Inspection on 27/06/06 for Rusthall Lodge Nursing Home

This inspection was carried out on 27th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Rusthall Lodge Nursing Home 12/07/07

Rusthall Lodge Nursing Home 29/12/05

Rusthall Lodge Nursing Home 16/08/05

Rusthall Lodge Nursing Home 08/09/04

Rusthall Lodge Nursing Home 21/06/04

Similar services:

The Shelley

Thorndene

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

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

CARE HOMES FOR OLDER PEOPLE Rusthall Lodge Nursing Home Rusthall Lodge Nellington Road Rusthall Tunbridge Wells Kent TN4 8SJ Lead Inspector Mrs Ann Block Key Unannounced Inspection 27th June 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 Rusthall Lodge Nursing Home DS0000026203.V296277.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Rusthall Lodge Nursing Home DS0000026203.V296277.R01.S.doc Version 5.2 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 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) Rusthall Lodge Housing Association Limited Mrs Sarah Ann Louise Burger Care Home 47 Category(ies) of Old age, not falling within any other category registration, with number (47) of places Rusthall Lodge Nursing Home DS0000026203.V296277.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A care home providing nursing which may also include 5 older people who are terminally ill. 29th December 2005 Date of last inspection Brief Description of the Service: Rusthall Lodge is a detached premises and has been a residential/nursing home for twelve years. The current building is due to be replaced in two stages, the first stage nearing completion. Residents will be transferred to the new building allowing the demolition of the existing building and building of stage 2. Current accommodation is 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/dining room, television room, and small 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. 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. Access to the garden is restricted due to the new build. Current fees range from £450.00 to £775.00. Rusthall Lodge Nursing Home DS0000026203.V296277.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A key inspection was carried out by Ann Block, regulatory inspector, including an unannounced site visit to the home between 9.33am and 5.42pm on Tuesday 27th June 2006. During the site visit residents, relatives, the manager and staff agreed to speak with the inspector both privately and in groups. Three residents were case tracked which included talking with the resident where possible, talking with staff involved in their care, looking at associated records and observing practice. A tour of part of the home was made. As part of the key inspection process comment cards are provided. At the time of writing this report, responses were received from 19 residents, 29 relatives and friends and 9 health and social care professionals. Comments from residents included: ‘My room, bed etc perfect’ ‘Every day there is something to take part in’ ‘My daughter arranged for me to come here and I am quite satisfied with the home’ ‘Meals are varied and good’ ‘The (staff) are friendly and so helpful when you are feeling down’ ‘Rusthall Lodge is run efficiently in a very caring manner’ and from relatives and visitors: ‘The staff are always kind & patient’ ‘This home is a vast improvement on my mother’s previous home’ ‘All residents are well cared for. All the staff are kind and friendly to me’ ‘My mother is very well looked after at Rusthall (Lodge) & my thanks to all the staff for their kindliness & understanding throughout her stay’ ‘I feel very fortunate that my mother is in such a well run home. The staff are very caring & management efficient’ ‘Overall extremely satisfied with all aspects of my aunt’s care and attention to her requirements’ from professionals: Rusthall Lodge Nursing Home DS0000026203.V296277.R01.S.doc Version 5.2 Page 6 ‘Absolutely fine. I have no concerns at all’ ‘The home communicates very clearly their needs and works in partnership with me to develop good practice and safe delivery of care within the home’ Where appropriate evidence for judgements about the quality of service includes responses from this survey. Judgements may also include using evidence from previous inspections where outcomes remain the same. Feedback was provided to the manager during and at the end of the site visit. What the service does well: What has improved since the last inspection? The right of residents to be cared for by staff who are suitable to do so has improved as all staff have criminal records bureau declarations and the reason for leaving any work with vulnerable people is validated, this will be further improved if systems are put in place to monitor any subsequent offences or cautions. Rusthall Lodge Nursing Home DS0000026203.V296277.R01.S.doc Version 5.2 Page 7 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 DS0000026203.V296277.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rusthall Lodge Nursing Home DS0000026203.V296277.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can make a choice whether Rusthall Lodge will be suitable for them through a sound admission process. 