Care Home: Holmer Care Centre

What the care home could do better: The home needs to ensure that the administration records can demonstrate that the people who are using the service are having their medicines administered as prescribed. The home needs to ensure that the care plans have detailed information about the administration of medicines. The service must ensure that all medicines are stored at the correct temperature. The service must ensure that the staff administering medication to the people who use the service are safe and competent to do so. Random inspection report Care homes for older people Name: Address: Holmer Care Centre Leominster Road Hereford Herefordshire HR4 9RG 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: Ian Henderson Date: 2 9 0 9 2 0 1 0 Information about the care home Name of care home: Address: Holmer Care Centre Leominster Road Hereford Herefordshire HR4 9RG 08453455745 01432342390 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs S Roberts,Mr Jeremy Peter Ewens Walsh Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 49 Number of places (if applicable): Under 65 Over 65 0 0 dementia mental disorder, excluding learning disability or dementia Conditions of registration: 49 49 The maximum number of service users who can be accommodated is: 49 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: Dementia (DE) 49, Mental disorder, excluding learning disability or dementia (MD) 49 Date of last inspection 2 0 0 7 2 0 1 0 Care Homes for Older People Page 2 of 10 Brief description of the care home Holmer Care Centre is on the outskirts of the city of Hereford. It is owned and managed by The Holmer Partnership, Blanchworth Care. The Home was first opened in December 1991. It is a Victorian property that has been extended to provide a Care Home with nursing for a maximum of 49 older persons over the age of 65 years, of both sexes, who have dementia or a mental disorder. Twenty nine bedrooms are single occupancy, eighteen have en-suite facilities. The Home has a passenger lift. The Home operates a locked door policy, as indicated in the Homes Statement of Purpose and Service User guide. There is information literature describing the service displayed at the home and copies are available on the Providers website address. New residents receive a copy of this information and it also forms part of staff induction packs. Details of fees and additional charges are available from the Providers website address. A copy of this report can be viewed at the home. Care Homes for Older People Page 3 of 10 What we found: The reason for the visit was to assess whether the home had met the requirements set out in the Statutory Requirement Notice issued on the 17th September 2010. The home was required to comply with the notice by the 27th September 2010. The home was required to 1) Make suitable arrangements for the recording handling safekeeping safe administration and disposal of medicines received into the care home. 2) Ensure that accurate records are maintained of all medicines in the Home and where discrepancies are found take appropriate action to rectify the problems 3) Ensure that staff are aware of the written procedure for the administration of medicines which is monitored to make sure that the nursing staff follow safe practices. In order to assess whether the home had complied with the Statutory Requirements Notice a number of medication and care records were examined. We started by examining a sample of the medication records along with the medicines present in the home in order to determine whether the home had systems in place to demonstrate that medicines were being administered as prescribed. The first person we looked was chosen because the safeguarding team at the local authority had raised concerns about two tablets being found on the floor of this persons bedroom. We found that the tablets found were two Diazepam 2mg tablets which according to the homes record were not prescribed for her. We found that this incident was still under investigation and the management team was asked to report their findings to CQC when the investigation had been concluded. The audit process found that 28 Bisoprolol 2.5mg tablets had been received on the 23rd September 2010. We found that the administration had commenced on the 27th September 2010 and that two tablets had been administered since that date. On the 27th September 2010 the medication records indicated that this tablet was not administered due to a difficulty in swallowing. We examined the disposal record but there was no record of this tablet being discarded. We therefore expected to find 26 tablets remaining however we found 25 tablets. We also found with some Mirtazapine 30mg tablets that 28 tablets had been received on the 23rd September 2010 which were due to be started on the 27th September 2010. The administration records showed that none of the tablets had been administered from the 27th September 2010 again because of swallowing difficulties. The disposal record had no entries identify that these tablets had been disposed of. We therefore expected to find 28 tablets remaining however we found 27 tablets. We found with some Macrogol powder sachets that 28 sachets had been received on the 23rd September 2010 and from the 27th September the medication records indicated that three sachets had been administered. We therefore expected to find 25 sachets remaining however we found 33 sachets. We found that some sachets that had been carried over from the previous month had not been recorded and therefore the home was unable to evidence how many sachets had actually been administered. We found that this person had been prescribed a liquid antibiotic that had to be kept in the fridge. We found that the nurse on duty had failed