Shrewsbury care home which gave medication to wrong patient told it must improve
A Shrewsbury care home which gave medication to the wrong patient and dispensed out-of-date medicine has been told it must improve.
Inspectors from the Care Quality Commission visited Coton Hill House last month.
They found that medicines were not stored correctly and that some of those stored in the fridge were out of date.
In their report, which was released this week, the inspectors said: "This medicine should have been discarded 90 days after opening. This had not been identified as part of the provider's checks and a person had received this medicine after the date they should.
"In addition, we saw a recent incident where one person had been given another's persons prescribed medicine by mistake. This medicine had been stored in the fridge. In both instances the staff members failed to complete the proper checks prior to the administration of the medicine."
Inspectors were also concerned that important measures to prevent the spread of infection had not been adhered to.
They said: "There were several rooms at Coton Hill House which were not occupied and contained sinks and taps.
"We asked to see the provider's legionella checks which would include action to flush out infrequently used outlets. The registered manager could only provide water temperature checks and there was no record of water flush outs. They, along with the maintenance person, told us these checks had been completed yet their documentation was blank. We could not be assured these checks had occurred in accordance with best practice and their own risk assessments. This put people at the risk of harm of contractible illnesses."
Improvements
The home which provides accommodation and nursing or personal care for up to 45 people, some of whom are living with dementia, was rated as requiring improvement.
However, inspectors said that residents said the staff were 'wonderful' and 'caring' who treated them with respect and dignity.
They also reported that the service was effective and responsive although they said that it must improve in its leadership.
The inspectors added: "At our last inspection we identified there was a new manager in post and they needed to embed systems and processes to ensure the improvements made could be sustained over time. At this inspection we saw general oversight was still required regarding the recording of quality systems."
Chris Wall, chief executive of Coverage Care Services which operates the home, said: “We acted immediately to respond and rectify the issues raised which were rated as needing improvement and look forward to demonstrating this when inspectors return. They did find that our services at Coton Hill are caring, effective and responsive, rating all three aspects as ‘good’.
“The report highlighted our residents felt that they were “treated with care by a kind, interactive and friendly staff team”; that they “felt safe” and that they were treated with dignity and respect. Inspectors also praised our compassionate staff and our links with the local community.
“Coton Hill is an important care home to the Shrewsbury community providing vital residential and dementia accommodation care and support at a time of increasing need.”
