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Inspection on 10/10/06 for Russell Court Nursing Home

Also see our care home review for Russell Court Nursing Home for more information

This inspection was carried out on 10th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Care plan records contain good information about service user`s support needs and how these are met. Care staff met work hard to meet the needs of service users. They take opportunities available to obtain training appropriate to the needs of service users. Bedrooms and communal areas are comfortable. The home is well maintained. Service users and visitors spoke highly of the efforts of staff in making them comfortable and supporting them. Service users are encouraged to remain as mobile as possible. They are helped to move about the premises and take part in various activities by care staff and an activities organiser.

What has improved since the last inspection?

The owner, manager and members of staff continue to review service user`s perception of services provided and to make improvements to make the lives of service users better. This is achieved partly by taking note of responses to quality assurance questionnaires. Requirements and recommendations made in previous inspection reports have received reasonable consideration but full account has not been taken of these.

What the care home could do better:

Prospective service users and their representatives receive good pre-admission information but this should be updated to make the information more accurate and relevant. Care plan records should also be improved by having more references to the actual condition of service users. This should include information about the variety of unexplained bruising seen on a number of service users during the visit and where service users have weight loss and what is being done to address this. Service users should not be required to rise as early each morning as part of procedures operated by staff on the night shift prior to staff on the first shift of the day taking over. Where restraint is practiced (eg. strap used on wheelchairs other than when the service user is being transported), the reasons should be carefully documented in care plan records and agreed with service users, care managers and, if appropriate, service user`s representatives or main supporter. Service users must be protected by good recruitment practices. Application forms should be amended to enable specific information to be obtained about at least 2 referees (including one from the person`s current or last place of work). At least two references must be taken up. Where applicants from abroad are considered for employment, checks must be carried out to assess the validity of claims made about previous appointments including claims to have held senior academic or public positions. The home must keep information in an appropriate way about CRB and POVAfirst checks carried out. The training provided to staff must be reviewed and updated. This involves the need to modify the procedure for providing mandatory training, an increase in the level of NVQ 2/3 training, better induction training, and training in topics relevant to the care of some service users (eg. dementia care, physical disabilities in younger people, learning disabilities). The issuing of certificates by the home must be reviewed so that the standard and level of training is independently validated. There is an acknowledged need for training in some cases to supplement the skills of staff from abroad in communicating better.

CARE HOMES FOR OLDER PEOPLE Russell Court Nursing Home Russell Square Longfield Kent DA3 7RY Lead Inspector Eamonn Kelly Key Unannounced Inspection 10th October 2006 10:00 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 Nursing Home DS0000026202.V315474.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 Nursing Home DS0000026202.V315474.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Russell Court Nursing Home Address Russell Square Longfield Kent DA3 7RY 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) 01474 708151 01474 707371 russellcourt@btconnect.com Russell Court Limited Jean Skelton Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40), Physical disability (5) of places Russell Court Nursing Home DS0000026202.V315474.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The maximum number of bed spaces is restricted to 40 Date of last inspection 6th October 2005 Brief Description of the Service: The home provides accommodation and care for up to 40 people. All service users have single bedrooms with en-suite facilities. Accommodation is on 2 floors. The premises have a passenger lift. A registered nurse is on duty at all times (with 2 on duty between 7am-2pm). Care assistants provide the majority of care support services. Six care assistants are on duty in the earlier part of the day and 5 are on duty in the afternoon and evenings. Train and bus services are available in the town. Weekly fees as shown in the Service User’s Guide are £673.00 Short term care is charged at the rate of £100.00 per night. The PCT assessed nursing element is deducted before service user’s invoice is sent. Additional charges are made for: • • • • • • • • • Chiropody (£9 per session), Newspapers, Hairdressing, Transport for outings, Routine escort (£6 per hour but no charge is made for emergency escort), Private telephone costs and call charges, Private dentistry or medical costs (that are not prescribed by a GP), Use of vending machine for drinks and snacks (residents and relatives drinks and snacks supplied free of charge), Items sold from the homes trolley sales (prices of items are shown in the home’s “Service User Guide”, a copy of which is available from the manager of the home and which is given to all residents or their main representative and updated annually), £25 charge for inclusion in the home’s supplementary billing scheme (the home has asked for this to be described as a charge to open a credit account at the home). DS0000026202.V315474.R01.S.doc Version 5.2 Page 5 • Russell Court Nursing Home Beautician sessions (waxing £10, manicure £10) are also available as services directly purchased by residents. Russell Court Nursing Home DS0000026202.V315474.