Care Home: Lickhill Manor Nursing Home

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What the care home does well This was a focussed inspection on medicine management. We did not look at any other aspects of care within the service. What the care home could do better: We gave full feedback to the manager. We explained the shortfalls identified in this random inspection and that we were concerned about the control and handling of medicines in the service. We found that the four medicine requirements had not been met and people were at risk of harm. We informed the manager that further enforcement action may be taken by CQC. Random inspection report Care homes for older people Name: Address: Lickhill Manor Nursing Home Lower Lickhill Road Stourport on Severn Worcs DY13 8RL zero star poor service 09/02/2010 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: 2 8 0 6 2 0 1 0 Information about the care home Name of care home: Address: Lickhill Manor Nursing Home Lower Lickhill Road Stourport on Severn Worcs DY13 8RL 01299827789 01299878065 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Lynda Ann Mason Type of registration: Number of places registered: Conditions of registration: Category(ies) : Gentle Care Services Limited care home 40 Number of places (if applicable): Under 65 Over 65 40 0 old age, not falling within any other category physical disability Conditions of registration: 0 40 The maximum number of service users to accommodated is 40 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 (OP) 40 Physical Disability (PD) 40 Date of last inspection Brief description of the care home Lickhill Manor Nursing Home is a large grade II listed building, which has been extended to provide nursing and personal care for 40 people. The majority of people in Care Homes for Older People Page 2 of 12 0 9 0 2 2 0 1 0 Brief description of the care home the home are elderly people, but the home accommodates some younger people with debilitating illnesses, for example multiple sclerosis. The home is located on the outskirts of Stourport-on-Severn next to Lickhill caravan park. It is situated in over an acre of landscaped gardens providing pleasant views from the rooms. The home is difficult to access on public transport but is within short distance of the town with the shops and the river Severn. The home provides plenty of car parking for visitors within the grounds. Accommodation is provided on three floors in both single and shared rooms. The home provides a range of aids and equipment to assist them in meeting the needs of people using the service. A passenger lift is available to assist people using the service to access all three floors of the home. Communal areas are available with three lounges and a separate dining area, so that people have a choice of where they wish to spend their day. The home is owned by Gentle Care Services Limited. The registered manager for the home is Lyn Mason who is a first level registered nurse with many years experience, having worked at the home for 16 years. Lyn is responsible for the day to day running of the home. Information regarding the home can be obtained from the Statement of Purpose and the Service Users Guide which are available from the home. Information regarding fees for the Home should be requested direct from the manager or from the owners. Copies of the most recent Care Quality Commission inspection report are readily available within the Home and on request. Care Homes for Older People Page 3 of 12 What we found: The pharmacist inspector visited the home on 28th June 2010 to check compliance with four requirements relating to the safe handling of medicines. These had been made at a previous inspection on 18th March 2010. We looked at all of the Medicine Administration Record (MAR) charts and three peoples care plans. We were in the home for three hours. We spoke to the nurse on duty and the manager. Temperature records were not available for the storage of medicines. Medicines should be stored at 25 degrees C or below. We saw a thermometer in the medicine store room, which was reading 24 degrees C. This was within the safe storage temperature for medicines. However, there were no records available to ensure that the temperature was recorded on a daily basis. Medicine Administration Record (MAR) charts had not been signed to show if prescribed medicines had been given to people or a reason documented to explain why they had not been given. For example, we saw two people had been prescribed eye drops, which had not been given as prescribed. The first person was prescribed an eye drop to be given into both eyes every morning and every evening. We saw no record for the administration of the eye drop for seven evenings. When we asked to see the eye drop bottle the nurse on duty could not locate it. We were concerned that the bottle was not available particularly as the medicine records had been signed for administration on the morning of the day we visited. The nurse on duty could not give an explanation for this. The nurse ordered another prescription in order to obtain the eye drops. The second person was prescribed an eye drop to be given every morning and every tea time. We saw no record for the administration of this eye drop at tea time on seven occasions. The nurse on duty could not give an explanation for this. This means that the medicine records show that two people were not given their prescribed eye drops according to the directions of a doctor, which means there were poor outcomes for their health and welfare. Changes were made to medicine records, which were not discussed with a doctor. For example, we saw that one persons MAR chart was altered during our visit. The person was prescribed an eye drop to be given twice a day, however we saw that the MAR chart was only recorded as given once a day in the morning. The Manager told us that the person did not have their eye drops later on. When we asked to take a copy of the MAR chart we saw that the administration of the eye drops had been changed from twice a day to once a day. The manager had initialled the change. There had been no discussion with a doctor about this change to a prescribed medicine. This means that the person was at an increased risk of harm. Medicines prescribed to be given as a variable dose, such as one or two tablets, were not recorded accurately onto the MAR charts. It was not clear how many tablets had been given. There was no information available in order for staff to determine how many tablets should be given to the person. For example, one person was prescribed a tablet as one or two tablets to be taken in the morning. We looked at the MAR chart and saw that staff had not recorded if one or two tablets had been given. The nurse on duty told us that she had given two tablets on the morning of our visit. The amount given was not recorded