Care Home: Earsdon Grange

What the care home does well The ordering and receipt of medication within the service is now well managed and should ensure that supplies of medication are maintained at all times. What the care home could do better: Medicines storage, particularly for medicines requiring refrigeration, could be improved.Handwritten entries on MAR charts are not always fully completed. Inspecting for better lives Random inspection report Care homes for older people Name: Address: Earsdon Grange Thorntree Drive Wellfield Whitley Bay Tyne & Wear NE25 9NR 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 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: Michael Earnshaw Date: 0 6 0 4 2 0 0 9 Information about the care home Name of care home: Address: Earsdon Grange Thorntree Drive Wellfield Whitley Bay Tyne & Wear NE25 9NR 01912532272 01912532298 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) : Southern Cross OPCO Ltd care home 48 Number of places (if applicable): Under 65 Over 65 28 20 dementia old age, not falling within any other category Conditions of registration: 0 0 The maximum number of service users who can be accommodated is 48 The registered person may provide the following category 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: Old age, not falling within any other category - Code OP, maximum number of places: 20 Dementia, over 65 years of age - Code DE(E), maximum number of places: 28 Date of last inspection Brief description of the care home This purpose-built care home opened in November 2005. It was re-registered by Southern Cross Opco Limited in May 2007. It is situated in the centre of Monkseaton, a residential area two miles from Whitley Bay and the coast. It has its own gardens. It is close to bus and Metro services, and to local shops, pub and other amenities. It Care Homes for Older People Page 2 of 9 Brief description of the care home provides care for 21 elderly persons on the ground floor, and 27 elderly persons suffering from Dementia on the first floor unit. All bedrooms have en-suite facilities. There is a coffee shop, hairdressing salon, two dining rooms, large kitchen, and spacious lounges. Fees are from #414:02 to #522:50 per week, with hairdressing and chiropody extra. Care Homes for Older People Page 3 of 9 What we found: The reason for the visit was to undertake a pharmacist inspection of the service.The visit lasted 5 hours and involved looking at the arrangements within the service that support the safe handling and administration of medicines. We looked at medication records, stock control, the medicines policy, storage and security of medicines.We also observed some medicines being administered and looked at the training records of staff who handle medicines. The ordering of medicines is undertaken by senior carers and records are maintained to confirm what has been ordered and received for each service user.Prescriptions now go to the home first for checking and recording before being sent to the pharmacy. The record sheet does not identify the dates that medicines were ordered or received but we were informed that the documentation was being amended to include this. The service has very recently started to use a medication discrepancy book to record any medicines that have not arrived with the monthly order.This is checked daily to ensure that outstanding medication orders are not overlooked and that supplies of all medicines are maintained. The medication administration record (MAR) charts for all service users in the home were looked at. There were no significant gaps on the MAR charts but the administration of creams, ointments and nutritional supplements were not always fully recorded. Handwritten entries on MAR charts, including changes made to medication, were not always complete and often did not include the signature of the carer making the change, the date or a witness signature to confirm that the details were correct. There were no significant administration gaps on the MAR charts although some records for medicines prescribed with variable doses were not complete as they did not indicate the dose administered and so could not be accounted for. One service user prescribed trimethoprim twice daily received three doses a day for 2 days because of confusion over the agreed administration times. One service user was prescribed warfarin but there was no copy of the current anticoagulant guidance to confirm the daily dose to be administered. In addition, there was a discrepancy between the dose printed on the MAR sheet, the dose printed on the dispensing label and the actual dose being administered. Subsequent investigation confirmed that the correct dose of warfarin was being administered. A number of MAR sheets contained details of a lot of medication no longer being administered. This makes it difficult for staff to check that all medication has been given as prescribed and increases the risk of medication being overlooked during the medicine round. We observed medicines being administered on the ground floor. Two trained carers are currently involved in the administration process to reduce medication errors or omissions. However, we noted that the second carer was not fully observing the whole administration process including observing the service user taking the prescribed Care Homes for Older People Page 4 of 9 medication. All staff who handle medication have received appropriate safe handling medication training and we were informed that some additional update training was to be provided in April. Staff are trained, observed and assessed as competent before handling medication but full records of this are not maintained. Regular monthly audits of the medication system are undertaken and help confirm that staff are following the homes medication policy. Medicine storage facilities on the ground floor are poor with only sufficient storage space to hold the medicines trolley. There was no medicines fridge and we were shown medicines required to be refrigerated stored in a locked box in the kitchen fridge. The treatment room upstairs was untidy and medicines for oral use were not separated from medicines for external use, needles and blood testing strips. The fridge was not locked at the time of the inspection and the monitoring of the fridge and room temperatures was very poor. The controlled drug cupboard appears to meet safe custody regulations and records in the controlled drug register were accurate and well maintained. Regular stock checks on controlled drugs stored in the home are not being carried out. 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 9 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 6 of 9 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 Medication must be stored securely and at the temperature recommended by the manufacturer To safeguard the health and welfare of people living at the home 30/06/2009 2 9 13 Medicines must be given at 30/06/2009 prescribed times and a record made at the time that it is given To safeguard the health and welfare of people 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 2 9 9 Stocks of controlled drugs should be regularly checked and a record made in the controlled drug register Staff should sign and date all handrwitten entries they make on the MAR charts. Each entry should be checked and countersigned by a second person to reduce the risk of error when copying information Care Homes for Older People Page 7 of 9 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 3 9 The medicines policy should be updated to include the new arrangements for the ordering and receipt of medication in the home The medicines fridge should be locked when not in use and the key kept with the person in charge The temperature of the treatment room and the fridge should be regularly monitored. This makes sure that medicines are being stored at the temperature recommended by the manufacturers Consideration should be given to relocating medicines storage on the ground floor to provide sufficient and appropriate storage for medicines and to accommodate a medicines fridge and hand washing facilities A comprehensive record of staff who have been assessed as competent to administer medicines should be maintained, including dates of assessment A list of staff authorised to administer medicines, together with specimen signatures should be kept with the MAR charts. This will help identify who was involved in administration if a problem or error was to occur The written instructions provided by the anticoagulant clinic should be kept attached to the MAR chart for people receiving anticoagulant treatment. This makes sure that staff have accurate and up to date guidance on the dose to be administered 4 5 9 9 6 9 7 9 8 9 9 9 Care Homes for Older People Page 8 of 9 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. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 or Textphone: or 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. 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