Care Home: Nightingale Care Home

What the care home does well The random inspection looked specifically at how the home manages medicines for people living there. We found overall that the home has satisfactory arrangements in place for the safe storage of medicines. The home also has systems in place for auditing medication records but this could be improved. Steps have been taken to ensure there are regular medication reviews undertaken by GPs or visiting Primary Care Trust pharmacists. Members of staff authorised to handle and administer medicines to people living at the home have received training on medicine management What the care home could do better: The home must ensure medicines are always administered to people in line with most recent prescribed instructions. This must be demonstrated by accurate record-keeping practices. Internal audits should include regular and frequent accounting of medicines. Medicines prescribed for `PRN` administration by staff must be given to people only when clinically justified. This must also be demonstrated by the home`s record-keeping practices. Care plans should be developed for medicines prescribed on a PRN basis giving clear individualised guidance on the circumstances when such medicines can be considered for use. Pain assessment tools should be considered for people with dementia prescribed PRN painkillers. Inspecting for better lives Random inspection report Care homes for older people Name: Address: Nightingale Care Home Church Lane Welborne Dereham Norfolk NR20 3LQ zero star poor 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 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: Mark Andrews Date: 1 7 0 3 2 0 0 9 Information about the care home Name of care home: Address: Nightingale Care Home Church Lane Welborne Dereham Norfolk NR20 3LQ 01362850329 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) : Ablecare (UK) Ltd care home 47 Number of places (if applicable): Under 65 Over 65 0 47 dementia old age, not falling within any other category Conditions of registration: Date of last inspection Brief description of the care home 47 0 Nightingale Care Home provides personal care and accommodation for up to fortyseven (47) Older People who may have dementia. The building was purchased by Able Care (UK) Ltd and they have refurbished the Home. Registration of the service provider and the first manager was completed on 12th October 2007. The Home did not admit residents until March/April 2008. The current Manager, Caroline Newman, started work at the Home in October 2008 and is currently in the process of applying for registration with the Commission. The home is located in the village of Welbourne and next door to the village church. Accommodation is provided on the ground and first floors. All except two shared bedrooms have en-suite facilities. There is ample communal space and the lift makes it Care Homes for Older People Page 2 of 13 Brief description of the care home easy for people to move between the floors. There are gardens to the front and side of the building, with safe access to an enclosed decked area. Car parking space is located at the front of the premises. Currently the fees range between £417 - £500 per week. Please contact the Home for up to date information about fees. Care Homes for Older People Page 3 of 13 What we found: An unannounced inspection of the homes management of medicines was conducted by the Commissions pharmacist inspector Mark Andrews. We looked at how the home stores medicines and at current and previous medication charts and records for the disposal of medicines against medicines currently available for administration to people living at the home. The manager Caroline Newman was on duty and the findings of the inspection were discussed in detail with her during the inspection. Medicines are held secured in a ground floor clinic room. The temperature of the room and the medicine refrigerator are monitored and recorded at satisfactory temperatures on a daily basis. Medicines such as creams and ointments were said to be no longer stored in peoples rooms but in a large cabinet near the clinic room. A cabinet is in use for the storage of controlled drugs however this is not bolted to the wall by a minimum of two bolts in line with Misuse of Drugs (Safe Custody) Regulations. The supplying pharmacy currently supply most medicines in two types of 7-day monitored dosage system (MDS) containers with medicines for each scheduled round stored in one compartment. The manager said that steps are in place to change medicine supplier to provide a single 28-day system with separately packaged medicines. There are other medicines that are supplied in original pharmacy-type containers. Current 28-day medication charts are located in a folder and are interleaved by resident-identifying photographs, medication care plans and other information such as faxed confirmation of warfarin doses after blood testing. Some identifying photographs were missing for some people living at the home. When we looked at medication charts and compared them to medicines and their containers that were available we found that records indicate the majority of medicines are being administered as prescribed and scheduled however, we found some evidence of medicine records being completed when medicines still remained in containers. We also found several examples of medicines that had not been offered to people as prescribed. These generally were medicines that had either recently been prescribed or had not yet been supplied in MDS containers. For example, for one person, moderate painkiller co-dydramol tablets had recently been prescribed at a dose of one tablet daily when required but on two occasions two tablets were recorded as administered and on another day the medicine was administered twice within a 24 hour period. Another person prescribed an oral antifungal agent for four times daily administration had been offered this only three times daily for several days and then twice daily only. We noted a number of external medicines that were being offered for application less frequently than prescribed. We found two numerical medicine discrepancies where medicines could not be accounted for in full. The manager said that internal medication audits were being conducted approximately weekly but the audit did not establish medicine audit trails and enable medicines not supplied in MDS containers to be accounted for. For example, whilst records were completed for a person prescribed warfarin in line with recent prescribed instructions, because the home does not keep a periodic count of such medicines they cannot be accounted for to establish they are being given as prescribed. This principle of medicine management was discussed in detail with the Care Homes for Older People Page 4 of 13 manager and other examples were used to illustrate this. We also found some medicines that had not been transcribed from the previous 28-day medication chart period to the current. One of these, cardiovascular medicine perindopril, was no longer in use but there were no records indicating that staff had identified this and checked it with prescribers or that authority for its discontinuation had been received at the home. Another example was oral and topical painkillers that were not written on the current chart but were still present in the medicine trolley and it was unclear if these medicines were still being administered. We looked at medicines prescribed for people for the management of psychological agitation prescribed for administration at the discretion of care staff (PRN administration) but that are also of a potentially sedative nature. For example, we noted that for one person pericyazine was