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Inspection on 20/08/07 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 20th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

The home has good admission procedures which help residents settle into the home quickly. Residents know their needs can be met before they move in to the home. Residents benefit from a warm friendly atmosphere, with a staff team which works well together and with the residents. Residents benefit from having their personal care needs met by trained nursing staff as well as care staff. Residents benefit from a varied activity programme, which includes frequent trips out. The majority of residents enjoy the quality and variety of menus. The environment is pleasant and well maintained. The quality assurance processes carried out at the home are comprehensive .

What has improved since the last inspection?

The service user guide has been updated and now reflects the practices, lifestyle aims and objectives of the home. The home now follows robust recruitment procedures and 2 written references are required prior to the post being offered. The health needs of residents are better met and actions taken to address and meet needs are better documented. All residents are weighed regularly and actions taken to address weight loss are well documented. Residents are benefiting from the newly refurbished shower room, and meeting room, which can be used by residents or staff. Standards relating to food have improved as the cook`s hours have been increased, so that the cook is now present to prepare and cook all meals. Residents are enjoying more trips out as the home has purchased its own minibus.

What the care home could do better:

Documentation relating to one resident for whom some restraint is used must be improved; any restraint used has been agreed with the resident and relative, the multi-disciplinary team should also bee involved. Support for staff studying NVQ`s should continue, to bring the home`s count up to 50% or above. A photograph and the proof of identity should be kept on all staff files. Proof of training undertaken and providing timely and appropriate training for all staff, will help ensure good standards care. Kitchen staff must receive food hygiene training as soon as possible to enable them to carry out their jobs safely.

