Inspection on 20/09/07 for Russell Hill Lodge

This inspection was carried out on 20th September 2007.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Russell Hill Lodge 15/04/08

Russell Hill Lodge 18/04/06

Russell Hill Lodge 23/12/05

Russell Hill Lodge 15/08/05

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 David Halliwell Key Unannounced Inspection 20th September 2007 09:30 Russell Hill Lodge DS0000025833.V350695.R01.S.doc Version 5.2 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 Hill Lodge DS0000025833.V350695.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 Adults 18-65. 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 Hill Lodge DS0000025833.V350695.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Russell Hill Lodge Address 39 Russell Hill Road Purley Surrey CR8 2LD 020 8668 3212 F/P 020 8668 3212 ronchiwome@yahoo.co.uk 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) Laurel Residential Homes Limited Post Vacant Care Home 18 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (18) of places Russell Hill Lodge DS0000025833.V350695.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th April 2006 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 towns amenities and transport. The house is a large detached traditional brick built building. It has 18 single rooms, a lounge, dining area and conservatory. One of the single bedrooms has en - suite facilities, including bathing and catering facilities. There are also 2 self contained flats that are used for residents who are able to live more independently. Russell Hill Lodge DS0000025833.V350695.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection visit over 2 days undertaken by the Inspector responsible for Russell Hill Lodge. The Inspection covered all the key standards and involved a tour of the home, a review of all the homes records and formal interviews with staff and service users. Informal interviews were conducted with other service users as a part of the inspection of the home. Since the last inspection carried out at Russell Hill Lodge some progress has been achieved by the Manager and his staff team in meeting the previously set requirements and recommendations from the inspection carried out in April 2006. This is reflected in the report that follows. As a result of this key standards inspection several new requirements and recommendations have been made. Feedback on all these new requirements and recommendations was given verbally to the Manager at the end of this inspection visit. The Inspector found the residents and staff very helpful and they are to be thanked for the assistance that they gave him over the course of this inspection visit. What the service does well: What has improved since the last inspection? The filing and layout of information in the resident’s files has significantly improved and the link between residents needs assessments, care plans and action planning are one area that demonstrates some considerable improvement. Russell Hill Lodge DS0000025833.V350695.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Russell Hill Lodge DS0000025833.V350695.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Russell Hill Lodge DS0000025833.V350695.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and prospective residents may be assured that most of their needs will be assessed. Resident’s religious and cultural needs should be included in the assessment process. EVIDENCE: Standard 2 - The Inspector reviewed 4 of the 15 residents files, 2 of these files were for recent admissions of residents to the home since the last inspection in April 2006. Assessments of the resident’s needs had been undertaken by the Manager for each new person admitted to Russell Hill Lodge and these needs assessments covered most of the essential areas of a person’s life except their religious and cultural needs. Improved coverage in the needs assessment of the person’s rehabilitative and therapeutic needs is also required. It is noted that residents do sign their assessments although the residents own comments and views about their needs should be included as a part of the assessment. In addition to the assessment carried out by Russell Hill there was also assessment and care planning information supplied by the referring agencies. This however was not always as comprehensive as would have been expected and the Inspector has again recommended that the Manager should always request specific information to do with the rehabilitative aims and objectives from the referring agencies at the time of their request Russell Hill Lodge DS0000025833.V350695.R01.S.doc Version 5.2 Page 9 to place a new resident. This would ensure that staff at Russell Hill have all the available information about a prospective resident at an early stage of the process and would enable a fully informed decision to be made about whether and how best a residents needs could be met. Russell Hill Lodge DS0000025833.V350695.