Inspection on 30/01/06 for Rustington Hall

This inspection was carried out on 30th January 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Rustington Hall 04/08/09

Rustington Hall 17/09/08

Rustington Hall 13/09/06

Rustington Hall 17/08/05

Rustington Hall 10/12/04

Rustington Hall 26/07/04

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 Rustington Hall Station Road Rustington West Sussex BN16 3AY Lead Inspector Miss Helen Tomlinson Unannounced Inspection 30th January 2006 10:00 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.V277903.R01.S.doc Version 5.1 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.V277903.R01.S.doc Version 5.1 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 Post Vacant 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.V277903.R01.S.doc Version 5.1 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. 17th August 2005 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.V277903.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Since the last inspection at Rustington Hall in August 2005 the registered manager and the Chief Executive had left the employment of the Society which owns the home. A new manager was in place who was in the process of being registered with the Commission. She had been in post for three months at the time of this inspection. A new deputy manager was also in post. The position of Chief Executive remained vacant. This was an unannounced inspection. The first day of the inspection was Monday the 30th January 2006. On this day there was an infection in the building used for residents receiving personal care only. Visitors were discouraged due to the risk of spread of the infection therefore the inspection of the personal care unit took place at a later date, on the 27th February 2006. This infection had been spreading throughout the local area, including the hospital, and staff at Rustington Hall followed the correct procedures to meet the needs of the residents and prevent the spread of infection. On the first day of the inspection the inspector arrived in the nursing unit at 10am and left at 4pm. On the second day the inspector arrived on the personal care unit at 8.20am and left at 11.45am. The registered manager was present throughout both inspection visits. During the course of the inspection twenty two residents, two visitors and nine members of staff were spoken with. One visiting professional was interviewed and was complimentary about he care and records. Staff were observed giving support and assistance. Residents files were examined and other records were seen as necessary. A tour of the premises took place. Staff files were examined. Following the last inspection seven requirements and three good practice recommendations were made. At this inspection five requirements remained outstanding. The three good practice recommendations from the last inspection had been met and three new ones were made. What the service does well: Residents and staff were complimentary about the new manager. They said she was “supportive” “open” and “approachable.” Residents said they felt more included and consulted about the running of the home, with an increase in the opportunity to have meetings and talk to the manager. Residents also praised the staff saying they worked very hard, were very busy, but were always cheerful, helpful and polite. The necessary equipment was present, on both units, to assist the residents safely, encourage independence and provide the aids and adaptations necessary to meet their needs. Residents in both units commented that the home was always clean and tidy with no offensive odours. Residents could personalise their bedrooms with Rustington Hall DS0000024208.V277903.R01.S.doc Version 5.1 Page 6 furniture, photographs, pictures etc, should they wish. Personal entertainment equipment and telephones were present in some bedrooms. The health assessments and plans of care in the nursing unit were thorough, up to date and reflective of the current situation. 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. Rustington Hall DS0000024208.V277903.R01.S.doc Version 5.1 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 Rustington Hall DS0000024208.V277903.R01.S.doc Version 5.1 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): 3 Standard 6 is not applicable to this home. Residents were not admitted to the home unless an assessment of their needs had been carried out. EVIDENCE: Residents admitted to the home since the last inspection had been seen by a suitably qualified member of staff from the home, prior to them becoming accommodated. An assessment of their needs had been carried out and documented. This was translated into a plan of care to meet these needs. Rustington Hall DS0000024208.V277903.R01.S.doc Version 5.1 Page 9 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 and 9 Standard 10 was assessed and met at the last inspection. All residents had a plan of care. On the personal care unit these were not always kept up to date. The health care needs of the residents were assessed and met. The storage, recording and administration of medication safeguarded the residents. An issue of concern regarding self medication was identified on the personal care unit. EVIDENCE: All residents, on both units, had plans of care documented. On the nursing unit these contained detailed information about the needs of the residents and how these were to be met. The resident’s choices and preferences were recorded. These plans had been reviewed and kept up to date. On the personal care unit these plans varied in the amount and accuracy of the information documented. Examples were seen where the resident’s needs and current situation had changed, but the care plan had not been reviewed to reflect this. This resulted in the current care the resident was receiving and the risks due to the change in condition, not being recorded and no strategy for management being in place. Staff had recognised this change in situation and were working to make sure the resident received the correct care. The Rustington Hall DS0000024208.V277903.R01.S.doc Version 5.1 Page 10 care plans must reflect the current situation. The system of reviewing the care plans had changed on the personal care unit and they were now being documented monthly. As discussed above this review must inform a change in the plan of care where necessary. For most residents on the personal care unit there was no detail as to how their needs were to be met by staff. On both units there was no evidence of