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Inspection on 16/08/05 for Rusthall Lodge Nursing Home

Also see our care home review for Rusthall Lodge Nursing Home for more information

This inspection was carried out on 16th August 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

What has improved since the last inspection?

Residents` rights to know that the service can meet their needs are clearer now that each is normally visited in their current place of abode, assessed and a letter to confirm this is sent to them before admission. Residents` safety is better protected now that a fire risk assessment has been carried out and the majority of staff handling food have food hygiene awareness training. Visitors and others are less frustrated now that the front door bell is answered more quickly. Residents` rights to know that monies held on their behalf are properly managed are better met through accurate records and audits.

What the care home could do better:

The home must be able to demonstrate they can meet resident`s needs, if necessary by making an application for variation of conditions of registration; where they cannot be met accommodation must be terminated. There must be evidence that sufficient staff who have a clear understanding of roles and responsibilities, provide care and support. Residents have the right to know that all staff are aware of their needs and how they will be met, improved assessment, care planning and triggers for administration of medication would evidence this. Residents have the right to live in an environment which is suitable for them. The right of residents to be cared for by staff who are suitable to do will be improved when all staff have criminal records bureau declarations and the reason for leaving any work with vulnerable people validated. Residents` safety will be improved when all staff receive suitable training including moving and handling, fire drills and first aid and the fire safety officer has approved the fire risk assessment. Residents will be assured that the organisation ultimately responsible for their care know how well the service is functioning when visits by a representative of the Trust are made monthly.

CARE HOMES FOR OLDER PEOPLE Rusthall Lodge Nursing Home Rusthall Lodge Nellington Road Rusthall, Tunbridge Wells Kent TN4 8SJ Lead Inspector Ann Block Announced 16 & 17 August 2005 09:30 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 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. Rusthall Lodge Nursing Home H56-H06 S26203 Rusthall Lodge V234675 160805 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Rusthall Lodge Nursing Home Address Rusthall Lodge Nellington Road Rusthall Tunbridge Wells Kent TN4 8SJ 01892 531378 01892 519461 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) Rusthall Lodge Housing Association Limited Mrs Sarah Ann Louise Burger CRH Care Home 47 Category(ies) of Old age (47) registration, with number of places Rusthall Lodge Nursing Home H56-H06 S26203 Rusthall Lodge V234675 160805 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. A care home providing nursing which may also include 5 older people who are terminally ill. Date of last inspection 08 September 2004 Brief Description of the Service: Rusthall Lodge is a detached premises and has been a residential/nursing home for twelve years. There is accommodation on two floors with forty-one single and three double rooms. Two bedrooms provide en-suite facilities of toilet and washbasin. Eighteen bedrooms are located on the ground floor. The day space consists of a lounge, television room, sun lounge and dining room in the lower dependency wing and a dining room and two lounges in the higher dependency wing. There are three shaft lifts providing access to all levels. Each room has a call alarm and television point. Some rooms have their own telephone points fitted. Planning permission has been granted to replace the existing building, work is due to start this autumn. The first stage, being a new build in the grounds adjacent to the existing building, is hoped to be completed in a year followed by demolition and replacement of the existing building. The home is located in a residential area on the outskirts of Rusthall. Access to public transport is a short distance from the home with the nearest shops and other amenities approximately ¼ mile away. The town of Tunbridge Wells is approximately two miles away with a wide selection of shops and other amenities and a main line station. The home stands in large grounds with lawns and a wide selection of shrubs and trees. There are areas for service users to sit out in fine weather and good facilities for car parking to the front of the building. Rusthall Lodge Nursing Home H56-H06 S26203 Rusthall Lodge V234675 160805 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The commission was represented by regulatory inspector Ann Block who carried out an announced inspection between 9.30am and 5.15 pm on both Tuesday and Wednesday 16 and 17 August 2005. During that time residents, visitors and staff agreed to speak with the inspector both privately and in small groups. As part of the inspection process, a number of comment cards were received from residents, visitors and relatives, and health professionals. Judgments in this report have been made from conversation, observation, records, comment cards and a tour of the home. The inspector is familiar with the service and