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection visit took place on 10th October (06.15am01.45pm) and 12th October (11am-3pm) 2006. It consisted of meeting with service users, an owner, the manager, members of staff and visitors. Copies of the home’s quality assurance surveys carried out in 2004 and 2006 were made available. Care practices were observed and discussed with members of staff, service users and visitors. A variety of records were seen during the visit principally those that supported the care of service users. The outcome of the inspection visit was that service users and visitors indicated that they were generally satisfied with the levels of care and support. The owner and manager keep a record of service user’s views of services provided and they take these views into active consideration. The home is committed to a continuous programme of improvement for the benefit of service users and the issues included in the paragraph below (“What they could do better”) relate to issues that the home has undertaken to address. What the service does well: What has improved since the last inspection? What they could do better: Russell Court Nursing Home DS0000026202.V315474.R01.S.doc Version 5.2 Page 7 Prospective service users and their representatives receive good pre-admission information but this should be updated to make the information more accurate and relevant. Care plan records should also be improved by having more references to the actual condition of service users. This should include information about the variety of unexplained bruising seen on a number of service users during the visit and where service users have weight loss and what is being done to address this. Service users should not be required to rise as early each morning as part of procedures operated by staff on the night shift prior to staff on the first shift of the day taking over. Where restraint is practiced (eg. strap used on wheelchairs other than when the service user is being transported), the reasons should be carefully documented in care plan records and agreed with service users, care managers and, if appropriate, service user’s representatives or main supporter. Service users must be protected by good recruitment practices. Application forms should be amended to enable specific information to be obtained about at least 2 referees (including one from the person’s current or last place of work). At least two references must be taken up. Where applicants from abroad are considered for employment, checks must be carried out to assess the validity of claims made about previous appointments including claims to have held senior academic or public positions. The home must keep information in an appropriate way about CRB and POVAfirst checks carried out. The training provided to staff must be reviewed and updated. This involves the need to modify the procedure for providing mandatory training, an increase in the level of NVQ 2/3 training, better induction training, and training in topics relevant to the care of some service users (eg. dementia care, physical disabilities in younger people, learning disabilities). The issuing of certificates by the home must be reviewed so that the standard and level of training is independently validated. There is an acknowledged need for training in some cases to supplement the skills of staff from abroad in communicating better. 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. Russell Court Nursing Home DS0000026202.V315474.R01.S.doc Version 5.2 Page 8 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 Nursing Home DS0000026202.V315474.R01.S.doc Version 5.2 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5, 6. Quality on this outcome area is adequate. This judgement was made using available evidence including a visit to this service. Prospective service users and their supporters have the benefit of receiving good initial advice and guidance that enables them to assess the quality, facilities and suitability of the home. A more accurate and up-to-date Service User’s Guide would be of additional benefit to them. EVIDENCE: Prospective service users and their representatives receive guidance to enable them to decide if the home is able to meet their support needs. This includes receipt of a Service User’s Guide that contains details of services and facilities. The guide contains detailed information but it is in need of updating as it contains potentially misleading information. Each service user receives a personal contract. As part of the home’s commitment to quality assurance measures, the manager will review whether Russell Court Nursing Home DS0000026202.V315474.R01.S.doc Version 5.2 Page 10 this contract