Care Home: Abbeyfield House

What the care home does well The service has staff who regularly update their medication training. Well-trained staff are less likely to make mistakes. Information about medicines currently kept in the home was available for staff to refer to whenever they had queries and the home had a good relationship with the supplying pharmacist. What the care home could do better: All medication must be stored securely at all times in order to reduce the risk of medicines being misused, mishandled or accessed by unauthorised people All medication must be administered as prescribed in order to protect the health and well-being of people who use this service. There must be complete and accurate records of all medication received, administered and leaving the service in order to account for all medicines. There must be a system for regularly auditing (checking) the standard of handling and recording medication within the service so that standards can be monitored and improved where necessary. Inspecting for better lives Random inspection report Care homes for older people Name: Address: Abbeyfield House Abbeyfield House Union Street Low Moor Clitheroe Lancashire BB7 2NH two star good service 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 assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. 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: 2 1 0 1 2 0 0 9 Information about the care home Name of care home: Address: Abbeyfield House Abbeyfield House Union Street Low Moor Clitheroe Lancashire BB7 2NH 01200442550 01200425740 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) : The Abbeyfield Lancashire Extra Care Society Limited care home 29 Number of places (if applicable): Under 65 Over 65 29 old age, not falling within any other category Conditions of registration: 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 The maximum number of service users who can be accommodated is: 29 Date of last inspection Brief description of the care home Abbeyfield House is a home for older people and is situated in a residential area in Clitheroe close to a bus route with easy access to the town. Abbeyfield House is part of The Abbeyfield Lancashire Extra Care Society Limited, Care Homes for Older People Page 2 of 9 Brief description of the care home which is a voluntary organisation. The home can accommodate a maximum of 29 older people of both sexes aged 65 years and over. It is a purpose built, detached property set in its own grounds and offers 27 single and 1 shared bedroom, all of which have en-suite facilities. There are 2 lounges and a dining room on the ground floor and a quiet lounge on the first floor. There is a paved patio area and garden to the rear of the home with a small car park to the side. At the time of the inspection there were 27 residents living at the home and they all appeared to be well cared for. Current weekly fee is £390 and additional extras like hairdressing, private chiropody and newspapers are paid for by the residents. Care Homes for Older People Page 3 of 9 What we found: We visited the home because the manager had told us about a mistake that had happened when giving and recording medicines. The visit was carried out by a pharmacist inspector. It lasted four hours and involved speaking with the manager and two senior carers. We checked the medicines storage areas, a sample of medicines stocks and medicines records. We gave detailed feedback to the manager and one senior carer throughout the visit, and repeated the main findings to them both at the end of the visit. Overall we found that whilst most medicines were given correctly, some poor practice when handling and recording medicines meant that the health and wellbeing of people who live in the home may be at risk of harm. 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 in the cupboards. There was no obvious system of stock control because stock was not properly recorded (carried forward) at the beginning of each month. 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 missed a medicine to treat stomach problems twice in the last 21 days. Another person was prescribed painkillers, but it was not possible to see how many had been given. Missing medicines can seriously affect a persons health and wellbeing. 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). Some medication administration records were confusing as they had lots of entries for medicines that were no longer given. Mistakes are more likely to happen when records are not kept up to date. Some people were prescribed medicines to be taken only when required e.g. painkillers. There was no formal system for recording detailed information about how and when these medicines were to be given. Having clear written information helps to ensure that people are given their medicines consistently and correctly. We looked at the storage of medicines and found that the service had appropriate medication cupboards and a trolley available. Some medicines, however, were stored in a large, unlocked cupboard. This meant that they were available to people other than authorised senior staff. The manager and senior members of staff all had keys to the medicine cupboards. The security of medicines may be at risk when more than one set of keys is in use. Medicines waiting to be returned to the pharmacy were kept in a disorganised way and it was impossible to account for these medicines. Medicines are at risk of being misused and mishandled when they are not kept securely and cannot easily be accounted for. A fridge was used for medicines requiring cold storage but the maximum and minimum temperatures of the fridge had not been recorded regularly, so we could not be sure that medicines had been kept at the correct temperature. Storing medicines at the wrong temperature can spoil them. Care Homes for Older People Page 4 of 9 We checked how controlled drugs (medicines that can be misused) were handled. A suitable cabinet was used for storage and a special register was used for record keeping. The register was usually completed correctly, however the cabinet was also used for storing money and other valuable items. This cabinet should only be used for the storage of controlled drugs. Having good arrangements for the handling of controlled drugs helps prevent them being mishandled and misused. The manager told us that no formal audits (checks) of the medicines handling system were carried out. This meant that mistakes were not being found and acted upon to help prevent them happening again. For example, the manager said that staff knew to record the opening date on bottles of eye drops, however, this had not been done for the stock in current use. 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 staff who were authorised to handle medication, completed appropriate trainings approximately every two years. There was no formal system for checking and recording the competence of staff actually administering or recording medicines. Checking the competence of staff ensures that staff have understood the training and are safe to carry out their duties without supervision. Information about medicines currently kept in the home was available for staff to refer to whenever they had queries and the home had a good relationship with the supplying pharmacist. 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 9 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 6 of 9 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, Care Homes 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 There must be complete and 27/02/2009 accurate records of all medication received, administered and leaving the service in order to account for all medicines. There must be sysytem for 27/02/2009 regularly auditing (checking) the standard of handling and recording medication within the service so that standards can be monitored and improved where necessary. 2 9 21 3 9 13 All medication must be administered/used as prescribed in order to safeguard the health and well being of people who use this service 27/02/2009 4 9 13 All medication must be stored securely at all times in order to reduce the risk of medicines being misused, mishandled or accessed by 27/02/2009 Care Homes for Older People Page 7 of 9 unauthorised 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 1 9 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 avaialble for staff to refer to, so that these medicines are given correctly and consistently. The maximum and minimum temperature of the medication fridge should be recorded so that staff can take action should the fridge become too warm or cold. Money and other personal items should not be stored in the Controlled Drugs cabinet. There should be a system for checking and recording the competence of staff in handling medication in order to ensure these tasks are performed safely Care Homes for Older People Page 8 of 9 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. 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