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Inspection on 14/07/09 for Whitestone Lodge Residential Care Home

Also see our care home review for Whitestone Lodge Residential Care Home for more information

This inspection was carried out on 14th July 2009.

CQC found this care home to be providing an Adequate 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

We found no significant examples of good practice when handling medicines.

What the care home could do better:

To ensure peoples health and well-being medicines must be safely administered as prescribed. The safe handling of medicines must supported and evidenced by clear and accurate record keeping.

Random inspection report Care homes for older people Name: Address: Whitestone Lodge Residential Care Home 56 - 58 Church Road Roby Knowsley Merseyside L36 9TP one star adequate service 28/04/2009 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: Stephanie West Date: 1 4 0 7 2 0 0 9 Information about the care home Name of care home: Address: Whitestone Lodge Residential Care Home 56 - 58 Church Road Roby Knowsley Merseyside L36 9TP 0151-480-4237 Telephone number: Fax number: Email address: Provider web address: whitestonelodge@btconnect.com Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Caulton,Mrs V Caulton care home 20 Number of places (if applicable): Under 65 Over 65 20 20 old age, not falling within any other category physical disability Conditions of registration: 0 0 The registered person may provide the following category/ies 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 Physical disability, over 65 years of age Code PD(E) The maximum number of service users who can be accommodated is: 20 Date of last inspection Brief description of the care home Whitestone Lodge is located in the Roby area of Liverpool, close to Huyton Village. Mr & Mrs Caulton own the home and the registered manager is Ms Paula Allen. The home is situated in a residential area within access to public transport to surrounding areas, Prescot and Liverpool. The home can have up to twenty residents who are of old age Care Homes for Older People Page 2 of 10 2 8 0 4 2 0 0 9 Brief description of the care home or with a physical disability. The home is pleasantly decorated and is situated over two floors. Single accommodation is provided and there are two double bedrooms for couples or for those who wish to share. There are three bathrooms, which are equipped with aids to assist less independent residents. There is a large enclosed garden to the rear of the home with a ramp and handrail and car parking space to the front. The fee rate for accommodation is £418.00 a week. Care Homes for Older People Page 3 of 10 What we found: We carried out this visit to make sure medicines were being handled safely. The visit was carried out by a pharmacist inspector and lasted approximately six hours. We checked medicines records, medicines stock and discussed medicines handling with the manager and senior staff. At the end of the visit we took photocopies of some medicines records and gave feedback to the manager about our findings. Overall we found shortfalls in the way medicines were being handled that place the health and wellbeing of people that live in the home at unnecessary risk. We checked a sample of peoples current medicines and records and found we could not always account for (track) the safe handling of medicines. For example, one record showed that someone had returned from hospital with three antibiotic tablets to complete a course, but the homes record impossibly showed that 12 tablets had been given. The same person had been prescribed a new spray whilst in hospital, but this new medicine was not included on their medication administration record. Staff were also uncertain about whether a previously prescribed inhaler was still needed. A second person had been using a nasal spray up to when the new delivery of medicines arrived at the home. Staff did not know whether the spray had been stopped by the doctor or if it had just not been delivered. A third person was being given prescribed laxative sachets from a box labeled for another resident. Staff were unable to confirm who should actually be having the laxative sachets. It is important that a complete list of currently prescribed medicines is kept so that staff know what should be administered and people receive the treatment they need. We were concerned to see that staff had continued to administer someone a medicine on five occasions after it had been stopped by the doctor. The risk of this error occurring would have been reduced if the stopped medicines had been removed from the in-use medicine rack. We also saw that advice from healthcare professionals could be acted upon more promptly. One record showed that a cream recommended by a District Nurse was not ordered until five days after their visit and was not used until twelve days after its use was advised. Staff said that the pharmacy had a problem getting supplies of the cream, but there was no evidence that advice had been sought to see if there was a suitable alternative. Similarly, records showed a delay of eight days between a new tablet being prescribed and administered to a second person. It was additionally of concern that records impossibly showed fifty tablets had been given from a bottle of sixty, but twentyfour were left. This means doses must have been missed. We were concerned to find no records to show that a course of antibiotic