Care Home: Albury House

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What the care home does well People living in the home are given the opportunity to self medicate where possible. What the care home could do better: Medication storage facilities are poor. Some medicines are transferred into monitored dose system boxes by care staff rather than being undertaken in the pharmacy.A record of medication carried forward from the previous month is not always recorded. Audit of the medication system is not carried out. The home`s medicines policy is not comprehensive and does not give sufficient detail on all aspects of handling medication. Allergies to medication are not recorded on the MAR or in the MAR file. Some medicines are transferred from an old container to the newly dispensed pack rather than being left in the original pack dispensed by the pharmacy. Medicines for people who self medicate are not always stored securely. There is no controlled drug cupboard and controlled drug register to store and record controlled drugs. There is no lockable fridge for the sole storage of medicines requiring refrigeration. Random inspection report Care homes for older people Name: Address: Albury House 17-19 Tweed Street Berwick Upon Tweed Northumberland TD15 1NG two star good service 12/12/2008 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: Michael Earnshaw Date: 1 3 0 7 2 0 1 0 Information about the care home Name of care home: Address: Albury House 17-19 Tweed Street Berwick Upon Tweed Northumberland TD15 1NG 01289-302768 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs M L Burn Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs M L Burn,Mr A E Burn care home 12 Number of places (if applicable): Under 65 Over 65 1 11 dementia old age, not falling within any other category Conditions of registration: 0 0 The home is able to provide one place for a named resident under the age of 65. Should this person leave the home, the CSCI must be notified. Date of last inspection Brief description of the care home Albury House provides accommodation for up to twelve older people in a two-storey town house near the centre of Berwick upon Tweed. The house is in a quiet residential area and has been converted from a family home to suit its present use. Bus and train services are available within a short walk. 1 2 1 2 2 0 0 8 Care Homes for Older People Page 2 of 11 Brief description of the care home The home has accommodation on two floors and there are stair lifts fitted so that the first floor is accessible. There is an emphasis on retaining the feel of a family home. Furnishings and the decor have been chosen with this in mind. Fees are £449.00 per week. The Statement of Purpose has been reviewed since the last inspection and is available at the home. Information for prospective residents is also available. Care Homes for Older People Page 3 of 11 What we found: The reason for the visit was to carry out a pharmacist inspection of the service to look at the handling of medication in the home. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the services are not being put at significant risk or harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. A pharmacist spent five hours in the home and the inspection involved looking at medication storage, stock control, examination of the current Medication Administration Records (MARs) , policies and procedures relating to the management of medicines in the home, and discussion with the manger and senior carer handling medication. During the visit we gave verbal feedback to the manager. The outcome is as follows: Facilities for the storage of medicines are poor, consisting of a small,cramped area under the stairs. The store was locked, but was of inadequate size, lacked sufficient shelf space and was in a poor state of repair. At the time of the inspection the internal light did not work. Some medicines dispensed in boxes and bottles were stored in open plastic cartons on the floor. There was no medicines fridge and medication requiring refrigeration was stored in the kitchen food fridge. This was not locked and contained a bottle of Chlormethiazole syrup.We were told that fridge temperatures are regularly checked but records to demonstrate this could not be located during the inspection. Prescriptions are sent to the home first for checking prior to being sent to the pharmacy and a record of any medication returned for disposal is made. On the day of the inspection the medication for disposal book had not been returned from the pharmacy and could not be examined. We found an unopened bottle of Chloramphenicol eye drops, dispensed three months previously, in a storage box on the floor of the storage area.We were told that this should have been recorded and sent for disposal. Some people living in the home self administer their medication and appropriate risk assessments are carried out. Medication for these residents was stored in unlocked bedside drawers and the bedroom door is not always locked by the resident when they leave the room. This means that medication may not always be securely stored within the home. We saw a supply of some medication which had been repacked into an unlabelled Dosette box to assist one person taking their own medication. We were told that a senior carer transferred medication from the pharmacy dispensed packs and without any second check, rather than asking the pharmacy to undertake this task. We noticed a rack of dirty medicine cups in the storage area, labelled with room numbers, suggesting that these were used to transfer dispensed medication from their original packs to the residents. We were told that these cups were no longer in use and should have been destroyed. Medication must be administered directly from the labelled containers supplied by the pharmacy to reduce the risk of medication error. We found no gaps on the MARs and only one discrepancy between the quantity of Care Homes for Older People Page 4 of 11 medication supplied, the number of doses recorded and the quantity of medication remaining. This indicates that people can generally expect to receive their medication correctly as prescribed. However, we did find a supply of Nitrazepam 5mg tablets for one resident which could not be reconciled with the quantity