines must be administered from a pharmacy labelled box to confirm they are administered to the Care Homes for Older People Page 4 of 15 correct person they are prescribed to, at the correct dose and it is their current medicine regime. Nursing staff failed to record any cream or ointment application as these were often kept in the persons room without a cream chart. After visiting one persons room two pots of ointment were found that were out of date, but were still available to apply increasing the risk of infection. The person said they dont put any cream on my legs despite her legs being very dry and flaky. The recently dispensed steroid ointment had not been applied. In addition she said that a soap substitute was used instead of soap but the pot found in her room had been dispensed in June 2008. Had it been used properly it should have run out but was still available. Again there was no record of its use. People were encouraged to self administer their medicines but the care plans were not updated when they could no longer do so safely. In addition two inhalers were found in one persons room that had not been locked away. Staff had recorded they had administered them and the person was not self administering them. These should have been kept in the locked trolley. At the previous inspection it was noted that one person had very sticky eyes indicating a possible eye infection. No medical help had been sought and the nursing staff were still bathing her eyes in boiled and cooled water. The antibiotic eye drops prescribed previously in January had been used for one month and despite these not successfully treating the infection no further medical intervention was sought. This is of serious concern. The nurses spoken with did have a good knowledge of what the medicines were for but failed to understand the implications when people went without prescribed medicines for a sustained period of time. They failed to act when a person was constipated that may have been caused by one of the prescribed medicines and seek further medical advice. The care plans recorded some of the peoples clinical conditions but this was not inclusive of all their medical conditions. Without such information it would be difficult for staff to fully meet the persons clinical needs. There were still no protocols detailing when to administer medicines prescribed for occasional use. The manager assured us that they were in the process of being drafted but could not show any evidence of this during the inspection. This was a requirement from the last inspection. 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 15 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 7 12 Action must be taken to 07/12/2009 ensure that information relating to Do not resuscitate [DNR] is supported by the relevant authorised documents from a medical consultant or removed. This should ensure people are given the relevant nursing intervention if and when needed. 2 7 15 Measures must be taken to 23/12/2009 ensure staff have access to clear, informative care plans. This should ensure staff know how meet peoples needs properly. 3 9 13 The necessary measures should be taken to ensure a written protocol is in place for the use of When Required medicines. This should ensure staff know when and how to administer these medicines properly. 07/12/2009 4 9 13 The appropriate measures must be taken to ensure medication administration records are completed 07/12/2009 Care Homes for Older People Page 6 of 15 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 accurately. This should ensure people receive their medicines safely. 5 12 16 The necessary measures should be taken to ensure people are appropriately supported enabling them to pursue their chosen social interests. This should ensure all people live a fulfilled and stimulating lifestyle. 6 16 22 Action must be taken to 04/01/2010 ensure people have access to a complaint procedure in a format they understand. This should ensure people know how to share their concerns. 7 19 23 The appropriate action must 30/11/2009 be taken to ensure all clutter in the corridor that pose a tripping hazard and compromise the means of escape in the event of fire are removed. This should promote safety standards within the home. 8 19 23 Action must be taken to ensure all fire doors are in working order. This should allow staff sufficient time to evacuate the premises in the event of Care Homes for Older People Page 7 of 15 30/12/2009 26/01/2010 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 a fire. 9 19 23 The necessary measures must be taken to ensure the driveway is repaired and maintained. This should reduce the risk of falls and damage to peoples vehicles. 10 22 23 The necessary measures 29/01/2010 need to be taken to ensure people are provided with relevant equipment or adaptations that are safe and meet their needs. This should support peoples independence and safety. 11 27 18 The necessary action must 30/11/2009 be taken to ensure sufficient staffing levels are provided throughout the day and night This should ensure people are appropriately supported and their needs met properly. 12 33 26 The necessary action must be taken to ensure monthly quality assurance visits are carried out. This should ensure the service provided meets peoples needs. 13 37 12 Action must be taken to ensure furnishings disposed of outside the building are removed. 18/12/2009 30/12/2009 31/03/2010 Care Homes for Older People Page 8 of 15 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 This should ensure people are not placed at risk of harm. 14 38 13 The necessary measures 30/11/2009 must be taken to ensure any windows that may place people at risk are fitted with an appropriate restrictor. This should ensure peoples safety. 15 38 23 Measures must be taken to ensure the practice of wedging fire doors open stops. This should promote fire safety standards within the home. 16 38 12 Action must be taken to ensure all wardrobes are secured to the wall or a written risk assessment put in place that show control measures to reduce the risk to people. This should ensure people are not placed at risk of injury. 17 38 13 The appropriate measures must be taken to ensure all chemicals are securely stored. [An immediate requirement was issued on the day of the inspection]. This should ensure people are not placed at risk of Care Homes for Older People Page 9 of 15 30/11/2009 18/12/2009 14/11/2009 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 harm. 18 38 23 Action must be taken to 26/01/2010 ensure all deficiencies shown in the homes fire risk assessment dated March 2007 are addressed and also comply with the Enforcement Notice issued by the Fire Safety Department. This should enhance fire safety systems in the home. Care Homes for Older People Page 10 of 15 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 8 13 Medical help must be sought 25/03/2010 for all clinical conditions. This is to ensure that all medical conditions are treated by a healthcare professional if necessary 2 9 13 All dose regimes must be 25/03/2010 clearly written on the medicine chart and checked by a second member of staff for accuracy. This is to ensure that the nursing staff have clear directions to follow. 3 9 13 All medicines that are administered must be administered from a pharmacist labelled container. This is to ensure that the correct medicine is administered to the right service user, is in date and is their current prescribed medicine. 25/03/2010 Care Homes for Older People Page 11 of 15 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 4 9 13 All service users must be risk 25/03/2010 assessed as able to self administer their own medication and regular compliance checked undertaken and documented. This is to ensure that they can handle their medication safely 5 9 12 All prescribed medicines must be available for administration. This is to ensure that the service users is administered their prescribed medication as the doctor intended. 25/03/2010 6 9 13 A quality assurance system must be installed to assess staff competence in their handling of medicines. Appropriate action must be taken when these indicate that medicines are not administered as prescribed and records do not reflect practice. This is to ensure that individual nursing staff practice is assessed on a regular basis and appropriate action is taken if audits indicate that they do not administer the medicines as prescribed. 25/03/2010 7 9 13 A system must be installed to check the prescription prior to dispensing and to check the dispensed 25/03/2010 Care Homes for Older People Page 12 of 15 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 medication and the medicine charts against the prescription for accuracy. All discrepancies must be addressed with the healthcare professional. The quantity of all medicines received and any balances carried over from previous cycles must be recorded to enable audits to take place to demonstrate the medicines are administered as prescribed. This is to ensure that the audit trail for all medicines is seen and all medicines are administered as prescribed at all times. 8 9 13 The medicine chart must 25/03/2010 record the current drug regime as prescribed by the clinician. It must be referred to before the preparation of the service users medicines and be signed directly after the transaction and accurately record what has occurred. This is to ensure that the right medicine is administered to the right service user at the right time and at the right dose as prescribed and records must reflect practice Care Homes for Older People Page 13 of 15 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 It is recommended that all medication polices are reviewed and reflect good practice. and staff are trained to adhere to them. Care Homes for Older People Page 14 of 15 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 15 of 15 - 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!