contains all the elements included in Standard 2.2 of national minimum standards. In a forthcoming monthly report to the CSCI by the registered responsible person, the outcome of this review will be referred to. The manager carries out an assessment of prospective service user’s support needs. The pre-admission assessment records seen indicate that relatively good information is obtained prior to a decision about admission. However, some records seen suggested that information obtained in each case fell short of what is required under Standard 3.3 of national minimum standards. In a forthcoming monthly report to the CSCI by the registered responsible person, the outcome of this review will be referred to. Prospective service users and their supporters are encouraged to visit the home and assess the quality, facilities and suitability of the home. The home provides long-term care and short periods of respite care for service users rather than care for people recovering from hospital stays before returning home. Russell Court Nursing Home DS0000026202.V315474.R01.S.doc Version 5.2 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality on this outcome area is adequate. This judgement was made using available evidence including a visit to this service. The health, personal and social care needs of service users are identified and addressed by registered nurses and care assistants. Service users would benefit if all aspects of service user’s condition were recorded in individual care plan records. EVIDENCE: Individual care plan records seen for six service users indicated that a range of information is identified for all service users in relation to their health, personal and social care support needs. In some cases, the changing support needs of service users were not documented sufficiently. Examples related to why some service users we awakened at 5am and sat up after receiving support to dress until breakfast time watching early morning TV, why some were strapped into wheelchairs during this time and why there were instances of unexplained bruising and weight loss. It was stated by the owner that service users have agreed to arrangements in place but some service users said that they were confused by Russell Court Nursing Home DS0000026202.V315474.R01.S.doc Version 5.2 Page 12 the situation and they had no choice about the arrangements. Others met were unable to give a view. Instances were observed during the visit where GP involvement was considered necessary by staff. However, the vagueness of some care plan records seen as referred to in the previous paragraph needs to be addressed as service users do not have the benefit of attention by district nurses and the majority of close care is carried out by care assistants. Care assistants met had a good knowledge of service user’s support needs. However, the changeover exercise attended at 7am had a number of instances where information communicated to members of the in-coming shift was indistinct. The staff rota indicated that there is only one registered nurse on duty in the afternoon, evening and night. Where a weight was recorded in September 2006, the actual date was not shown. However, a new weight requested by the visiting inspector showed that the service user’s weight had remained constant since the previous month but had fallen significantly over a six month period. Some members of staff said that they were not sufficiently involved in the maintenance of care plan records as this activity was substantially the responsibility of the registered nurse on duty. It was stated that a nutritionist attends regularly where there are concerns about weight loss. This assistance was not seen to be present in the instances where care plan records were seen on this occasion. However, service users, visitors and staff said that meals are good and members of staff were seen to assist with feeding. Where this support is necessary (as part of meeting assessed needs), it would be expected that the need is recorded as a permanent or temporary need in individual care plan records with further reference as to progress or otherwise. Visitors stated that service users have good access to dentists and opticians. The nurse on duty administers medication and records each administration in MAR (medication administration record) sheets. The manager stated that all members of staff administering medication attend a training course and that this would be reviewed to ensure that refresher courses are provided and a competence checking procedure is involved. The manager said all staff administering medication has a close knowledge of national minimum standards 9.1 to 9.11 and has daily access to up-to-date literature (including changes to the most recent BNF edition including guidance on prescribing). As part of the home’s responsibility for notifications to the CSCI, any instances where medication was administered incorrectly are reported. According to service users, staff and visitors service users are treated with respect and their right to privacy is respected. Russell Court Nursing Home DS0000026202.V315474.R01.S.doc Version 5.2 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality on this outcome area is good. This judgement was made using available evidence including a visit to this service. Service users have the benefit of good contact with relatives and friends at all times. They receive opportunities and encouragement to participate in a broad range of activities. EVIDENCE: