Inspection on 20/06/07 for Russell Court

This inspection was carried out on 20th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Russell Court 21/06/06

Russell Court 09/01/06

Russell Court 01/08/05

Russell Court 29/12/04

Russell Court 05/07/04

Russell Court 24/02/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Russell Court Overfield Road Russell Hall Estate Dudley West Midlands DY1 2NY Lead Inspector Mrs Cathy Moore Unannounced Inspection 20th June 2007 07.15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Russell Court DS0000041944.V342397.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Russell Court DS0000041944.V342397.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Russell Court Address Overfield Road Russell Hall Estate Dudley West Midlands DY1 2NY 01384 813375 01384 813377 tony.cooksey@dudley.gov.uk N/K Dudley Metropolitan Borough Council Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Tony Cooksey Care Home 32 Category(ies) of Dementia - over 65 years of age (9), Mental registration, with number disorder, excluding learning disability or of places dementia (1), Old age, not falling within any other category (22) Russell Court DS0000041944.V342397.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. All requirements contained within the registration report of 7 January 2003 are met within the timescales contained within the action plan agreed between Dudley Metropolitan Borough Council and the National Care Standards Commission. Day care provision must not encroach on the facilities, staffing and services, provided to residential service users. By the 31 September 2003, all radiators within areas accessed by service users shall not exceed 43 degrees celsius. In the interim, following risk assessments, strategies are implemented to safeguard service users. Service users to include up to 22 OP, 9 DE(E) and up to 1 MD. When service user category of MD`s placement is terminated new service users must be accommodated within the categories of OP or DE(E) as appropriate. 9th January 2006 2. 3. 4. Date of last inspection Brief Description of the Service: Russell Court is a purpose built home, owned and managed by Dudley Local Authority. The home is registered to provide care to a maximum of 32 service users at any one time. Registration categories approved are primarily for older people with nine places for older people who have a diagnosis of dementia. The home offers 32 single occupancy bedrooms, all have en-suite facilities which comprise of a hand washbasin, walk in shower and toilet. The accommodation is divided into four units. Two units are situated on each of the two floors. Each unit provides eight bedrooms and has a comfortable lounge/ dining area and a joining kitchenette. A passenger lift is available to enable access to both floors. Ramped access to and from the home is available. The home has one assisted bath on the ground floor and a number of assisted toilets. Russell Court overall, is maintained in terms of flooring and furniture to a good standard. The home has a generous size garden and a number of car parking spaces. Russell Court offers open visiting times between 7AM and 11PM. The weekly fees for Russell Court range from £355-£450. These fees may be raised in the near future due to the annual year uplift. Russell Court DS0000041944.V342397.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out this unannounced key inspection one day between 07.15 and 16.30 hours. Prior to the inspection information was requested from the manager and questionnaires were sent to service users’ and relatives to complete to gain their views about the service provided by the home. I spent time on both Abbey and Castle units where I could observe daily routines, meal times and service user and staff involvement. I spoke to four staff and four service users to further gain views on services provided by the home. I looked at three service user files to assess admission processes and the standard of care planning. I looked at three staff files to assess recruitment practices, training and supervision processes. I observed meal times on two units. I looked at medication systems to assess their safety and efficiency. I looked at service records concerning fire fighting and other equipment and also health and safety generally within the home. I randomly looked at parts of the premises which included; Three bedrooms, living areas in Abbey and Castle units, toilets, bathrooms and the laundry. The manager was involved with the inspection throughout the day. What the service does well: The home was purpose built. It has generous sized gardens and car parking space. The home is divided into four units. Each unit has it’s won dining and living space making it feel comfortable and homely. Bedrooms are all single occupancy with en-suite shower, hand wash basin and toilet facilities which increases privacy and dignity and decreases infection spread. The home is well maintained. It has ramped access and a passenger lift to make access easier and safer on both floors. The home was found to be clean and well organised. The atmosphere was positive, friendly and welcoming. On the whole service users’ spoken to were content and happy. Russell Court DS0000041944.V342397.R01.S.doc Version 5.2 Page 6 The manager and senior staff work well as a team. Which ensures effective instruction and support to staff. The staff are motivated and committed to providing a good standard of care. I made observations and saw that they were kind and caring. They knew the people in their care well. The home has open and flexible visiting times. Service users’ are encouraged to maintain contact with family and friends. A high number of staff have attained NVQ level 2 or above in care. The following comments were received in questionnaires