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 & 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are able to make decisions about their lives with assistance as needed. Their care plans are based on their assessed needs, however the reviews of these plans need to focus more on the progress that has been made over the period under review as to the achievements or otherwise in meeting the care plan objectives. Residents are supported to take risks as part of moving towards a more independent lifestyle. EVIDENCE: Standard 6 - As indicated in the previous section the Inspector reviewed 4 residents’ files and found evidence of individual plans having been drawn up and reviewed for each of these residents. At the last inspection in April 2006 a requirement was made that concerned the development of care planning to ensure all residents needs are planned for, monitored and reviewed including the social care and rehabilitative needs of the residents. The Manager informed the Inspector that since the last inspection a good deal of work has been Russell Hill Lodge DS0000025833.V350695.R01.S.doc Version 5.2 Page 11 carried out by his care team on the development and overhaul of residents care plans and a new model and format has been implemented. The review of the residents’ files at this inspection showed that some positive progress has been made towards achieving the requirement. The care plans seen were more detailed than before with specific care plan objectives that related to the assessed needs of the resident. In most cases the care plan objectives were linked in with an action plan for both the resident and keyworking staff to follow so that the objective may be achieved. The Manager informed the Inspector that the care plans are reviewed monthly and documentation was seen on file to support this. However the monthly reviews of these care plan objectives lacked sufficient detail relative to the progress or lack of it that had been made in meeting the objectives. Care plan objectives and action planning should be reformulated at the review in an appropriate way to better meet the resident’ needs. Sometimes care plan objectives will be completed changed where it becomes apparent they are unrealistic and unachievable. It is a requirement therefore that reviews monitor the success or otherwise of the care plan objectives and that they are revised in the light of the review findings. Care plans had been signed by residents and were dated. The care plans could also be seen to be linking in with the relevant care programme approach documentation of the mental health clinical teams. It is indicated earlier in this report that there is a need to develop the needs assessment process to include residents’ cultural and religious needs. Care plan objectives should also include these areas of a person’s life. All of the information required in schedule 3 of the Regulations was seen by the Inspector to be documented on the files and of the residents interviewed by the Inspector all said that they had been involved in the drawing up of their individual care plans. All residents interviewed felt that they had been properly consulted as to their own views and wishes and that what they had said had been properly considered in their care plans. Regular residents meetings are held within the home and there is an opportunity for residents to make their views known about relevant topical issues. Standards 7 & 9 - Residents are enabled to make decisions about their lives with assistance as needed. Risk assessments were seen on each of the files reviewed as a part of the initial assessment and care planning undertaken by Russell Hill. This helps in making the appropriate decision about a suitable placement and then in taking risks as a part of developing an independent lifestyle. Russell Hill Lodge DS0000025833.V350695.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 & 17. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Residents are able to take part in appropriate activities and are to a reasonable extent involved in local activities. Residents have appropriate relationships and their rights and responsibilities in their daily lives are recognised and respected by the staff in the unit. Residents are offered a healthy diet and they are assisted in learning cooking and food preparation skills. EVIDENCE: Standard 12 – The Inspector did find evidence that care support staff appropriately encourage the maintenance of resident’s relationships with family and friends if residents also wish to do so. The Manager told the Inspector that visitors to the home are encouraged and that they use the visitor’s book to sign in. The visitor’s book was seen in the hall and was evidently in regular Russell Hill Lodge DS0000025833.V350695.R01.S.doc Version 5.2 Page 13 use. The Manager also said that residents are enabled to take part in appropriate activities by the care staff, although when the Inspector looked at the files there was no evidence to show how a person’s cultural and religious needs had been assessed and considered in care planning terms. This needs to be addressed. The Manager told the Inspector that since the last inspection no residents currently attend college or adult education classes. One of the residents told the Inspector that she had recently been working in a bank as part of her care plan objective to help her get back into work. She said that this had had to cease during a period of relapse in her mental health, however she also told the Inspector that she is hoping to move on to less supported accommodation and also to find work. She said that her experience of working in a bank had helped her to regain some of lost confidence in being able to work successfully. Standard 13 - Interviews with residents demonstrated that they do attend some local community events although their wishes for an active community social life are somewhat limited. Information is made available and staff do encourage residents to be involved as much as possible in local activities. Some residents told the Inspector that they like to go to the shops. Residents make full use of local public transport facilities in order to get out and about and to see friends and family. Residents interviewed said that they thought local transport facilities were good. All residents living at Russell Hill Lodge are registered to vote in elections and are supported by staff to do so if they wish. The Inspector saw that some information is made available within the home about local