Care Home: Russell Hill Lodge

What the care home does well Residents and staff interviewed during the course of this inspection spoke positively about the support they receive at Russell Hill. Residents clearly feel happy and at ease in this their home. What has improved since the last inspection? Specific areas where improvements have been achieved are as follows: Diary sheet entries and monitoring and review of care plans has improved. The order of the residents files has been improved and the provision of information as required under Schedule 3 has also been improved. The range and scope of activities for residents has been expanded. The quality of the food and the menu choices have been improved. MAR sheets are properly completed now. Stock levels of medications for residents were checked and seen to be appropriate. Water testing has been carried out. What the care home could do better: Specific areas where improvements are required and recommended are as follows: It is recommended that each file should contain a contract between the service and the resident. It is recommended that each resident should have an inventory of their valuable belongings that is updated regularly and as appropriate. It is recommended that all the communal areas including the kitchen and all the bathrooms are refurbished and redecorated more frequently. All staff should now have an NVQ qualification at level 2. This is a requirement. CRB checks need to be renewed every 3 years and they must be agency specific, this is a requirement. All staff should have a valid contract on their staffing files. This is a requirement. It is recommended that induction training be offered to all staff within the first 6 weeks and a proper record kept of exactly what areas have been covered. It is a requirement that all staff receive annual appraisals. It is recommended that there are discussions with all staff in supervision about their keyworking with residents and the work that is carried out with them to meet care plan objectives. This should be recorded on the supervision notes.The Manager must complete his NVQ training for the Registered Managers Award at Level 4 in the next 3 months. This is a repeated requirement and must be completed in the new timescale if enforcement action is to be avoided. It is recommended that an analysis of all the quality assurance feedback information should be completed in order to identify strengths and weaknesses and in order to improve the services being offered to the residents. The Manager must ensure that all hot water outlets are checked on a monthly basis. This is a recommendation. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Russell Hill Lodge 39 Russell Hill Road Purley Surrey CR8 2LD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: David Halliwell     Date: 0 6 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: Russell Hill Lodge 39 Russell Hill Road Purley Surrey CR8 2LD 02086683212 F/P02086683212 ronchiwome@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Laurel Residential Homes Limited care home 18 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Additional conditions: 18 The maximum number of service users who can be accommodated is: 18 The registered person may provide the following category of service only: Care Home Only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home Russell Hill Lodge is registered to provide care to up to 18 adults who have past or present mental health problems. The home is situated close to Purley town centre and therefore well placed for access to the towns amenities and transport. The house is a large detached traditional brick built building. It has 18 single rooms, a lounge, dining area and conservatory. One of the single bedrooms has en suite facilities, including bathing and catering facilities. There are also 2 self contained flats that are used for residents who are able to live more independently. Ownership of Laurel Residential Homes has recently been sold to a new Company that Care Homes for Adults (18-65 years) Page 4 of 36 Brief description of the care home must now register with the Commission for Social Care Inspection. Care Homes for Adults (18-65 years) Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The stars quality rating for this service is good. This means that people who use these services experience good quality outcomes. Service users said that they like to be called residents. This was an unannounced inspection visit undertaken over the period of a day. The Inspection covered all the key standards and involved a tour of the home, a review of all the homes records and formal interviews with the Manager, 3 members staff and 4 residents. Informal interviews were conducted with other residents as a part of the inspection of this home. We received feedback questionnaires from 5 of the 17 residents. We did not receive a Care Homes for Adults (18-65 years) Page 6 of 36 completed Annual Quality Assessment (AQAA) form. Since the last inspection carried out at Russell Hill Lodge some positive progress has been achieved by the Manager and his staff team in meeting the previously set requirements and recommendations from the inspection carried out in April 2008. As a result of this key standards inspection 3 new requirements and 1 repeat requirement has been made. 7 recommendations have also been made. Feedback on all the requirements and recommendations was given verbally to the Manager at the end of this inspection visit. What the care home does well: What has improved since the last inspection? What they could do better: Specific areas