Care Home: Lucas Court Nursing Home

What the care home does well The home was ensuring that the right people received the correct medicines. The mars also reflected that medication was being accounted for when received in to the home. A checklist was being used to ensure that when antibiotics are prescribed these are given as instructed and checked daily. It was noted that when a medicine was prescribed as a variable dose that the actual dose quantity given had been marked on the record sheet eg for lactulose solution prescribed for one service user. The clinical lead and allocated project manager are carrying out medication audits of the administration sheets every time they are working. Nurses are also checking the administration sheets at handover. There had been training given to all carers that are involved in applying external creams and ointments to people who use the service. What the care home could do better: The mars could have schedule times printed on them and the timing of the medication administration rounds should be adhered to. Accurate records must be maintained for all medicines that are administered. The record sheets should be signed at the time of each witnessed administration or as soon as practically possible. All prescribed "when required" medication especially those given for aggression or behavioural reasons must be managed by producing a plan of action in the care plan and information relating to the reasons for administration should be noted. The home could produce medication profiles in the individuals care records to ensure any changes to prescribed regimes are recorded centrally and not solely on the mars. The medication audit process needs to ensure that it is not only viewing paper base records but also monitoring actual giving process and timings of rounds. The audits need to be carried out regularly. Inspecting for better lives Random inspection report Care homes for older people Name: Address: Lucas Court Nursing Home Northampton Lane North Moulton Northampton NN3 7RQ new service which has yet to be given a quality rating 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: Naveeda Knopp Date: 1 6 0 2 2 0 0 9 Information about the care home Name of care home: Address: Lucas Court Nursing Home Northampton Lane North Moulton Northampton NN3 7RQ (01604)493233 01604493234 lucascourt@schealthcare.co.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) : Southern Cross Healthcare Services Limited care home 60 Number of places (if applicable): Under 65 Over 65 28 1 60 6 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Conditions of registration: 0 0 0 6 All service users in the category of DE(E) must be accommodated on the first floor. No one falling in the category of DE(E) may be admitted into the home where there are 28 service users who fall within the category of DE(E) already accommodated in the home No one falling in the category of OP may be admitted in the home where there are 60 service users who fall within the category of OP already accommodated in the home. No one falling in the category of PD may be admitted into the home where there are 6 service users who fall within the category of PD already accommodated in the home Care Homes for Older People Page 2 of 11 No one falling in the category of PD(E) may be admitted into the home where there are 6 service users who fall within the category of PD(E) already accommodated in the home. To be able to admit the named person under 65 years of age named in variation application no V000029387 dated 7th February 2006 To be able to admit the named person under 65 years of age named in Variation Application No. V000020533 dated 13th May 2005. Two named female service users may be accommodated in the category of Mental Disorder, until such time as they leave the home. No further service users may be admitted in this category Date of last inspection Brief description of the care home Lucas Court is a care home providing personal and nursing care for up to 60 people. Currently Lucas Court provides care for older people, older people with dementia, older people with a mental disorder and people with a physical disability. Southern Cross Healthcare owns the home and it is located in the village of Moulton on the outskirts of Northampton. The village has some local shops and public houses and is on a bus route in to Northampton. The home is a two storey building with the first floor allocated for dementia care, and care for people with mental health needs. Fifty of the bedrooms are single rooms with forty-eight of these rooms having en-suite facilities. There are five double rooms in the home. The home has a passenger lift. There is an enclosed well-maintained garden to the rear of the home, which is accessible to wheelchair users, and a car park. A scale of charges confirmed as being current at the time of the inspection in July 2008 states that fees are from 650 pounds to 750 pounds perr week. The fees quoted are exclusive of any free nursing contribution, which is collected from the Primary Care Trust by Southern Cross Healthcare. Local Authorities who are funding people are charged at a set rate. These people will be asked for a top up fee, which varies according to their ability to pay. The fees include personal care and where applicable nursing care, meals and accommodation. Chiropody, hairdressing services, and newspapers can be arranged and are charged separately. Other costs would include clothing and toiletries. Information about the services provided including the complaints procedure is displayed in the foyer of the home. This includes the statement of purpose, a service user guide and a copy of the most recent Commission for Social Care inspection report. 2 1 1 0 2 0 0 8 Care Homes for Older People Page 3 of 11 What we found: On arrival the manager reported difficulties with the heating system at the home since Friday. He said that there are heaters in everyones rooms. A risk assessment for this issue was seen in all the care plans viewed during this inspection. The room temperature of the areas visited by the Pharmacist inspectors did not cause any concerns. The clinical lead was completing the medication round on the ground floor . She stated there were still 2-3 people remaining. On arrival on the first floor (also known as EMI floor) an RGN on duty requested a further 10-20 minutes to complete the medicine round. She informed the inspectors that she had 10-11 out of the twenty people left. When asked about the normal routine for this medication round she stated there had been sickness in the morning, so had been short staffed. She informed the inspectors that she was doing breakfasts before starting medicine round. In addition some of the people on this floor are not up until 10.30am. After a further 30 minutes after arriving on this floor the round had still not been completed. The RGN agreed to inform the inspectors once completed.This was not until another 30 minutes had elapsed.When which she stated she had spent some time cleaning the medication vessels. The next round was to be commenced after 2.00pm. RGN stated the home does not do medicine round during lunchtime -unsure with the reasons why. Due to the closeness in the timings of the morning and noon rounds there was a risk of overdosing which could lead to unpleasant side-effects and harm. On viewing the current medication