Inspection on 06/01/09 for Russell Lodge

This inspection was carried out on 6th January 2009.

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 but made no statutory requirements on the home.

Other inspections for this house

Russell Lodge 28/05/08

Russell Lodge 10/08/06

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

CARE HOMES FOR OLDER PEOPLE Russell Lodge 235 Lowestoft Road Gorleston Great Yarmouth Norfolk NR31 6JH Lead Inspector Jane Craig Key Unannounced Inspection 6th January 2009 09:30 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.V373676.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.V373676.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 Dementia (1), Old age, not falling within any registration, with number other category (10) of places Russell Lodge DS0000064961.V373676.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28/05/08 Brief Description of the Service: Russell Lodge is a purpose built residential care home that accommodates up to 10 older people. It is owned and managed by Mr Moonoosamy. The home 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 ensuite facilities, all of which are on the ground floor. There is 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. People thinking of moving into the home were given a welcome pack, which included the service users guide. A copy of the latest CSCI inspection report is available on request. At 6th January 2009 the weekly fees ranged from £328.00 to £500.00. Extra charges were made for hairdressing, newspapers and chiropody. Russell Lodge DS0000064961.V373676.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means that people who use the service experience adequate quality outcomes. 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 includes information gathered since the last inspection and two unannounced site visits. The first visit was carried out on 6th January 2009 by two regulatory inspectors. A second visit was carried out on 29th January 2009 by the pharmacist inspector, who looked at the way medicines were managed in the home. During the site visits we asked residents about their views and experiences of living at Russell Lodge. Some of their comments are included in this report. Two residents were case tracked. This meant that we looked at their care plans and other records and talked to staff about their care needs. We held discussions with the owner/manager, who is referred to as the registered person. We also spoke to staff and visitors. We looked around the home and viewed a number of documents and records. Prior to the visit a number of surveys were sent out to staff members and relatives of people living at Russell Lodge, their responses were taken into account when compiling the report. We also included information from the Annual Quality Assurance Assessment (AQAA), which is a self-assessment that the registered person has to fill in and send to the Commission every year. What the service does well: Before anyone moved into the home the registered person visited them to assess what care they needed and to make sure that their needs could be properly met at Russell Lodge. Residents said they were well looked after. Their relatives commented that staff were good at getting the right balance between providing care and helping residents to maintain their independence. Residents could make choices about their day to day lives. One person said, I am flexible about my bedtime, it depends what is on TV. The staff made sure that people went out for walks as often as they wanted to. A relative remarked that this helped their father to feel and look better. Russell Lodge DS0000064961.V373676.R01.S.doc Version 5.2 Page 6 There were no set times for visiting which meant that people could see their friends and family at times that suited everyone. Visitors said they were made to feel welcome at the home. There was a clear complaints procedure and residents and relatives knew who to speak to if they had any concerns about the service. One resident said that she would take it up with the manager if she had any complaints. A relative said that he had made a complaint to the manager and it had been dealt with immediately. Residents were happy with their bedrooms, many of which had been personalised with ornaments and pictures. A relative described their mothers room as, delightful. We were told that the home was always clean and there were no unpleasant smells. What has improved since the last inspection? What they could do better: Residents, or their representatives, must have opportunities to be involved in planning and reviewing their care, so that they can be sure that they are going to receive the care that is right for them. Staff must review care plans and associated records and update them as and when changes occur so that staff have up to date and accurate directions about the care to be provided. Care plans to reduce risks to residents health should be relevant to the individual. In order to promote residents health, medicines must be given to them correctly and as they are prescribed. Controlled drugs must be stored securely to prevent mishandling and misuse. In order to protect the health and safety of residents and prevent the spread of food related infections, systems must be put into place to manage food safely. Staff must also follow procedures that are in place to reduce the risk of spreading other infections in the home. The registered person should review the way that activities are planned and recorded to ensure that more people have access to activity and occupation that meets their needs. Russell Lodge DS0000064961.V373676.R01.S.doc Version 5.2 Page 7 The registered person must ensure that there is a staff rota that clearly identifies who should be working at any given time. The rota must clearly reflect, by name, those members of staff who are designated as sleeping in or on call staff. This was a requirement from the previous inspection and has not been met. We may consider taking enforcement action to ensure that the registered person complies. There should be sufficient staff to carry out cleaning and cooking duties without having to take staff away from direct care duties. In order to protect the health and safety of residents, potentially hazardous substances, such as cleaning materials, must be stored safely. 