CARE HOMES FOR OLDER PEOPLE Russell Court Nursing Home Russell Square Longfield Kent DA3 7RY Lead Inspector Justine Williams Key Unannounced Inspection 20th August 2007 09:30 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.V346024.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.V346024.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 Lilian 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.V346024.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 10th October 2006 Brief Description of the Service: The home provides accommodation and nursing 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. The home was purpose built around 20 years ago and is privately owned. A registered nurse is on duty at all times (with 2 on duty between 7am-2pm). Train and bus services are available in the town, which is around a 10-minute walk. The local town has a church, school, shops and pubs. Weekly fees as shown in the Service User’s Guide are £703.00 per week. 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. The fees do not include newspapers, personal toiletries, chiropody, hairdressing etc. Russell Court Nursing Home DS0000026202.V346024.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced inspection was carried out on 20th August 2007 between 09.30 am and 2.30pm by regulatory inspector Justine Williams. During that time residents, staff and the manager agreed to speak with the inspector both in public and privately. This report contains assessments made from observations, conversations and records, case tracking and a tour of the premises. Feedback was given during and at the end of the inspection. As part of the inspection process surveys were sent to service users, GP’s, health care professionals, care managers and relatives of residents. Some specific comments made included: “I consider myself to be very fortunate to be given a place here” “No-one would choose to be old and infirm and not back in their own homes but Russell Court gives them the care and support vital to them in their declining years” “Inevitably when in the people business things go wrong, but I have always found management readily available, willing to listen and discuss, and do their utmost to get it right” What the service does well: What has improved since the last inspection? The service user guide has been updated and now reflects the practices, lifestyle aims and objectives of the home. Russell Court Nursing Home DS0000026202.V346024.R01.S.doc Version 5.2 Page 6 The home now follows robust recruitment procedures and 2 written references are required prior to the post being offered. The health needs of residents are better met and actions taken to address and meet needs are better documented. All residents are weighed regularly and actions taken to address weight loss are well documented. Residents are benefiting from the newly refurbished shower room, and meeting room, which can be used by residents or staff. Standards relating to food have improved as the cook’s hours have been increased, so that the cook is now present to prepare and cook all meals. Residents are enjoying more trips out as the home has purchased its own minibus. What they could do 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. The summary of this inspection report can be made available in other formats on request. Russell Court Nursing Home DS0000026202.V346024.R01.S.doc Version 5.2 Page 7 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.V346024.R01.S.doc Version 5.2 Page 8 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): 1,3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have the information they need to make and positive choice to move into the home. Residents have their needs assessed and are assured their needs can be met. EVIDENCE: Residents receive written information about the home prior to moving in, the service users guide has been updated to reflect the practices of the home and give prospective residents an idea of what it is like to live at the home. Residents said they found the information in the guide useful. Some residents had their family visit the home on their behalf, as they were too unwell to visit it themselves. Residents said the home made them feel welcome and had provided them with enough information to make a positive choice to move in. Russell Court Nursing Home DS0000026202.V346024.R01.S.doc Version 5.2 Page 9 The manager or other senior and experienced nurse carry out an assessment of prospective residents prior to their moving to the home. Once the resident moves in another assessment is carried out, and the care plan is based on these assessments. The home requests copies of assessments for residents who have been assessed by social services. Each resident is assessed by a nurse from the Primary Care Trust for the level of nursing input required. Russell Court Nursing Home DS0000026202.V346024.R01.S.doc Version 5.2 Page 10 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health and personal care needs are well managed. EVIDENCE: Each resident has a care plan, residents or their relatives are asked to sign the care plan, not all the care plans have been signed however. The care plans set out in detail how each resident’s needs are to be met, and care plans included residents social needs. Residents each have a risk assessment one part of which is about the prevention of falls for that individual. Risk assessment must contain adequate detail of lap and leg straps used in a residents wheelchair and should be signed by the care manager GP or any other appropriate professional, as well as the resident and next of kin where appropriate. All the care plans had been regularly updated at least monthly and any new information had been written into the care plan. The daily records gave a reasonable description of how the resident had spent their day. Residents confirmed that they get up and dressed at the time they prefer and around 4 Russell Court Nursing Home DS0000026202.V346024.R01.S.doc Version 5.2 Page 11 residents who choose to, are helped to get up before 7am. This information is now recorded in the care plans. Residents said they bathe or shower as often as they like and at a time they prefer. All residents now have their weight recorded monthly; the manager discussed the difficult weighing one resident on the seated scales, due to the resident disability and discomfort. The provision of equipment appropriate to the changing needs of residents was discussed. Residents said they have access to their GP and other health care professional at any reasonable time and the home arranges visits to and from dentists, opticians etc; an optician was present on the day of the visit to the home seeing a resident. 2 residents have pressure sores both acquired at the home through ailing health and these were being managed appropriately by the home. A trained nurse assesses all resident regularly for prevention of pressure sores, continence management, nutritional screening; all the assessments are regularly updated. Records show regular visits by the residents GP’s confirmed by residents and the manager. 1 resident had a recurrence of an eye problem, which is yet to be addressed the staff. The home has a medication policy, which staff work to, medicines are recorded entering and leaving the home and are retained in the event of a service users death. None of the current residents are self-medicating at present but the home has a policy in place to enable resident to do so. The home has 2 trolleys, which are tethered to a wall when not in use. The storage of medicines must be reviewed to comply with good practice guidelines. Residents confirmed that staff respect their privacy and dignity, they knock before entering their rooms and always address them by their preferred name. Residents were very happy about the way they are treated by staff, saying that they are “friendly” “very good”, “always very helpful”. Many resident have their own private telephone lines but those who don’t have access to the payphone, which they can use in private. All bedrooms are single rooms. Russell Court Nursing Home DS0000026202.V346024.R01.S.doc Version 5.2 Page 12 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. This judgement has been made using available evidence including a visit to this service. Residents have a relaxed comfortable lifestyle with opportunities to occupy themselves with a range of interests. EVIDENCE: Unfortunately the activity co-ordinator is on unplanned leave and is expected to be away for some time. In spite of this residents said care staff and the manager are still managing to run some activities and in particular the owner and manager continue to take residents out on a rota system to a variety of places including the Dickens museum, Medway Maritime, boat rides, pub lunch, garden centre trips, and several theatre trips. The home has purchased its own minibus since the last inspection. Efforts to incorporate resident’s interests into the activity programme are made and residents said in spite of the absence of the activity co-ordinator they are still satisfied with the activities. The home continues to have a themed day, regularly where staff dress up and food is that from the “theme” country, but has not had a fun day this year due to the poor weather. Russell Court Nursing Home DS0000026202.V346024.R01.S.doc Version 5.2 Page 13 Residents said they were particularly pleased at the