some judgments have been made including information gained from previous inspections which remains relevant. The manager and deputy manager assisted the inspector in the process of inspection and were provided with verbal and written feedback. What the service does well: Rusthall Lodge is focussed on providing care for older people, many of whom need nursing care. Good pre admission assessments are carried out and moving into the home is made as easy as possible. Staff are committed to providing good care and meeting individual need. Nursing standards are high with trained staff always on each shift, medication is well managed and aids and equipment are provided. Management and staff are aware of indicators that all is not well with a resident and action will be taken to improve wellbeing. As far as possible in the current environment residents are made comfortable in the home and can personalise their own room. Residents like the range of activities offered and the opportunities to maintain contact with family and friends. Meals are good with choices and dietary needs met. The home is clean and clothes are well looked after. Residents like the staff and feel they can talk to them. Complaints will be listened to and there are meetings to further voice opinions. Residents are looking forward to the commitment and investment being made to improve their environment. Positive comments received as part of the inspection included: ‘We always find the staff very pleasant and cheerful and the home clean, bright and welcoming. The care given to our sister and friend is excellent – kind and efficient’ ‘My mother will have been at Rusthall Lodge (for) 6 years. She is well, very happy, loves it there, and the joy and appreciation my wide and I feel towards Rusthall Lodge run Rusthall Lodge Nursing Home H56-H06 S26203 Rusthall Lodge V234675 160805 Stage 4.doc Version 1.30 Page 6 by the excellent Sarah Burger is difficult to put into words. We really appreciate it all as indeed does my mother’. 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. Rusthall Lodge Nursing Home H56-H06 S26203 Rusthall Lodge V234675 160805 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Rusthall Lodge Nursing Home H56-H06 S26203 Rusthall Lodge V234675 160805 Stage 4.doc Version 1.30 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 standard(s) 1,2,3,4,5 & 6 Residents can make a choice whether the home is suitable for them through the good admission procedures in place. Conditions of registration are not met, as a resident with dementia cannot be properly cared for. EVIDENCE: Prospective residents have access to written information about the home which gives detail of services the home provides, the client group catered for, staffing structure and admission procedures. One resident said that she had come to look at the home with her family, another relied on family to make the decision. One said that she had had friends who knew the home and had recommended it to her. Many residents said they have moved there to maintain contact with friends and family in the area. A number remembered meeting a member of staff before they moved in. Some remembered being asked about their health and their lifestyle. The admission process was confirmed by records seen which included assessment records. Residents move in on a trial basis during which time they can decide whether the home is suitable for them and their needs can be met there. Residents now have a letter which welcomes them to the home and confirms that following assessment needs can be met there. Following admission a contract is Rusthall Lodge Nursing Home H56-H06 S26203 Rusthall Lodge V234675 160805 Stage 4.doc Version 1.30 Page 9 provided between the resident and home listing rights and responsibilities. There are differing contracts dependent on the fee payee and level of care provided. Through the process of inspection it was found that one resident now has a formal diagnosis of dementia and at times needs are difficult to meet. This is in clear breach of conditions of registration. Respite and occasional rehabilitative care is provided with one room currently designated a respite room. A number of residents find this introduction to a residential care setting to be a useful taster of permanent care. Rusthall Lodge Nursing Home H56-H06 S26203 Rusthall Lodge V234675 160805 Stage 4.doc Version 1.30 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 standard(s) 7,8,9,10 & 11 Residents are treated as individuals with the rights of respect through to the later stages of life. That care and health needs are met, would be better evidenced by sound and accurate record keeping. EVIDENCE: Each resident has a plan of care which includes nutritional, skin integrity and moving and handling assessments. The care plans are sectioned into areas of care with reviews and updates recorded in the relevant section. Separate daily notes are made, current ones being held in a single file for ease of access. Staff are expected to keep up to date with care plans, evidence suggests this does not reliably happen, greater reliance being on shift handover information. Difficulties in tracking events for an individual are compounded by inconsistent archiving of old notes, lack of evidence of how assessment results have been obtained, lack of evidence of follow up on records of health issues and falls. Qualified staff, nursing assistants and keyworkers are expected to maintain accurate