Care Home: St Margaret`s

What the care home does well We found that medicines are stored within a dedicated area and that a lockable trolley is provided for transport of medicines around the home. What the care home could do better: We found that the Medication Administration Record charts were poorly maintained and that there was no system in place to pick up errors that had been made and correct them. We also found that there was no clear system for monitoring stock levels of medicines at the home and that people did not always have a continuous supply of their prescribed medicines. We could not be certain that medicines requiring refrigeration had been stored in accordance with the manufacturers directions. We found that valuables were stored with the medicines and there was no clear audit of who these belonged to or when they had all been placed in the cupboard. We found that the medicines policy currently in use did not relate to the home itself and also contained inappropriate directions within it. Inspecting for better lives Random inspection report Care homes for older people Name: Address: St Margaret`s Mylord Road Fraddon St Columb Cornwall TR9 6LX 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 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: Brian Brown Date: 0 8 0 5 2 0 0 9 Information about the care home Name of care home: Address: St Margaret`s Mylord Road Fraddon St Columb Cornwall TR9 6LX 01726861497 Telephone number: Fax number: Email address: Provider web address: clydon@btconnect.com Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Blakeshields Limited care home 28 Number of places (if applicable): Under 65 Over 65 28 0 0 old age, not falling within any other category physical disability terminally ill Conditions of registration: 0 5 5 Total number of service users not to exceed a maximum of 28 Date of last inspection Brief description of the care home St. Margarets is situated on the main road within the village of Fraddon. It is a care home with nursing, and is currently registered for 28 residents within the category of old age not falling into any other category. This includes residents who may have physical disability (5), or be terminally ill (5). The home provides day care for 2 residents up to twice a week. A trained nurse is on duty over the 24 -hour period. There are communal facilities comprising a dining room and lounge areas. A passenger lift provides access to the first floor for those with mobility problems. The majority of Care Homes for Older People Page 2 of 9 Brief description of the care home rooms offer single accommodation. There is a new reception area. There is a small car parking area to the front of the building. There is a small patio and lawned area too. Fees range from #455.36 to #600 per week. Care Homes for Older People Page 3 of 9 What we found: This random inspection was carried out following a concern being raised in relation to the handling of Controlled drugs at the home. The inspection was carried out by Brian Brown, Regional Lead Pharmacist over a period of 3hrs 40minutes . Although only one person carried out the inspection it was carried on behalf of the Commission so the term we will be used throughout the report. We found that medicines are supplied from the local Dispensing GP practice and they also provide Medication Administration Record (MAR) charts for the service. We found that some of these medicines had been packed into Monitored Dosage Systems and that for some of these medicines this was not appropriate as the manufacturer has stated they are not suitable for inclusion in these packs and must be stored in the original container. This may place people at risk of receiving medicines that may be less effective then expected. The reference source available to staff at the home contained this information. When looking at the Medication Administration Record (MAR) charts we found some anomalies and errors that may affect the well being of people living at the home. These specifically were a failure to record the actual dose administered when medicines were prescribed with a variable dose, a lack of recording for the application of external products, the omission of a prescribed dose from some charts. The failure to record what has actually been administered may compromise the persons care as it is no longer possible to comment on the efficacy or otherwise of the prescribed treatment. It may also lead to the person not receiving an appropriate dose on the next administration occasion. The lack of recording of application of external products means that the response of the person to the prescribed medicine cannot be effectively monitored meaning they may not get the treatment they require. We found that following an injection that morning the needle used had been resheathed. This is not good practice as it may lead to a needle stick injury occurring and an increased risk of infection with Hepatitis B. We also found that when blood sugars are being monitored by staff that they are not using appropriate lancing devices and again this may lead to an increased risk of needle stick injuries and infection with Hepatitis B. However the injection in use was stored at room temperature meaning that when given it is less likely to cause pain to the person receiving it. The reserve stock of this medicine was seen to be kept in the fridge but only the current temperature of the fridge was monitored and recorded with no indication of the temperature range that medicines requiring refrigeration were being stored. For other people prescribed eye drops we found that these were stored in the fridge after opening which was not in accordance with the manufacturers directions and this could lead to discomfort when these were administered and also to a loss of effectiveness when administered. We found for one person that prescribed medicine was not present in either the medicines trolley or the treatment room. The MAR chart had been marked to indicate that this medicine was out of stock. We could find no record to indicate that a replacement supply had been ordered or that the prescriber had been contacted for an alternative. When we asked the person in charge they were also unable to find this information. This means that people cannot be confident that there are systems in place to ensure that their prescribed medicines are available to them when they need them. Care Homes for Older People Page 4 of 9 We then looked at the storage and management of Controlled Drugs. We found that there is a cupboard provided that meets the current regulations and is fitted in accordance with these. We did however find that not all Controlled Drugs were stored in accordance with the regulations. We also found that the disposal of some of these medicines had not been in accordance with the current regulations. It was not possible at the inspection to confirm that the stocks of all controlled drugs balanced as we were not able to see all of the record books that had been used. We did speak to the acting manager at a later time who confirmed that all medicines had at some stage been entered into these record books although they did not reflect the current stock in the home. This increases the risk of diversion of these medicines occurring. We also found that the medicine cupboards were being used to store peoples valuables. This is not good practice and puts both the person at risk of losing their property and also the member of staff at risk of allegation. Some of the envelopes contained large sums of money and these were not sealed in anyway and did not indicate that the contents had been checked. For one of these people there had been an entry made in their daily record but his had not been signed. Other envelopes were seen to have been present in the cupboard for a long period of time. We also looked at the current policy in the home for the safe handling of medicines. Some parts of the policy were seen to relate to another care home and other parts were seen to instruct the members of staff to commit an offence if they followed the policy. This means that people cannot be reassured that the policies and procedures at the home promote safe working practices in relation to the handling and administration of medicines. 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 30 18 The registered manager must promote staff training, and make arrangements for this to be available to staff. 01/09/2008 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 (2) Arrangements must be 12/06/2009 made to ensure that there is a safe system available to store valubles that does not involve keeping them in the medicines cupboard. This is to ensure that access to the medicines cupboard is minimised to essential use so reducing the risk of diversion of any medicines. 2 9 13 (2) Arrangements must be 12/06/2009 made to ensure that there is a safe system in place to audit stock levels and the Medication Administration Record charts. This is to reduce the risk of a person not having medicines administered in accordance with the directions of the prescriber. It is also to ensure that records made are timely and accurate. 3 9 13 (2) Arrangements must be made to ensure that lancets used are suitable for the purpose. 12/06/2009 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 This is to reduce the risk of harm and cross infection 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 medication policy be reviewed to reflect current legislation and practise. This is to reassure people that they will have their medicines handled and administered safely. Care Homes for Older People Page 8 of 9 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. 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