Care Home: Denville Hall

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What the care home does well We saw that throughout the home that variable doses of medication were being recorded accurately. In the dementia unit special instructions for creams and other topical medicines were clearly written on the MAR. We saw that the home was re-introducing protocols for medicines prescribed as required (PRN) so that everyone knew what dose of a medicine to give and when to repeat it . Many service users were self-medicating and we saw that there were risk assessments in place and that they were regularly updated. What the care home could do better: The home needs to ensure that there is robust auditing throughout the home particularly for more complex medicines such as warfarin and controlled drugs. They need to tighten up on record keeping for controlled drugs and ensure that stock is rotated and when it is destroyed entries are completed and signed and witnessed. They need to expand and update their medication policy and make sure that all current procedures are together in one document and that they have a procedure for managing warfarin and controlled drugs. Random inspection report Care homes for older people Name: Address: Denville Hall 62 Ducks Hill Road Northwood Middlesex HA6 2SB 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 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: Jane Shaw Date: 0 1 0 7 2 0 1 0 Information about the care home Name of care home: Address: Denville Hall 62 Ducks Hill Road Northwood Middlesex HA6 2SB 01923825843 01923841855 denvillehall@yahoo.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Julie Gladys Bignell Type of registration: Number of places registered: Conditions of registration: Category(ies) : DENVILLE HALL (REG CHARITY NO. 209480) care home 40 Number of places (if applicable): Under 65 Over 65 0 40 0 dementia old age, not falling within any other category physical disability Conditions of registration: 15 0 40 The maximum number of service users who can be accommodated is: 40 The registered person may provide the following category of service only: Care Home with nursing - Code N 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 Dementia - Code DE maximum number of places: 15 Physical disability - Code PD Date of last inspection Care Homes for Older People Page 2 of 11 Brief description of the care home Denville Hall is a large Victorian detached house, set in spacious grounds. The home provides both nursing and personal care for retired actors and people of affiliated professions. The home offers permanent and respite accommodation. 5 years ago the home was completely refurbished and a new dementia care wing built. The bedrooms are spacious and individually designed, each with an en suite comprising of shower, toilet and wash hand basin facilities. There are several communal rooms, providing a variety of usages, to include a library, drawing room, theatre room, green room, games room, relaxation room, art crafts room, hairdressing salon, two dining rooms, two bar facilities, several sitting rooms of varying sizes plus conservatory and courtyard areas. The extensive external grounds are landscaped and well maintained, with a selection of seating areas. The home is situated within a short drive of Northwood town centre, where there are shops and restaurants, plus public transport links in the form of bus and underground services. The fees range from GBP 590 to GBP 900, dependent on the service users level of care needs. Care Homes for Older People Page 3 of 11 What we found: We carried out a pharmacist inspection to see how safely medicines were managed. This was because of concerns raised at an inspection 2/11/2009, a change in management at the home and reports we had received of recent medication errors. We looked at the storage of medication, the recording of receipts, administration and disposal of medication and we did some random auditing to see if medicines were being administered as prescribed. We were told that the home had a new GP service and had changed the way they were ordering medicines. Most medicines were supplied in a Monitored Dosage System (MDS) . We noticed that one medicine was out of stock for 3 days at the beginning of the medication cycle. The deputy manager had noticed this when checking the medicines in at the beginning of the cycle and had ordered it. We saw two omissions in the recording of administration. In both cases the medicine was not in the MDS so we assumed it was given but not signed as given. Receipts of medication were all documented and waste records showed that medicines were destroyed if not needed or left over at the end of the cycle. We carried out an audit of 14 medicines supplied in their original containers. We found two discrepancies where there were one and two too many tablets left which suggests that either the wrong dose was given or the medicine was not given and signed as given. We were particularly concerned about the management of warfarin as record keeping was confusing and unclear and could lead to error. The home was carrying out regular audits but they had stopped for two weeks in one unit. In the other unit they were complete and we found no discrepancies and good record keeping. We looked at the storage and recording of controlled drugs. We noted that there were some gaps in signatures and initials when controlled drugs were received into the home.In the dementia unit we found a balance of a controlled drug from 2009 but no record that it had been destroyed. In the nursing unit we found a stock of a controlled drug and no entries in the register. Also in the nursing unit we found too much of one controlled drug and that one had expired because stock was not being rotated. Waste medicines were stored in the clinical room but we noticed that the door was not always locked and although all other medicines were secure that these were not. We read the homes medication policy and noticed it to be basic with separate additions.The waste procedure was ambiguous and the ordering procedure had recently changed. Overall we noted that the home had met requirements around cold storage and selfassessment. Further attention is needed in maintaining continuous supplies and accurate record keeping and robust auditing. What the care home does well: We saw that throughout the home that variable doses of medication were being recorded accurately. In the dementia unit special instructions for creams and other topical medicines were clearly written on the MAR. We saw that the home was re-introducing protocols for medicines prescribed as required (PRN) so that everyone knew what dose of a medicine to give and when to repeat it . Many service users were self-medicating and we saw that there were risk assessments in place and that they were regularly updated. Care Homes for Older People Page 4 of 11 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 15 There must be evidence that 01/02/2010 residents are involved in their service user plan, so that their needs can be discussed, recorded and a clear plan formulated to meet these needs. Where a resident is not able to or needs assistance to be involved in this process, involvement of their representative must be sought, unless it is impracticable to do so. This is so the plan of care is an accurate reflection of the needs and wishes of the individual. Service user plans must be up to date and accurately reflect the needs of each resident. They must be reviewed monthly and whenever there is a change in the residents needs. This is to ensure that staff have accurate information to follow. That all medication administration records are accurate and up to date and that the processes for 01/02/2010 2 7 17 3 9 13(2) 06/11/2009 Care Homes for Older People Page 6 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 auditing medications are adhered to, with any discrepancies noted being reported to the Manager without delay. This is to safeguard residents. 4 9 13(2) That a stock of all prescribed 06/11/2009 medications is available at all times. This is to ensure all residents receive medication as prescribed. Further work is needed to 01/02/2010 provide residents and their families with the opportunity to discuss the care they want in the event of health deterioration and during their final days, so that their wishes are clearly identified, recorded and can be respected. That a full environmental audit be carried out, and an action plan drawn up to address any shortfalls identified, with realistic timescales for completion. This it to maintain the home in a good condition throughout at all times. 01/01/2010 5 11 12 6 19 23 7 29 18 All staff employment records 01/12/2009 must contain the information required under Schedule 2 of the Care Home Regulations 2001. This is for the protection of residents. Page 7 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 8 33 26 That Regulation 26 visits are 01/12/2009 carried out in accordance with Regulation 26 of the Care Home Regulations 2001. This is to ensure the home is being monitored effectively. For there to be evidence that 01/01/2010 health & safety training and fire drills have been completed by all staff at the required intervals. This is to keep their knowledge up to date and protect residents, staff and visitors. 9 38 23 Care Homes for Older People Page 8 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 That the management and 02/08/2010 recording of controlled drugs in improved. To comply with current legislation 2 9 13 That the homes medication 01/09/2010 policy is expanded and updated and includes the management of warfarin and controlled drugs. This is to ensure that medicines are managed safely and comply with current legislation. 3 9 13 That there is robust auditing 02/08/2010 of medication throughout the home. Particular attention must be given to complex medicines such as warfarin. So that medication administration and recording errors can be quickly identified to protect the health and welfare of the service users. Care Homes for Older People Page 9 of 11 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 That the home works with the GP and pharmacist to ensure that there are continuous supplies of medication for all service users. 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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