documents, this is not reliably taking place. Records contain a range of health information but less of social and emotional matters. Families consider that generally there is a good response in practice to health needs Rusthall Lodge Nursing Home H56-H06 S26203 Rusthall Lodge V234675 160805 Stage 4.doc Version 1.30 Page 11 with appointments with health professionals made and where necessary escorts provided. Domiciliary visits are made by a chiropodist and optician. Elements of health provision would be better met if scheduled events were monitored and recorded when carried out. Residents are able to manage their own medication if risk assessed as safe to do so. Staff spoke of the systems in place to monitor that a resident remained competent to self administer. Medication records and practice confirmed that medication is administered as per the prescriber’s directions. Staff liked the change to a blister pack monitored dosage system as it is easier to ensure the correct medication is given to the individual. Good practice includes that homeopathic and homely remedies are detailed in the medication record. It was agreed that consistency to ensure residents had medication at the time they required would be improved if triggers for the administration of medication as required were recorded and explanation of terms such as ‘random testing’. Care is taken to ensure that medication is reviewed, potential side effects are monitored and pain relief is well managed. Medication is securely stored in a clean, safe and well ordered manner with unwanted medication disposed of correctly. Arrangements for care, with minor exceptions, demonstrated residents’ privacy and dignity were respected. Great care is taken to ensure residents are dressed in the manner they prefer, with their own clothes well cared for and returned to them promptly after laundering. Doors to toilets and bathrooms are lockable, the new build will provide even greater privacy. A newly admitted resident had asked that staff call him by his abbreviated name and this was impressed upon staff during handover. As a home provides nursing care, many residents will remain in the home through the later stages of life. Letters and feedback from family recorded thanks to the staff for excellent care of their relative. Residents are enabled to be as pain free and untroubled as possible. Staff understand any concerns and worries expressed by the resident or family during such difficult times and are supportive. Rusthall Lodge Nursing Home H56-H06 S26203 Rusthall Lodge V234675 160805 Stage 4.doc Version 1.30 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 standard(s) 12,13,14 & 15 Residents take part in a lifestyle which they help to choose and where they have access to social, recreational and spiritual activities. EVIDENCE: Most residents said they had a good idea of what a residential home would be like and whether Rusthall Lodge would be a place they would choose. The majority of those spoken with felt that their expectations were being met, with a few minor grumbles. They considered they had freedoms in their daily routines, although commenting that this could be restricted by the availability of staff. Those wishing to continue with religious observance can attend a service given by a visiting religious minister. Residents and visitors unanimously spoke highly of the activities coordinator and the occupations she offered. A resident spoke of quizzes, bingo (adding quickly “not for money of course”), cookery groups and exercise sessions. A list of activities for the week is displayed in the dining room. Trips out are offered including a recent accompanied walk to a local garden party. The local community minibus can be booked for outings further afield. A hairdresser visits weekly and has use of a designated room. Residents can purchase clothes from the bi-annual clothes shop visits. Rusthall Lodge Nursing Home H56-H06 S26203 Rusthall Lodge V234675 160805 Stage 4.doc Version 1.30 Page 13 Residents said they have regular visits from family and friends as seen during the days of inspection. Visitors said they felt welcomed to the home, meals can be taken for a small charge. Many visitors like to use the communal lounges or sit outside, where they can include others in the social group. The majority of bedrooms have an easy chair for visitors use. Family members are involved in regular reviews where their views on service provision are listened to and actioned as appropriate. A number of those who formerly lived locally retain connections with the area. A Friends of Rusthall Lodge group has been set up who meet regularly and provide advocacy and friendship services to those who need them. Residents’ rooms are very well personalised. Quite often bringing in personal possessions is a staged process as people settle in. A record of furniture owned by the resident is held to ensure ownership is properly acknowledged. Residents said they liked the food, they were aware of what the choices would be at lunchtime, menus were also on each table. Individual dietary needs and preferences are met and a vegetarian option is always available. Residents said they were able to have a hot drink and biscuits at night. Small fridges are available near to bedrooms for residents to safely store their own food. Care is taken to monitor weight and nutrition. Rusthall Lodge Nursing Home H56-H06 S26203 Rusthall Lodge V234675 160805 Stage 4.doc Version 1.30 