Random inspection report
Care homes for older people
Name: Address: Wall Hill Broad Street Leek Staffordshire ST13 5QA one star adequate service 15/06/2009 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: Ian Henderson Date: 2 2 1 0 2 0 0 9 Information about the care home
Name of care home: Address: Wall Hill Broad Street Leek Staffordshire ST13 5QA 01538399807 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) : Wall Hill Care Home Limited care home 34 Number of places (if applicable): Under 65 Over 65 0 34 dementia old age, not falling within any other category Conditions of registration: 7 0 The maximum number of service users who can be accommodated is: 34 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 - maximum number of places 34 Dementia Code DE, maximum number of places 7 Date of last inspection Brief description of the care home Wall Hill is registered to provide care and accommodation for 31 older people, 9 of whom may have needs associated with a physical disability, 9 of whom may have mental health needs and 4 whom may have dementia. The home is located close to the centre of the historic market town of Leek in the Staffordshire Moorlands. There is
Care Homes for Older People Page 2 of 11 1 5 0 6 2 0 0 9 Brief description of the care home a wide range of community facilities, including shops, restaurants, pubs and other leisure amenities in the town. There is good access to local bus services. The home also has its own minibus which is a well used and popular facility. The home is a twostorey building that has undergone considerable refurbishment to meet the needs of people who use the service. A passenger lift allows easy access to the first floor. Of the 29 single bedrooms available, 26 have en-suite toilet facilities. There is one shared bedroom available. The environment is well maintained and decorated throughout. Attractive communal sitting areas are provided at Wall Hill, with large and small lounge areas with comfortable seating and a large and attractive dining room that opens onto the rear grounds and patio area. People interested in accommodation at Wall Hill are advised to contact the home direct to obtain information about current fees and availability. Care Homes for Older People Page 3 of 11 What we found:
The reason for the visit was to fully assess the management of medicines within the home following some concerns raised at the key inspection on the 15th June 2009. In summary we found the management of medicines to be poor and placed people at risk of harm. At the key inspection we found that Paracetamol tablets were being shared between people who used the service. We found at this inspection that the issue of the sharing of Paracetamol had ceased as each person prescribed Paracetamol now had their own individual supply. We found that the medication records were still poor and could not be used to evidence that medicines were being administered as prescribed. The quantity of medication received into the home was not being recorded. Any medication carried over from the previous month was not being taken into account and added to the new quantities at the start of the next month. We found that where variable doses had been prescribed the records did not show what quantity had been given. Also where medication had not been administered and a generic abbreviation had been used there was no definition of the abbreviation and therefore the reason for the non-administration was not evident. We found evidence that the staff were signing the MAR charts but not actually administering the medicine. We found that a quantity of 10 tablets of an antibiotic had been received into the home. We found that there were 12 signatures on the MAR chart confirming that administration had taken place. We observed the lunchtime medicine administration round and on the whole it was carried out very well. A couple of issues were identified and these included the administration of eye drops being carried out by a person who was not the designated person administering the lunchtime medicines. We saw that this person did not refer to the MAR charts and did not sign the MAR charts either. Instead this was left to the person who had been designated to administer the lunchtime medicines. The second issue was that medicines were being placed next to the person they had been prescribed for and left there for the person to take when they were ready. The problems here was that the MAR charts were being signed even though the person had not taken the tablets yet. There was also the potential for another person sitting at the same table to take the medicines that had not been prescribed for them. We observed that a pot of Paracetamol tablets were situated on a table for twenty minutes before the person they had been prepared for took them. The home must record the receipt of all medication entering the home. The home must accurately record the administration of all medication and this record must be made by the individual who administered the medication. The home must also accurately record the disposal of all medication detailing the date of disposal, the person the medication had been prescribed for and the quantity being disposed. The accurate recording of all three elements of the medication records will ensure that the home can account for all medication that is received, administered and disposed of by the home and can ensure that people receive their medication as prescribed by their doctor. We found overall that the care plans were poor for containing information about the
