Random inspection report
Care homes for older people
Name: Address: Madeleine House 60 Manor Road Stechford Birmingham West Midlands B33 8EJ two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Debby Railton Date: 2 4 0 6 2 0 0 9 Information about the care home
Name of care home: Address: Madeleine House 60 Manor Road Stechford Birmingham West Midlands B33 8EJ 01217861479 01217850621 Telephone number: Fax number: Email address: Provider web address: www.anchor.org.uk Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Anchor Trust care home 41 Number of places (if applicable): Under 65 Over 65 0 41 41 dementia old age, not falling within any other category physical disability Conditions of registration: 10 0 0 The maximum number of service users who can be accommodated is: 41 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 41 Physical disability - over 65 years of age (PD(E)) 41 Dementia (DE) 10 Date of last inspection Brief description of the care home Madeleine House is registered to provide residential care for up to 41 residents who are over 65 years of age and require assistance for reason of old age and physical
Care Homes for Older People Page 2 of 9 Brief description of the care home disability. This includes ten residents who can be accommodated for reasons of dementia care. The Home is owned and managed by Anchor Trust. It is a modern two storey building set back off the road in its own grounds with adequate off road parking to the front of the building. It is well maintained internally and externally and is run as one unit. There is a garden that is suitable for wheel chair users to the rear of the property and access can be gained from the dining room patio doors via a ramp. The Home is well located with easy access to public transport, shops, a public house and swimming baths. Accommodation is provided in 41 single flats, all having en-suite facilities that consist of a toilet and hand wash basin and a small kitchen area including a fridge. There is a call bell facility in each flat in order for residents to summon assistance from staff 24 hours a day. Communal space comprises of a lounge/dining room on the ground floor and a small quiet sitting room on the first floor. An attractive spacious conservatory has recently been built as an alternative sitting area for residents to enjoy. Madeleine House is a non smoking building however following assessment residents are permitted to smoke within their flats and in the garden. There is a passenger lift that gives access to all areas in the Home and there is a range of equipment for moving and handling residents who may have decreased mobility. The physical environment of the Home is suitable for wheelchair users. A number of assisted bathrooms and shower rooms are strategically situated around the Home and these meet the needs of the residents living there. Staff are available to provide assistance with bathing a Care Homes for Older People Page 3 of 9 What we found:
The pharmacist inspection lasted three hours. The reason for the inspection was to check the systems within the home following the report of missing Controlled Drugs. Four people who live in the home, medicines were looked at, together with their medicine administration record (MAR) chart and care plans. The practice of one care assistant was observed and she was also spoken with during the inspection. All feedback was given to the deputy manager who was present throughout the inspection and the new manager, Linda Bryant. The home had recently started the new 28 day cycle of medicines and was currently on day three of the cycle, so an audit was also undertaken, looking at the previous monthly MAR charts and the returns books that recorded discarded medication. The home did not collect or see the prescriptions prior to the pharmacy dispensing the medicines. This had caused huge problems, in so much, that if a medicine had not been prescribed it was not noticed until the medicines were delivered, so it was too late to address the problem and obtain a supply in time. This resulted in many residents going without prescribed medication while the new supply was sought, in some instances for up to four days. This is considered very poor practice and detrimental to the health and wellbeing of the people who live in the home. The pharmacy did send a copy of the prescription for some of the medicines only. Without a copy of all the prescriptions, the care assistants cannot check in the medicines and MAR charts adequately. Problems were further compounded when some prescriptions were automatically sent to other pharmacies, so again inadequate checks were performed to ensure that the residents were administered their medicines exactly as the prescriber intended. Other problems were found where an inadequate supply of medication was either prescribed or dispensed again resulting in a break in the residents medication. Medicines owed were often re-ordered. This resulted in duplication of medicines that were then discarded at the end of each month, increasing wastage of medicines and also creating storage problems. Some medicines delivered outside the 28 day supply did not always have a computer printed MAR chart. Care staff hand wrote the instructions but not all the relevant details had been recorded, for example the date, quantity received, the strength of the medicine or the dose. Audits indicated that the majority of medicines had been administered as prescribed but a few mistakes were seen. For example, only one tablet had been administered instead of the prescribed two so the resident received half the prescribed dose. The errors had already been identified by the deputy manager who had introduced an auditing system. She had acted appropriately to address the problem but new mistakes were still seen. Some MAR charts were missing, due to a poor filing system. The home was in the process of sorting out its paperwork into a more manageable system.
Care Homes for Older People Page 4 of 9 The care plans were in the process of being updated. One that had been was very good and included all the clinical indications of the resident as well as details of their prescribed medication. This was not seen for another care plan looked at. No medication reviews had taken place on a regular basis in line the National Service Framework for older people. It was not possible to see why one medicine had been prescribed. The deputy manager was keen to address this issue immediately. All Controlled Drug (CD) balances were correct and the CD register entries matched those on the MAR chart. Daily checks had been installed to ensure that no other CDs go missing in the home and if they do it is easily and quickly identified. Residents are encouraged to self administer their own medication following a risk assessment. Whilst compliance checks are undertaken these were not fully documented on the MAR charts. The care assistant and deputy manager both had a very thorough understanding of what the medicines they administer were for and also the clinical conditions of the people they looked after in most cases. The care assistant showed the people respect whilst administering medication and had a good rapport with them and this was commended. She read the MAR chart before the preparation of the medicines and then recorded the transaction immediately afterwards, which is good practice. One trolley during the medication round was left unattended and unlocked in the dining room. We, the commission, were able to open the trolley and have full access to all the medicines within. This is considered poor practice and increases the risk of unauthorised access to medicines in the home. The new manager was in the process of installing a new medication room. It was very hot in the room and it was agreed that the temperature would be monitored to ensure that if it was to be used the medicines would be stored below 25C to maintain their stability. A sink and new cupboards to securely hold the surplus medicine within would also be installed. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 5 of 9 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 7 15(1) Arrangements must be made 15/09/2007 to ensure that all staff are aware of the support required in order to meet residents short term care needs. Residents confidentiality must be maintained at all times. 15/08/2007 2 10 12(4)(a) 3 19 13(4) The garden must be fit for 01/10/2007 the purpose and needs of all residents living at the Home. (Timescale of 15/09/06 and 15/04/07 not met). 4 30 13(4)(5)18(1) Arrangements must be made 01/11/2007 for all staff to undertake refresher training in mandatory areas so that they should have the necessary skills and knowledge to work in a safe and competent manner. Care Homes for Older People Page 6 of 9 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 9 13 A system must be installed 24/07/2009 to check the prescriptions prior to dispensing and to check the dispensed medicines and MAR charts received into the home for accuracy. All discrepancies must be addressed with the health care professional in a timely fashion. All medicines must be available for administration at all times This is to ensure that all medicines are administered as prescribed and are available to be administered at all times 2 9 13 All dose regimes must be 24/07/2009 clearly written on the MAR chart and checked by second member of staff for accuracy. All relevant details must be recorded including the date, quantity, dose and strength of the medication This is to ensure that staff have clear, accurate directions to follow and Care Homes for Older People Page 7 of 9 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action audits can take place to demonstrate that the staff adminsiter the medicines as prescribed and records reflect practice 3 9 13 The medicine trolley must be 24/07/2009 locked at all times when not in use This is to ensure that all the medicines are securely held at all times in the home to reduce the risk of unauthorized people gaining access to them Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 8 of 9 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 9 of 9 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
