Inspection on 12/10/05 for Russell House

This inspection was carried out on 12th October 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Russell House 18/09/06

Russell House 06/04/05

Russell House 30/11/04

Russell House 19/07/04

Russell House 16/02/04

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

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

CARE HOME ADULTS 18-65 Russell House Hortham Lane Almondsbury South Glos BS32 4JH Lead Inspector Paula Cordell Announced Inspection 12/10/05 0930 Russell House DS0000020286.V256861.R01.S.doc Version 5.0 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 House DS0000020286.V256861.R01.S.doc Version 5.0 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 House DS0000020286.V256861.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Russell House Address Hortham Lane Almondsbury South Glos BS32 4JH 01454 619131 NONE 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) Aspects and Milestones Trust Mrs Sousan Asef-Evans Care Home 6 Category(ies) of Learning disability (6), Physical disability (6) registration, with number of places Russell House DS0000020286.V256861.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. May accommodate up to 6 persons with learning disabilities and physical disabilities who are receiving nursing care. Staffing Notice dated 13/10/1997 applies Manager must be a RN on Parts 5 or 14 of the NMC register Date of last inspection 6th April 2005 Brief Description of the Service: Russell House is a care home registered to provide personal and nursing care to six people with a physical and a learning disability. The home is situated in a rural location off the A38 in Almondsbury and has its own minibus which is essentially to provide access to the local social and community venues. The home is set in its own grounds. There is an extensive garden with a patio area, which provides level access for service users. Car parking is available. The home is a converted property and all accommodation is provided on the ground floor. This comprises two single rooms and two double rooms. Whilst none of the rooms have ensuite facilities all rooms have a washbasin. Communal rooms include a lounge, dining room and a multi sensory area. The bathroom and toilet areas have been fitted with adaptations to meet the care needs of the service users in the home. Appropriate equipment is provided for individual use based on the assessed identified need. Russell House DS0000020286.V256861.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection. The purpose of the visit was to review the progress to the requirements and recommendations from the inspection in April 2005 and to monitor the quality of the care provided to the six service users. Evidence at this inspection was that the home has demonstrated compliance with the requirements from the previous inspection. There have been no additional visits during this period. The home has been keeping the Commission for Social Care Inspection informed of incidents that affect the wellbeing of the individuals living at Russell House. The inspection was conducted over 6 hours. This included observation of the meal, discussions with the manager and three members of staff and the housekeeper. The inspector had an opportunity to have a tour of the building and a number of records were seen. Please note that due to profound and multiple disabilities, service users are unable to verbally communicate their views about the home. There was an opportunity throughout the day to sit with five of the six service users. One service user was out for the day at a day centre. What the service does well: Russell House is suitable for individuals with a physical impairment. There is level access and adequate adaptations to ensure the safety of the service users. All communal areas and the bedrooms were free from odour, evidencing that the management of continence was satisfactory in the home. The service users appeared comfortable and well cared for. Service users require a high level of support with their personal care needs. From talking with staff and the manager the home was reviewing many of the practices in the home to ensure that they reflected current good practice and to ensure that care was person-centred. Much work has been completed since the last inspection including an increase in daily activities for the individuals living in the home and the introduction of a new care-planning tool. This was having a positive affect on the morale in the home and ensuring that the service user was the focus of the care delivery. Staff have available to them a prospectus of training including a National Vocational Award. Training records evidenced that staff had attended training relevant to the care needs of the service users. Russell House DS0000020286.V256861.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Russell House DS0000020286.V256861.R01.S.doc Version 5.0 Page 7 The home must review whether the carpet in the communal areas in the home requires a deep clean or replacement. This would enhance the homely feel of the home to the benefit to the service users. Staff would benefit from having regular formal supervision with an appropriate person at least six times per year. 