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Inspection on 05/05/05 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 5th May 2005.

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

The Provider is committed to ensuring the home remains environmentally pleasing. The home is kept clean and tidy. A choice of appetising meals is available and Service Users can choose where to eat. The two visitors spoken with said they felt their relatives receive good care. The Registered Manager is committed to ensuring staff are appropriately trained.

What has improved since the last inspection?

Almost all of the requirements made at the last inspection have been met. The Registered Manager has developed links with community based Health Care Professionals, who provide appropriate support when required. Seven Health Care Assistants are now trained to NVQ II or higher, and two are currently doing their NVQ level II training. A programme to refurbish bedrooms and ensuite rooms has commenced. Bathrooms are also being refurbished. The home has acquired two more hoists for the safe moving and transferring of service users.

What the care home could do better:

All care staff must receive learning disability training. A system must be devised to ensure details of all complaints and comments, including lost property, is recorded and made known to the manager. Robust recruitment vetting systems must be developed and followed. Staff must not commence employment at the home until satisfactory references and clearance have been received. Although Registered Nurses are striving to improve their record keeping skills, care records inspected for case tracking purposes were incomplete of all current needs and problems.

CARE HOMES FOR OLDER PEOPLE Russell Court Nursing Home Russell Square Longfield Kent DA3 7RY Lead Inspector Elizabeth Baker Unannounced 05 May 2005 10:35 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 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 H56-H06 S26202 Russell Court V225076 050505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Russell Court Nursing Home Address Russell Square Longfield Kent DA3 7RY 01474 708151 01474 707371 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Russell Court Limited Mrs Eunice Melinda Meek Care Home 40 Category(ies) of Old Age, not falling within any other category registration, with number (40) Physical Disability (40), Terminally ill (40) of places Russell Court Nursing Home H56-H06 S26202 Russell Court V225076 050505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Staffing Notice dated 19 October 1999. Date of last inspection 25 April 2004 Brief Description of the Service: Russell Court Nursing Home is a care home providing nursing care for 40 Older People, including within that total Physically Disabled (5) and Terminal Illness (5). Russell Court Limited is the Registered Provider. The home is a purpose built two-storey property. All bedrooms are for single occupancy and have ensuite WC facilities. Accommodation on the first floor can be accessed by a five-person passenger lift. Day space consists of a large lounge and connecting quiet room. A separate dining room is also available. There is a secluded patio area, with water feature, adjacent to the quiet room, which can be accessed by service users with a physical disability. The home is situated near to the centre of Longfield. Train services to and from London Victoria, Medway Towns and the Kent Coast are available from Longfield Station. Bus services to the neighbouring areas of Hartley, New Ash Green, Dartford and Gravesend, as well as the nearby Bluewater Shopping complex at Greenhithe are also available from Longfield. Longfield has a variety of shops and restaurants, as well as a bank, building society, small library and a church. Russell Court Nursing Home H56-H06 S26202 Russell Court V225076 050505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over six hours on the 5 May 2005. Lead Inspector Elizabeth Baker carried out the inspection. A partial tour of the home took place. The visit was spent talking with service users both privately and collectively, members of staff and two visitors. The Registered Manager Mrs Meek provided assistance throughout the inspection process. Some judgements about the quality of care, life and choices were taken from direct conversation with service users and evidencing records held at the home. Some records were inspected as part of case tracking and to assess work on requirements and recommendations made at previous inspections. At the time of the visit 38 service users requiring nursing care were resident at the home. What the service does well: What has improved since the last inspection? Almost all of the requirements made at the last inspection have been met. The Registered Manager has developed links with community based Health Care Professionals, who provide appropriate support when required. Seven Health Care Assistants are now trained to NVQ II or higher, and two are currently doing their NVQ level II training. A programme to refurbish bedrooms and ensuite rooms has commenced. Bathrooms are also being refurbished. The home has acquired two more hoists for the safe moving and transferring of service users. Russell Court Nursing Home H56-H06 S26202 Russell Court V225076 050505 Stage 4.doc Version 1.30 Page 6 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. Russell Court Nursing Home H56-H06 S26202 Russell Court V225076 050505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Russell Court Nursing Home H56-H06 S26202 Russell Court V225076 050505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 4 Prospective service users are visited by a Registered Nurse and appropriately assessed prior to admission. This assists prospective service users and their representatives in making an informed choice. Despite this, the needs of a long-term service user are not fully met, as staff still require specific training. EVIDENCE: Registered