Care Home: Stowlangtoft Hall Nursing Home

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What the care home does well Regular audits of medication and medication records are undertaken. What the care home could do better: All medicines and prescribed dressings must be locked away when not in use. Medicines must be stored under suitable environmental conditions and records made to demonstrate this. Medicines controlled under the Misuse of Drugs Act must be stored in accordance with the Act and associated Regulations. The cupboard used to store controlled drugs must only be used for this purpose and must not be used for the storage of other items and valuables. Records made when medicines are given to people must be accurate and complete. Where people are prescribed medicines on a "when required" basis, there must be clear guidelines in care plans for staff to follow. Any variation to prescribed instructions for medicines must only be done with the documented agreement of the prescriber. Risk assessment and risk management plans must be in place where people look after and take their own medicines. All staff who administer medicines by any route must be trained and assessed as competent to do so. The temperature of the fridge used to store medicines should be monitored and recorded using a maximum/minimum thermometer and re-set for the next recording period. Random inspection report Care homes for older people Name: Address: Stowlangtoft Hall Nursing Home Stowlangtoft Hall Nursing Home Stowlangtoft Bury St Edmunds Suffolk IP31 3JY zero star poor service 18/05/2010 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: Derek Brown Date: 2 6 0 8 2 0 1 0 Information about the care home Name of care home: Address: Stowlangtoft Hall Nursing Home Stowlangtoft Hall Nursing Home Stowlangtoft Bury St Edmunds Suffolk IP31 3JY 01359230216 01359233346 iain@stowlangtofthall.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Hilary Anne MacDonald Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Hilary Anne MacDonald,Mr Hector Iain MacDonald care home 37 Number of places (if applicable): Under 65 Over 65 37 0 old age, not falling within any other category physical disability Conditions of registration: Date of last inspection Brief description of the care home 0 37 1 8 0 5 2 0 1 0 The present Stowlangtoft Hall was built in 1859 for the Maitland Wilson family and stands in seven acres of garden and woodland. In 1939 the property was let to London County Council as an evacuation centre for mothers and babies from the East End of London. The Hall has been used as a nursing home since 1969. Many of the original features of the hall have been retained for the enjoyment of the Care Homes for Older People Page 2 of 13 Brief description of the care home residents and visitors, including an Orangery with a glazed dome roof where residents may sit in the warmer weather. The home has established strong links with the local community and the larger grounds around the home are often used for community events. The home is currently registered for 37 places for older people or those with physical disabilities and are admitted for either short or long term care. The home was taken into administration during February 2010 and is being managed by Healthcare Management Solutions whilst decisions are made about the future of the service. During this period of change, please contact the Manager for details of current fees. Care Homes for Older People Page 3 of 13 What we found: The purpose of this inspection by a pharmacist inspector was to assess progress towards meeting the requirements made concerning medication practices at the key inspection on 18th May 2010. At this random inspection we looked at the practices and procedures for the safe storage, handling and recording of medicines. We talked to some members of staff and some residents and looked at some care records. Most medicines were stored securely for the protection of residents, but we found some medicines in peoples rooms which were not locked away. We also found that the room used to store prescribed creams, ointments and dressings was also not locked. This means these could be accessible to unauthorised people and people they are not prescribed for. The temperature of the cupboard used to store medicines is monitored and recorded but not on a daily basis. At the time of the inspection we found the temperature to be at the maximum recommended level and the record showed it to have been above this level 11 times out of 13 times it was recorded during the previous 26 days. The temperature of the fridge used to store medicines was acceptable but again, the temperature is monitored infrequently and only the current temperature is recorded, not the maximum and minimum reached during the recording period, which is good practice. The failure to store medicines at the correct temperature could result in people receiving medication that is ineffective. The cupboard used to store controlled drugs does not meet the requirements of the Misuse of Drugs Regulations, but we saw that a new cupboard was waiting to be installed. We found money and jewellery stored in this cupboard, which is not an acceptable place to store peoples valuables. We looked at the medication and medication records for several people resident in the home. The records of receipt and disposal of medicines is not kept with the medication administration record forms so it was difficult to account for all medicines in use. We found a number of unexplained gaps in the records giving no indication of whether medicines had been given or not, and if not the reason why was not recorded. Where people are given medicines on a variable dose basis e.g. one or two tablets, the actual dose given is not always recorded and this could result in people receiving too much or too little medication. Where medicines are given on a when required basis, there is inconsistent recording giving no clear indication of whether the medication was omitted as it was not required or for any other reason. We could also find no guidance in care plans for people prescribe such medication to ensure medication is used appropriately and consistently, to meet their needs. We found that the record to indicate prescribed creams had been used were sometimes ticked, sometimes initialled by the person administering the medication and sometimes left blank. One persons medication which was prescribed to be used every 7 days was recorded as being used only 5 days apart. We also saw that some people who were prescribed medicines to be used on a regular basis, the record indicated that they were being given only when required and there was not record made that this variation in instruction had been discussed with the prescriber. Care Homes for Older People Page 4 of 13 Some people take their own medicines and store these in their rooms but they are not stored in lockable facilities and care plans do not have risk assessment to ensure the risks to the person themselves and other people in the home are minimised. We watched some medicines being given to people during the morning and this was done with an acceptable level of professional practice. The acting manager has undertaken some audits of the medication and medication records and some of the issues raised above have been identified, particularly the storage temperatures for medicines, but not all. At the key inspection on 18th May 2010 we made a requirement to put