administration record sheets (mars) it was seen that the home opted to define the rounds as morning, noon, tea-time and night. It was also estimated that too close dosing would be a problem for at least five people on this floor. The medication administration records for the people on the EMI floor included photocopies of current prescriptions and photographic identification.These records also reflected that medication was being accounted for when received in to the home. Reviewing the mars for a person on the EMI floor showed that for a prescribed antibiotic, Co-amoxiclav 375mg, a check sheet was in place to audit them. For a second item, Seretide 250mcg inhaler the mars starting 23rd January showed omissions from 14th Feb teatime to morning 16th February. There were no annotations made on the corresponding reverse side of mars.The RGN on duty was shown this, who said she was on duty for all four shifts and definately gave the inhaler. She then proceeded to complete the records. This person had recently had an exacerbation of their breathing condition, as noted by the fact on the 23rd January to 31st January a course of Amoxicillin 500mg were taken three times a day and a short course of a steroid- Prednisolone 5mg enteric coated tablets which for given for 6 days. Further gaps on the mars were seen for omeprazole 20mg, lactulose liquid and movicol sachets on the morning of 16th February for the same person. For others, a dose of Ramipril 1.25mg and Tamoxifen 20mg tablets information on the corresponding Care Homes for Older People Page 4 of 11 records for 16th February indicated not given. Again after showing all these to the RGN, she stated had administered them all and then completed the records. A person was prescribed Promazine 25mg/5ml as a when required(prn) medicine and as a dose of 5ml at 17.00pm. The mars showed this was administered on the 4th February and 5th February. It was not needed since then -this is recorded on reverse MAR charts but nothing had been recorded on mars or daily notes to state why given on those two dates.There was no information in the care plan or a behavioural chart to indicate how to manage this prn medicine. A person was prescribed Haloperidol 500mcg capsules twice daily when required for agitation. Records indicated this was administered twice daily regularly from 4th February until the 16th February. Again there was no information within this persons care plan to indicate how this is manage or the use of behavioural charts to monitor. A supply of Trazadone s/f liquid was signed to indicate given on the 4th February, twice a day then the sheets are marked with G from then up until current date. The sheets where annotated contact Dr Bailey before resuming. No further information was found to indicate that this doctor had been contacted or the reasons for this to have been stopped in the first place. There was an anomaly in the quantity available of Glycerol 4 g Suppositories for a person and whether a supply had been readily available for use. The mars indicated that there was only one carried forward (on 04/02/09) to the current medication cycle but then the signatures for administration showed that one suppository was used by the service user on 5th and another on the 7th February 2009.The charts were marked with N for the 4th,6th,8th,and 3th February then subsequently a supply of 40 were checked in to the home.N means not available at the home. Fourteen audits for medicines which were not dispensed from the Pharmacy in the monitored dosage system, were carried out. Twelve of the audits indicated the administration tallied with the supplies remaining. Two audit indicated errors were made in administration or accounting in the first 13 days of current MAR chart period. Both of these related to either a deficit or surplus of one tablet. Medication that is no longer needed is removed from the premises regularly and is recorded in a duplicated book. A mar checked for the application of a prescribed cream three times a day was satisfactory. Controlled drugs can be stored securely. A diary entry made for 30/01/09 showed that three medicines where missing out of next months supplies and that the home had made steps to obtain these supply before the change over day. Reviewing previous mars indicated that medicines were in continual supply with no gaps showing. Ten omissions for the same day (3rd February) were seen on the mars for people on the Care Homes for Older People Page 5 of 11 ground floor unit. 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 6 of 11 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 9 13 (2) Accurate, complete and up to 11/09/2008 date medication records must be kept to ensure that medication is administered correctly, safely and as intended by the prescriber to manage individual health needs. 2 19 23 (2) (d) Carpets must be kept clean 30/09/2008 and free from odour and replaced as required to ensure people have a pleasant environment to live in. 3 27 18 (1) (a) Staffing levels must be 30/09/2008 reviewed and monitored in consultation with people who use the service and sufficient staff provided to meet their needs. 4 30 18 (1) (c) (i) Staff training should be 30/10/2008 implemented to address gaps identified in the staff training matrix to ensure that all staff have up to date training to meet residents needs. Care Homes for Older People Page 7 of 11 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 5 33 24 (1) (a & b) Quality assurance systems must be effective in improving and maintaining the quality of care provided to people who use the service. 30/09/2008 Care Homes for Older People Page 8 of 11 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 Accurate records must be maintained for all medicines that are administered. The record sheets should be signed at the time of each witnessed administration. 13/04/2009 This is to prevent any harm to people who use this service. 2 9 13 All prescribed when required 13/04/2009 medication especially those given for aggression or behavioural reasons must be managed by producing a plan of action in the care plan and information relating to the reasons for administration must be noted. This is to protect and prevent any harm to people who use this service 3 9 13 Medicines should be given as 13/04/2009 prescribed at the desired time where there is going to optimum benefit to the Page 9 of 11 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 person and there is sufficient time between subsequent medication rounds so that there is no risk of the next dose causing an overdose. A medicine round should be completed within an hour timescale. This is to prevent any harm to people who use this 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 home could produce medication profiles in the individuals care records to ensure any changes to prescribed regimes are recorded centrally and not solely on the mars. The medication audit process needs to ensure that it is not only viewing paper base records but also monitoring actual giving process and timings of rounds. The audits need to be carried out regularly. 2 9 Care Homes for Older People Page 10 of 11 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. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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. 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