Care Home: Holmer Court

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What the care home does well The service has worked well to improve medication standards to ensure that people who live in the service are protected from harm. What the care home could do better: The service should highlight to staff the importance of maintaining accurate medicine records and the importance of reporting omissions or delays in people receiving medicines in order to ensure that positive action can be taken. Random inspection report Care homes for older people Name: Address: Holmer Court Attwood Lane Holmer Hereford Herefordshire HR1 1LJ one star adequate service 08/01/2010 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: Morag Ross Date: 0 3 0 3 2 0 1 0 Information about the care home Name of care home: Address: Holmer Court Attwood Lane Holmer Hereford Herefordshire HR1 1LJ 01432351335 Telephone number: Fax number: Email address: Provider web address: showard@ashberry.net Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Ashberry Healthcare Ltd. care home 33 Number of places (if applicable): Under 65 Over 65 0 33 dementia old age, not falling within any other category Conditions of registration: 33 0 The maximum number of service users to be accommodated is 33.. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 33 Old age not falling within any other category (OP) 33 Date of last inspection Brief description of the care home Holmer Court is a large Georgian house with modern extensions, situated on the outskirts of the city of Hereford. It is registered to accommodate up to 33 older people whose care needs may arise from frailty due to the ageing process or a dementia illness. All rooms are single, apart from one, which is shared by two people. Twenty Care Homes for Older People Page 2 of 8 0 8 0 1 2 0 1 0 Brief description of the care home rooms have en-suite facilities. There are a range of communal rooms, a new conservatory and good-sized gardens that are accessible for service users. Ashberry Healthcare Ltd bought the home in July 2006. Please contact the home for information about the current range of fees. A copy of this report can be viewed at the home. Care Homes for Older People Page 3 of 8 What we found: The pharmacist inspector visited the home on 3rd March 2010 to check the management and control of medicines within the service. A previous inspection on 8th January 2010 had identified some medication issues. We sent you an urgent action letter relating to medication. We received a written response from Ann Comer, Care Manager dated 22nd January 2010, which informed us of the new systems that had been put in place. The reason for this inspection was to check compliance with the requirements relating to medication. We looked at medication storage, some care records and medication administration records. We spoke to the Care Manager and one member of staff. We were informed by the Manager that trained staff in the home had been working hard to ensure medication was handled safely. For example, staff were having further medication training and more checks were being made on medicine records. We were shown a report made by a pharmacist following a routine check of the services medication on 2nd February 2010. There were some issues identified including over ordering of medicines and to ensure a medication review is undertaken on peoples medicines by a GP. We were informed by the Manager that they had made improvements to the ordering of medicines and a Duty GP from the Primary Care Trust visits the home every Monday to check peoples medication. This means that staff have received appropriate training in order to handle peoples medication within the service, a GP is available every week to check medication and the home checks that peoples medicines are given safely. We saw that medication was secure. For example, we saw that there was a locked room used to store peoples medication and a locked medicine trolley. We found that the storage temperatures of medicines were being monitored each day including the room and the refrigerator temperature. The temperatures were all within the recommended safe storage temperatures for medication. We saw that medication was stored neatly and tidily which made it very easy to locate peoples medication. There was no overstocking of medication and only medication that was required was kept. We were shown new lockable cupboards that are located in each persons bedroom, which will be used to store peoples medication. We discussed how this new system will work with the Manager. This means that medication was stored securely and was well organised, which helped to ensure that people who use the service were protected from harm. Controlled drug medication, which requires special storage, was not always stored according to the legal requirements of the Misuse of Drugs Act 1971 and the Misuse of Drugs (Safe Custody) Regulations 1973. We saw some medication stored in the medicine trolley that should be stored in the controlled drug cabinet. We informed the Manager who put the medicine into the controlled drug cabinet immediately to meet the legal storage requirements. We looked at the medication administration record (MAR) charts, which were printed by the pharmacy. The majority were documented with a signature for the administration of medication. We saw that any handwritten entries or changes made on the MAR charts were not always checked and signed by two trained members of staff. For example, we saw a new MAR chart had been hand written but there was no month or year recorded. The chart had not been checked to ensure it was accurate. Care Homes for Older People Page 4 of 8 We found that the homeley remedies list of medication for each person living in the home had been reveiwed by a GP in January 2010. This means that medication required for a minor ailment had been reviewed and agreed with the persons GP. We found that medication records were generally up to date. For example, we saw current records for the receipt and disposal of medication. The date of opening of boxes and bottles of medicines were usually recorded and balances of medication were carried forward from old records to new records. These records helped to ensure there was a clear audit trail of medication. We found that counts and checks made on the majority of medicines were accurate. However we found that one person may not have been given a course of antibiotics according to the directions of the prescriber. The antibiotic was prescribed to be given three times a day. We saw that the MAR chart had not been signed for three mornings from 24th February to 26th February 2010. We counted a total of 20 signatures for administration but 21 capsules had been received. This means that the records show that the antibiotic had not been given regularly and increases the risk of harm to the person. We discussed this issue with the manager,who could not explain why there were gaps in the records. We were informed that the person had recovered and was well. We were concerned that the manager had not been made aware of this incident and therefore ensure it was investigated. We did however acknowledge that the service had improved medication management and agreed that all other current medication records had been recorded. We did not check the requirements about nutritional needs or staff recruitment records but will make enquiries about these at a later date. We are not taking any enforcement action at this stage but we will be writing to the provider about the issues identified. 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 8 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 8 12 (1) You must ensure that effective action is taken when any significant weight loss or gain is recorded. This is to ensure that peoples nutritional needs are met. 28/02/2010 2 9 13 (2) You must ensure that 28/02/2010 accurate recordings are kept of the administration of medication. This is so that there is a clear record to show that people have received their medication as prescribed. 3 28 19 (1)(b) You must obtain in 28/02/2010 respect of all persons employed at the home all of the relevant information and documents as required by Regulation 19(1)(b) and paragraphs 1 - 9 inclusive of Schedule 2 of the Care Homes Regulations 2001. This is so that people can be confident that only suitable staff are employed at the home. Care Homes for Older People Page 6 of 8 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 Care Homes for Older People Page 7 of 8 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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