Service users are encouraged to dress and leave their bedrooms unless they are confined to bed because of medical conditions. They receive encouragement to do a variety of activities by activities organisers and members of staff. There are a number of themed events throughout the year. Service users are helped to visit external locations via hired minibus. A new minibus owned by the home is due for delivery soon (the cost was met jointly by the owners and through donations). The home’s newsletter for June 2006 stated that service users have opportunities for a range of new activities including a themed day each month. The newsletter highlights dates for 9 special events for the last 6 months of 2006. Russell Court Nursing Home DS0000026202.V315474.R01.S.doc Version 5.2 Page 14 A hairdresser (who is a member of staff) attends 3 days a week. A chiropodist visits every 6 weeks and a beautician visits once a month. Service users are encouraged to maintain contact with friends and family. Visitors met were complimentary about the standard of care services and support at the home. Service users have a reasonable degree of control over their lives, subject to their health requirements. Some visitors said that their relatives were extremely ill when admitted and had made sustained recoveries. Members of staff have successfully cared for people with a variety of support needs including younger people with physical disabilities and learning disabilities. Breakfast and dinner was observed during the inspection visit. Both were relaxed events and service users said that they enjoyed the food they received. Some service users received help with feeding. Russell Court Nursing Home DS0000026202.V315474.R01.S.doc Version 5.2 Page 15 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality on this outcome area is good. This judgement was made using available evidence including a visit to this service. Service users and their supporters can be confidant that their concerns will be taken seriously and that service users are protected from abuse. EVIDENCE: The home received a number of complaints during the past year and some were partially substantiated after investigation by the home. A record is kept of all complaints and their outcome. Service users and their supporters are confident in making comments about how they perceive standards of care at the home. Each year they are invited by the home to give their views through a survey. During the inspection, two annual surveys were seen. The 2004 survey had a greater response than the 2006 survey and service users expressed a number of concerns. There was evidence that these concerns had been addressed. Some members of staff met were not fully aware of the home’s procedures for alerting social services within local authority’s adult protection policy and procedures. Some were not conversant with current procedures involving possible referrals to the protection of vulnerable adults office (pova) where staff practices were regarded as questionable. Members of staff met had a good knowledge of what constituted adult abuse. The manager said that adult protection procedures would be added to induction training as part of the general development of induction procedures. Russell Court Nursing Home DS0000026202.V315474.R01.S.doc Version 5.2 Page 16 Russell Court Nursing Home DS0000026202.V315474.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 23, 24, 25, 26. Quality on this outcome area is good. This judgement was made using available evidence including a visit to this service. Service users live in premises that are suitable for their support needs. EVIDENCE: Each service user has a single bedroom that has an en-suite facility. There is a large lounge area and an adjoining smaller lounge. Service users have the use of a patio area at the rear of the premises. Domestic staff (on duty during weekdays) keep the premises clean and tidy. During the inspection visit, the premises were free of offensive odours. A spa bath has been installed on the ground floor for the benefit of service users. A passenger lift links the ground and first floors. Russell Court Nursing Home DS0000026202.V315474.R01.S.doc Version 5.2 Page 18 The June 2006 newsletter stated that 10 bedrooms were newly re-decorated. It also stated that a member of the maintenance staff had received training to enable PAT (portable appliance testing) to be carried out. It referred to the success of some members of staff in achieving NVQ Levels 2 and 3 in care. Members of staff met said that difficulties are being experienced with water that is too cold being delivered to water outlets accessible to service users. The home has a range of lifting equipment including sling and standing hoists. An exercise was observed involving 2 members of staff successfully hoisting a service user to enable a weight reading to be obtained. During 2006 a meeting room for visitors and specially adapted shower, toilet and washing facility were completed. A sluice room was discontinued and a shower room was converted to a storeroom. During the visit, there were some examples of untidiness, some of which had a potential safety implication (tablets left unattended, a store room and an electrics room left unlocked, empty water bottles from the home’s vending machine left on handrails and an open store room with wheelchair footrests encroaching on a corridor). Russell Court Nursing Home DS0000026202.V315474.