Care Home: Manor Court Nursing Home

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What the care home does well The home was managing many service users with complex needs . They were workingwell with other health care professionals such as the GP, palliative care team and home care team. What the care home could do better: The home needs to urgently address the capacity of the controlled drug cabinets. There needs to be more attention to keeping accurate records in the CD register. Patches for pain relief must be applied as prescribed. The home must improve its auditing processes so that there is evidence of safe handling of medication at all times. Random inspection report Care homes for older people Name: Address: Manor Court Nursing Home Britten Drive North Road Southall Middlesex UB1 2SH 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: Jane Shaw Date: 2 9 0 4 2 0 1 0 Information about the care home Name of care home: Address: Manor Court Nursing Home Britten Drive North Road Southall Middlesex UB1 2SH 02085715505 02085749243 jacksonpae@bupa.com www.bupa.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Stewart McGinn Type of registration: Number of places registered: Conditions of registration: Category(ies) : BUPA Care Homes (CFHCare) Ltd care home 120 Number of places (if applicable): Under 65 Over 65 0 0 0 0 0 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability terminally ill Conditions of registration: 0 0 0 0 0 A maximum of 30 service users over the age of 60 with Mental Disorder. A maximum of 30 service users over the age of 60 years with Dementia. A maximum of 60 service users with a Physical Disability of which 20 may be under 60 years. Three may require palliative care. Care Homes for Older People Page 2 of 10 Date of last inspection Brief description of the care home Manor Court is a 120-bedded purpose built care home, divided into four separate buildings, each of which is self contained having its own communal facilities. The home has 90 Continuing Care beds. The other 30 beds are funded by Ealing Primary Care Trust, Social Services and privately. All bedrooms are single rooms. There are no ensuite facilities. Service users access GP services via the home s own doctors, an allocated GP or through signing up with a GP of their choice. A consultant psychiatrist visits the home for service users who have mental health needs. The home is situated in a residential area of Southall, with a few local shops nearby. There are bus services that pass near to the home. The fees range from GBP659 to GBP1,200 per week. Care Homes for Older People Page 3 of 10 What we found: This pharmacist inspection was to review the safe handling of medication, particularly the management of controlled drugs stored in the home. We inspected the storage and recording of controlled drugs in the four flats of the home. We noted that there was a large quantity, and in one flat there was not sufficient storage in a cupboard complying with The Misuse of Drugs Act. We looked at the recording in the register and noticed that two balances were incorrect. One patch had been applied the morning of the inspection, and not recorded in the register. For the other we were told that a patch two days previously, had been removed from the cupboard recorded in the register, but not applied and later returned. The service user did not receive pain relief on this occasion although it was recorded that he did. We noticed that this flat was not carrying out daily checks of controlled drug balances and recording the formulation of the controlled drug in the register. This good practice was advised on a recent visit by Controlled Drug Police Liaison Officers investigating another discrepancy in stock. In a further two flats, balances of controlled drugs were correct. We noted on the Medication Administration Record (MAR) and in the register in one flat that fentanyl patches were being applied every 96 hours instead of the prescribed 72 hours. For the same service user, when we looked at the previous months MAR we noted that patches were out of stock for three doses in March 2010, because there was no stock. We looked at the recording of receipts , administration and disposal of other medication in the home. We noted in two flats that there were no omissions in record keeping, and when we audited medication against the records, we could reconcile all the samples and were satisfied that medication was being administered as prescribed. In one flat we noticed discrepancies in balances of one or two tablets for one service user. We also noticed an omission in recording movicol and simvastatin at night on one occasion. In another flat there were a significant number of anti-psychotics carried forward from the previous month and because the quantities were not recorded, it was difficult to audit. We noticed that variable doses of medication were recorded for regularly prescribed medication. When a service user was prescribed a dosage range however the actual dose administered was not always recorded. We saw that the home was recording medicines for disposal and that the Medication Administration folder was well organised with details of anticoagulant tests, hospital discharge letters , copies of prescriptions and authorizations for syringe drivers. There was evidence of good management of service users with diabetes and being fed enterally. Blood glucose results and protocols for feeding were all kept with the MAR for ease of reference. Storage of medication was well organized. One flat kept three oxygen cylinders and only one was secure in a stand. Because of the errors in administration of two controlled drugs we asked that the home investigate and send us the two reports of what happened and their action so that they did not happen again. What the care home does well: The home was managing many service users with complex needs . They were working Care Homes for Older People Page 4 of 10 well with other health care professionals such as the GP, palliative care team and home care team. 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 10 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 17(1)(a) Wound care records must be 03/07/2007 accurate and kept up to date. 2 8 17(1)(a) Where input from healthcare 03/07/2007 professionals is identified as required, this must be promptly actioned by the home. 3 15 16(2)(i) Where service users require a soft diet, an appropriate, appetising meal must be provided. 03/07/2007 4 18 13(6) Any issues identified that 03/07/2007 could be a POVA incident must be reported in order to safeguard the residents. Any repairs must be promptly identified and addressed. 03/07/2007 5 19 23(2)(b) 6 19 23(2)(b) (d) The redecoration and refurbishment programme must be up to date and contain timescales for 03/07/2007 Care Homes for Older People Page 6 of 10 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 completion. Where timescales are exceeded, a clear explanation must be available. 7 22 23(2)(l) There must be adequate storage facilities in the home. 03/07/2007 8 25 13(4) The home must confirm that 03/07/2007 all the radiators in service user areas have controlled surface temperatures. Appropriate action, for example the fitting of guards, must be taken for any radiators that do not meet this requirement. 9 26 13(2) Infection control and COSHH 03/07/2007 procedures must be fully adhered to. 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 That the home checks Controlled Drugs on a daily basis To ensure accurate recording 17/05/2010 2 9 13 All controlled drugs must be 31/05/2010 stored in a cupboard meeting the requirements of the Misuse of Drugs Act. This is to comply with the current legislatiom 3 9 13 The homes audits must be improved so that systems are robust in preventing errors in administration and records from occurring. This is to maintain the health and well being of the service users. 17/05/2010 4 9 13 That the home administers 17/05/2010 medication as prescribed. If not administered then the correct endorsements on the MAR must be used. If a variable dose regimen is prescribed then the record of Page 8 of 10 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 administration must be accurate. This is to maintain the health of the service users. 5 9 13 That the recording of controlled drugs in the register is improved so that balances are correct To comply with the Misuse of Drugs Act 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 17/05/2010 1 2 9 9 That all oxygen cylinders are stored securely. That if medicines are carried forward from one cycle to the next then the brought forward quantity is always recorded for audit purposes. That there are protocols in place for all as required medicines eg cyclizine 3 9 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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