Inspection on 23/05/06 for Russettings

This inspection was carried out on 23rd May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Russettings 02/04/09

Russettings 03/04/08

Russettings 22/11/07

Russettings 08/11/05

Russettings 27/07/05

Russettings 28/02/05

Russettings 20/11/04

Russettings 29/04/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Russettings Mill Lane Balcombe West Sussex RH17 6NP Lead Inspector Mrs J Hough Unannounced Inspection 23rd May 2006 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 Russettings DS0000037746.V290461.R01.S.doc Version 5.1 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. Russettings DS0000037746.V290461.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Russettings Address Mill Lane Balcombe West Sussex RH17 6NP 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) 01444 811630 01444 811932 russettings@russettings.fsnet.co.uk Alpha Health Care Limited Post Vacant Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (45) of places Russettings DS0000037746.V290461.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Up to 45 male and/or female service users in the category of Old Age, not falling within any other category may be admitted/accommodated. Only service users over the age of 65 years may be admitted. Date of last inspection 8th November 2005 Brief Description of the Service: Russettings is a care home with nursing registered to provide accommodation for forty-five service users within the category OP (Old age, not falling within any other category). The home is located in Balcombe village, close to local shops. The village is situated between Haywards Heath and Crawley town centres. The home consists of three floors, two of which provide service user accommodation and communal space. Both floors are accessible by passenger lift. The establishment was registered with the current provider in January 2003. Alpha Health Care owns Russettings and the Responsible Individual is Mrs Sian Sobti. There is a new manager in place, Julie Jones who is to apply for registration with the Commission of Social Care Inspection (CSCI) in the near future. Russettings DS0000037746.V290461.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over 9 hours with two inspectors carrying out the inspection. The newly appointed manager Julie Jones was present at the inspection and provided the information requested by the inspectors. A tour of the premises took place and some of the resident’s rooms were seen. Fifteen residents, five members of staff and two visitors were spoken with to find out their views of the home. One relative gave their view of the home via a telephone call. Records were looked at with regard to the resident’s care plans and assessments, medication, complaints, accidents, staff files to check recruitment procedures, and maintenance records. Julie Jones the manager completed a pre-inspection questionnaire and information given in this formed part of the evidence for this report. The current scale of charges is from £680 to £765 per week. What the service does well: The home’s admission procedures are well planned and thorough ensuring that the home can meet the needs of residents prior to any agreement being made for admission. Comments received from relatives said that the home provided them with all the relevant information prior to admission. The home was generally well maintained except for some minor issues that have been referred to in the inspection report. The communal areas are comfortable and homely for the residents, and the resident’s bedrooms were furnished to suit their individual needs. The home employs an activity organiser and there is a varied programme of activities provided. Russettings DS0000037746.V290461.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Russettings DS0000037746.V290461.R01.S.doc Version 5.1 Page 7 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 Russettings DS0000037746.V290461.R01.S.doc Version 5.1 Page 8 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): 1,2,3,5.6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s admission procedures are well planned and thorough and the residents move into the home knowing their needs will be fully met. EVIDENCE: Pre-admission assessments are carried out prior to any resident being admitted to the home. All residents move into the home on a four- week trial basis. The Statement of Purpose and Service User Guide was available in reception and residents have a copy of the Service User Guide in their rooms. The Statement of Purpose requires some amendments and updates that include an amendment made to the name of the manager and the name of the inspector as given on the complaints procedure. The resident’s contracts and terms and conditions of residency did not include the fees or the number of the room to be occupied. Russettings DS0000037746.V290461.R01.S.doc Version 5.1 Page 9 A discussion was held with the relatives of a resident who had recently moved into the home and they said that the staff had been very informative and helpful giving them all the information they required together with the Statement of Purpose for the home. A full needs assessment was carried out prior to any agreement for admission. The home does not provide intermediate care. Russettings DS0000037746.V290461.R01.S.doc Version 5.1 Page 10 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. Quality in this outcome is adequate. This judgement has been made using available evidence including a visit to this service. Some of the care plans were not updated giving all the relevant information on the care needs of residents to ensure they receive the appropriate level of care and assistance. The medication procedures in the home ensure safe practice in the administration and storage of the resident’s medicines. EVIDENCE: A sample of the resident’s care plans and assessments were seen. The assessments were thorough in identifying the needs of each resident and risk assessments were completed where necessary especially for those residents who were at risk from falling. However, the information given on the needs assessment or risk assessment was not in all cases included on the care plan outlining the actions needed by the staff. Monthly reviews took place and any changes were recorded on the review sheet, but this was not always followed through by updating the care plan. Russettings DS0000037746.V290461.R01.S.doc Version 5.1 Page 11 A wound assessment chart is completed in the cases where a resident has a pressure sore that requires a dressing by the nurses. From observations and discussions with the residents and staff it was clear that the residents are treated with respect and are given choices about how they spend their day and what to wear etc. Staff were observed knocking on bedroom doors before entering resident’s rooms. The medication administration records were examined and well maintained. Handwritten entries