Random inspection report
Care homes for older people
Name: Address: Meppershall Nursing Home 79 Shefford Road Meppershall Bedfordshire SG17 5LL zero star poor service 17/12/2009 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: Mark Andrews Date: 1 9 0 5 2 0 1 0 Information about the care home
Name of care home: Address: Meppershall Nursing Home 79 Shefford Road Meppershall Bedfordshire SG17 5LL 01462811224 01462812027 gagroup@btconnect.com gacontracts@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Manager post vacant Type of registration: Number of places registered: Conditions of registration: Category(ies) : G A Projects Ltd care home 84 Number of places (if applicable): Under 65 Over 65 0 49 0 dementia old age, not falling within any other category physical disability Conditions of registration: 30 0 5 The Maximum number of service users who can be accommodated is 84 The registered person may provide the following category of service only: Care Home with Nursing - Code N 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 - Code OP Dementia - Code DE Physical Disability Code PD Date of last inspection 2 3 0 2 2 0 1 0 Care Homes for Older People Page 2 of 8 Brief description of the care home Meppershall is a purpose built care home with nursing in the the village of Meppershall, in Bedfordshire. The service is registered to provide residential and nursing care for 84 people: 54 in the main nursing home and 30 in the dementia care unit. The main building referred to as the nursing home is built on two floors, and managed in four units, two on each floor. Each unit consists of a number of bedrooms which either have ensuite toilet and washbasin facilities, or have a washbasin in the bedroom, a sitting area, bathrooms and a nurses station. There is a dining room on each floor, and a large sitting room on the ground floor. The home was extended in July 2008. A separate, thirty-place unit was built next to the existing home, and attached to it by a glass corridor. This building is known as the dementia care unit and accommodation is on two floors accessed by a lift. There are fifteen bedrooms, all with ensuite facilities, a lounge, dining room and bathrooms on each floor. There are also kitchen and laundry facilities, and a small office. The home is surrounded by large grounds and parking spaces for staff and visitors are provided. The home has links with the local community and shares transport for people with its sister home. Hairdressing, newspapers, toiletries, and staff escorts to medical appointments are not included in the fees. People who have their own telephone are responsible for the bills. Information about this home can be obtained by phoning and visiting the home direct, and there is also an entry for this company on several care home websites. The fees for this service vary between £440 and £530 per week: the exact fees are reflected in individual service contracts for the residents. Care Homes for Older People Page 3 of 8 What we found:
This inspection of medicine management was conducted by pharmacist inspectors Mark Andrews and Jean Carter to follow up on a statutory requirement notice issued to the service on 23rd March 2010 and which expired on 23rd April 2010. The statutory requirement notice required the registered service provider; 1. To make arrangements to ensure that all medication is administered as directed to the prescriber to the service users as it was prescribed, labelled and supplied for 2. To make arrangements to ensure that medication administration records are accurately maintained; that reasons for non-administration of medication are recorded by the timely entry of an appropriate code or entry on the medication administration record; that the meaning of any such codes are clearly explained on each record; and that the person administering the medication completes the Medication Administration Record in respect of each individual service user at the time of administration. 3. Put in place effective arrangements that ensure the homes auditing procedures and processes accurately reflect the amount of individually prescribed medication available at the home for each service user. During this inspection we looked at medicine administration records and took samples of medicines in two areas of the service and audited them against records attempting to ensure medicines can be accounted for and records for receipt and administration of medicines have been properly completed including records for the non-administration of medicines and recording codes used. We also looked at associated records for some peoples medicine administration. We considered systems put in place by the service provider and the services own internal audit system for their evidence of compliance with the notice. We looked at a sample of current medication administration records (period 10th May to 31st may 2010), sampled a number of medicines available for administration and found no numerical discrepancies. We found there to be no medicines remaining in monitored dosage systems that had been signed as administered and we found that where medicines had not been given there were appropriate records indicating why they had not been administered. Codes used to record their non-administration were clearly recorded. We found there to be no omissions in medicine administration records or records for the receipt of medicines. The home has put in place daily records with running balances of medicines that are not supplied in monitored dosage system containers. There are also carried forward figures recorded for the start of new medicine administration records for such medicines. The senior person on duty described to us the auditing systems that have been put in place including daily audit checks. We identified a controlled drug medicine in patch form where there was a surplus of one patch which had not been administered as scheduled on 09/04/10 preceding expiry of the statutory requirement notice and which had not been annotated as carried forward on the current medicine administration record. We discussed this with both the senior person on duty and the registered provider at the end of the inspection. We also discussed controlled drugs that we had noted had been recorded as disposed of but where the
Care Homes for Older People Page 4 of 8 remaining balances were recorded incorrectly in the controlled drug register when the amount remaining should have been zero. We also noted during the inspection that medicine administration records indicate some medicines scheduled for lunchtime are due for administration at 12.00hrs and others at 14.00hrs. We noted that at 13.00hrs the medicines due for earlier administration at 12.00hrs had not been administered. The senior person on duty confirmed this with us. We saw that in the ground floor unit the medicine round for all lunchtime medicines was then conducted at 13.20hrs. We raised this as a concern with the senior person on duty and registered provider as some people were not receiving their medicines as scheduled and some records for the administration of medicines scheduled for lunchtime are consequently inaccurate. We suggested it may be that the home needs to take advice from the prescriber on rationalising the time medicines can be administered at lunchtimes. We also noted that there were five times annotated on the medicine administration record for a person receiving temporary administration of paracetamol tablets as a homely remedy This medicine entry was hand-written and also gave written directions that the medicine is to be administered upto four times daily only. Therefore we concluded that scheduling five times daily is potentially misleading. We noted, however, that records indicated the medicine had been given only once to date but discussed this with the senior person on duty and the registered provider. When we discussed the findings of our inspection we asked the registered provider how he intends to sustain improvements made to date. He responded by telling us that the level of auditing currently in place will be sustained and not withdrawn and that the pharmacy suppliers will continue to be involved in ensuring all members of staff authorised to handle and administer medicines are trained. In view of the improvements we found the Commission does not intend to take further action in relation to the statutory requirement notice at this time. 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 8 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 6 of 8 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 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 1 9 It is recommended that the home seeks the advice of prescribers to rationalise times at which medicines scheduled for lunchtime administration can be given in order to avoid inaccurate record-keeping and inaccurate timing of medicine administration It is recommended that members of staff authorised to handle and administer medicines are given clear guidance on recording the disposal of controlled drugs so that accurate residual records of controlled drug stocks remaining are recorded at all times 2 9 Care Homes for Older People Page 7 of 8 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 8 of 8 - 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!
