Scotland’s care home regulator has issued three damning reports into Selkirk’s Riverside Healthcare Centre.
The Riverside nursing home on Bridge Street provides 24-hour care for up to 45 older people.
The Care Inspectorate’s (CI) first two reports, seen by The Wee Paper, investigated complaints made last year by a relative of a female resident concerning her end-of-life care, and the use of a scheduled drug Oramorph: a morphine sulphate painkiller.
The CI’s third report then followed a surprise inspection in December.
In the first two reports, the CI upheld nine out of 14 elements of the relative’s complaints, observing: “There is a record of administration of medication signed approximately two hours after a person had died.”
The report concluded there was: “inaccurate and poor-quality recording of medication administration”. The regulator then sent an error response form to the home to identify any factual errors.
The CI also identified inconsistencies in medication records called ‘MAR’ charts: “For example, entries signed by named nurses when they were not on duty.”
It concluded: “This would suggest retrospective signing of medication administration.”
The CI gave Riverside 24 hours to clean up its paperwork, ordering “a clear, accurate and immediate record of all medication administered”.
Moreover, the CI established: “There appears to be a culture in the home, that it is acceptable to use other people’s medication. We found four incidents of this, involving different nurses.”
In the case of the resident whose family complained, the CI reported she was, “given two injections of Midazolam from a supply prescribed for another resident”.
The CI warned: “Any item prescribed and dispensed for a named person on an NHS prescription is the property of that person and must not be used for someone else.”
NHS Borders staff who prescribed the drugs were unaware the practice was going on and the home’s manager assured it would cease immediately, as the CI required, the report said.
Turning again to the specific case of the resident, the CI upheld that: “The service failed to discuss how [the resident’s] pain would be assessed and managed”, ruling: “a nurse did not carry out a pain assessment prior to the administration of Oramorph,” and “failed to assess [the resident] when [their] family raised concerns about [their] difficulty in breathing following the administration of Oramorph.”
However, the CI did not uphold that the painkiller was administered unnecessarily.
Overall, the CI found, “there was a lack of consultation with [the] family before the move to palliative care,” adding: “there was no planned approach to palliative or end of life care and good practice guidance was not followed.”
After its October and November reports, the CI then made an unannounced inspection in December, grading Riverside ‘weak’ in quality of care and support, and in quality of management and leadership.
The report stressed “both residents and the majority of relatives spoke highly of their experience of the care home,” and that “we are satisfied that services are working hard to provide consistently high standards of care.”
But it identified “short comings in medication practice and in how the care home plans to provide palliative care.” It continued: “These were highlighted earlier in 2013 following complaint investigations. We found only limited progress had been made in implementing the requirements made.”
It stated: “The majority of requirements which were made following two complaints in 2013 have been repeated in this report.” In contrast to it’s two previous inspections, in December 2012 and March 2013, Riverside scored ‘Very Good’ in all four categories/across the board. You can download the full report from December 2013 at www.scswis.com.
A Care Inspectorate spokesperson said: “We take all complaints very seriously and, if upheld, require changes. Every person is entitled to safe, high-quality compassionate care and we will not hesitate to act where that isn’t happening. Anyone with concerns about a care service can call us on 0845 6009527, anonymously if needed.”
We asked Riverside Healthcare Centre to respond to the issues highlighted in the reports, and explain how they are improving on the Care Inspectorate’s requirements, but by the time we went to press The Wee Paper had received no response.