Care Home: Palace Road, 18-18a

What the care home does well There is evidence staff are encouraging people to take their prescribed medicines as there were very few missed doses. There were also no gaps on medicines charts, providing evidence that staff record when medicines are given accurately. We checked the quantities of a few medicines, and these tallied with the quantities recorded on the medicines chart, indicating that staff are now giving medicines accurately and as prescribed. What the care home could do better: Medicines in use are kept locked, to ensure the safety of people at the service, however medicines for return are kept in an open box in the office. These should be kept in a locked cupboard until they are picked up the the pharmacist for the safety of people at the home. Allergy information is missing for some residents. This should be recorded on people`s medicines charts to avoid people being prescribed or given any medicines they are allergic to. Although all medicines were available on the day of the inspection, one person has been without a medicine for constipation for 3 days in the last month. This is because the GP has not prescribed enough to last the month. We were told that this is being addressed with the GP. No other prescribed medicines were unavailable or doses missed. Some people have printed medicines charts from the pharmacy on which staff record medicines given. Some people have charts handwritten by staff, as certain medicines are supplied from the hospital and community psychiatric team who do not supply printed medicines charts. One person was given their medicines at the wrong time of day for a few days before the chart was checked by someone else and the correct time was added. It is recommended that all handwritten charts have a robust check for accuracy before being used; this is usually a second check by another member of staff. We looked at the training staff have been given in medicines handling. The supplying pharmacist was visiting the home the day after the inspection to carry out a medicines workshop, and a nurse consultant was also going to provide extra training in medicines handling. As we noted a few issues with medicines handling, the manager of the service should assess the competency of all staff who give medicines to ensure that people have had an appropriate level of training, as some staff giving medicines have had a one day training course which is not sufficiently detailed to allow people to give medicines safely, although it is suitable for induction training. These competency assessments should be documented. Random inspection report Care homes for adults (18-65 years) Name: Address: Palace Road, 18-18a Palace Road, 18-18a Streatham Hill London SW2 3NG one star adequate service 31/03/2010 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: Vashti Maharaj Date: 0 5 0 8 2 0 1 0 Information about the care home Name of care home: Address: Palace Road, 18-18a Palace Road, 18-18a Streatham Hill London SW2 3NG 02086717849 02086839591 nwi@mht.co.uk www.mst-online.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Metropolitan Support Trust Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 20 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Conditions of registration: 20 The maximum number of service users who can be accommodated is: 20 The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home 18 Palace Road is registered to provide care, support and accommodation for twenty people that have experienced mental health related conditions. The premises are owned and managed by the Metropolitan Housing Trust. The home is located in a quiet residential road between Tulse Hill and Streatham Hill railway Care Homes for Adults (18-65 years) Page 2 of 10 3 1 0 3 2 0 1 0 Brief description of the care home stations. Public transport links are good. The majority of the communal rooms are located on the ground floor. There are twenty single occupancy bedrooms located over the ground, the first and second floors. A passenger lift is provided to enable access to all three floors. Fees range from £514 to £710 per week Care Homes for Adults (18-65 years) Page 3 of 10 What we found: We carried out an unannounced inspection on 5th August 2010 to assess how the service manages medicines following on from a notification informing us that a person had received the wrong medicines for 4 days in July 2010. This inspection was carried out by one of the Commissions Pharmacist Inspectors. We inspected records of medicines received, used and returned to see if the service was able to account for the use of all medicines. We also inspected medicines supplies and storage areas, staff training in medicines handling, and we looked at evidence of how staff support people to self administer their medicines. We discussed the medicines error with the senior support worker in charge on the day of the inspection, and also with the support worker who noticed the error. The error was caused by staff re-dispensing medicines supplied by the pharmacist into a compliance aid for someone who was being supported to self administer his medicines. This person did not notice that they had been given the wrong medicines by staff, and took 4 days supply before the error was picked up by staff. Staff took appropriate action after the error was picked up to make sure the person was safe, by informing the persons GP and care co-ordinator immediately. The GP reviewed the persons health and has confirmed they have suffered no long term effects. Management at the service also took appropriate action by arranging for retraining in medicines handling for all staff and by stopping the practice which caused the error. The practice of re-dispensing medicines greatly increases the risk of error to people at the home. Guidance from the Care Quality Commission and professional bodies such as the Royal Pharmaceutical Society of Great Britain and the Nursing and Midwifery Council discourage this practice by care staff. The person in charge confirmed that this was no longer happening. The supplying pharmacist is going to supply medicines in weekly blister packs for people who self administer. There is evidence that people are receiving their medicines on time, and records kept are accurate, with staff recording all medicines given at the time of administration. One person is on warfarin, and staff have clearly documented when changes have been made to the dose. Another person is on insulin. This is given by the community nurse. The nurse keeps the administration records. It would be safer for the records to be kept at the home. Staff are also supporting two people to take their own medicines to increase their independence. One person is given a months supply of medicines. Staff carry out spot checks to make sure this person is still managing safely. One person is given 4 days supply of medicines at a time, as this person is being prepared to leave the home. After the medicines error, staff stopped this persons self administration on a temporary basis to make sure they were able to identify their medicines correctly and also to make sure Care Homes for Adults (18-65 years) Page 4 of 10 they would be able to inform staff if they were given the wrong medicines. This person should continue to be supported to self-administer. 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 Adults (18-65 years) Page 5 of 10 Care Homes for Adults (18-65 years) 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 24 23 The organisation must forward to the Care Quality Commission the refurbishment plans for the service. The premises needs to be kept in good repair both internally and externally 28/05/2010 2 33 18 The home must make sure 30/04/2010 that employment of persons at the home on a temporary basis will not prevent service users receiving continuity of care. The staff team must have a permanent staff member on duty for all shifts to promote continuity 3 34 19 The home must not employ any person to work at the home unless they are fully vetted first. Documents as required by Schedule 2 must be available for any persons working at the home including agency staff. 30/04/2010 4 37 8 The organisation must have a capable and competent manager to manage the service. 30/04/2010 Care Homes for Adults (18-65 years) Page 7 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 The manager must be registered with CQC. 5 37 9 The registered person must 30/08/2007 ensure that the manager submits and application form to register with CSCI. Since the last inspection the registration process has taken place. Since the reregistration of the last manager in 2009 the managers post has been vacated. 6 41 17 The service must ensure that 30/04/2010 record keeping is improved, records required by regulation must be up to date and well organised. To ensure that service users interests are safeguarded. Care Homes for Adults (18-65 years) Page 8 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 20 13 Medicines dispensed, labelled 14/09/2010 and supplied by the pharmacy or hospital must not be re-dispensed by staff into other containers. To ensure the safety of people at the service. 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 2 3 4 5 20 20 20 20 20 Handwritten medication charts should have a robust check for accuracy before being used. Supplies of prescribed medicines should be checked at the beginning of each cycle to ensure medicines do not run out. Copies of records of insulin given by the community nurse should be kept at the service. Medicines for return should be kept in a locked cupboard. Allergy information should be recorded on medication charts for all people at the service to ensure their safety. Care Homes for Adults (18-65 years) 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 Adults (18-65 years) 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. Care Homes for Adults (18-65 years) Page 10 of 10 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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