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 Lodge DS0000064961.V373676.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.V373676.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff received sufficient information about new residents to understand and plan for their needs but the shortage of accessible information could result in residents not being clear about the service to be provided. EVIDENCE: The home had a service user’s guide and welcome pack, which gave people some information about what they could expect from the service. A recommendation had been made at a previous inspection that the registered person should think about making the document available in larger print or alternative formats to make it more accessible to people who have a visual impairment. There was no evidence that this had been acted upon. A previous requirement had been made to provide people who funded their own care with a contract and terms and conditions of residency. One page Russell Lodge DS0000064961.V373676.R01.S.doc Version 5.2 Page 10 contracts were seen on files but they did not all include essential information. For example, one did not state the residents name. Anyone who was thinking of moving into the home was assessed by the registered person to make sure that their needs were understood and could be met at Russell Lodge. The assessments highlighted the persons strengths as well as their needs, which helped staff to understand how to help someone to maintain their independence. The information from the assessment was used to establish a plan of care. Standard 6 was not applicable. Intermediate care was not provided at Russell Lodge. Russell Lodge DS0000064961.V373676.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents health and personal care needs were met in accordance with their wishes however, some medication practices were unsafe and could place people at risk. EVIDENCE: Care plans were in place to address residents health and personal care needs. The standard of plans varied. There were some good examples of person centred plans, which included the residents individual needs and preferences. This helped staff to understand what was important to the resident and how they wished to be cared for. Other plans were vague and did not contain sufficient detail to make sure that staff provided consistent care. Care plans included strategies for helping people to maintain their independence. A number of relatives confirmed that the staff were good at this. One commented, They have the care/independence balance right. Russell Lodge DS0000064961.V373676.R01.S.doc Version 5.2 Page 12 Another wrote, They allow dad to be independent, he can stay in his room all day or walk about freely. Care plans directed staff to maintain residents privacy and dignity, especially when assisting with personal care. During the course of the inspection staff were seen to speak respectfully to residents. A relative said that staff had suggested a strategy to maintain their mothers dignity at mealtimes. Family members indicated that they were kept up to date with important issues in the way they wanted. One relative said that the owner would telephone her straight away even though she visited almost every day. Another relative wrote, I live some distance from the home so unless the situation is urgent I am unable to rush there - the owner knows this so informs me at a later date. However, there was no evidence that residents, or their relatives, were consulted about their care plans or were invited to be involved in reviews. This meant that residents might not have opportunities to influence the way their care was planned and delivered. Care plans were not reviewed every month. There were no evaluation notes to indicate whether the planned care was effective and people were making progress towards meeting their goals. None of the care plans seen had been altered or updated with any new information. Daily progress notes were very general and did not provide enough information to assist staff to evaluate the care given. Despite some shortfalls in care records staff who completed surveys said they were given up to date information about residents care needs. A relative also wrote, small home provides individual care and each carer knows the resident and their needs well. Everyone had a set of assessments to monitor risks to their health, for example, from falls or poor nutrition. These helped staff to identify the specific factors that put people at risk. However, the care plans to reduce risk did not always address the problems that had been identified. For example, accident records showed that one person had a number of falls at a particular time of day. The registered person described the strategy they were using to minimise the specific risks at that time but the residents care plan did not reflect this. The annual quality assurance assessment (AQAA) indicated that the staff were good at identifying health care issues quickly. Care plans showed that residents were referred to the appropriate health care professionals and any advice, for example from district nurses, was transferred to the care plan to make sure it became part of everyday practice. Residents confirmed that they were well looked after. The inspection of the medication standard was conducted by the Commissions pharmacist inspector Mark Andrews on 29th January 2009. This inspection follows three previous visits during 2008 when medication management issues Russell Lodge DS0000064961.V373676.R01.S.doc Version 5.2 Page 13 of a serious nature were identified. During this inspection the inspector looked at current and some previous medication record charts, medicines available for administration and some residents care notes. On arrival for inspection the registered provider was on duty. We noted that medicines were secure, however, we observed that keys to the storage of medicines were not being held by the registered provider as senior person on duty. When we looked at how controlled drugs were being stored we found that temazepam tablets were not being kept in the cabinet used for the storage of controlled drugs but in the wooden cabinet surrounding this cabinet. The keys to the controlled drug cabinet were also held in