Inspection on 08/11/05 for Russettings

This inspection was carried out on 8th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Russettings 02/04/09

Russettings 03/04/08

Russettings 22/11/07

Russettings 23/05/06

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 L Riddle Unannounced Inspection 8 November 2005 th 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.V260284.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V260284.R01.S.doc Version 5.0 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 Mrs Theodora Susan Verner Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (45) of places Russettings DS0000037746.V260284.R01.S.doc Version 5.0 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 27th July 2005 Brief Description of the Service: Russettings is a care home registered to provide accommodation and nursing care for up to forty-five elderly persons - (OP) old age not falling within any other category. The registered provider is Alpha Health Care Limited for whom the responsible individual is Mrs Sian Sobti. The post of registered manager is vacant, the previous manager having recently left after only a very short time in post. The home is situated in the West Sussex village of Balcombe close to a few local shops and public house. The three storey building is set in good sized gardens with ample parking space at the front. Resident’s accommodation and communal space is arranged on ground and first floors only and there is a passenger lift for access. Russettings DS0000037746.V260284.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out between the hours of 16:40hrs and 19:45hrs by two inspectors as part of the yearly inspection process. Prior to the inspection the previous inspection report was read along with other documents and correspondence relating to the home. Some records and documents were examined and a tour of the premises was undertaken. Four residents and two staff members were spoken with and there was brief discussion with the nurse –in-charge and the administrator who both gave some assistance and made documents and records available. Forty one residents were being accommodated at the time of inspection. What the service does well: What has improved since the last inspection? Arrangements for ensuring that medication stocks are sufficient to prevent any resident running out and therefore missing a medicine, are now in place. Radiators in corridors have been covered for safety. The grounds of the home are now well maintained and minor maintenance is being attended to promptly. Russettings DS0000037746.V260284.R01.S.doc Version 5.0 Page 6 What they could do better: Ensure that resident’s risk assessments are regularly reviewed and updated. Expedite arrangements for contractual disposal of unused medication. Ensure that the home’s Adult Protection procedures do not conflict with those of West Sussex County. Provide covers to radiators in every bedroom. (Previously a requirement) Thoroughly clean and refurbish the Gallery kitchen. (Previously a recommendation) Recruit a new manager. The company must ensure that the next manager to be appointed is fully supported by the company to enable him/her to carry out the management role effectively. The Commission has since met with the provider to discuss these issues and strategies for improvement have been agreed. There have been three managers since the service was first registered, in January 2003. Provide more trained staff. Carry out unannounced monthly visits to the home and send copies of the reports of these to the Commission for Social Care Inspection. Ensure that if fire doors need to be held open they are fitted with an approved device for doing so. Ensure that all serious accidents are notified in accordance with RIDDOR and to the Commission as necessary. Russettings DS0000037746.V260284.R01.S.doc Version 5.0 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Russettings DS0000037746.V260284.R01.S.doc Version 5.0 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 Russettings DS0000037746.V260284.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 5 The admission procedures enable prospective residents to visit and spend time in the home before they decide to move in. EVIDENCE: The home has a written policy and procedures in place concerning admissions to the home. In the absence of a registered manager, the deputy manager or a senior nurse will visit residents in their own homes, hospital or other locations to carry out a needs assessment. The prospective resident and his/her relative or representative is invited, where practicable to visit the home and spend some time, perhaps having a meal, before a final decision is made as to whether that person will move in. A check list is held in each file for new admissions to ensure all procedures are undertaken such as introducing the person to others, showing them where specific rooms are located, telling them the times of meals etc. Russettings DS0000037746.V260284.R01.S.doc Version 5.0 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 The health and personal care of residents are generally well managed but failure to update risk assessments could place residents at increased risk. Medications are stored and administered safely but disposal arrangements need to be in accordance with the law so as not to place residents at risk. Some concerns expressed by residents about the attitudes of staff could make the lives of those residents difficult and unhappy. EVIDENCE: Care plans