activities for residents to take up if they wish. Standard 15 – Some of the residents interviewed by the Inspector said that they do keep in regular contact with their families and friends. Staff were seen to encourage the residents to keep and maintain contacts with family and friends so that they benefit from having appropriate relationships. There is a visitor’s room in the house that can be used by visitors who wish to see their relatives in the house. Standard 16 - Policies seen by the Inspector to be established within the unit ensure that resident’s rights to privacy, respect and dignity are respected. Residents who were interviewed confirmed that they felt staff respected these rights. Residents said that they have a key to their own bedrooms, their mail is unopened, their preferred form of address is used by staff and staff do knock on their doors before entering. The Inspector observed staff to be interacting with residents in a friendly and respectful manner. Russell Hill Lodge DS0000025833.V350695.R01.S.doc Version 5.2 Page 14 Interviews both with staff and residents confirmed that residents participate in household chores as a part of the community living experience and weekly “chores” are detailed in the weekly action sheets. Smokers are now required to go outside to smoke; however a tour of the premises together with the Manager clearly revealed that people do smoke in their bedrooms. The Manager told the Inspector that this is strongly discouraged by staff and risks associated with one resident in particular are risk assessed. There are appropriate policies regarding drug and alcohol taking on the premises. Standard 17 - With regards to meals and meal times there is a planned and varied menu which 3 residents told the Inspector they enjoy. The Inspector saw suitably planned menus for the week ahead. Specific needs are catered for and alternative choices are provided. Residents are able to state their preferences when the menus are planned and there are discussions about this at the resident’s community meetings, which are held regularly. The Inspector asked the Manager whether a dietician is ever asked for assistance, given the fact that weight-monitoring records are maintained for each resident. The Manager said that where necessary a dietician’s advice will be sought, as will the advice of the clinical team in CPA reviews where weight or diet is an issue. The Manager told the Inspector that residents do sometimes prepare their own food, mainly at breakfast and sometimes at lunch times, staff assist them when necessary as part of the rehabilitation programme. Evening meals are generally cooked by a member of staff. A bowl of fresh fruit was seen to be available in the kitchen for residents. Russell Hill Lodge DS0000025833.V350695.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 & 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users may be assured that they will receive personal support in the way that they prefer and require and that their physical and emotional needs will be met. Service users can rely on the home providing a well managed service with regards to medication. EVIDENCE: Standard 18 – The Manager explained to the Inspector that residents are expected to be up and about each morning by 9.30am so that they are able to participate in their rehabilitative care packages and this includes their need to take their medications at 9.30 each morning. The residents interviewed at this inspection said that they do choose when to go to bed, when to have a bath, what they wish to wear and what activities they do during the day. Some said that they have allocated housework chores on specific days of the week. Residents do not have a choice of their allocated key worker however the Manager said that they have a chance to discuss any issues they may have or Russell Hill Lodge DS0000025833.V350695.R01.S.doc Version 5.2 Page 16 which arise subsequent to the allocation of their key workers. Residents did not raise any concerns with the Inspector about their key workers. Residents at Russell Hill Lodge continue to receive regular input from their Community Psychiatric Nurses and from other professionals in their clinical teams. Standard 19 – With regards to the health care of the residents the Manager informed the Inspector that all residents are supported to keep well through accessing appropriate healthcare and associated mental health care support. All residents are signed up with local GP surgeries and some are registered with local dentists. The Manager told the Inspector that annual health checks take place at the GP surgeries and residents attend there. The Manager said that whether or not a resident uses the dentist is left up to the resident’s own decision but staff will encourage residents to use this service if required. Residents who spoke with the Inspector said that they go to see their GPs as and when necessary but they said they prefer not to go to the dentist. The Manager told the Inspector that an optician visits Russell Hill Lodge once annually. Standard 20 - The unit’s policies and procedures manual contains a policy for medication that includes the procedures that staff need to take in order to ensure the safe administration of medication to residents. A member of staff who was interviewed indicated to the Inspector that they were aware of the policy and know what the procedures are when administering medication to the residents. The Manager told the Inspector that only senior staff administers medication to the residents and only once they have completed training to do with the safe handling of medicines. 