This inspection was carried out on 1st March 2010.
CQC has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CQC judgement.
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.
Random inspection report
Care homes for adults (18-65 years)
Name: Address: Withnell House, Inward House Projects Bury Lane Withnell Chorley Lancs PR6 8BH new service which has yet to be given a quality rating 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 3 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 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 because we had noted some concerns about the giving and recording of medicines at our last visit. The visit was carried out by a pharmacist inspector. It lasted approximately five hours and involved speaking with the manager, the responsible person 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 manager throughout the visit, and repeated the main findings to the manager and responsible person at the end of the visit. Overall we found that there was some very poor practice when handling, administering and recording medicines. This meant that health and wellbeing of people who live in the home was being put at unnecessary risk of harm. We looked at the policies and procedures for handling medicines within the care home. These were basic and 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 a sample of records and stock and we found it 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. There was no obvious system of stock control because stock was not properly recorded (carried forward) from one record to the next. Of the medicines that we could check, we found some that did not add up correctly, showing that they had been missed. For example, one person had not been given a medicine for an eye infection as prescribed, whilst another person had not been given their prescribed medicines for four out of the last 14 days. Missing medicines can seriously affect a persons health and wellbeing. The care home produced their own medication administration records, based on an outdated format of using two separate sheets per person. These were found to be inaccurate, incomplete and difficult to follow. The two sheets were not cross referenced carefully and the records became meaningless if the sheets were separated. This was of particular concern when key details such as the residents names and dates were not recorded on both sheets. Some records were typed whilst others were handwritten, but none had been double signed by two members of staff to show they had been thoroughly checked. For example one person was at very serious risk of harm as his medication records stated that the medicine should be injected into a vein, whereas the doctors instructions were for them to be injected into a muscle. The manager showed us a sample of a new style of medication record that she hoped would be in use shortly. 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
Care Homes for Adults (18-65 years) Page 4 of 10 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. 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. We looked at the storage of medicines and found that whilst the service had an appropriate medication cupboard, the keys were not securely held at all times. This meant that the keys were accessible to staff who were not necessarily authorised to handle medicines. Some medications had to kept in a fridge according to manufacturers guidance. The designated fridge was not secure. It had a broken door and was running at a temperature higher than that recommended. There was a large amount of ice present and this was discoloured and contaminated. Medicines can spoil and become unfit for use if they are not kept at the correct temperature in hygienic conditions. Using spoilt medicines places the health and welfare of people living in the home at serious risk of harm. We found that staff regularly filled dosette boxes with medication. This outdated process is known as secondary dispensary and is very risky as mistakes can easily happen. In this case it was particularly dangerous as medicines within the containers were labelled poorly or not at all. There was no formal method for recording which staff had filled the containers or that they had been passed to the care of the resident. People living in the home were not generally encouraged to look after their own medication. 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 usually called to the general office to be given their medicines. The office was seen to be a busy place with carers, other staff and visitors often present. This environment provided people with little privacy and/or dignity in this area of their care. We asked the manager about audits (checks) that were carried out to assess how well medicines were managed within the home. She told us that there were currently no formal audits in place. This meant that mistakes were not being found and acted upon to help prevent them happening again. We gave some advice to the manager on how audits can be performed and how they help to maintain and improve standards. We looked at training and found that only senior carers who had been given medication training were authorised to handle medication. However, there was no evidence of a 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:
Care Homes for Adults (18-65 years) Page 5 of 10 There were no examples of good practice with regard to handling medication seen at this visit. 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 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 arrangements 01/03/2010 for the recording, handling, safe keeping, safe administration and disposal of medicines received into the care home. In order for service users health to be protected. 2 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 Care Homes for Adults (18-65 years) 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 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 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 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 30/04/2010 4 20 13 Medication must be stored securely at all times 30/04/2010 Care Homes for Adults (18-65 years) Page 8 of 10 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 to prevent it from being misused or mishandled 5 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. 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 20 Medication administration records should be updated regularly, so that only currently prescribed medicines and dressings are listed. Detailed information for the administration of when required medication should be available for staff to refer to, so that these medicines are given correctly and consistently. 2 20 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!
