Care Home: Heathgrove Lodge Nursing Home

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What the care home does well We saw that the history of allergy was well completed and that the home was keeping abreast with current good practice. The recent alerts from the National Patient Safety Agency regarding the safe handling of insulin and warfarin were clearly displayed either attached to a notice board or in the medication folder. Copies of original prescriptions were kept for cross checking and a fax detailing changes to INR and the dose of an anticoagulant for a service user prescribed warfarin were clearly accessible. What the care home could do better: The service needs to improve its auditing processes so that the MAR are completed accurately and there is evidence from audits that medication is being given as prescribed. Nurses must be trained and competent to follow the home policies and procedures particularly around the safe administration of medication. Random inspection report Care homes for older people Name: Address: Heathgrove Lodge Nursing Home 837 Finchley Road Golders Green London NW11 8NA 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: Jane Shaw Date: 2 0 0 7 2 0 1 0 Information about the care home Name of care home: Address: Heathgrove Lodge Nursing Home 837 Finchley Road Golders Green London NW11 8NA 02084583545 02082091650 askewt@bupa.com www.bupa.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) BUPA Care Homes (CFC Homes) Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 36 Number of places (if applicable): Under 65 Over 65 36 36 dementia old age, not falling within any other category Conditions of registration: 0 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 Dementia - Code DE The maximum number of service users who can be accommodated is: 36 Date of last inspection Brief description of the care home Heathgrove Lodge is a purpose built home owned and operated by British United Provident Association BUPA, which aims to provide care with nursing for up to thirtyCare Homes for Older People Page 2 of 9 Brief description of the care home six people aged over sixty-five years of age. Accommodation for residents is arranged over four floors. All bedrooms are provided with en-suite facilities. A passenger lift provides access to all floors. On the ground floor is a dining area and a lounge. To the front of the home is off street parking for several vehicles. To the rear is a large wellkept garden with an attractive pond in the middle. The aim of the home is to ensure that individual needs are carefully identified, regularly reviewed and handled with professionalism and dignity. The home provides care under the supervision of registered level one nursing staff, with a GP visiting once a week or when requested. Additional medical support such as psychiatric consultancy, physiotherapy and chiropody can be accessed via GP referral and services such as opticians and dentistry are provided as required. A hairdresser visits the home on a weekly basis. The home employs two activities co-ordinators working on a job share basis who organise social activities to residents such as bingo, a musician, quizzes, flower arrangement and outdoor visits to the pub and theatre. The home is situated on the busy Finchley Road near to Golders Green underground station and Golders Green bus terminus. There are also local shops, pubs, restaurants and a park within a short walk of the home. The fees charged at the home range between GBP750 GBP1472.69 per week. Care Homes for Older People Page 3 of 9 What we found: This pharmacist inspection was to review the safe handling of medication following a report to us of a concern regarding medication. We looked at the recording of receipts, administration and disposal of medication and we carried out some random auditing to see if medication was being administered as prescribed. We noticed that a nurse was filling in the administration records (MAR) well after the medication round had been completed. We saw for one service user that there were two tablets left in the Monitored Dosage System (MDS) but that the tablets were recorded as given. For another service user we saw that tablets were not in the MDS and had not been signed as given the morning of the inspection. Overall we noted that records were completed for receipts of medicines into the home. There were some omissions noted though when a service user was discharged from hospital or medicines were carried forward from one cycle to the next. In total we counted 11 samples of medication supplied in their original boxes. In four cases we could not reconcile balances of stock with records of receipts and administration and there were one or two too many tablets left. We looked at the MAR charts for 24 service users and in total noted that there were 17 gaps. When the tablet was not in the MDS ( Monitored Dosage System) we could assume that it had been given, but for liquid medicines and inhalers we had no evidence that it was given. One service user was self medicating and there was a risk assessment in place. It had not been updated since 2009 but the home were recording the amount of a painkiller given to this service user and were ensuring only a minimum quantity was supplied each time. We saw that several services were prescribed PRN or as required medicines. When these were painkillers there were individual protocols in place. But when a calming medicine was prescribed or medicines for treating seizures there were no individual protocols for staff to know when the medicine was to be given and how many doses. We looked at several care plans and saw that there were records for recording blood glucose in service users who were diabetic. There were diabetic care plans and how to recognise the physical signs of hypo and hyperglycaemia. We did not see any details of what level of blood glucose level would trigger a referral to the GP. Several service users had swallowing difficulties and we saw that fluid balance charts were completed. We looked at the protocols for feeding and records of visits by healthcare professionals. One service user prescribed feeds to be administered enterally did not have a record of review of the regimen by a dietician for 2 years. We looked at the homes medication audits and saw that they were carried out monthly. The medication policy and procedures were detailed and available in the clinical room. We saw a current BNF and a file of patient information leaflets on medication so that nurses always had reference to medicines information. Because we were concerned about the inconsistencies in recording medication accurately Care Homes for Older People Page 4 of 9 and the poor practices noticed around giving medication, we left an immediate requirement notice so that the home would address these issues straight away. 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 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 1 4 The statement of purpose must be revised so that all the information required by Schedule 1 of The Care Homes Regulations 2001 is included. . 01/08/2009 2 19 23(4) All fire door doorguard 01/06/2009 devices must be checked and repaired as required. The manager must apply to 01/06/2009 the Care Quality Commission for registration. 3 31 8 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 1 9 13 That medicines are recorded on the MAR at the time they are observed to have been administered This is so that medicines administration is recorded accurately and doses are not duplicated or missed. 22/07/2010 2 9 13 That audits identify poor 26/07/2010 recording and administration This is to protect the health and welfare of the service users 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 That care plans and risk 23/08/2010 assessments are updated with respect to blood glucose testing, self medication,the management of service users having seizures and being fed enterally. So that the health and welfare of services users is maintained. 2 9 13 That audits are robust and carried out regularly and identify poor recording and 26/07/2010 Care Homes for Older People Page 7 of 9 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 administration. So that the health and welfare of service users is maintained 3 9 13 That staff are trained and competent in the homes mediciation polices and procedures So that they administer medication safely 4 9 13 That there are individual protocols in place for all medicines which are prescribed as required. So a nurse knows what the medicine is for, what dose is prescribed for and when the dose can be repeated. 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 02/08/2010 23/08/2010 Care Homes for Older People 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 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. 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