about what the home does well; Very clean and hygienic. Meals are very good, fresh veg, fruit etc. Good meals She is very well fed. They check on her even in the night. Care is good. They always keep my mother fresh and clean, they change her clothes frequently. Friendly staff Very good management What has improved since the last inspection? The manager has been successful with his application to the Commission. He has recently been registered as a fit person to be in charge of the home. The home is more organised. Staff, all levels are aware of their roles and responsibilities. There is more confidence within the staff team. Decoration has taken place in many areas of the home. New carpets and curtains have been provided in two lounges making them feel fresh and bright. The many windows in the home have been cleaned inside and out. Staff. have received training in a number of areas such as protection and diabetes awareness. Russell Court DS0000041944.V342397.R01.S.doc Version 5.2 Page 7 What they could do better: Admission processes have shortfalls. Two service users’ have been admitted to the home since the last inspection who should not have been as they have a physical disability and the home is not registered to provide care to meet these needs. Evidence was lacking to confirm that the home gives written assurance that it can meet the needs of service users being offered a placement. Contracts for service users going into the home are still not being given a contract to inform them of their rights and the cost of their placement. These issues were addressed during the inspection as documents were produced or amended accordingly, staff must be aware that they should be used in future. I was disappointed to discover that care plans and risk assessments for one service user admitted back from hospital had not been updated. Further, although a letter from the hospital confirmed that this service user had been dehydrated adequate action had not been taken by the home to prevent a reoccurrence of this risk. Medication systems have improved but still need some’ fine tuning’ in respect of evidence to confirm that ointments and nutrition supplements are being given as prescribed. Generally I was provided with evidence that day time staffing levels are adequate. However, night staffing levels are not and must be increased from two to three. Generally the home takes appropriate action to make the home safe. Attention must be paid however, to make sure that any hot pipe work in the home is adequately protected to prevent burning. The following comments were received from questionnaires about what the home could do better; Social activities e.g entertainment. Singing etc in home. Crafts Bric-a-brac I would like to see them having more little trips to the riverside in the summer such as Stourport or Bridgenorth. More showers for the elderly people because summer time arriving. Air fresheners for nice surrounding. My mother is a very friendly person and there are lots of things she would like to do, like just going to the pub for a beer that was her favourite hobby and she met lots of people too. She likes to chat but the staff just do not have time. Russell Court DS0000041944.V342397.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Russell Court DS0000041944.V342397.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Russell Court DS0000041944.V342397.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4. Quality in this outcome area is adequate. There is a lot of information in the home for new service users’ to look at and prospective service users’ are all assessed before placements are offered to help aid their decision making as to whether the home will be suitable for them. More attention however, must be paid to ensure that new service users’ needs fall within the home registration categories and conditions and that they are provided with required documents to inform them of for example, their rights and costing of placements. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Russell Court DS0000041944.V342397.R01.S.doc Version 5.2 Page 11 I saw that a range of written materials were available in the home examples being; the homes’ statement of purpose, service user guide and last inspection report for proposed users and their families to look at. Other documents I looked at such as; service user files told me that where possible service users’ are invited to spend time at the home to experience the service it provides first hand. These processes good practice as service users’ are given a range of opportunities to enable them to make a decision about the home’s suitability. That enough information is made available to proposed service users’ was proven by completed service user and relative questionnaires. Six of seven service user questionnaires confirmed that they had been given enough information to enable them to make a decision about the homes’ suitability, one did not answer. Two of three completed relative questionnaires answered yes to the same question. I looked at two new service users files. Both of these service users’ had been admitted to the home for short term care. It was disappointing that although a previous requirement had been made following the last inspection of June 2006 neither file had contract or terms and conditions document to inform them of their rights and the cost of the placement. When asked the manager was not able to confirm that this document had been issued. I saw that an assessment of need had been carried out for these service users’ demonstrating that the home does pay some attention to ensuring that it can meet the needs for proposed service users’. However, processes have not been adequately proactive to ensure that the home fully meets it’s legal responsibilities in terms of registration categories and conditions. Two service users’ moved from another home both have a physical disability and the home is not registered to provide care to persons with these needs. Further, there was no evidence on service user files to show that the home is given written assurance that it can meet their assessed needs. The need to abide to registration conditions was discussed with the manager during the inspection. Other issues were rectified before the inspection finished in that contracts were produced for service users’ who may be admitted for short stay and blank letter templates to acknowledge that needs, can be met were discovered. Russell Court DS0000041944.V342397.