the wooden cabinet so temazepam tablets were not being properly stored. We discussed with the registered provider steps to improve security of keys to medicine storage. The home has recently put in place an alternative medicine administration system whereby most medicines are administered from 28-day blister packs supplied by the pharmacy. The registered provider said he was waiting for the delivery of equipment to enable the system to be more safely stored and handled by staff. The system is not yet synchronised with the 28-day medication charts but this is expected within the next two weeks to improve ease of use of the system. The home has put in place identifying photographs to assist in the safe medicine administration to people living at the home. We looked at current medication charts and found there were no gaps in records for the administration of medicines. The home is now recording the receipt of medicines on the medication charts but staff signatures and dates were missing. The registered provider conducts a daily count of some medicines to monitor records and their administration. We conducted a sample numerical audit of medicines comparing records against medicines available and whilst we noted improvement we still found two discrepancies where there were more medicines than predicted from records of their administration. We also found for one person there were two medicines available in the medicine trolley that were not recorded on the medication charts and we could not determine if they were still being administered to the person. Whilst we found generally there were separate records in peoples care notes relating to GP prescriptions and reviews, when we asked the registered provider, he was unable to find documentary evidence that the two medicines had been stopped by the GP. One of these was an inhaler for regular twice daily use. We looked at a persons care notes who is prescribed a medicine for staff discretionary administration when experiencing increased psychological agitation. Daily care notes confirmed the circumstances when the medicine was used and there was care plan guidance available for staff to refer to, however, the care plan would be more beneficial placed alongside the medication charts for staff to refer to when administering the medicine. We noted that this medicine had recently been prescribed replacing a more sedative medicine, however, the medication profile in the persons care notes had not been updated and gave inaccurate information. Russell Lodge DS0000064961.V373676.R01.S.doc Version 5.2 Page 14 For another person prescribed anticoagulant warfarin, records indicated the medicine has been given as prescribed following blood test results. The blood test results were alongside the medication for reference however we discussed with the registered provider how warfarin schedules information could be transfered to the medication chart to assist with the safe administration of the warfarin. The home now keeps a specimen signature list of staff authorised to handle and administer medicines at the home. The registered provider showed us documentary evidence that each member of staff listed had been provided medicine management training at University of East Anglia. He added that a further three members of care staff are planned to receive training in February 2009. Russell Lodge DS0000064961.V373676.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The limited range of activities on offer meant that not everyones social and recreational needs were met. EVIDENCE: Despite a previous recommendation no one had up to date information on their files about their social interests and preferences for activities. There were no individual social care plans for staff to help residents to plan how to spend their day. Most residents were escorted out for walks on a regular basis, which many people made positive comments about. One relative wrote, They take him out for a stroll in the fresh air which helps him to feel and look better. Another commented, They take her out for a walk most days - something she enjoys. However, there was little else going on in the home. Two residents said that they did not do much each day. During the visit residents remained in their bedrooms watching TV. One relative said the lack of socialisation was a deficiency of the service. Russell Lodge DS0000064961.V373676.R01.S.doc Version 5.2 Page 16 The AQAA told us that the registered person had plans to improve the level and range of activities after a recent survey indicated that not everyone was satisfied with the current level. Residents had choices in their day-to-day lives. The registered person described routines in the home as flexible to meet individual needs. Residents confirmed that they went to bed and got up when they wished. Relatives who returned surveys were generally happy with the home. One person wrote, He doesnt say he is unhappy any more which he used to when he was in the previous home. A resident said they were, Very satisfied with the service. There was open visiting. Relatives said they felt welcome in the home and were offered refreshments. A number of residents went out with their families to local places. Others were assisted by staff to go out and maintain links in the local community. There was a two week rotating menu which, if followed, gave people little variety or choice. The registered person said that he often cooked other meals and people had a choice of two main meals. This could not be evidenced because there was a lack of records of meals served. Comments about the food were generally positive. One resident described it as quite nice. Another said they could have a choice. A relative said people were given good, wholesome meals. There were mixed views about mealtimes, which were earlier than usual. One resident said they would like to eat a little later, another said they were quite satisfied with the times. The registered person said there was flexibility and people could ask to have their meals later if they wished. Russell Lodge DS0000064961.V373676.