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: Katrina Derbyshire Date: 2 3 0 2 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 Care Homes for Older People Page 2 of 12 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 12 What we found:
This unannounced random inspection was undertaken on 23rd February 2010 by three Regulatory Inspectors and one Pharmacy inspector. Following a key inspection in December 2009 and subsequent poor rating, we wrote a warning letter to the owner and asked for him to submit an improvement plan to us. This improvement plan needed to tell us how and when improvements to the standards of care would be made. Some requirements had not been complied with when we inspected in December 2009 and significant shortfalls in the management of medication were identified at that time. The reason for this inspection was to check on progress and compliance with outstanding requirements and requirements made at a key inspection on 17th December 2009. In addition the recruitment procedure of the current acting manager was to be looked at. The care of six people was looked at in detail, four of who lived in the nursing unit and two in the dementia care unit. Through discussion, observation and reading records, we tracked the experiences of a sample of people who use the service. A pharmacy inspection was also undertaken within three areas in the home and the recruitment records of the current acting manager were examined. The acting manager was present throughout the inspection, the owner arrived shortly after the start of the inspection and left prior to its conclusion. What the care home does well:
At visits in both November and December 2009 we identified people who had sustained skin tears, one through poor moving and handling practise. None of the people selected for case tracking at this inspection had sustained any skin tears. We noted that the tissue viability nurse had supplied the home with best practise guidance on wound care since the last inspection. Photographic guidance was now in place on a chart that helps a nurse identify the grade of a wound, additional written guidance to supplement this was also in place that makes clear the action the nurse must take subject to the wound grade/type. The nurse in charge of the dementia unit advised that no nursing clients are are in receipt of wound care by nurses employed at the home currently: any wound care was being done by district nurses as people were residential. This was confirmed by staff. Two of the people tracked within the nursing unit required treatment, both were seen to be receiving the care detailed within their plans. One example for one person showed directions from the tissue viability nurse was to redress the wound every 3-4 days and this had been carried out in addition to faxing the tissue viability nurse about progress. Information regarding the 6 people selected for case tracking from 17th December 2009 to the date of this inspection, showed no evidence of a safeguarding matter not being referred by the home. Care Homes for Older People Page 4 of 12 We observed staff on duty communicating with residents, during that time residents appeared to be able to understand the staff on duty and in turn communicate their wishes to staff. Changes had been made to the menus in the home, with additional hot teas now being offered. Some peoples expressed needs were catered for, for example one person only likes fish fingers which is what they were given. Fluid charts were in place for people who needed them, although not always added up at the end of the day. We also observed other residents in the home, all had drinks provided to them alongside nutritional supplements. Moving and handling was observed throughout the inspection, during this time safe practise was seen to be followed by staff. We also looked at the recruitment of the current acting manager who took up post in December 2009. The owner had secured 3 references and undertaken safety checks prior to her starting work at the home. What they could do better:
Our Pharmacist Inspector undertook an audit of medication to assess whether the service had complied with the 2 requirements on medication issued on 17th December 2009 where we also seized records. We looked at a sample of medication records on all units, at medication supplies and storage, at training for staff, auditing of medication and observed people being given their medicines by staff. When we visited on 17th December 2009, we found evidence that 14 doses of medication for 2 residents had not been given although staff had signed medication records to say that they had been given. At this visit, during a 9 day period from 15th to 23rd February 2010 we found evidence that 4 doses of medication for 2 residents had not been given although staff had signed medication records to say they had been given. Additionally we found that for a third resident, staff had signed to say the district nurse had given 9 injections during the same 9 day period, however the number of injections received into the home and the number used according to medication records did not tally with the quantity remaining. We also found evidence that the quantity of medicines in stock for an additional 7 prescribed medicines for 7 residents did not tally with medication records. From this evidence, the service has not complied with the Requirement that was made. The service was required by 5th February 2010 to ensure medication audits were carried out and action taken as appropriate to ensure the recording, handling, storage, administration and disposal of medication are satisfactory.The Manager provided evidence that both internal and external audits have been carried out, however due to the issues found, these audits have not been effective in picking up and addressing shortfalls with medicines recording so this requirement has not been met. We served the acting manager with a Code B Notice, a procedure in line with the Criminal Procedure and Investigations Act 1996, and allowing inspectors to seize or copy any documents relevant to their investigation. We are now looking at our wider legal options to secure the improvements required.
