CARE HOMES FOR OLDER PEOPLE
Rustington Hall Station Road Rustington West Sussex BN16 3AY Lead Inspector
Miss Helen Tomlinson Unannounced Inspection 19th September 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 Rustington Hall DS0000024208.V310411.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. Rustington Hall DS0000024208.V310411.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Rustington Hall Address Station Road Rustington West Sussex BN16 3AY 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) 01903 775001 01903 777502 Littlehampton And Rustington Housing Society Limited Mrs Sally Baylis Care Home 59 Category(ies) of Old age, not falling within any other category registration, with number (59), Physical disability (6) of places Rustington Hall DS0000024208.V310411.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Maximum of fifty nine (59) of whom thirty five (35) persons may be in receipt of nursing care. A maximum of six (6) service users in the category physical disability (PD) aged 50 years and over may be accommodated. 30th January 2006 Date of last inspection Brief Description of the Service: Rustington Hall is a care establishment registered to accommodate up to 59 residents aged 65 years or over. 35 of these residents may be receiving nursing care. Half of the establishment was built many years ago as a private house, but this was converted to an establishment to provide care for 24 people some years ago. The second half of the building was purpose built at a later date to accommodate 35 residents in need of nursing care. The 2 establishments are run and registered as 1 care home. They are situated a few feet away from each other. In both establishments the bedrooms are situated on 2 floors with a passenger lift to provide access. Communal lounges and a dining room are present in both buildings. The cooking for main meals for the whole establishment is done in the main kitchen in the smaller home and taken, in a hot trolley, to the nursing home. Gardens with seating for residents were present. The property is located in Rustington, a large village near the town of Littlehampton. The care home is in a residential area with easy public transport links. A large car park is available for visitors. Rustington Hall DS0000024208.V310411.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection. The inspector arrived at 8.30am and left the home at 6pm. The registered manager and responsible individual were present throughout the inspection. The responsible individual had recently been recruited to this post and that of Chief Executive Officer of the Rustington and Littlehampton Housing Society. He had quickly made himself familiar with the care home and had made changes which staff and residents saw as positive. Prior to the visit to the home information was gathered from previous inspections and information received regarding the service. During the inspection a full tour of the premises took place, the inspector spoke to the residents, staff and visitors. Care practices were observed, care plans examined and other documents seen as necessary throughout the inspection. Following the last inspection of January 2006 five requirements were made. All of these had been met at this inspection. Two requirements were made following this inspection. What the service does well:
Residents spoke highly of the staff in the home saying they were friendly, polite, kind and helpful. One resident said “you couldn’t wish for better staff, they are all lovely.” Interactions between staff and residents were informal, but respectful with one to one conversations, which showed the high level of understanding of the individuality of the residents. All prospective residents had their needs assessed to ensure the home could meet their needs, prior to them being admitted to the home. The same amount of comprehensive information was gathered for those residents who were staying for a short period of respite. The records kept regarding the resident’s health and personal care needs were comprehensive, up to date and regularly reviewed. These were drawn up from assessments of health and their needs were met by qualified nurses with other professionals being involved if necessary. The atmosphere, particularly on the unit for personal care, was one of inclusion of the residents in the day to day life of the home. Residents said their choices and preferences around their day to day routines were sought and respected. They said there were plenty of activities to join in if they wished or they were
Rustington Hall DS0000024208.V310411.R01.S.doc Version 5.2 Page 6 assisted to carry on with their own individual pastimes. Assistance to join in activities was given to those more dependant residents. Visitors to the home were warmly welcomed and could stay as long as they wished, seeing their relative in the communal lounges, or their own bedrooms. Residents were particularly complimentary about the food served, saying it was tasty, varied, plentiful and a good choice was offered. Special diets were catered for. Residents and visitors said the manger and staff were approachable and they would discuss any issues or concerns they may have, feeling confident appropriate action would be taken. The home was clean, tidy, free from offensive odours and well maintained. Residents used the varied communal space, including the spacious gardens and said the home was “home from home.” Staff were employed in sufficient number and with an adequate mix of skill, knowledge and experience to meet the needs of the residents accommodated. They received a good amount of training which was pertinent to their work and specific to the residents needs. What has improved since the last inspection? What they could do better:
The recording and administration of controlled drugs must comply with the Nursing and Midwifery Council code of practice and the Dangerous Drugs Act.
