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Inspection on 10/03/10 for Woodgreen Nursing Home

Also see our care home review for Woodgreen Nursing Home for more information

This inspection was carried out on 10th March 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 1 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

The manager had worked hard to improve the standard of medicine management in the home. Eight of the eleven requirements regarding the safe handling of medicines had been met.

What the care home could do better:

The manager must ensure that the remaining three outstanding requirements and the new requirement are met at the next inspection. In line with the commissions policy, we are making a referral to the enforcement team who will then make a decision was to what further enforcement action is to be taken, to encourage full compliance with the regulations.

Random inspection report Care homes for older people Name: Address: Woodgreen Nursing Home 27 Wood Green Road Wednesbury West Midlands WS10 9AX zero star poor service 03/12/2009 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: Debby Railton Date: 1 0 0 3 2 0 1 0 Information about the care home Name of care home: Address: Woodgreen Nursing Home 27 Wood Green Road Wednesbury West Midlands WS10 9AX 01215560381 01215052772 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) : Woodgreen Care Home Ltd care home 40 Number of places (if applicable): Under 65 Over 65 40 old age, not falling within any other category Conditions of registration: 0 The maximum number of service users to be accommodated is 40 The registered person may provide personal care (with nursing) and accommodation to service users of both sexes whose primary care needs on admission to the home are within the following categories: Older People (OP) 40 Date of last inspection Brief description of the care home Woodgreen Nursing Home is a privately registered care home providing nursing care for up to 40 elderly people. Situated opposite Brunswick Park on a main road between Walsall and the M5 motorway, it is within walking distance of Wednesbury town. There is car parking at the front of the home surrounded by mature garden borders. There are two lounges, a conservatory and a large dining room which is split up be a fireplace all on the ground floor. The garden to the rear of the property is pleasantly landscaped with borders, patio and a small lawn. The Home has single and shared bedrooms, Care Homes for Older People Page 2 of 11 0 3 1 2 2 0 0 9 Brief description of the care home located on both ground and first floor, the majority of which have en-suite facilities. There is a staff call system throughout the home. There is a small passenger lift that enables people access between the ground and first floor. There are two adapted bathrooms that can be used by dependent people and also a number of toilets throughout the home. The home arranges for the chiropodist, dentist and optician to visit on a regular basis and arrange visits by the GP, as people need it. Ancillary services of catering, cleaning, laundry and maintenance are provided in-house. The mobile hairdresser visits regularly and an additional charge is made for this service. Information about the range of fees the service charges in not available in the service user guide. Readers of this report are asked to contact the home directly for this information. Care Homes for Older People Page 3 of 11 What we found: The pharmacist inspection lasted three and a half hours. Five peoples medicines were looked at together with their Medicine Administration Record (MAR) charts. The reason for the inspection was to check compliance with the eleven requirements left at the last inspection regarding the medicine management in the home. The manager had worked hard to improve the service. All the surplus medicines had been returned and they had changed supplying pharmacy. They now use a monitored dosage system (MDS), where one dose of medicine is dispensed in a blister pack for each day of the 28 day cycle. The medicines were stored in two medicine trolleys, which were used to transport the medicines to the people in the home. A larger medicine trolley was also on order. All controlled drugs were stored in compliance with current regulations and medicines requiring refrigeration were stored in a locked medicine refrigerator. The temperatures of both the refrigerator and the room were monitored daily to ensure that the medicines were stored at the correct temperature to maintain their stability. All the prescriptions were seen prior to dispensing and used to check the medicines and MAR charts received into the home. One prescription had not been checked thoroughly enough and the dose had changed but the old dose had been prescribed and thus dispensed. This had not been addressed with the doctor and the new dose written on the MAR chart. This resulted in the person receiving seven times the new prescribed dose on the day of the inspection. This was confirmed by the nurse stating what she had given. She had also failed to record exactly what she had administered on the chart so this error would have gone unchecked. We were assured by the manager that the new dose had been administered on the previous two occasions. This was confirmed by audits. The quantities of all medicines received had been recorded. This enabled audits to take place to assess whether the nursing staff administer medicines as prescribed. The majority of medicines had been. Errors