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Inspection on 29/12/05 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 29th December 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

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. Residents and visitors think the standard of care is very good, a relative said `I can`t fault mothers care`. Another said `I am very happy with the home`. Residents say they can make choices about their lives, they like the staff who they say are kind and considerate. Nursing standards are high with trained staff always on each shift. Management and staff are aware of indicators that all is not well with a resident and action will be taken to improve wellbeing. Where necessary external support and advice will be obtained. 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. Residents say they like the food, they have a choice of meal and dietary needs are met. The home is clean and clothes are well looked after. Relatives think communication between staff and themselves is good. Whilst a resident said he had no complaints at all, complaints will be listened to and there are meetings to further voice opinions. Safety of residents is promoted.

What has improved since the last inspection?

Staff are better equipped to work safely and competently with older people now that core and fire safety training has been undertaken. Residents can be assured that the organisation ultimately responsible for their care know how well the service is functioning as visits by a representative of the Trust are made monthly.

What the care home could do better:

The home must be able to demonstrate they can meet resident`s needs. Residents have the right to know that all staff are aware of their needs and how they will be met, improved assessment, care planning, weight monitoring and triggers for administration of medication would evidence this. Residents rights would be better demonstrated when the laws of consent are routinely taken into consideration. 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 the fire safety officer has approved the fire risk assessment.