where improvements are required and recommended are as follows: It is recommended that each file should contain a contract between the service and the resident. It is recommended that each resident should have an inventory of their valuable belongings that is updated regularly and as appropriate. It is recommended that all the communal areas including the kitchen and all the bathrooms are refurbished and redecorated more frequently. All staff should now have an NVQ qualification at level 2. This is a requirement. CRB checks need to be renewed every 3 years and they must be agency specific, this is a requirement. All staff should have a valid contract on their staffing files. This is a requirement. It is recommended that induction training be offered to all staff within the first 6 weeks and a proper record kept of exactly what areas have been covered. It is a requirement that all staff receive annual appraisals. It is recommended that there are discussions with all staff in supervision about their keyworking with residents and the work that is carried out with them to meet care plan objectives. This should be recorded on the supervision notes. Care Homes for Adults (18-65 years) Page 8 of 36 The Manager must complete his NVQ training for the Registered Managers Award at Level 4 in the next 3 months. This is a repeated requirement and must be completed in the new timescale if enforcement action is to be avoided. It is recommended that an analysis of all the quality assurance feedback information should be completed in order to identify strengths and weaknesses and in order to improve the services being offered to the residents. The Manager must ensure that all hot water outlets are checked on a monthly basis. This is a recommendation. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 36 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and prospective residents may be assured that their needs will be assessed. Residents religious and cultural needs should be included in the assessment process. Evidence: We reviewed 5 of the 17 residents files, 4 of the 5 files were for the most recent admissions of residents to the home since the last inspection. It was immediately noticeable that residents files had been re organised into a much better order and into clearly labelled sections and that they contained appropriate information. Pre admission assessment information about each of the residents needs had been gathered and was seen to be held on their files. This mainly consisted of care programme approach documentation and clinical care team needs assessments. These needs assessments covered most of the essential areas of the residents lives and it Care Homes for Adults (18-65 years) Page 11 of 36 Evidence: was noted that residents sign their needs assessments as an agreement to their contents. At the last inspection it was recommended that the Manager should always request specific information to do with the rehabilitative aims and objectives from the referring agencies at the time of their request to place a new resident. The Manager has now achieved this with the latest admissions to the home and so the recommendation has been met. This helps to ensure that staff at Russell Hill have all the available information about a prospective resident at an early stage of the process and are consequently better able to make a fully informed decision about whether and how best a residents needs could be met. Care Homes for Adults (18-65 years) Page 12 of 36 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to make decisions about their lives with assistance as needed. Their care plans are based on their assessed and changing needs. Residents are supported to take risks as part of moving towards a more independent lifestyle. Evidence: We reviewed 5 residents files and found evidence of individual plans having been drawn up and reviewed monthly for each of these residents. The care plans seen were sufficiently detailed with specific care plan objectives that related to the assessed needs of the resident. In all cases the care plan objectives were linked in with an action plan for both the resident and the keyworking staff to follow so that the objective could be achieved. Care Homes for Adults (18-65 years) Page 13 of 36 Evidence: The Manager informed us that the care plans are reviewed monthly and documentation was seen on file to support this. The monthly reviews of these care plan objectives could still include more detail relative to the progress or not that had been made in meeting the objectives. Sometimes care plan objectives will be changed where it becomes apparent they are unrealistic and unachievable. However an improvement in this process was noted and therefore the requirement that was made at the last inspection has now been met. Care plans had been signed by residents and were dated. The care plans could be seen to be linking in with the pre admission information, i.e the relevant care programme approach documentation of the mental health clinical teams. All of the information required in schedule 3 of the Regulations was seen by us to be documented on the files with the exception of a contract, signed and dated by both parties. It is recommended that each file should contain a contract between the service and the resident as required under standard 5 of the National Minimum Standards. Those residents who we interviewed said that they had been involved in the drawing up of their individual care plans. They said they felt that they had been properly consulted as to their own views and wishes and that what they had said