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 standard(s) 16,17 & 18 Residents’ rights to receive a safe and satisfactory service are protected. EVIDENCE: Residents have access to a complaint procedure, copies of which are displayed around the home. During the inspection the administrator inserted timescales for response into the policy and was to change those on display. Complaints are seen as a positive part of providing a satisfactory service. Records of complaints are held which showed how the complaint was investigated, action taken and the response to the complainant. Residents and visitors said they were able to make comment about the service to the manager or other staff and felt they would be listened to. Residents who wish to place an election vote are able to do so. There is a good awareness of consent issues and the rights of residents to be the decision makers. Staff have a good understanding of the risks of abuse and how to prevent such risks. Where necessary action has been taken in line with Kent and Medway adult protection policies. The implications of the Protection of Vulnerable Adults procedures is known and used to further protect residents. Rusthall Lodge Nursing Home H56-H06 S26203 Rusthall Lodge V234675 160805 Stage 4.doc Version 1.30 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 standard(s) 19,20,21,22,23,24,25 & 26 Many residents do not have a suitable environment in which to live. EVIDENCE: A completely new build replacement for the existing home is due to start this autumn and is expected to be carried out in two stages over two years. The new build will address the deficiencies in layout and facilities in the current home. A number of inadequacies were identified in a building inspection carried out by the Health Inspection Unit under the Registered Homes Act 1984 including undersized high dependency care rooms, unsuitable access between the original and newer building and lack of storage space. Best use is being made of the existing home which is separated into higher and lower dependency units, each with a dining room, lounges, bathrooms and toilets. The newer wing presents with an institutional feel, unlike the older wing which is bright and airy, leading directly onto the grounds. It is recognised that there are insufficient baths in the current home, all rooms in the new build will be en-suite with a range of bath/shower rooms. A number of existing toilets do not have a washbasin in situ and some are in small blocks. Again this will be Rusthall Lodge Nursing Home H56-H06 S26203 Rusthall Lodge V234675 160805 Stage 4.doc Version 1.30 Page 16 addressed in the new build. The laundry, clothes airing room and medical room are in the newer wing. A new state of the art washing machine has recently been purchased which provides for high level of disinfection and cleanliness. A new additional commercial tumble drier has also been purchased. Aids and equipment such as pressure relieving mattresses, hoists, including movable ceiling hoists, lifts to give access to all levels, grab rails and toilet risers have been provided. The hard wired call system in use on the days of inspection was due to be replaced the following week with a radio linked pager system. This will address deficiencies in the existing system which potentially leaves some residents vulnerable. Two sluices are available which were clean and well ordered, deficiencies in equipment will be addressed in the new build. Rooms are for single occupancy and may be personalised to the occupant’s choice. Some rooms, mainly in the older wing are of a good size, however not all rooms have space to allow for assistance from either side of the bed. Bedroom locks do not have the facility to be opened from the outside in emergency. Residents generally choose not to hold a key. The building remains maintained by a full time maintenance person with routine safety and service checks carried out. The risks of scalds from hot water is reduced by the use of temperature regulating valves. Residents considered they are warm enough in the home but in a few areas are at some risk from burns and scalds from pipework. A fire risk assessment has been carried out, the inspector strongly recommends that it be sent to the local Fire Safety Officer for their approval. The latest Environmental Health Officer inspection awarded the catering services a Gold Award. Domestic staff work hard to maintain a good standard of cleanliness and hygiene. Residents thought the domestic staff were very good and took care with their belongings. Rusthall Lodge Nursing Home H56-H06 S26203 Rusthall Lodge V234675 160805 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 & 30 There is insufficient evidence that residents’ needs are met by sufficient, suitably trained and recruited staff EVIDENCE: Approximately 50 of the comment cards returned as part of the inspection recorded that there were insufficient staff to meet the needs of residents. A number referred to staff not being readily accessible in the communal areas and not answering call buzzers quickly. Some residents mentioned that choices could be limited by staff availability. Staff said that there would be 7 staff on each morning and afternoon with three staff on duty during the night, in addition there would be one or two qualified staff, i.e. nurses. Where necessary, agency staff are used to fill in any shortages. From findings of the inspection indicators were that