were still seen, three of which were serious. The manager had written a chart to record when a three monthly injection was due to be administered and nurses were able to record when they had administered it and also the next date it was due. Whilst this was good practice, no-one in the home had recognized that the dose due to be administered on 10th February 2010 had not been given. Audits confirmed that this had not been administered. This is of serious concern. Reasons for non administration recorded on the MAR chart were not always accurate. One MAR chart recorded that a person was offered a pain relieving medicine, when in fact there was none available to offer. The manager had installed a quality assurance system. This had improved the standard of medicine management seen since the last inspection and together with the new dispensed medicines in MDS, the majority of medicines had been administered as prescribed. The manager had also introduced a returns book. This recorded all the medicines that were no longer required. It was possible to track whether a medicine had been administered as prescribed throughout the cycle and this was commended. Care Homes for Older People Page 4 of 11 The manager has also introduced a new medication policy and staff had received training to enable them to adhere to this was well as training from the community pharmacy. Further training was to take place following the outcome of this inspection due to the serious errors found. 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 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 14 The home must make sure that peoples assessments are kept up to date and reflect changes in their condition. Peoples needs change and this must be recorded. 31/03/2010 2 8 13 People using bed rails must have a comprehensive risk assessment in place before they are used. This will prevent the misuse of bed rails and also make sure that only those people who require bed rails have them on their beds. 29/01/2010 3 8 17 The home must make sure 31/03/2010 that it keeps regular monthly records of peoples weights. This will enable them to take action when unplanned weight loss or gain occurs. 4 9 13 The medicine chart must 22/02/2010 record the current drug regime as prescribed by the clinician. It must be referred to before the preparation of the service users medicines and be signed directly after the transaction and accurately record what has Page 6 of 11 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 occurred. This is to ensure that the right medicine is administered to the right service user at the right time and at the right dose as prescribed and records must reflect practise 5 9 13 All dose regimes must be 22/02/2010 clearly written on the MAR chart, checked by a second member of staff for accuracy and the MAR chart must includes all relevant details for example the date. This is to ensure that the staff have clear directions to follow and the recorded information meaningful. 6 9 13 A system must be installed 22/02/2010 to check the prescription prior to dispensing and to check the dispensed medication and the medicine charts against the prescription for accuracy. All discrepancies must be addressed with the healthcare professional. The quantity of all medicines received and any balances carried over from previous cycles must be recorded to enable audits to take place to demonstrate the medicines are administered as prescribed. This is to ensure that the 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 audit trail for all medicines is seen and all medicines are adminsitered as prescribed at all times. 7 29 19 The home must audit the 26/02/2010 staff recruitment and training files to make sure that all required information is there and is easily accessible for inspection. They must do this so that they are not in breach of the Care Homes Regulations 2001 and to protect the people living in the home. 8 33 24A The home must submit an improvement plan that shows how they will address the issues in this report. This will be required 9 38 17 The home must keep records 30/04/2010 of the hot water temperature. They must also record what action they have taken when temperatures are not within recommended limits. This will provide the home with a clear record of the action they have taken in order to maintain a consistent supply of hot water for people. 10 38 12 The home must make sure 12/12/2009 that all bed rails are fitted as per manufacturers instructions. The use of bed Page 8 of 11 05/03/2010 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 rails must also be suitably risk assessed for each individual prior to their use. This will reduce the risk to the people living in the home. 11 38 13 The home must make sure that there is a consistent supply of hot water throughout. This will reduce the risk to the people living in the home. 12/12/2009 Care Homes for Older People Page 9 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 12 All prescribed medicines must be available for administration at all times This is to ensure that the service users health and wellbeing is maintained 10/04/2010 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 2 9 9 It is advised that all prescribed as directed doses are confirmed with the doctor. It is advised that clear MAR charts are written for warfarin doses and 0.5mg tablets are prescribed if necessary for administration. 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. 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