had been properly considered in their care plans. Regular residents meetings are held within the home and there is an opportunity for residents to make their views known about relevant topical issues. Residents are enabled to make decisions about their lives with assistance as needed. We saw staff respecting residents rights to make their own decisions and to make individual choices in their daily lives. Residents also told us via their feedback questionnaires and at interview that they felt staff do respect them and that staff are supportive in helping them to decide about how they are to move forward in their lives. Risk assessments were seen on each of the files reviewed as a part of the initial assessment and care planning being undertaken by Russell Hill. It was also clear that the risks identified in the risk assessments are now being better integrated into care plans drawn up for residents. Monthly reviews were also seen as being part of this process. The Manager told us that both care plans and risk assessments are reviewed monthly as a part of the homes procedures for care planning. This helps in making the appropriate decision about a suitable placement and then in taking risks as a part of Care Homes for Adults (18-65 years) Page 14 of 36 Evidence: developing an independent lifestyle. Care Homes for Adults (18-65 years) Page 15 of 36 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Residents are able to take part in appropriate activities and are to a reasonable extent involved in local activities. Residents have appropriate relationships and their rights and responsibilities in their daily lives are recognised and respected by the staff in the unit. Residents are offered a healthy diet and they are assisted in learning cooking and food preparation skills. Evidence: We found evidence that care support staff appropriately encourage the maintenance of Care Homes for Adults (18-65 years) Page 16 of 36 Evidence: residents relationships with family and friends when residents also wish to do so. We were told by the Manager that visitors to the home are encouraged and that they use the visitors book to sign in. The visitors book was seen in the hall and was evidently in regular use. The Manager also said that residents are enabled to take part in appropriate activities by the care staff and that 2 new activities files have been drawn up that include all the necessary details about activities that are available for residents both inside and outside of the home. We looked at both of these files and saw information that indicated residents participation in the following activity groups on a fairly regular basis. This included, art therapy, educational groups run by the staff on mental health issues and physical issues, a gardening group, cooking preparations, the charity shop, group outings, swimming, snooker, music appreciation, football, bowling, board games and discussion groups on topical and current affairs. Residents told us that they enjoyed participating in these activities. Interviews with residents demonstrated that they do attend some local community events although their wishes for an active community social life are somewhat limited. Information is made available and staff do encourage residents to be involved as much as possible in local activities. Some residents told us that they like to go to the shops. Residents make full use of local public transport facilities in order to get out and about and to see friends and family. Residents interviewed said that they thought local transport facilities were good. All residents living at Russell Hill Lodge are registered to vote in elections and are supported by staff to do so if they wish. Some of the residents interviewed by us said that they do keep in regular contact with their families and friends. Staff were seen to encourage the residents to keep and maintain contacts with family and friends so that they benefit from having appropriate relationships. There is a visitors room in the house that can be used by visitors who wish to see their relatives in the house. Policies seen by us to be established within the unit ensure that residents rights to privacy, respect and dignity are respected. Residents who were interviewed confirmed that they felt staff respected these rights. Residents said that they have a key to their own bedrooms, their mail is unopened, their preferred form of address is used by staff and staff do knock on their doors before entering. We observed staff to be interacting with residents in a friendly and respectful manner. Care Homes for Adults (18-65 years) Page 17 of 36 Evidence: Interviews both with staff and residents confirmed that residents participate in household chores as a part of the community living experience and weekly household tasks are detailed in the weekly action sheets. Smokers are now required to go outside to smoke; however a tour of the premises together with the Manager clearly revealed that people do smoke in their bedrooms. The Manager told us that this is strongly discouraged by staff. There are appropriate policies regarding drug and alcohol taking on the premises. With regards to meals and meal times there is a planned and varied menu which 4 residents told us they enjoy. We saw a suitably planned summer menu for the week ahead. Specific needs are catered for and alternative choices are provided. Residents are able to state their preferences when the menus are planned and there are discussions about this at the residents community meetings, which are held regularly. At the last inspection some concerns were