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: Claire Lee Date: 2 8 0 9 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 11 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 11 What we found:
The purpose of this inspection was to look at action taken to improve care planning and medicines handling in order to meet with current requirements. Previous visits to the service found weaknesses in care planning and medicines handling that need to be addressed to help ensure people at the service are best protected. We looked at care documentation within the home and the medication systems that were in place. We spoke with care staff, and the manager. We also spoke to two people who used the service about their experiences and care whilst living at the home. Serious concerns about the safe handling of medicines were identified at our previous visit. A Statutory Requirement Notice was issued to the owners of the home in August 2009. This notice required owners operating the home to improve the control of medicines. We found that action had been taken to improve medicines handling at the home but that weaknesses in the arrangements for re-ordering medicines continued to put people at risk of not having their medicines when needed. This meant that requirements of the Statutory Requirement Notice served in August 2009 were not met, in that they remain in breach of Regulation 12 (1) (b). We looked at medicines administration. Where people chose to self-administer medicines written assessments had been completed to help ensure they received any help they may need to safely manage their own medicines. One person spoken with was happy with the arrangements in place to support them to manage their own medication. The medication administration records were up-to-date and to help ensure medicines were administered as prescribed, records were completed at the time of administration to each person. However, we were concerned to find that where the quantity of medication received was not sufficient to last until the next months supply people were at risk of running out of medicines. We saw that three people had run out of painkillers the previous month, and on the visit day one person had again run out and a second person had only two tablets left. The home no longer kept home remedies so supplies of painkillers were not available to residents without a prescription. It was of concern that one persons care plan referred to the need for paracetamol if requested due to arthritis but their medication administration record did not include any painkillers. Daily records for a second person on occasion showed that they were complaining of pain, but again no painkillers were listed on their medicines administration record. We looked at how medicines were recorded and found recent records of receipt, administration and disposal to be generally clear and accurate. But, it was of concern that one record impossibly showed that more doses of a liquid medicine had been given than actually received into the home. Most medicines administration records were pre-printed by the pharmacy but handwritten entries were not always checked and countersigned. This is recommended to reduce the risk of errors. Records for communication with doctors were mostly clearly completed so changes to medicines could be promptly made and tracked. But, we saw daily records for one person that suggested they were continuing to experience itching and discomfort after a new medicine had been prescribed for this. This could possibly have been followed up more quickly by care staff. The homes medicines policy was available for reference, but in some areas it could be usefully reviewed to provider clearer guidance for staff. The manager said all staff had
Care Homes for Older People Page 4 of 11 completed a formal medicines training course and confirmed that observations were carried out to help ensure staff understand and follow the homes medicines procedures. Regular audits (checks) were carried out but could be broader to help ensure that medicines are being handled safely and that should any weaknesses arise they can be dealt with promptly. We looked at residents care files to ensure staff had the information they needed to provide the necessary care and support to the residents. The manager is making changes to the care plans following the last key inspection however the layout of the care plan limits the staff as to how much they can record. Changes to this document would enable staff to record more information as to the level of support the residents need and how this is going to be achieved. The manager completes a care needs assessment for residents who wish to live at the home. An assessment seen had information recorded regarding areas such as, eating and drinking, mobility, communication, well being and social care. The information recorded was limited, however the staff have contacted the family to provide further information to assist with the plan of care. The manager should also contact a residents doctor when medicines are brought in to the home to check that these are the the current medicines being prescribed. This type of check was not carried out for a resident who had been admitted from the community. There was some information recorded in the daily care notes regarding a residents admission to the home. It would be beneficial to write up a summary of the persons care needs and state of health when they arrive. This will help the staff get to know the resident and to understand their health and social care needs. We noted a number of good practices. For example, residents who may not be eating or drinking sufficiently had been referred to a dietitian for their advice and support. This helps to ensure a good nutritinal intake. We noted however, examples of when it was not possible to determine whether or not residents were being appropriately supported with their care needs. This was due to a lack of information in their care files. For example, it was not clear whether tests prescribed by a doctor had taken place and although staff had recorded to the need to contact the GP again there was no evidence to support this had taken place. The manager was not able to provide any further information regarding this. Residents who were prescribed medicines for conditions that affected their health did not have a plan of care to provide the staff with the necessary information to care for them and to improve their health. It was noted also that there was a lack of detail recorded for residents who had frail skin and needed protection in the form of special dressings. This was recorded in the daily care notes as being applied but there was no follow up regarding the condition of the persons skin, who prescribed the treatment or a plan of care as to how a resident should be supported. These examples show that the health care needs of the residents are not being properly recorded and there is a risk that their health need are not being monitored effectively by the staff. What the care home does well:
Medicines Records are referred to and completed at the time medicines are administered, helping to reduce the risk of mistakes. Care Homes for Older People Page 5 of 11 The home presented with a warm and friendly atmosphere. Staff were seen to chat with the residents on a one to basis or within a group. 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 (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. 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 3 8 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 4 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. 20/06/2009 Care Homes for Older People Page 7 of 11 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 To ensure the health and well being of the resident. Care Homes for Older People Page 8 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 13 Service users must have a supply of their medication available to enable medication to be administered in exact accordance with the prescribers directions. 04/09/2009 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 3 The manager should contact a residents doctor following admission to the home to ensure they are taking the correct medicines in accordance with their prescription. It would be beneficial write up a summary of a persons care needs and state of health on admission. This will help the staff get to know the resident and to understand their health and social care needs. 2 7 The layout of the care plan summary should be reviewed so that staff can record in details the care needs of the residents. The homes medicines policy and procedures should be
Page 9 of 11 3 9 Care Homes for Older People 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 reviewed to provide clear guidance for staff in the safe handling of medicines at the home. Handwritten entries on the medication administration records should be checked and countersigned to reduce the risk of errors. 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!
