Care Home: Laura Chambers Lodge Care Home

What the care home does well A quality assurance system had been implemented and staff are regularly checked to see if they administer and record correctly. What the care home could do better: We found there to be some shortfalls in the way the providers manages medicines for people in service. Mrs Stephanie Wilkinson accepted these findings and gave us verbal assurances during the inspection that necessary improvements would be made to safeguard people. Inspecting for better lives Random inspection report Care homes for older people Name: Address: Laura Chambers Lodge Care Home Swansdowne Drive Clifton Nottingham NG11 8HW three star excellent 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 assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. 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: Mathias Foundling-Miah Date: Information about the care home Name of care home: Address: Laura Chambers Lodge Care Home Swansdowne Drive Clifton Nottingham NG11 8HW 01159157900 01159157902 steff.wilkinson@nottinghamcity.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Nottingham City Council care home 30 Number of places (if applicable): Under 65 Over 65 25 30 dementia old age, not falling within any other category Conditions of registration: 0 0 Out of the total number of beds 25 beds may be used for the category of DE(E) Date of last inspection Brief description of the care home Laura Chambers Lodge is a care home primarily for older people who have dementia. It is situated in the residential area of Clifton, approximately five miles to the south west of the city centre. The care home is owned, managed and staffed by Nottingham City Council. Laura Chambers Lodge is located on two floors with the upper floor being accessed via a passenger lift and stairs; there is also a range of assisted bathing for those people who need additional physical support. The City Council?s Domiciliary Care service - The Jack Dawe team is also located within the building, as is a small day care service, which serves the local community. Laura Chambers Lodge is a very well presented care home, with high quality fixtures and fittings. To the rear of the property Care Homes for Older People Page 2 of 9 Brief description of the care home is a pleasant, enclosed garden area, designed with numerous sitting areas. Fees: Fees are assessed on an individual basis by the referring social worker. Care Homes for Older People Page 3 of 9 What we found: The reason for this inspection was following medication management concerns raised after a visit made by a monitoring officer from the Nottingham City Council (Adult Services Housing and Health Procurement Management Team) in August 2008. A further visit made in October 2008 the contracts officer findings were that the home had improved. The home had responded in a robust and positive manner. The outcome from this inspection is as follows: Sample audits of Medication Administration Records (MAR) charts are generally up to date for each person in service and medicines received and administered were generally recorded. The home is also reliant on making records from medicines brought in by people coming into the home, particularly for short term care. Handwritten entries were made, they were not checked and dated by a second carer to ensure the records were accurate. They were not copied exactly as the dispensing labels stated. Dosages and frequency were written in numbers rather than words which the staff could potentially misread and incorrectly administer medicines. A person in service was allergic to Penicillin which was clearly highlighted in their care plan but was not on the MAR chart. The home was informed to update all the MAR charts and liaise with the supplying pharmacist to include any allergies where appropriate. Two gaps in the MAR charts was seen where staff had not signed to record they had administered an antidepressant and Paracetamol 500mg tablets. The manager had already identified these gaps during routine auditing of the carers practice and had raised this mistake with them. We saw the manager had regularly highlighted and given feedback to the relevant staff of any shortfalls made. The medicines audited were generally correct and these reflected accurately in the MAR chart. However we found the number of signatures exceeded the number of uses clicks registered on one type of inhaler. This indicated the inhaler was used less than actually recorded. There were also a number of inhalers unused. Similarly the number of capsules of Tramadol 50mg medicine counted did not correspond with the quantity received into the home. There were 10 capsules missing. The home was informed of both these shortfalls and we requested a Reg 37 notification to investigate this. We were informed by the home in February 2009 that this was investigated by the manager to a satisfactory outcome. The missing capsules were found and the inhalers are used and recorded in strict accordance to the GP directions. The home assured us that further improvements to the audit system would be made. We observed part of a medicine round and staff had greeted people living in the service with a friendly approach. We saw inconsistent medication procedures in staff handling medicines. Medicines was popped out from the medicine blister packs into the care staffs hand then placed into the persons hand. The drug trolley was left unattended to fetch some water for another person living in the service. Staff did not wait to check a chewable medicine was swallowed, immediately closing the door behind and the MAR chart was signed before administration. A member of staff was unsure how to record a when required medication administered. Care Homes for Older People Page 4 of 9 We informed the home that when people are prescribed medicines on a when required basis there must be clear protocol. The staff need to understand and use appropriate recording for their use. This will ensure a consistent approach by staff ensuring medicines are administered in a safe and accurate way. The home was informed that an improved system to assess staff competence in medicine management must be in place to ensure medicines are administered in a safe and accurate way. The home has a medication policy which was accessible to all staff. Further improvement was necessary to ensure staff follow good practice and safe practice guidelines. This is to ensure that people in service are protected by the safe management and administration of medication. Medication was stored appropriately and securely in medicine cabinets and the fridge. However the Controlled drugs were stored inappropriately. We informed the home to obtain a CD cabinet that meets the CD storage regulations. Daily records were kept of fridge and external temperatures. The treatment room was clean, records and medicines were well organized and tidy. There was records of receipt and disposal of medicines. Discussions took place with registered Manager and feedback was given and she took notes during and at the end of the visit. 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 £ No R Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set. No. Standard Regulation Requirement Timescale for action 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 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 When people are prescribed 20/03/2009 medicines on a when required basis there must be clear protocol and staff understand and use appropriate coding/recording for their use. This will ensure a consistent approach by staff, ensuring medication is used appropriately. To safeguard the health and welfare of people living in the service. 2 9 13 A revised quality assurance system must be installed to assess staff competence in their handling of medicines. Appropriate action must be taken when these indicate that medicines are not administered as prescribed and records do not reflect practice. To safeguard the health and welfare of people living in the service. 20/03/2009 3 9 13 The purchase and installation 30/04/2009 of a Controlled Drug cabinet Page 7 of 9 Care Homes for Older People that complies with the Misuse of Drugs (safe custody) Regulations 1973 is required to safely store all controlled drugs on the premise. To safeguard the health and welfare of people living in the service. 4 9 19 The Registered Manager 20/03/2009 must ensure staff responsible for medicines administration including inhalers and external preparations has the necessary skills and training. Staff must be trained to adhere to the homes policy and safe practice guidelines. To safeguard the health and welfare of people living in the service. 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 The policies and procedures relating to the handling of medication should be reviewed and updated in line with the guidance from the Royal Pharmaceutical Society document The Handling of medicines in Social Care settings published 2007. Action to be taken that any known allergies must be recorded on the MAR sheet or nil known where appropriate. To liaise with the supplying pharmacist to include this on the MAR charts. All hand written medicine charts must be checked signed and dated by a second member of staff to ensure that the details are written accurately from current records including current copy of prescriptions and medicines received into the home. 2 9 3 9 Care Homes for Older People Page 8 of 9 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI 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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