Latest Inspection
This is the latest available inspection report for this service, carried out on 8th March 2010. CQC found this care home to be providing an Good service.
The inspector found there to be outstanding requirements from the previous inspection
report. These are things the inspector asked to be changed, but found they had not done.
The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.
For extracts, read the latest CQC inspection for Durnsford Lodge Residential Home.
What the care home does well During this inspection we looked at how medicines are handled in the home. Other areas of care were not looked at. What the care home could do better: The registered manager must ensure that medicines are stored and administered safely. Accurate records must be kept of all medicines given by staff and of the disposal of unwanted medicines. This is ensure medicines are given as prescribed to safeguard people`s health. Action must be taken to ensure that testing people`s blood sugar is done in an appropriate manner. Staff must receive training from a suitably qualified person. Suitable devices must be available for tests to be done safely. Action must be taken to ensure that care plans provide relevant information about people`s medicines to help staff to give them safely and appropriately.Action must be taken to ensure that systems in place allow staff to audit medicines supplied in standard packs. This is so that staff can check that medicines have been given correctly. We recommended that staff investigate how they could carry medicines around the home more securely. This would allow them to take medicines in their labelled containers to the person, along with the medicines administration records. They could then check the medicine label and administration record immediately before giving the medicine. Hand written additions to the medicines administration record sheet must be signed and dated by the person making the addition and be checked by a second member of staff who should also sign the record. Staff should discuss with their pharmacist how they can minimise the need to make handwritten additions to the medicines administration record sheet. It is strongly recommended that the registered manager take action to ensure that suitable storage for controlled drugs is obtained, as set out in the misuse of Drugs act (safe custody regulations) 1973. This is so that if any of this group of medicines are prescribed suitable storage will be available. It is recommended that staff involved with administering medicines receive assessment at regular intervals to help ensure safe practice. Random inspection report
Care homes for older people
Name: Address: Durnsford Lodge Residential Home 90 Somerset Place Stoke Plymouth Devon PL3 4BG 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 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: Sue Fuller Date: 0 8 0 3 2 0 1 0 Information about the care home
Name of care home: Address: Durnsford Lodge Residential Home 90 Somerset Place Stoke Plymouth Devon PL3 4BG 01752562872 01752562872 care@durnsfordlodge.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Carole Diane Scott Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Iris Emily Bertie,Mr Ernest Boyter Bertie care home 28 Number of places (if applicable): Under 65 Over 65 0 28 dementia old age, not falling within any other category Conditions of registration: 28 0 The maximum number of service users who can be accommodated is 28 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender 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) Date of last inspection Care Homes for Older People Page 2 of 11 Brief description of the care home Durnsford Lodge is situated in a residential area of Stoke close to local shops and other amenities and local transport links. The home provides accommodation and personal care for 28 residents over the age of 60 for reasons of old age, dementia and physical disability. There is 24hour staffing including night waking staff. The home is 2 large houses redesigned to become one home that has further been extended. The home provides 20 single and 4 double bedrooms, of which 5 and 1 respectively have en-suite facilities. There are 2 lounge rooms. A large dining room has the other lounge leading off it. A passenger and stair lift provides access to all floors. The garden is well maintained and accessible for residents by way of ramps. Some bedrooms overlook it and other bedrooms have a view of Plymouth Sound and the coastline of Mount Batten and Jenny Cliff. Residents are enabled to access any health and social care services they require. Parking is available at the front of the property and in the street. Durnsford Lodge is not registered to provide nursing care and it does not provide intermediate care. The fees at Durnsford Lodge are from #355 to #475. Extra costs include hairdressing and chiropody (information provided by the Registered Provider April 2010). Care Homes for Older People Page 3 of 11 What we found:
The pharmacist inspector carried out this inspection following concerns passed to the Care Quality Commission about the handling of medicines in the home, which had resulted in a person receiving the wrong dose of one of their medicines. During this inspection we (the Care Quality Commission) spoke to the manager and a senior carer on duty. We saw some lunchtime medicines being given. We also looked at how medicines are stored in the home and the records kept of their receipt, administration and disposal. No-one living in the home is able to look after their own medicines. Senior carers look after and give out medicines as prescribed. Two people involved with giving medicines had completed a distance learning course about medicines and one person had received in-house training. Since concerns have been raised, advice about handling medicines has been received from social services and a nurse from the primary care trust (PCT). The manager told us that their pharmacist had visited the home and provided training for five staff. Seven staff are due to do a safe handling of medicines course. The manager told us that she did sometimes watch staff giving medicines but there is no formal way to assess people and check that they are able to give medicines