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 House DS0000020286.V256861.R01.S.doc Version 5.0 Page 8 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 House DS0000020286.V256861.R01.S.doc Version 5.0 Page 9 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 the following standard(s): 1,2,3,4,5, Service users have available to them information about the home. There are clear procedures on the admission process. Service users’ assessed care needs were being met and kept under review. EVIDENCE: Since the last inspection the home has introduced a statement of purpose and a service user guide clearly describing the facilities and the aims and objectives of Russell House. The home has demonstrated compliance with the legislation. However, the home should ensure that the statement of purpose includes information on the daily staffing arrangement of the home and that care plans would be reviewed at least six monthly in accordance with the National Minimum Standards for Care Homes. This information was contained in the service user guide but not in the statement of purpose. The manager stated that this would be completed and a copy sent to the Commission for Social Care Inspection. No requirement was made on this occasion as the manager amended the documentation at the time of the inspection. Other information seen included a contract, which contained the rules of the home, and what is included in the fees. Contracts were written in plain English and evidence was provided that these had been read to the service users by a named carer. Russell House DS0000020286.V256861.R01.S.doc Version 5.0 Page 10 The manager described the difficulties of ensuring that the information was in an accessible format suitable to the individuals living in the home. The manager stated that if a more able individual moved to the home this would be addressed, however, information is presently only available in written word as none of the service users use symbols. Documentation was written in plain English and included photographs. There was an assessment of need for each service user, which was being kept under review. This included an assessment and a care plan drawn up by the placing authority and other professionals involved in the care of the individual. The home has an admission process to guide them, clearly describing the process to follow. Many of the individuals living in the home have lived in Russell House for many years since it opened thirteen years ago with the last admission being two years ago. It was evident that the home was meeting the assessed care needs of the individuals living in Russell House. Staff had received training appropriate to the care needs of the individuals. Russell House DS0000020286.V256861.R01.S.doc Version 5.0 Page 11 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 the following standard(s): 6,7,8,9,10 Service users each have a plan of care, which reflects their changing needs and personal goals. Risk assessments were in place to ensure the safety of the individuals. Service users are assured that information is treated with confidence. EVIDENCE: Care plans reviewed included a range of information showing how to assist service users with their physical needs. These were tailored to the individual. Care plans seen were being reviewed and updated in accordance with the National Minimum Standards. Since the last inspection care plans have been updated to include a risk assessment on the use of restraint in the form of wheelchair straps and bedsides. This had been completed in consultation with other professionals. This is good practice. Russell House DS0000020286.V256861.R01.S.doc Version 5.0 Page 12 Care records included a communication dictionary for each service user detailing how an individual uses non-verbal communication to effectively get their needs known. Staff were observed supporting individuals to communicate effectively and responding appropriately to service users’ body language. This is good practice. Due to the complex communication needs of individuals the home has sought support from an independent advocate in making complex decisions. This is good practice. It was evident that the staff actively advocate for the individuals living in the home. This was clear from letters written to professionals on matters relating to health and social activities and general conversations with staff throughout the inspection. Service users were involved in day-to-day decision processes including menu choice, what to wear and where to spend their time in their home. More complex decisions were being made by the staff due to the nature of the individuals and their dependence on staff for all areas of their care. It was pleasing to note that all staff spoken with stated that all the service users would let them know if they did not want to continue with an activity or were generally unhappy. It was evident that staff would act appropriately. Staff demonstrated an awareness of maintaining confidentiality by ensuring that information that was personal to one was not discussed in front of another. The home has a policy on confidentiality and this forms part of the staffs’ contract and terms and conditions of service. Staff stated that this is discussed during their induction and through the National Vocational Award. Russell House DS0000020286.V256861.R01.S.doc Version 5.0 Page 13 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 the following standard(s): 11,12,13,14,15,17 Residents have opportunities for personal development and accessing the community. There was an increase in leisure activities available to individuals living in the home. A healthy diet was available to individuals living in the home. EVIDENCE: It was evident from talking with staff that service users would be supported to pursue different activities and that their physical disability would not hinder or prevent them. Two service users are going on an activity holiday and another regularly meets at a local pub with individuals who enjoy motorbikes. Staff stated that this has built good relationships for the individual and is missed when they