Rustington Hall DS0000024208.V310411.R01.S.doc Version 5.2 Page 7 This applied to one qualified nurse only and the manager confirmed that appropriate action would be taken to ensure the safety of all residents. Risk assessments should be carried out for all residents who use the small flights of steps in the personal care unit. Measures to prevent falls should be taken. 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. Rustington Hall DS0000024208.V310411.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 Rustington Hall DS0000024208.V310411.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): 3 Residents needs were assessed prior to them being accommodated in the home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The files seen contained assessments of the resident’s needs which contained a large amount of information and included all aspects of physical and health care and personal information. These had been completed prior to the resident being accommodated in the home. The same needs assessments were completed for any resident coming to the home for a short respite stay. There was no evidence that it was confirmed to the residents, in writing, that their care needs could be met. Rustington Hall DS0000024208.V310411.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 All residents had a comprehensive, up to date, plan of care drawn up from health assessments. Residents’ health care needs were met. Residents said their privacy and dignity was respected and staff were kind and polite. Medication was safely stored and administered with records kept. An issue regarding the recording of administration of controlled drugs was raised. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service EVIDENCE: Six care plans were examined. These consisted of three in each area of the home. In both units the information recorded was comprehensive, giving a good picture of the resident’s needs and how these should be met by staff at the home. Health and risk assessments were carried out which included nutrition, moving and handling, risk of developing a pressure sore and risk of falls. The needs identified, from these assessments, had a plan of care documented. In both units these had been updated and changes made with any change in condition or need. On the unit for residents needing personal
Rustington Hall DS0000024208.V310411.R01.S.doc Version 5.2 Page 11 care there were two different documents for this purpose, one of which was reviewed monthly and one was not. The use of this documentation should be consistent. On the unit for residents needing personal care there were two different tools for assessing the risk of development of a pressure sore. These gave differing rates of risk and again only one tool should be used. On some of the plans seen there was evidence that the resident, or a relative, had been involved in the drawing up of these plans. Some residents and relatives were aware they had a plan of care and could see it if they wished, others were not aware. All medication was safely stored, administered and recorded. On the unit for nursing care medication was administered by qualified nurses. On the unit for personal care it was administered by care assistants who had received relevant training. At the time of the last inspection it was discussed, on the unit for personal care, that when a risk assessment had been carried out for the self administration of medication, this must be kept under review and any identified risks minimised. This had been done at this inspection and the risk assessments seen were thorough and had been reviewed. On the unit for nursing care the records regarding the administration of one controlled drug were inaccurate and the correct procedure for checking this medication had not been followed. This was discussed with the manager and the qualified nurse involved, as it was a breach of the Nursing and Midwifery Council code of practice. The manager confirmed that appropriate action would be taken promptly to ensure the safety of the residents. Residents spoken with said the staff were very friendly, polite and helpful. They said they treated them with respect and protected their dignity. Bedroom and bathroom doors were closed when personal care was being given. Residents asked said they had been offered a key for their bedroom door and most had a lockable storage facility. Staff interacted with residents in an informal way, using their preferred name and showing a good understanding of their likes and choices. Rustington Hall DS0000024208.V310411.R01.S.doc Version 5.2 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 and 15 Residents said the social activities and pastimes on offer met their preferences and choices. They could have visitors at any time and visitors said they were welcomed into the home. Residents said the meals were good with a wide choice offered and plenty of food available. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service EVIDENCE: Residents said there were plenty of organised activities for them to join in with, should they choose to do so. These included quizzes, a film club, a scrabble club, bingo, exercise classes and entertainers coming to the home. Residents could choose to join in activities which took part in the sheltered housing complex, within the same grounds. Residents were assisted and supported to continue with their individual choices of pastime, such as jigsaws, knitting or listening to music. The programme of activities was present on both units with those resident’s who were more dependant on staff being assisted.
Rustington Hall DS0000024208.V310411.R01.S.doc Version 5.2 Page 13 Residents, particularly on the personal care unit, were involved in the day to day life of the home. Staff interacted with them to ascertain their wishes and choices and respected these. Some preferences, likes and dislikes were recorded on the plans of care. Residents said the routines were flexible and they could choose the times to go to bed or get up. Visitors spoken with said they could come to the home at any reasonable time and stay as long as they wished. They were included in the care of their relative, should they so wish, or could take them out of the home, if they were able. They said they received a warm welcome from the manager and staff. Residents praised the food served at the home saying it was always of a good quality and there was plenty of it. They were particularly impressed with the choice offered, which was varied and they could ask for things which weren’t on the menu, should they wish. Some residents had enjoyed a cooked breakfast that morning. The lunchtime seen was a sociable affair with staff present to assist residents, should this be necessary. They assisted in a discreet and unhurried manner. Residents could choose to have their meals in their bedrooms should they wish, or the attractive dining rooms. Special dietary needs were catered for. Rustington Hall DS0000024208.V310411.R01.S.doc Version 5.2 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 and 18 Residents were confident that any concerns or complaints they raised would be dealt with. Residents were protected from abuse. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service EVIDENCE: Three complaints had been made to the home, since the last inspection. These had been dealt with by the manager, to the satisfaction of the complainant. Copies of the correspondence were present, but no other record of complaints was kept. The complaints procedure was in the service user guide, but was not on display in the home. This should be done to enable visitors to have access to it. Two allegations of abuse had been made since the last inspection. These had been correctly reported, investigated and appropriate actions taken. Residents were safeguarded by the correct procedures being followed. All staff had received training in the protection of vulnerable adults. Rustington Hall DS0000024208.V310411.R01.S.doc Version 5.2 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): 19,22 and 26 Residents live in a clean, tidy and well maintained environment, with the equipment necessary to meet their needs. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service EVIDENCE: Both units were clean, tidy, free from offensive odours and well maintained. The unit for residents requiring personal care is a converted large house and as such has a homely feel with domestic fixtures and fittings. The nursing unit, being purpose built is more functional, but measures have been taken to make the environment pleasant and homely. Fresh flowers were present in the communal areas and dining rooms of both units. Residents in both units were happy with their bedrooms and had brought personal items into the home. A variety of communal areas, which were appropriate and safe for resident’s use, were available, including spacious well maintained gardens.