raised by residents about the quality of food being purchased. At this inspection the Manager told us that the budget has been improved and a new summer menu put together with the residents input. Residents told us that they thought there have been some improvements in the quality of food being purchased for them and that they have the opportunity to choose the food they want to eat. We asked the Manager whether a dietician is ever asked for assistance, given the fact that weight monitoring records are maintained for each resident. The Manager said that where necessary a dieticians advice will be sought, as will the advice of the clinical team in CPA reviews where weight or diet is an issue. The Manager told us that residents do sometimes prepare their own food, mainly at breakfast and sometimes at lunch times, staff assist them when necessary as part of the rehabilitation programme. Evening meals are generally cooked by a member of staff. A bowl of fresh fruit was seen to be available in the kitchen for residents. At the last inspection it was recommended that some of the kitchen equipment needed replacement. This has since been done, however our inspection this time of the kitchen at Russell Hill Lodge indicated the need for some other items of the equipment to be repaired or replaced. This is addressed under Standards 24 and 30 later in this report. Care Homes for Adults (18-65 years) Page 18 of 36 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users may be assured that they will receive personal support in the way that they prefer and require and that their physical and emotional needs will be met. Service users can rely on the home providing a well managed service with regards to medication. Evidence: The Manager explained that residents are expected to be up and about each morning by 9.30am so that they are able to participate in their rehabilitative care packages and this includes their need to take their medications at 9.30 each morning. The residents interviewed at this inspection said that they do choose when to go to bed, when to have a bath, what they wish to wear and what activities they do during the day. Some said that they have allocated housework chores on specific days of the week. Care Homes for Adults (18-65 years) Page 19 of 36 Evidence: Residents do not have a choice of their allocated key worker however the Manager said that they have a chance to discuss any issues they may have or which arise subsequent to the allocation of their key workers. Residents did not raise any concerns with us about their key workers. Residents at Russell Hill Lodge continue to receive regular input from their Community Psychiatric Nurses (CPN) and from other professionals in their clinical teams. This was confirmed by a CPN we spoke to at this inspection. With regards to the health care of the residents the Manager said that all residents are supported to keep well through accessing appropriate healthcare and associated mental health care support. All residents are signed up with local GP surgeries and some are registered with local dentists. The Manager said that annual health checks take place at the GP surgeries and residents attend there. The Manager said that whether or not a resident uses the dentist is left up to the residents own decision but staff will encourage residents to use this service if required. Residents who spoke to us said that they go to see their GPs as and when necessary but they said they prefer not to go to the dentist. The Manager said that an optician visits Russell Hill Lodge once annually. Inspection of 5 of the residents files demonstrated that monthly reports are being kept for each resident. These reports cover 8 areas of need including residents healthcare and action plans show how these needs are to be met. In addition to this a record is kept on each residents file of every healthcare appointment that the resident has had arranged. Inspection of the 5 files indicated that all these residents maintained regular contact with all the appropriate healthcare professionals. The homes policies and procedures manual contains a policy for medication that includes the procedures that staff need to take in order to ensure the safe administration of medication to residents. Members of staff who were interviewed indicated that they were aware of the policy and know what the procedures are when administering medication to the residents. The Manager told us that only senior staff administer medication to the residents and only once they have completed training to do with the safe handling of medicines. 2 staff are required to fill in the medication record sheets when medication has been administered. The Manager said that some residents do administer their own medication unsupervised and others self medicate but with supervision. Following a recommendation previously made, the Manager said that risk assessments are now Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: completed in conjunction with residents who are unsupervised. This is welcomed as it should help to minimise any potential hazards for the resident or others. Inspection of the medication records MAR sheets found no unexplained gaps and the Manager explained that 2 staff now administer all medications and both are required to sign the MAR sheet records immediately after the residents have been given their medications. The Manager explained that Boots provide the pharmacy services to Russell Hill Lodge and that they come to the home regularly and inspects the medication procedures. Photographs of each resident were seen on the medication