Inspection on 17/05/10 for Wear Court

This inspection was carried out on 17th May 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Wear Court 27/05/10

Wear Court 16/03/10

Wear Court 18/02/10

Wear Court 11/12/09

Wear Court 30/07/09

Wear Court 01/08/08

Wear Court 08/11/07

Wear Court 01/12/06

Wear Court 25/01/06

Wear Court 13/09/05

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Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 04/09/2010.

Random inspection report Care homes for older people Name: Address: Wear Court Rock Lodge Road Roker Sunderland SR6 9NX zero star poor 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: Janet Long Date: 1 7 0 5 2 0 1 0 Information about the care home Name of care home: Address: Wear Court Rock Lodge Road Roker Sunderland SR6 9NX 01915496441 01915485305 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Moorlands Care Homes (N.E.) Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 30 Number of places (if applicable): Under 65 Over 65 30 old age, not falling within any other category Conditions of registration: Date of last inspection Brief description of the care home 0 1 8 0 2 2 0 1 0 Wear Court Nursing Home provides nursing and personal care for 30 older people.The home is situated in a residential area of Sunderland approximately 50 metres from the sea front and within easy reach of public transport facilities.The three-storey house was originally a residential dwelling and was converted to a care home in 1993. There is a passenger lift, which provides access to most areas of the home. A stair lift provides access to several bedrooms on the first floor that are inaccessible via the passenger lift.There are twenty-seven bedrooms, four of which are double and are currently used as single rooms. Eight single and two double rooms have en-suite toilet Care Homes for Older People Page 2 of 12 Brief description of the care home facilities however, some are not of a suitable size to allow access for wheelchair users or people with mobility difficulties. Corridors and door widths are wide enough to allow access for wheelchair users. The laundry, kitchen, dining room and lounge areas are all on the ground floor with the majority of bedrooms on the upper floors.There is a conservatory to the rear of the building, which overlooks the private and mature gardens.It costs between 405 pounds and 485 pounds per week to live at this home.The costs of newspapers, hairdressing, and toiletries are not included in the fees.Fees vary depending on peoples circumstances, further details can be found in the homes Service User Guide. Care Homes for Older People Page 3 of 12 What we found: The reason for carrying out this inspection was to check compliance with a Statutory Requirements Notice issued for medicines with a compliance date of 12 April 2010. A Statutory Requirement notice is a legal notice, which is served on the provider when there has been a breach of regulations. The notice describes which regulations have been broken and what the provider must do to put right the breach; it also gives the date by which it must be done. We must then follow up the notice by visiting the service to make sure that actions have been taken to meet the requirements and regulations. The requirement in this notice was made to make sure that residents health was not at risk from poor medicines practises. The service was required by 12 April 2010 to; Put in place effective arrangements at the home to ensure that all medication is stored at the correct temperature as recommended by the manufacturer. Put in place effective arrangements at the home to ensure that all medication is administered as directed by the prescriber to the service user it was prescribed, labelled and supplied for. Put in place effective arrangements in the home to ensure that medication records are accurately maintained. Put in place effective arrangements at the home to ensure that any omissions or variations in the administration of prescribed medication and the reasons for these are clearly, legibly and promptly recorded. Put in place effective arrangements in the home to ensure that the person administering the medication completes the Medicine Administration Record in respect of each individual service user at the time of administration. Put in place effective arrangements at the home to ensure that hand written entries on Medication Administration Records are fully recorded to include the signature of the person making the entry, the date of the entry, the quantity of any medication received or carried forward from the previous month, and the signature of a second carer confirming the accuracy of the entry. Ensure that regular audits of medication systems are carried out and an action plan implemented when any discrepancies or concerns are identified. From this visit it is clear that the requirements of the statutory requirement notice have not been fully met. A pharmacist inspector spent six hours in the home and the inspection involved looking at medication storage , stock control , policies and procedures relating to managing medicines in the home and examination of medication administration records (MARs). The current MAR had just started on the day of the visit so the majority of evidence was Care Homes for Older People Page 4 of 12 collected from the records for the period 19/4/10 to 16/5/10. There was an updated policy document which was basic but covered the essential areas. However there were areas where there were differences between practise and policy. For example the policy stated that room temperature would be recorded and this was not happening. The policy also said that people living in the home would be offered three monthly reviews by the GP. Policy also stated that a copy of the prescription will be kept by the home and this was happening for prescriptions supplied as part of the monthly cycle but a copy of the prescriptions for two antibiotic medicines for two people supplied mid month could not be found. The prescription is the authority for the staff to administer medication to the person. This also enables staff to check when making handwritten entries. The records for the disposal of medication were not complete and some medicines were stored for disposal but had not been entered in the disposal record book. Consequently the medication audit trail is not complete. Only a basic audit of the medication system is being carried out by the home. There was a file in the medication room with a document called the Residents Medication Stock Checklist dated 3/3/10 and 31/3/10 which checked a number of boxed medication against expected stock from MAR records. No further checks had been completed since this time. All medication was stored within a secure treatment room which was tidy. Medication was stored in a locked trolley or in locked cupboards, however one tube of prescription only cream was stored