Rustington Hall DS0000024208.V310411.R01.S.doc Version 5.2 Page 16 All bedrooms in the nursing unit and some in the personal care unit have ensuite bathrooms. There were sufficient bathrooms and toilets, with moving and handling equipment, to ensure the needs of more dependant residents were safely met. Both units had a passenger lift to access the first floor. The personal care unit has many areas, including the large communal lounge and most first floor bedrooms, where access can only be gained via three or four steps. Hand rails for these were in place and a call bell for the lounge. However for some residents these steps presented a risk of falls. Some risk assessments were present, but not all residents who used these steps had been assessed for them safely doing so. Hoists were available for those residents who were not mobile. One bathroom on the personal care unit had items stored in a way which prevented safe access and could present a hazard to the residents. Two issues of health and safety were noted and both were made safe during the inspection. At the last inspection some fire doors, including resident’s bedroom doors, were wedged open. This presented a risk to residents in the case of a fire. At this inspection all fire doors were closed, unless held open by a device which meets the guidance of the fire authority. Risk assessments had been carried out for each resident which included their ability to evacuate the building. Staff had received infection control training. Appropriate preventative clothing was worn during the day and sufficient hand washing facilities were in place. Rustington Hall DS0000024208.V310411.R01.S.doc Version 5.2 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): 27,28,29 and 30 The staff numbers and skill mix was suitable to meet the needs of the resident’s accommodated. Staff received appropriate training and were recruited in a manner which protected the vulnerable adults in their care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: An accurate duty rota was recorded which showed staff to be present in sufficient number and with appropriate skills, knowledge and competence to meet the needs of the residents accommodated. Senior care assistants, who had completed NVQ qualifications, were in day to day charge of the personal care unit. Qualified nurses were in this position on the unit for nursing care. The manager confirmed staff numbers and skill mix were assessed using a recognised tool and kept under review. Staff had received a large amount of training which, they said, was relevant to the work they were doing. This included all statutory training and some pertinent to individual residents needs. At the present time there was no recorded training plan. The manager confirmed this would be devised. Three staff recruitment files were examined. At the last inspection a requirement was made that all necessary checks must be carried out, prior to the person starting work, to ensure they were fit to work with vulnerable adults. At this inspection all these checks had been done in the files seen. It was discussed with the manager that should a staff member be working under the supervision of another this should be recorded.
Rustington Hall DS0000024208.V310411.R01.S.doc Version 5.2 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Residents and staff benefit from the home being run by an experienced manager. Quality reviews are carried out in the home. Staff and the manager protected the health and safety of the residents. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service EVIDENCE: The home is run by an experienced nurse who has worked for many years managing nursing homes. She had been the manager at Rustington Hall for less than twelve months. In that time she had made changes to care practices, which the staff said had a positive impact on the residents. Staff, residents and visitors spoke highly of the manager, saying she was approachable, “took their views into account” and managed the home well. Reviews of the quality of the service did take place, which included visits and reports from trustees of
Rustington Hall DS0000024208.V310411.R01.S.doc Version 5.2 Page 19 the charity. Some audits were already undertaken and the manager was working on plans for further improvements in the home. Some resident’s personal money was managed by staff at the home. This was securely stored with records of all transactions kept. Accident records were kept, but currently no audit of accidents took place to assess any emerging pattern. Staff had received training in health and safety and fire prevention and procedures. All staff spoken with had an understanding of their role in maintaining the health and safety of the residents. Two issues of potential hazards to residents were identified during the inspection. Both of these had been made safe before the inspector left the premises. Rustington Hall DS0000024208.V310411.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Rustington Hall DS0000024208.V310411.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement Accurate records for the administration of controlled drugs must be kept. Qualified nurses administering controlled drugs must do so within their code of practice and in a manner which protects the residents. Risk assessments for residents using the small flights of steps in the personal care unit must be carried out and measures taken to reduce the risk of falls. Timescale for action 22/09/06 2. OP19 13(4)(c) 30/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Rustington Hall DS0000024208.V310411.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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