there is time spent in practises which could be better managed to give more time to work with residents, the call system sounds continuously but in fact is a number of people ‘calling’ and being responded to in sequence. It is expected that a review of staffing levels, roles, responsibilities and dependency levels is carried out before the transfer to the first stage of the new build and it is required that this be completed in respect of existing staffing by December 31st 2005. Domestic, activities, laundry and catering staff are employed with cover at weekends. Recruitment practices have improved with better evidence that staff are suitable to work with older people including a detailed application form, Rusthall Lodge Nursing Home H56-H06 S26203 Rusthall Lodge V234675 160805 Stage 4.doc Version 1.30 Page 18 interview records, copies of training certificates and references. Suitability would be better evidenced where the reason for leaving any previous work with vulnerable people is validated. Staff each have a job description, which they sign, and are given a contract of employment. Files for newly recruited staff showed that a criminal records bureau declaration from a previous employ had been used. It is required that a new criminal records bureau declaration is made for all new staff, it no longer being transferable. Training was not inspected in detail, it was noted that the training matrix did not evidence that all staff have received moving and handling, first aid or fire training. Rusthall Lodge Nursing Home H56-H06 S26203 Rusthall Lodge V234675 160805 Stage 4.doc Version 1.30 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35 & 38 Residents benefit from a structure which has the interest of older people at heart but which needs more clarity in senior staff roles and responsibilities. Safety will be better maintained when all staff have regular fire drills and practices. EVIDENCE: The manager has a registered general nurse qualification with many years experience in the care of older people and a commitment to updating her own skills and knowledge. Residents, visitors and staff spoke of the manager as being ‘a very pleasant, nice person’ with a genuine interest in older people. There is a management structure ultimately responsible to the Trust. There is shortly to be a change of deputy manager. A new role of nursing assistant has been created to give staff with NVQ level 3 in care career progression and Rusthall Lodge Nursing Home H56-H06 S26203 Rusthall Lodge V234675 160805 Stage 4.doc Version 1.30 Page 20 greater responsibility. There is some lack of clarity in individual roles and responsibilities and lack of direction in day-to-day management, possibly due to the proximity of the start of the new build which is taking up a considerable amount of time in planning and meetings. Regular resident, relative and staff meetings are held, including meetings to relay progress on the new build. Meeting minutes are displayed. Residents and relatives felt they could talk to staff and would be listened to. Questionnaires are sent to residents and relatives annually as part of a quality assurance process. A representative of the Trust visits the home and prepares a report, this is not being carried out monthly as required. Suitable insurance is taken out for resident’s belongings up to £100, personal and employer’s liability. Budgets are managed both in respect of the current service and the planned building work. A senior administrator controls home budgets and has set up a 5-year plan. Residents who wish to hold monies for day-to-day expenditure have good systems in place to ensure accountability for individual amounts and receipts for any expenditure made on their behalf. Further accountability is provided by regular audits by third person. If necessary any shortages would be funded from the home petty cash system. Information presented as part of the inspection recorded that servicing of equipment and supplies has taken place in correct timescales. A clinical waste contract is used for any contaminated waste. Records of staff attendance at fire drills and practices was ambiguous. From discussion with staff it became evident that a number of staff have not attended a fire drill since October 2004, including night staff, this potentially puts residents at risk. Rusthall Lodge Nursing Home H56-H06 S26203 Rusthall Lodge V234675 160805 Stage 4.doc Version 1.30 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 1 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 1 1 1 1 3 2 2 3 STAFFING Standard No Score 27 1 28 x 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 2 3 1 3 x x 1 Rusthall Lodge Nursing Home H56-H06 S26203 Rusthall Lodge V234675 160805 Stage 4.doc Version 1.30 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 OP4.1 Regulation 12.1 Requirement The registered person shall ensure that the care home is conducted so as (a) to promote and make proper provision for the health and welfare of service users; (b) to make proper provision for the care, and where appropriate, treatment, education and supervision of service users. Where there is evidence that needs are not being met in the care home either: a) accommodation must be terminated and this notified to the commission or b) application for variation of conditions of registration must be made, which will include evidence of how action will be taken to ensure needs can be properly met in the home Care plans must