Care Home: Marley Court Nursing & Residential Home

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What the care home does well Medicines including controlled dugs are safely locked away helping to reduce the risk of miss-handling or miss-use. What the care home could do better: Medicines record keeping needs to improve to better support and evidence the safe administration of medication and the arrangements for handling peoples prescribed creams need to be reviewed to ensure they are applied correctly. Where people selfadminister medication written assessments need to be completed to help ensure they receive any support they may need. Random inspection report Care homes for older people Name: Address: Marley Court Nursing & Residential Home Bolton Road Heath Charnock Chorley Lancashire PR7 4AZ one star adequate service 13/10/2009 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: Stephanie West Date: 1 4 0 1 2 0 1 0 Information about the care home Name of care home: Address: Marley Court Nursing & Residential Home Bolton Road Heath Charnock Chorley Lancashire PR7 4AZ 01257226700 01257234407 marleycourtnh@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Sharon Anne Brennan Type of registration: Number of places registered: Conditions of registration: Category(ies) : Marley Court Nursing Home Limited care home 49 Number of places (if applicable): Under 65 Over 65 49 old age, not falling within any other category Conditions of registration: 0 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 - Code OP The maximum number of service users who can be accommodated is: 49 Date of last inspection Brief description of the care home Marley Court is a purpose built home, which is registered to provide both personal and nursing care for older people. The accommodation at Marley Court is offered on two Care Homes for Older People Page 2 of 10 1 3 1 0 2 0 0 9 Brief description of the care home floors, the first floor being accessed by stairs or passenger lift. There are a range of single rooms some with en suite facilities and double or companion rooms, some of which also have en suite facilities. There are two lounge/dining rooms, one on each floor and a range of toilet and bathing facilities throughout, there is also a fully equipped laundry. There is a large patio area at the front, furnished with hardwood garden furniture and set around a central fountain. This area, along with the side gardens is fully accessible to residents, regardless of mobility. As Marley Court is situated on the main A6 road from Chorley to Adlington it is well provided by public transport. The current fees charged at Marley Court are £365 to £583 per week. Additional charges are payable for hairdressing, newspapers, chiropody and toiletries. A statement of purpose and service user guide is available to people considering using the service and their relatives on request. Care Homes for Older People Page 3 of 10 What we found: The purpose of this visit was to look at the action taken to improve medicines handling in order to addresses weaknesses seen at previous visits and to meet with current requirements. This visit focused on medicines handling, other areas were not examined on this occasion. We looked at care documentation within the home and the medication systems that were in place. We spoke with nursing staff about the arrangements made for handling peoples medicines. At the end of the visit feedback was given to the deputy manager. Overall, we found that although suitable arrangements had been made for the handling of medication, the homes policies and current guidance were not always followed in practice. This meant there were some weaknesses that need to be addressed to reduce the risk of errors and, to help ensure that the safe handling of medication is better supported. We looked at medicines administration. Medicines were mostly administered by qualified nurses but people wishing to self-administer medication were supported to do so, helping to retain their independence. However, it was of concern that written assessments and care plans were not completed for someone who managed their own inhalers. Written guidance is important to help ensure that people receive any support they may need to manage their medicines safely. We looked at medicines stocks and record keeping. Records of medicines received into the home and showing the administration of medication were generally up-to-date but there were some areas that need to be improved to ensure their completeness and clarity: it was not always possible to account for (track) the handling of medicines in the home because where quantities of medication were brought forward from a previous months delivery the quantity was not recorded. We also saw some gaps in the records where the reason for non-administration of regular medicines was not recorded. On occasion, a comparison of medicines stocks with records showed that medicines had been given but not recorded. It was of concern that records were not always completed to show the application of prescribed creams. This meant it was impossible to tell whether they had been used correctly. We also found some discontinued or otherwise unwanted creams in peoples rooms. We found examples where individual information about the use of prescribed creams had not been kept up-to-date and examples where information about the use of medicines prescribed when required could be usefully expanded. Clear and accurate guidance will to help ensure they are used correctly, when needed. Most administration records were pre-printed by the pharmacist but where handwritten entries were made these were not always signed and countersigned. This is recommended to help reduce the risk of errors. We looked at medicines storage. We found that medicines including controlled drugs were stored securely. This helps to reduce the risk of miss-handling or miss-use. But, we found that stocks of prescribed external preparations (e.g. creams) were not well managed. Care needs to be taken to maintain adequate stocks without overstocking. Any unwanted medication should be promptly segregated for safe disposal. Since our previous visit the manager had developed templates for carrying out audits (checks) of medicines handling and for assessing staff competency in the homes medicines procedures. It is recommended that these checks are carried out to help Care Homes for Older People Page 4 of 10 ensure medicines are safely handled and that should any weaknesses arise, they will be identified and quickly addressed. 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 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 7 13 Where it is considered necessary to use bed rails a risk must be carried before they are used. This will ensure they used appropriately and safely for people using the service. 27/11/2009 2 7 15 A care plan for the safe use of bed rails must be put in place for each person where they are used. This will make sure that members of staff have clear directions to follow so that bed rails are used safely and any risks effectively managed. 27/11/2009 3 8 12 Wound care plans must be clear and kept up to date. This will ensure that nursing staff have up to date and accurate information about the care and treatment of all wounds. 27/11/2009 4 9 24(1) There should be an effective system in place to check medicines and staff competence to help make sure people who live in the home are kept safe. 28/09/2008 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 5 18 13 All members of staff must 31/12/2009 have training in safeguarding vulnerable adults. This will help to protect people using the service from abuse. 6 29 29 An application form must be completed and two written references obtained before members of staff start working at the home. This protects people using the service from the employment of unsuitable staff and volunteers. 13/11/2009 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 There must be a complete, clear and accurate list of currently prescribed medication (including external preparations) for each person and of the time and date of administration. This is to help ensure medication is safely administered as prescribed. 22/02/2010 2 9 13 Where people choose to self- 22/02/2010 administer medication written assessments must be completed to help ensure people receive any support they may need. 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 Clear written instructions should be in place for staff to follow to ensure medication prescribed when required and prescribed external preparations (e.g. creams) are given or applied correctly. Page 8 of 10 Care Homes for Older People 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 Hand written instructions on the medication administration records should be signed and witnessed. This ensures that instructions have been copied correctly. 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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