front sheet on the MAR sheet records and this is good practice as it helps staff ensure they are administering medication to the correct resident. This is welcomed as it should assist in the protection of residents. At the last inspection it was required that guidance be provided for each resident who uses PRN medication. At this inspection this was seen to have been put in place for each resident and is held in the medication files and is therefore readily accessible for staff and residents alike when needed. This should help in protecting the residents, ensure that PRN medication is given appropriately and when required and be of great assistance to staff who have to give residents PRN medication. We undertook a stock take of medications held in the home, together with the Manager. Records kept were inspected and stock levels of medications were seen to be satisfactory. Appropriate medication cabinets were seen in the office. Care Homes for Adults (18-65 years) Page 21 of 36 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can be fully confident that their complaints will be acted upon at Russell Hill. Residents are protected from abuse, neglect and self harm by the policies and procedures of the home. Evidence: The Manager told us that there had been no complaints received since the last inspection in April 2008. We saw the complaints procedure for this home and we can confirm it contains all of the relevant and necessary information and is readily available to the residents, their relatives and other visitors. 5 residents who completed their feedback questionnaires told us that they would know the procedure for making a complaint if they needed to do so. This all means that residents do feel that their views are listened to and acted upon as required. Care Homes for Adults (18-65 years) Page 22 of 36 Evidence: The Manager advised us that there is in place a policy for the Protection of Vulnerable Adults and that staff have been provided with training and guidance about what actions they need to take if the need arises. We saw the policy in the Units policies and procedures file, the procedures are robust for responding to suspicion or evidence of abuse or neglect and they include a whistle blowing procedure for staff. We inspected 5 staffing files as a part of this inspection. Training records seen by us evidenced that 3 of the 5 staff have received POVA training in 2009 using an in house training method. We pointed out that it is important that all Russell Hill Lodges staff compliment receive this full training at least once every 2 or 3 years as this will help ensure that all staff are up to date with the policies and procedures and other issues to do with the protection of vulnerable adults at Russell Hill Lodge. On 3 of the 5 residents files inspected we saw an inventory for each resident of their valuable belongings. At the inspection carried out in 2007 it was recommended that each resident should have an inventory of their valuable belongings that is updated regularly and as appropriate. The Manager is reminded of this recommendation that is repeated here. Care Homes for Adults (18-65 years) Page 23 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are living in a relatively comfortable and safe environment. Evidence: Over the last 2 inspections several issues have been raised to do with the quality and standard of the decorations and furnishings at this home. Once again the overall feel of Russell Hill Lodge is that it needs an uplift. A number of residents and staff told us that they feel the home needs revitalising in terms of the decorations and furnishings in the communal areas. The Manager told us that there is a new refurbishment programme that means that every bedroom will be redecorated and newly furnished when ever a new resident comes to live at the home. Evidence of this was seen by us in one bedroom that had just been vacated and also in other bedrooms that had recently been occupied. As well as this the hall on the ground floor has been newly painted and this all helps to lift the overall feel of the home. Care Homes for Adults (18-65 years) Page 24 of 36 Evidence: The Manager told us also that there is a plan to renew the flooring in parts of the home and that the furniture in the lounge is also to be renewed. This is a positive development and is to be welcomed. However progress is relatively slow and it is recommended that all the communal areas including the kitchen and all the bathrooms are refurbished and redecorated more frequently in order to provide the revitalised feeling that the staff and the residents all have alluded to and with which we concur. As a part of this inspection we made a tour of all areas of these premises together with the Manager. These were the findings on the day of the inspection: In the kitchen one of the two freezers needs to be replaced and the kitchen staff need to be issued with catering clothing or uniforms in the interests of health safety. We understand from the Manager that the kitchen units are to be replaced. This is necessary since they are old and need renewal. One of the drawer units is missing and needs replacement. The front garden needs some care and attention and although part of the driveway has been replaced with tarmac, the upper end of it still needs to be replaced. The flower beds in the front garden are neglected and if they were upgraded this would significantly raise the standard and no doubt the spirits of the residents and of the staff as they enter the premises. We inspected 4 of the residents bedrooms. The bedrooms of those newly