Random inspection report Care homes for older people Name: Address: Nightingale (Gold Care Limited) 218-220 Kettering Road Northampton Northants NN1 4BN The quality rating for this care home is: one star adequate service The rating was made on: 07/01/2009 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: Date: Naveeda Knopp 2 6 0 5 2 0 0 9
Information about the care home Name of care home: Address: Nightingale (Gold Care Limited) 218-220 Kettering Road Northampton Northants NN1 4BN Telephone number: 01604626272 Fax number: 01604626272 Email address: Provider web address: Name of registered provider(s): Type of registration: Gold Care Limited care home Number of places registered: 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 dementia 19 19 Conditions of registration: No person under 50 years of age who falls within the category DE may be accommodated in the home. The home may continue to accommodate two named service users whose needs fall within the category Mental Disorder over the age of 60 who were accommodated in the home prior to re-registration with CSCI. Date of last inspection 0 7 0 1 2 0 0 9 Brief description of the care home Nightingale is a care home providing personal and nursing care for up to 19 older people. The home can accomodate people from 50 years of age. The home is situated close to the centre of Northampton overlooking the 'racecourse' park. The home comprises of a three-storey building, with off road parking to the rear of the house, and an enclosed garden area. The original frontage of the house has been retained so that the home blends in with others in the road. Care Homes for Older People Page 2 of 10
Brief description of the care home There are two lounges a dining room and a conservatory. The majority of bedrooms are single with one double. Some rooms have en-suite washbasins and toilets. Owing to the complex needs of residents in the home, fees are charged on an individual assessed basis. Further information about current fees can be obtained from the manager. Care Homes for Older People Page 3 of 10
What we found: Medication is blistered in to a Manrex monitored dosage system and also enters the home in original manufacturers packs as dispensed by the Pharmacy. The medication trolley used would be locked when not in use and is secured to a wall in the office. An appropriate clinical fridge is being used to store medicines that require cold storage. The home are regularly monitoring and recording the maximum and minimum temperatures to ensure the clinical stability of these medicines. A suitable controlled drugs cabinet is being used to store Temazepam tablets. Audits were carried out for two people prescribed Temazepam tablets ( controlled drug) at the home and showed all records and current stock holdings to be correct. 3 x adrenaline ampoule's 1mg/1ml exp 08/07/10 in white box in cupboard. A protocol for its use was not seen at the home. A signature checklist was in place with the current medication administration records (mars) to confirm the nurses signatures. Fourteen out of the 15 people who use the service had a medication profile and a photographic identification page. The nurse on duty stated the person who did not have these pages because she was new at the home. The timings of doses given were handwritten by the home on the computer generated mars. M=morning, N/Lunch =lunchtime dose, T=Teatime and B/Night = Bed-time dose. The nurse stated that morning round would start from 8.30 and finish at 9.30; lunch-time round would start at 12.30 and finish at 1; tea-time round would start at 530 and finish at 6;Bed-time medication round would start between 8.00-9.00 and finish at 9.30 ish. A person prescribed lorazepam 1mg tablets at a dose of 0.5-1mg three times a day, when required (prn). The records showed that the nurses are marking what dose was given. There was no supporting information available as to why the individual nurses selected these doses at these times of day. A resident was prescribed promazine 25mg/5ml syrup at a dose of 2.5mls three times a day, prn. This was recorded on the mars, as regularly given at teatime and bedtime. When asked about why this is given like this, the nurse said "would give if agitated and restless". This person was also prescribed Zopiclone ( a sleeping tablet) 3.75 mg at night. There was no information available in the care plan which related behavioural or sleeping issues. For another person taking Promazine liquid at a dose of 5 ml three times a day as a regular dose, there was gap on for the bed-time dose for 23/05/09. The nurse said "supposed didn't need". Lorazepam 1mg tablets was prescribed for a person, no tablets were supplied in this month but a dose was given on 23/05/09 at 1830. No explanation noted as to why this had been given and if it was from a balance remaining from previous supplies. The same person is also prescribed Promazine 25mg/5ml at a dose of 5mls to be given three times a day. This had been given regularly except on 25/05/09 20.00 where there was a gap on the mar. Care Homes for Older People Page 4 of 10
In addition to the two above medicines which could cause drowsiness as a side effect the person was prescribed temazepam 10mg at night. On the morning of inspection it was noted that this person was very drowsy. The manager was asked about this resident and he explained porridge was offered to him at 8.30 AM but he did not want. The manager stated that "the Lorazepam was administered for his mental health condition when he is agitated and angry". "He is also an insulin dependant diabetic". "So we give this to relaxed so can take other medicines and diet". He said "this person would have a care plan around his blood sugars 3 times a day checking. He said " if we need to, will do care plan around his medication as well. " Further evidence was seen that the home are not accurately accounting for medicines and using unaccounted carried forward balances, as a person prescribed a dose of senna tablets, the mar stated none supplied but regular doses were given at tea-time from 18th may 2009 until 25 th May 2009. For a person who is prescribed Haloperidol 10mg/5ml 0.5 ml twice a day there had been "prn" handwritten on to the mar. This was not given during 18th May -26th May 2009. No quantity checked on the current mar sheets but have 40/100ml in a bottle dispensed on 29/11/2008 by local Pharmacy. Lactulose prn was not given and no supplies checked in but have 250/500mls in stock. Lorazepam 1mg prn to be taken three times a day, none checked in on the current mars but have 3 boxes containing 24.5 tablets in total. One of the boxes of the above Lorazepam contained a foil strip that has been cut from the manufacturers original, it does not show expiry date, nor the name of product only can see " 1mg tablets and PL 17521/0060". On discussion with the manager he could not explain why there was a half tablet for this person. It was noted that a person did not receive any Paracetamol liquid he