Inspection on 15/08/05 for Russell Hill Lodge

This inspection was carried out on 15th August 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Russell Hill Lodge 15/04/08

Russell Hill Lodge 20/09/07

Russell Hill Lodge 18/04/06

Russell Hill Lodge 23/12/05

Russell Hill Lodge 13/01/05

Russell Hill Lodge 12/08/04

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

CARE HOME ADULTS 18-65 Russell Hill Lodge 39 Russell Hill Road Purley Surrey CR8 2LD Lead Inspector Margaret Lynes Unannounced 15 August 2005, 11.30-1830 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 Hill Lodge G53 G53 S25833 russellhilllodge V194610 150805 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Russell Hill Lodge Address 39 Russell Hill Road, Purley, Surrey, CR8 2LD 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) 020 8668 3212 020 8668 3212 Laurel Residential Homes Limited Mrs Nina Harman Care Home 18 Category(ies) of Mental disorder registration, with number of places Russell Hill Lodge G53 G53 S25833 russellhilllodge V194610 150805 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13/1/05 Brief Description of the Service: Russell Hill Lodge is registered to provide care to up to 18 adults who have past or present mental health problems. The home is situated close to Purley town centre and therefore well placed for access to the town’s amenities and transport. The house is a large detached traditional brick built building. It has 18 single rooms, a lounge, dining area and conservatory. The latter area is the designated smoking room. One of the single bedrooms has en - suite facilities, including bathing and catering facilities. Russell Hill Lodge G53 G53 S25833 russellhilllodge V194610 150805 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced, and was conducted over one day. During that time a number of records were examined, a tour was made of the communal areas of the home, and time was spent talking with service users and staff. The last inspection report contained 9 requirements. Of these two were in the process of being completed (the replacing of the hallway and stair floor covering; and repairs to damaged bath panels), while a new system has been devised re quality assurance but it is not yet operational. The need for the proprietors to visit the home on a monthly basis and provide a written report of each visit is still not being fully achieved. The remainder of the requirements have been met. This visit resulted in a further 2 requirements being made. These should not be difficult to meet. In meeting them the home will improve the overall quality of the service being provided, and improve the well-being of the service users. What the service does well: What has improved since the last inspection? What they could do better: This report contains just two new requirements. One relates to the need to better document pre-admission assessments, the other to ensure that new Russell Hill Lodge G53 G53 S25833 russellhilllodge V194610 150805 stage 4.doc Version 1.40 Page 6 staff receive an appropriate induction and that this is recorded. The outstanding requirements concern the need to have a quality assurance system in place, and for the proprietors to write a report of each of their monthly visits. None of these requirements should be difficult to meet, and in doing so the quality of the service being provided will be further enhanced. 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 Hill Lodge G53 G53 S25833 russellhilllodge V194610 150805 stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Russell Hill Lodge G53 G53 S25833 russellhilllodge V194610 150805 stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 and 2 The home has met the previously made requirements regarding the Service User Guide and the Statement of Purpose, which means that prospective service users now have the information that they need to make an informed decision about where to live. The Inspector was not satisfied that adequate assessments were being made of prospective service users. This means that service users cannot be assured that the home has taken into account their individual needs, and that it can meet them; and that the staff in the home will not be as familiar as they could be with new service users, or have a full understanding of what specific service they will need to provide. EVIDENCE: Prior to this inspection a copy of the revised Statement of Purpose and Service User Guide were sent to the local CSCI office. They now contain all of the information required in the Regulations. The files of the three newest residents were examined. The system in this home for processing referrals is for the placing Authority to visit and if they want to pursue a placement to then send the home a copy of the latest CPA review for their client. The client and possibly their relatives will then visit the Russell Hill Lodge G53 G53 S25833 russellhilllodge V194610 150805 stage 4.doc Version 1.40 Page 9 home. Following this the home manager will visit the potential service user, and if they think they will fit into the Russell Hill environment and the home can meet their presenting needs, a six week trial placement will be offered. While there is a lot of pre-placement work being done, there was little to actually evidence this – hence the view of the Inspector that the Standard could not be said to be fully met. Russell Hill Lodge G53 G53 S25833 russellhilllodge V194610 150805 stage 4.doc Version 1.40 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 and 9 There was good evidence of the involvement of service users in planning their care. This means that service users are kept fully appraised of their assessed and changing needs and can feel that the plan is an accurate reflection of their personal goals. The service users spoken with all felt that they were enabled to make decisions about their lives, with as much input from staff as necessary. They also felt that they were enabled to take risks as part of an independent lifestyle. EVIDENCE: The manager is in the process of revising the way staff record care plans, progress notes and risk assessments. Service users are being encouraged