CARE HOMES FOR OLDER PEOPLE
Russell Court Nursing Home Russell Square Longfield Kent DA3 7RY Lead Inspector
Elizabeth Baker Announced 06 October 2005 09:30 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 V245750 061005 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Russell Court Nursing Home Address Russell Square Longfield Kent DA3 7RY 01474 708151 01474 707371 russellcourt@bt.connect.com Russell Court Limited 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) Mrs Eunice Melinda Meek Care Home with Nursing 40 Category(ies) of Old Age (40) registration, with number of places Physical disability (5) Terminally ill (5) Russell Court Nursing Home H56-H06 S26202 Russell Court V245750 061005 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: The maximum number of bed spaces is restricted to 40 Date of last inspection 05 May 2005 Brief Description of the Service: Russell Court Nursing Home provides nursing care for up to 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 fiveperson 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 a water-feature, adjacent to the quiet room, which can be accessed by residents 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 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 V245750 061005 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The announced inspection took place over seven hours on the 6 October 2005. A partial tour of the home was carried out. Some residents and a visitor were spoken with, as well as a number of staff. One member of staff was interviewed in private. At the time of the visit the home was fully occupied. The Registered Manager Mrs Meek and Head of Care Mrs Skelton were available during the inspection process. Some judgements about the quality of care, life and choices were taken from conversations with residents, visitor and staff, as well as direct and indirect observations. Some records were seen as part of case tracking and to assess work on the requirements and recommendations made at the last inspection. In response to the announcement of this inspection the Commission received a total of 46 comment cards from Relatives/Visitors (17), Residents (15), GPs (2), Care Managers (4) and Health (and allied) Care Professionals (8). Some of their comments have been incorporated into this report. This is the second inspection of this home for the year 2005/06. Not all key standards have been inspected on this occasion, where they were met at the first visit. This report should therefore be read in conjunction with the inspection report dated 5 May 2005. What the service does well:
Management is committed to ensuring the environment is kept to a good standard and staff are appropriately trained. Indeed 64 of health care assistants are now trained to NVQ level II or equivalent in care. Comment card respondents’ additional remarks included “I am very happy with the care my [relative] receives from the staff. My [relative] is happy and secure and enjoys a very good relationship with all the staff. The managing staff are very approachable and friendly”; “My [relative’s] treatment here is wonderful; my [relative] wants for nothing and is treated with dignity and respect”; “I love the activities that the home provides for the clients”; “I am happy with the way my [relative] is taken care of, always pleased with food and all that goes on”; “I feel that this is a first rate nursing home having seen a number of other homes that leave a lot to be desired”; and “Very happy altogether. Staff very helpful and always willing to help you”. Russell Court Nursing Home H56-H06 S26202 Russell Court V245750 061005 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? 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 V245750 061005 Stage 4.doc Version 1.40 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 V245750 061005 Stage 4.doc Version 1.40 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) 2 and 4 Prospective residents and their relatives and advocates are provided with information about the home to assist them in making a decision about moving into the home. EVIDENCE: The home has a Statement of Purpose and brochure informing prospective residents and their advocates about the services and facilities provided at the home. The brochure is currently being reviewed to ensure it contains up to date information about the home. Residents and/or their advocates are provided with details of terms and conditions of residency at the home. This helps both parties understand the rules, responsibilities and costs of staying at the home. Arrangements are in hand for all care staff to receive appropriate training for a long term resident who has specific needs, in addition to nursing care, for which the home is not actually registered for. This will ensure the resident’s complete needs are met in accordance with current good practice. The home is not registered for intermediate care.