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11. Quality in this outcome area is good. Whilst it is very positive that the content and reviewing of care plans has improved considerably more attention must be paid to ensure that care plans and accompanying documents are updated for service users when they are admitted back from hospital. Generally evidence to confirm that health care services are accessed and personal care provided to a good standard. More attention must be paid to prevention of risk such as dehydration. Medication systems have improved but need some ‘ fine tuning’ to increase safety further. Service users’ are treated with respect. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Russell Court DS0000041944.V342397.R01.S.doc Version 5.2 Page 13 The standard of care plans in terms of content, instruction to staff and review have improved considerably. I saw that care plans include a range of care needs examples being; personal care and medication. I saw that care plans were in plans for service users’ admitted for short term care which had been lacking during previous inspections. This improvement is good as it means that staff are given instruction on how to care for service users’ to keep them safe. However, it was disappointing to determine that the care plan for one service user who is frail had not been fully reviewed on admission back from hospital. Vital information provided by the hospital such as; being prone to dehydration had been missed therefore this risk was not highlighted. On discharge the hospital had written a letter about one service user it said that she had suffered from dehydration. Further before her hospital admission the home had identified that this person was at risk from dehydration and had instructed staff to ‘ record all fluids ’. I was concerned then to identify that although this service user had been put on a diet and fluid intake chart, it was not being completed fully and therefore would not show precisely much fluid this person had taken, potentially placing her at risk. Fortunately I did witness this service user drinking two beakers of tea within one and a half hours, which is an adequate intake of fluid. Generally measures were in place to promote health and prevent risk, which is good as these will help to keep service users’ safe. I saw evidence on all service user’ files to confirm that they are weighed regularly and that weights are monitored. However, I did note that one service user had not been weighed on her readmission to the home from hospital, which should have been done to identify any risk. I saw evidence on files to confirm that the doctor is called when there is a concern and that other services such as the district nurse and chiropodist are accessed when needed or on a fairly regular basis. I saw that risk assessment processes are in place for nutrition and tissue viability and that where risks are identified such as tissue damage actions are taken for example; the provision of specialist mattresses. A sample of staff, relatives and service users’ views about health and personal care provision is as follows;“ Oh yes, if anyone ill the doctor or ambulance is called”. “ They check on her even at night”. “ They always keep my mother fresh and clean, they change her clothes frequently”. One service user said; “ They really care for us”. A staff member said; “ Yes I think that they are all looked after, definitely”. Six of seven completed service user questionnaires confirmed that they always receive the medical support they need, one answered usually to this question. Whilst en-suite showers are provided in every bedroom the first floor does not have an assisted bath and does restrict the choice of bath or shower. An assisted bath is available on the ground floor but that would mean that the service user would have to be taken to this floor to access this facility. A bath on the first floor would offer more choice and be more effective in terms of time and accessibility. Russell Court DS0000041944.V342397.R01.S.doc Version 5.2 Page 14 I was interested to hear about a new initiative in the home where two staff have been delegated to care for service users’ feet and finger nails. Each service user is examined regularly to ensure that their feet are satisfactory. If not then records are made to bring to the chiropodist’s attention. Finger nails are also examined to ensure that they are clean and of a satisfactory length. I spoke with one staff member who has been allocated responsibility for feet, she is very enthusiastic about this role. The manager told me; “ Not only does it ensure that feet and nails are well cared for. It gives service users’ additional one to one attention and is therapeutic because of the massage and touch”. Medication systems have improved within the home. Medication trolleys have been purchased for easier and safer medication administration. A staff member told me; “ Better, especially in the evenings as some service users’ are in their bedrooms others in the lounges. We can take the trolley safely to them, don’t have to keep going backwards and forwards to