onto the MAR chart. There was no record to explain why the nurse had given Care Homes for Older People Page 4 of 12 two tablets and not one. This means that due to a lack of clear information and a lack of clear records it was not possible to determine how many tablets to give the person and also to check how many had been given. This increases the risk of a medicine error. Medicines were not given as prescribed by a doctor. We found that one person had not been given their prescribed antibiotic according to the directions of the doctor. The antibiotic was to be given three times a day for five days. We saw no records for the receipt of the medicine.We saw fifteen signatures on the MAR chart for administration of the antibiotic, however we saw that one tablet remained in the box. The nurse in charge could not give an explanation for this medicine error. This means that the medicine records did not match with the amount of medicine remaining and therefore the medicine had not been given according to the directions of a doctor. Personal care plans were not kept up to date with information relating to peoples medication. For example, we looked at three peoples care plans. Two people had been prescribed eye drops. Both care plans documented that the eye drops were to be given as directed. However, we saw that the eye drops had not been given as directed and there was no information recorded to explain why the eye drops were not being given correctly. One persons MAR chart had been changed from twice a day to once a day, which was not recorded in the persons care plan. One person was to be given their tablets as a variable dose as one or two tablets, however there was no recorded information to help support staff to know when to give one or two tablets. We looked at the persons care plan and found no information documented about any of the changes made to the medicine. We discussed this with the nurse on duty who agreed that the information was not available. This means that the care plans were not kept up to date with regard to peoples medication which increases the risk to their health and welfare. 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 12 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 7 15 Reg 15 1 2 b All people living 31/03/2010 in the home should have a care plan which accurately reflects their health and welfare needs and provides clear guidance for the staff to follow. This should be reviewed and updated to reflect any changes or at least monthly. Some progress with development, but not fully met So that people can be confident that staff have clear guidance and understanding in ensuring that there health and personal care needs are met. 2 8 12 The home should ensure that 19/03/2010 appropriate risk assessments have been completed, and any potential risks are dealt with to ensure that the persons health and welfare is not being compromised. This includes referring to other professionals for advice and treatment for people where it is required. Not fully met Care Homes for Older People Page 6 of 12 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 To ensure peoples health and welfare needs are met. 3 9 13 Regulation 13 2 To make 09/04/2010 arrangements to ensure that records are kept of all medicines received, administered and leaving the home or disposed of. This is to ensure that the care service maintains accurate records of medicines. Requirement not met To further protect people using the service. 4 9 13 Regulation 13 2 The service 30/04/2010 must make arrangements to ensure that medication is stored securely at the correct temperature recommended by the manufacturer. Requirement not met To ensure peoples medication is safe to administer. 5 9 13 The service must make 31/03/2010 arrangements to ensure that records are kept of all medicines received, administered and leaving the home or disposed of to ensure that accurate checks can be made on peoples medication. Requirement not met To ensure that they can Care Homes for Older People Page 7 of 12 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 account for peoples prescribed medication at all times. 6 9 13 Regulation 13 2 To make 09/04/2010 arrangements to ensure that care plans include detailed information and instructions for staff in respect of administration and management of medicines, including the reasons to give medicines when required and what constitutes needed for the named person. This is to ensure that there are clear directions for staff to give medicines prescribed when required. Not fully met. To ensure that people have their medication safely 7 15 12 Reg 12 1 The home should ensure that peoples dietary needs are being met, which can be reviewed and acted upon. To ensure people are receiving sufficient diet and fluids 8 19 12 Reg 12 1 a ensure that all the systems and equipment are serviced to ensure that they are wirking correctly. To keep people warm, have hot water and are safe from harm. 31/03/2010 31/03/2010 Care Homes for Older People Page 8 of 12 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 9 19 16 To ensure that people living 31/03/2010 in the home have damage to furnishings and fittings repaired in a timely manner. Not assessed To assist in protecting the person from harm. 10 27 18 To demonstrate that their are sufficeint staff on shift. Not fully assessed for compliance To ensure that health and welfare needs of people are safely met. 31/03/2010 11 30 18 To demonstrate that the staff 31/03/2010 are skilled and experianced to meet the assessed needs of the people living in the home. Standard not met To ensure that their health and social care needs are met. 12 30 Regulation 12 The registered person must 07/07/2009 (1)(a)(b) ensure that there is a system in place to monitor staff training and development. The service must be able to demonstrate mandatory training, training in the protection of vulnerable adults and specialist training is being planned for and provided to staff. This will ensure staff fulfil the aims of Page 9 of 12 Care Homes for Older People 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 the home and meet the changing needs of people using the service. Not fully met 13 37 37 The home should notify the CQC about any event in the home which affects the well being or safety of anyone. Remains Outstanding To protect people living in the home. 17/03/2010 14 38 25 Reg 25 The registered provider to produce his buisness plan for the next five yeras to show that the home is financially viable. Information not received in writing To protect the people living in the home 03/04/2010 Care Homes for Older People Page 10 of 12 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 11 of 12 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. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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