Russell Court Nursing Home H56-H06 S26202 Russell Court V245750 061005 Stage 4.doc Version 1.40 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 and 11 The health needs of residents are well met with evidence of good multidisciplinary work taking place on an assessed needs basis. EVIDENCE: Three care records were inspected as part of the case tracking process. The residents have been provided with care plans and associated clinical risk assessments, such as nutrition, oral hygiene, skin integrity and moving and handling. However, there was no evidence on the records to show whether the resident or an advocate had been involved in the writing up of the care plan, if indeed they wished to be involved. The admission assessments were incomplete of information and one skin integrity assessment was not totally reflective of the resident’s current condition as indicated in the corresponding daily records. The records contained information of input from other clinicians’ involvement in the residents care. This ensures residents receive all their NHS entitlements and additional specialist support. The medication administration record charts relating to the three care records inspected were completed as required. This ensures residents receive their appropriate medications. Russell Court Nursing Home H56-H06 S26202 Russell Court V245750 061005 Stage 4.doc Version 1.40 Page 10 The manager discussed the problems associated with trying to obtain details of residents’ preferences and wishes in the event of death and dying. Whilst recognising this is a delicate matter, not having this information readily available could result in unnecessary distress at an already difficult time. Russell Court Nursing Home H56-H06 S26202 Russell Court V245750 061005 Stage 4.doc Version 1.40 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) These standards were met at the last inspection. Therefore they have not been re-inspected on this occasion. EVIDENCE: Russell Court Nursing Home H56-H06 S26202 Russell Court V245750 061005 Stage 4.doc Version 1.40 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 Residents are protected from risk by the home’s complaints procedures. EVIDENCE: Most of the comment card respondents indicated they knew who to speak to if they had a complaint or were unhappy about their care. Following a recommendation made at the last inspection, records are kept of all complaints. This is good practice as it assists the home in quality assurance monitoring. The activities organiser has recently introduced “lost property” sessions into the activities programme. This is a good way of ensuring lost property is returned quickly to the rightful owners. Russell Court Nursing Home H56-H06 S26202 Russell Court V245750 061005 Stage 4.doc Version 1.40 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, 20, 21, 22, 23, 24, 25 and 26 The home provides a clean and well-maintained environment for residents to live in. EVIDENCE: The home was clean, tidy and odour free. Indeed a visitor said the home is always clean and odour free. The provider continues to ensure the home is decorated to a good order throughout. A number of bedrooms have been redecorated since the last inspection and a bathroom has been revamped. A resident described how much they enjoyed using the new bath. Maintaining the home to a good standard ensures residents live in a homely and comfortable environment. An environmental health technical officer carried out a food hygiene inspection on 27 July 2005, which identified some matters required attention. The manager has subsequently confirmed the work has been completed. Russell Court Nursing Home H56-H06 S26202 Russell Court V245750 061005 Stage 4.doc Version 1.40 Page 14 The home has a range of lifting equipment including two sling and three standing hoists. This ensures staff transfer residents in a safe manner. To complement the home’s range of nursing beds, two new fully adjustable beds have been purchased. These beds have a device, which enable residents to adjust the bed for their own comfort. Bedrooms visited had been individualised with personal affects. Colour schemes of the recently re-decorated bedrooms were done in consultation with the residents. Bedrooms are of a good size and allow for nursing aids and equipment to be accommodated, if required by the resident, without cramping the room. A number of residents commented on the good size of their bedrooms. The home has a large, separate dining room in which residents can choose to take their meals or not. There is also a large lounge and adjoining quiet room. Indeed this room is appreciated by some residents and one commented that the quiet room feels like home. A choice of day rooms ensures residents can choose where to spend their time. Russell Court Nursing Home H56-H06 S26202 Russell Court V245750 061005 Stage 4.doc Version 1.40 Page 15 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) 28 and 29 Residents are safely cared for by appropriately trained staff. EVIDENCE: The pre inspection questionnaire form indicates 64 of health care assistants are now trained to NVQ level II care, ensuring appropriately trained staff care for residents. A review of two staff files identified the system for vetting and recruiting staff has improved. Indeed a member of staff described their appointment process and said they had been impressed by the honesty and tactics used during the interview. The candidate had previously worked in other care homes. Russell Court Nursing Home H56-H06 S26202 Russell Court V245750 061005 Stage 4.doc Version 1.40 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, 25 and 38 Residents benefit from a well run home managed by an appropriately qualified and experienced manager. EVIDENCE: Mrs Meek has successfully completed the remaining units required to obtain the Registered Managers Award. Mrs Meek is a Registered Nurse. This ensures the home is run and managed by an appropriately qualified person. Staff spoke enthusiastically about their different roles and demonstrated an eagerness to do the best they could for residents. The employee interviewed commented on the full support she has received from all members of staff since she began working at the home. Comment card respondents from Health Care Professionals stated “all staff at Russell Court have worked closely with me and followed through all recommendations to the benefit of my client”
Russell Court Nursing Home H56-H06 S26202 Russell Court V245750 061005 Stage 4.doc Version 1.40 Page 17 and “Staff are always concerned over the clients’ best interests physically and mentally. It is a pleasure to visit”. The home has responsibility for maintaining personal allowances for one resident. Systems are in place to ensure this is handled appropriately on the resident’s behalf. The pre inspection questionnaire form in support of this visit, indicates servicing and testing of the home’s equipment and systems is carried out appropriately to keep the home safe. Russell Court Nursing Home H56-H06 S26202 Russell Court V245750 061005 Stage 4.doc Version 1.40 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 3 x 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 x 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x
COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 x 28 3 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 4 3 3 x 3 x x 3 Russell Court Nursing Home H56-H06 S26202 Russell Court V245750 061005 Stage 4.doc Version 1.40 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 residents assessed needs. (Timescale of 31/08/04 not completely met) Timescale for action 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP7 OP8 OP11 OP8 Good Practice Recommendations Care plans must be composed and reviewed with the involvement of the residents and or their advocates. If this is declined the decision must be recorded. Skin integrity assessments must reflect residents current condition. Details of residents wishes and preferences in respect of death and dying must be obtained and recorded. Assessments should be complete of all fields and prompts. Russell Court Nursing Home H56-H06 S26202 Russell Court V245750 061005 Stage 4.doc Version 1.40 Page 20 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
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