was prescribed on a "prn" basis during the current medication cycle. I asked the manager about how do they know he is in pain? He replied "just by touching him and watching if he is uncomfortable"- this is not in his care plan. He stated that this person " would not complain". The current paracetamol stock holding was dispensed 21/03/08 which I asked to be removed as it was not sure if it was now out of date. A person was prescribed to take fortisip in the morning and there was no signature on the mar to stated she had this on the day of inspection. The nurse explained " she will have at 11.00am I am giving her a cup of tea this morning and she is having her break fast". Observation in the dining area showed that this person with assistance ate her breakfast. A male carer was dealing with her in a respectful and gentle manner. This person was not using clear words to verbally communicate but the male carer and a housekeeper were engaging in conversation with her. The nurse was seen to administer medication one at a time but was bulk signing the mar sheets after wards.while she is handing out medication she does not take charts with her but the rooms are just off the hall. It was observed that she gave out medicines in a respectful way. She also asked a resident if she required her pain relief before deblistering from supply. She washed and dried hands in between giving out medicines to different service users. Sudocreme cream was prescribed to be applied prn for a resident. The acting manager Care Homes for Older People Page 5 of 10
stated carers apply creams and dressings under nurses instructions. The acting manager caries out medication audits by mainly checks on the monitored dosage systems and Temazepam bottles. Medication that is no longer needed is returned to approved waste company. Two staff check and countersign what is returned and the record in the returns book. Evidence from previous monthly mar sheets: For someone taking Haloperidol tablets, the mars showed the home did carry forward balances on this occasion. Lorazepam audit trail from 29th Dec 08 until 26 may 09 shows 62 tablets should be in stock. This was not carried forward on to the current mar. For a resident transferring to another care home the medicines were handed over to the relatives on the day of leaving and records were only made for the temazepam tablets. Other observations at the home during this inspection: A person who uses the services was walking up and down the corridor with just his socks on when the floor was wet. The acting manager was asked about his shoes. He said his slippers were wet from the wet accident and were just being washed. Daily reports for this person stated 24/05/09 Fall; 23/05/09 scratch on ear and bruised elbow. This person had not seen a GP regarding this fall. 10.00 am It was noted X was asleep in wheelchair in middle room/dining area with a half eaten jam sandwich stuck on his front. There was no one tending to him. The acting manager informed me that X was brought down stairs for 9.00-930am. AT 10.06 am X had a warm mug of tea sitting on his lap. This was warm to touch and decided could scold and removed from his lap and told the nurse. She said "is ok now ".I requested the manager to come to X he then explained that X is very independent and would not like a beaker with a straw. This was said next to X. Two other people who use the services were in the room. one (Y) of them refused his medication. The other (Z) person tried to encourage him by touching his foot.y threaten Z with a fist and aggressive body language. The nurse and acting manager had left the room. What the care home does well: Medication is stored securely and appropriately at the home. A suitable controlled drugs cabinet is being used to store Temazepam tablets. Audits were carried out for two people prescribed Temazepam tablets ( controlled drug) at the home and showed all records and current stock holdings to be correct. It was observed that the nurse gave out medicines in a respectful way. She also asked a person if she required her pain relief before deblistering from supply. She washed and dried hands in between giving out medicines to different people. Care Homes for Older People Page 6 of 10
Medication that is no longer needed is returned to approved waste company. Two staff check and countersign what is returned and the record in the returns book. What they could do better: The home would need keep accurate accounts of all medicines prescribed for their residents. Each person who is prescribed an anti psychotic for a when required basis would need a specific care plan on when this is administered and managed. The home need to ensure that there are systems in place to ensure that all when required medication is given to the individual person in a way that best suits that person needs and is care planned. Ensure that the timings of each medication avoids anyone having a second dose of their medication within a four hour of the last dose. The home should ensure that people who use their services have regular medication reviews by their GP or Psychiatrists. This is to ensure that medication that is no longer needed is removed from that persons regime or adjustmets can be made if side-effects are being experienced. 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 7 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 7 15 Individual plans of care must detail peoples current care needs and be updated as people's needs change. 14/04/2009 To make sure that staff have the information that they need to care for people in the right way. 2 31 8 The current manager must apply for registration with the Commission for Social Care Inspection. 14/04/2009 To ensure accountability for complying with national standards of care. 3 33 24 The home must audit and evaluate the quality of care and services being provided and act on any areas for improvement identified. 14/04/2009 To make sure that the home is providing a high quality of care and service that meets the needs and aspirations of the people who live there. Care Homes for Older People 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 9 13 When medication is prescribed on a when reuired basis there must be clear guidance and record keeping for their use. 06/07/2009 This will ensure appropriate use and safeguard residents' health and well being 2 9 13 All medicines at the home must be accurately accounted for. 06/07/2009 This is to protect people who use 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 9 Review the timing of medication rounds and how they write the tinings on the medication administration records to ensure that a delayed round can not cause a potential over dose. 2 9 All residents to have a regular medication review by a GP or Psychiatrist. Care Homes for Older People 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 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. Copyright (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 10 of 10