consultation with the resident, or their representative, for the drawing up of the care plan. Health care assessments were carried out for various health issues including the development of pressure sores, nutrition and mobility risks. These were used to devise the plan of care. On both units these assessments had been reviewed monthly. There was evidence of other health professionals being consulted, as was necessary, for advice and support. At the last inspection it was required that any resident who stored and administered their own medication had a risk assessment completed to ensure their safety and that of other residents. This had been done at this inspection, with a thorough document having been devised and put into use. For one resident there was an issue of concern that they were not safely administering their own medication. This had been thoroughly documented, but no remedial action, to ensure the safety of the resident, or others, had been taken. The identified risks had not been acted upon. The manager was made aware of this issue and assured the inspector the procedure would be made safe for the resident. The recording of administration in the personal care unit had improved since the last inspection. Medication on the nursing unit was administered by qualified nurses. This was safely stored. Staff were advised to sign and witness hand written changes to the medication administration sheets. Where a G.P. or other doctor has changed medication this should be recorded on the medication administration sheet. All prescribed external preparations must be signed for by staff administering it. Correct signage to indicate oxygen being stored must be in place. Rustington Hall DS0000024208.V277903.R01.S.doc Version 5.1 Page 11 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): 13 and 14 Standards 12 and 15 were assessed and met at the last inspection. Residents were assisted and encouraged to maintain contact with family and friends. Residents said their choices were explored, understood and respected by staff. EVIDENCE: Staff said there was no restriction on the visiting times for relatives or friends. Residents said they could see their visitors in the privacy of their own bedrooms or in the communal areas, as they wished. Friends and relatives were supported to take residents out of the home, should they wish and it was safe to do so. Visitors spoken with said they felt welcome in the home and were greeted in a friendly manner. Contacts with the local community were encouraged and supported. A religious service, from a local minister took place, school parties and volunteers visited the home. Residents said their choices and preferences were asked for by the staff in terms of food, rising and retiring times, where they would like to spend their time and their routines for daily living. Those more dependant residents said the staff helped and supported them in the way they wanted and they could discuss how they liked to be helped with the staff and management. Rustington Hall DS0000024208.V277903.R01.S.doc Version 5.1 Page 12 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): 18 Standard 16 was assessed and met at the last inspection. Residents were protected from abuse EVIDENCE: At the last inspection a requirement was made regarding the written procedure in the home, to be taken should an allegation of abuse be made. At this inspection this had been reviewed and was in line with current guidance. A recent allegation of abuse had been made at the home. The correct procedure had been followed and residents had been safeguarded. The manager stated all those who were in charge of the home had been made aware of the correct procedure to follow. Rustington Hall DS0000024208.V277903.R01.S.doc Version 5.1 Page 13 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. Standard 26 was assessed and met at the last inspection. Residents lived in a well maintained, comfortable environment. Some areas of the personal care unit could present risks for residents with reduced mobility. One aspect of fire safety remained unmet from the last inspection, two others had been met. Adequate communal facilities were present in both units. There were potential access difficulties to the main lounge in the personal care unit. There were sufficient and suitable bathing and toilet facilities in both units. EVIDENCE: Both units were well maintained, clean, nicely decorated and comfortable. The personal care unit had some particularly homely and domestic areas, which the old building made possible. The nursing unit had been made as domestic as possible in the communal areas. Fixtures, fittings and furniture were of a good standard At the last inspection requirements were made regarding fire safety. At this inspection two of the three issues raised had been addressed. Staff had received further fire safety training and the procedure had been reviewed and clarified. Some fire doors, on both units were held open with wedges or other Rustington Hall DS0000024208.V277903.R01.S.doc Version 5.1 Page 14 items. All fire doors must be kept shut, unless held open by a device which meets the guidance of the fire service. There were adequate communal areas in both units. On the nursing unit there is one large lounge, a smaller lounge and a large dining area. There is a garden around the whole building and a courtyard in the nursing unit. Residents said they could sit in the communal areas, should they wish, but many chose to stay in their own bedrooms. On the personal care unit there was a large lounge and a smaller lounge on the ground floor. A large dining room was also available. Residents were seen to use the lounge and it was a sociable place during the morning. There is a small flight of steps up to the main lounge. Residents said they could manage these, with the help of staff and a call bell was well positioned for them to request help should they wish to leave the lounge. It was discussed with staff and the manager that this could present a hazard to residents and prevent access with lifting equipment, should it be needed in the main lounge. Other areas of the home have small flights of steps to bedrooms and bathrooms. It was advised that an occupational therapy assessment should be carried out to gain advice on alternatives to make these areas safer and more accessible for the residents. In both units there were toilets and bathrooms conveniently situated and in sufficient number, to meet the needs of the residents. These included assisted baths with bath hoists