Inspection on 21/04/05 for Russets

This inspection was carried out on 21st April 2005.

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

Russets 05/07/07

Russets 02/05/06

Russets 28/09/05

Russets 17/02/05

Russets 19/04/04

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

CARE HOME ADULTS 18-65 Russets (Social Services) Gatcombe Drive Hilsea Portsmouth PO2 0TX Lead Inspector Clare Jahn Unannounced 21 April 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Russets (Social Services) Version 1.10 Page 3 SERVICE INFORMATION Name of service Russets (Social Services) Address Gatcombe Drive Hilsea Portsmouth PO2 0TX 023 9266 3780 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Portsmouth City Council Care Home 15 Category(ies) of LD - 15 registration, with number of places Russets (Social Services) Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 17.02.05 Brief Description of the Service: Russets is a purpose built home run by Portsmouth County Council, which provides respite care for up to 15 adults with learning disabilities. Accommodation is split up into smaller living units and can support people with physical disabilities. Russets can provide daycare although most service users attend local day services. Russets (Social Services) Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was undertaken by one inspector over seven hours. The home was under staffed by two staff on the day of the visit and there was also an agency carer employed. The inspector therefore adjusted the visit to suit the needs of the service and staff without disturbing the running of the service further. At present there are 5 residents living at Russets on a long term basis which is difficult for a respite service to manage although the home is trying to meet their needs as well as they can. Four other long stay residents have been relocated since this was raised at the last inspection Russets has also been without a permanent manager for two years which has resulted in additional demands being placed on the deputy manager who has acted up into this role whilst dealing with the general under staffing and increasing demands on the service. The managers position is due to be readvertised following discussion with the commission regarding the job role specification. There are also difficulties in recruiting staff on a permanent basis, which has necessitated the use of agency, and bank staff. Despite the concerns regarding staffing levels, the staff team have found imaginative and innovative ways of dealing with these difficulties, especially when trying to promote the residents activities, but staff do feel frustrated that they cannot offer more appropriate leisure activities due to financial limitations and lack of staff. What the service does well: Staff spoke of residents with caring attitudes, knowledge, respect and appeared very committed to ensuring the service users were supported. The deputy manager demonstrated his committment to trying to find ways to always further improve the services provided. The cleaning, catering and laundry staff demonstrated a high standard of service during the visit. Though short staffed all requests by the inspector were received with full cooperation and full assistance. Russets (Social Services) Version 1.10 Page 6 What has improved since the last inspection? What they could do better: The responsible individual in the absence of a registered manager must address the areas of concern that remain outstanding from this and previous visits. The home must be run in conjunction with its registration and its stated purpose. The homes intention to provide respite services to people with learning disabilities in conjunction with high physical disabilities must be reviewed to ensure it is included in the homes statement of purpose and registration and appropriate staffing levels are provided to meet the intended needs. The admission of residents with high combined needs must be limited, their dependency measured and admissions restricted when suitable levels of staffing are not available as it was established that an increase in the dependency of the service users and the shortage of staff has a direct effect on the home in meeting the needs of the residents. Further concerns identified were that the staff are not being consistently provided with adequate supervision and training. Appropriate supervision and support of service users with high needs is not being given due to staff shortages. The current clients demonstrate mixed needs, which are not compatible in this environment Other areas of serious concern were that the homes current process for the safe administration of medication is inadequate and must be improved. Russets (Social Services) Version 1.10 Page 7 The provision for activities and meeting the residents emotional and social needs is not being met. The lack of activities was raised as an issue by staff as a staffing issue and also due to the lack of an activities budget. All required records in relation to staff necessary information in respect of recruitment are not kept in the home and this must be addressed. Monthly reports are not provided to the Commission as required and the Commission is not notified when the staffing levels fall below the required level. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Russets (Social Services) Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Russets (Social Services) Version 1.10 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 standard(s) 1,2,3,5 The homes current registration does not reflect the service currently provided and therefore the needs of the service users are being compromised .The process for admission, the stated purpose of the home and the specific needs of in individuals must be reviewed. EVIDENCE: There are currently 5 long-term service users at Russets, which is not in accordance with the homes statement of purpose as a respite care facility. Residents using the respite facility have high physical needs and the service is not registered to provide a service for people who have physical disabilities, of which the service is not registered for. The current groups of residents are not compatible and the home must address this as the individual needs of current long /short- term stay