Fifth of care homes failing to meet medication standards

Up to a fifth of nursing and residential homes in England are failing to give patients their medicines or meet basic professional standards with potentially fatal consequences, the regulator has discovered.

Inspectors for the Care Quality Commission (CQC) found “a worrying number of examples” where medicines were not being managed properly, sometimes with potentially fatal consequences.

In one case staff failed for a fortnight to give an elderly resident the blood-thinning medication needed to stop clots forming and reduce the risk of stroke.

Inspectors regularly found poor record keeping of when – or even if – drugs were given.

A fifth of nursing homes failed to meet the CQC’s standards, and a sixth of residential care homes.

The same proportion of home care agencies, which provide carers to look after people in their own homes, failed to do so.

The problems are detailed in a new CQC report, published today, giving a “snapshot” of performance at the end of March by providers in the sectors it covers: health, dental and social care.

The report also warned some homes were in a very poor state of repair – perhaps due to local authority funding cuts sparked by the economic crisis – with dirty lavatories and broken furniture increasingly evident.

Regarding medicines, inspectors found they were commonly not being stored properly, while staff were frequently failing to accurately record when they had been given.

At Hugh Myddelton House in north London, inspectors “found issues with most of the records” for medicines of 23 people they reviewed.

“We saw that 12 prescribed medicines had run out during March 2012, so people had missed medicines for up to five days which may have affected their health and well-being. These included medicines for pain relief,” they noted.

More worryingly, they found one resident at heightened risk of stroke had been without their medication for two weeks while staff waited for medical advice.

“This could have placed the person’s health at risk,” said the inspectors.

Pain-relieving medicine was “often given late” to another at the care home, they found. The owner, Barchester Healthcare, has been warned it must make “immediate improvements”.

At Stangrove Lodge in Edenbridge, Kent, inspectors last year found “antibiotic medicine was not given regularly as instructed” and “on a few occasions people’s medicine administration records were blank”, which “did not tally with stocks”. One drugs cupboard could be pulled off the wall, which “did not comply with the law”. It has since been found to be compliant.

The findings chime with a 2009 report by Professor Nick Barber, of the School of Pharmacy at University College London, which found on any given day seven in 10 care home residents have a medication error.

Last night he said: “It’s clearly a matter of concern that these problems still exist.

“However, the solution is not just to put pressure on the homes, but also look at how the others contribute to problems, including doctors and pharmacists.”

He said one idea that merited further investigation was to have pharmacists dedicated to a number of homes, doing ’rounds’ to check on patients and make sure processes were in order.

Care home residents are increasingly more ill than in the past, according to the CQC, requiring more highly-skilled staff to deal with their medical needs.

A spokesman said: “We are starting to see more complex drug treatments and significant growth in co-morbidity [more than one illness in a patient], putting an increasing demand on social care environments in particular.”

Some nurses moving into the care sector from hospitals found they had to take on greater responsibility for medication accuracy, inspectors also found.

Frank Ursell, chief executive of the Registered Nursing Home Association, agreed, saying homes now had to deal with residents with far more complex medical needs than in the past. It comes after councils tightened up criteria so that only those with the most severe needs receiving care.

“The patients who would have been in hospitals 20 years ago are now in nursing homes and the people who would have been in nursing homes 20 years ago are now in care homes,” he said.

“Some of the patients we have now are really quite intensive, there are patients on end-of-life care and machines delivering drugs intravenously.

“These things are a day-to-day reality in nursing and care homes.”

The CQC report also noted a trend toward home being more run-down since the onset of the economic downturn.

In some homes this amounted to little more than faded wallpaper or flaking paint.

But inspectors occasionally found holes in floors and walls left unrepaired, plus dirty lavatories and broken furniture.

In one home bedrooms were devoid of all furniture other than a single bed screwed to the floor and a television and radio which was kept locked away.

Inspectors said it was impossible to tell whether the crumbling state of some care homes was directly linked to the economic crisis but CQC said a trend appeared to be emerging.

Amanda Sherlock, director of operations, said: “Over the last year, inspectors have noticed deterioration in the physical state of some of the care homes they inspect.

“Often it’s just cosmetic, but occasionally it’s things that actually present a risk to people’s safety.

“While difficult to evidence, it’s likely that increasing failure to address these kind of problems is linked to increasing economic pressure within the system.”

Sarah Pickup, president of the Association of Directors of Adult Social Services (Adass) said: “There will be some care home providers who are trying to keep their costs down and are putting off redecorating, I don’t think it is universally the case.

“You can get great care in a place that needs a coat of paint but there is a difference between needing brushing up and serious need of renovation.”