safely. We recommended that an assessment should be introduced to help ensure safe practice. Staff told us that up until the present time all medicines have been given by the day staff. This has meant that night time medicines have been given at 8pm. However night staff are also receiving medicines training so that they will be able to give night time medicines at an appropriate time. We saw some medicines being given at lunchtime. Staff checked the persons administration record sheet, put out the medicine and took it to the resident. They signed the administration record sheet after the person had taken the medicine. It is recommended that staff use a secure means of carrying medicines around the home, particularly for taking medicines to people in rooms upstairs. This would allow them to take medicines in their labelled containers to the person, along with the medicines administration record sheet. Medicines are supplied by the pharmacy using a monthly blister pack system. We looked at several of these monthly blister packs and saw that they agreed with the records of medicines given by staff. We also checked a number of medicines supplied in standard packs. It was not always possible to check that these had been given correctly because there was no record of when the pack had been started. The manager should ensure that a system is in place that allows medicines to be audited. This means that staff can check that medicines have been given as prescribed. The pharmacy provides printed medicines administration record sheets each month. These are kept in plastic wallets with a picture of the person attached to the wallet. Photographs must be named to make sure that the record sheets are not paired with the wrong picture, which could result in medicines being given to the wrong person. The manager told us that if they needed medicines outside of their monthly order they often took the prescription to a local pharmacy and did not receive a printed administration record for this medicine. This has resulted in staff making handwritten
Care Homes for Older People Page 4 of 11 additions to the record sheets for these medicines. On one occasion the wrong dose instructions had been written on the sheet, resulting in a person being given the wrong dose of medicine. We saw several record sheets with hand written additions, all had been signed by the person making the entry, but there was no evidence that they had been checked by a second person. The manager told us that they had all been checked but the check had not been recorded. All handwritten additions to the administration record must be signed and dated by the person making the addition. To reduce the risk of mistakes a second member of staff should check and sign these additions, whenever possible. When staff are giving medicines they should always check the dosage instructions on the medicine label to ensure that they are giving the correct dose. The manager told us that they had been advised to request a spare medicine label from the pharmacy, to attach to the administration record to avoid hand written additions. They have started to use these. However this is not recommended practice because the labels are slightly larger than the space available on the record sheet, they may be removable and so not a permanent record, could obscure another entry and could be attached to the wrong chart. Staff should discuss alternative solutions with their pharmacist. We saw that some medicines had been prescribed with a variable dose but several peoples records did not show how much medicine they had been given. Several people prescribed creams and ointments had gaps in the administration record so it was not clear that these medicines had been used as prescribed. For example the record for one person prescribed a cream twice daily had only six entries in ten days. Another person prescribed an antibiotic cream three times a day had only nine entries in nine days. This means there is no evidence that the creams have been given as prescribed so they may not be effective. Action must be taken to make sure that medicines are given as prescribed. Records must be kept of all medicines given by staff. Records are kept of the receipt of medicines into the home. We saw some recent records for the disposal of medicines which were made on loose sheets of paper. The manager told us that these are sent to the pharmacy to sign and not always returned. It is recommended that these records are made in a book so that individual sheets cannot be lost. Staff must keep clear records of the disposal of medicines so that there is a clear audit trail to show medicines have been used appropriately. Medicines are kept in a locked cupboard. There is no secure means of taking medicines around the home.There is no separate medicine fridge available. Action must be taken to ensure that medicines are kept in a locked container in the fridge so that they are secure. We saw a record of the temperature of this fridge. There is no suitable cupboard for storing medicines called controlled drugs which need additional security. None of this group of medicines were stored in the home at the time of the inspection, however these could be prescribed in future and would need to be stored appropriately. It is strongly recommended that action be taken to obtain a suitable cupboard. Several people have weekly tests to check their blood sugar level. All staff must receive training from a suitably qualified person to make sure they are able to do this safely. Action is needed to ensure that the testing devices used are fit for the purpose. We looked at one persons records to see if they had a care plan for having their blood sugar tested. The results of the tests had been recorded but there was no information about how often this should be done, what the results should be or what action staff
