Inspection on 18/02/10 for Wear Court

This inspection was carried out on 18th 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 5 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 17/05/10

Wear Court 16/03/10

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

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 16/05/2010.

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: Michael Earnshaw Date: 1 8 0 2 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): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Moorlands Care Homes (N.E.) Limited 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 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 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 Care Homes for Older People Page 2 of 12 Brief description of the care home 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 progress made against the medication requirements issued at the last key inspection in December 2009 and against the contents of the subsequent Warning Letter sent following that inspection. These requirements concerned the storage, handling and recording of medicines in the home. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk or harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. A pharmacist inspector spent seven hours in the home and the inspection involved looking at medication storage, stock control, examination of the current medication administration records (MARs), policies and procedures relating to managing medicines in the home and discussion with the manager of the home. We found that: All medication was stored within a secure treatment room which had been recently refurbished and was clean and tidy. Temperatures of the medicines fridge and the treatment room are recorded regularly although we could not find completed temperature records for February 2010. Earlier records indicated that the room temperature had usually been at the top end of the temperature range recommended by the manufacturer. However, the fridge records showed that the temperature of the fridge had been regularly above the range (2 to 8 degrees centigrade) recommended for the storage of medicines requiring refrigeration. At the time of the inspection the fridge temperature was recorded at 11 degrees centigrade and a vial of flu vaccine, which must be stored between 2 and 8 degrees centigrade, was stored inside the fridge. We were informed by the manager that the current fridge was faulty and a new fridge had been ordered but had not yet been received, and the matter had recently been discussed with the supplying pharmacy. Prescriptions are sent to the home first for checking, prior to being sent to the pharmacy. This is good practice and helps identify any omissions or discrepancies promptly so that all the medication a person needs is ordered in time. Photocopies of the prescriptions are maintained but records of the prescriptions requested, received, sent to the pharmacy for dispensing and medication received into the home are not comprehensive. Consequently, the medication audit trail is not complete and it is difficult to track all stages of the ordering process. We discussed with the manager how this could be improved. The storage of medicines for disposal was secure and appropriate records are maintained. We noted that some medication refused by one person had been sent for disposal but had not been recorded in the disposal records. In addition, there was no record in the disposal book to confirm that waste medication had been removed from the home and when this had taken place. The controlled drug cupboard appears to meet safe custody regulations and there were no discrepancies between entries in the controlled drug register and the quantities of controlled drugs remaining in stock. Entries in the controlled drug register were fully recorded and witnessed. Disposal of controlled drugs is appropriately managed and Care Homes for Older People Page 4 of 12 recorded in the controlled drug register, but not in the disposal record book. Regular stock checks on controlled drugs are not carried out. The current MARs were looked at and a sample of medication was counted and checked against the medication administration records. We noted four discrepancies between the quantity of medication received, the number of doses recorded and the quantity of medication remaining. In addition, we noted five gaps relating to two people, where administration of medication had not been recorded, or a non administration code entered on the MAR. In each case the dose of medication no longer remained in the monitored dose pack indicating that the medication had probably been given but not recorded. For a further person a daily application of Efudix cream had not been recorded for three days of the prescribed 28 day treatment cycle. Furthermore, this treatment had been recorded on the MAR as being completed three days short of the prescribed treatment period. These observations indicate that people living in the home may not be receiving all their medication correctly as prescribed and accurate records of medication administration are not being maintained. Some handwritten entries on MARs were not countersigned by a second person to confirm that the entries were accurate and complete. Quantities of medication carried over from the previous month were not always recorded on the MARs. This means that there is no accurate record of medication in the home and makes it difficult to confirm that medication has been given as prescribed. One box of Alendronic Acid, labelled as originally containing four tablets, contained six tablets comprising of two different batches. The MAR indicated that 9 tablets had been carried forward from the previous month meaning 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. The application of creams and ointments was generally well recorded with only occasional gaps on the MARs. The administration of medication at lunchtime was observed.This followed good practice guidance and people were given support and encouragement to take their medication. We noted that the pulse was not checked and recorded prior to giving Digoxin medication. We discussed this with the nurse handling medication who did not appear to be aware that this was good practice. Staff handling medication have recently received safe handling of medication training. The homes medicines policy and procedures does not give sufficient guidance on all aspects of handling medication and does not always reflect local practices within the home. Audit of the medication system is not carried out, although at the time of the inspection the manager produced a copy of documentation recently prepared for this purpose. Regular audit of the medication system helps to identify any medication discrepancies promptly and helps confirm that staff are closely following the homes medicines policy. What the care home does well: Care Homes for Older People Page 5 of 12 The administration of medicines was well managed and followed good practice guidance. The treatment room has been recently refurbished. 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 19 13,23 The registered person must 01/02/2010 continue the work to audit and improve the environment in line with the plans already submitted to CQC. This must include all of the items identified in this report. This is so that people who live in the home have an acceptable level of comfort, hygiene and safety. 2 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 3 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. 01/02/2010 Care Homes for Older People Page 7 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 will minimise the risk of cross infection. 4 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. 5 33 24 The quality assurance and 29/01/2010 monitoring systems must be fully implemented in line with the companys proposal. This will make sure that the quality of the service is regularly reviewed taking account of the residents views. 6 38 13 Arrangements must be 29/01/2010 reviewed and action taken to safeguard the health, safety and welfare of residents and people working in the home. Care Homes for Older People Page 8 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 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. 2 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. 12/04/2010 3 9 13 All medication must be stored at the correct temperature recommended by the manufacturer. Timescale of 01/10/09 not met To ensure that medication 12/04/2010 Care Homes for Older People Page 9 of 12 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 remains safe to use. 4 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. 5 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. Care Homes for Older People Page 10 of 12 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 Medication should remain in the original pack dispensed and labelled by the pharmacist until administered to the person it was prescribed for. Regular controlled drug checks should be carried out and recorded. The medicines policy should be updated to include guidance on homely remedies and to reflect local medication practice in the home 2 3 9 9 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. 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 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. 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