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. A number of residents said they had left the decision of choice of home to relatives or friends. Many residents said they moved to the area to be near family. One said how difficult it was leaving her house and old friends behind but that she knew she would be cared for, not be a burden on family and had the opportunity to make new friends. The admission process was confirmed by records seen which included assessment records. Residents said they remembered meeting the manager Rusthall Lodge Nursing Home DS0000026203.V296277.R01.S.doc Version 5.2 Page 10 or deputy as part of the admission process, one resident said the manager visited her in hospital ‘to make sure they could look after me’. Following admission a contract is provided between the resident and home listing rights and responsibilities. There are differing contracts dependent on the fee payee and level of care provided. Relatives considered the contract fair and accurate. 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 have a letter which welcomes them to the home and confirms that following assessment needs can be met there. The manager fully understands the category of residents the home can accommodate and takes action when the placement no longer becomes suitable i.e. needs can no longer be met, even though at times this can be a very difficult decision, especially when the person has been at the home for some time but needs have changed. Respite and occasional rehabilitative care is provided, this system being used at present to offer short term care pending the transfer to the new build. A number of residents find this introduction to a residential care setting to be a useful taster of permanent care. Rusthall Lodge Nursing Home DS0000026203.V296277.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 & 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are treated as individuals with the rights of respect through to the later stages of life. Effective record keeping would better evidence that care and health needs are met. EVIDENCE: Each resident has a plan of care which includes nutritional, skin integrity and moving and handling assessments. Separate daily notes are made, current ones being held in a single file for ease of access. In addition, a stand alone keyworker tick box checklist is maintained. The keyworker checklist links in one column that a check has been carried out of hearing aid/glasses. This is not a useful record that hearing aids are properly maintained. It is to be commended that staff have had training in maintaining hearing aids. As found at previous inspections, there is a lack of continuity in daily notes and links to care plans. Events are not tracked, implications of comments made are not documented. A member of staff discussed the care and health needs of her link resident and demonstrated an excellent knowledge of the resident, her Rusthall Lodge Nursing Home DS0000026203.V296277.R01.S.doc Version 5.2 Page 12 likes and dislikes, how health appointments were managed and family background, very little of this was recorded and what was recorded was difficult to locate quickly due to the arrangement of the care plans. Another care plan was inspected as part of case tracking and had a better level of personalised and relevant care needs. Looking at proposed care plan record sheets there is a risk that rather than implementing a simple, accessible, need to know care file, there will be so much documentation that staff will continue to find it difficult to have time to locate key information and complete records as expected. Qualified staff, nursing assistants and keyworkers are expected to maintain accurate documents, this is not always taking place. Care plans must be consistent with current practice. Records contain a range of health information but less of social and emotional matters. Some work has been undertaken on risk assessments but remain deficient in being set up in response to changing circumstances, such as the building work or using formats which take into account frequency and likelihood of risks such as falls. Not all risk assessments where a risk is assessed as moderate or high have an associated risk management procedure. Residents are able to manage their own medication if risk assessed as safe to do so. At a previous inspection 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. A blister pack monitored dosage system is used 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. 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. Staff who administer medication hold the qualifications and training, which is updated as required, to do so. A relative commented that prescribed medication has been delayed. On investigation it was found that a GP had prescribed remotely, using the results of a test carried out by in house staff and took 2 days to arrange for a prescription for an antibiotic to be issued. Staff said they received an excellent service from the pharmacy who when a prescription was received ensured it was with the home as soon as possible. Arrangements for care, with minor exceptions, demonstrated that residents’ privacy and dignity were respected. Care is taken to ensure residents are dressed in the manner they prefer. Residents considered the laundry service was good with clothing normally returned to the rightful owner. Doors to toilets and bathrooms are lockable, the new build will provide even greater privacy. Screens are provided to maintain dignity when hoists are used in communal areas. Residents confirmed that they were called by their preferred