Care Home: Cravenside

What the care home does well Regular audits (checks) of medicines handling were carried out and should any areas for improvement be identified, action was planned to help bring about any changes needed. What the care home could do better: Some medication records could be more clearly and completely made to better support the safe handling of medicines and reduce the risk of mistakes. The medicines ordering procedures need to be reviewed to reduce the risk of medicines `running out`. Consideration needs to be given to the times that medicines are administered to help ensure they are administered at the best and right times. Inspecting for better lives Random inspection report Care homes for older people Name: Address: Cravenside Lower North Avenue Barnoldswick Lancashire BB18 6DP one star adequate 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: Stephanie West Date: 0 9 0 3 2 0 0 9 Information about the care home Name of care home: Address: Cravenside Lower North Avenue Barnoldswick Lancashire BB18 6DP 01282816790 01282853620 JulieBurns@careservices.lancscc.gov.uk 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) : Lancashire County Care Services care home 44 Number of places (if applicable): Under 65 Over 65 15 2 21 6 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Conditions of registration: 0 0 0 6 Within the overall total of 44 the service is registered to accommodate: up to 20 service users over the age of 65 years (OP); up to 15 service users in the dementia (DE) category; 2 named service users in the category Mental Disorder over the age of 65 years (MD(E)); 6 service users in the category of Physical Disability (PD) for intermediate care only Date of last inspection Brief description of the care home Cravenside is registered to provide personal care and accommodation to a total of 44 people in the categories of older people; older people who also have dementia and Care Homes for Older People Page 2 of 8 Brief description of the care home people needing rehabilitation care. The home is owned and managed by Lancashire County Care Services, which is a Lancashire County Council direct services organisation. At the time of the inspection visit the fees charged were £332.00 £433.00 per week. Additional charges were made for hairdressing; private chiropody; toiletries; newspapers; dry cleaning and part contributions to outings. The home has a booklet about service details to give to prospective residents and displays a copy of the most recent CSCI inspection report by the front door. Cravenside is located near to Barnoldswick town centre, with footpath access to the town centre shops and other amenities. The home looks out onto a green and has an enclosed protected garden at the front. There are sitting areas and a car park by the front entrance and each unit. The premises are purpose-built, comprising three ground and three first floor residential units (each accommodating between 6 to 8 people) and a first floor lounge/hairdressing salon. There is a passenger lift. Each Unit has single bedrooms, a bathroom, toilets and communal lounge/dining area with an integral kitchen (for light meals and snacks). The main kitchen and pay telephone are located on the ground floor. The home provides limited car and mini-bus transport (booked in advance). Care Homes for Older People Page 3 of 8 What we found: This visit was carried out to look at the arrangements for the safe handling of medication and to discuss any changes made, following a report of two medicines concerns by the manager. This visit was focused on medicines handling and other areas and requirements were not examined on this occasion. The visit lasted approximately six hours and involved discussing the handling of medication with senior staff, examination of medicine records and storage arrangements. At the end of the inspection feedback was given to senior staff in charge. Overall, we found that senior staff were aware of any shortfalls in the current medication arrangements and that action was being taken to help bring about improvement in the handling of medication. Medicines policies were available for reference at the home and staff had completed certificated training in the safe handling of medication. But, sometimes there was only one staff member on duty trained to administer medication, this is a difficult task for one person. The manager has recognized this and further training is planned. It was of concern that there was a risk that where doses of medicine were repeated throughout the day, they will be given too closely together. Senior staff had begun to monitor the times that medicines are administered to help ensure this will be addressed. Having more trained staff should also help ensure greater flexibility and choice in the times that medicines are administered. Part of the morning and lunch-time medicines rounds were observed. Care was taken to complete the records immediately after administration to help ensure they were accurately maintained, reducing the risk of mistakes. But, when we looked at a sample of medication administration records we found some gaps where administration or the reason for non-administration was not recorded, indicating that this was not always the case. We also saw that: When medicines were prescribed for example, one or two the actual dose given was not always recorded and, handwritten medication administration records were not checked and signed by a second person, to help reduce the risk of making mistakes. The administration times pre-printed on the medication administration records did not always reflect the times that medicines were actually given, this should be reviewed and updated. Complete and accurate record keeping helps support the safe administration of medication, so it is important that records are signed at the time of administration. Records for the application of prescribed creams, inhalers and eye drops were kept in individual rooms, these were not so well completed having more gaps, so it was not always possible to tell if they had been administered or missed. Unusually, eye drops and inhalers were administered and recorded by staff who had not completed the certificated medicines course. Eye drops and inhalers are also prescribed medicines and this should be reviewed to ensure the arrangements are safe and appropriate. Records for the receipt and disposal of medication were generally clear and accurate. But where medicines were received into the home outside the normal monthly delivery, a record of receipt was sometimes missed. This made it impossible to track (account for) the safe handling of these medicines. We compared a sample of medicines records with medicines stocks and found Care Homes for Older People Page 4 of 8 occasional examples where medicines had run out over the weekend. Action had been taken to get new supplies. Staff were aware of a problem with the monthly medicines delivery and were working to address this. It is recommended that all monthly prescriptions are seen and checked by the home to enable any queries or concerns to be quickly addressed before the stocks run out. We found that medicines, including controlled drugs, were stored securely. This helps to ensure that they are not misused or mishandled. It was of concern that although the handling of controlled drugs was shown in the controlled drugs register, administration was not always recorded on the administration record. Both, records must be completed to demonstrate the safe handling of controlled drugs. The controlled drugs register showed that a pain-reliving patch was on occasion not changed as frequently as it should be, this needs to be addressed as there is a risk of poor pain control if patches are left on too long. Regular in-house audits of medicines handling are completed, but these do not include the handing of creams, inhalers and eye drops. Carrying out a regular comprehensive medicine audits helps to ensure that medicines are handled safely and that should any shortfalls be identified they will be promptly addressed. 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 8 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 15 (2) (b) The care plans must be kept 15/07/2008 under review, to ensure staff have up to date written information about the residents needs. The care plans must cover the residents healthcare needs and provide clear guidance for staff on how best to meet these needs. 15/07/2008 2 8 15 (1) 3 12 16 (2) (m) Following consultation with 15/07/2008 the residents a programme of meaningful activities must be established, to ensure the residents enjoy a full and stimulating lifestyle. A review of staffing levels 01/08/2008 must undertaken and completed to ensure the number of staff is appropriate for the health and welfare of the residents. 4 27 18 (1) (a) Care Homes for Older People Page 6 of 8 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 Complete, clear and accurate 30/04/2009 records of all medication (including prescribed external preparations) received and administered, must be maintained to help ensure medication is safely administered as prescribed. 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 Handwritten entries should be signed and countersigned to reduce the risk of errors. The homes ordering procedures need to be reviewed to reduce the risk that medicines will run out. Then times that medicines are administered needs to be reviewed to help ensure they are administered at the right and best times. The arrangements for handling eye drops and inhalers need to be reviewed to demonstrate they are safe and appropriate, as for all prescribed medicines. Care Homes for Older People Page 7 of 8 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. 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. 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