cupboards”. The manager has acted correctly by seeking advise from the Commission about a service user being readmitted back from hospital who at times refused medication and whilst the hospital had been happy to disguise this medication in food the manager was not happy with this arrangement. I saw that the folder holding the medication administration records was up to date. There was an example initial list to allow easy identification of which staff member have been responsible for medication on any day for clarity and tracking any errors. Copies of each staff members certificate to confirm that they have received safe handling of medication training were available. I indirectly observed the staff member giving the medication on Abbey unit. I saw that she stayed with the service users’ to make sure that they took their medication and that if she left the medication trolley she ensured that it was locked both good practices to ensure medication safety. I looked at medication records on Castle and Abbey units. I saw that there was a lack of initials to show that certain prescribed items have been given to service users’ as they should be as follows; no initials on medication records for 4,6,11, and 15-16 June 07 concerning prescribed Forticreme and no initials on 8, 15 and 18th for prescribed Contran. There were no care plans in place for medications that are prescribed on an ‘ as required’ basis and no risk assessment for one male service user who self medicates his inhaler. Whilst it was positive that a medication allergy( Asprin) for one service user had been highlighted on her medication record. At least three other service users’ medication records did not indicate whether or not they were allergic to anything. These issues need to be addressed to make sure that medication safety is increased within the home. Privacy and dignity within the home is increased, as all bedrooms are single occupancy with en-suite facilities. During the inspection I heard staff speaking to a number of service users’ they were friendly and polite. Russell Court DS0000041944.V342397.R01.S.doc Version 5.2 Page 15 I saw on records that the preferred form of address has been determined for each service user. I was pleased during the morning handover to hear the senior staff member asking a male carer to provide personal care to a named service user as it is his wish to be cared for by a male. I was pleased to see in the care plan of one service user of Afro-Caribbean origin mention to her hair care. It was written that it was her and her family’s choice that the family take responsibility for the platting of her hair. These actions taken by the home further increases service user dignity. It was recorded on service user files their last wishes and after death arrangements. Where service users’ themselves could not make choices their relatives have been asked. Russell Court DS0000041944.V342397.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is good. Generally the home try’s it’s best to meet service user preferences in terms of daily routines in particular rising and retiring times. Whilst a range of activities and outings are offered some improvement is needed to occupy and stimulate service users’ who are very frail. Visiting times are open and flexible. Service users’ are encouraged to maintain contact with family and friends. Efforts are made to ensure that service users’ retain choice and control over their lives such as access to advocacy services and being able to personalise their bedrooms. Meals provided are varied and nutritious. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Russell Court DS0000041944.V342397.R01.S.doc Version 5.2 Page 17 Records that I looked at demonstrated good practice in that that all service users’ are asked their preferred rising and retiring times. I asked two service users’ if they could get up and go to bed when they wanted and they told me; “ I do things when I want to” and “ Yes I go to bed and get up when I want to”. A staff member told me the following; “ They get up and go to bed when they want to. There are no rules about people getting up”. I sat in two lounges Abbey and Castle for a number of hours. I observed that staff did interact with service users’ however at times there was little contact or interaction especially with service users’ who were frail. I looked at activity records for one of these service user’s and saw that there was only limited activity provision as follows; 18.6.07 visited, watching TV. 19.6.07 lying on bed. Completed service user questionnaires told me that five of seven feel that activities are arranged by the home that they can take part in, two answered usually to this question, which is fairly positive. A relative made the following comment;” I would like to see more trips to the riverside…” It is clear though that the home does do well generally, in terms of activity provision. Notice boards detailed many activities both past and present. The Saturday before the inspection six service users’ went to Worcester, they went to a pub and to a garden centre. On the day of the inspection five went to the Safari Park. I saw them when they returned and was told; “ We had a lovely time” and “ That was great”. The manager told me that he is trying to ensure more activity and recreational input is secured. One staff member is hoping to start a gardening group. The home has open, flexible, visiting arrangements. A number of service users’ told me that they receive visitors regularly which was evidence further by records made. In handover staff highlighted that the daughter of one ‘ poorly’ service user had spent a long time at the home. I saw that information concerning external advocacy arrangements was on display on notice boards in the home and detailed in the homes service