Care Home: Nazareth House

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What the care home does well Medication was stored securely. This helps to prevent medicines from being mishandled. Staff responded quickly to suggestions of how to handle medicines more safely. What the care home could do better: There must be clear records of all medicines received, administered and returned to the pharmacy so that medication can be accounted for. Medicines must be given to people as prescribed and at the right time in relation to food intake in order to protect the health and well being of people living in the home. For people that look after their own medicines a regularly reviewed written risk assessment and care plan must be developed so that they receive the right amount of support from staff to do it safely. Controlled drugs (strong medicines that can be misused) must be accurately recorded to help prevent mishandling and misuse. An effective system for auditing (checking) all aspects of recording, handling and administering medicines within the home must be developed to help make sure medicines are handled safely. All staff who are responsible for handling medicines should have effective training and assessments to ensure that they are competent to carry out their duties safely. Random inspection report Care homes for older people Name: Address: Nazareth House Liverpool Road Crosby Liverpool Merseyside L23 0QT 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: Maggy Howells Date: 0 5 0 2 2 0 1 0 Information about the care home Name of care home: Address: Nazareth House Liverpool Road Crosby Liverpool Merseyside L23 0QT 01519283254 01519287723 nazarethhouse@crosbyuk.freeserve.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) : Sisters of Nazareth care home 66 Number of places (if applicable): Under 65 Over 65 2 64 dementia old age, not falling within any other category Conditions of registration: 0 0 The registered person may provide the following category of service only: Care home only: Code PC, to people 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 (maximum number of places: 64). Dementia over 65 years of age: Code DE(E) (maximum number of places: 2). The maximum number of people who can be accommodated is: 66. Date of last inspection Brief description of the care home Nazareth House is a care home for older people owned by the Sisters of Nazareth. The registered manager is Sister Rose Ita, who has many years experience in health care and service to the community. The ethos of Nazareth House is rooted in Catholicism and there is an integral chapel with daily Mass for those who live there. The religious Care Homes for Older People Page 2 of 9 2 6 0 3 2 0 0 9 Brief description of the care home beliefs of service users of all denominations are respected in this home through arrangements for visiting ministers accordingly. Nazareth House accommodates sixty six residents and to ensure a homely and personalised service, the accommodation is divided into three self-contained floors or units. Each unit is individually managed by nominated senior staff, under the supervision of the registered manager, who has ultimate responsibility for the day to day management of the home. Nazareth House is situated on the main Liverpool to Southport Road with close links by public transport and nearby shops, a cinema, local churches, and a wealth of local amenities. Care Homes for Older People Page 3 of 9 What we found: We carried out this visit to make sure that Controlled Drugs (strong medicines that may be mishandled and/or misused) were being handled safely. As a result of our findings, we then also checked the recording and handling of other medicines. The inspection was carried out by a pharmacist inspector and lasted approximately six hours. We checked a sample of medicines records, medicines and stock. We spoke to the registered manager, deputies and senior staff who were responsible for administering medicines. Overall we found shortfalls in the way medicines were being handled that were placing the health and wellbeing of people at unnecessary risk. We looked at how medicines were stored and found that generally, medicines were stored in appropriate locked cabinets and trolleys. Keeping medicines safely helps to prevent them from being mishandled. When we checked the medicines records against current stocks we found that there was no system in place for auditing (checking) current stocks. This meant that it was not possible to see how much medication should have been present and therefore we could not tell whether or not medicines had been given correctly. Failure to keep full and accurate records of medicines received, administered and disposed of places the health and well being of people living in the home at risk of harm. Several people that were prescribed medicines to be taken only when required did not have any information recorded about how and under what circumstances they should be given. Having clearly written instructions helps to make sure that people get their medicines consistently and correctly. We found that some residents were not given their medication as prescribed because staff had not followed the instructions carefully. Some medicines had special instructions, such as to be given half to one hour before food, but these directions had not always been followed. If special instructions are ignored then medicines may not work properly and residents health may be placed at risk from harm. We looked at how people were supported to look after their medicines and found that the paperwork was missing or incomplete. No risk assessments had been carried out to identify potential problems, care plans did not have any information about how people were to be supported and there were no records of checks made by staff to make sure people were looking after and taking their medicines safely. Having up to date records helps make sure people receive the right amount of support to manage their medicines safely. Senior staff immediately acted to produce appropriate documents that would help staff ensure that risks were identified and managed correctly. We checked how controlled drugs (medicines that can be misused) were handled. These medicines were stored safely and a special register was used for record keeping. The entries we checked were usually signed by a second member of staff however the quantity of medication recorded did not accurately reflect current stocks. On checking further we found that staff had not maintained accurate running totals of medicines in stock. It is important that staff check entries carefully before signing records as being correct. Having clear, accurate records is essential to ensuring these powerful medicines Care Homes for Older People Page 4 of 9 are handled safely. We looked at how staff were trained and how medicines were audited (checked). We found that the manager had no system in place to check staff practice, records and medicines stocks. This meant that mistakes and areas of weakness were not identified and so action was not taken to improve. Staff had received medicines training from their local pharmacist, but this had not addressed all aspects of safe medicines management. No formal assessments had been carried out to ensure that staff were competent to carry out their duties safely. We were told that the supplying pharmacist had visited the home on February 4th, looked at records and medicines handling but had found no problems. This had obviously, but incorrectly, given staff the impression that the current procedures were safe. We gave advice about how medicines should be handled, how to carry out effective audits and to how to ensure staff have the necessary skills information and guidance to perform their duties safely. 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 9 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 38 13 Risks to peoples safety and wellbeing should be identified, recorded, addressed and regularly reviewed, regarding leaving the building and use of bedrails. This is to ensure that peoples safety and wellbeing will be promoted and protected in Nazareth House. 22/05/2009 Care Homes for Older People Page 6 of 9 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 All staff who are responsible 31/03/2010 for handling medicines should have effective training and assessments to ensure that they are competent to carry out their duties safely 2 9 13 There must be evidence of 31/03/2010 an effective system for regularly auditing (checking) all aspects of recording, handling and administering medicines within the home to make sure medicines are handled safely and action taken where problems are noted. Controlled drugs (strong 31/03/2010 medicines that can be misused) must be accurately recorded to help prevent mishandling and misuse. 3 9 13 4 9 13 There must be clear records of all medicines received, 31/03/2010 Care Homes for Older People Page 7 of 9 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 andministered and returned to the pharmacy so that medication can be accounted for. 5 9 13 Medicines must be given to 31/03/2010 people as prescribed and at the right time in relation to food intake in order to protect the health and well being of people living in the home. 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 13 There should be regularly reviewed written risk assessments, care plans and records of checks made for people who look after and take their own medication so that they receive the right amount of support from staff to do so safely. Care Homes for Older People Page 8 of 9 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. Copyright © (2009) Care Quality Commission (CQC). 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