CARE HOMES FOR OLDER PEOPLE
Russell Haven 15 - 19 Clevedon Road Weston Super Mare North Somerset BS23 1DA Lead Inspector
Juanita Glass Unannounced Inspection 09:30 19 and 26th July 2007
tth 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 Russell Haven DS0000020380.V337031.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. Russell Haven DS0000020380.V337031.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Russell Haven Address 15 - 19 Clevedon Road Weston Super Mare North Somerset BS23 1DA 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) 01934 620195 01934 622670 traceyngreen@yahoo.co.uk Mr Nunzio Notaro Ms Tracey Green Care Home 38 Category(ies) of Old age, not falling within any other category registration, with number (38), Physical disability (2) of places Russell Haven DS0000020380.V337031.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. May accommodate up to 38 service users aged 50 years and over requiring nursing care. 04th July 2006 Date of last inspection Brief Description of the Service: Russell Haven is registered with the CSCI to provide nursing care to 38 residents aged 50 years and over. The home is located within walking distance of the beach and local amenities and is conveniently placed for access by public transport. All areas are accessible for wheelchair users and access to the upper floor is provided by a lift. Current fees £527 Russell Haven DS0000020380.V337031.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over two days with a total of 8 hours spent in the home. The manager Ms T Green was present throughout. Evidence to support this inspection was gained through 1-1 and group discussions with eight residents, one relative and three members of staff. Written surveys were not obtained in this instance. The records for six residents and four members of staff were reviewed as well as maintenance, health and safety checks and a tour of the premises. A visiting pharmacy technician not linked with the CSCI was auditing medication. What the service does well: What has improved since the last inspection?
It was evident that staff morale had improved since the last inspection. Staff were observed to be cheerful and to chat amiably with residents. Manual Handling practices were observed to be appropriate and residents were involved at all stages throughout the process. All the requirements from the last inspection had been met. Staff had a clear understanding of the needs of residents with insulin-controlled diabetes. Care plans for specific needs were in place and those residents able too had agreed to their plan of care. The manager was adhering to robust recruitment procedures. During the second day of the inspection the dining room floor was being levelled and the surface re-laid. Residents spoken to said they were enjoying the upheaval as it meant they could ‘eat in the lounge with a picnic type atmosphere.’
Russell Haven DS0000020380.V337031.R01.S.doc Version 5.2 Page 6 The manager has consulted residents on the level of activities in the home. Responses reviewed were largely happy with the provision already in place 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. The summary of this inspection report can be made available in other formats on request. Russell Haven DS0000020380.V337031.R01.S.doc Version 5.2 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 Russell Haven DS0000020380.V337031.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, and 5. 6 does not apply Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides adequate information enabling prospective residents to make an informed decision when choosing a home. The manager carries out a comprehensive assessment before an admission is agreed, this includes the provision for a visit to the home. EVIDENCE: The statement of purpose and service user guide both contained comprehensive information about the home and how they work to meet the needs of their resident group. A Relative spoken to said that the information had been easy to read and helped in the final decision. Individual care records reviewed showed that preadmission assessments were being carried out prior to admission to the home. One resident spoken to said that the staff had made
Russell Haven DS0000020380.V337031.R01.S.doc Version 5.2 Page 9 her transfer an easy process and that she was happy with the information she had been given. Nobody else was able to comment on his or her admission. Prospective residents and their representatives are able to visit the home prior to admission; this enables them to make an informed choice on whether they choose the home or not. A relative or representative usually does this on the residents’ behalf. One resident said the visit had been a helpful experience. Russell Haven DS0000020380.V337031.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents receive effective personal and health care support. This is recorded in a way that reflects person centred care. Residents are enabled to access health care services within the home and the wider community. Residents are treated with respect and dignity. EVIDENCE: All residents’ records reviewed had some very clear and concise care plans that showed an awareness of person centred care. They were individualised and contained adequate guidance for care staff. Care plans have been reviewed to indicate personal likes and dislikes so that the residents feelings are central to their care. One resident spoken to said ‘they are aware of my condition and look after me very well.’ Since the last inspection specific needs are identified clearly in care plans with clear guidance for staff. Residents changing needs were also recorded. This included temporary changes such as chest infections. Residents spoken to said that staff were excellent and knew how to meet their
