Care Home: Firs Hall

What the care home does well There is an effective system of auditing, checking, how medication is being handled. This will help improve record keeping standards and improve medicines administration so that residents` health is not at risk. What the care home could do better: Suitably trained and competent staff must be on duty at all times to make sure residents can be given medicines if it is needed. Medicines must be stored safely and under the correct conditions to make sure the medicines are effective. Medicines must always be given as prescribed because missing doses of medication could seriously affect residents` health. Inspecting for better lives Random inspection report Care homes for older people Name: Address: Firs Hall Firs Avenue Failsworth Manchester M35 0BL zero star poor service 04/11/2008 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: Avril Frankl Date: 1 0 0 3 2 0 0 9 Information about the care home Name of care home: Address: Firs Hall Firs Avenue Failsworth Manchester M35 0BL 01616835154 01616887324 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) : Firs Hall Care Home Limited care home 31 Number of places (if applicable): Under 65 Over 65 0 31 dementia old age, not falling within any other category Conditions of registration: 12 0 The registered person may provide the following categories of service only. Care home only - code PC, to people 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: 12). The maximum number of people who can be accommodated is: 31 Date of last inspection Brief description of the care home Firs Hall is a large, detached, residential care home accommodating up to 31 older people. The home is located on the Oldham/Manchester border and is accessible for local amenities and bus routes. Accommodation comprises 21 single rooms, 12 with en-suite toilets, and five double bedrooms, one with an en-suite toilet. Other facilities include two lounge/dining areas. 0 4 1 1 2 0 0 8 Care Homes for Older People Page 2 of 10 Brief description of the care home The home has recently come under new management and is now owned by a limited company, Firs Hall Care Home Limited. The responsible individual is Mr J Heifetz and there is no registered manager at the present time. The weekly fees range from 334.00 to 351.00 pounds, which does not include the following: hairdressing; newspapers; toiletries; dry cleaning; prescription fees; transport/taxi fares; private health care services; clothing; continence products; trips out; private telephone and satellite TV installations and rentals and `the tuck shop. A service user guide and statement of purpose are available on request and are displayed in the reception area of the home. Care Homes for Older People Page 3 of 10 What we found: We visited the home because at previous inspections we had found some serious concerns in the way medicines were handled. This visit was to make sure that improvements had been made to ensure that residents health was not at risk from poor medication practices. The visit was carried out by a pharmacist inspector and lasted about four hours during which time we looked at medication together with records about medicines for six people. We also spoke to the manager, the area manager and one resident . We gave detailed feedback to the manager and area manager at the end of the visit. We found that a number of improvements had been made since our last inspection. The medicines are now being supplied by a more local pharmacy. Medicines are delivered to the home on a weekly basis which has helped to make sure that medicines can be audited , checked , more easily. The manager told us that she has found that staff are making fewer errors and residents are being given most of their medicines properly. The manager has audited medication every two weeks and when she found that errors in recording or administration of medicines had been made, she brought this to the attention of the staff so that they could work together to improve standards. We saw that staff who were given the responsibility of administering medicines had been on recent medication training courses and the manager had assessed most of those members of staff as competent to administer medicines. Other staff were supervised when administering medicines to help them make sure that they did so safely. We found there were not enough staff trained to make sure the medicines, such as occasional pain relief or inhalers, could be given during the night if they were needed. It is vital that there are enough trained and competent staff working in the home at any time to meet the needs of all the residents. We told the manager she must make arrangements for suitably qualified staff to work at night to make sure residents can have medication if needed. Medicines were kept in a locked cupboard in a bathroom. It is not suitable to keep medicines in warm and steamy places such as bathrooms because this may stop them from working properly, we told that manager that they must be moved to a more suitable place. The storage of creams was also a concern, we found that some creams were kept on open shelves in communal bathrooms, which could cause cross infection if they are applied to more than one resident. Other creams were kept in residents rooms, creams can be kept in bedrooms, as long as it has been assessed that it is safe to do so and they are locked away . Creams were not were not locked away and there was no assessments that it was safe to keep creams in their bedrooms. We looked at medication records to make sure they could show that all medicines had been given properly and could be accounted for. The standard of record keeping had greatly improved and we found that all the medicines which were supplied in the Care Homes for Older People Page 4 of 10 monitored dose system had been administered as prescribed. The records showed that most medication could be accounted for and was not being mishandled. Some staff wrote on the back of the administration charts the reason why medicines may not have been given to a resident as prescribed.For instance sometimes laxatives were not given as prescribed because the resident did not need them. However not all staff were writing this information down and sometimes it was not clear why medicines were not given properly. The reasons why medicines are not given as prescribed must always be recorded. Sometimes medicines were not given to residents as prescribed because the medicine had run out. We looked at records for six people and found that three people had run out of one of their medicines for one dose during the past month.We also saw that sometimes liquid medicines and those supplied in traditional boxes were not given properly.One resident had not been given their medication to help control diabetes. The administration charts were signed to indicate that the medicine had been given, however a stock check showed that the medicine had not been given.Residents health may be at risk if medication is not given properly. We looked to see if there was enough information about how to give someone their when required medicines . We found there was no information available. It is very important for staff to know when and why to give medicines to people.It is especially important for this information to be available if the resident can not tell the staff how they feel. We did find examples where there was good information recorded about how to given medicines.One resident was prescribed a thickener to help them swallow fluids safely. The care plan contained full details of how to do this which protected the health of the resident. Another resident needed to be given her medicines covertly, by disguising her medication in food. In the care plan there was full information of why this needed to be done and that the appropriate people had been consulted to make sure it was done safely. We looked at how residents were supported to look after their own medicines safely. Although there was a risk assessment document on file, it lacked detail as to exactly where the resident kept her medicines and what medicines she was taking. Staff needed to review the amount of support this resident needed to make sure she remained safe. The manager also told us that there were no systems in place to check that people looking after some or all of their medicines continued to do so safely. We checked how controlled drugs ( strong medicines which could be misused) were recorded and stored. A new special register was used to make records about controlled drugs and this was being used correctly and these drugs could be accounted for. Since the last inspection some checks had been made to find out if the controlled drugs cupboard met legal requirements. They had placed the cupboard in a more suitable place, however the construction of the cupboard and the way it was fixed to the wall still did not comply with legislation and a new controlled drugs cupboard must be bought to comply with current legislation. What the care home does well: Care Homes for Older People Page 5 of 10 There is an effective system of auditing, checking, how medication is being handled. This will help improve record keeping standards and improve medicines administration so that residents health is not at risk. 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 6 of 10 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 9 13 A legally compliant controlled 04/02/2009 drugs cupboard must be available to store controlled drugs This will help to prevent mishandling and misuse. Care Homes for Older People Page 7 of 10 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 1 10 18 A member of staff who is trained and assessed as competent to administer medication must be on duty at all times To make sure that residents can be given their medicines when and if they are needed. 18/03/2009 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 All medicines must be administered as prescribed. Missing doses of medicines could seriously affect residents health 18/03/2009 2 13 13 All medicines must be stored 31/03/2009 in a suitable location and all medicines must be stored securely To ensure that the effectiveness of medicines are not affected by poor storage conditions.Medicines must be locked away to ensure they are not misused or mishandled in any way. Care Homes for Older People Page 8 of 10 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 Care Homes for Older People Page 9 of 10 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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