include: · evidence that health care needs, such as catheter changes, are properly met · a record of activities of daily living made on a daily basis · evidence that falls, accidents and incidents are followed through to confirm that Timescale for action Action to have been taken by 30 September 2005 2. OP7.1 15 (1) & (2) To be actioned by 31 October 2005 thereafter Rusthall Lodge Nursing Home H56-H06 S26203 Rusthall Lodge V234675 160805 Stage 4.doc Version 1.30 Page 23 3. OP19.1 OP20 OP21 OP22 23 (1) (a) 23 (2) (a) & (b) 4. OP27.1 18 (1) 32 (1) 5. OP29.1 19 (1) appropriate action has been taken · proper archiving of records so that tracking and accountability of recent events can be made. · comprehensive risk assessments on a range of activities of daily living · evidence of how scoring of health assessments, such as Waterlow scores, have been made that information is current and consistent within the care plan The premises must be suitable for the purpose of achieving the aims and objectives set out in the statement of purpose. The registered person shall ensure that the physical design and layout of the premises to be used as the care home meet the needs of the service users. The premises to be used as the care home must be of sound construction and kept in a good state of repair externally and internally. This remains a requirement from inspections over the last three years – a new build is due to start in autumn 2005. An audit and review of staffing levels, competence in individual roles and resident dependency levels must be carried out with any necessary action taken to meet this regulation. Outcomes must also be presented to the commission. The registered person shall not employ a person to work at the care home unless he has obtained in respect of that person the information and documents specified in paragraphs 1 to 7 of Schedule 2 An action plan has been received To be completed by 31 December 2005 To be actioned from 31 August 2005 and thereafter Page 24 Rusthall Lodge Nursing Home H56-H06 S26203 Rusthall Lodge V234675 160805 Stage 4.doc Version 1.30 6. OP29.3 19 (5) 7. OP30.1 OP38.1 13 (4) (e) 8. OP38.2 23 (4) (e and he is satisfied on reasonable grounds as to the authenticity of the references referred to in paragraph 5 of Schedule 2 in respect of that person. This will include validation of the reason for leaving any previous work with vulnerable people. The registered person shall not employ a person to work in the care home unless full and satisfactory information is available in relation to each of the matters specified in paragraph 7 of Schedule 2 – this being the obtaining of a positive Criminal Records Bureau declaration. This remains outstanding from the inspections of 21/06/04 and 08/09/04 The registered person must make suitable arrangements for the training of staff in first aid and moving and handling The first part of this requirement is repeated from the inspections of 9 December 2003, 21 June and 8 September 2004. The registered person must ensure that all staff receive fire drills and practices at regular intervals which are at not greater than 3 monthly intervals for night staff and 6 monthly intervals for day staff. There must be evidence that this training has been carried out. Application for relevant existing staff to be made by 31 August 2005 and for newly recruited staff from thereafter Training to be provided by 31 October 2005 and from thereafter Evidence that all staff have attended a recent fire drill or practice must be provided to the commissio n by 30 September 2005 An action plan as to how this regulation will be met Page 25 9. OP34.1 26 (2) A visit to the care home must be made by the responsible individual, or a member of the Trust, or a person employed them, not less than once in Rusthall Lodge Nursing Home H56-H06 S26203 Rusthall Lodge V234675 160805 Stage 4.doc Version 1.30 every month with a report made on outcomes of each visit . to be sent to the commissio n by 30 September 2005 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 OP9.4 Good Practice Recommendations To improve consistency in the administration of medication as required and understanding of terminology such as random testing, triggers for administration and explanation of general terminology should be recorded. It is strongly recommended that the fire risk assessment be sent to the local Fire Safety Officer for approval. All service users should be provided with locks to their rooms unless a risk assessment suggests otherwise using locks which meet the requirements of the fire safety officer and can be opened from the outside in emergency. This remains a recommendation from inspections over the last three years – a new build is due to start in autumn 2005. Pipe work and radiators should be guarded or fitted with guaranteed low temperature surfaces. This remains a recommendation from inspections over the last three years – a new build is due to start in autumn 2005. 2. 3. OP19.5 OP24.7 4. OP25.5 Rusthall Lodge Nursing Home H56-H06 S26203 Rusthall Lodge V234675 160805 Stage 4.doc Version 1.30 Page 26 Commission for Social Care Inspection The Oast, Hermitage Court Hermitage Lane Maidstone Kent TN16 9NT 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 Rusthall Lodge Nursing Home H56-H06 S26203 Rusthall Lodge V234675 160805 Stage 4.doc Version 1.30 Page 27 - 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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