Russell Haven DS0000020380.V337031.R01.S.doc Version 5.2 Page 11 needs. One relative said that staff were very good in identifying needs and meeting them. One resident spoken to said they were aware of their care plans but did not want to be involved in their review. They felt they had been adequately consulted on admission about the care they would need. Resident’s records show that they were assisted to attend health care services such as the GP surgery, chiropodist, dentist, optician and outpatient appointments. The home requests district nurse input when necessary, and also have a palliative care link nurse. The inspector did not carry out an audit of medication as a company pharmacy technician was carrying out her own inspection. Several issues were raised and the home needs to comply with the recommendations left by the pharmacist. During the day, staff working practices were observed and residents and visitors spoken to. Staff were noted to have a very friendly but professional rapport with both residents and their relatives. Working practices were noted to be person centred with emphasis on talking to residents and explaining what was about to happen. Residents spoken to said that staff treated them well and worked hard to meet all their needs, they confirmed that staff respected their dignity and privacy. Residents who had chosen to remain in their own rooms said staff respected their right to privacy and always knocked before entering. Russell Haven DS0000020380.V337031.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are involved in meaningful activities of their choice. The home encourages them to maintain contact with family, friends and the wider community. Residents feel they are enabled to maintain choice and control where possible. A nutritious and well balanced diet is provided and staff are sensitive to those who require assistance to eat. EVIDENCE: Records reviewed and residents spoken to confirmed that the home provides a full programme of meaningful activities for all residents. They can exercise personal choice on which ones to attend. Activities are provided by outside sources and include reminiscence, singing and dancing, visiting entertainers and games. Residents go out for outings and staff take residents out for walks along the promenade, or into town. Residents spoken to said they always had the choice of attending an activity. The manager has carried out an activities survey asking residents to comment on the activities provided and to suggest further activities that they would like to do. Comments were largely complimentary; a few residents stated they would like to go out more often.
Russell Haven DS0000020380.V337031.R01.S.doc Version 5.2 Page 13 Residents and visitors spoken to said that there were no restrictions on visiting times. One visitor said they were always made welcome and commented on the cheerful and respectful approach of staff. The home has a six-week menu, which is reviewed seasonally. Residents spoken to said choices were available if you did not like the meal offered. One resident said staff had asked what their likes and dislikes were. A choice is offered for the evening meal between a cooked dish and sandwiches. During the second day of the inspection the dining room floor was being levelled and the surface re-laid. Residents spoken to said they were enjoying the upheaval as it meant they could ‘eat in the lounge with a picnic type atmosphere.’ One visitor spoken to said they were always offered a meal when they visited and felt the food provided was of a very good standard. Staff were observed helping residents eat in a sensitive unhurried approach. Russell Haven DS0000020380.V337031.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints policy and procedure, and clear guidance for the protection of vulnerable adults; all staff spoken to demonstrated a clear awareness of adult protection issues. EVIDENCE: The home has a robust policy and procedure for the handling of complaints, a record is maintained which shows the agreed outcome. One visitor said they knew who to approach if they needed to raise a concern and they felt that they would be listened to and taken seriously. Residents spoken to said they could approach any member of staff. They felt they could talk quite openly to the manager. The homes policies and procedures for the protection of vulnerable adults are very clear and concise. They are stored in the office and available for staff at all times; a copy of the North Somerset policies and procedures were also available. Staff spoken to had received adult protection training and showed an awareness of the issues. Russell Haven DS0000020380.V337031.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable and homely environment, which is appropriate to the needs of the resident group. Specialist aids are provided where necessary. Residents are encouraged to personalise their rooms. The home is clean tidy and free from offensive odours. EVIDENCE: Russell Haven maintains a high standard of cleanliness, residents spoken to commented on the hard work the ancillary staff put in to maintaining such a pleasant atmosphere. One visitor stated they had never seen the home untidy at any time of day. Residents spoken to liked their rooms and many contained personal items including pictures and photographs. Residents have access to safe wellmaintained gardens and the community areas are well lit and ventilated.