in place effective arrangements for the recording, handling, safe keeping and safe administration of medicines. This requirement has not been fully met by the given timescale of 30th July 2010 and so further requirements have been made. Most medicines are given to people by qualified nurses but some creams are administered by untrained care staff. We were told that further training is planned and that assessments of competence to administer medicines was planned for the following week and saw a letter to staff dated 25th August 2010 confirming this. At the key inspection on 18th May 2010 we made a requirement to ensure that staff involved in the administration of medicines are provided with suitable training. This requirement has not been met by the given timescale of 30th July 2010, but given the plan to provide further training and to undertake competence assessments we have extended the timescale for compliance. What the care home does well: What they could do better: All medicines and prescribed dressings must be locked away when not in use. Medicines must be stored under suitable environmental conditions and records made to demonstrate this. Medicines controlled under the Misuse of Drugs Act must be stored in accordance with the Act and associated Regulations. The cupboard used to store controlled drugs must only be used for this purpose and must not be used for the storage of other items and valuables. Records made when medicines are given to people must be accurate and complete. Where people are prescribed medicines on a when required basis, there must be clear guidelines in care plans for staff to follow. Any variation to prescribed instructions for medicines must only be done with the documented agreement of the prescriber. Risk assessment and risk management plans must be in place where people look after and take their own medicines. All staff who administer medicines by any route must be trained and assessed as competent to do so. The temperature of the fridge used to store medicines should be monitored and recorded using a maximum/minimum thermometer and re-set for the next recording period. Care Homes for Older People Page 5 of 13 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 7 15 You must put in place effective arrangements to ensure that care plans are reviewed when appropriate or when peoples needs change and they are up dated to reflect those changes. If care plans are not reviewed regularly staff may miss important changes to the residents care and needs may go unrecognised. 30/07/2010 2 7 15 You must put in place effective arrangements to ensure people living in the home have all their needs assessed and there is a written plan as to how those needs are to be met. Peoples health and wellbeing can be put at risk if care plans do not properly address their assessed needs. 30/07/2010 3 7 13 You must put in place 30/07/2010 effective arrangements to ensure that unnecessary risks to the health and safety of people living in the home are identified and so far as possible eliminated. Page 7 of 13 Care Homes for Older People 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 Good quality risk assessments enable people to live a fulfilling life while still protecting them from unnecessary harm. 4 8 12 You must put in place 30/07/2010 effective arrangements to ensure that you promote and make proper provision for the health and welfare of people living in the home. People must be supported to make decisions that will promote their wellbeing. 5 8 15 You must ensure that where 30/07/2010 risk assessments are carried out peoples mental capacity must be considered and taken into account. If it is felt that someone may lack capacity and may put themselves at risk it should be considered having their capacity tested in accordance with the Mental Capacity Act. 6 8 13 You must put effective 30/07/2010 arrangements in place to ensure that people living in the home receive, where necessary, treatment, advice and other service from any healthcare professional. People must be supported to make decisions that will promote their wellbeing. 7 9 18 You must ensure that staff 30/09/2010 Page 8 of 13 Care Homes for Older People 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 involved in the administration of prescribed medicines are provided with suitable training. It is important that staff are suitably trained in all areas the management and use of medication to avoid mistakes that can have serious consequences. This is a repeat requirement. Previous timescale of 30/07/2010 has not been met. 8 25 23 You must put in place 30/07/2010 effective arrangements to ensure that there is suitable and adequate heating provided in all areas used by people living in the home. It is essential for the welfare of the residents that all areas in the home are kept at a comfortable temperature. 9 25 23 You must put in place 30/07/2010 effective arrangements to ensure that all rooms used by people living in the home have a suitable and adequate supply of hot and cold water. To protect the health and welfare of the people living in the home it is essential that there is a clean and reliable water supply to all areas of the home. 10 26 23 Steps must be taken to 30/07/2010 Page 9 of 13 Care Homes for Older People 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 ensure that all bathrooms and toilets in the home are kept in a good state of repair. The condition of bathroom and toilets in the home do not promote good hygiene. 11 30 18 You must ensure that there 30/07/2010 are sufficient staff on duty at all times to meet peoples assessed needs. It is not sufficient to set staffing levels on comparing the ratio of staff to residents. The size and layout of the building and the residents care needs must also be taken into consideration. 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 Risk assessment and risk management plans must be in place where people look after and take their own medicines. This will ensure risks to people are identified and minimised. 30/09/2010 2 9 12 Any variation to prescribed instructions for medicines must only be done with the documented agreement of the prescriber. This will ensure people receive their medicines as prescribed. 15/09/2010 3 9 15 Where people are prescribed 30/09/2010 medicines on a when required basis, there must be clear guidelines in care plans for staff to follow. This will ensure people are protected from harm and medicines are used consistently and appropriately. 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 4 9 13 Records made when 15/09/2010 medicines are given to people must be accurate and complete. This will demonstrate that people receive their medicines as prescribed. 5 9 13 All medicines and prescribed 15/09/2010 dressings must be locked away when not in use. This will ensure medicine are not accessible to unauthorised people or people they are not prescribed for 6 9 13 Medicines must be stored 15/09/2010 under suitable environmental conditions and records made to demonstrate this. This will ensure people are given medicines of suitable quality. 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 The temperature of the fridge used to store medicines should be monitored and recorded using a maximum/minimum thermometer and re-set for the next recording period. Care Homes for Older People Page 12 of 13 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. 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