Care Home: Evergreen Lodge Nursing Home

What the care home does well Medicines are stored safely. This helps to ensure they are not mishandled. What the care home could do better: Care must be taken to ensure that all medication is given as prescribed so that the health and wellbeing of people who use the service is protected. Care must be taken to accurately record the time that medication was administered, so that an adequate length of time is left between doses. A system of audit (check) should be put into place to ensure that people receive their medicines correctly and that staff are following good practice. Information detailing how and when to use medicines prescribed on a when required basis should form part of an individual`s care plan to make sure they are given correctly Inspecting for better lives Random inspection report Care homes for older people Name: Address: Evergreen Lodge Nursing Home 38 Haddon Road Rock Ferry Birkenhead Wirral CH42 1NZ 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: Maggy Howells Date: 2 1 1 0 2 0 0 8 Information about the care home Name of care home: Address: Evergreen Lodge Nursing Home 38 Haddon Road Rock Ferry Birkenhead Wirral CH42 1NZ 01516431068 0151446486 haddon@newbloom.co.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) : Evergreen Lodge Limited care home 34 Number of places (if applicable): Under 65 Over 65 34 34 dementia dementia Conditions of registration: Date of last inspection Brief description of the care home 0 34 Evergreen Lodge is a purpose built care home providing personal care and support for thirty four older people with dementia care needs. The home is owned by a company know as Newbloom, who also own another home on the Wirral. The home has a sitting room, conservatory and dining room on the ground floor. Bedrooms are available on the ground and first floors. There are twenty six single rooms, two of which have ensuite facilities. There is an enclosed courtyard to the rear of the home that provides a nice place for people to sit. Evergreen Lodge has a no smoking policy. The home is situated in a residential area of Rock Ferry in Birkenhead. There is easy access to the local bus and train routes. The tunnel to Liverpool is within a five minute drive and provides access to and from the Liverpool area. Parking is available at the front access of the building. The fees range from 450 pounds up to 1799 pounds per week . This Care Homes for Older People Page 2 of 9 Brief description of the care home depends on the assessed needs of the individual. The avergae fees for the home are 610 pounds per week. Privately arranged fees are based on the assessed individual needs of the individual. Personal items such as newspapers are charged separately. Care Homes for Older People Page 3 of 9 What we found: The home was visited in order to look at the arrangements for handling medication, following concerns raised by the lead inspector. The visit lasted approximately six hours. We discussed the handling of medication with two senior members of staff as the manager was not available on the day of the visit. We also looked at medicine records, care plans and storage arrangements. At the end of the inspection feedback was given to the senior members. Overall, we found shortfalls in the arrangements for handling and recording medicines that need to be addressed to ensure peoples health and wellbeing is protected. We looked at the policies and procedures for handling and recording medicines. These were very detailed, but were not always followed in practice. For example the policies stated that personalised details of each persons pain needs and how to use medicines prescribed only when required should be recorded in care plans. These details were not present in care plans that we looked at. The health and wellbeing of people using the service is at risk of harm when staff do not follow the policies and procedures provided. We looked at medicines administration. On the day of the visit, the morning medication round was started at 9:30am and was not completed until after midday. It was of serious concern that all the morning medication was recorded as having been given at 8am. The lunchtime medication was then given at 2pm, which meant that some people were at serious risk of being given their medication doses too close togther. This was particularly true for those who were prescribed products containing paracetamol, where a minimum of 4 hours must be left between doses. Failing to accurately record the time at which medicines aregiven means that staff are unable to calculate when the next dose is due. The health and well being of people is at serious risk of harm if adequate gaps are not left between doses. All medicines are administered by qualified nurses. As a result of previous concerns, extra training on handling medicines had been arranged for later this year and every nurse had been given a copy of their professional guidelines. When staff are fully trained and working within their professional standards they are less likely to make mistakes. We checked medicines record keeping. Records of medicines received into the home and for the safe disposal of unwanted medicines were generally clearly recorded. Most medicines administration records were preprinted by the pharmacy but some handwritten records had not been signed and checked by a second person. Failure to do this means that there is increased risk of mistakes. We found some gaps and omissions in the medicines administration records, which, in some cases, made it difficult to tell whether medicines had been given correctly. Some people had medicines that could be given at a dose of, for example, one or two tablets each night, but the actual number of tablets given had not been recorded. This made it difficult to see how many tablets should have been left. One person was seen to take only a small amount of a liquid medicine that was offered to her. Despite showing patience and kindness, the person would not take the rest and the nurse had to discard the remaining medicine. The dose was signed for, showing that the person had Care Homes for Older People Page 4 of 9 been given a full dose. There was no note to record that most of the dose had been refused. There were no records to show what creams and other external products had been used. Failure to accurately record exactly what medication has been given places peoples health and well being at risk. We compared a sample of medicines stock and records. We found that medicines in the monitored dosage (blister packed) system were generally given correctly, however this was not the case when we checked samples of medicines contained in packets and bottles. For example, one record showed that fifty six tablets were received and the person should have been given two tablets each night. A check showed that there an extra tablet was left in stock on the day of the visit. This meant it was not possible to tell whether medicines in boxes and bottles were given correctly. Some people had medicines prescribed to be taken only when required. There was no guidance available for staff detailing how and when these medicines should be used. Some people had poor communication skills and could not easily express their needs. Staff had no way of assessing whether these people were in need of pain relief or other medication. Failure to keep this type of information means that staff may not know how to use these medicines correctly and peoples health and well being may be at risk of harm. We looked at how medicines were stored and found that all medicines, including controlled drugs, were safely stored helping to reduce the risk of mishandling. We looked at how medicines were audited (checked). The senior staff said that no audits had been done recently. Failure to carry out regular audits (checks) means that there is a risk that any weaknesses in medication handling, recording or staff practice will go unnoticed and therefore not be improved. 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 R No £ Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set. No. Standard Regulation Requirement Timescale for action 1 29 19 All staff need to be 31/10/2007 appropriately checked before they start working. This includes references, police checks and a fully explored working history. 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, Care Homes 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 You must record the time of medication administration accurately so that an adequate length of time is left between doses so that peoples health and wellbeing is protected 30/01/2009 2 9 13 You must administer all medication as prescribed ensuring it is given at the correct time of day so that people receive their medication correctly 30/01/2009 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 There should be an effective system of auditing all aspects of medicines handling and recording so as to assess the quality of this service. Handwritten entries on medication administration records should be double signed and dated to reduce the risk of errors. Information detailing how and when to use medicines prescribed on a when required basis (including painkillers) should form part of an individuals care plan to make sure Page 7 of 9 Care Homes for Older People they are given correctly. 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. 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