eye drops had been administered to another person. Failing to administer medicines as prescribed can seriously affect a persons health and wellbeing. We found that the home did not have a suitable range of measures (pots and spoons) for administering liquid medicines. Staff explained that they used cutlery instead (teaspoons and dessertspoons). The supplying pharmacist will be able to provide suitable measures. We saw that the medicines administration records were poorly completed, several records had not been completed to show the administration of medicines the previous evening, 13th July 2009. This increases the risk of mistakes as it is not always possible to tell who has already had their medicines. Additionally, staff are reliant on memory when later Care Homes for Older People Page 4 of 10 completing the medicines records so they cannot be relied upon as being accurate records of the treatment people have received. A written assessment and care plan had not been completed for someone who had chosen to self-administer one of their own medicines. It is important that assessments are competed to help ensure people receive any help they may need to safely manage their own medicines. We looked at medicines storage and found that all medicines were safely locked away. Arrangements were in place for the safe handling of controlled drugs but none were currently prescribed. It was of concern that we found an unlabelled inhaler and an unlabelled tub of medicines. The supplying pharmacist should be approached to see if the inner medicines container can be labelled as well as the box. Homely remedies were available for the treatment of minor ailments without a prescription, but it was not possible to account for their safe handling. The medicines were not kept in the original box; instead the loose foils (strips of tablets) were tipped into a plastic tub. This makes it difficult to check the expiry date and means there is no packaging information for staff to refer to. The manager explained that audits (checks) of medicines handling were carried out but it was evident that these had not been effective in bringing about improvement in the handling of medicines at the home. Care needs to be taken to ensure clear action plans are made, carried out and monitored to help ensure any weaknesses found are promptly addressed. The manager explained that staff had recently completed refresher medicines training and that further competency assessments were also planned, to help ensure staff follow the correct procedures. Regular training, formal competency assessments and detailed auditing will help ensure staff have the necessary skills to handle medicines safely. The homes medicines policy and procedures could also be usefully reviewed and updated to provide clearer guidance to staff about the safe handling of medicines in the home. 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 10 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 Care plans must include an appropriate level of information on the persons support with health care needs. So as to ensure care staff are aware of the persons needs and how to meet these. 20/07/2009 2 7 15 (1) (2) (b) The health and personal care 05/07/2008 of the resident must be recorded in a plan of care. This will ensure staff are aware of their current needs and will provide the necessary care and support. 13 A clear record must be maintained to demonstrate that residents where necessary are receiving treatment, advice and other services from health care professionals. To enusre that residents are being appropriately supported with their health care needs. 20/07/2009 3 8 4 8 13 Assessments and risk 20/07/2009 assessments must be carried out appropriately and any issues arising from these be clearly reflected in the Page 6 of 10 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 persons care plan. So as to demonstrate that appropriate action is being taken and ensure staff are aware of how to support the person. 5 9 13 Medication must be managed 20/06/2009 safely and in line with appropriate policies and procedures. To promote the health, safety and well being of residents. 6 19 23 All areas of the care home must be safe and free from hazards. The flooring in one of the residents bedrooms must be made safe. To ensure the health and well being of the resident. 20/06/2009 Care Homes for Older People Page 7 of 10 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 Complete, accurate and up- 04/09/2009 to-date lists of currently prescribed medicines and the time and date of administration must be maintained to support and evidence the safe handling of medicines. 2 9 13 Medicines must be safely administered as prescribed -care must be taken to ensure any changes to peoples medicines are promptly and accurately made. to help ensure peoples health and wellbeing. 04/09/2009 3 9 13 Where people chose to selfadminister medicines assessments must be completed to help ensure they receive any help they may need to do so safely. 04/09/2009 Care Homes for Older People Page 8 of 10 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 The homes medicines policy and procedures should be reviewed to provide clear guidance for staff in the safe handling of medicines at the home. Care Homes for Older People Page 9 of 10 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 10 of 10 - 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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