in an unlocked drawer with other creams. There was no record of room temperature kept and the room was very warm. The home had obtained a new fridge and a minimum/ maximum thermometer. There was a Clinical Refrigeration Monitoring form completed for April and May 2010. There were five gaps for April. The monitoring form for May showed that all dates had a temperature recorded but when staff were asked they were unsure how to read the new thermometer and confirmed that the temperature being recorded was the minimum temperature. Staff were also unsure how to reset the thermometer. This is not an accurate method for checking fridge temperatures to make sure that medication is stored at the correct temperature. No controlled drugs were currently stocked. The MARs were looked at in detail and a sample of medication was counted and checked against the records. There were ten boxes of Movicol sachets on the medication trolley, of these five did not have a pharmacy label stating which person they were prescribed for. When records were checked none of the stock remaining matched the records for this medication. Some MAR records indicated that medication had been signed for but not given. For example records for a liquid medication for one person contained no gaps or non administration codes but the quantity supplied by the pharmacy was only sufficient to last 24 doses and MAR records showed that 28 doses were given. An antibiotic medication for another person indicated that nine doses were signed for as being given but only seven doses had been recorded as supplied to the home by the pharmacy. Handwritten entries for two people were incomplete in that the quantity of medication received or carried forward had not been recorded on the MAR chart, others were not signed or Care Homes for Older People Page 5 of 12 countersigned by a second person to confirm that the entries were accurate and complete. One box of medication, labelled as originally containing 30 capsules was found to contain 32 capsules comprising of two different batches. This may indicates that staff in the home had transferred medication from one dispensed pack to another. Transfer of medication in this way can lead to medication error. Medication for two people had been out of stock for a number of days. For one person a pain relief liquid had been out of stock for three days up to the date of visit and for another person a pain relief medication had been out of stock for seven days. It is important to make sure that the quantity of medication is regularly checked so that a prescription can be ordered in plenty of time to prevent people being without. 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 12 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 9 13 To make arrangements to 12/04/2010 ensure that medication administration records are accurately maintained; that the reasons for nonadministration of medication are recorded by the timely entry of an appropriate code or entry on the medication record; that the meaning of any such codes are clearly explained on each record; and that the person administering the medication completes the Medication Administration Record in respect of each individual service user at the time of administration. To maintain an accurate record of medication administered. 2 9 13 To make arrangements to 12/04/2010 ensure that records are kept of all medicines received, administered and leaving the home, disposed of or carried forward from one month to the next. To maintain a full audit trail of medication in the home. 3 9 13 All medication must be 12/04/2010 Page 7 of 12 Care Homes for Older People 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 stored at the correct temperature recommended by the manufacturer. Timescale of 01/10/09 not met To ensure that medication remains safe to use. 4 9 13 To make arrangements to ensure that all medication is administered as directed by the prescriber to the service user it was prescribed, labelled and supplied for. To safeguard the health and welfare of people living in the home. 5 9 13 Regular audit of the 12/04/2010 medication system must be carried out and an action plan implemented when any discrepancies or concerns are identified. Timescale of 30/01/10 not met This helps identify any medication issues promptly, and helps confirm staff are following the homes medicines policy. 6 24 16,23 The registered person must continue to implement the action submitted to CQC to provide suitable furniture and fittings in all bedrooms. This will provide a comfortable environment for people to live in. 01/02/2010 12/04/2010 Care Homes for Older People Page 8 of 12 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 7 26 13 Staff in the home must be provided the facilities to adequately clean and disinfect equipment being used for personal care including the provision of adequate numbers of hot wash sterilisers. This will minimise the risk of cross infection. 01/02/2010 8 30 18 Ensure that sufficient 31/07/2010 numbers of staff receive first aid training in order that first aid assistance is always available in the home. Ensure that all members of staff with responsibility for administering medication are trained to do so. Provide all staff with training in adult safeguarding and whistle blowing. Ensure that all staff are provided with training in moving and handling which is appropriate to their work. Provide all staff with suitable training in health and safety. Provide all staff with suitable training in infection control. Provide all staff who prepare and handle food with suitable training in food safety and hygiene. Provide all staff with suitable training in the Mental Capacity Act and deprivation of liberties safeguarding. Care Homes for Older People Page 9 of 12 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 is to ensure that people are cared for by staff who are competent and trained for the work they are to perform. 9 30 18 The registered person must 29/01/2010 ensure that staff are provided with appropriate training for the work they are to perform. This is so that people living in the home receive the care and support they need. 10 38 13 Ensure that free standing wardrobes in bedrooms are risk assessed and where necessary securely fixed. This is to prevent toppling incidents and prevent injury. 21/05/2010 Care Homes for Older People Page 10 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, 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 All medication must be administered as prescribed and be available to administer from. This will make sure that people receive their medications correctly and the treatment of their medical condition is not affected 14/07/2010 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 Care Homes for Older People Page 11 of 12 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. 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