Inspection on 09/02/10 for Rushall Mews

This inspection was carried out on 9th February 2010.

CQC found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Rushall Mews 22/09/09

Rushall Mews 23/09/08

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Extracts from inspection reports are licensed from CQC, this page was updated on 25/04/2010.

Random inspection report Care homes for older people Name: Address: Rushall Mews New Street Rushall Walsall West Midlands WS4 1JQ one star adequate 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: Ian Henderson Date: 0 9 0 2 2 0 1 0 Information about the care home Name of care home: Address: Rushall Mews New Street Rushall Walsall West Midlands WS4 1JQ 03701924060 03701924061 Telephone number: Fax number: Email address: Provider web address: www.housing21.co.uk Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Housing 21 care home 26 Number of places (if applicable): Under 65 Over 65 26 old age, not falling within any other category Conditions of registration: 0 The maximum number or service users to be accommodated is 26. 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) 26 Date of last inspection Brief description of the care home Rushall Mews is a purpose built establishment providing intermediate care for up to twenty- six older people. Intermediate care is short term care with an aim to improve peoples daily living skills and enable them whenever possible to return home. Care and support is usually provided for up to six weeks as a maximum. The home is separated into four units Chelsea, Linley, Kensington and Avon. Each unit has its own Care Homes for Older People Page 2 of 10 Brief description of the care home lounge come dining room, kitchenette and bathing facilities for dependent people. All bedrooms are single. Kensington has twelve bungalows with people having their own bed sitting room and kitchen. The home is situated in Rushall close to local amenities and is on a main bus route. Limited car parking is available at the home. The home has pleasant and sheltered gardens. The service user guide seen identified that there is no charge for intermediate care. The fee information given applied at the time of the inspection; persons may wish to obtain more up to date information from the service. Care Homes for Older People Page 3 of 10 What we found: The reason for the visit was to check on how the home was progressing in meeting the requirements made at the key inspection on the 22nd and 23rd September 2009. We found that the home had rationalised the recording of the ordering and receipt of medicines. We found that as a consequence of this the home had improved on recording the receipt of medicines coming into the home. This meant that the home had a good starting point when trying to account for the medication handled within the home. We found that the home was now able to obtain printed medicine administration record [MAR] charts from their local supplying pharmacy. This meant that the anomalies between the instructions on the medicine labels and the administration records seen at the last inspection had been effectively eradicated. In order to discover how medicines were being managed around the home the records of three people who were using the service were examined in detail. The first person was chosen because they had recently been prescribed some antibiotics for an infection. We found that this person was administering their own medication and a risk assessment was in place. We found when entering this person`s room that the prescribed medication was on open display and available for anyone who entered the room to consume. On examining the monitored dosage system we found that some medication had not been taken on the Sunday morning prior to the inspection. We examined the care plan and the stock check monitoring form to see if there was any reason why this medication had not been taken. We found no information in the care plan and we found that the stock check monitoring form had not been completed for a number of weeks. This meant that there was no information about whether this person had been taking their medicines as prescribed by the doctor since arriving at this particular unit. We found that the second person was also administering their own medication. Due to the quantity of medicines being recorded upon arrival we were able to calculate how much of the prescribed medicines should have been taken and compared this with the quantity that remained in the person`s medicines cabinet. We found anomalies with all but one of this person`s medicines. We found with some of the medicines that it appeared that too much had been taken and with the rest not enough had been taken. We also found that the person had run out of one of the medicines and had missed two doses one dose on the morning of the inspection and the second dose on the previous evening. We found that there was again no evidence that the staff were regularly monitoring the administration of these medicines. We found that the person had arrived in the home on the 12th January 2010 and the only stock check done was on the 6th February 2010. This person was also an insulin dependent diabetic and we found that the insulin was being stored in a fridge that was located in the kitchen on the unit. We found that the home had purchased a number of maximum and minimum thermometers and had installed them in all of the kitchen fridges. We found that the staff had been instructed to measure the temperature of the fridge on a daily basis using the thermometer. On this unit we found that the staff were recording the temperature of the fridge on a daily basis but were not