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality on this outcome area is adequate. This judgement was made using available evidence including a visit to this service. Service users are cared for and supported by members of staff who know their care needs and work hard to meet these needs. This support would be complemented by better recruitment and training practices. EVIDENCE: The “skill mix of staff” includes management staff, registered nurses, care assistants, domestic staff, cook and kitchen assistant, laundry assistant and maintenance staff. Six care assistants and 2 registered nurses are on duty in the earlier part of the day (7 days a week). In the afternoon and evening, one registered nurse and 5 care assistants are on duty (during weekdays, the number of care assistants is increased to 6 between 5-8pm). One registered nurse and 3 care assistants are on duty at night. Perusal of staff files during the inspection revealed that hourly deductions of 70p are made for a number of weeks while new staff undertook induction. Induction records indicated that new members of staff were required to sign an induction checklist that indicated all induction items had been covered in one day. In other cases, new staff had signed across several signature boxes to indicate that they had received the required level of tuition and support. The manager said that, in future, the induction procedure would comply with current standards and care would be taken that employee signatures and the Russell Court Nursing Home DS0000026202.V315474.R01.S.doc Version 5.2 Page 20 manager’s approval signature would properly indicate that appropriate tuition and support had been provided over the requisite period of time (at least 3 months). Parts of procedures recommended by “Skills for Care” were discussed with the manager during the visit. As part of the required changes, an appropriate induction record would be maintained for each member of staff. Some members of staff were recruited without the appropriate number of references being taken up (or requested in the application form). Some members of staff were employed without adequate investigation of claims that they previously held senior posts abroad. In their response to the report, the manager and registered responsible person suggested that the reason for references not being available for inspection was that they might have been misfiled. The home does not have information in a way that shows the outcomes of criminal records bureau (CRB) for each member of staff so that an assessment can be made every 3 years or sooner as to whether a new check is necessary. The home’s Service User’s Guide claims that all staff receive appropriate training that enables staff to meet the wide range of service user’s support needs. The home is not yet meeting the objective of having most of its care assistants trained to NVQ Level 2. In their response to the draft inspection report, the manager and registered responsible person asked for the following clarification to be added “…the home prior to this inspection exceeded the objective of having 50 of its staff qualified to NVQ Level 2 or equivalent. However following recent staff changes the percentage has fallen to 40 . The home has 3 care staff training for the Level 2 qualification”. Mandatory training by the home is unsatisfactory. Certificates of training issued to staff by the home indicate that members of staff receive training in all 6 mandatory subjects in one day (ie. COSHH, Moving & Handling, Health & safety, First Aid, Cross Infection and Food Hygiene). These are likely to mislead members of staff into thinking that they had received training at the right level and intensity. There is no independent validation of the home’s right to award such certificates apart from COSHH training being provided by an outside agency. The manager is a trained trainer for moving and handling vulnerable people. All care staff should be aware of local authorities adult protection policies and procedures. Current induction records as referred to above do not give suitable initial support during the first 3 months of employment to new members of staff. Members of staff receive regular supervision the outcome of which is recorded. Russell Court Nursing Home DS0000026202.V315474.R01.S.doc Version 5.2 Page 21 Separate meetings with all staff on duty suggested that they had a good knowledge of service user’s support needs. Service users and their supporters can be confident that service users are in safe hands at all times although significant progress on recruitment practices and training levels is needed as a matter of overall policy and procedure. Russell Court Nursing Home DS0000026202.V315474.R01.S.doc Version 5.2 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38. Quality on this outcome area is good. This judgement was made using available evidence including a visit to this service. Service users have the benefit of a well run home. EVIDENCE: The manager is a registered nurse and has achieved the Registered Manager’s Award. She was previously the head of care at the home. The CSCI does not receive monthly reports from the home’s registered responsible person. The manager undertook to arrange for this to be carried out. Comments from service users and visitors indicated that service users are well cared for at the home. The views of service users and their visitors are listened Russell Court Nursing Home DS0000026202.V315474.R01.S.doc Version 5.2 Page 23 to and taken into account. The home carries out annual