service users are not being met. The home does not provide a contract to service users. This is under review and will be looked at on the next visit. Admissions to the home must be in line with the categories of registration for the home. The commission is meeting with the responsible individual for the organisation in order to discuss the continued registration of it’s service including Russets. Russets (Social Services) Version 1.10 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8,9, The unplanned extension of stay for service users compromises continuity in their health care needs being met. The current assessment and review process does not allow for the needs of the residents to be met when they are admitted outside of the homes intended purpose. The Homes staffing levels are not adequate to deal with the current needs of the service users. EVIDENCE: Residents with high needs requiring 1:1 ratio support as a long term stay were not having their needs met due to the lack of staff. The number of residents with high physical needs are not being met due to the staffing ratio being inadequate. The continuity of healthcare support provided to service users when they are in the community is lost when their stay is extended without adequate planning. Russets (Social Services) Version 1.10 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,13,14,17 The current staffing levels inhibit the Homes capacity to provide adequate social activities and emotional support to individuals The staffing levels negatively affect community links, social inclusion and leisure. The home provides current residents with a good choice of foods EVIDENCE: The mix of long and short term residents, including those with high needs requiring 1:1 support and those with high physical needs does not achieve the homes stated purpose nor provide long stay clients with the support for the promotion of living skills. The demand of the current client group with that of the low staffing levels and lack of leisure budget inhibits the service from providing an adequate level of activities for the residents, regardless of how innovative the staff are being with their time under current financial limitations. Russets (Social Services) Version 1.10 Page 12 A policy giving guidance on relationships remains outstanding from previous inspections. The food served throughout the day was consistent with choices and preferences and audit of services provided being considered. Russets (Social Services) Version 1.10 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20, The staff do endeavour to ensure a level of continuity of care by implementing a key worker system and applying this for each admission. The homes current medication procedures, process for administration and records require urgent review and concerns have been identified that the combined admissions for long term and respite are not compatible. EVIDENCE: Through the homes respite service, residents are, when possible, given the same key worker on each admission. The homes medication procedure needs urgent review as resident identification prior to administration is not under taken, policies are needed to guide staff in the covert administration of medication and crushing medication which was being done inappropriately and the current process for the receipt of home medications to be given during periods for short stay require pharmacist review. One service user admitted for a period of respite and then remained on a longer term basis has not had the appropriate reviews of medication undertaken of which identified a serious concern in relation to this extension of stay and the service users healthcare needs being over looked. Staff have not had training in handling medication. Current records of medication given was inadequate and not completed and /or explained for each occasion. Medications requiring regular review had not been under taken Russets (Social Services) Version 1.10 Page 14 and staff continue to undertake a role in which they have not been deemed competent. This is of particular concern in a respite unit which has a constantly changing resident group. Russets (Social Services) Version 1.10 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 The acting manager appropriately addresses complaints received. EVIDENCE: The home has received one complaint since the last inspection which was investigated and responded to within the criteria of the homes complaint procedure. Russets (Social Services) Version 1.10 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 25,26,28 The homes environment is not suitable for the purpose it is currently being used for. EVIDENCE: The premises is not appropriate for all the residents currently housed here. The upstairs lounge area does not have adequate furnishings due to their continual destruction by one service user who demonstrates challenging behaviour and is accommodated in an upstairs room, long term. This further identifies that the current ratio of staff cannot provide adequate 1:1 support for those long term residents demonstrating challenging behaviour in such an expansive area and therefore the disruption of the environment and effect on those residents requiring appropriate surroundings for respite is not being met. Residents requiring close monitoring are not in appropriate rooms on the ground floor as these rooms are kept for service users with combined high physical needs and therefore some service users are not being adequately supervised Russets (Social Services) Version 1.10 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,33,34,35,36 The numbers of staff on duty do not meet the needs of the service and the home does not store on the premises the necessary records required. The staff are not provided with the training necessary to enable them to fulfil their role. EVIDENCE: Discussions with staff identified that the home has not had a manager for over two years. The service is understaffed for the service it provides. Staff confirmed that adequate training had not been undertaken, not because of availability but having adequate staffing levels so to release staff to attend. The home does not meet the required numbers of staff trained in care (NVQ 2) and staff under take medication administration without