on the medication administration records were not signed and dated. The trained nurses administer the medicines. There are two drug trolleys one on each floor both secured safely in a locked cupboard. The home was not administering any Controlled Drugs at the present time. Suitable arrangements had been made with a clinical waste company for the safe disposal of medicines within the home. All medicines placed in the bin for disposal are recorded and signed for on collection. Russettings DS0000037746.V290461.R01.S.doc Version 5.1 Page 12 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. Quality in this outcome is adequate. This judgement has been made using available evidence including a visit to this service. The residents are able to make personal choices in what they do during the day and their lifestyle. There have been some recent complaints about the food and the home is taking appropriate actions to remedy the situation. EVIDENCE: Resident’s notice board displays regular visiting entertainment during 4 months of the year. A full activities programme also offers a variety of activities held on five week days morning and afternoon including bingo, quizzes, music, flower arranging, scrabble, film etc. Church services are held on regular basis in the home. The Service User Guide includes information stating the visiting arrangements are at any reasonable times. A mobile library visits the home. An activities organiser is employed from 9am to 5pm weekly. One day is not covered at present due to sickness. Russettings DS0000037746.V290461.R01.S.doc Version 5.1 Page 13 Outings are arranged and the residents can choose where they would like to go. A couple of months ago ten residents went to Brighton on the Bluebird bus. The activity organiser said she endeavours to make room visits and give individuals quality time. The menus seen were a four- week rotating menu that were imaginative and varied with a daily selection of alternatives available. The menu book was available in the reception. Surveys carried out in January 2006 showed positive comments about the food. However resident’s comments and table menus did not reflect entirely the menus described in this book. Some resident’s comments included the food has been awful at times but we are doing something about it as we have requested a resident’s meeting to discuss the issues. One resident felt the choice of food was poor especially for residents who required a special diet. Currently the summer menus were in use. There has been a new chef appointed recently who is looking at setting up new menus following discussions with the residents. Russettings DS0000037746.V290461.R01.S.doc Version 5.1 Page 14 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. Quality in this outcome is good. This judgement has been made using available evidence including a visit to this service. The home has a clear complaints procedure and residents and others know how and to whom they should complain if the need arises. A procedure is in place in relation to protecting residents from abuse but requires some amendments. . EVIDENCE: The complaints record was examined and there had been five complaints since the last inspection in November 2005 that had been clearly documented showing the investigations had been made and action taken to resolve them. The complaints procedure is displayed in the reception of the home. The complaints procedure contained in the Service User Guide needs updating to state the Commission of Social Care Inspection. Information leaflets on the new complaints and concerns procedure for the Commission were left in the home and the complaints procedure for the home needs updating to reflect the Commission’s new procedures. The abuse policy for the home still requires reviewing to ensure it is in line with the West Sussex County Council procedures. The home’s own procedure for action in the event of abuse or suspected abuse describes the way in which the home may investigate the allegation when the West Sussex County Council procedures clearly states that West Sussex County Council is the lead agency in all adult protection investigations and should be the first point of contact. Russettings DS0000037746.V290461.R01.S.doc Version 5.1 Page 15 However any incidents or allegations of suspected abuse in the home have been referred following the correct procedures, following two incidents one in November 2005 and January 2006 both of which had been satisfactorily resolved. Staff have had training on Adult Abuse that is updated and staff spoken with understood their responsibilities in reporting any suspected incidents of abuse. The residents spoken with were happy with the way they were cared for and spoke well of the staff and the services they receive. Russettings DS0000037746.V290461.R01.S.doc Version 5.1 Page 16 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): 19,23,26. Quality in this outcome is good. This judgement was made using the available evidence including a site visit to this service. The residents live in a clean and comfortable home with the exception of some areas that were identified as needing some maintenance work carried out. EVIDENCE: A tour of the premises took place and generally the home was fresh and clean and the décor and furnishings were satisfactory. However, the sluice situated on the ground floor had an unpleasant odour and the washbasin was inaccessible due to a waste bin being in the way. Some minor maintenance work was required to one window that was found difficult to shut, a commode chair was in poor repair, and the wheels needed cleaning. The basin in one bathroom and a toilet or radiator in another bathroom appeared to be leaking. The walk-in shower required a shower Russettings DS0000037746.V290461.R01.S.doc Version 5.1 Page 17 curtain to be fitted to ensure the privacy and dignity of residents. One of the en-suite shower rooms and the room marked laundry were being used inappropriately for storage purposes. On running the tap in the assisted bathroom on the first floor it was found that the hot water was excessively hot. There was no record of the monitoring of the hot water prior to residents having a bath and there was no thermometer available as seen in the other bathrooms. There was no sign on the downstairs toilet and shower room to indicate whether it was vacant or engaged. En-suite WC’s are impractical to use due to their size for those residents who require assistance with toileting. Furniture in the upstairs lounge areas was torn and wearing badly in some areas. The resident’s rooms seen were comfortable and suited their individual needs and some contained their own personal small items of furniture and belongings. The kitchenette situated on the first floor that was found to be in need of cleaning at the last inspection was found on this occasion to be clean and tidy. Russettings DS0000037746.V290461.R01.S.doc Version 5.1 Page 18 