user guide. Information had contact numbers for service users’ if they wish to secure input for additional choice. All bedrooms I looked at held a range of possessions making them feel personalised and homely. One service user likes to look after her own room she told me; “ I still look after me own room and do my jobs, I like to be busy”. The manager told me that the home is in the process of introducing new menus. The cook told me; “ We had meetings with the service users’ to find out what meals they want. We have tried a number of new things lately. They like the smoothies that we make”. Food provided by the home is plentiful and of a good quality. The manager said; “ We were wasting a lot of money by cooking full breakfasts every morning that service users’ did not eat. So in an attempt to prevent waste Russell Court DS0000041944.V342397.R01.S.doc Version 5.2 Page 18 service users’ are asked the day before if they would like a cooked breakfast or not. Obviously more is cooked that is needed just in case they change their minds”. I observed breakfast time on Abbey unit. The tables were nicely laid, the tea pot, sugar bowl and milk jug on the table for those service users’ who can to help themselves. Breakfast was varied with cereals, bread and butter, toast and tomatoes and sausage. I saw that beakers and straws were available to enable service users to be more independent. After breakfast one service user told me; “ That was nice”. I heard staff asking service users what they would like for their tea this proving that they are given choices. I observed lunch time on Castle unit. I saw a staff member feeding a service user soup. She had cut a piece of bread into small squares to give with the soup. Whilst feeding the service user the staff member sat down and spoke to her reassuringly. I saw written on one-service users’ file, ‘does not eat pork due to religious reasons’. I asked a staff member if there was anything this service user could not eat her response was; “ Pork, because she is an Adventist “ . I read on another service users’ file ‘ Can not eat fruit’. I heard staff checking with each other to make sure that cakes were available without fruit in them for this service user. These observations were positive as it means that staff are aware of the service users’ special dietary needs and requirements. The following comments about food were received from feedback during the inspection day. “ The meals are alright, there are choices”. “ Food is brilliantdon’t use frozen, all fresh”. “ Meals could be tastier”. “Good Meals”. “ She is fed well”. “ The meals are very good, you can have what you want”. About meal provision I identified the following from completed service user questionnaires; three of seven confirmed that they liked the meals at the home, two answered usually and one sometimes to this question. One did not make comment. Russell Court DS0000041944.V342397.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. Quality in this outcome area is good. Complaints procedures are available in the home that have been produced in a part written and part pictorial format. The majority of service users’ and their relatives’ know how to make a complaint. Processes are in operation to protect service users’ from harm and abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Commission has not received any complaints about this service. The home has not received any complaints. The home has a complaints procedure that I saw was available in the home and also detailed in the home’s service user guide. The complaints procedure I saw in the home has been produced in part writing and part pictures, which is positive as it means that the home wants to ensure that service users’ can understand it. Feedback about complaints from completed service user and relative questionnaires was as follows; Six of seven service users’ know who to speak to if they are not happy, one usually knows. Six of seven service users’ confirmed that they know how to make a complaint one answered usually to Russell Court DS0000041944.V342397.R01.S.doc Version 5.2 Page 20 this question. Two of three relatives confirmed that they know how to make a complaint , one did not. There have not been any reports of abuse at this home or incidents since before the last inspection. It is positive that written confirmation has been provided to the Commission about concerns identified during the previous inspection carried out in June 2006. A number of staff have received abuse awareness training. I asked service users’ and staff if they had experience or witnessed any concerns abuse such as rough handling, shouting or hitting their responses were as follows; “ No they are kind”. “ No , nothing like that”. “ No I haven’t seen anything like that”. “ No there is nothing at all, no concerns”. “ No, never seen anything concerning at all”. “ Oh, no. If I was concerned I would go straight to the office. If I wasn’t happy I’d go to the top!” These responses positive as they indicate no concerns in the home and that staff would report, if there were. Russell Court DS0000041944.V342397.