Care Home: Grace Lodge Nursing Home

What the care home does well Medicines are stored safely and securely. This helps to reduce the risk of them being mishandled or misused. Only qualified staff are allowed to handle medicines. having well trained staff reduces the risk of mistakes being made. Medication records are generally clear and accurate. This means that medicines can be accounted for easily. What the care home could do better: Medicines must be given at the correct time of day, particularly with regard to food and drink intake in order for medicines to work properly and/or reduce side effects. There must be sufficient stocks of medication available for each person living in the home at all times, so that people receive their medicines as prescribed. There should be clear and accurate information for staff to follow regarding the administration of feeds and medication via PEG tubes. This information must be personalised to ensure the individual`s needs are met safely and consistently. Random inspection report Care homes for older people Name: Address: Grace Lodge Nursing Home Grace Road Walton Liverpool L9 2DB two star good service 11/05/2010 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: Maggy Howells Date: 2 9 0 7 2 0 1 0 Information about the care home Name of care home: Address: Grace Lodge Nursing Home Grace Road Walton Liverpool L9 2DB 01515237202 01515237203 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Kim Alison Truscott Type of registration: Number of places registered: Conditions of registration: Category(ies) : Ocean Cross Ltd care home 65 Number of places (if applicable): Under 65 Over 65 65 old age, not falling within any other category Conditions of registration: 0 The registered person may provide the following category of service only: Care home with nursing - Code N. 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. The maximum number of service users who can be accommodated is: 65 Date of last inspection Brief description of the care home Grace Lodge provides nursing and residential care and support for up to sixty-five people. The home is purpose built and is situated off a busy residential and shopping area of Walton Vale Liverpool. The home is well served by public transport (bus and rail) and a motorway network is approximately ten minutes away by car. The home is Care Homes for Older People Page 2 of 9 1 1 0 5 2 0 1 0 Brief description of the care home built on two levels, is centrally heated and well maintained. A passenger lift and stairways access the first floor. There is a well maintained garden to the rear of the home. The home is staffed twenty-four hours each day with both trained nurses and care staff. A representative of the owner visits at least monthly to report on the running of the home. Care Homes for Older People Page 3 of 9 What we found: We visited the home because we had been told about some concerns about the way that medicines were handled and recorded. This visit was carried out by a pharmacist inspector. It lasted approximately five hours and involved speaking with the manager and nurses on duty. We checked the medicines storage area, a sample of medicines stocks and records. We gave detailed feedback to the manager throughout the visit. This was an unannounced visit, which meant that neither the management nor staff knew we were going. Overall, we found that medicines were usually handled, administered and recorded safely and accurately. However, there were some areas of concern that meant the health and wellbeing of people who live in the home may be being put at unnecessary risk of harm. We looked at the storage of medicines and found that the home had appropriate medication cupboards and trolleys with the keys being held securely at all times. There was a dedicated fridge available for medicines needing to be kept cold and the temperature of this was monitored regularly. Keeping medicines securely and in the correct way helps to ensure they are safe to use and that they are not accessible to unauthorised people. We looked at a sample of records and stock and found it very easy to account for medicines. This meant that we could be sure that medicines had been given to people correctly, and that the right amount of stock was left. We found that all medicines entering the home had been recorded accurately and there were clear records of all changes made to peoples medication and doses. Records of medicines leaving the home were sometimes incomplete, with strengths and reasons for disposal not always stated. The medication administration records were generally pre-printed by the supplying pharmacy, although some had been written by hand. The handwritten ones were accurate and had been double signed by two members of staff to show they had been thoroughly checked. Keeping complete and accurate records means that all medicines can be accounted for. Some medicines have to be taken at specific times, for example an hour before food, in order to work properly. Whilst some medicines were clearly given an hour before breakfast, we could see no evidence that this was done with all such medicines or at other times of the day. We saw medicines prescribed to be taken 30-60 minutes before food being given after lunch and some medicines being given together against manufacturers advice. People are unlikely to get the best from their medication if it is not given at the correct time, especially in relation to food and drink. When we looked at a sample of stocks, we found that some peoples medication had been allowed to run out. This is unacceptable. The health and welfare of people living in this home is placed at unnecessary risk of harm if they are not given their medication at the correct time. We saw that some people were given their food and medication via PEG tubes (special feeding tubes going into the stomach). Some of the information describing how feeds and medication should be given to these individuals was unclear and out of date. It is very Care Homes for Older People Page 4 of 9 important that this information is accurate at all times so that staff are able to ensure these peoples medication and nutritional needs are met safely and consistently. We looked at how staff were trained and found that all nurses had recently been given medication training and had had their competence to handle medication safely checked. Checking the competence of staff ensures they are safe to carry out their duties without supervision. We looked at how Controlled Drugs (strong medicines that are likely to be misused) were handled and recorded. These medicines were stored and disposed of correctly and all details recorded in a special register. Staff must remember to sign for these medications only after they have been administered and not before. We saw that one dose of a long acting pain killer had not been given correctly. The manager immediately took steps to investigate this incident. The manager explained that there were currently issues with obtaining accurate information about medication from the local hospitals when people were admitted and/or readmitted to the home. There were similar issues with obtaining blood test results from the local warfarin clinics. Evidence was seen that the home did all that was possible to obtain this information and that the issues had been brought to the attention of the Primary Care Trust responsible. There was a formal system of auditing (checking) medication records and practices. This helps to identify any shortfalls or areas of concern and ensures that improvements are made where necessary. 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 Care Homes for Older People Page 6 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 7 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 Medicines must be given at the correct time of day, particularly with regard to food and drink intake in order for medicines to work properly and/or reduce side effects. 03/09/2010 2 9 13 There must be sufficient stocks of medication available for each person living in the home at all times so that people receive their medicines as prescribed. 03/09/2010 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 clear, accurate and personalised information for staff to follow regarding the administration of feeds and medication via PEG tubes to ensure that each persons needs are met safely and consistently. Page 8 of 9 Care Homes for Older People 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. 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