show that resident’s health care needs are attended to in accordance with their assessed needs. This includes oral care including any visits by the dentist. GP visits are recorded in each file with details of any changes which might occur such as medications and treatments. Nutritional screening is undertaken and weights were seen to be monitored and recorded regularly. It was confirmed by the nurse in charge that only one resident had minor pressures sores at the time of inspection which were receiving appropriate treatment. Risk assessments were in place for those at risk of developing pressure sores and falling. It was noted however, that one resident who had recently returned from hospital following a fractured hip had suffered two further falls since returning home. A care assistant said that she was Russettings DS0000037746.V260284.R01.S.doc Version 5.0 Page 11 worried about this person who was having to sleep in another room because of problems in her own room. The carer was concerned that she might fall out of bed and had told the nurse in charge. It was seen that this resident’s risk assessment had not been updated since her return from hospital to reflect the increased risk she presented and to show what, if any precautions were being taken to reduce the risk of further falls. Medications were seen to be stored safely and records showed that they are administered in accordance with directions, by trained staff. No arrangements have yet been made with a licensed waste disposal company for the disposal of unused medications as now required by law. Two residents expressed anxiety about the attitude of some carers. One said that one or two staff just come into her room do not say anything such as “hello”, they just “plonk something down” or say “eat your tablets” and leave “slamming the door”. This person described some staff as being “abrupt”. It is understood that some training has recently been provided in relation to such matters but this may need to be extended to more or all staff. Other residents spoken with were happy with the way they are cared for and spoke well of the staff and the services they receive. Russettings DS0000037746.V260284.R01.S.doc Version 5.0 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): 14 Residents are able to exercise choice in the course of their daily lives. EVIDENCE: Residents manage their own personal monies or have relatives/representatives to do so on their behalf. A range of activities is provided and residents can choose which if any of these they wish to attend. They choose how they spend their days and whether they remain in their rooms or mix with others in the communal areas. Mealtimes provide a choice of menu from which residents select what they want, as they confirmed. Information leaflets including those about contacting advocacy services are provided in the entrance hall of the home. Russettings DS0000037746.V260284.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 The 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 this is at variance with the County procedures and could result in delay and inappropriate action being taken. EVIDENCE: A clear written procedure for making complaints is displayed in the home. Residents asked, said that they knew who to complain to if the need arises. Forms for making written complaints are also provided for residents and visitors. The record of complaints received was examined and seen to be clearly documented showing what investigations had been made and action taken to resolve them. The home’s own procedure for action in the event of abuse or suspected abuse of any resident describes the way in which the home may investigate the allegation. The West Sussex County Council (WSCC) procedures of which the home has a copy clearly states that the home must not make it’s own investigation in relation to adult protection. WSCC Social and Caring Services is the lead agency in all adult protection investigations and should be the first point of contact. Based on comments from some residents there is some concern that the attitudes and behaviour of a small number of staff may be detrimental to the well being of those and possibly other residents. Russettings DS0000037746.V260284.R01.S.doc Version 5.0 Page 14 Russettings DS0000037746.V260284.R01.S.doc Version 5.0 Page 15 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): 25, 26 Residents live in comfortable surroundings which are generally very clean with the exception of one kitchenette which is dirty, in poor repair and therefore hazardous to resident’s health. EVIDENCE: Corridor radiators have been covered for safety since the previous inspection. It was noted that some bedroom radiators remain uncovered. If these are the type which have low surface temperatures the registered provider should confirm this in writing to the Commission. The Gallery kitchen on the first floor is still in need of thorough cleaning. The floor covering is in poor repair. The work surface is broken and encrusted with old food posing a hazard to health as this kitchen is used to prepare drinks/teas for residents and visitors. The action plan received by the Commission from the registered person following the last inspection stated “Supervisor of cleaning to update rota for cleaning upstairs’ kitchens.” Russettings DS0000037746.V260284.R01.S.doc Version 5.0 Page 16 The Galley kitchen cupboard is now used to store medical dressings. This cupboard is not lockable. If this room is no longer used as a kitchen