to help write their own plans and progress notes, which staff will then go through with them. Some of the files had already been restructured; others contained the ‘old’ records which staff continued to work with until new ones could be completed. The files of the newest residents did not, actually, contain any of the aforementioned documentation. For the first six weeks of any placement, staff Russell Hill Lodge G53 G53 S25833 russellhilllodge V194610 150805 stage 4.doc Version 1.40 Page 11 will continue to use the care plan drawn up as part of the Care Programme Approach, which contains a crisis plan as oppose to a risk assessment. After six weeks, if the placement is going to continue, staff and service user will draw up an in-house care plan to supplement that of the CPA, and this will be based on needs assessed during that initial six-week period. Russell Hill Lodge G53 G53 S25833 russellhilllodge V194610 150805 stage 4.doc Version 1.40 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 15, 16 and 17 The Inspector was able to witness residents engaging in both pre-planned and ad-hoc activities, in-house and in the community. This means that the service users are given the opportunity to take part in appropriate activities, and be part of the local community. The level of contact with family and friends varies considerably. Some of the service users have little or no contact with friends/family or associates outside of the home. Nevertheless, contact with family and friends is supported and encouraged. The service users are offered a healthy diet, and all said that they enjoyed their meals, particularly since the appointment of a new cook. EVIDENCE: There is a large activities board in the office upon which is displayed the weekly planned activities for the service users. These activities varied from attending local clubs, to cooking sessions, to domestic chores. There is also an in/out board in the entrance upon which residents are encouraged to record Russell Hill Lodge G53 G53 S25833 russellhilllodge V194610 150805 stage 4.doc Version 1.40 Page 13 their more ad-hoc activities. A number of the service users took the trouble to talk with the Inspector. All were very pleased with the services on offer and the non-judgemental support of the staff team. Relatives are encouraged to maintain contact and play a part in the care of their family member. At the time of this visit however, there were none available to meet with. The home has recently appointed a new cook. Although only in post for two weeks the service users were already making favourable comments about her cooking. Residents can use the kitchen to make themselves drinks and snacks. Russell Hill Lodge G53 G53 S25833 russellhilllodge V194610 150805 stage 4.doc Version 1.40 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 20 From observing the interaction between the staff and the service users, and having also talked to a number of service users, it was evident that they felt that they were being treated with respect and that they received personal support in the way that they preferred. Staff ensure that each resident is able to access community based health facilities as and when required. The Inspector was satisfied that service users were adequately protected by the home’s policies and procedures re medication, and service users are encouraged to self medicate wherever possible. EVIDENCE: The service users spoken with were complimentary about all of the staff team. They felt that they were well looked after, but were also given the opportunity to be involved in their care and make decisions, including how they received personal support, for themselves. To the extent that community based services are available for this client group, staff do all they can to enable the residents to access it. They are encouraged to make and attend their own medical appointments and, where appropriate, Russell Hill Lodge G53 G53 S25833 russellhilllodge V194610 150805 stage 4.doc Version 1.40 Page 15 collect their own medication. The Inspector was a little concerned at the number of times service users did not receive their medication because it was out of stock. This was apparently due to occasional delays in medication being prescribed and the local Resource Centre (from where some of the residents collect their medication) receiving it. It is recommended that the manager explore this issue to see if there is any way to improve the process, so as to enable service users to receive their medication on time. The previously made requirement regarding the need to ensure that the medication administration records are accurately completed at all times had been met. Russell Hill Lodge G53 G53 S25833 russellhilllodge V194610 150805 stage 4.doc Version 1.40 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 The home has a satisfactory complaints procedure in place, which is accessible to service users. There was also a satisfactory adult protection procedure in place which, if followed by staff, will offer sufficient protection to service users. EVIDENCE: No complaints have been made since the last inspection. Similarly, there have not been any adult protection concerns at the home. The majority of the staff team have attended training in the protection of vulnerable adults. Russell Hill Lodge G53 G53 S25833 russellhilllodge V194610 150805 stage 4.doc Version 1.40 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 and 30 A tour was made of the areas of the home that had been previously identified as needing attention. Two of the previous issues were still in the process of being rectified, however the vast majority of the home was in a good state of repair, and once these issues have been dealt with, the home will fully meet the need to provide a safe and well-maintained environment. EVIDENCE: Following the previous inspection two requirements were made with regard to the need to replace the carpet in the hallways and on the stairs, and to replaced damaged bath panels. Work has started on rectifying both of these issues. Most of the new flooring has been laid, while refurbishment of the bathrooms is also underway. Several of