2 staff are required to fill in the medication record sheets. The Manager informed the Inspector that some residents do administer their own medication unsupervised and others self medicate but with supervision. Following a recommendation previously made by the Inspector, the Manager said that risk assessments have now been completed in conjunction with residents who are unsupervised. This is welcomed as it should help to minimise any potential hazards for the resident or others. Inspection of the medication records MAR sheets found no unexplained gaps and the Manager explained that 2 staff now administer all medications and both are required to sign the MAR sheet records immediately after the residents have been given their medications. The Manager explained that Boots provide the pharmacy services to Russell Hill Lodge and that they come to the home regularly and inspects the medication procedures. The Inspector asked to see the last Boots report and noticed that they had recommended a photograph of each resident be placed on a new medication front sheet on the Russell Hill Lodge DS0000025833.V350695.R01.S.doc Version 5.2 Page 17 MAR sheet records so as to help Russell Hill staff ensure they are administering medication to the correct resident. The Manager told the Inspector that this has since been completed and evidence was seen by the Inspector on the medication records. This is welcomed as it should assist in the protection of residents. The Inspector also looked at the medication records for each resident who uses PRN medication to see if there is staff guidance relating to the PRN medication. The Manager said that there is no such guidance in place. It is now therefore required and should be in place for each resident, be held in the medication files and readily accessible for staff and residents alike when needed. The guidance should set out clear information for each person using PRN medication covering possible side effects, when to give the medication and when not to give it. This should be completed in conjunction with the resident’s GP. When in place it should help in protecting the residents, ensure that PRN medication is given appropriately and when required and be of great assistance to staff who have to give residents PRN medication. The Inspector undertook a stock take of medications held in the home, together with the Manager. Records kept were inspected and stock levels of medications were seen to be satisfactory. Appropriate medication cabinets were seen in the office. Russell Hill Lodge DS0000025833.V350695.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 & 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users views cannot be fully confident that their complaints will be acted upon at Russell Hill. Although residents are protected from abuse, neglect and self harm by the policies and procedures of the home, staff should receive regular training in the protection of adults from abuse. EVIDENCE: Standard 22 – The Manager showed the Inspector the complaints record book as a part of the inspection process. 2 residents had made 3 complaints since the last inspection on 28.5.07. Issues raised by the 2 residents were to do with a lack of variety of food and also to do with a lack of sufficient heating. No record had been made of any actions taken or whether the complaints had been resolved or not. It is a requirement that any complaint made, be followed up by the Manager and staff at Russell Hill Lodge and that the policy and procedures are strictly followed in terms of process and timescales. A copy of the complaints process should be posted on the home’s notice board and in each resident’s service user guide. The Inspector spoke to one of the residents who had complained and asked about the issues she had raised as complaints and whether they had been resolved. She felt that they had been partially resolved in that there is now enough heating in the home but back in May it had been cold. Standard 23 – The Manager advised the Inspector that there is in place a policy for the Protection of Vulnerable Adults and that staff have been provided Russell Hill Lodge DS0000025833.V350695.R01.S.doc Version 5.2 Page 19 with training and guidance about what actions they need to take if the need arises. The Inspector saw the policy in the Unit’s policies and procedures file, the procedures are robust for responding to suspicion or evidence of abuse or neglect and they include a whistle blowing procedure for staff. Training records seen by the Inspector evidenced the fact that only 2 out of the 4 staff files seen have received POVA training from an authorised trainer in the last year. The Inspector pointed out that it is important that all Russell Hill Lodge’s staff compliment receive this full training at least once every 2 or 3 years. It is therefore required that the Manager ensure that all staff who have not done so, receive full and authorised POVA training in the near future. This will help ensure that all staff are up to date with the policies and procedures and other issues to do with the protection of vulnerable adults at Russell Hill Lodge. Certificated evidence will be required to be seen within the timeframe given at the end of this report. An inventory for each resident is now being kept on the residents’ files of their valuable belongings. The Inspector saw evidence of this. A recommendation made at the last random inspection has now been met. Russell Hill Lodge DS0000025833.V350695.