Care Homes for Older People Page 4 of 11 administration of medicines. In particular we found little or no information about how and when medicines prescribed on a when required basis should be administered. We found no information about how variable doses should be managed to meet the individuals needs. We found very little information about the reasons for the administration of the medication and where appropriate the length of treatment, in particular the administration of medicated creams. We found that the home used a number of medicines that could be bought from a pharmacy, which were termed homely remedies. We found that the home had no information about whether the use of these medicines was safe for each individual living in the home. We found that a number of people who were using the service were holding and administering part of their own medication. We found that there was no documented assessment of the risks to either the people themselves or other people in the home associated with this activity. We also found that there was no monitoring programme in place to ensure that the people were administering the medication as prescribed by the doctor. We found that following the key inspection the carers had watched a video on how to apply creams and ointments correctly. The service indicated that this training was ongoing and further training was in the pipeline. We found that medicated creams were still being kept the bedrooms of the people they had been prescribed for. We visited the room of one of the people that had been prescribed a medicated cream and found that it was being kept in a draw that was not being kept locked. We found that none of the staff had undergone any assessments to establish whether they were able to administer medication safely and in accordance with good administration practices. In light of some of the issues identified during the inspection the assessment of the care staffs competency to administer medication safely must be carried out as soon as possible. We found that the maximum and minimum temperatures of the fridge were not being measured and recorded on a daily basis and therefore the home could not guarantee that the medication in the fridge was being stored at the correct temperature. The home was advised to obtain a maximum and minimum thermometer as a matter of urgency and ensure that the temperature of the fridge was maintained at between 2 and 8 degrees centigrade. We found that the Controlled Drugs cabinet had not been secured to the wall using the correct fittings and therefore did not meet the Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007. We found that the home was recording the receipt administration and disposal of Controlled Drugs on loose leaf pages which were not numbered. It was recommended that the home obtain a Controlled Drugs register to record the handling and administration of Controlled Drugs. What the care home does well:
The service had a wonderful atmosphere and the people who used the service appear to enjoy living there. Care Homes for Older People Page 5 of 11 The service was very keen to know where improvements were required. 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 11 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 15 Req. 15(1) The home shall 17/07/2009 prepare a written plan giving details as to how the persons needs in respect of his health and welfare are to be met. The plan should be reviewed regularly and at point of change. This will assure people who use the service that they will receive a person centred service for their individual needs. Care Homes for Older People Page 7 of 11 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 18 To ensure that staff are suitably qualified, experienced and competent to safely administer medication before they administer medication to people who use the service. regulation 18(1)(a). The registered person shall ensure thats at all times suitably qualified competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users 22/01/2010 2 9 13 Appropriate information 22/01/2010 relating to medication must be kept for example in risk assessments and care plans to ensure that staff know how to use and monitor all medication including when required as directed and self administered medication so that all medication is administered safely correctly and as intended by the prescriber to meet individual
Page 8 of 11 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 health needs. Regulation 13(2). The registered person shall make arrangements for the recording handling safekeeping safe administration and disposal of medicines received into the care home. 3 9 13 The service must ensure that 22/01/2010 medication is stored securely at the correct temperature recommended by the manufacturer. Regulation 13(2). The registered person shall make arrangements for the recording handling safekeeping safe administration and disposal of medicines received into the care home. 4 9 13 To make arrangements to ensure that controlled drugs are stored securely in accordance with the requirements of the Misuse of Drugs Act 1971, the Misuse of Drugs (Safe Custody) Regulations Amended 2007 and the guidelines from the Royal Pharmaceutical Society of Great Britain Regulation 13(2). The registered person shall make arrangements for the recording handling safekeeping safe
Care Homes for Older People Page 9 of 11 22/01/2010 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 administration and disposal of medicines received into the care home. 5 9 13 The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Regulation 13(2). The registered person shall make arrangements for the recording handling safekeeping safe administration and disposal of medicines received into the care home. 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 22/01/2010 1 9 The receipt administration and disposal of Controlled Drugs are recorded in a Controlled Drugs register. Care Homes for Older People Page 10 of 11 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 11 of 11 - 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!