it should be re-named and the door to the room or the cupboard kept locked. Russettings DS0000037746.V260284.R01.S.doc Version 5.0 Page 17 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, The number of qualified staff available to cover night and day time hours is insufficient to provide the necessary safeguards to residents without the staff working excessive hours which can put residents at risk. EVIDENCE: Duty rotas which covered four-week periods were examined. They showed that without a registered manager in post there are now only four trained nurses to cover and take charge of night and day shifts throughout each week. The deputy manager was on leave for the week when the inspection took place leaving only three trained nurses who were each working 60 hours. This is considered excessive and was discussed with the provider following the inspection who assured it was for a short period only. The work is demanding and requires senior staff to make decisions, provide leadership and direction to other staff and be able to deliver the care which each resident needs in a way that is acceptable to them. The period until a suitable new manager is appointed could be lengthy and during that time trained staff may require holidays, have sickness time off as well as normal time off. This will mean the remaining trained staff undertaking more extra hours to provide the necessary cover over an indefinite period. These circumstances could put residents at risk. Residents commented that the home is sometimes short-staffed and the care staff spoken with said that the workload is heavy at present with many residents being very dependent. Russettings DS0000037746.V260284.R01.S.doc Version 5.0 Page 18 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, 37, 38 The home is currently without a registered manager to provide direction and guidance to staff. EVIDENCE: There is no registered manager in post at present. The deputy manager is temporarily in charge and Alpha Care have said that the home is being closely monitored by external senior personnel of the organisation. The home generally has good recording systems in place. There were however, no copies of reports to show that monthly unannounced official visits to the home by a member of the organisation had taken place since July 2005. Similarly no copies have been sent to the Commission since that time. Records of fire alarm testing showed that the tests are being undertaken weekly. Fire safety instruction to staff had taken place at regular intervals and accidents recorded. One serious accident to a resident which had resulted in Russettings DS0000037746.V260284.R01.S.doc Version 5.0 Page 19 her being hospitalised had not been reported under RIDDOR. Two fire doors to bedrooms were observed to be wedged open. These rooms were occupied by residents in bed who clearly needed to be easily observed by staff. In circumstances where fire doors need to be kept open for any reason, approved devices for doing so should be fitted after consultation with the fire officer. A sign on the nearby nursing station stated “Staff must not wedge doors open at any time”. Russettings DS0000037746.V260284.R01.S.doc Version 5.0 Page 20 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 x x x x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 1 x x x x x x 2 2 STAFFING Standard No Score 27 1 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x x x x x 2 1 Russettings DS0000037746.V260284.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP8 Regulation 14(2)(a)( b) Requirement The registered person shall ensure that the assessment of the service user’s needs is kept under review and reviewed at any time when it is necessary to do so having regard to any change of circumstances. The registered person shall make arrangements for the safe disposal of medicines received into the care home. The registered person shall make arrangements by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. The registered person shall make suitable arrangements for maintaining satisfactory standards of hygiene in all parts of the care home. 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 service DS0000037746.V260284.R01.S.doc Timescale for action 30/11/05 2 OP9 13(2) 31/12/05 3 OP18OP10 13(6) 09/11/05 4 OP26 16(j) 30/11/05 5 OP27 18(1)(a) 30/11/05 Russettings Version 5.0 Page 22 6 7 OP31 OP37 8(1)(b)(i) 26(2)(3)( 4)(5) 23(4)(c ) 8 OP38 9 OP38 37(1)(c ) users. The registered provider shall appoint an individual to manage the care home. The care home shall be visited in accordance with this regulation and provide a copy of the report to the Commission. The registered person shall make adequate arrangements for containing fires. (keep all fire doors closed unless fitted with an approved device for holding them open) The registered person shall give notice to the Commission without delay of any serious accident to a service user. 28/02/05 30/11/05 08/11/05 30/11/05 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 OP25 Good Practice Recommendations All radiators should be covered for safety unless they are of the type which have low surface temperatures in which case this should be confirmed in writing to the Commission for Social Care Inspection. Russettings DS0000037746.V260284.R01.S.doc Version 5.0 Page 23 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.V260284.R01.S.doc Version 5.0 Page 24 - 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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