Nurses undertake pre admission assessment visits to prospective service users prior to a decision of residence being made. Additional information is obtained from care management where this is relevant. A service user with a learning disability has lived at the home for many years and likes living there. Sadly care staff have still not received specific training to ensure they are providing appropriate care. The Manager said arrangements have been made for this to be undertaken at a nearby day centre shortly. This training need has been identified at previous inspections and must be addressed. Russell Court Nursing Home H56-H06 S26202 Russell Court V225076 050505 Stage 4.doc Version 1.30 Page 9 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 standard(s) 7, 8, 9, 10 and 11 Not all service users’ needs, wishes and risks are adequately recorded in their care records. Personal care and support is offered in a way to protect service users privacy and dignity. EVIDENCE: Through discussion with staff it was evident that care needs were known and being addressed. Sadly this information was not always recorded in the respective plans. It was difficult to establish whether the plans had been composed with input from the service user and or their advocate either, as they did not contain their signatures or reference to any involvement. Some care records fields/prompts had been left blank, giving the impression the documents were incomplete. Clinical risk assessments are used to monitor the effectiveness of the care planned. These include moving and handling, tissue viability, nutrition and observations. The nutritional assessment in one case and an observation Russell Court Nursing Home H56-H06 S26202 Russell Court V225076 050505 Stage 4.doc Version 1.30 Page 10 chart in another were not reflective of two particular service users’ current condition. Medication administration record charts are maintained. Some service users are prescribed “as required medication” for pain relief. However precise administration details were not stated in the respective care records. Registered Nurses support most service users with their medication, although one service user likes to self-administer a particular medication. There was no written record of whether this practice had been risk assessed or indeed was being subsequently monitored. The home is registered for terminal illness. The records inspected did not provide sufficient information in respect of service users wishes and preferences in respect of death and dying. Whilst recognising this is a sensitive subject, it is important aspect of care, which must be addressed. The carpet flooring in the room now used to store medications and nursing aids and sundries is badly stained and is not appropriate for a clinical setting. Russell Court Nursing Home H56-H06 S26202 Russell Court V225076 050505 Stage 4.doc Version 1.30 Page 11 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 standard(s) 12, 13, 14 and 15 Service users are served appetising meals and can choose where to eat. Service users are enabled to continue their links in the community and choose how to spend their day. EVIDENCE: Service users are offered choice of menu. The chef meets daily with service users to obtain their views and opinions of the meals provided. Service users said the food is good. Lunchtime meals are served in two sittings enabling service users to eat in the manner they wish. Many service users were seen enjoying a game of Bingo in the afternoon of the visit. Other service users were seen in their rooms resting or watching their TV. A service user expressed delight at having been able to purchase new clothes from a clothes sale recently held at the home. Visitors are able to come and go as they wish. A quiet room is available if visitors wish to have a private meeting. The results of two recent surveys carried out by the home indicated relatives and service users are satisfied with the present range of activities. Fundraising is underway for the home to purchase its own mini bus, which will enable more frequent external trips. Russell Court Nursing Home H56-H06 S26202 Russell Court V225076 050505 Stage 4.doc Version 1.30 Page 12 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 standard(s) 16, 17 and 18 The current method of recording details of all types of complaints, including lost property, is not adequate, and may result in service users and or their representatives feeling their comments are not listened to. Service users are enabled to participate in the political process. Staff have an understanding of adult protection issues, which protects service users from abuse. EVIDENCE: A complaints procedure is prominently displayed in the reception hall. Service users said they speak to staff if they are concerned about anything. A visitor said their relative had recently lost their glasses. The Manager was not aware of this. The Commission has not received any formal complaints about the home since the last inspection. A member of the Primary Care Trust will be providing Adult Protection awareness training in the near future. Arrangements had been made for service users to vote in the General Election. Russell Court Nursing Home H56-H06 S26202 Russell Court V225076 050505 Stage 4.doc Version 1.30 Page 13 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 standard(s) 19, 25 and 26 Service users live in a clean, comfortable and safe environment. EVIDENCE: The Provider ensures the home’s environment is well maintained. A bedroom and ensuite refurbishment programme has commenced. Bathrooms are being refurbished. Service users spoke positively about the new bath. The standard of cleaning at the home is good. Indeed visitors and service users said the home is always kept very clean. Beds are being replaced with a model, which enables service users to adjust the bed themselves. Russell Court Nursing Home H56-H06 S26202 Russell Court V225076 050505 Stage 4.doc Version 1.30 