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Kings Lodge Nursing Home Good

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Inspection report

Date of Inspection: 10 September 2014
Date of Publication: 31 October 2014
Inspection Report published 31 October 2014 PDF

People should be given the medicines they need when they need them, and in a safe way (outcome 9)

Meeting this standard

We checked that people who use this service

  • Will have their medicines at the times they need them, and in a safe way.
  • Wherever possible will have information about the medicine being prescribed made available to them or others acting on their behalf.

How this check was done

We looked at the personal care or treatment records of people who use the service, carried out a visit on 10 September 2014, observed how people were being cared for and talked with people who use the service. We talked with carers and / or family members and talked with staff.

We spoke to health professionals.

Our judgement

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

Reasons for our judgement

We carried out an inspection at Kings Lodge Nursing Home on 28 January 2014 where we found that people were not protected against the risk associated with medication because the provider did not have appropriate arrangements in place to manage medicines.

Following our inspection the provider sent us information advising that they were compliant. They told us that changes had been made to ensure that appropriate arrangements were in place with regard to management of medication to protect people. We found that the service was compliant with this essential standard.

There were systems in place for the ordering, receipt, storage and administration of medication. We saw that they were ordered on a four weekly cycle and that they were checked on receipt, and stored in a secure cabinets in a locked rooms. This showed that appropriate systems were in place in relation to obtaining the medication prescribed for people.

We watched two members of staff administering medication. They were seen to administer safely and follow good practice. Medication was administered individually from the trolley, and the medication administration record (MAR) chart was signed when the person had taken the medication. This meant that people received the medication that they were prescribed.

We looked at the two medication rooms. We found that the temperature of the storage cupboards, including the fridge, was monitored. This meant that systems were in place to prevent deterioration of medicines. However, we found that the temperature in one room was recorded as 26-27°c; the temperature should have been approximately 23°c, and there was no evidence that action had been taken to address this. The provider may wish to note that staff had not followed the homes procedures with regard to correct storage of medication.

At the last inspection we found that two people were given their medication covertly. The reasons for this covert administration were documented as, ‘if refused’ and ‘spits it out’. However, people had not had their capacity assessed with regard to refusing medication, and there was no evidence that the decision for covert administration was in their best interests. At this inspection we found that a policy for the use covert administration had been developed, which showed that the GP was consulted before medication was administration covertly. We found that this policy had been followed for one person whose medication was administered in yoghurt. However, the person had not refused to take the medication and was aware that it was put into yoghurt. This meant that staff had used a policy that was not required for this person. We discussed this with the manager who said that additional training would be provided for staff, to ensure they understood and followed the policy correctly.

Controlled drugs were ordered and stored in a separate locked cabined. These medicines were recorded in the home’s controlled drugs book, they had been checked by two staff, and reflected the correct amount in the cupboard. We found regular checks and good practice with regard to medication administered through patches. They were recorded in the controlled drugs book, the MAR chart and on the person’s body map in the care plan. This showed that the records reflected that prescribed medication was administered appropriately.

We looked at the policies and procedures for the administration of medication and found that ‘as required’ (PRN) guidelines were in place. However, there were no policies and procedures in place to underpin some practices. For example, the administration of warfarin. This meant that people may be at risk of receiving the incorrect dose.

A medication audit had been developed and introduced since the last inspection. We looked at the one completed on the 9 September, which had looked at the storage of medication, the MAR charts and ‘as required’ medication. A number of issues had been identified and the manager said they had been discussed w