Random inspection report
Care homes for adults (18-65 years)
Name: Address: Withnell House, Inward House Projects Bury Lane Withnell Chorley Lancs PR6 8BH one star adequate service 08/01/2010 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: Maggy Howells Date: 0 1 0 6 2 0 1 0 Information about the care home
Name of care home: Address: Withnell House, Inward House Projects Bury Lane Withnell Chorley Lancs PR6 8BH . Telephone number: Fax number: Email address: Provider web address: www.inwardhouse.co.uk Name of registered provider(s): Name of registered manager (if applicable) Miss Jayne Naylor Type of registration: Number of places registered: Conditions of registration: Category(ies) : Inward House Projects care home 29 Number of places (if applicable): Under 65 Over 65 0 0 past or present alcohol dependence past or present drug dependence Conditions of registration: 29 29 The maximum number of service users who can be accommodated is 29. 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: Past or present drug dependence - Code D, Past or present alcohol dependence - Code A. Date of last inspection Brief description of the care home Withnell House is a care home offering rehabilitation for adults with a history of drug and/or alcohol dependency. The service provides 24 hour staff support and
Care Homes for Adults (18-65 years) Page 2 of 10 0 8 0 1 2 0 1 0 Brief description of the care home accommodation for up to 29 people. The home is situated in a rural area approximately eight miles from both Preston and Chorley. The home has a mix of single and shared bedrooms, with some having en suite facilities. The building has separate accommodation areas for male and female service users. Withnell House is able to accommodate service users with a physical disability, having wheelchair access, a lift and specific shower and toilet facilities. The length of the programme varies according to the needs of the individual service user, but will normally be between six and nine months. A three month programme may also be offered if this is appropriate to the needs of the service user. The programme is designed to allow service users the time to reflect on how to overcome their addiction or dependency, and take responsibility for decisions. The service user is central to their own recovery. The programme is provided through a series of group and one to one sessions. Inward House Projects, the provider organisation also offers an aftercare programme. Details of the fees can be obtained by contacting the manager of the home. Care Homes for Adults (18-65 years) Page 3 of 10 What we found:
We visited the home to see whether the service had complied with requirements made about the giving and recording of medicines at our last visit. The visit was carried out by a pharmacist inspector. It lasted approximately six hours and involved speaking with the acting manager and carers on duty. This was an unannounced visit, which meant that neither management nor staff knew we were going. We checked the medicines storage area, a sample of medicines stocks and medicines records. We gave detailed feedback to the acting manager throughout the visit, and repeated the main findings at the end of the visit. Overall we found that there had been no improvements made and that there was still very poor practice when handling, administering and recording medicines. This was very disappointing. Failure to improve meant that health and wellbeing of people who live in the home continued to be put at unnecessary risk of harm. We looked at the policies and procedures for handling medicines within the care home. These had not been reviewed, and so still did not cover all aspects of medicines management. This meant that staff did not have clear instructions for dealing with a number of situations including dealing with errors, providing medication for people whilst they were away from the home, obtaining supplies, or recording medication leaving the care home. We looked at the storage of medicines and found that the medication cupboard had still not been secured to the wall and the keys were not kept securely. This meant that the keys were accessible to staff, visitors and other people (including people living in the home) who used the office. The medication fridge had not been replaced or repaired meaning that the service could still not store some medicines safely. Medicines are at risk of being misused and/or mishandled when they are not stored safely and securely. We looked at a sample of records and stock and we found it still very difficult to account for medicines. This meant that we could not be sure they had been given to people correctly, or if the right amount of stock was left. Records of medication entering and leaving the home were still incomplete and inaccurate. The care home still produced their own medication administration records, but had changed the format. Records were all handwritten, but none had been double signed by two members of staff to show they had been thoroughly checked. Some records showed entries for medicines that were no longer being taken, but there was no record of who had authorised these to be stopped or when this had happened. In some cases there was still stock available in the cupboard. When the administration of medicines is not accurately recorded, people are at risk of being given the wrong amount of medicine (too much or too little). Mistakes are far more likely to happen when records are incomplete and inaccurate. Some people were prescribed medicines to be taken only when required e.g. painkillers. There was no system in place for recording detailed information about how and when these medicines were to be given in peoples care plans. Having clear written information helps to ensure that people are given their medicines consistently and correctly. Care Homes for Adults (18-65 years) Page 4 of 10 Some medicines have to be taken at specific times, for example an hour before food, in order to work properly. We could see no evidence that these medicines were given correctly. There were numerous examples of medicines prescribed to be taken before food being given at the same time as other medicines that should only be taken after food. People are unlikely to get the best from their medication if it is not given at the correct time in relation to food and drink. People living in the home were still not generally encouraged to look after their own medication despite having spoken about this at the last visit. No risk assessments had been completed to assess whether people could manage their own medicines safely, or what support they may need in order to be able to do so. Most people stayed in this home for a relatively short period of time before moving on to being self caring. Learning to manage medicines safely is essential for residents as they prepare to leave the service. We found that people living in the home were still being called to the general office to be given their medicines. This environment provided people with little privacy and/or dignity in this area of their care. We had given advice to the registered manager at our last visit on how audits (checks) can be performed on the medication and how audits help to maintain and improve standards, but no action had been taken to put any checks into place. This meant that mistakes were not being found and acted upon to help prevent them happening again. There was no formal system for checking and recording the competence of care staff (including temporary staff) actually administering or recording medicines. Checking the competence of staff ensures they are safe to carry out their duties without supervision. Given the serious nature of our findings the competence of some staff is questionable. 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 Adults (18-65 years) Page 5 of 10 Care Homes for Adults (18-65 years) Page 6 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 20 13 There must be complete and 30/04/2010 accurate records of all medication, particularly controlled drugs received, administered and leaving the service in order to account for all medicines. 2 20 12 Medicines must be given at the correct time of day, particularly with regard to food and drink intake in order for medicines to work properly and/or reduce side effects. 30/04/2010 3 20 24 There should be a system in 30/04/2010 place for checking and recording the competence of all nurses and care staff involved in administering and/or handling medication in order to ensure that staff are able to perform these tasks safely 4 20 13 There must be arrangements 01/03/2010 for the recording, handling, safe keeping, safe administration and disposal of medicines received into the care home. Care Homes for Adults (18-65 years) Page 7 of 10 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 In order for service users health to be protected. 5 20 13 Medication must be stored securely at all times to prevent it from being misused or mishandled 6 20 12 All medication must be administered/used only as prescribed in order to safeguard the health and well being of people who use this service 7 37 7 A responsible individual for the organisation must be registered with the CQC. In order that there is a nominated person from Inward House Projects who is responsible for supervising the management of the care home. 01/03/2010 30/04/2010 30/04/2010 Care Homes for Adults (18-65 years) Page 8 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 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 Adults (18-65 years) 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 Adults (18-65 years) 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 Adults (18-65 years) 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. 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!
