CARE HOMES FOR OLDER PEOPLE
Russell Lodge 235 Lowestoft Road Gorleston Great Yarmouth Norfolk NR31 6JH Lead Inspector
Hilda Stephenson Unannounced Inspection 10th August 2006 10:30 X10015.doc Version 1.40 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 Lodge DS0000064961.V308332.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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Russell Lodge DS0000064961.V308332.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Russell Lodge Address 235 Lowestoft Road Gorleston Great Yarmouth Norfolk NR31 6JH 01493 668265 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) sammoonoosamy@hotmail.com Anbanaden Moonoosamy Mrs Krishna Venie Moonoosamy Anbanaden Moonoosamy Care Home 10 Category(ies) of Old age, not falling within any other category registration, with number (10) of places Russell Lodge DS0000064961.V308332.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 18/10/2005 Brief Description of the Service: Russell Lodge is a purpose built residential care home that accommodates up to 10 older people. It has undergone a change of ownership since the previous inspection. It is now owned and managed by Mr Moonoosamy who also lives in. It is situated opposite the District General Hospital on the outskirts of Great Yarmouth in Gorleston on Sea, within easy reach of local shops and sea front.The accommodation consists of 6 single and 2 shared rooms with en-suite facilities, all of which are on the ground floor, with a combined lounge and dining room. The surrounding enclosed gardens are laid to lawn with flowerbeds and are well maintained. There is a small car parking area to the rear of the premises. Russell Lodge DS0000064961.V308332.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Care services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out using information from the providers, the service users as well as others who work at or visit the home. This report gives a brief overview of the service and the current quality judgements for each outcome group. In previous inspections the home was falling behind on the requirements that were issued in line with the minimum standards. This visit found that the proprietor had completed the past requirements and the standard of record keeping had vastly improved. What the service does well:
Russell Lodge is a small home and residents are cared for by a small team of friendly staff led by the proprietor who also manages the home. Care staff was observed spending time with residents and assisting them in a dignified and sensitive manner, respecting the wishes of those who wished to stay in their own rooms. The proprietor has worked hard to complete the record keeping, training and supervision of staff hence the standards have improved. All seven of the residents commented on how hard working the staff are and that they were treated with respect. They also commented on how the change of ownership had been a positive step forward and that the new proprietor was always approachable and available to speak with them if they had any concerns. All the residents were well presented and appeared comfortable. The home has six single rooms and two shared rooms all having en-suite facilities. It offers good clean attractive accommodation that is well furnished and odour free, with two separate enclosed well-maintained gardens. Russell Lodge DS0000064961.V308332.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better:
Although, no requirements or recommendations were issued during this site visit, there were two concerns that the proprietor is currently dealing with. Comments were received prior to this inspection from both residents and relatives about the lack of social activities and lack of staff numbers. The proprietor has just completed a quality assurance survey resulting in similar comments as above. Due to the home having a small number of residents there are usually two care staff on duty during the day. The proprietor has now made arrangements to improve staffing levels to allow more flexibility when arranging sociable activities on a more individual basis. Russell Lodge DS0000064961.V308332.R01.S.doc Version 5.2 Page 7 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 Lodge DS0000064961.V308332.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Russell Lodge DS0000064961.V308332.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4,5 The quality outcome in this area is good. The Proprietor visits residents to assess their needs and invites them or their relatives to visit the home prior to admission. Adequate written information is made available to explain the facilities and services provided at Russell Lodge. EVIDENCE: Two residents were case tracked to collate the evidence of their admission process. One set of records seen was the latest resident to move into the home and the second was selected at random. The home has a good clear service users guide to assist residents to make their own mind as to whether the home will meet their needs adequately. Russell Lodge DS0000064961.V308332.R01.S.doc Version 5.2 Page 10 After the proprietor receives the initial referral, he visits the prospective resident to discuss their personal care needs. An assessment is undertaken; sometimes a relative or social worker is involved with this initial meeting. The proprietor then invites the prospective resident or their representative to look round the home before moving in, some have stayed for lunch in the past. The initial assessment details are written in the care plan and any specialist equipment is obtained prior to admission. The home tends to admit residents who are not highly dependent due to the small numbers of care staff. Russell Lodge DS0000064961.V308332.