do not attend. Service users had opportunities to go out on the day of the inspection with staff and a community day care worker. Service users have available to them a minibus. The service users fund this, including the day-to-day running costs. Russell House DS0000020286.V256861.R01.S.doc Version 5.0 Page 14 Information on the funding arrangements was included in the individual’s contract and policy describing the covering of the petrol. Whilst the cost is high the manager stated that this has been investigated but due to the physical disabilities of the group a specialist vehicle is required. Each service user had an individual timetable of activities; this varied depending on the funding authority. However, it was evident that since the last inspection there were more opportunities for individuals to access the local community. Staff stated that the home has two activity co-coordinators who in addition to their caring role, who organise trips to the theatre, cinema, football matches and places of interest. Staff stated that two service users attend football matches when the local team are at home. Another two service users regularly attend church. Staff stated that activities are arranged in the home. This tends to focus on listening to music and relaxation due to the level of physical disabilities of the individuals living in Russell House. An area of the home has been set aside as a relaxation area and includes specialist equipment. Staff have been creative in making this area comfortable. Individuals’ rooms have been made comfortable with sensory and relaxation equipment. The manager stated that all service users would have an opportunity to go on holiday in this financial year. Further holidays will be organised in addition to the activity holiday a trip to Butlins that was organised for a small group. It was evident that the holidays were planned with the individuals in mind. Service users were supported by staff throughout the morning, staff were patient and sensitive to service users’ care needs. Staff had a good understanding of the individuals’ preferences in aspects of daily living including personal care, social activities and food likes and dislikes. This was evidenced through conversations with staff, observations and care records. Service users were included in the conversations and not excluded. This was evident at the mealtime when service users and staff ate together and sat at the table chatting after the meal had finished. Service users were spoken to in a respectful manner and all personal care was conducted behind a closed door to ensure privacy. Service users have available to them a wholesome and varied diet. The home employs a cook to prepare the meals on a daily basis. Staff supported individuals at the dinner table discreetly and sensitively. The meal was unrushed and the atmosphere relaxed. . Russell House DS0000020286.V256861.R01.S.doc Version 5.0 Page 15 Russell House DS0000020286.V256861.R01.S.doc Version 5.0 Page 16 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 the following standard(s): Service users’ personal and health care needs were being met. There was a robust system of ensuring the safe administration of medication. EVIDENCE: Records were informative about the personal care needs of individuals giving clear direction to staff. This included individual preferences on how they wanted to be supported. Service users are supported to attend appointments with the GP, opticians, dentist and hospital. Service users nursing care needs are being met. The home is supporting one service user with artificial feeding (PEG Feed). The registered nurses have received training on the use of a PEG feed. Evidence was seen of this in the form of a certificate and one nurse confirmed their attendance. District nurses were supporting the home with advice on the PEG feed. Registered nurses support service users at all times. The staff rota provided evidence that a registered nurse staffs the home 24 hours a day in accordance with the home’s certificate of registration. The home is registered to provide nursing care. Russell House DS0000020286.V256861.R01.S.doc Version 5.0 Page 17 The home has good management of prevention of pressure sores. This includes guidance for staff in the form of training, a local policy and individual risk assessments and equipment to prevent skin breakdown including special seating, pressure relieving mattresses and evidently good personal care. On the day of the inspection staff responded to the care needs of the service users in a sensitive and patient manner. Personal care was administered in the privacy of the individual’s room or the bathroom behind closed doors. The manager ensured that the individual’s privacy was maintained by checking with staff who was being assisted prior to showing the inspector around the home. This is good practice further evidencing that the culture of the home includes maintaining service users privacy and dignity. Staff were seen knocking on doors before entering. Service users are supported daily with their personal care needs. Service users had very distinctive style in clothes and haircuts. Service users seen on the day of the inspection had the appearance of being well cared for. Medication was satisfactory. The home has developed medication risk assessments and protocols for each individual involving the doctor. This included a homely remedy protocol for each individual. This is good practice. The information was informative and detailed to enable new staff to support individuals. The registered nurses are responsible for the administration of medication. Each staff member has been assessed as being competent in the administration of medication. Records were in place and were periodically reviewed. This is good practice. Russell House DS0000020286.V256861.