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service were safeguarded by the complaints and safeguarding procedures in the home. EVIDENCE: There was a clear complaints procedure in the service user’s guide and on display in a key area of the home. Relatives who completed surveys said they how to make a complaint. During the inspection residents and relatives told us they could speak to the owner if they had a complaint. One person said she felt able to talk to any of the staff if she had any problems. Another relative said when they had made a complaint it had been addressed immediately. Staff said they knew how what to do if anyone made a complaint to them. Records of complaints showed that complaints were taken seriously and investigated within the stated timescales. There was a detailed training pack and policy on safeguarding, which new staff went through during their induction. Staff also had refresher training each year. Staff said that they would immediately report any allegation of abuse to the registered person, who was clear about his role in referring to social services. However, there was no clear procedure for senior staff to follow in Russell Lodge DS0000064961.V373676.R01.S.doc Version 5.2 Page 18 the absence of the registered person, which meant that safeguarding incidents might not be dealt with correctly. Russell Lodge DS0000064961.V373676.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was clean and well maintained and the standard of décor and furnishings provided people with a comfortable and homely place to live. EVIDENCE: There was a plan for ongoing maintenance and the home was generally in a good state of repair. Records showed that any problems identified during routine maintenance and servicing were attended to. A resident said they had a problem with their radiator, which had been fixed. Safety measures were in place. Radiators were guarded and hot water was maintained at a safe temperature to prevent scalding. Russell Lodge DS0000064961.V373676.R01.S.doc Version 5.2 Page 20 There was a plan for redecoration and renewal. The registered person said he had started with bedrooms because these were the most important to the residents and communal areas would be refurbished at a later date. Overall the décor and furnishings were homely and comfortable. A number of bedrooms were highly personalised with pictures and ornaments. Those residents who were asked said they were happy with their bedrooms and were comfortable. A relative wrote that their mother had, A delightful room. The home was clean and free from unpleasant odours. Visitors told us that this was always the case. The AQAA indicated that the service had an action plan to control the risk of spread of infection. The registered person told us that all staff had received recent training in infection control techniques. However, during the visit we observed some practices that could increase risk. For example, staff did not always wear disposable aprons which meant they were wearing the same clothing when delivering personal care and handling laundry as when they were handling food. Russell Lodge DS0000064961.V373676.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using the service were protected by the recruitment practices but there were not enough staff who had appropriate training to meet their needs. EVIDENCE: Despite a requirement at the last inspection, the registered person did not keep a formal staffing rota. There were diary entries to show which staff covered shifts but these did not include sleeping in or on-call staff and the hours they worked. This meant that the records to evidence which staff were on duty at any one time and providing care to the residents were incomplete. We made a requirement following the last inspection to ensure there were adequate staff at all times. The entries showed that there were always two staff on duty during the day. However, the service did not employ any staff specifically for cooking, cleaning and laundry duties. This meant that one of the two staff on duty would be taken away from direct care for parts of the day. We asked residents and relatives whether they thought there were enough staff to attend to their needs. They were unsure about the number of staff on duty but said that there was always a member of staff on hand to Russell Lodge DS0000064961.V373676.R01.S.doc Version 5.2 Page 22 help. Two out of three staff who filled in surveys indicated that there were always enough staff on duty and the other said usually. Residents made very positive comments about their relationships with staff. One described staff as good as gold and another said, Staff are very kind. A relative also said staff were very kind and caring. The files of two new staff were seen. The files included all the necessary information and documents to show that the required pre-employment checks had been carried out. All employees received a contract of employment. Staff who completed surveys said they were not allowed to commence work until their background checks were complete. There was a high turnover of staff. One relative suggested that the home could be improved by retaining staff longer so they could establish relationships with the residents. The registered person was aware of and trying to resolve this issue. New staff went through an induction programme, which covered the topics of the induction training recommended by the national training organisation. This ensured that staff had basic skills to help them understand and meet residents needs. The registered person signed staff off as being competent after observing their practice but there were no formal assessments of competency. Most staff who filled in surveys said their induction training covered everything they needed to help them to understand their role. Not all staff had recent training in health and safety topics. Other training relevant to their role was available. For example, most staff were booked onto a dementia care course which should give them greater understanding of the specialist needs of some of the people in the home. Staff who completed surveys confirmed that they had relevant training which kept them up to date. However, less than half of the care staff were qualified to National Vocational Qualification (NVQ) level 2 or above. Russell Lodge DS0000064961.V373676.