received and the administration records. We were told that the dose of Nitrazepam had recently been reduced, but some staff may have continued to give the higher dose in error, although the current MAR listed the correct reduced dose. The manager confirmed that this would be investigated. We have not been formally notified of this issue as required under the Care Home Regulations 2001. The allergy status to medication is not recorded on the MAR or on the resident photograph profile in the MAR file. Allergies to medication, or the words none known should be recorded on all MARs and the photograph profile page so that staff are aware that it is safe to give medication to residents. There is no controlled drug cupboard in the home but we found a supply of Temazepam tablets located in a small locked cash box, labelled controlled drugs, in a plastic storage box on the floor of the medicines storage area. A controlled drug register to record all receipts and administrations of controlled drugs was not available in the home and the senior carer on duty was not aware of the need to make records in a register as well as on the MARs. Some medication had been transferred over from the previous month but was not recorded on the MAR. For example, a supply of 56 Adcal tablets were received for one resident and 17 doses were recorded as administered. However, 52 tablets remained in stock with two different batch numbers. This indicates that some Adcal was carried forward from a previous month and transferred into the box of recently dispensed Adcal. If carry forward quantities of medication are not recorded on MARs it means that there is not a complete record of medication in the home and makes it difficult to check that medicines are being given as prescribed. Transferring medication between dispensed containers may also lead to medication error. The manager told us that regular audit of the handling of medicines in the home is not carried out. This means that there is no regular check to ensure that staff are closely following the homes medication policy and to help identify any medication problems promptly. The medicines policy and procedures for the home do not cover all aspects of handling medication. For example there is no clear guidance on ordering and disposal of medicines, use of controlled drugs, managing repeated refusal of medication and handling of medication for people going on social leave. What the care home does well: What they could do better: Medication storage facilities are poor. Some medicines are transferred into monitored dose system boxes by care staff rather than being undertaken in the pharmacy. Care Homes for Older People Page 5 of 11 A record of medication carried forward from the previous month is not always recorded. Audit of the medication system is not carried out. The homes medicines policy is not comprehensive and does not give sufficient detail on all aspects of handling medication. Allergies to medication are not recorded on the MAR or in the MAR file. Some medicines are transferred from an old container to the newly dispensed pack rather than being left in the original pack dispensed by the pharmacy. Medicines for people who self medicate are not always stored securely. There is no controlled drug cupboard and controlled drug register to store and record controlled drugs. There is no lockable fridge for the sole storage of medicines requiring refrigeration. 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 £ No R 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 Care Homes for Older People Page 7 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 Arrangements must be made 21/10/2010 to ensure that controlled drugs are stored securely in accordance with the requirements of the Misuse of Drugs Act 1971, the Misuse of Drugs (Safe Custody) Regulations 1973 and in accordance with the guidelines from the Royal Pharmaceutical Society of Great Britain. To maintain security of controlled drugs and to comply with legal requirements. 2 9 13 All medicines must be stored 21/09/2010 safely and securely, including medicines requiring refrigeration and medicines for people who selfmedicate. To maintain medication security and to protect people living in the home. 3 9 13 Medication must only be administered directly from 21/08/2010 Care Homes for Older People Page 8 of 11 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 the containers supplied by the pharmacy. To reduce the risk of medication error when transferring medication. 4 9 13 Regular audit of medicines 21/08/2010 and records should be undertaken to promptly identify and resolve any discrepancies and to confirm that staff are closely following the homes medicines policy. To protect the health and welfare of people livivng in the home. 5 9 18 Additional training that reflects best practice guidelines must be provided to all staff involved in the administration of medicines. To reduce the risk of medication error. 6 9 37 Medication incidents which 02/08/2010 may adversely affect the well-being and safety of people living in the home or possible theft of medication must be reported to the Care Quality Commission. To safeguard the health and welfare of people livivng in the home. 7 9 13 The medicines store should 21/09/2010 be relocated to a secure area which is of adequate size, Page 9 of 11 21/10/2010 Care Homes for Older People 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 and appropriately furnished, for the storage of medicines. To protect medicines stored in the home. 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 The medicines policy and procedures should be updated to provide detailed guidance for staff on all aspects of handling medication. Known allergies to medication, or the words none known, should be recorded on all MARs and the photograph profile page for all people living in the home. All medication received into the home, or carried over from the previous month should be recorded on the MAR, and the entry dated and signed. A small lockable medicines fridge should be obtained for the storage of medicines requiring refrigeration. 2 9 3 9 4 9 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. © 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. 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