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are living in a relatively comfortable and safe environment. EVIDENCE: Standard 24 – Russell Hill Lodge provides accommodation both in the main house and also in 2 additional flats attached to the main house. The Manager told the Inspector that both flats were vacant at the time of this inspection. The accommodation in the house provides a large lounge and dining room, a number of single bedrooms, a kitchen with good catering facilities, and several bathrooms and toilets on both floors. As a part of this inspection the Inspector made a tour of all areas of these premises together with the Manager. These were the findings on the day of the inspection: • Bathroom on the ground floor has had new taps and a shower unit as well as a new floor laid since the last inspection and a new bath panel. This has improved the conditions in this room for the residents. Russell Hill Lodge DS0000025833.V350695.R01.S.doc Version 5.2 Page 21 • • • • The Laundry room – the air pipe that vents the tumble dryers exits right next to the shed in which is housed the units freezers. The whole area is covered in fluff and debris from this pipe. It may lead to contamination of food in the freezers and a re-siting of the freezers is now required. The floor covering on the first floor landings that was newly laid at the time of the inspection in April 2006 has still not been finished in that it remains unsealed at its edges and where it joins with other rooms the floor levels are different providing trip hazards that provide a real danger to unwary residents. The lack of a sealed edge around the landing floors must make it extremely difficult to clean and could also provide a health hazard. Bedroom 14 was inspected; the decoration is very poor and tired and needs renewal. The stair carpet on the main stairway is stained and dirty and needs renewal. Several other of the residents’ bedrooms were inspected and as with room 14 the decoration was in a poor state and needs renewal. The tour of the premises undertaken together with the Manager identified a general need for the renewal and refreshment of the interior decorations as the existing state of the interior does nothing to lift the spirits and is depressing. Given the purpose of the unit this cannot be helpful for achieving the stated aim and purpose of this home. At the inspection carried out in April 2006 the Inspector spoke with the Manager and one of the Proprietors about the need for a development plan that identifies all the required maintenance and repairs and sets them out in a timetabled and costed schedule. This has now just been done by the Manager who showed the Inspector a copy of the schedule. This should be kept updated by the Manager on a regular basis and copied to the proprietors. It should help ensure that all repairs are addressed within a set timescale and with the priority repairs identified at the top of the list. Standard 30 – Within the home’s policies and procedures manual information is provided relevant to the control of infection. The home also has an infection control procedure which staff who were interviewed said they were aware of. Some training is provided by the agency and staff told the Inspector that they had received training in this area of work. Systems are in place to ensure that the spread of infection is controlled and minimised. Laundry facilities are sited so that soiled articles are not being carried through the kitchen and hand washing facilities are appropriately provided to ensure staff can use them where appropriate. This helps to ensure Russell Hill Lodge DS0000025833.V350695.R01.S.doc Version 5.2 Page 22 the protection of the residents’ health and to ensure that the home is clean and hygienic. Russell Hill Lodge DS0000025833.V350695.R01.S.doc Version 5.2 Page 23 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34, 35 & 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are supported by competent staff and by the home’s recruitment policy and procedures. Some improvements are still required in the training and supervision of staff. EVIDENCE: Standard 32 – The Manager informed the Inspector that as a part of the induction process all staff are issued with job descriptions and are asked to read and discuss the homes policies and procedures. The Manager could not confirm that all staff had been asked to sign to say that they had read, had a chance to discuss the policies and procedures with their supervisor in their supervision sessions and would be willing to work within them. It is recommended that the Manager ensure all staff do this. The Manager told the Inspector that there is a training programme underway and that a good deal of the training offered to staff is in house training offered by Managers. Courses provided to staff include: 1. The safe handling of medication and administration, 2. 1st Aid, Russell Hill Lodge DS0000025833.V350695.R01.S.doc Version 5.2 Page 24 3. 4. 5. 6. 7. Fire safety, Manual handling, Food hygiene, The rehabilitation process, Aggression and violence. With regards to the need to ensure that all staff hold an NVQ qualification by the end of this year, the Manager told the Inspector that most staff have or are completing their NVQ training at level 2 or above. Evidence will need to be seen of NVQ certificates (for those staff still receiving training) on the staff training files, that confirms that all staff have obtained their NVQ qualifications. Residents interviewed told the Inspector that staff are approachable and the Inspector saw staff taking time to deal with resident’s questions. Standard 34 - There is in place an appropriate recruitment policy. 