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. Quality in this outcome is adequate. This judgement has been made using available evidence including a site visit to this service. The numbers and skill mix of staff available was insufficient to give the residents the time they required to meet all their needs. The recruitment procedures for the home ensure that all new members of staff have the necessary checks carried. References in one case need further investigation. EVIDENCE: From examining the staff rotas for April and the beginning of May 2006 they showed that without the manager there were four permanent trained nurses plus three bank nurses to cover and take charge of night and day shifts throughout each week. The manager had been appointed since April 2006 and her previous post of deputy manager is vacant. The rotas also showed that the manager is on some shifts the only qualified nurse on duty. Staffing numbers on the day of the inspection were one trained nurse who had only recently started working in the home plus seven care assistants. The manager was rostered to start work at 9am. Some residents commented that staffing numbers had improved but the home was still short staffed at times. Comments included that they had to wait long periods of time to get help from the staff with their toileting and one resident raised a concern about not having staff available at all times in the lounge areas. Staff spoken with said they were only able to give basic care and were Russettings DS0000037746.V290461.R01.S.doc Version 5.1 Page 19 often rushed and could not spend quality time with the residents. The general opinion of the staff was that there were insufficient nurses as one was needed on each floor, as at present there were a lot of dressings to be done and the dependency levels of the residents was high. It was especially busy in the evenings as many of the residents required assistance with their eating and more residents were choosing to eat in their rooms. One relative spoken with via the telephone said staffing numbers were often insufficient as their relative required assistance with eating and drinking and often had to wait for long periods before any staff were available to assist with the meal. The pre-inspection questionnaire shows that 30 of the care staff had achieved the National Vocational Qualifications at level 2 or above. Four staff files were examined of staff employed since the last inspection in November 2005 and all files showed that the appropriate checks had been carried out prior to commencing employment. However one staff file showed that the member of staff had not given the latest employers name for reference purposes and the reason given on the application form for leaving the last employment had not been checked out. Russettings DS0000037746.V290461.R01.S.doc Version 5.1 Page 20 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): 31,32,33,36,38. Quality in this outcome is good. This judgement was made using available evidence including a site visit to this service. The residents live in a home where their safety and welfare are promoted by good working practices. All health and safety checks were in good order and up to date, providing residents with a safe environment in which to live. EVIDENCE: The manager had been appointed in April 2006 and was in the process of applying to the Commission to be the registered manager. Staff and residents said she was approachable and said they would be comfortable to speak with her on any matter. She has worked in the home for 3 years as the Deputy. The staff spoken with confirmed that staff supervision takes place at regular intervals. However it was noted that the manager, trained nurses and the chef Russettings DS0000037746.V290461.R01.S.doc Version 5.1 Page 21 who are supervisors had not had the appropriate training to carry out the supervision of staff. There was evidence that surveys had been given to residents and sent to relatives in January 2006 and an audit completed that showed that generally outcomes were good. It was highlighted that there were some maintenance issues but that was when there was no handyman. The manager confirmed that head office send out surveys to residents and relatives each year. There was no evidence that the home had a written annual development plan. A handyman has been in post for 7 months and the in house maintenance checks were examined and found up to date. Records were maintained for equipment, water temperatures and emergency lighting, and all fire systems. However there were no routine checks carried out for window restrictors and cot sides. The fire logbook showed that ten members of staff had attended fire training in February 2006 and six in March 2006. Alpha Care provides the training for staff in the home. A falls specialist nurse carried out training for staff in May 2006. The manager believes all but two members of staff had Adult Protection training in December 2005. Training records were not fully up to date so it was impossible to ascertain which staff had attended what training. The manager is working to improve this. A trained first aider is not available on all shifts. The accidents books were examined and there had been a total of 102 accidents recorded since the last inspection in November 2005. All slips and trips are recorded whether they result in an injury or not. General policies and procedures were last reviewed in July 2005. Risk assessments were in place for the environment but some were not dated. Russettings DS0000037746.V290461.R01.S.doc Version 5.1 Page 22 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 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X 3 X X 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 Russettings DS0000037746.V290461.R01.S.doc Version 5.1 Page 23 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(2) (b) Requirement The registered person shall keep the resident’s care plan under review. The registered person shall ensure that the home’s policy and procedure on abuse is in line with the West Sussex County Council’s Vulnerable Adults Procedures. The registered person shall ensure that at all times suitably qualified, competent and experienced persons are working at the care home in numbers such as are appropriate for the health and welfare of the residents. (Previous timescale not met 30/11/05) 4 OP15 16(2)(i) The registered person shall provide suitable, wholesome and nutritious food, which is varied and properly prepared. 30/06/06 Timescale for action 30/06/06 2 `OP18 13(6) 30/06/06 3 OP27 18(1((a) 31/07/06 Russettings DS0000037746.V290461.R01.S.doc Version 5.1 Page 24 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 Russettings DS0000037746.V290461.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY 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 Russettings DS0000037746.V290461.R01.S.doc Version 5.1 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!