welcome their relatives received when visiting the home, and that their relatives are always offered a drink and biscuits. Residents felt in control and said they made decisions about there own lives. Residents may bring in their own furniture and personal items. Residents spoke very positively about the food, with only one saying that some food was not well cooked. Residents said there is always a good choice of meals, which are nicely presented. Residents feed back about menu choices at residents meetings and recent discussion at residents meetings has highlighted an issue with legroom in the dining room. As a result of this the dining room is to be extended, and the manager plans to purchase round tables to eliminate this issue. The cook’s hours have changed to ensure the cook is on site preparing all meals; the cooks are supported by 4 kitchen assistants who also serve drinks throughout the day. Russell Court Nursing Home DS0000026202.V346024.R01.S.doc Version 5.2 Page 14 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. This judgement has been made using available evidence including a visit to this service. Residents have access to people who listen to any concerns and who will take action to ensure they are protected from abuse. EVIDENCE: The home has received 5 complaints in the last 12 months, 2 of which were upheld. The home has a clear complaints procedure, which is well displayed, and residents were aware of how to make a complaint. The manager takes responsibility for monitoring and investigating complaints. Information in the file was clearly documented. The manager and staff spoken with had good knowledge of their responsibilities regarding reporting and acting on allegations of abuse. The home has a clear adult protection policy, which fits in with the Kent and Medway policy. Training in adult protection is provided at induction, and training and updates are arranged regularly for all staff. The home recruits staff safely. Russell Court Nursing Home DS0000026202.V346024.R01.S.doc Version 5.2 Page 15 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): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have a homely, well-maintained and comfortable environment in which to live. EVIDENCE: The home was purpose built and as such is accessible, with wide corridors, and all single rooms with en-suite facilities. There is a programme of routine maintenance and rooms are redecorated as they become vacant or more frequently if necessary. The home is decorated to a good standard throughout, and residents have use of 2 lounges, and a dining room as well as a patio in the garden. The grounds are well maintained and residents appreciate the attractive garden. The proprietor is planning to extend the dining room as residents have said the do not like the layout of the tables and that legroom is tight for those who use wheelchairs. The proprietor and manager have tried Russell Court Nursing Home DS0000026202.V346024.R01.S.doc Version 5.2 Page 16 variations of layout and different tables but have decided to extend the room and invest in new furniture. The residents are very pleased and are looking forward to the work being completed. The proprietor is also in the process of planning a sensory garden. The home now has an environmental risk assessment, which formally identify any areas of risk and to document actions taken to minimise risk. The manager confirmed that health and safety issues are dealt with promptly. The home was clean tidy and pleasant smelling throughout, and residents said their rooms are kept clean and tidy. The laundry is clean and orderly and has designated staff in charge of laundry. The home has appropriate sluicing facilities and no infection control issues were identified. Residents are enjoying the newly refurbished shower room. Russell Court Nursing Home DS0000026202.V346024.R01.S.doc Version 5.2 Page 17 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 Adequate. This judgement has been made using available evidence including a visit to this service. Residents are cared for and supported by properly recruited staff, they will benefit further when all staff receive training appropriate to the work they perform. EVIDENCE: Residents benefit from the numbers of staff employed, and on duty each shift. Residents said they get up and go to be when they wish and do not have to wait long for assistance when they ring for help. The home keeps a rota to indicate which staff are on duty and but should add in what capacity they are employed. Other staff are employed in sufficient numbers to ensure the home is clean, well maintained and laundry and cooking standards are met. 11 members of staff have attained NVQ, 4 with level 3 and 8 with level 2, a further 8 are in the process of studying for NVQ 2. Therefore the home has almost achieved 50 of care staff with NVQ. The manager has amended the induction documents and is confident it now complies with skills sector guidance. The recruitment files of 2 newly recruited staff were looked at and both contained application forms, 2 written references proof of CRB and POVA Russell Court Nursing Home DS0000026202.V346024.R01.S.doc Version 5.2 Page 18 checks, 1 did not contain proof of identity or a photograph. Copies of contracts were on file. The manager is working to ensure all staff are up to date with their “core training” and receive additional training relevant to their jobs. 2 kitchen staff need to completed their food hygiene training, and no staff have received dementia training. The manager has a training matrix but this indicates many staff have not received the core training; the manager stated that the matrix is not up to date. Russell Court Nursing Home DS0000026202.V346024.R01.S.doc Version 5.2 Page 19 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. This judgement has been made using available evidence including a visit to this service. Residents live in a safe and well-managed home. EVIDENCE: The manager has been in post for 18 months and prior to this was deputy at the home. The manager has attained the Registered Managers Award, is a registered nurse, and undertakes other training periodically to update her skills. The home has several quality assurance and monitoring systems in place including surveys, residents meetings, documentation audits, tracking of complaints and accidents for trends and patterns etc. the home must now Russell Court Nursing Home DS0000026202.V346024.R01.S.doc Version 5.2 Page 20 prepare an annual development plan for the home in line with amended regulations and based on improving the lifestyle experienced by residents at the home. The home does not manage residents’ monies and uses an invoicing system, residents who are able to continue to look after their own finances and have lockable storage space to secure their belongings. The self assessment completed by the manager for the CSCI indicates that all relevant health and safety checks, maintenance and servicing of equipment is up to date. A written environmental risk assessment is now in place to formally evidence that the manager takes action to minimise and manage risk. The manager must ensure the kitchen staff receive the training arranged in food hygiene, and the matrix should be up to date in order to proactively plan training and updates for staff. The fire risk assessment needs to contain contingency plans for evacuation and must identify a safe location for residents to stay in should they be unable to return to the building. It is recommended that the fire risk assessment be submitted to the fire officer. Russell Court Nursing Home DS0000026202.V346024.R01.S.doc Version 5.2 Page 21 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 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 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Russell Court Nursing Home DS0000026202.V346024.R01.S.doc Version 5.2 Page 22 yes Are there any outstanding requirements from the last inspection? 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 OP7 Regulation 13 (8) Requirement Timescale for action 30/09/07 2 OP30 18 (1)(c) “On any occasion on which a service users is subject to physical restraint the registered person shall record the circumstances including the nature of the restraint” in that any restraint used should be a multi disciplinary decision and with the consent of the service user. The registered person shall 30/11/07 ensure that the persons employed receive training appropriate to the work they are to perform, in that staff employed to work in the kitchen receive food hygiene training and other training is provided for care staff such as dementia care. 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 Good Practice Recommendations DS0000026202.V346024.R01.S.doc Version 5.2 Page 23 Russell Court Nursing Home 1 2 Standard OP29 OP30 It is recommended that the home continue to put staff forward for NVQ training in order to meet or surpass the 50 goal It is recommended that the training matrix be kept up to date to indicate what training staff have received and when, and what training is planned. Russell Court Nursing Home DS0000026202.V346024.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. Extracts may not be used or reproduced without the express permission of CSCI Russell Court Nursing Home DS0000026202.V346024.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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