Care Home: Wall Hill

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What the care home does well On the whole the management and awareness of medicines had improved since the last inspection. What the care home could do better: The home could rationalise their storage of medicines so that all excess stock is stored in the same location and are organised so that each individuals medicines are stored together and separate from other individuals medicines. The home needs to reduce the risks for the administration of Warfarin. When new dosage regimes are received for Warfarin the information should be transferred to the MAR charts and is set out in a way that will ensure that the correct doses are administered by the staff. Staff should not be transferring medicines from one container to another. These medicines must remain within the container they were originally dispensed into. The home needs to ensure that when errors are detected during the auditing of medicines these errors are investigated immediately so that the appropriate action to safeguard the individual concerned can be taken. Random inspection report Care homes for older people Name: Address: Wall Hill Broad Street Leek Staffordshire ST13 5QA one star adequate service 27/04/2010 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: Ian Henderson Date: 2 8 0 7 2 0 1 0 Information about the care home Name of care home: Address: Wall Hill Broad Street Leek Staffordshire ST13 5QA 01538399807 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Susan Jane Briand Type of registration: Number of places registered: Conditions of registration: Category(ies) : Wall Hill Care Home Limited care home 34 Number of places (if applicable): Under 65 Over 65 0 34 dementia old age, not falling within any other category Conditions of registration: 7 0 The maximum number of service users who can be accommodated is: 34 The registered person may provide the following category of service only: Care Home only Code PC To service users 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 34 Dementia Code DE, maximum number of places 7 Date of last inspection 2 7 0 4 2 0 1 0 Care Homes for Older People Page 2 of 9 Brief description of the care home Wall Hill is registered to provide care and accommodation for 31 older people, 9 of whom may have needs associated with a physical disability, 9 of whom may have mental health needs and 4 whom may have dementia. The home is located close to the centre of the historic market town of Leek in the Staffordshire Moorlands. There is a wide range of community facilities, including shops, restaurants, pubs and other leisure amenities in the town. There is good access to local bus services. The home also has its own minibus which is a well used and popular facility. The home is a twostorey building that has undergone considerable refurbishment to meet the needs of people who use the service. A passenger lift allows easy access to the first floor. Of the 29 single bedrooms available, 26 have en-suite toilet facilities. There is one shared bedroom available. The environment is well maintained and decorated throughout. Attractive communal sitting areas are provided at Wall Hill, with large and small lounge areas with comfortable seating and a large and attractive dining room that opens onto the rear grounds and patio area. People interested in accommodation at Wall Hill are advised to contact the home direct to obtain information about current fees and availability. Care Homes for Older People Page 3 of 9 What we found: The pharmacist inspector visited Wall Hill on the 28th July 2010 to establish what progress the home had made in meeting the requirements carried over from the last inspection on the 27th April 2010. Upon arrival the inspector was met by the manager and the responsible individual who updated the inspector on the progress the home had been making. The manager said that all of the staff who were involved in the administration of medicines had completed further training courses on the safe management of medicines. The manager said that there was an ongoing programme to assess staff on their competency to handle and administer medicines safely. The manager said that they were closely monitoring the administration of medicines by carrying out audits of the medicines held within the home. On the morning of the inspection the random audit check had identified three signatures missing on a medication chart from the previous nightly administration round. The responsible individual was in the process of investigating this when the inspector arrived. We found that the home was ensuring that medicines stored in the fridge were being stored at the correct temperature by monitoring the maximum and minimum temperatures on a daily basis. We found that all Controlled Drugs were being stored in the Controlled Drugs cabinet and their receipt was being recorded immediately in the Controlled Drugs register. We found that there were a small number of people who were using the service who were administering all or part of their prescribed medicines. At the last inspection we found that risk assessments for these people had been completed but there was no monitoring programme in place. We found that the home now had a monitoring programme in place to ensure that these people were administering their medicines as prescribed. We found that the medication records had improved and overall could evidence that people using the service were having their medicines administered as prescribed. We found that there had been improvements in recording of the receipt of medicines and consequently audits to account for the medicines could be carried out by the home to ensure that medicines were being administered as prescribed. We found that a monthly stock check accounted for all of the medicines that were carried over from the previous monthly medication cycle. Apart from the missing signatures mentioned above the inspector found no other missing signatures on the medication charts sampled. We also found that the home was recording the quantity given for those medicines that had been prescribed with a variable dose. At previous inspections the inspector had not been able to audit the anticoagulant tablets because of the failings in the systems to record the receipt administration and disposal of medicines. At this inspection we found that the recording of the receipt and administration had improved. Unfortunately the much improved system highlighted a couple of problems with the two people we looked at. With the first person the audit showed that a 1mg Warfarin tablet could not be accounted for. With the second person the audit showed that two 3mg Warfarin tablets could not be accounted for and a dose of 3mg had been administered on Wednesday 21st July 2010 when 2mg should have been administered. Care Homes for Older People Page 4 of 9 The audit also indicated that the home had not been administering some tablets used to treat benign prostatic hyperplasia as directed by the prescriber. We found that 28 tablets had been received and the administration record showed that 10 tablets had been administered. We therefore expected to find 18 tablets remaining but we found 27 tablets. This indicated that over the past 10 days only one tablet had been administered. The responsible individual was asked to carry out an investigation to determine whether this was the case and report to CQC his findings. The responsible individual reported that he had spoken to all the members of staff concerned and had obtained assurances that all of the tablets for had been given out. He therefore concluded that the only explanation was that a previous balance had not been accounted for in the records but had been used for the nine days indicated on the administration chart. The inspector raised concern with the responsible individual that the investigation had not taken place soon after the discovery of the problem. The responsible individual was reminded that any issue with medicines where potentially too much or not enough has been administered an investigation must be carried out immediately in order to safeguard the individual concerned. 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 8 12 Where people require regular 01/05/2010 weighing this must be completed. This will ensure that if significant weight changes occur they are identified and acted upon. 2 35 20 Where the service is looking 11/06/2010 after peoples money this must be kept separately from the account used to run the business. This will improve the safe keeping of peoples money. 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 Any errors detected during the auditing of medicines must be investigated immediately so that the appropriate action to safeguard the individual concerned can be taken. This will safeguard the health and welfare of the people using the service. 06/09/2010 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 When new dosage regimes are received for Warfarin the information is transferred to the MAR charts and is set out in a way that will ensure that the correct dose is administered by the staff. Staff should not transfer medicines from one container to another. These medicines must remain within the container they were originally dispensed into. Excess medicines are all stored in the same location and are organised so that each individuals medicines are stored together and separate from other individuals medicines. Page 7 of 9 2 9 3 9 Care Homes for Older People 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 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. © 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 Older People Page 9 of 9 - 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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