or specialist baths, raised toilet seats, grab rails and toilet frames. All bathrooms seen were clean and tidy and safely accessible to the residents. In the nursing unit en-suite facilities were present. In the personal care unit commodes were provided, in the resident’s bedrooms, when necessary. Rustington Hall DS0000024208.V277903.R01.S.doc Version 5.1 Page 15 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 and 29 The numbers and skill mix of staff was sufficient to meet the needs of the residents accommodated. Staff received training for the work they were doing. The recruitment procedures were not adequate to ensure protection for the vulnerable adults in the home. EVIDENCE: Following the last inspection a recommendation was made that the use of agency staff in the home be reduced. The recruitment drive to have more permanent staff in the home continued. Residents said they were seeing more familiar faces, but there were times when they did not recognise staff on duty. They were aware this was being addressed. The duty rota showed that staff were on duty in sufficient numbers to meet the needs of the residents. It was seen that agency staff were given a good induction to the home and residents and were assisted by permanent staff to feel part of a team. The manager stated that a large number of care assistants were taking or had completed the NVQ qualifications. The training records were not up to date and the manager said she was working on this at present. Other training had been carried out since the last inspection including fire safety, medication and protection of vulnerable adults. Staff reported that training was ongoing, on a daily basis, when working with qualified nursing staff. The files for 2 members of staff were examined. These did not contain evidence that all necessary checks, to ensure they were fit to work with vulnerable adults had been carried out. A full employment history was not present and gaps in employment were not explained. There was evidence that Rustington Hall DS0000024208.V277903.R01.S.doc Version 5.1 Page 16 they had not been checked for a criminal record or against the Protection of Vulnerable Adults register before they started work in the home. No person must work in the home until the satisfactory checks have been carried out. The requirement made following the last inspection remains unmet. Rustington Hall DS0000024208.V277903.R01.S.doc Version 5.1 Page 17 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): 38 Standards 33 and 35 were assessed and met at the last inspection. Residents have been through an unsettled period with changes of manager, but now benefit from an experienced manager being in post. Generally there is an awareness of health and safety issues. One aspect of fire safety remains unmet from the previous inspection and one issue of potential risk to residents had not been addressed. EVIDENCE: At this inspection the manager of the home had been in post for three months. Her registration with the Commission had not been completed due to administration difficulties. She is an experienced manager, having managed care homes for older people for many years. She is a qualified nurse with the recognised management qualification. Staff said she was approachable and had some “good ideas for changes in the home.” The manager discussed her plans for improvement and had identified priorities. Rustington Hall DS0000024208.V277903.R01.S.doc Version 5.1 Page 18 Staff were aware of their role in protecting the health and safety of themselves, residents and colleagues. Most had received some training in this aspect of their role. The windows in the nursing unit had restrictors fitted. Those in the personal care unit did not. Many of these windows opened very wide and the hinges meant they swung outwards when opened. At the last inspection it was required that risk assessments should be carried out for the safety of all residents who are in rooms with no restrictor fitted. These were not present at this inspection. As discussed in standard nineteen on issue of fire safety remained unmet since the last inspection. Accidents were recorded and followed up to prevent a recurrence. Rustington Hall DS0000024208.V277903.R01.S.doc Version 5.1 Page 19 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 2 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 2 3 3 X X X X X STAFFING Standard No Score 27 3 28 3 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X 2 Rustington Hall DS0000024208.V277903.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Timescale for action 30/09/05 2 OP9 3 OP19 4 OP29 All care plans must be kept under review and reflect the current situation. The review must be documented. This requirement remains unmet since the inspection of 17/08/05. The timescale given of 30/09/05 has expired. 31/08/05 13(2) All residents who self medicate must have a thorough risk assessment completed which includes storage and staff checks on medication. Risks identified must be acted upon This requirement remains unmet since the inspection of 17/08/05. The timescale given of 31/08/05 has expired. 23(4)(b)(c Fire doors must be closed or held 30/09/05 ) open by a device which meets the guidance of the fire service. This requirement remains unmet since the inspection of 17/08/05. The timescale given of 30/09/05 has expired 19 & All checks on staff working at the 31/08/05 DS0000024208.V277903.R01.S.doc Version 5.1 Rustington Hall Page 21 schedule 2 5 OP38 13(4)(c) home must be carried out prior to them starting employment. This requirement remains unmet since the inspection of 17/08/05. The timescale given of 31/08/05 has expired Risk assessments for the fitting of window restrictors should be completed. This requirement remains unmet since the inspection of 17/08/05. The timescale given of 31/08/05 has expired. 31/08/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP7 OP9 Good Practice Recommendations Care plans should be drawn up in consultation with the resident or their representative. Hand written changes to the medication administration sheets should be signed and witnessed. Signs should be in place to indicate oxygen storage. A record of administration of prescribed external preparations should be kept. An occupational therapy assessment should be obtained for the small flights of steps leading to the lounge and bedrooms. 3 OP20 Rustington Hall DS0000024208.V277903.R01.S.doc Version 5.1 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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