CARE HOMES FOR OLDER PEOPLE Rusthall Lodge Nursing Home Rusthall Lodge Nellington Road Rusthall Tunbridge Wells Kent TN4 8SJ Lead Inspector Ann Block Unannounced Inspection 29th December 2005 10:25 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.V264314.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. Rusthall Lodge Nursing Home DS0000026203.V264314.R01.S.doc Version 5.0 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.V264314.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. A care home providing nursing which may also include 5 older people who are terminally ill. 16th August 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. 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. Work has begun to replace the current building. The first stage, being a new build in the grounds adjacent to the existing building, should be completed by the end of 2006 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 DS0000026203.V264314.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced inspection was carried out on Thursday 29th December 2005. The commission was represented by Ann Block, regulatory inspector, who was in the home from 10.25 am until 15.45 pm. During that time, a number of residents, relatives and staff spoke with the inspector in private and in small groups. The focus of the inspection was to talk primarily with residents to assess their quality of life in the home. Many standards were not assessed, having been assessed in full at the inspection of 16th August 2005. To gain a more comprehensive view of service provision it is recommended that the reader access the report of that inspection. The inspector is familiar with the service, judgments for this report have been made from conversation, observation, records and previous experience of the service where relevant. The manager and deputy manager assisted the inspector in the process of inspection and were provided with verbal and written feedback. All feedback was very complimentary of the service, including the qualities of staff. Staff must be commended for their commitment in taking on additional roles and working long hours to provide care and services to residents in very difficult circumstances over the Christmas period. Residents commented that staff were ‘absolutely brilliant’. 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. Residents and visitors think the standard of care is very good, a relative said ‘I can’t fault mothers care’. Another said ‘I am very happy with the home’. Residents say they can make choices about their lives, they like the staff who they say are kind and considerate. Nursing standards are high with trained staff always on each shift. Management and staff are aware of indicators that all is not well with a resident and action will be taken to improve wellbeing. Where necessary external support and advice will be obtained. 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. Residents say they like the food, they have a choice of meal and dietary needs are met. The home is clean and clothes are well looked after. Relatives think communication between staff and themselves is good. Whilst a resident said he had no complaints at all, complaints will be listened to and there are meetings to further voice opinions. Safety of residents is promoted. Rusthall Lodge Nursing Home DS0000026203.V264314.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Rusthall Lodge Nursing Home DS0000026203.V264314.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rusthall Lodge Nursing Home DS0000026203.V264314.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 4,5 & 6 Residents can make a choice whether the home is suitable for them. Conditions of registration are not met until the resident with dementia moves to a more suitable placement. EVIDENCE: Rusthall Lodge provides care for older people, some of whom may need nursing care. The service is unable to cater for people with significant mental health needs such as those with dementia. A resident who has a diagnosis of dementia is in the later stages of moving to a more suitable home and was being assessed by the receiving home during the inspection. A resident said he had visited the home with his son before moving in, had stayed for lunch and met staff. He was aware of the type of home it was, but let his son make the judgment whether it would be suitable for him. He thought his son had made the right choice as he was happy with the home, staff and his room. Rusthall Lodge Nursing Home DS0000026203.V264314.R01.S.doc Version 5.0 Page 9 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 DS0000026203.V264314.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): 7,8,10 & 11 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. The recently appointed deputy manager is aware that care records are not being maintained efficiently. Some care plans are being updated, suggestions were made regarding the manner of recording key information to be specific and personal to the resident concerned – ideally encouraging staff to recognise through such records that the resident is the key decision maker and central to the care plan system. Separate daily notes are made, current ones being held in a single file for ease of access. As found at previous inspections, there is a lack of continuity in daily notes. Events are not tracked, implications of comments made are not documented. Whilst staff often knew the current status of a residents health and wellbeing, records didn’t reliably evidence that monitoring was taking place, such as routine monitoring of weight. Qualified staff, nursing assistants and keyworkers are Rusthall Lodge Nursing Home DS0000026203.V264314.R01.S.doc Version 5.0 Page 11 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. 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 and relatives 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. Residents confirmed that they were called by their preferred name. Access to specialist health and ancillary services is provided. A chiropodist was visiting during the inspection. The deputy mentioned the support provided by the speech therapist regarding swallowing and nutrition problems. Skin integrity is promoted. Staff spoke of intact skin even where there was a high risk of skin breakdown. They felt this 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. Letters of thanks to staff referred to excellent care being provided. 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 DS0000026203.V264314.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): 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, a number already knew of Rusthall Lodge. Those spoken with felt that the home met their expectations. 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. Those wishing to continue with religious observance can attend a service given by a visiting religious minister. The activities coordinator, about whom residents and visitors spoke very highly at the last inspection, was not on duty. A young volunteer was working with some residents on activities of their choice and mentioned the types of activities residents liked including bingo, quizzes, films and craft. A list of activities for the week is displayed in the dining room. In better weather trips out are offered to those residents who are able and would benefit from them. The local community minibus can be booked for outings further afield. Many residents said they go out with Rusthall Lodge Nursing Home DS0000026203.V264314.R01.S.doc Version 5.0 Page 13 families. Some Christmas festivities had been postponed, the Christmas party is to be held in mid January and another Christmas dinner is planned for late January. A hairdresser visits weekly and has use of a designated room, residents said they were looking forward to her next visit after the Christmas break. Residents can purchase clothes from the bi-annual clothes shop visits. 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 said they would be involved in decision making if the resident chose and felt staff let them know if there were any concerns. The new nurse call system has benefited visitors in that the front door is now answered much more quickly. 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. 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 saying that one would always be a vegetarian option, menus were also on each table. Individual dietary needs and preferences are met. The chef and 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. Small fridges are available near to bedrooms for residents to safely 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. Rusthall Lodge Nursing Home DS0000026203.V264314.