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30 Since the last full assessment of standard 29, vetting and recruitment practices have declined with appropriate checks not being carried out and potentially leaving service users at risk. Staffing levels are based on staff competencies and skills and the dependency of service users. The arrangements for induction of staff are good with staff demonstrating a clear understanding of their roles. EVIDENCE: The home uses the staffing levels stated in the staffing notice issued in 1999 as a basis to determine staffing levels. These levels are then reviewed to reflect the dependencies of the current service users. An off duty record is maintained. Service users said the home now has more staff to help them when they require assistance. Staff are also employed for activities, cooking, cleaning, laundry, administration and maintenance. Management is committed to training. Four health care assistants are trained to NVQ level II care, three are trained to NVQ level III and two are currently doing their NVQ level II training. Two Registered Nurses and a number of health care assistants have completed appropriate palliative care training. Recent training topics include MS, wound care, Parkinsons, moving and Russell Court Nursing Home H56-H06 S26202 Russell Court V225076 050505 Stage 4.doc Version 1.30 Page 15 handling and First Aid. This ensures service users receive up to date nursing care. The files of two newly appointed care staff were inspected. The files contained application forms, terms and conditions of appointment and ID evidence. Only one file contained a full CV. Both files contained letters addressed to referees, but only one reference had been received. Criminal Record Bureau check clearance had not been received. POVAFirst checks had not been obtained either. Both staff have commenced working at the home. The Manager has introduced a more comprehensive induction programme, which follows the Skills for Social Care training requirements. A new member described how she was working through her induction programme and said she is well supported by other members of staff. This ensures new staff are appropriately equipped to care for service users Registered Nurses are encouraged to maintain a portfolio of evidence for the post registration education requirements. Russell Court Nursing Home H56-H06 S26202 Russell Court V225076 050505 Stage 4.doc Version 1.30 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33 and 38 Service users and staff are supported by a competent and experienced Manager. EVIDENCE: The Registered Manager, Mrs Meek, is a Registered General Nurse registered with the Nursing and Midwifery Council. Mrs Meek is in the process of attaining RM1 and RM2 units of the Registered Managers Award. Satisfaction surveys are carried out and the results analysed and published on the home’s notice board. Relatives meetings are arranged. Service users are asked for their suggestions but said they could not recall having attended a residents meeting lately. The home is a member of the National Care Homes Association and is audited by them. Russell Court Nursing Home H56-H06 S26202 Russell Court V225076 050505 Stage 4.doc Version 1.30 Page 17 Appraisals have been carried and supervision is about to commence. Staff meetings take place regularly and are minuted. Registered Nurse meetings have been introduced. This allows Registered Nurses to discuss clinical practice matters. Russell Court Nursing Home H56-H06 S26202 Russell Court V225076 050505 Stage 4.doc Version 1.30 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x x x x 3 3 STAFFING Standard No Score 27 3 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 3 3 2 3 3 x x x x 3 Russell Court Nursing Home H56-H06 S26202 Russell Court V225076 050505 Stage 4.doc Version 1.30 Page 19 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 OP4 Regulation 18 Requirement Care staff must be trained in aspects of care relevant to the current service users assessed needs. (Timescale of 31/12/04 not met). The clinical room floor must be kept in a hygienic condition. (Timescale of 6/12/04 not met). Care staff must not commence employment at the home until satisfactory references and CRB clearance has been obtained. Full employment histories, together with explanations of any gaps, must be obtained. Timescale for action 31/08/05 2. 3. OP9 OP29 13 19, Sch 2 31/07/05 06/05/05 4. OP29 19, Sch 2 06/05/05 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. 2. 3. 4. Refer to Standard OP11 OP9 OP7 OP7 Good Practice Recommendations Service user plans must contain information service users wishes and preferences in respect of death and dying. Risk assessments must be carried out with regard to Service Users self-administering medications. Care records should be complete of all fields and prompts. Service users plans must be composed and reviewed with H56-H06 S26202 Russell Court V225076 050505 Stage 4.doc Version 1.30 Page 20 Russell Court Nursing Home 5. 6. 7. 8. 9. OP7 OP28 OP31 OP8 OP16 the involvement of the Service Users and or their advocates. If this is declined, the decision must be stated. Service user plans must be complete and current of all needs and problems Fifty percent of care staff must be trained to NVQ level II or equivalent. The Registered Manager must attain the requisite units to complete the Registered Manager Award. Clinical risk assessments must be complete and current. A record of all complaints and comments, including lost property, should be maintained. Russell Court Nursing Home H56-H06 S26202 Russell Court V225076 050505 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone Kent, 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. Extracts may not be used or reproduced without the express permission of CSCI Russell Court Nursing Home H56-H06 S26202 Russell Court V225076 050505 Stage 4.doc Version 1.30 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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