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The quality outcome of these standards was good. The home is updating the storage and administration procedure of medicines. Residents can be assured the home continues to update and improve individual care. EVIDENCE: Evidence was seen when examining care records of two residents who were selected for case tracking. Both care plans included their personal care needs and instruction on how these should be carried out; with the care records showing evidence that residents wishes and input were included. Russell Lodge DS0000064961.V308332.R01.S.doc Version 5.2 Page 12 The medication policy had been rewritten and staff were aware of the content. One member of staff who was on duty was newly employed and was supervised by the proprietor when administering the medication. The proprietor explained that the medication system was being switched over to the Monitored dosage system and the pharmacist had been booked to instruct the staff beforehand. The proprietor is a qualified nurse and has adequate procedures in place to monitor and regularly supervise staff with the medication process. Overall, seven residents were spoken to and all commented that they felt their privacy was respected and that staff were sensitive with their personal care. The staff member on duty, although newly employed had a very good understanding of the nine residents and was observed having a kind attitude towards the residents during the days interaction. Comments received from relatives stated that a hundred per cent were satisfied with the overall care the staff provided. Russell Lodge DS0000064961.V308332.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 The quality outcome for these standards was adequate. The home offers a limited amount of social activities due to the small amount of staff on duty every day. Residents are offered a well balanced diet with seasonal changes taken into account. EVIDENCE: Russell Lodge is a small home accommodating up to ten residents. Currently, nine residents are living in the home, as one of the double rooms is occupied as a single room. Seven residents were spoken to during the day, with the majority stating that ‘they felt well cared for’. Comments received from residents prior to the site visit stated that the home did not provide suitable activities for them to join in. During the visit some residents were leaving the home to go out with their relatives and preferred to stick to their own routine. The proprietor had recently compiled a quality assurance questionnaire of comments received from residents, that indicated social activities were in need of improvement and had started to obtain suggestions from them.
Russell Lodge DS0000064961.V308332.R01.S.doc Version 5.2 Page 14 Several residents when spoken with stated that they went out with relatives or friends, and some days there were only a small number of residents staying in. Extra staff were brought in when outings were arranged or residents wanted to go shopping. Due to the home having a small number of occupants, and having two staff on during the day, activities were generally organised on an individual one to one basis with card games, discussion, watching videos, singing or listening to music rather than large organised games which hadn’t been well attended in the past. Social interests were recorded in each individual care plan, and several residents continued to go out on social visits with their relatives. Two residents indicated that they would like to go to visit the Saturday market in town like they used to do and this suggestion was passed to the proprietor. The home employs one cook, with a relief member of staff to cover days off. The majority of residents praised the meals that were offered and enjoyed a good balanced diet. The lunchtime meal consisted of two courses with one resident taking a liquidised diet due to swallowing difficulties. Russell Lodge DS0000064961.V308332.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The quality outcome of these standards is good. Residents felt safe and that there views have been acted upon. EVIDENCE: The complaints procedure is written within the Service User Guide and a copy is on display on the notice board. The majority of residents knew who to complain to if they had a concern, preferring to speak to the proprietor first. Comments received from relatives indicated that 71 knew how to complain, with 57 having successfully used the complaints procedure in the past. The member of staff on duty was aware of the complaints procedure and adult protection procedure after completing recent induction training. Two concerns had been received at the CSCI office regarding the low number of staff on duty, these concerns were discussed with the proprietor who has already employed another member of staff and has advertised for another two to allow more flexibility. Russell Lodge DS0000064961.V308332.R01.S.doc Version 5.2 Page 16 One complaint had been investigated by CSCI earlier in the year with one requirement and one recommendation being issued. The proprietor has completed both and has arrangements for a senior carer to ‘sleep in’ when he is away from the premises. A portable call bell system is now in place to allow the care staff to call for assistance from the proprietor when he is not ‘on the floor’. The proprietor has updated the adult protection policy consistent with new regulation. Evidence from staff training records showed that staff have attended adult protection training and that this topic was also included in the NVQ course. Russell Lodge DS0000064961.V308332.