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Management and administration systems were not effective enough to ensure that the home was always run in the best interests of the people living there. EVIDENCE: The registered person ran the home on a day to day basis. In addition to carrying out his managerial duties he worked in a hands on capacity carrying out care and ancillary duties. The lack of supernumerary management time could be contributing to the failure of the service to meet the required standards with regard to care planning, management of medicines and staffing records. Russell Lodge DS0000064961.V373676.R01.S.doc Version 5.2 Page 24 Residents and relatives made positive comments about the registered person. One resident described him as very kind and attentive. Staff who returned surveys said they received support from the manager and records confirmed that staff had regular supervision sessions to discuss their roles and whether they needed further support or training. There were limited systems in place to monitor the quality of the service. Residents and relatives had opportunities to make their views known through meetings and they were also invited to complete surveys. The most recent surveys indicated that people were not completely satisfied with the level of planned activities in the home. The manager said this was the main area for development. Staff training was also an area where he hoped to make further improvements. There were no internal audits or other methods of monitoring systems and procedures. People were encouraged to look after their own finances if they were able but they were mainly managed by their families. The registered person does not act as appointee for anyone. At the time of the visit there was no money or valuables held on behalf of residents but secure facilities were available if needed. Maintenance and servicing of electrical and gas installations and appliances were up to date. Fire safety equipment was checked regularly. The fire risk assessment had not been reviewed for at least two years but the registered person stated it had been approved by the fire officer in the last year. There were no records to show that there were systems in place to ensure the kitchen was run safely and in accordance with environmental health legislation. During a tour of the building we noticed that hazardous cleaning materials were left in an unlocked room. These could be dangerous for someone who might be confused and not understand the risks associated with handling or ingesting them. Russell Lodge DS0000064961.V373676.R01.S.doc Version 5.2 Page 25 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 2 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 1 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Russell Lodge DS0000064961.V373676.R01.S.doc Version 5.2 Page 26 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 OP7 Regulation 15(1)(2) Requirement People using the service, or their representatives, must be provided with opportunities for involvement in care planning and reviews of care plans. This is to ensure that people can influence how their care is planned and delivered. Care plans and associated records must be reviewed and updated as and when changes occur. There should be a written evaluation to show whether care has been effective and the progress the person has made towards meeting their goals. Medicines must be properly secured by the safe handling of keys. Controlled drugs must be stored in a cabinet compliant with the Misuse of Drugs (Safe Custody) Regulations 1973. Action must be taken to ensure medicines are being administered to people in line with most recent prescribed DS0000064961.V373676.R01.S.doc Timescale for action 31/03/09 2. OP7 15(2) 31/03/09 3. OP9 13(2) 31/01/09 4. OP9 13(2) 31/01/09 Russell Lodge Version 5.2 Page 27 instructions keeping full and accurate records at all times. Medicines no longer in use must be promptly disposed of. 5. OP26 13(3) In order to protect the health and safety of people using the service, staff must follow the procedures to control the risk of spread of infection. The registered person must ensure that there is a staff rota that clearly identifies who worked at any given time. The rota must clearly reflect, by name, those members of staff who are designated as sleeping in or on call staff. This requirement had a timescale of 30/06/08 which has not been met. Enforcement action is now being considered 7. OP38 13(3) In order to protect the health 28/02/09 and safety of people using the service and prevent the spread of food related infections, systems must be put into place to manage food safely. Fridge, freezer and food temperatures must be checked daily and a cleaning schedule must be drawn up and followed. In order to protect the health and safety of people using the service, potentially hazardous substances, such as cleaning materials must be stored safely. 28/02/09 28/02/09 6. OP27 17 (2) schedule 4 (7) 31/01/09 8. OP38 13(4) Russell Lodge DS0000064961.V373676.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard OP2 OP8 OP9 OP9 OP9 Good Practice Recommendations Contracts should include the name of the person using the service and sufficient information to ensure that people understand the care and services they receive. Strategies to reduce risks to peoples health should be more individualised and address the specific risk factors. Warfarin dose schedule information should be transferred to medication charts. Medication profiles should be promptly updated following prescriber changes to medication. Care plan guidance relating to the administration of medicines prescribed for use at the discretion of care staff should be placed alongside medication charts for easier reference by staff. Care plans should include information about peoples interests and how their individual social and recreational needs can be met. There should be a clear procedure for senior staff to follow to make a safeguarding referral. There should be sufficient staff to carry out ancillary duties to ensure that care staff are not taken away from the direct care of the residents. In order to ensure that staff have the knowledge and skills to understand and meet residents needs they should be trained to NVQ level 2 or above. 6. OP12 7. 8. OP18 OP27 9. OP28 Russell Lodge DS0000064961.V373676.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. 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