Care Home: Mossley Manor

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What the care home does well Medication was stored securely and accessible only to authorised staff in order to reduce the risk of medicines being misused or mishandled. What the care home could do better: All medication must be administered as prescribed, in order to protect the health and wellbeing of people who use this service. There must be complete and accurate records of all medication received, administered and disposed of by the service in order to account for all medicines. There must be sufficient stocks of medication available for each person at all times, so that they receive their medicines as prescribed. There must be a system for regularly auditing (checking) the standard of handling and recording medication within the service so that standards can be monitored and improved where necessary. Medicines must be given at the correct time of day, particularly with regard to food and drink intake in order for medicines to work properly and/or reduce side effects. Handwritten medication administration records should be thoroughly checked and signed by two members of staff in order to reduce the risk of making mistakes. Random inspection report Care homes for older people Name: Address: Mossley Manor North Mossley Hill Road Mossley Hill Liverpool Merseyside L18 8BN two star good service 11/02/2010 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: Maggy Howells Date: 2 8 0 7 2 0 1 0 Information about the care home Name of care home: Address: Mossley Manor North Mossley Hill Road Mossley Hill Liverpool Merseyside L18 8BN 01517242856 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Amer Latif,Mrs C K Latif Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 47 Number of places (if applicable): Under 65 Over 65 47 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 only - Code PC 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: 47 Date of last inspection Brief description of the care home The home was originally built in 1878 and over the years has been modernised and converted to its present state. The home is registered for forty seven residents who require personal care and support. The home is situated in Mossley Hill, a quiet suburb Care Homes for Older People Page 2 of 10 1 1 0 2 2 0 1 0 Brief description of the care home of South Liverpool. Shops, cafes, pubs and public transport facilities are nearby. Residents are provided with single rooms; the two double rooms are currently being used for single accommodation. Residents have aids and equipment to help them with their mobility and ramps and a lift allow access to all parts of the house and gardens. There are communal lounges and dining rooms, which are homely and comfortable. Residents can entertain their visitors in these areas or the privacy of their own rooms. A call bell system with an alarm facility operates throughout the home to enable residents to call for assistance. The fee rate for accommodation is GBP 330.00 a week plus GBP 28 per week for en-suite facilities. Care Homes for Older People Page 3 of 10 What we found: We visited the home because we had some concerns about the giving and recording of medicines. This visit was carried out by a pharmacist inspector. It lasted approximately six hours and involved speaking with the deputy manager and carers on duty. This was an unannounced visit, which meant that neither management nor staff knew we were going. We checked the medicines storage area, a sample of medicines stocks and records. We gave detailed feedback to the deputy manager at the end of the visit and also to the manager by phone two days later. Overall we found that there was some poor practice when handling, administering and recording medicines. This meant that health and wellbeing of people who live in the home was being put at unnecessary risk of harm. We were told that policies and procedures for handling medicines within the home had been produced, but were unavailable for staff to refer to at the time of the visit. This meant that staff did not have clear instructions for handling medication within the care home. We looked at a sample of records and stock and found it very difficult to account for some medicines. This meant that we could not be sure that these had been given to people correctly, or if the right amount of stock was left. There was no obvious system of stock control because stock was not properly recorded (carried forward) from one month to the next. When we looked at records, we found that not all medicines entering the home had been recorded. There were no records of medicines leaving the home. Records of all medicines received, administered by and leaving the home must be complete and accurate in order to account for all medicines. The medication administration records were generally preprinted by the supplying pharmacy, although some had been written by hand. The handwritten ones had not been double signed by two members of staff to show they had been thoroughly checked. We found that these contained lots of inaccuracies, for example the strength, dose and form of medicine was often missing. One record did not have the date or the name of the person written on. When the administration of medicines is not accurately recorded, people are at risk of being given the wrong amount of medicine (too much or too little). Mistakes are far more likely to happen when records are incomplete and inaccurate. Some people were prescribed medicines to be taken only when required e.g. painkillers, whilst others were prescribed creams for external use. There was a clear system in place for recording detailed information about how and when these medicines were to be given, but this had not been completed in all cases. This information is vital in order to ensure that people be given their medicines consistently and correctly. It is important that this information is regularly reviewed and updated where necessary. We checked a sample of records showing when creams had been used. We found three examples where people had not been given their creams correctly. Staff must apply Care Homes for Older People Page 4 of 10 creams as prescribed for them to work properly. Some medicines have to be taken at specific times, for example an hour before food, in order to work properly. Whilst some medicines were clearly given an hour before breakfast, we could see no evidence that this was done at other times of the day. We saw medicines prescribed to be taken 30-60 minutes before food being given after lunch. People are unlikely to get the best from their medication if it is not given at the correct time in relation to food and drink. We looked at the storage of medicines and found that the service had appropriate medication cupboards and trolleys with the keys being held securely at all times. There was a dedicated fridge available for storing medication such as insulin. Keeping medication at the correct temperature helps to prevent it from spoiling and becoming unusable. When we looked at a sample of stocks, we found that some peoples medication was not available as the supply had run out. This is unacceptable. The health and welfare of people living in this home is at serious risk of harm if they are not given their medication as prescribed. We looked at how the home handled Controlled Drugs (strong medicines that are likely to be misused). These medicines were stored in an appropriate cabinet and records kept in a special register. We did find some errors, where pain relief patches had not been changed correctly, but the manager assured us that these incidents had been dealt with. Some people living in the home chose to look after some or all of their own medicines. This is considered to be good practice and helps to promote peoples independence. However, no risk assessments had been completed to assess whether people were able to manage their own medicines safely, or what support they may need from staff in order to be able to do so. There were no records telling staff when and how to check that people continued to manage their medicines safely and no records of any checks taking place. We asked the manager about audits (checks) that were carried out to assess how well medicines were managed within the home. She told us that there was currently no audit system in place. This meant that mistakes were not being found and acted upon to help prevent them happening again. We gave some advice to the manager on how audits can be performed and how they help to maintain and improve standards. We looked at training and found that only the senior carers who had been given medication training were authorised to handle medication. However, there was no evidence of a formal system for checking and recording the competence of care staff (including temporary staff) actually administering or recording medicines. Checking the competence of staff ensures they are safe to carry out their duties without supervision. Some peoples medication administration records had course finished written on certain items. We tried to check in peoples care records when and why the medication had been stopped, but the information was not available. This made it impossible to tell who had authorised medication to be stopped. In some examples, the type of medication was not usually prescribed as a course, but appeared to have run out. peoples health and wellbeing is at risk of harm if medication is stopped without authority from the prescriber. Care Homes for Older People Page 5 of 10 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 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 15 16 Provide a choice of meals 02/04/2010 which are varied and served at the correct temperature at suitable times. To improve the nutritional arrangements for service users and to make mealtimes enjoyable. 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 8 13 There must be complete and 27/08/2010 accurate records of all medication received, administered and disposed of by the home in order to account for all medication 2 9 13 All staff must be assessed as 27/08/2010 competent to handle medication before being allowed to administer medication unsupervised in order to ensure staff are able to perform tasks safely 3 9 13 There must be sufficient supplies of medicines for each person available at all times so that people receive their medicines as prescribed 27/08/2010 4 9 13 People living in the home must be given their medication as prescibed in order to protect their 27/08/2010 Care Homes for Older People Page 8 of 10 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 health and well being 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 Two members of staff should check and sign all handwritten entries on medication administration records, in order to reduce the risk of making mistakes. Risk assessments should be carried out to ensure all people wishing to look after their own medication are safe to do so. There should be a clear care plan showing staff how to support these people 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. 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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