Care Home: Drayton Wood

What the care home does well The service has in place a monitored dosage system to assist in the safe administration of medicines. For other medicines an accounting system is in place to enable the use of these medicines to be monitored. What the care home could do better: The inspection has highlighted areas in medicine management requiring improvement to safeguard the health and welfare of people living at the service who are prescribed medicines. Random inspection report Care homes for adults (18-65 years) Name: Address: Drayton Wood Drayton High Road Drayton Norwich Norfolk NR8 6BL two star good service 08/06/2009 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: Mark Andrews Date: 1 3 0 8 2 0 1 0 Information about the care home1 Name of care home: Address: Drayton Wood Drayton High Road Drayton Norwich Norfolk NR8 6BL 01603409451 01603426568 office@benellcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Sonja Serruys Type of registration: Number of places registered: Conditions of registration: Category(ies) : Benell Care Services Limited care home 37 Number of places (if applicable): Under 65 Over 65 0 learning disability Conditions of registration: 37 The maximum number of service users who can be accommodated is: 37 The registered person may provide the following categories 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: Learning Disability - Code LD Date of last inspection Brief description of the care home Drayton Wood is registered to provide care and support to people with learning disabilities. It is set large landscaped gardens and woodlands. In the grounds there are pens for pygmy goats and chickens and there is an aviary. Care Homes for Adults (18-65 years) Page 2 of 11 0 8 0 6 2 0 0 9 Brief description of the care home There are five separate houses. Drayton Wood is the original building and dates back to Victorian times. There are four more recent purpose-built houses known as Holly Lodge, Cedar Lodge, Honeysuckle Lodge and Spruce Lodge. They are registered as one home, but have separate staff teams and groups of people with different needs. Nine people live in the main house, Drayton Wood. There is one double bedroom that is used for couples wishing to share, and seven single bedrooms. Seven of the eight rooms have en-suite facilities. There is a large lounge and dining area and a separate day care centre. Honeysuckle Lodge, Spruce Lodge, Holly Lodge, and Cedar Lodge each accommodate seven people, in single rooms with en-suite facilities. Each home has its own kitchen and dining facilities, and living rooms. Spruce Lodge has a lift to help people get up to the first floor. People can get into Norwich by bus or one of the homes cars. There are also used for people to go to other nearby towns and villages. Drayton Wood has the Investors in People Award and this was been renewed in December 2007. This is given for commitment to staff training. It costs from, £460.00 to £1004.86 per week to live at the home, dependent upon peoples needs. There are additional charges - for example for hairdressing, chiropody, transport and personal spending. Care Homes for Adults (18-65 years) Page 3 of 11 What we found: This inspection was conducted by the Commissions pharmacist inspector. We looked at how medicines were being stored, the arrangements for medicine administration, recordkeeping practices and the training and competence of care staff authorised to handle and administer medicines for people living at the service who are prescribed them. In the central building at Drayton Wood medicines are held within the ground floor office. On the day of inspection whilst at the time we arrived, the door to the office room was locked the key to the cabinet used for the storage of medicines was located in the cabinet door lock. The senior carer on duty said that the key to the cabinet is normally held on a nearby wall-hook and confirmed that this office is accessible by any member of care staff including those that are not trained and authorised to access, handle and administer medicines. By this arrangement, medicines are not being kept adequately secure. We looked at medicine storage arrangements in two other units and noted they are stored in metal cabinets within office rooms. In one unit, for a person who is prescribed insulin, there is a small refrigerator in use to store back up supplies of insulin. However, whilst on the day of inspection a thermometer showed the temperature to be 8 degrees C (which is at the upper temperature limit), there were no records from 11 July 2010 to 8 Aug 2010 therefore the service cannot demonstrate the insulin has been stored within the accepted temperature range at these times. The service currently does not have a cabinet suitable for the storage of controlled drugs. Whilst we noted some controlled drugs of lesser classification at the home which do not require proper controlled drug cabinet storage, should a person be prescribed schedule 2 (or some schedule 3) controlled drugs, a cabinet compliant with the Misuse of Drugs (Safe Custody) Regulations would be required. On this basis, we recommend the service obtains such a cabinet for the storage of controlled drugs where applicable. The service is supplied most medicines in a 28-day monitored dosage system from which they are administered. 28-day medicine administration charts are used to record the receipt and administration of medicines for the 28-day period. On one unit the charts were mis-aligned with the other units by one day so we suggested action is taken to resolve this. Current medicine charts were located in a folder in each unit. We noted a list with the specimen signatures for care staff authorised to handle and administer medicines on each unit, however, the senior carer on duty agreed lists were not dated or up to date. There were cards between each persons medication charts with information about them, however, some peoples identifying photographs which can be used to assist in safe administration of medicines were missing. We noted that for some medicines which are prescribed on a PRN basis (for administration at the discretion of care staff) there were written protocols alongside medication charts providing information to staff. However, for one medicine loperamide, we noted there to be a written protocol but the medicine was not written on the current medication chart so it was unclear if this medicine was currently actively prescribed. We discussed the need to ensure medication charts are checked and signed off by a competent member of care staff prior to their use. For another medicine, lorazepam 1mg, prescribed for discretionary administration at times of psychological agitation there was no written information available to assist staff Care Homes for Adults (18-65 years) Page 4 of 11 with administration of the medicine. The senior carer showed us an