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,23,24,26. Quality in this outcome area is good. Service users’ live in a home that is well maintained, comfortable, hygienic and safe. Attention however, must be paid to room sizes which accommodate service users’ with physical disabilities and those who need specialist equipment to make sure that their needs are met and that they and staff are free from risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Russell Court DS0000041944.V342397.R01.S.doc Version 5.2 Page 22 The home is large and detached. It is located in a residential area close by to Russell Hall hospital, a number of shops and other public amenities. Internally it is divided into four separate units, a maximum of eight service users’ can be accommodated on each. These small units with their own living and dining space feel personalised and homely. I felt that the home has a nice atmosphere which is welcoming and friendly. I saw that the home is well maintained. The manager has a planned maintenance programme. New furniture and carpets have been purchased for two units since the last inspection. The manager told me we are getting quotes at the moment for en-suite flooring and new bedside cabinets. A service user told me; “It’s a nice environment”. I looked at three service user bedrooms which were homely, comfortable and well maintained. One service user told me; “ I like my room”. Another said; “ I like my bedroom”. I had a discussion with the manager about bedroom sizes. I saw that one service user is mobility independent with her electric wheelchair. The manager was surprised when I told him that service users’ who are wheelchair independent should not be given a bedroom smaller than 12 square metres. I showed him National Minimum Standard 23.4 to confirm this. Although the service user in question told me that she ; “ Liked her bedroom”. Some staff are finding it difficult. I was told; “ Some of the rooms ,a problem with size, equipment and hoist”. This situation needs to be addressed as if space is causing problems with equipment it could place both service users’ and staff at risk. I saw that the home was clean and orderly. Bathrooms and toilets were provided with liquid soap and paper towels. The laundry is spacious and has processes to prevent infection transmission. Laundry equipment is adequate and is commercial, to allow sluice and pre-wash cycles. Cleaning and laundry staff are provided every day to keep the home clean. That the home is clean and fresh was confirmed by comments received as follows; “ Very clean and hygienic”. “ Always clean”. Completed service user questionnaires told me the following; Six of seven feel that the home is always fresh and clean, one feels that the home is usually fresh and clean. Russell Court DS0000041944.V342397.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is good. Day time staffing levels are adequate in terms of number and skill mix, night time numbers however, should be increased to ensure that needs are met and that service users’ are safe. The home has a good attainment level for staff achieving NVQ awards, induction processes are in place to give new staff the required information to look after service users’. Recruitment practices are robust ensuring that service users’ are protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the morning of the inspection I saw that six care staff, one senior and the manager were on duty. Six carers are also provided during afternoons and two wakeful staff on the night shift. I was concerned to learn from listening to the handover in the morning that four of the six morning care staff were from an agency. However, the senior told me; “ This is because staff are on diabetes training and others are taking service users’ to the Safari Park”. She further told me “ Three of the agency staff have worked in the home for sometime, so know the home and the service users’”. This was confirmed by one of the agency staff who told me; “ I Russell Court DS0000041944.V342397.R01.S.doc Version 5.2 Page 24 have been working here from March 2006. I do about five shifts here every week”. I asked staff and service users’ if they felt that the staffing levels were adequate. I was told; “ I think there are enough staff on days, if short they get agency”. “ Always six staff, if short get agency”. Yes enough”. Night staffing levels however, do not seem adequate. I could see that the dependency needs of the service users’ has risen in that the hoist has to be used, a number of service users’ look frail, one was very poorly and one was being looked after in bed. The building must also be taken into account and emergency procedures such as; fire and fire evacuation procedures. I was told; “ Two staff are not enough. We have people to get ready for day centre. The dependency levels have risen, we have people with communication problems that need more time and have to use more equipment. Late evening and early mornings are very rushed”. To prevent risk meet needs and keep service users safe night staff levels should be increased from two to three. Positive comments were received from service users’ and relatives about the staff group which included; “ Friendly staff”. “ Staff are very nice and kind”. I looked at training information and was provided with other information confirming that seventeen of the twenty nine care staff have NVQ level 2 or above and 10 more are working towards this award. This is positive as it shows that staff have, the required knowledge base and competency to look after the people in their care. The manager confirmed that staff are working with the required induction standards. He told me; “ I have given this task to one of the seniors. It takes a lot of time for each one”. I checked three staff files and found these to be satisfactory in terms of recruitment processes. Written references were available as was evidence to prove that the Criminal Records Bureau as required had checked them. Russell Court DS0000041944.V342397.