4 of the 10 staff files were inspected. Generally the files were in much better order than at the last inspection and most of the information required under the Standard 34 was in evidence. Staff interviewed did confirm that have a contract of employment and that they understand their terms and conditions as well as their roles and responsibilities within the home, however a copy should be available for reference in the unit. The Manager informed the Inspector that all the staff at Russell Hill Lodge have appropriate and valid criminal record bureau checks and that these checks will be renewed every 3 years. The Inspector saw evidence of this on those files inspected. Standard 35 - The Manager informed the Inspector that a structured induction programme is offered to new staff. At the last inspection 2 new staff confirmed they had attended this induction training. The Manager informed the Inspector that there is an overall training and development plan and budget for the 3 units that make up the Laurel Group of Homes. Disaggregating the information specifically for Russell Hill was not possible. There is a person responsible for the training and development of staff. It would be beneficial for Russell Hill if there was identified a specific training and development plan and budget for the unit as a part of the overall plan and it recommended that this be drawn up. This would enable the Manager some flexibility to meet identified training needs of his staff group and to arrange timely and appropriate training for example adult protection training and training on rehabilitation care planning. Russell Hill Lodge DS0000025833.V350695.R01.S.doc Version 5.2 Page 25 At the last inspection it was suggested that the Manager draw up training files for each member of staff that identifies what training that individual has achieved and when; what their training needs are that need to be met and evidence of the training courses attended. The Manager was able to show the Inspector a newly developed training file that contains some information about what training staff have completed but still required is the certificated evidence of training staff have received and a training needs analysis for staff of training required for the future. It is therefore recommended that the work on the training file for staff is completed as soon as possible. Standard 36 – The Manager informed the Inspector that since the last inspection all but 2 staff have been appraised. The Inspector saw evidence of this on the staffing files. With regards to staff supervision; the Manager told the Inspector that 1:1 supervision is now happening but not with the required frequency. Records shown to the Inspector demonstrated that supervision has been very infrequent indeed. One member of staff’s records showed supervision sessions having been held on: 3.05; 4.06; 7.07; 9.07. Another staff members records showed the frequency of supervision to be 6.06 and 9.07. Similarly another staff member’s supervision records showed supervision had happened on 3.07 and another staff member on 3.07 and 9.07. Clearly the required standard of supervision frequency is not being met and recorded notes of supervision do not demonstrate that the content of supervision sessions cover all the required areas. The Manager agreed with the Inspector that there is still work to be done in continuing to improve the quality of staff supervision in the home. It is essential for instance that there is discussion in supervision with staff about how to implement in practice the home’s philosophy and aims when working with individual residents. Equally it is essential for the successful delivery of care to residents as well as providing job satisfaction for staff, that supervisors help them to monitor their work with individual service users and analyse the success or not of care plan outcomes in meeting their residents’ needs. For this reason a requirement remains in place for staff supervision. This requires: 1) That staff supervision should happen every 4 – 6 weeks. 2) That supervision notes should be maintained regularly and kept on staff files. 3) That areas of discussion in supervision must include the following: • Translation of the homes philosophy and aims into working with individuals, • Actual monitoring of the key working that staff undertake with individual service users. This should include an analysis of care plan objectives and the work being done to help meet them, • Support and professional guidance, and the • Identification of training and development needs, Russell Hill Lodge DS0000025833.V350695.R01.S.doc Version 5.2 Page 26 Annual appraisals. The Manager explained to the Inspector that whilst not all files contained supervision records some staff have received supervision more frequently than the indicate. The Manager told the Inspector he provides supervision to all 10 staff and that he has not had the chance to type up the notes of these sessions. This needs to be addressed and the Manager assured the Inspector that this would be done. It is also required that the Manager be provided with authorised supervision training. Russell Hill Lodge DS0000025833.V350695.R01.S.doc Version 5.2 Page 27 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39, & 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users may be assured that they will benefit from a well run home. Once the quality assurance system is fully implemented they will be able to be confident that their views underpin all developments in the home. They should also be assured that their health, safety and welfare will be promoted. EVIDENCE: Standard 37 – At this inspection the Manager told the Inspector that he is half way through his NVQ training for the Registered Manager’s Award [at Level 4] and is expecting to complete this in the next 6 months, he is previously a qualified Registered Nurse and he maintains his professional registration. It is important now that he does complete this training this year. Russell Hill Lodge DS0000025833.V350695.R01.S.doc Version 5.2 Page 28 The Inspector was shown by the Manager his job description that covers all the requirements set out under the Standard 37.3. Standard 39 – This