Care Homes for Older People Page 5 of 11 should take. Staff told us that they would contact the doctor if the result was abnormal. Staff should discuss this with a health care professional for each person to ensure that suitable care plans are in place. We looked at the medicines administration records and care records for a person who had received the incorrect dose of one of their medicines. There was no information available about the reason why the medicine had been started or the persons response to it. The dose on a hand written addition to the administration record was different to that printed by the pharmacy on the next months record sheet. In addition the medicine had been prescribed twice daily but records showed that after three days it was only given once daily with a line drawn through the morning dose. There was no written explanation as to why this had been changed. The mistake in dose was noticed by a community nurse who visited the home. In the file with the medicines administration records we saw a note from the doctor advising staff to stop this medicine. But we found no mention in the persons records of this. We spoke to the manager about this person and she explained to us why the medicine had been prescribed for this person. However this showed that the daily records did not give an accurate picture of how this person was or what had happened to them. We looked at the care file for a person who had been taking a medicine that needs careful monitoring. We saw copies of test results and information about the dose of medicine to be taken. However there was no care plan in place or any information about the use of this medicine, which would help staff look after this persons health. One recent result meant that the medicine had to be stopped but there was no information about this in the daily records. One person had moved to the home recently. We saw two support plans one said that the person managed their own medicines and the other said that they needed their medicines to be given by staff. Staff had not recorded this persons current medicine. The homes assessment document does not mention medication. This means that people could be given the wrong medicines because no proper check of current medicines is included when people move to the home. What the care home does well: What they could do better:
The registered manager must ensure that medicines are stored and administered safely. Accurate records must be kept of all medicines given by staff and of the disposal of unwanted medicines. This is ensure medicines are given as prescribed to safeguard peoples health. Action must be taken to ensure that testing peoples blood sugar is done in an appropriate manner. Staff must receive training from a suitably qualified person. Suitable devices must be available for tests to be done safely. Action must be taken to ensure that care plans provide relevant information about peoples medicines to help staff to give them safely and appropriately.
Care Homes for Older People Page 6 of 11 Action must be taken to ensure that systems in place allow staff to audit medicines supplied in standard packs. This is so that staff can check that medicines have been given correctly. We recommended that staff investigate how they could carry medicines around the home more securely. This would allow them to take medicines in their labelled containers to the person, along with the medicines administration records. They could then check the medicine label and administration record immediately before giving the medicine. Hand written additions to the medicines administration record sheet must be signed and dated by the person making the addition and be checked by a second member of staff who should also sign the record. Staff should discuss with their pharmacist how they can minimise the need to make handwritten additions to the medicines administration record sheet. It is strongly recommended that the registered manager take action to ensure that suitable storage for controlled drugs is obtained, as set out in the misuse of Drugs act (safe custody regulations) 1973. This is so that if any of this group of medicines are prescribed suitable storage will be available. It is recommended that staff involved with administering medicines receive assessment at regular intervals to help ensure safe practice. 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 7 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 29 19(1)(b)(4)(b The Registered Provider must 30/09/2008 )(5)(d)Schedu obtain the required prele 2 employment checks for all persons working in the home prior to the commencement of their employment. 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 Action must be taken to 30/04/2010 ensure that care plans provide relavent information about peoples medicines to help staff to give them safely and appropriately. To protect peoples health 2 9 13 Action must be taken to 16/04/2010 ensure that testing peoples blood sugar is done in an appropriate manner. Staff must receive training from a suitably qualified person. Suitable devices must be available for tests to be done safely. To protect peoples health 3 9 13 The registered manager 16/04/2010 must ensure that medicines are stored and administered safely. Accurate records must be kept of all medicines given by staff and of the disposal of unwanted medicines. To ensure medicines are kept Care Homes for Older People Page 9 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 safely and given as prescribed. 4 9 13 Action must be taken to 16/04/2010 ensure that systems in place allow staff to audit medicines supplied in standard packs. So that staff can check that medicines have been given correctly. 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 It is recommended that staff involved with administering medicines receive assessment at regular intervals to help ensure safe practice. We recommended that staff investigate how they could carry medicines around the home more securely. This would allow them to take medicines in their labelled containers to the person, along with the medicines administration records. They could then check the medicine label and administration record immediately before giving the medicine. It is strongly recommended that the registered manager take action to ensure that suitable storage for controlled drugs is obtained, as set out in the misuse of Drugs act (safe custody regulations) 1973. This is so that if any of this group of medicines are prescribed suitable storage will be available. 2 9 3 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. Care Homes for Older People Page 11 of 11 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