Care Homes for Older People Page 5 of 12 We also found other issues with medication which need to be addressed and provide evidence that the requirements have not been met and the service must improve its medication practises for the safety of residents. One resident has been prescribed a sedating medicine for agitation on an as required basis, however there was no guidance on the medication record on how many doses could be given in 24 hours, and what the time interval between doses should be.One resident has been prescribed a medicine for regular use three times a day. Staff have not given this at all during the past 9 days as not required, however if this medicine is to be given on an as required basis, the service should request that the prescriber reviews this medication and change the prescription to reflect what is being given.One resident has been prescribed a cream for use as directed, staff are using this twice daily, however the instructions have not been added to the medication record. One resident has been prescribed a medicine with a variable dosage, either one or two tablets. This has been given 9 times in a 9 day period, staff have not indicated how many have been given for 5 of these doses. Staff also approached inspectors, they advised that it was their view and the view of a relative that the recent minutes from the relatives meeting were not accurate. This related to information concerning one of the activity coordinators. The minutes described everyone stating that they were satisfied, inspectors were advised that this is not what was said, in fact one person commented that they would not attend as they had issues with certain activity sessions. This was fed back to the acting manager. On speaking with residents one person said, I would raise concerns but Im afraid to, not because of what will happen to me but the owner is so harsh with them. During the lunchtime meal several tables were without a pepper pot, the inspector raised this with staff. One resident said she would not do this as the staff would have got into trouble, they went on to advise that most staff were very good yet others she found difficulty understanding due to a language barrier. She would not say anything to management because of the repercussions to staff. The accuracy and purpose of some documents seen needs to be looked at by management. As outlined in the previous section changes and improvements have been made to care documents, however some of these changes have resulted in care plans for example being written that are not relevant. One example for one person who is immobile had a care plan written in January to state they were at risk of falling. Another area was the nutritional intake charts for one person did not reflect that the food supplements had been given as often as prescribed, although the Medication Administration records indicated that they were given. We had some concern about staffs understanding of dementia. People have to make a choice the previous day of what they will want to eat. Staff seemed surprised, and somewhat exasperated, that people dont remember what they chose, or have changed their minds. The use of a Handover book that staff write brief information about each person at each handover does not meet data protection guidance. We explained the reasons why this is considered to be poor practise, not least that each person has a right to see everything that is written about them, which isnt possible when the information is among
Care Homes for Older People Page 6 of 12 information about other people. We observed some residents who had previously been confined to their room, are now being brought into the lounge in a special chair, and staff reported how much better people are. However, there is only one chair, so only one of these three people can be in the lounge at any one time. The nurse said the families have been approached to buy a chair for their relative. 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 7 of 12 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 9 13 Medication audits must be carried out and action taken as appropriate. This is to ensure that the recording, handling, storage, administration and disposal of medication are satisfactory. (A Code B Notice served immediately). 05/02/2010 2 9 13 Medication must be 18/12/2009 administered to residents as prescribed by the doctor and appropriate medication administration records are maintained at all times. This is to ensure the health and safety of residents. (A Code B Notice served immediately). 3 30 18 All staff must receive training 31/03/2010 in the Mental Capacity Act and how it affects their work. This is so that they comply with it and ensure the protection of residents. Other training identified includes medication and care planning. Care Homes for Older People Page 8 of 12 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 4 12 Management must 26/03/2010 demonstrate the homes capacity to meet the assessed needs (including specialist needs) of all individuals admitted to the home. In the case of people with dementia, the service provided must be based on current good practise and reflect relevant specialist and clinical guidance so that people receive sufficient stimulation, care and emotional support in their lives. Regulation 12, 16 & 23. Through having sufficient seating people will be able to participate in daily life and will not become isolated. When staff have an understanding of dementia they will understand why a person cannot remember their meal selection, they will then be able to offer the support the person needs. Care Homes for Older People Page 9 of 12 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 2 9 13 There must be arrangements 17/03/2010 for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home in particular -the quantities of medicines received into the home or carried forward must be recorded accurately -there must be full instructions for use for all medicines used on as as required basis -the dose given for medicines with a variable dosage must be recorded -medicines must be given as prescribed or the prescriber contacted to amend the prescription This is to make sure that people receive the correct medication when they should to help maintain their health and safety. 3 32 12 The owner and management 26/03/2010 must ensure good personal and professional relationships are maintained with each other and residents. This is to ensure that residents are not afraid to raise complaints for fear of the repercussions to staff. Care Homes for Older People Page 10 of 12 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 7 Care plans should only be written when a person has an assessed need that staff need to support. Care Homes for Older People Page 11 of 12 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 12 of 12 - 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!