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38. Quality in this outcome area is good. The Commission as a fit person to be in charge of the home has recently approved the manager. Quality assurance and monitoring processes have developed and are improving to ensure that the home is run in the best interests of the service users’. He has however, yet to attain his Registered Managers Award. Service user money held by the home is safe and well managed. Generally health and safety observance in the home is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Russell Court DS0000041944.V342397.R01.S.doc Version 5.2 Page 26 The Commission as a fit person to run and be in charge of the home has recently approved the manager. He is very motivated and dedicated to continually improve processes to enhance the quality of life for people in his care. This evidence by findings from this inspection compared to the last which took place in June 2006. I discussed with the manager the requirement for him to attain his Registered Managers Award. It is clear that the manager gives the required support and guidance to the staff. Staff I spoke to said; “ If we have any problems we go to the seniors or manager. No concerns very approachable”. “ I am happy and comfortable to go to the seniors or manager”. Positive comments were made by one relative and following a recent elected members visit as follows; “ Very good management”. “ A well run establishment – it was a joy to visit”. Quality assurance and quality monitoring systems have developed and continue to improve. The home uses questionnaires to gain the views of service users’, staff and other stakeholders. Regular staff and service user meetings are held to give these people the chance to make suggestions and to give their views. The manager showed me his self- audit, quality monitoring system whereby he has started to monitor the homes functioning against the National Minimum Standards for Older People. His aim is to get someone from another unit to assess his home to make the process totally unbiased and objective. I looked at three service users’ money. These are held securely. I saw that written records are made of each transaction and that receipts are obtained for expenditure. I looked at staff training records and saw that the majority is up to date. Where gaps have been identified training is being arranged. I saw information in the office to confirm that staff are attending training. Courses available at the present time are appointed persons first aid and diabetes awareness. I looked at a range of records and service equipment examples being the servicing of the lift, hoists and fire fighting and prevention equipment. These were all in order which, is good as that means that service users’ are safe. I did however see two concerns that I highlighted to the manager. Pipe work under hand washbasins and in the main entrance was hot to touch and not guarded. I observed on e service user (G) having difficulty getting into a standing position because the chair was too low. These issues need to be addressed to prevent risk and increase safety further. Russell Court DS0000041944.V342397.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 2 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 4 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x 2 3 x 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 x x 3 Russell Court DS0000041944.V342397.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP4 Regulation 14(1)(d) Requirement No service user must be admitted to the home if they have needs which fall outside of the homes registration conditions. This requirement has been made to ensure that service users can be looked after and that they will be safe. The registered person must ensure that care plans are reviewed for any service user who has been in hospital Timescale for action 24/07/07 2 OP7 15(1)(b) 24/07/07 3 OP8 13(4)( c) Evidence must be available at all times to show that adequate action is being taken to prevent dehydration. This requirement has been made to prevent risk to service users’ and to keep them safe. 24/07/07 Russell Court DS0000041944.V342397.R01.S.doc Version 5.2 Page 29 4 OP9 13(2) The registered person and manager must ensure that all prescribed preparations for example food supplements and creams are signed for when given. Timescales of 09/01/06 and 01/07/06 not fully met. 24/07/07 5 OP9 13(2) The medication records must 24/07/07 show either any allergies or none allergies. Where medications are prescribed on an ‘ as required’ basis a care plan must be produced instructing staff when these medications should be given. These requirements have been made to increase medication safety and to ensure service users’ are safe. Night staff hours must be provided as follows; three staff per night. This requirement has been made to ensure that needs are met and that the service users are safe. 6 OP27 13(4)( c) 18(1) 24/07/07 Russell Court DS0000041944.V342397.R01.S.doc Version 5.2 Page 30 7 OP38 13(4)( c) All hot pipe work under hand wash basins and in the main entrance hall must be suitably protected. A higher chair for SU (G) must be provided. These requirements have been made to prevent risks and make sure that service users’ are safe. 24/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP2 Good Practice Recommendations The full range of weekly fees should be prominently displayed within the home. A regulation 14 acknowledgement letter should be given to all service users before they are admitted confirming that an assessment of need has taken place and that the home can meet their needs. Service users should all be weighed on their return from any stay in hospital. The registered person and manager must ensure that an assisted bathing facility is provided on the first floor. Bedroom sizes must ensure that they meet needs and do not pose as a risk in terms of equipment required and limited space. The manager must attain the Registered managers Award. 2 3 4 5 OP8 OP8 OP23 OP31 Russell Court DS0000041944.V342397.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Halesowen Office West Point Mucklow Office Park Mucklow Hill Halesowen B62 8DA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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