to return the antibiotic to the fridge following the morning medication round and this was only realised after the lunchtime medication round when the inspector enquired about its whereabouts. We found that the Care Homes for Older People Page 4 of 10 nursing staff were unsure about a change made to some medication by the persons doctor the day before the inspection. This person prior to the doctors visit had been taking Sinemet 62.5mg tablets one twice a day and one slow release Sinemet 125mg tablet at night. The records suggested that the doctor had discontinued the Sinemet 62.5mg tablets and had increased the dose of the slow release Sinemet 125mg tablets to one tablet twice a day. Due to all of the confusion the nursing staff had continued to administer the Sinemet 62.5mg tablets although the doctor had indicated that they had been discontinued on the administration records. One of the nurses on duty had said that she had not been sure what to administer during the morning medication round. In order to clarify what had been changed the inspector asked the nursing staff to contact the doctor and it was confirmed by the doctor that the Sinemet 125mg slow release tablets were to be administered twice a day and the Sinemet 62.5mg tablets had been discontinued. With the second person we looked at we found that 500ml of Lactulose solution a medicine that was used to treat constipation had been received on the 23rd September 2010. The records showed that 75ml had been used by the home so we expected find approximately 425 ml remaining in the bottle. We measured the quantity found in the bottle found in the trolley and this was found to be 150ml. We also found another 500ml bottle in the excess stock cupboard which had not been opened and by the dispensing date on the label was the bottle that had been received on the 23rd September 2010. The bottle currently being used had been carried over from the previous month but had not been taken into account at the start of the new medication cycle. It was again impossible for the home to evidence that the solution had been administered as prescribed. We found that this person had been experiencing low blood sugar levels upon waking in the morning. The home had been warned about this after the last inspection when it was found that the poor storage conditions of the insulin could possibly affect its efficacy. We found that the home was reacting to the low blood sugars by administering milk and sugar. We found that following a low blood sugar result the home was not always carrying out another blood sugar test to determine if the milk and sugar had raised the blood sugar to safe levels. We would have also expected that the blood sugar would have been tested at night to see if this persons blood sugar was low before going to bed. We found that the persons doctor had requested this level of monitoring on the 28th September 2010. We were also concerned that a hypoglycaemia rescue kit was not available to be used if the staff had had problems in rousing this person from their sleep. We also found that the current insulin being used had been subjected to poor storage conditions and therefore this insulin should have been discarded and a new supply obtained which had been stored correctly. Upon identifying this issue this insulin was withdrawn from use and discarded. The incidents discovered during the inspection was evidence that the nursing staff were not fully competent to safely manage medicines for the people using the service. We found that the evidence showed that the Statutory Requirement Notice had not been complied with. In accordance with CQCs enforcement procedures this evidence was copied and removed from the home under the code of practice of the Police and Criminal Evidence Act 1984. What the care home does well: What they could do better: Care Homes for Older People Page 5 of 10 The home needs to ensure that the administration records can demonstrate that the people who are using the service are having their medicines administered as prescribed. The home needs to ensure that the care plans have detailed information about the administration of medicines. The service must ensure that all medicines are stored at the correct temperature. The service must ensure that the staff administering medication to the people who use the service are safe and competent to do so. 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 £ 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 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 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 (2) You must ensure that 27/09/2010 accurate records are maintained of all medicines in the Home and where discrepancies are found take appropriate action to rectify the problems. This requirement is subject to a Statutory Requirement Notice. This is so that people can be confident that medication is managed safely. (2) You must ensure that 27/09/2010 staff are aware of the written procedure for the administration of medicines which is monitored to make sure that the nursing staff follow safe practices. This requirement is subject to a Statutory Requirement Notice. This is so that people can be confident that medication is managed safely. (2) You must make suitable 27/09/2010 Page 8 of 10 2 9 13 3 9 13 Care Homes for Older People 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 arrangements for the recording handling safekeeping safe administration and disposal of medicines received into the care home. This requirement is subject to a Statutory Requirement This is so that people can be confident that medication is managed safely. 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 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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