name, one person remembered being asked this question when she was admitted. To reduce stress in having to go through the dressing process Rusthall Lodge Nursing Home DS0000026203.V296277.R01.S.doc Version 5.2 Page 13 unnecessarily, a resident having a bath in the afternoon is given a choice whether they wish to get dressed in full or pop on a dressing gown. Access to specialist health and ancillary services is provided with records seen of access to chiropody, audiology, dental and optical services. A speech therapist has provided advice and support regarding swallowing and nutrition problems. Skin integrity is promoted. At a previous inspection, staff spoke of intact skin even where there was a high risk of skin breakdown which they felt resulted from good care, correct pressure relieving equipment and regular monitoring. As a home provides nursing care, many residents will remain in the home through the later stages of life. 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. The manager is looking to implement a end stage of life care plan which will support the residents own preferences or known wishes. Rusthall Lodge Nursing Home DS0000026203.V296277.R01.S.doc Version 5.2 Page 14 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 area is good. This judgement has been made using available evidence including a visit to this service. 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, a number already knew of Rusthall Lodge. Those spoken with felt that the home met their expectations, one comparing Rusthall Lodge favourably to a previous home she had been in where she had felt no-one bothered to do anything for her, ‘not like here where you only have to ask and it’s done’. Residents explained how they were able to choose their daily routines within reason. They were aware that a group living situation and the availability of staff sometimes restricted choice, but generally were happy to accept what they expected in a residential home. One felt it was difficult having to wait sometimes when you needed to go to the toilet but was aware that other residents might also be needing similar help. The former activities co-ordinator had left due to a house move with a new appointment made. The new activities co-ordinator had only been at the home Rusthall Lodge Nursing Home DS0000026203.V296277.R01.S.doc Version 5.2 Page 15 for a short time but had already gained favour with residents and had started to set up a record of possible activities where she could engage quieter residents in addition to those who were always ready to join in any group. She had contacted organisations such as the RNIB and was hoping to attend training in providing activities for older people. During the site visit a small group were watching ‘Annie’ on DVD, the following day some residents, staff and volunteers were going to Penshurst Place gardens. A list of activities for the week is displayed in the dining room with residents able to say what would be on offer that week. A favourite being bingo ‘not for money of course, just a bar of chocolate or fruit’. One person said that she didn’t know what activities were on offer but had actually been asked earlier whether she wanted to join in the day’s activities. Many residents said they go out with families. A hairdresser visits weekly and has use of a designated room. Residents can purchase clothes from the bi-annual clothes shop visits. One resident said there had been a visit the week before and she had bought a dress. Those wishing to continue with religious observance can attend a service given by a visiting religious minister. Residents said they have regular visits from family and friends as seen during the 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 where they can include others in the social group. The majority of bedrooms have an easy chair for visitors use. Relatives spoken to during the site visit said they would be involved in decision making if the resident chose and said staff always let them know if there were any concerns. 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. The use of photographs in rooms can be a trigger for talking about ‘old times’, many families realise this and bring in favourite photographs and treasured items. One resident said ‘the photographs are my life, I quite often sit here and talk to them, I know some of them aren’t here any more but it give me comfort’. Quite often bringing in personal possessions is a staged process as people settle in, one person was hoping to bring in some more furniture when she moved to the new build. 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 which corresponded with food offered. Individual dietary needs and preferences are met. Staff have a very good understanding of individual need and plate food up knowing the likes and dislikes of each person. Residents said they are able to have a hot drink and biscuits at night with a trolley taken round mid morning and mid afternoon. One person liked to make herself a snack during the night which she was able to do. Small fridges are available near to bedrooms for residents to safely Rusthall Lodge Nursing Home DS0000026203.V296277.R01.S.doc Version 5.2 Page 16 store their own food. Care is taken to monitor weight and nutrition. The former dining room on the upper level has been made smaller as part of the new build, an adjacent lounge has been made into a second dining room. Users of both rooms said they liked the changes, albeit temporary. One resident said she had her breakfast and lunch in the dining room but had tea in her room. Residents who need assistance to eat are helped discreetly. Rusthall Lodge Nursing Home DS0000026203.V296277.