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 The home has robust systems for dealing with complaints and concerns including protection of service users. EVIDENCE: In this particular home it is difficult for service users to make verbal complaint due to their degree of physical disability. However, the staff in the home had a good knowledge of the service users and their preferences. However, it was difficult to fully judge how the home would respond to a complaint. The home has not had a complaint since the new manager commenced in post, in June 2004. Relatives and visitors have available to them a list of contacts. This was on display in the hallway of the home and next to the visitors’ record. Care records included communication methods for each individual. This could enable staff to interpret when service users are not happy and complaining about the activity being undertaken or the care service. Staff on the day of the inspection demonstrated how non-verbal communication was interpreted to ensure that a service user was happy. A procedure for responding to allegations of abuse was in place and clearly described the role of staff, the manager and the involvement of other agencies. The manager stated that all staff had attended a half a day course on abuse and the procedure. This is compulsory training given to all staff annually. Russell House DS0000020286.V256861.R01.S.doc Version 5.0 Page 19 During the course of the inspection a new member of staff stated that they had not attended the course but was aware that this was being planned and this was discussed as part of the induction process and the Learning Disability Award Framework. This member of staff had no hesitation that they would report any concerns to the qualified staff managing the shift or the manager. The home has procedures and checks in place that protects service users’ money. Records showed transactions of all expenditure, receipts and two staff signatures were in place. Staff check money on a daily basis. This is good practice. A service user inventory was included in care records and these were periodically reviewed and updated. Russell House DS0000020286.V256861.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29,30 Service users are provided with a homely and safe environment, which meets its stated purpose. However, service users would benefit from the carpeting in the communal area being cleaned or replaced. EVIDENCE: The inspector had an opportunity to view the home. All areas seen were clean and free from odour. The kitchen has had a deep clean since the last inspection and was found to be clean in response to a previous requirement. An environmental health officer has visited the home since the last inspection and made one recommendation that the kitchen surfaces are replaced. The manager stated that the Trust has agreed to replace these within this financial year. This will be followed up at the next inspection. No requirement was made, as it was evident that the Trust’s intention was to replace. Maintenance was being responded to promptly ensuring a safe place for service users to live. Staff maintain a monthly audit report on the environment including equipment and the general upkeep. It was evident that any deficit would be reported to the Trust. The Trust has a property manager who has ultimate responsibility for major expenditure. Russell House DS0000020286.V256861.R01.S.doc Version 5.0 Page 21 The home has a number of aids and adaptations including hoists, high low bath and beds that can be raised to assist an individual with a physical disability. The manager is a manual-handling instructor. Records seen evidenced that staff had attended training in manual handling. There were clear instructions in care records tailored to the individual on the equipment to be used. Service users have access to a large, well kept garden. There is sufficient off street parking. There are two shared bedrooms and two single rooms. Rooms that were shared had screening to ensure the privacy of each person. The manager stated the organisation is exploring options to address the shared living arrangement. As yet no plans have been confirmed. The manager has agreed to keep the Commission for Social Care Inspection informed of the situation. Service users have access to a large open plan lounge; part has been sectioned off to provide a sensory area. At the end of the lounge is the dining room and kitchen. These areas were homely. The manager stated that the seating in the lounge area is being replaced. The carpeting throughout the communal areas and the office had deep staining. Staff stated that this is regularly cleaned. This must be addressed. Bedrooms had been furnished and decorated to reflect the service users’ interests. This helped in giving an individual feel to the rooms. Adequate furnishing was provided as per the standard. There was sufficient space for staff to assist with personal care. Service users were seen making full use of their home supported by staff. Service users were either in the lounge areas or their bedrooms. Service users were engaged in listening to music or watching the television and sitting with staff. Service users have adequate bathrooms and toilets available to them. These areas were lockable and there was a safety override device if necessary. The home had policies on infection control and individual guidelines in care plans. There was a supply of plastic gloves, aprons, liquid soap and paper towels in toilets and in bedrooms. The home has a separate