Russell Haven DS0000020380.V337031.R01.S.doc Version 5.2 Page 16 During a tour of the premises it was noted that several bedroom doors identified to the manager did not close completely. This puts residents at risk in the event of fire. The manager dealt with this immediately and on the second day of the inspection all the identified doors closed properly. Russell Haven DS0000020380.V337031.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from adequate numbers of staff who are competent and trained to meet their individual needs. The home is working to meet the 50 NVQ trained staff. Robust recruitment procedures protect residents from abuse. EVIDENCE: Staffing records reviewed and residents, visitors spoken to confirmed that there are adequate numbers of staff on duty to meet the assessed needs of the current resident group. During the inspection staff were observed to carry out their duties in a relaxed and unhurried manner. Staff morale was high and a cheerful atmosphere was evident in the home. Residents stated that they rarely had to wait long for the call bell to be answered. This was also witnessed throughout the two day inspection all call bells were answered within a reasonable space of time. Staff records showed that the company encourage training and personal development either within the home or from outside agencies. The manager is currently encouraging care staff to take up the NVQ level 2 and 3 training. Residents spoken to with specific needs stated that they felt staff had an understanding of their diverse needs which may at times differ from the usual duties staff need to perform. Since the last inspection all staff have an
Russell Haven DS0000020380.V337031.R01.S.doc Version 5.2 Page 18 awareness of the management of insulin controlled diabetes and have maintained regular training in areas specific to the needs of the resident group. Manual handling training is regularly up dated with the use of a video. Staff need to attend training that enables them to experience practical demonstrations and the chance to practice techniques shown. A review of staff personnel records showed the manager adheres to a robust recruitment procedure. This ensures residents are protected from abuse. All required checks and documentation had been obtained for new staff before they commenced work. The manager had also confirmed ‘To whom it may concern’ references, which is good practice. Russell Haven DS0000020380.V337031.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has the required qualifications and experience to run the home. The ethos is open and inclusive resulting in residents feeling that they do have a say in the management of their care. Residents’ financial interests are protected through a robust system. Staff receive regular supervision providing continuity of care for residents. The home has sound policies and procedures and works to a clear health and safety policy. EVIDENCE: The manager is a qualified nurse with experience in management. She has completed the Registration process with the CSCI. Both residents and staff spoken to state that the manager was always ready to listen to them and
Russell Haven DS0000020380.V337031.R01.S.doc Version 5.2 Page 20 spend time with them, an easy and friendly rapport was noted through out both days of the inspection. It was also noted that staff morale was high, they felt supported and valued in their work. Systems are in place for residents, visitors and relatives to comment on the running of the home, copies of questionnaires seen showed that residents and relatives are happy with the running of the home. The manager re introduced relative/resident meetings but these were poorly attended. An activities survey was also carried out and residents commented on the provision of activities and made suggestions, which the manager hopes to provide. The Notaro group maintains a secure system for safeguarding residents’ finances. All staff carry out an induction within the first week of the start of employment. A supervision agreement is signed and the responsibility for staff supervision is cascaded down from the manager through senior staff. Evidence of regular staff supervision was seen on the day of inspection. This promotes a feeling of continuity of care in the home. All health and safety checks were in place and up-to-date. The fire risk assessment for the building is available for inspection and the fire log showed that all recommended checks were being carried out. It was noted that a small group of night staff had not attended the fired drills that are carried out regularly in the home. The manager stated that she would ensure they were enabled to take part in regular fire drills. Accident records were maintained which included a record of the follow-up carried out by staff to identify outcomes. Russell Haven DS0000020380.V337031.R01.S.doc Version 5.2 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 3 X 3 X 3 N/A 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 4 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 Russell Haven DS0000020380.V337031.R01.S.doc Version 5.2 Page 22 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. Standard Regulation Requirement Timescale for action 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 OP9 OP30 Good Practice Recommendations The manager and staff need to comply with the issues raised by the pharmacy technician. Manual Handling training needs to include practical demonstrations and give staff the chance to practice the techniques in a safe environment rather than rely solely on video training. Night staff need to attend regular fire drills instructing them on how to manage in case of a fire. 3 OP38 Russell Haven DS0000020380.V337031.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection South West Regional Office Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Russell Haven DS0000020380.V337031.R01.S.doc Version 5.2 Page 24 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