standard concerns the development and implementation of an appropriate quality assurance system that seeks service users views and measures the success of the home in meeting the aims and objectives laid out in the Statement of Purpose. At the last inspection a requirement was set in order to develop this system at Russell Hill Lodge. At this inspection the Manager told the Inspector that Laurel Homes is still developing its quality assurance system in a number of different fields. He said that an audit of staff training has been undertaken recently, which includes indicators that reflect on the effectiveness of training which has been provided; on how staff needs are being met and importantly on how service users needs are being met. The last standards of service survey undertaken at Russell Hill has just been carried out, and it was agreed with the Manager that an analysis tool which uses annual feedback from service users, relatives and visiting and referring professionals is needed. The information gathered from this would compliment the other elements of the quality assurance system that Russell Hill and Laurel Homes are developing and would usefully inform an annual development plan for the home. Collaboration between the Managers in the 3 units of Laurel Homes is useful and the form that has been developed at Jordan Lodge for gaining feedback from relatives and visiting professionals might prove helpful at Russell Hill. This requirement however remains outstanding and must be implemented as soon as possible and before the next key standards inspection. Standard 42 – At the last inspection a requirement was made for the Manager to carry out a review of the previous risk assessment for the building and to ensure that all risks are identified and strategies developed to meet the potential risks identified. At this inspection the Inspector was informed by the Manager that he is now undertaking regular risk assessments and reviews for the building. Evidence of these risk assessments were shown to the Inspector and it could be seen that these are comprehensive in their coverage and they now form a part of the reports to the Area Manager and the Regulation 26 reports. This is helpful since risk assessments help to assure the health and safety of the residents. Russell Hill Lodge DS0000025833.V350695.R01.S.doc Version 5.2 Page 29 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 Standard No Score 1 X 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 3 X Russell Hill Lodge DS0000025833.V350695.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? Yes. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA2 Regulation 14 Requirement That the needs assessments should include the resident’s religious and cultural needs. Improved coverage in the needs assessment of the person’s rehabilitative and therapeutic needs and the residents own comments and views about their needs should also be included as a part of the assessment. That the review of care plans monitor the success or otherwise of the care plan objectives and that they are revised in the light of the review findings. PRN medication guidance for staff should be included on the medication records for each resident who uses PRN medication. That any complaint received is followed up by the Manager and staff at Russell Hill Lodge and that the home’s complaints policy and DS0000025833.V350695.R01.S.doc Timescale for action 01/11/07 2. YA6 14 01/11/07 3. YA20 13 01/12/07 4. YA22 22 01/11/07 Russell Hill Lodge Version 5.2 Page 31 procedures are strictly followed in terms of process and timescales. A copy of the complaints process should be posted on the home’s notice board and in each resident’s service user guide. 5. YA23 13 That the Manager ensures that all staff who have not done so, receive full, authorised and certificated training in POVA. That the Manager ensures that the areas of the home identified in this report that require repair and maintenance are addressed within the timescale set out here. 01/01/08 6. YA24 20 01/01/08 7. YA36 18 01/11/07 1) That staff supervision should happen every 4 – 6 weeks. 2) That supervision notes should be maintained regularly and kept on staff files. 3) That areas of discussion in supervision must include the following: • Translation of the homes philosophy and aims into working with individuals, • Actual monitoring of the key working that staff undertake with individual service users. This should include an analysis of care plan objectives and the work being done to help meet them, • Support and professional guidance, and the • Identification of training DS0000025833.V350695.R01.S.doc Version 5.2 Page 32 Russell Hill Lodge • 8. YA39 24 and development needs, Annual appraisals. An appropriate quality 01/01/08 assurance system must be implemented in the home, which seeks residents 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 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. No. 1. Refer to Standard YA32 Good Practice Recommendations Evidence will need to be seen of NVQ certificates (for those staff still receiving training) on the staff training files, that confirms that all staff have obtained their NVQ qualifications. Further work is recommended on the staff training file. Certificated evidence of training that staff have received should be held on file and a training needs analysis for the future needs of staff’s training is still required. 2. YA35 Russell Hill Lodge DS0000025833.V350695.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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 Hill Lodge DS0000025833.V350695.R01.S.doc Version 5.2 Page 34 - 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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