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have access to people who listen to any concerns and who will take action. EVIDENCE: Residents have access to a complaint procedure, copies of which are displayed around the home. Complaints are seen as a positive part of providing a satisfactory service. Records of complaints are held and show how the complaint was investigated, action taken and the response to the complainant. Residents and visitors said they hadn’t had to make any formal complaints, any minor ‘criticisms’ or comment about the service would be listened to. The manager is regularly available, residents also mentioned being able to talk to their keyworker or link nurse. They felt the majority of staff were approachable. As the manager explained it is so much easier to put right any problems if they are raised to the right people at the time they happen. The manager was aware that some concerns, which were dealt with at the time so they didn’t escalate into a complaint, were not recorded and decided in future she would record such concerns and ensure that relevant paperwork and supporting information would be documented. 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 Rusthall Lodge Nursing Home DS0000026203.V296277.R01.S.doc Version 5.2 Page 18 makers, this understanding should be used routinely in wishes about last stages of life. 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 DS0000026203.V296277.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25 & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Many residents do not have a suitable environment in which to live. EVIDENCE: A completely new build replacement for the existing home was started last autumn and will be carried out in two stages over two years, the first stage due for completion in September 2006. 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 dining areas, lounges, bathrooms and toilets. Elements of the home present an institutional feel. It is recognised that there are insufficient baths in Rusthall Lodge Nursing Home DS0000026203.V296277.R01.S.doc Version 5.2 Page 20 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 addressed in the new build. The laundry, clothes airing room and medical room are in the newer wing. A high specification washing machine was purchased in 2005 which provides for safe level of disinfection and cleanliness. An additional commercial tumble drier was purchased at the same time. Aids and equipment such as pressure relieving mattresses, age profiling beds, hoists, including movable ceiling hoists, lifts to give access to all levels, grab rails and toilet risers have been provided. Two sluices are available which were clean and well ordered, deficiencies in equipment will be addressed in the new build. A radio pager call system was fitted in 2005. It was felt that the new system, where time taken to answer calls could be monitored, resulted in a far quicker response. Any time over 10 minutes to respond would be investigated at the end of the shift and action taken. 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. A full time maintenance person maintains the building 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, additional local heat is provided by electric convector heaters. Some radiator covers have been removed, also to provide extra heat. Whilst these have been risk assessed for safe use, there remain areas where residents are at some risk from burns and scalds from pipework. There are no outstanding requirements from the Fire Safety Officer or Environmental Health Officer. Domestic staff work hard to maintain a good standard of cleanliness and hygiene. Linen cupboards were noticeably tidy and well ordered. Residents thought the domestic staff were very good and took care with their belongings. Rusthall Lodge Nursing Home DS0000026203.V296277.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected 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 area is good. This judgement has been made using available evidence including a visit to this service. Residents are cared for by a staff team who understand and anticipate residents’ needs and wishes. EVIDENCE: A significant number of the comment cards returned as part of the inspection recorded that there were insufficient staff to meet the needs of residents. At the site visit staff spoken to felt there were enough staff but certain residents took a long time to have care and support provided to their exact preference, this reduced staff available to others. A staffing audit was carried out as required at a previous inspection, the audit concluded that there were sufficient staff to meet current need. During the site visit buzzers were answered in good time and staff were seen to be accessible to people in communal areas. Where necessary, bank or agency staff are used to fill in any shortages. 