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Inspection report

Date of Inspection: 18 October 2013
Date of Publication: 3 December 2013
Inspection Report published 03 December 2013 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 18 October 2013, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We talked with staff and reviewed information given to us by the provider.

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

Medicines were kept safely. The home used a monitored dosage system with medication delivered by a local pharmacist once a month. Medication was kept in a locked cabinet which included a separate facility for storing controlled drugs. At the time of our inspection we were told that one person using the service was prescribed controlled medicines. We saw that there was a separate record book which two staff signed after administration. We noted that the medication cabinet was cramped and left little space for additional storage. As people using the service were prescribed large quantities of medicines, the provider may wish to note that the arrangements for storing medicines could be improved.

Medicines were prescribed and given to people appropriately. The provider had an up to date procedure for the safe management of medication, which provided guidance and support to staff when undertaking their responsibilities. We saw that all staff had completed a refresher course in the safe handling of medicines in August 2013 and training was repeated yearly. The manager also carried out regular observations of each staff member’s practical competency. Staff had also received training on epilepsy which included attending an additional course on how to administer rectal diazepam.

The home’s policy required a minimum of two staff to administer medication which minimised the risk of error. There was a signature list for those staff authorised to administer medication. Staff completed Medicine Administration Record (MAR) charts for each person. These charts had been prepared by a local pharmacy that delivered all medicines to the home. We saw records were completed in the right way and there were no gaps in signatures for administration. The records we checked were fully completed and showed that people received their medicines as prescribed.

Each person had a care plan for the administration of their medication. The plan explained what people’s prescribed medicines were for, how they were to be administered and were written in a person centred way. For example one person’s profile stated, “please give me one tablet at a time, on the spoon, with my cereal.” Where people needed medication ‘as required’ or only in certain circumstances there were individual protocols for administration. All of the protocols we looked at were in place for people who did not have the capacity to agree to, or understand the purpose of the medication. The protocols had been agreed and signed in their best interest by healthcare professionals such as the person's GP. People were prescribed a supplementary food and drink thickener for their dysphagia needs. Care plans included clear instructions on the amount of drinks required and when to administer them.

Appropriate arrangements were in place in relation to the recording of medicine. Medicines were handled and disposed of appropriately. Staff showed us how they recorded medicines received, administered and disposed of. A record was kept of any medicines that were no longer required and these were stored securely until collected by the pharmacist. The supplying pharmacist had carried out a recent audit in July 2013 and made no recommendations.

There was a system for checking all prescribed medication and records for the running balance of medication and any remaining stock. We saw that a member of staff undertook monthly medication audits to identify and resolve any medication discrepancies promptly. This meant that the records could be audited by the provider to determine whether people received their medicines as prescribed. We found that action had been taken if medication errors were made which including direct observation of the staff administering medication and additional medication training.