the bedrooms were inspected, where the occupants proudly showed off their improved housekeeping skills. The communal areas were clean and hygienic. Russell Hill Lodge G53 G53 S25833 russellhilllodge V194610 150805 stage 4.doc Version 1.40 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34 and 35 The Inspector was satisfied that there was an appropriate number of staff on duty, which means that service users were provided with the support that they needed. From the files examined the Inspector was not satisfied that the recruitment procedure has been appropriately robust. Not all new staff had been properly vetted before being appointed, which means that the service users were placed at unnecessary risk. While staff are able to access a variety of in-house training courses, the lack of (evidence of) an appropriate induction for new staff means that it is possible that the service users are not supported by a staff team which is as well trained as it could be. EVIDENCE: Following the previous inspection it was required that there be a designated shift leader on each shift, in addition to 2 care staff. From the rotas supplied it was evident that this was now being achieved, albeit on some occasions the manager worked as part of the rota. Although the new staff files did contain the required documentation, it was evident that two staff had commenced work without having received their Russell Hill Lodge G53 G53 S25833 russellhilllodge V194610 150805 stage 4.doc Version 1.40 Page 19 CRB/POVA checks. While POVA checks have subsequently been carried out, as have CRB disclosures (although the return of one is still outstanding), and no adverse information has arisen, the manager was clearly informed that this process was not acceptable. Training carried out recently includes topics such as food hygiene, health and safety, care planning, medication, record keeping, bi-polar illness and schizophrenia. It was pleasing to see that residents were encouraged to take part in the health and safety and food hygiene training. Obtaining a certificate in these areas will be a boost to their confidence and also stand them in good stead in their goals to achieve more independent living. A number of staff have commenced or are due to commence shortly, NVQ courses. This is commendable. It was unfortunate, however, that there was no evidence that the new care staff had received an appropriate induction to the home. The manager undertook to rectify this immediately. Russell Hill Lodge G53 G53 S25833 russellhilllodge V194610 150805 stage 4.doc Version 1.40 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39, 40, 41 and 42 The Inspector was not fully satisfied that the home was being run in the best interests of the service users as the quality assurance system had not yet been implemented, albeit it was now in place. The home’s policies and procedures were regularly updated, thereby contributing to the safeguarding of service users rights and best interests. Similar comments can be expressed regarding the records that were examined. The Inspector felt that in the areas that were inspected on this visit (risk assessment and fire safety), the home was being maintained to an appropriate level of safety, thus ensuring that service users were not subject to unnecessary risk. Russell Hill Lodge G53 G53 S25833 russellhilllodge V194610 150805 stage 4.doc Version 1.40 Page 21 EVIDENCE: Following the previous inspection four requirements were made with regard to this section. The first related to the need for a quality assurance system in the home. While a system has now been devised it has yet to be implemented. The second related to the need for the proprietors to carry out monthly visits to the home and to make a written report of each visit. This is still not being achieved on a monthly basis. The third concerned the need to ensure the policies and procedures were regularly revised and updated; while the fourth related to the need to ensure that all records were up to date. Both of these latter requirements have been met. Russell Hill Lodge G53 G53 S25833 russellhilllodge V194610 150805 stage 4.doc Version 1.40 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 2 x x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 3 3 Standard No 31 32 33 34 35 36 Score x x 3 3 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Russell Hill Lodge Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x 2 3 3 3 x G53 G53 S25833 russellhilllodge V194610 150805 stage 4.doc Version 1.40 Page 23 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 39 Regulation 24 Requirement Timescale for action 30/9/05 2. 3. 2 35 14 18 4. 39 26 An appropriate quality assurance system must be implemented in the home, which seeks service users views and measures the success of the home in meeting the aims and objectives laid out in the Statement of Purpose. The previously set timescale has not been met. The manager must ensure that 15/8/05 more detail recording is made of pre-admission assessments. The manager must ensure that 15/8/05 all new staff receive a suitable induction and that this is recorded. The proprietors must ensure that 15/8/05 they visit the home on a monthly basis and write a report of that visit. A copy of the report must be sent to the CSCI (local) office. The previously set timescale has not been fully met. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Russell Hill Lodge G53 G53 S25833 russellhilllodge V194610 150805 stage 4.doc Version 1.40 Page 24 No. 1. Refer to Standard 20 Good Practice Recommendations It would be good practice to investigate if there is any action that can be taken to remove the occasional delays in medication being available for collection, thus helping to ensure that service users do not have to do without. Russell Hill Lodge G53 G53 S25833 russellhilllodge V194610 150805 stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection 8th Floor, Grosvenor House 125 High Street Croydon CR0 9XP 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 Hill Lodge G53 G53 S25833 russellhilllodge V194610 150805 stage 4.doc Version 1.40 Page 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!