Care Home: First Row, 31

What the care home does well The recently introduced changes to medication documentation means that there is now a clear and complete audit trail of medicines and MAR charts are well maintained. What the care home could do better: Regular audit of the medication system should be introduced. This should include checking stocks of some medicines against administration records to help confirm that medicines are being given as prescribed. Medicines with a limited use once opened should be labelled with the date of first opening. Random inspection report Care homes for adults (18-65 years) Name: Address: First Row, 31 31 First Row Linton Morpeth Northumberland NE61 5SH 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: Michael Earnshaw Date: 1 4 0 7 2 0 0 9 Information about the care home Name of care home: Address: First Row, 31 31 First Row Linton Morpeth Northumberland NE61 5SH 01670861690 Telephone number: Fax number: Email address: Provider web address: coley@eldcare.fsnet.co.uk Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr John Thomas Cole,Mrs Delia Cole care home 3 Number of places (if applicable): Under 65 Over 65 0 learning disability Conditions of registration: Date of last inspection Brief description of the care home 3 Linton is a small village situated in a rural ex coal mining area of Northumberland. The village is a small close-knit community comprising rows of attractive terrace houses. The village has a small shop, which is run by the local community as a co-operative, and a local pub. 31 First Row Linton is a terraced house and has a large sitting room, dining area, kitchen and conservatory. The house has a large private garden. Three men live at the house and the home is a managed by Lynn Slassor, under the supervision of Mr Cole. The staff team is well established and also provides cover to the other homes in Linton. Mr and Mrs Cole also own these. The fees range from £622.79 to £675.44. Information about the home and inspection Care Homes for Adults (18-65 years) Page 2 of 9 Brief description of the care home reports are readily available. Care Homes for Adults (18-65 years) Page 3 of 9 What we found: The reason for the visit was to undertake a pharmacist inspection of the service and involved looking at arrangements in place that support the safe handling and administration of medicines. We looked at medication records, stock control and storage and discussed with the manager what arrangements the service had in place to monitor the medication system. New documentation has been introduced since the last key inspection to improve the way that medicines are recorded when received into the service and when taken out of the home with a service user. This means that a full audit trail of medicines received, administered and returned to the pharmacy for disposal is maintained. Medicine administration record (MAR) charts are now printed on site rather than being handwritten as before and were clear and comprehensive. However, the printed charts are not signed by the person preparing the chart, nor checked by a second person to confirm that all entries on the MAR chart are complete and accurate. When service users go out on a visit and will require medication to be administered a record sheet is sent with the service user recording all medication removed from the service and subsequently administered outside of the home. This record is returned to the service so that the medication audit trail is complete. A number of ointments and creams were in use at the time of the inspection but the date of first opening had not been recorded on any of the containers. This means that there is a risk that medication with a short use once opened may be used beyond the date recommended by the manufacturer and may not be safe to use. We were informed that arrangements were in place to include dates of opening when new packs were next brought into use. There were no significant gaps in the medication administration records although for one service user afternoon applications of emulsifying ointment had not been recorded. Documentation on the management of homely remedies is currently being reviewed and we were informed that it would be based on that being developed at 11/12 Third Row. The current draft document we observed on the day at 11/12 Third Row does not give full details of the doses of medication to administer, nor a limit on how long homely remedies can be administered before seeking advice from the service users doctor. All staff handling medication have received appropriate medication training and have been assessed as competent to administer medicines. Audit of the medication system is not carried out. Regular medication audit, including reconciliation of medicines against administration records, helps identify any medication problems promptly and helps confirm that carers are closely following the services medicines policy. The medicines policy itself is currently being updated but requires further amendment to include more guidance on handwritten entries on MAR charts, medication audit and Care Homes for Adults (18-65 years) Page 4 of 9 managing medicines with a short life once opened. 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 5 of 9 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 19 15 Where staff take action to 15/08/2009 follow protocol for managing behaviour, this must be recorded in the service user plan. This will ensure that the care plan and progress can be clearly monitored and evaluated. 2 34 19 Two written references must 15/08/2009 be obtained for each person working at the home. One of these should be from a most recent employer. This will help to protect service users interests. Care Homes for Adults (18-65 years) 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 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 20 Protocols for the administration of homely remedies should include full details of how medication is to be given and specify how many treatments can be administered before discussing with the service users doctor The date of opening of medicines with limited use once opened should be recorded so that they are not used beyond the date recommended by the manufacturer The medicines policy should be updated to incorporate guidance on medication audit, handwritten entries on MAR charts and managing medicines with a limited use once opened A list of signatures and initials for staff authorised to administer medication should be maintained. This will help identify who was involved in administration if a problem or error was to occur A current British National Formulary should be obtained so that staff can readily access medicines information if required Some additional training should be provided to staff to keep Page 7 of 9 2 20 3 20 4 20 5 20 6 20 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 them up to date with recent and on going changes in the handling of medication within the service 7 20 Regular medication audit which includes checking a sample of MAR chart records against the amount of medication remaining in stock should be completed. This will help confirm that people using the service are getting their medication as prescribed and that the medicines policy is being followed. Care Homes for Adults (18-65 years) Page 8 of 9 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. 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