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,24,25,26 The quality outcome of these standards is excellent. The home is kept in a very good state of repair and decoration. Residents can take their own personal possessions into the home with them to enable them to enjoy a familiar and homely environment. EVIDENCE: Evidence was collected through observation and from comments from residents. The home does not have designated domestic staff, with the care staff undertaking these duties. During periods of deep cleaning an extra member of staff is brought in to carry out these duties. One resident confirmed that she prefers to help keep her own room clean and tidy. Due to the current low dependency levels the proprietor is counted as the second member of staff on duty. Russell Lodge DS0000064961.V308332.R01.S.doc Version 5.2 Page 18 The home maintains a very high standard of cleanliness. Several of the bedrooms were seen to contain residents’ own furniture and personal possessions. Comments received from both residents and relatives confirmed 100 thought the home was kept exceptionally clean and tidy. There was evidence of regular maintenance of the building with plans in place for future decoration and upgrading. Two residents who were case tracked were happy with their rooms and pleased to be able to take in a selection of their own possessions. Russell Lodge DS0000064961.V308332.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The quality of these standards is adequate. Residents care needs are looked after by a small number of well-trained staff. EVIDENCE: The proprietor provided copies of the duty rota prior to this site visit which showed an adequate amount of staff on duty to care for the currently low dependency levels of the residents. If dependency levels rise then extra staff would be allocated. Since the change of ownership, staffing numbers have remained the same, with two staff and one cook on duty during the day, with one waking care staff on duty overnight with the proprietor providing assistance when required. When the proprietor is away another senior member of staff provides the ‘sleep in’ cover. The member of staff on duty had commenced two weeks previously and had undertaken an induction programme and been supernumerary for her first week. The employment records, references, CRB, POVA first check and induction programme were seen. The staff member confirmed she had read residents care records to enable her to provide quality continuing care. Russell Lodge DS0000064961.V308332.R01.S.doc Version 5.2 Page 20 The documentation received prior to this site visit showed evidence of training since the previous inspection in October 2005 which included first aid, medication administration, NVQ level 2, POVA, incontinence management, moving and handling, dementia awareness and fire updates. The proprietor has commenced regular supervision sessions with staff to enable them to air their views and discuss training or issues on an individual basis. A randomly selected staff record confirmed this. Russell Lodge DS0000064961.V308332.R01.S.doc Version 5.2 Page 21 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 The quality outcome of these standards is good. The proprietor ensures residents live in a safe and homely environment, and are cared for by staff that practice good management. EVIDENCE: The proprietor has written and updated policies to ensure that good practice is carried out. A sample of these policies were read and found to be adequate. Documentation to show evidence that staff had read and understood these policies were seen with supervision sessions monitoring this. Residents spoken to had been initially concerned about the change of proprietor, but appreciated the support and smooth transaction that had taken place. Russell Lodge DS0000064961.V308332.R01.S.doc Version 5.2 Page 22 The proprietor has introduced a system to monitor quality of care. The results are yet to be published and suggest a lack of social activities offered. The proprietor is taking action to improve this. Comments received prior to this site visit from relatives confirmed that 100 were happy with the overall care offered at Russell Lodge. Separate accounts are held for residents’ personal money and records correspond satisfactorily. Some residents manage their own finances and have a lockable facility within their rooms. A sample of the maintenance records on fire training and equipment, gas central heating and boiler, water temperatures and Legionella checks were in place and were satisfactory. Russell Lodge DS0000064961.V308332.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 x x x x 4 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 3 x 3 Russell Lodge DS0000064961.V308332.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Russell Lodge DS0000064961.V308332.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Lodge DS0000064961.V308332.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