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, references, interview records, proof of identity, copies of any work permit, copies of training certificates and the reason for leaving any previous work with vulnerable people validated. Staff each have a job description, which they Rusthall Lodge Nursing Home DS0000026203.V296277.R01.S.doc Version 5.2 Page 22 sign, and are given a contract of employment. All but one person holds a current criminal records bureau certificate, an application for the remaining person has been made and the Bureau, not the home, is causing the delay. A POVA first check has been carried out. It was recommended that consideration be given to implementing a system which requires staff to inform the manager of any cautions received, convictions or offences committed since the last criminal records bureau check was carried out. Staff spoke of receiving training, mainly in house. A member of staff has undertaken a training the trainer course and is now qualified to train staff in moving and handling. Staff mentioned how useful the training had been. Newly recruited staff spoke of detailed fire safety training being provided by the maintenance person. 37 staff hold a current first aid certificate. Other client specific training and NVQ training is accessed with 17 (68 ) of staff holding NVQ level 2 or above. Records of induction are held and staff confirmed a sound induction programme. Rusthall Lodge Nursing Home DS0000026203.V296277.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36,37 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a needs led and safe service, which is run in their best interests by a manager and staff who are committed to providing a good quality of life for older people. EVIDENCE: The manager has a registered general nurse qualification and the registered managers award, with many years experience in the care of older people and a commitment to updating her own skills and knowledge. Residents and visitors spoke well of the manager who they felt was approachable and interested in older people. There is a management structure ultimately responsible to the Trust. A deputy manager supports the manager in the running of the home and is undertaking the Registered Managers award. A role of nursing assistant Rusthall Lodge Nursing Home DS0000026203.V296277.R01.S.doc Version 5.2 Page 24 gives staff with NVQ level 3 in care career progression and greater responsibility. 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 monthly and prepares a report which is sent to the commission. 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. The business manager 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. Staff understand that once money is given to a resident, it is their right to choose what they wish to spend it on and records of such expenditure are not appropriate. A staff supervision system is in place. The manager, deputy and trained staff have supervision from the local elderly specialist nurse. They in turn supervise other staff. At a previous inspection staff spoken to thought supervision was good and useful. They said it took place regularly and covered topics such as training, personal development, residents and policy issues. A new member of staff said she had had regular meetings and one to one sessions with the manager, deputy and a qualified member of staff. 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. Staff spoken to were able to state correct fire evacuation procedure and spoke of regular fire safety system tests and fire drills. Safe food hygiene, COSHH, and moving and handling practices were seen during the site visit. Rusthall Lodge Nursing Home DS0000026203.V296277.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 1 1 1 2 1 2 2 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 3 Rusthall Lodge Nursing Home DS0000026203.V296277.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 (1) & (2) Requirement Care plans must include: • • ·evidence that health care needs are properly met ·evidence that falls, accidents and incidents are followed through to confirm that appropriate action has been taken and include responsive risk assessments ·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 that information is current and consistent within the care plan Timescale for action 30/09/06 • • • This remains outstanding from the inspection of 16/08/05 Rusthall Lodge Nursing Home DS0000026203.V296277.R01.S.doc Version 5.2 Page 27 2. OP19 23(1)(a)2 3(2)a,b As detailed under standards 19 to 24: 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 has started. 31/03/08 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 OP11 2 OP24 Refer to Standard Good Practice Recommendations As planned, the introduction of an end stage of life care plan would support residents to receive the type of care, support and intervention they prefer. 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 has started. Pipe work and radiators should be guarded or fitted with guaranteed low temperature surfaces. This remains a recommendation from inspections over the Rusthall Lodge Nursing Home DS0000026203.V296277.R01.S.doc Version 5.2 Page 28 3. OP25 last three years - a new build has started. 4 OP29 There should be a system which requires staff to inform the manager of any cautions received, convictions or offences committed since the last criminal records bureau check was carried out. Rusthall Lodge Nursing Home DS0000026203.V296277.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 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 DS0000026203.V296277.R01.S.doc Version 5.2 Page 30 - 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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