appropriate training. The staff do not undertake the TOPPS Induction and foundation training in support of the Learning and Disabilities Framework. Supervision for staff can not be given consistently and the home is relying on agency staff regularly. Staff recruitment files are not kept on the premises and therefore cannot be audited as required by statutory inspection requirements. Discussions with the cleaning and laundry staff identified that induction training and competency based skills relevant to their job role including knowledge of infection control practices were not up to date. The home does not currently inform the commission of all incidents when the home is running below the required number of staff. Russets (Social Services) Version 1.10 Page 18 Russets (Social Services) Version 1.10 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) The home does not ensure the health and welfare of the services users are protected and must improve the staffing, supervision and training of the staff. The organisation is not compliant to the homes current statement of purpose and registration and must improve its monitoring of the service being provided. EVIDENCE: Concerns identified and requirements raised following the statutory inspection in April 2004 have not been met. The home’s staffing levels and the staff access to adequate supervision, induction, and opportunities for training are all affected by the current staffing levels. This does therefore have a direct influence on the health and safety of the service users and the standard of care they receive. Russets (Social Services) Version 1.10 Page 20 Monitoring of the service has not been consistently undertaken and the responsible individual in absence of a registered manager must address the areas of concern. 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. Where there is no score against a standard it has not been looked at during this inspection. 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 x 2 2 x 1 Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 Russets (Social Services) Score 3 x x x Standard No 24 25 26 27 28 29 30 Score 2 3 3 3 2 x 3 Page 21 Version 1.10 10 LIFESTYLES x Score STAFFING Standard No 11 12 13 14 15 16 17 2 2 2 2 2 x 3 Standard No 31 32 33 34 35 36 Score 3 1 1 x 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 1 x Standard No 37 38 39 40 41 42 43 Score N/A x 2 2 2 2 2 Russets (Social Services) Version 1.10 Page 22 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 20 Regulation 13(2) Requirement The Responsible Individual must ensure that all staff under taking the administration of medication are trained and competent to do so and give medications according to the Royal Pharmaceutical guidelines.The current procedure for the recording,receipt, administration of medications requires urgent review and continuing audit.Appropriate guidance must be given to staff regarding covert administration of medications and guidance for crushing of medication. The Reponsible Individual must ensure that the service users social needs are met through the provision of adequate activities and leisure.A plan of action for the provision of regular outings appropriately staffed with an appropriate budget must be forwarded to the commission by the given date. Regulation 26 visits must be completed monthly and reports of each visit sent to the Commission.This is an oustanding requirement from Version 1.10 Timescale for action 31.05.05 2. 14 12, 16 31.05.05 3. 39 26 31.07.05 Russets (Social Services) Page 23 4. 1 16 5. 41 37 6. 15 12 7. 41 19 8. 30 19 17.02.05 Failure to comply with this requirement will result in enforcement action The home continues to accomodate service users on a long term basis and not in accordance with the statement of purpose. This requirement was raisedin April 2004.This will be discussed as a matter of urgency with Portsmouth City Council CSCI must be informed of all occassions when the staffing levels fall short of the required numbers A policy relating to personal relationships must be sent to the commission and held at the home,This requirement has been raised at every visit since 4/11/03 All staff records required under Schedule 2 must be available in the Home by the given date.This requirement has been raised again and it was stated in the report of the 19.04.04 that failure to comply with this requirement will result in the registration authority taking enforcement action.This has still not been met and will be dealt with separately to this report. All staff employed must be provided with the appropriate training to undertake the work they are employed for.This must include Learning and disability framework,vocational qualifications in care,and competency in administration of medication.This also applies to domestic staff and their being an appropriate level of training provided in infection control and competency in using equipments and receipt of adequate induction. Version 1.10 31.07.05 31.04.05 10.05.05 30.05.05 31.07.05 Russets (Social Services) Page 24 9. 10. 36 3 18(2) 18(1) 31.07.05 All staff must be appropriately supervised. A review of the dependency of 30.04.05 the clients must be undertaken and appropriate numbers of staff employed to meet current service users needs.The occupancy /vacancy level of the home must be adjusted accordingly when there are incompatabilities of service user groups,individuals with challenging behaviour and residents with high physical needs.The home can not admit unlimited numbers of clients with combined learning disability with high physical needs.Review of the homes registration and categories must be undertaken supported by the a review of the staffing of the home and the deputy manager must be supported to comply with this requirement THIS REQUIREMENT .WILL ALSO BE DISCUSSED SEPARATELY TO THIS REPORT 11. 12. 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 Good Practice Recommendations Russets (Social Services) Version 1.10 Page 25 Commission for Social Care Inspection 4th Floor, Overline House Blechynden Terrace Southampton SO15 1GW 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 Russets (Social Services) Version 1.10 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. 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