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17 & 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. 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. They felt all the staff were approachable. 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, 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.V264314.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): 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 was started last 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 dining areas, lounges, bathrooms and toilets. Elements of the home present an institutional feel. 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 DS0000026203.V264314.R01.S.doc Version 5.0 Page 16 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. Laundry staff said the new machines had proved invaluable over the Christmas period. 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. 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. Residents said that after some initial teething troubles, which have now been resolved, they are much happier as there was usually a reduction in time taken to answer calls. The time taken to answer each call can be monitored through a printout. 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 is 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, 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. A fire risk assessment has been carried out, the maintenance person was unsure whether it has been 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. A member of domestic staff said she was careful to base her routines around residents, when they were resting or unwell she made sure she didn’t disturb them unnecessarily. Rusthall Lodge Nursing Home DS0000026203.V264314.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 & 30 Residents are cared for by staff who they like and trust. EVIDENCE: Staffing levels were not assessed in depth as staff were just coming out of a critical period where they had worked extremely hard, taking on duties which were beyond their job descriptions and working long hours to ensure residents’ needs were met. Management had taken a lead role in covering shifts in a hands on capacity. The deputy manager appointed last autumn had started to identify her role in the organisation but also was affected. The deputy said she had started to look at training in liaison with an administrator. Core training for staff was nearly 100 complete, one person still needed moving and handling training and a few needed basic food hygiene awareness training. She felt the range of training offered was good, the administrator’s role was to correlate training available and advise the deputy what was available. The deputy felt there was a generous training budget she could use. Staff thought training offered was varied and useful. One person was looking forward to getting a place on NVQ training next spring, as others had spoken well of it. Whilst recruitment was not assessed, the volunteer spoke of sound systems to ensure she was safe and competent to work with vulnerable people. She said she was clear about her role and would not be providing direct care to any resident. Rusthall Lodge Nursing Home DS0000026203.V264314.R01.S.doc Version 5.0 Page 18 As part of the new build and transfer of the current resident group to stage 1 of the new build, numbers will be reduced slightly. The business manager has devised a staffing/care needs table which identifies to the manager whether hours needed are being provided and where any shortfalls are which give hours available for cover. The manager said she found this system useful. The table will provide the basis for the staffing needs assessment required at the last inspection. Domestic, activities, laundry and catering staff are employed with cover at weekends. Agency staff are used to cover shortfalls not met by home staff. Residents said they liked the staff and found them kind and courteous. Rusthall Lodge Nursing Home DS0000026203.V264314.R01.S.doc Version 5.0 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 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): 31,32,36 & 38 Residents live in a home with a more defined management structure and better protection against risk from fire. 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 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 new deputy manager has been appointed. Staff felt that there was an improvement in clarity of management structure, roles and responsibilities. A role of nursing assistant has been created to give staff with NVQ level 3 in care career progression and greater responsibility. Rusthall Lodge Nursing Home DS0000026203.V264314.R01.S.doc Version 5.0 Page 20 A representative of the Trust makes monthly visits to the home to assess and report on the standard of service provision. 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. 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. Records of staff attendance at fire drills and practices has been altered since the last inspection with two differing formats in use. The format which records a full list of staff against days drills were held, potentially offers better monitoring that staff have attended a recent fire drill. The current records indicated that the majority of staff have now received recent training. Night staff are aware they must attend a drill every three months. Certain staff are designated fire wardens. Staff spoken to and the volunteer were aware of correct fire procedures. The maintenance person, who holds responsibility for fire training, said he was impressed by staff awareness of fire safety and evacuation procedures. Following a recent fire safety officer’s visit, Dorgards (automatic noise activated door closures) have been fitted to areas identified in the inspection as vulnerable. Rusthall Lodge Nursing Home DS0000026203.V264314.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x x 1 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 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 Standard No Score 16 3 17 2 18 3 1 1 1 1 3 2 2 3 STAFFING Standard No Score 27 1 28 x 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 x x x 3 x 3 Rusthall Lodge Nursing Home DS0000026203.V264314.R01.S.doc Version 5.0 Page 22 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 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 29/12/05 - The person referred to is in the final stages of being moved to a more appropriate placement 2 OP7.1 15 (1) & Care plans must include: DS0000026203.V264314.R01.S.doc Timescale for action 28/02/06 28/02/06 Version 5.0 Page 23 Rusthall Lodge Nursing Home (2) · 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 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 This remains outstanding from the inspection of 16/08/05 3 OP19OP20 OP21OP22 23(1)(a) 23(2)a,b 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 4 OP27.1 18 (1) 32 (1) An audit and review of staffing levels, competence in individual roles and resident dependency levels must be carried out with DS0000026203.V264314.R01.S.doc 31/01/06 Rusthall Lodge Nursing Home Version 5.0 Page 24 any necessary action taken to meet this regulation. Outcomes must also be presented to the commission. This remains outstanding and will be completed by 31/01/06 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 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. 29/12/05 - Not inspected 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 29/12/05 - Not inspected 5 OP29.1 19 (1) 31/01/06 6 OP29.3 19 (5) 31/01/06 Rusthall Lodge Nursing Home DS0000026203.V264314.R01.S.doc Version 5.0 Page 25 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 2 OP9.4 Refer to Standard OP8.9 Good Practice Recommendations Where weight loss or gain indicates regular weight monitoring is needed, this should take place. 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. 29/12/05 - Not inspected 3 4 OP19.5 5 OP24.7 OP17.1 The laws of consent should be considered when recording wishes in respect of death. It is strongly recommended that the fire risk assessment be sent to the local Fire Safety Officer for approval. 29/12/05 - Not inspected 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. 6 OP25.5 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. Rusthall Lodge Nursing Home DS0000026203.V264314.R01.S.doc Version 5.0 Page 26 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.V264314.R01.S.doc Version 5.0 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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