prescribed for PRN administration but was being administered routinely twice daily. The manager confirmed that there were no records confirming that the use of this medicine was justified for this person. In addition, there were no individualised care plans available for reference for staff providing guidance on the management of agitation by non-medicinal measures and stating precise circumstances when such medicines may be used. There were, however, care plans in place for people prescribed PRN painkillers but these were scant and did not advise staff how to establish individual people with dementia exhibit symptoms of pain. We discussed the use of pain assessment tools with the manager. The manager informed us that regular medication reviews are undertaken by GPs attending the home. In addition, a Primary Care Trust pharmacist and technician have recently visited the home to undertake medication reviews. We asked to see a specimen signature list of staff authorised to handle and administer medicines for people living at the home. The manager provided a list that she confirmed was not up to date and needed some names added. We asked for documentary evidence that all such members of care staff have received training and whilst this was not available at the time of inspection was provided to use shortly following the inspection. The manager confirmed that she had only recently started assessing the competence of staff authorised to handle and administer medicines. What the care home does well: The random inspection looked specifically at how the home manages medicines for people living there. We found overall that the home has satisfactory arrangements in place for the safe storage of medicines. The home also has systems in place for auditing medication records but this could be improved. Steps have been taken to ensure there are regular medication reviews undertaken by GPs or visiting Primary Care Trust pharmacists. Members of staff authorised to handle and administer medicines to people living at the home have received training on medicine management Care Homes for Older People Page 5 of 13 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 13 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 1 4 It is required that the Statement of Purpose is accurate This will ensure that prospective residents have accurate information about the Home 30/04/2009 2 2 5 It is required that residents are issued with a statement of terms and conditions which includes their fees This will ensure that residents know what services they will receive 30/04/2009 3 7 15 It is required that the care plans contain detailed information about the residents needs and how these should be met To ensure that the residents needs are met in a consistent way 30/04/2009 4 7 15 It is required that risks are 30/04/2009 identified and assessed and that these are regularly reviewed and updated within the care plans To ensure that the staff have clear guidance about how to manage risks Care Homes for Older People Page 7 of 13 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 9 13 It is required that creams are 16/03/2009 stored securely To ensure that they do not pose a risk to residents 6 12 16 It is required that 29/05/2009 opportunities are available for residents to take part in a meaningful activities To ensure that the residents are given the choice to take part in activities 7 18 13 It is required that all concerns about possible abuse are referred to the Safeguarding team To ensure that residents are protected from abuse 16/03/2009 8 18 13 It is required that all staff receive appropriate training about Safeguarding Vulnerable Adults To ensure that residents are protected from abuse 30/04/2009 9 21 23 It is required that hot water 16/03/2009 is provided to all handbasins in the Home To ensure that the residents have access to hot water 10 21 23 It is required that the necessary aids are provided in the toilets and bathrooms To ensure that the residents have appropriate equipment to assist them 31/03/2009 Care Homes for Older People Page 8 of 13 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 11 22 23 It is required that the 31/03/2009 bedroom doors are adjusted so that the residents are able to open them easily as well as still meeting fire regulations To ensure that residents are able to have independent access to their bedrooms 12 25 23 It is required that the 31/03/2009 lighting in the corridors is suitable for the residents and in working order To protect the health and safety of residents 13 25 23 It is required that the central 16/03/2009 heating is provided in all bedrooms To ensure that the residents rooms are warm and that the heating is provided in a safe way 14 25 23 It is required that overhead blinds, fans and heating is provided in the conservatories To ensure that the residents can comfortably use these rooms throughout the year 30/04/2009 15 25 23 It is required that the problems with the sewage system at the Home are addressed To ensure that a suitable, safe system is in place 30/04/2009 Care Homes for Older People Page 9 of 13 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 16 26 23 It is required that appropriate infection control procedures are followed To provide protection to residents and staff 16/03/2009 17 27 18 It is required that staffing levels are increased to meet the needs of the residents To ensure that the needs of the residents can be met 25/02/2009 18 30 18 It is required that the staff receive appropriate training To ensure that the staff receive training necessary to meet the needs of the residents 29/05/2009 19 33 26 It is required that the provider carries out monthly visits and provides a report following these This is to ensure that the provider has a good understanding of the issues at the Home 31/03/2009 20 33 24 It is required that an effective quality assurance system is in place This is to ensure that the quality of the service provided is reviewed on a regular basis and improvements made where needed 30/06/2009 Care Homes for Older People Page 10 of 13 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 Medicines must be 24/04/2009 administered to people at the home in line with most recent prescribed instructions at all times. This must be demonstrated by accurate recor-keeping practices To safeguard the health and welfare of people at the home 2 9 13 Medicines prescribed for 24/04/2009 PRN administration at the discretion of care staff must be given to people only when clinically justified. This must be demonstrated by the record-keeping practices To safeguard the health and welfare of people at the home 3 9 13 The cabinet used for the 30/04/2009 storage of controlled drugs must be secured to a wall of solid construction by a minimum of two bolts in line with the Misuse of Drugs (Safe Custody) Regulations Care Homes for Older People Page 11 of 13 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 To ensure all medicines are appropriately stored in line with legislation 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 It is recommended that the homes internal auditing for medicines includes regular and frequent accounting or medicines It is recommended that care plans are developed for medicines prescribed on a PRN basis giving clear individualised guidance on the circumstances when such medicines can be considered for use. Pain assessment tools should be used to assess pain for people with dementia prescribed PRN painkillers. 2 9 Care Homes for Older People Page 12 of 13 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: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 13 of 13 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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