Croston Park Nursing Home, Town Road, in Leyland has been told by the Care Quality Commission that it requires improvement overall for the second time after failing to protect some patients from harm.
Although rated as good in the effective, caring and responsive aspects, the nursing home which provides accommodation for persons over 65 who require nursing or personal care, fell short in the safe and well-led categories.
An unannounced inspection carried out last December highlighted concerns which placed some people at risk of harm.
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In the safety aspect it was found that the provider's systems had not always been effective in identifying and addressing risks related to medicines management.
The report published last Friday showed how medicines were not always given safely, as one person had their insulin administered unsafely because good practice guidance had not been followed, while another person was given a medicine for a month even though the doctor had told the home to stop giving it.
One person was given four doses of a strong painkiller which was out of date. Another was given the wrong dose of their antibiotic for seven days.
Records about medicines were not always up to date or accurate and medicines could not all be accounted for because accurate records about how much medicine was in the home for some people were not made.
Four people's records about allergies to medicines had not been completed which meant they were at risk of being given medicines they may be allergic to.
Written guidance was in place when people were prescribed medicines to be given "when required".
However, the guidance was not always sufficiently detailed to ensure they were given safely and consistently.
When medicines were prescribed with a choice of dose there was no information about which dose to choose. Records were not always made about why these medicines were given or if they were effective.
One person's records about their prescribed feed had been written incorrectly which meant they were at risk of having too little food.
The records examined showed that over a period of six days nurses only recorded they made checks on three days to confirm the feeding tube was properly in the stomach.
In the well-led aspect the rating remained the same as the previous inspection in that it requires improvement.
The inspector's report read: "At our last inspection we rated this key question requires improvement. At this inspection the rating has remained requires improvement.
"This meant the service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.
"Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirements; Continuous learning and improving care.
"When we last inspected the service, we found provider and registered manager had failed to arrange robust oversight of the service in order to assess, monitor and improve the quality, safety and welfare of service users, who were put at risk of harm. This was a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Good governance).
"Following the last inspection, we served a warning notice to the old the provider they had to make improvements.
"During this inspection we found some improvements had been made, however, the provider was still in breach of regulation 17."
In the safe care and treatment the provider had not ensured the safe and proper management of medicines. Enforcement action was taken and an imposed condition was placed on the provider's registration.
Good governance audits and systems used for quality monitoring had failed to identify risks associated with the safe and proper management of medicines.
Risk of harm from the management of medicines was not appropriately identified, managed or mitigated.
It was noted however that the provider had made improvements in relation to recruitment practices, which helped to ensure only suitable staff were employed to work at the home.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
A relative commented: "The staff are very kind and helpful, they are really good." while another said: "I am pleased with the staff. They are cheerful, warm and compassionate."
The home was found to be clean and hygienic.
Two inspectors and a member of the medicines team carried out the inspection under Section 60 of the Health and Social Care Act 2008 which looked at the overall quality of the service.
The last rating for this service was also requires improvement from a report published in September 2021.
The provider completed an action plan after the last inspection to show what they would do and by when to improve.
At this inspection, it was found the provider had made some improvements, but was still in breach of regulations.
A follow up and an action plan from the provider has been requested to understand what the home will do to improve the standards of quality and safety going forward.
The report further read: "We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect."
Croston Park Nursing Home is run by Park Lane Healthcare (Croston Park) Limited.