laundry and sluice facility. This was adequate for the size of the home. The laundry doubled up as storeroom for wheelchairs and hoists were stored in the bathrooms. Whilst this was not perfect there are no other storage facilities available to the home. Staff stated that this does not pose a risk to service users. Russell House DS0000020286.V256861.R01.S.doc Version 5.0 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36, Competent and trained staff support service users. The home is adequately staffed to meet the care needs of the individuals. Informal supervision of staff is in place on a day-to-day basis. However, this should be enhanced by more frequent formal sessions on a one to one basis. EVIDENCE: Since the last inspection the home has managed to recruit new staff. This has evidently assisted with the planning of the duty rota and ensuring that adequate staff are working in the home. The manager stated that the home now has 1.4 qualified and one part time carer vacancy and these are still being actively advertised. This was seen as positive as the home has struggled to recruit staff due to the location. In addition the home has reviewed the shift pattern which has had positive effects on the staffing in the home including an increase in activities available to service users in the evening. The home continues to have a core group of bank staff that support the service users, offering consistency. This was confirmed by one of the bank staff who stated that they continue to work in the home on a full time basis. Russell House DS0000020286.V256861.R01.S.doc Version 5.0 Page 23 The home was staffed according to the service user guide and was evidently meeting the care needs of the service users. Staff were observed during the lunchtime and each individual was supported by a competent member of staff. Staff stated that they had been given guidance on each person’s preferences and skills relating to eating as part of the induction process. A number of staff have attended a course in supporting individuals with eating and drinking. Staff stated that the manager was planning further training, which would include staff being fed by another to encourage staff to empathise with the individuals living in the home. Staff stated that this has included using the hoist and other equipment in the home. This is good practice. Staff have received training relevant to the care needs of the service users. Discussions with staff and training records confirmed that staff had attended a variety of training since the last inspection and there was a prospectus of further training available relevant to the home. Many of the staff have attended a course in communication for individuals who use non-verbal communication and protection of vulnerable adults. The latter is being planned for the new staff employed. The manager was able to demonstrate that all staff complete the Learning Disability Award Framework as part of the induction process and all staff are supported where relevant to complete an NVQ 2 in care, unless they hold a registered nurse qualification or equivalent. The manager stated that of the nine home support workers, two staff have completed their NVQ 2 in care, a further three have enrolled and two staff have a professional qualification that is equivalent to the NVQ 2. Confirmation was seen in training records. The home is able to demonstrate they are committed to meet the government target to ensure that 50 of the workforce has an NVQ 2 by December 2005. This is good practice. Records confirmed that qualified staff are maintaining their registration with the Nursing Midwifery Council (NMC). A registered nurse was happy to show their PREP folder as required by the NMC for re-registration demonstrating a commitment to continual learning. It was evident that the registered nurses were attending training relevant to their role. Supervision was discussed with the manager who clearly stated that it was the Trust’s policy to complete formal supervision with staff at least 4-6 weekly and an annual appraisal of performance. However, records seen did not demonstrate that this was happening. In practice one member of staff has worked in the home since May 2005 and has only had one formal supervision and others had only had four supervisions in the last twelve months. However, it was evident from talking with staff that they felt supported in their role and the manager regular supervises informally staff’s practices as she works along side them providing the care. Russell House DS0000020286.V256861.R01.S.doc Version 5.0 Page 24 A bank care worker stated that the manager at Russell House has ensured that they have attended training with the home including manual handling, fire safety and food hygiene. In addition the manager is a manual handling trainer and an assessor and continually assesses staff competence and the care needs of the service users. The bank worker confirmed this. Since the last inspection the home has made significant progress on a requirement to ensure that the records relating to staff are held in the home. There was an application, two references and a health questionnaire for all staff employed since April 2002. There was proof of identification for some staff but not all. Criminal Record Bureau checks were held centrally with a letter confirming that this had been received by the Trust. Staff have brought copies of their own disclosure. The manager is advised to ensure that these are stored securely and within the guidelines of data protection as presently these are held with staff training records and not held securely with all the other recruitment information. One member of staff was not