electronically stored care plan for the management of agitation for this person but we noted this to provide only scant information and it did not refer to administration of lorazepam or provide information on when the medicine could be considered for administration after taking alternative steps. As this medicine could be administered up to 4mg in 24 hour period, there should also be information about when further or higher doses of the medicine can be administered. During the inspection we conducted sample audits of medicines against current and some previous medication records. We looked at medicines which had not been taken by people and which had been placed in two separate envelopes for disposal. We compared the dates of the envelopes to the records and found that for these people, records indicated the medicines had been administered as scheduled. There were no records indicating the medicines had not been given. We also noted that for some records on current charts indicating medicines had not been administered there were no further explanatory records indicating why the medicines were not administered. The medication chart coding system allows for O to be recorded but with further explanation. The senior carer on duty agreed that some records were incomplete or inaccurate and did not inform why peoples medicines were not being given to them. We noted that a persons container of prescribed eye drops had been dated at the time of its opening but that it was still in regular use several days after its 28-day expiry time. We also found a container of buccal midazolam that had expired in 2009. We noted that in the main building medicine storage cabinet many medicines that were not supplied within the 28-day monitored dosage system were located within a crate many still within their bag as supplied by the pharmacy. These medicines were not located on a shelf within the cabinet in a way in which medicine stocks could be easily monitored or rotated for use. We found that for a person who chooses to self-administer their insulin, there was a diabetic care plan in place, however, there was no recorded risk assessment in place showing that the home is regularly monitoring the persons ability to continue to manage this. We asked to see evidence of training provision for a sample of care staff at the service. The senior carer on duty confirmed to us that a member of care staff implicated in a recent medication error was currently not undertaking medicine handling or administration. The person received training on 16 June 2010. For another member of staff, records showed that most recent training had been undertaken in 2006. The senior carer confirmed that training by the supplying pharmacy is planned for 17 August 2010 and added this persons name to the list of staff members due to attend. The senior carer confirmed that all authorised members of care staff had received regular training on the administration of buccal midazolam for the management of epileptic seizures. During the inspection, another senior carer told us that staff who had received training were also assessed for competence in handling and administering medicines prior to undertaking this task but that staff were supported only when they requested further assistance. When we asked about this, we were told there was no regular assessment of staff competence undertaken on a regular basis. We did not observe how care staff administer medicines to people during this inspection. We were shown a medicine management policy document available at the home but we noted there was no written Care Homes for Adults (18-65 years) Page 5 of 11 procedure for the administration of medicines within the policy. There was a brief statement on the management of medicine administration errors. 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 Adults (18-65 years) Page 6 of 11 Are there any outstanding requirements from the last inspection? Yes 10/07/2009 £ 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 Adults (18-65 years) 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 20 13 Risk assessments must be completed, recorded and regularly reviewed when people choose to selfadminister their medicines To ensure they remain able to self-manage their medicines 10/09/2010 2 20 13 Steps must be taken to ensure medicines with limited lives on opening are safely handled and that medicines that have expired are promptly removed To safeguard peoples health and welfare 10/09/2010 3 20 12 Full and accurate records must be kept when medicines scheduled for regular administration are not given To safeguard peoples health and welfare 10/09/2010 4 20 15 Written care planned information must be 10/09/2010 Care Homes for Adults (18-65 years) 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 available for staff when considering the administration of a medicine prescribed for discretionary (PRN) administration To ensure staff are appropriately informed about PRN medicines 5 20 13 Steps must be taken to 10/09/2010 ensure all medicines that are actively prescribed are recorded To ensure staff consider all prescribed medicines for administration 6 20 13 Temperatures of medicines requiring refrigeration must be monitored and recorded on a daily basis To ensure medicines requiring refrigeration are stored at appropriate temperatures at all times 7 20 13 Medicines must be kept 10/09/2010 securely ensuring keys are accessible only by authorised persons . 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 10/09/2010 1 20 It is recommended that the medicine policy document is Page 9 of 11 Care Homes for Adults (18-65 years) 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 reviewed ensuring a written procedure for the administration of medicines is included. 2 20 It is recommended that the competence of staff authorised to handle and administer medicines is assessed regularly via supervision It is recommended that action is taken to check medicines for expiry on a regular basis. This can more easily be achieved by proper arrangements for storing back up supplies of medicines in the cabinets provided It is recommended that the use of monitored dosage system containers is aligned across the service and with their medication charts It is recommended that identifying photographs are obtained for all people living at the service who are prescribed and administered medicines It is recommended that staff specimen signature lists are dated and kept up to date It is recommended that a cabinet compliant with Misuse of Drugs (Safe Custody) Regulations is obtained and fitted for the storage of controlled drugs requiring special storage arrangements 3 20 4 20 5 20 6 7 20 20 Care Homes for Adults (18-65 years) 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 Adults (18-65 years) 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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