ensuring that the maximum and minimum temperatures of the fridge remained between 2 and 8 degrees Celsius. On the day of the inspection we found that the minimum temperature was 0 degrees Celsius and the maximum temperature was 23 degrees Celsius. As a consequence the home was advised Care Homes for Older People Page 4 of 10 to discard the insulin in the fridge and obtain new supplies. We also found that the insulin was being stored in a plastic container which had no locking facility and therefore the issue of security of medicines was brought into question again. We found that the third person was having their medicines administered by the care staff. We found that the receipt of the medicines had been recorded well. At the previous inspection we had suggested that the stock checks carried out by staff should coincide with the start of a new MAR chart. We found that this was not happening and so made any auditing more difficult than it should have been although not impossible. We found that the third person had been prescribed eight medicines over the period of the audit and of these the audit trail showed that four of these medicines had been administered as prescribed by the doctor. We found with some tablets that were used to prevent blood clots that 13 tablets were present on the unit on the 16th January 2010 and 11 were administered until they were discontinued on the 28th January 2010. We therefore expected to find that 2 tablets had been returned to the pharmacy instead the disposal register showed that 29 tablets were returned to the pharmacy. We found the home had recorded that 34 sachets which contained a medicine that was used to treat constipation were present on the 16th January 2010. We found that 9 of these sachets had been administered so we expected to find 25 sachets remaining but we found 26. We found that the directions for the administration of these sachets were to take one to three sachets daily. We could not find any information in the care plan about how the daily dose was being decided upon. We found that this person had also been prescribed some anticoagulant tablets and was to take 3 milligrams [mg] on a daily basis. The audit of the 3mg tablets showed that 28 tablets had been received on the 29th January 2010 and the records showed that 10 tablets had been administered. We therefore expected to find 18 tablets remaining but instead we found 19 tablets. This would indicate that on one occasion the MAR chart had been signed but the medicine had not been administered. We found that the person had also been prescribed some 1mg tablets of the same medicine and there was one signature on the MAR chart against this entry. We considered that maybe a member of staff had used 3 of these 1mg tablets instead of a 3mg tablet to meet the daily dose. However when we did the audit we found that 60 tablets had been received on the 29th January 2010 and 54 tablets were present on the day of the inspection indicating that 4 tablets had been used. As a result of this a discussion took place on how to ensure that these tablets were monitored more closely. We found that the home had obtained a cabinet that met with the Misuse of Drugs (Safe Custody) regulations and it had been secured to the wall correctly. We also found that the management of the Controlled Drugs was also much better and the records showed that people were receiving their medicines as prescribed. We found that none of the staff had undergone any assessments to establish whether they were able to administer medication safely and in accordance with good administration practices. In light of some of the issues identified during the inspection the assessment of the care staffs competency to administer medication safely must be carried out as soon as possible. We found that there had been some improvement in the management of medicines but further improvements were required to fully meet the four requirements that had not been met at this inspection. Due to the improvements and the prospect of further improvements Care Homes for Older People Page 5 of 10 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 6 of 10 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 18(1)(a) To ensure that staff are suitably qualified, experienced and competent to safely administer medication before they administer medication to people who use the service. To ensure that there is an effective system in place to request obtain and retain adequate supplies of prescribed medicines for people so that they can be given them as and when prescribed. 22/12/2009 2 9 12(1) 22/10/2009 3 9 13(2) Appropriate information 22/10/2009 relating to medication must be kept, for example, in risk assessments and care plans to ensure that staff know how to use and monitor all medication including as directed, when required and self administered medication so that all medication is administered safely, correctly and as intended by the prescriber, to meet individual health needs. Accurate, complete and up to 22/10/2009 date records must be kept of Page 7 of 10 4 9 13(2) Care Homes for Older People 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 all medication received administered and disposed of to ensure that medication can be accounted for and is given as prescribed. 5 9 13(2) To make arrangements to ensure that medication is stored securely and at the correct temperature recommended by the manufacturer. 22/10/2009 Care Homes for Older People Page 8 of 10 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 Care Homes for Older People Page 9 of 10 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. 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