aware of the General Social Care Council’s Code of Conduct. This was addressed with the individual who was shown the office copy. It was evident that many of the staff had seen this from the supporting signatures. The manager was given details of how to obtain individual copies for all staff in that they are free and all staff must have a copy. This will be followed up at the next inspection. It would be recommended that staff sign a record to say that they have received their own copy of the code of conduct. Job descriptions were in place, which reflected the role of carers at Russell House with the focus being that of supporting the service users. Russell House DS0000020286.V256861.R01.S.doc Version 5.0 Page 25 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,40,41,42 Service users benefit from a well managed home which is safe and free from hazards. Policies and records are in place to protect and safeguard the service users. EVIDENCE: Mrs Asef-Evans manages the home. She is passionate about her role as manager and the rights of the individuals living in the home to an individual tailored lifestyle. Mrs Asef-Evans is in the process of completing the Registered Manager’s award (NVQ 4) and is an NVQ assessor. Staff spoke positively about the changes that have been made to improve the running of the home and the philosophies of supporting the individuals. This has included challenging institutionalised practices and developing an understanding that the individuals have a right to lead full and active lifestyles and seeing beyond the physical disabilities. Staff stated that service users no longer all retire in the afternoon or go to bed early and this is service user led. Russell House DS0000020286.V256861.R01.S.doc Version 5.0 Page 26 This is good practice and was evident not only in conversations with staff but also in care records. Mrs Asef-Evans demonstrated a good understanding of the service users living in Russell House and has formulated a plan on what needs to be addressed to ensure that the home runs smoothly and meets the National Minimum Standards. Staff spoken with spoke positively about the support and the open approach of the manager. There was evidence of regular staff meetings covering a wide range of topics including development of an action plan. Quality assurance was discussed with the manager. She is in the process of developing a tool for Russell House. This will be followed up at the next inspection. It was evident that the manager has completed an appraisal of the service including individual care reviews, record keeping, supervision and an audit of the training of staff and has developed an action plan. It was evident through discussion with the manager that this has been shared with her senior manager. She stated that this is being monitored at supervisions and the monthly provider visits in respect of Regulation 26. Records were held securely and found to be current and up to date. There was a current certificate of insurance displayed in the home. From discussions with staff and staff training records it was evident that there is a rolling programme of health and safety training including manual handling, fire, food hygiene and first aid. The home has guidance on infection control and policies to ensure the safety and well being of service users and staff. Risk assessments were in place demonstrating that there were safe guidelines for staff and service users on a number of activities that are undertaken in the home and the community. These had been kept under review. There were good routine checks on the property and equipment to ensure the safety of service users and staff. Fire records were current demonstrating that staff attend periodic training and drills as prescribed by the fire officer and checks were being completed on the fire equipment. The home has demonstrated compliance to previous requirements. There was a fire risk assessment in place. The home has recently won an award from Environmental Health on the safe systems in place on the management of food. There were clear records demonstrating and supporting this, including food, fridge/freezer temperatures and clear labelling of all food and accompanying risk assessments. This is good practice. Russell House DS0000020286.V256861.R01.S.doc Version 5.0 Page 27 There was one recommendation as already stated to replace the worktops where worn. The manager stated that this is being responded to. This will be followed up at the next inspection. Russell House DS0000020286.V256861.R01.S.doc Version 5.0 Page 28 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 3 3 3 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 2 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Russell House Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 3 3 X DS0000020286.V256861.R01.S.doc Version 5.0 Page 29 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 YA28 Regulation 23 (2) (b) Requirement For the carpet in the communal areas to be cleaned within one month or replaced within three. Timescale for action 12/01/06 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 Refer to Standard YA36 Good Practice Recommendations For all staff to receive supervision at least six times per year to enable them to complete their role within the home. Russell House DS0000020286.V256861.R01.S.doc Version 5.0 Page 30 Commission for Social Care Inspection Bristol North Office 300 Aztec West Almondsbury South Glos BS32 4RG 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 House DS0000020286.V256861.R01.S.doc Version 5.0 Page 31 - 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. 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