Care Home: Rushall Mews

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What the care home does well The home now has a system to record the receipt administration and disposal of medicines and these records overall were able to demonstrate that people were receiving their medicines as prescribed. The home has quality assurance systems in place to ensure that the staff follow safe practices when administering medicines and people who are self administering are monitored for effective administration. What the care home could do better: Ensure that staff are better able to cope with equipment and situations that are not the norm to ensure that people receive their medicines as prescribed.Carry out the audits of the medicines towards the beginning of the week so that if a new supply of medicine is required there is enough time to order the prescription and have it dispensed by the pharmacy before the existing supply runs out. Ensure there is better communication between staff and relatives about medicines being brought into the home. 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: 2 3 0 6 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): Name of registered manager (if applicable) Ms Gloria May John 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 Care Homes for Older People Page 2 of 9 0 9 0 2 2 0 1 0 Brief description of the care home 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 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 9 What we found: The pharmacist inspector visited Rushall Mews on the 23rd June 2010 to establish what progress the home had made in meeting the requirements carried over from the last inspection on the 9th February 2010. Upon arrival the inspector was met by the manager of the home who updated the inspector on the progress the home had been making. The manager said that all of the staff who were involved in the administration of medicines had attended further training courses on the safe management of medicines. The manager said that the staff were being assessed on their competency to handle and administer medicines safely every three months and weekly audit of all medicines was being completed every Friday. In order to discover how medicines were being managed around the home the records of four people who were using the service were examined in detail. The first person was chosen because they were self administering their medicines. We found that this person had been using an electronic compliance device at home to ensure that their medicines were administered at the correct time. We found that the person had continued to do this on admission to the home and that their daughter was helping them manage the preparation of the compliance aid. We found that a risk assessment to determine whether this person was safe and capable to self administer their medicines had not been completed. We were told that this was because the preparation and administration process was already set up and therefore the staff had not considered doing the risk assessment. We found with the compliance device being used that you could not see the tablets inside the device and therefore the staff had not been recording the quantity of tablets coming into the home. This also involved those tablets that were not in the compliance aid and were being administered by the members of staff. The lack of vigilance was further exposed when it was discovered that some analgesic tablets had not been administered for three days because staff thought that the tablets were in the compliance aid and they were not. We also found that this person had recently been prescribed some tablets to help prevent bone loss and it had been written on the medication charts that these tablets were not to be given until the persons urea and electrolytes had been checked. The audit of these medicines found that they had been started before the home knew the results of the urea and electrolytes. The home was aware of this and had contacted the doctor for the results and advice. The matter was still under investigation and once completed the findings would be made known to the Care Quality Commission. It was felt that the first person we looked at was not a typical example of how the home was managing the medicines present in the home. Although it did underline the principles of recording the receipt of all medicines and setting out in the care plan how to manage people so that staff understood what was required of them. Because of this we decided to look at another person who was self administering but the difference here was that this had been done through a phased introduction during the persons stay. We found that risk assessments had been completed of the risks posed to and by this person to ensure safe handling and administration. The audit of this persons medicines in conjunction with the records showed that overall this person was taking their medicines as prescribed. We found that the staff were doing weekly audits to check that this person was taking their tablets properly. We did however find that one of the medicines was out of stock and the Care Homes for Older People Page 4 of 9 person confirmed that they had not had any of this medicine for two days leading up to the inspection. This issue of this person running out of this medicine had been picked up by the home on the Friday before the inspection and an order had been placed with the persons doctor for a new prescription. Due to the weekend however the medicines were not due to arrive until the day of the inspection. This problem did highlight the fact that the audits should be done towards the beginning of the week rather than the end so that if medicines are about to run out there is time when the surgeries are open to place an order and get the medicines to the home in time to ensure continuity of administration. It was also recommended that the audit for each area of the home be done on separate days rather than doing the whole home on the Friday. The next two people were chosen because the staff were totally responsible for administering their medicines to them. One of these people had also been prescribed anticoagulant tablets which posed a greater risk than other medicines to the person concerned if they were being administered incorrectly. We found that the audit of their medicines showed that the home was administering these medicines as prescribed by their doctor. We also found some eye drops being stored in a fridge which was located in the kitchen of one of the units of the home. We found that these eye drops were not being stored at the correct temperature of between two and eight degrees Celsius. We also found that any person in the home could access these eye drops. We contacted the manufacturers of the eye drops and found that they could be stored outside the required temperature range for a number of weeks. The eye drops had not been stored outside the required temperature for longer than this period and therefore it was concluded that the efficacy of the eye drops had not been unduly affected by the incorrect storage conditions within the fridge. We checked another of the kitchen fridges and found similar issues with the temperature the fridge not being maintained correctly and the monitoring of the temperatures not being carried out correctly. Fortunately this fridge was not storing any medicines at the time of the inspection. We also examined the fridge that was located in the medication storage room and found that this fridge was being maintained within the correct temperature range and the temperatures were being monitored on a daily basis. When feeding this information back to the manager she immediately took the decision to have all of the medicines that required cold storage conditions stored in the fridge in the medication storage area. This meant that in the future these medicines would be stored at the correct temperature and would be stored securely. What the care home does well: What they could do better: Ensure that staff are better able to cope with equipment and situations that are not the norm to ensure that people receive their medicines as prescribed. Care Homes for Older People Page 5 of 9 Carry out the audits of the medicines towards the beginning of the week so that if a new supply of medicine is required there is enough time to order the prescription and have it dispensed by the pharmacy before the existing supply runs out. Ensure there is better communication between staff and relatives about medicines being brought into the home. 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 9 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 7 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 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 Staff are made aware of the different compliance aids available and their limitations when it comes to recording the receipt of medicines. All medicines requiring cold storage conditions are kept in the fridge located in the medication storage room. The audit of medicines to ensure people are receiving their medicines as prescribed and to ensure that there is enough stock to continue administration are completed towards the beginning of the week and not towards the end. The different units could also be done on different days rather than leaving the whole home to the one day. 2 3 9 9 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. © 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. 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