quality assurance reviews and makes the results available to service users. It is the practice of the home that service users receive independent advice on all financial and legal matters. The home does not act as appointee to any service user and only a very small number handle their own financial affairs. Service users may, on a voluntary basis, subscribe to the home’s “pocket money” service. This unusual subscription is for them to receive a supplementary invoice for additional spending at the home. A refundable charge of £26 is made for this service (the home asked for a clarification to be made in the inspection report that this is a deposit required to open a credit account with the home). Each member of staff receives regular formal supervision. The pre-inspection questionnaire declared that safety checks had been successfully carried out by staff in respect of fire safety, heating system, water check to prevent Legionella, emergency lighting, hoists and adaptations, and electrical appliances in service users bedrooms. An environmental health officer visit was made in July 2006 following which no requirements or recommendations were made. The home’s newsletter declared that the hot water system that delivered water to service user’s bedrooms had been successfully repaired. The implication was that water at the required temperature is available in bedrooms and bathrooms. A member of the home’s maintenance staff has received training to undertake portable appliance testing and all electrical items are appropriately checked and marked. Russell Court Nursing Home DS0000026202.V315474.R01.S.doc Version 5.2 Page 24 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 2 3 3 x 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 3 10 3 11 x 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 3 x x 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 3 x 3 Russell Court Nursing Home DS0000026202.V315474.R01.S.doc Version 5.2 Page 25 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 OP30OP30 Regulation 18 Requirement The home must have a staff training and development programme that meets workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of service users. Improvements are needed to the induction procedure, for providing mandatory training and for ensuring that at least 50 of care staff are qualified to NVQ Level 2 in Care. The programme of mandatory training for all members of staff, including registered nurses, must include appropriate information on local authority adult protection procedures, the influence of the dept of health POVA manager, restraint, care plan records and further specialist training (eg. dementia care, care of younger adults with physical disabilities and learning disabilities). “The registered person shall…ensure that at all times suitably qualified, competent and experienced persons are working…in such numbers as are appropriate to the health Russell Court Nursing Home DS0000026202.V315474.R01.S.doc Version 5.2 Page 26 Timescale for action 15/12/06 and welfare of service users …and that persons employed…receive appropriate training…and…”. 2 OP29OP29 19 & Schedules 2&4 Service users must be further protected by good recruitment practices at the home. This includes the need for alteration of application forms so that specific information is obtained about at least 2 referees and such references are taken up. The claims made by applicants in application forms must be carefully checked as part of the recruitment process. The home must keep a suitable record relating to the outcome of CRB checks for each member of staff. “The registered person shall…not allow a person… to work at the home…unless…the information…in Schedule 2 (has been obtained)…”. 15/12/06 3 OP7OP7 OP8OP8 12 & 15 Individual care plan records 15/12/06 must include sufficient details of the identified care needs of service users and how these support needs are met on a dayto-day basis. The records should identify, for example, why service users are got ready at 5am onwards, why they are strapped into wheelchairs from this time and why some have unexplained bruises and weight loss. Where restraint is practiced, the details must be included in care plan records and agreed with care managers, the service user and representatives. “The registered person shall, for the purpose of providing care to service users, and making proper provision for their health and welfare…ascertain and take into account their wishes and feelings”. “”…the registered person shall…in respect (of service user’s health and welfare)…keep the service user’s plan under review…(and)…notify the service user of any such revision”. Russell Court Nursing Home DS0000026202.V315474.R01.S.doc Version 5.2 Page 27 4 OP1OP1 6 The pre-admission information provided to prospective service users must be updated so that all information is clear and unambiguous. A copy must be supplied to the commission and to each new service user (or their main representative). The section relating to the deployment and training of care staff must, as agreed during the inspection, be amended. “The registered person shall keep under review…the service user’s guide and notify the commission and service users of such revision…”. 15/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Russell Court Nursing Home DS0000026202.V315474.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 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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