admitted to the home were clean and the standard of the decoration was very satisfactory. However for some of the residents who have been living at this home for a longer time the decoration of their rooms was in a poor state and needs renewal. As we have already said the tour of the premises undertaken together with the Manager identified a general need for the renewal and refreshment of the interior decorations as the existing state of the interior does nothing to lift the spirits and is depressing. Given the purpose of the unit this cannot be helpful for achieving the stated aim and purpose of this home. Within the homes policies and procedures manual, information is provided relevant to the control of infection. The home also has an infection control procedure which staff who were interviewed said they were aware of. Some training is provided by the agency and staff said that they had received training in this area of work. Systems are in place to ensure that the spread of infection is controlled and minimised. Laundry facilities are sited so that soiled articles are not being carried through the kitchen and hand washing facilities are appropriately provided to ensure staff can use them where appropriate. This helps to ensure the protection of the residents health and to ensure that the home is clean and hygienic. Care Homes for Adults (18-65 years) Page 25 of 36 Care Homes for Adults (18-65 years) Page 26 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are supported by competent staff and by the homes recruitment policy and procedures. Some improvements are still required in the training and supervision of staff. Evidence: At this inspection staff were seen to be approachable to the residents and they were seen to take the necessary time to deal with the residents questions appropriately and sensitively. 3 staff who were interviewed told us that they took time to read the residents files so that they would better understand the residents needs, how they are to be met and the detail of their care plans. Staff also said that they take the necessary time to speak with residents so as to establish a more trusting relationship and one in which they understand the needs, wishes and preferences of the residents. Care Homes for Adults (18-65 years) Page 27 of 36 Evidence: We inspected 5 of the staffing files and the associated training records. We were able to see that 2 of the support staff have achieved an NVQ qualification at level 2. 2 other staff have not yet achieved an NVQ qualification and the fifth staff member has enrolled to do their NVQ training this August or September 2009. The Manager is reminded that all staff should now have an NVQ qualification at least level 2. This is a requirement. There is in place an appropriate recruitment policy. 5 of the staff files were inspected. Generally the files were in much better order than at the last inspection and most of the information required under the Standard 34 was in evidence. Staff interviewed did confirm that have a contract of employment and that they understand their terms and conditions as well as their roles and responsibilities within the home, however a copy should be available for reference in the unit. The Manager said that all the staff at Russell Hill Lodge have appropriate and valid criminal record bureau checks (CRBs). Inspection of the files showed us that whilst staff do have CRB checks in place 3 of the 5 staff files that we checked were out of date being more than 3 years old and 2 were not agency specific either for Russell Hill Lodge or for the Laurel Homes Group. CRB checks need to be renewed every 3 years and they must be agency specific, this is a requirement. All staff should have a valid contract on their staffing files. 2 of the 5 staffing files inspected did not have a contract, this is also a requirement. The Manager told us that a structured induction programme is offered to all new staff. However interviews with several staff indicated that induction is not being provided within the first 6 weeks of employment as is required for good practice. It is recognised that although induction is being provided within the first 6 months it must be carried out in the first stages of a new staff members employment at Russell Hill in order to maximise its effect on staff and residents alike. It is recommended therefore that induction training be offered to all staff within the first 6 weeks and a proper record kept of exactly what areas have been covered. The Manager informed us that all staff are issued with job descriptions and are asked to read and discuss the homes policies and procedures. The Manager said that all staff are being asked to sign to say that they had read, had a chance to discuss the policies and procedures with their supervisor in their supervision sessions and would be willing to work within them. New training files and a training matrix are in place for members Care Homes for Adults (18-65 years) Page 28 of 36 Evidence: of staff and they include their details of training achieved and their certificates. The Manager showed us these files which are a useful tool to assist in meeting the training needs of the staff. He said that there is a training programme underway and that a good deal of the training offered to staff is in house training offered by Managers. All staff should receive update training relevant to their work and this should be supported by certificated evidence seen in the training files. This should include: Food hygene Infection control Health and safety Manual handling Update on Medication Administration POVA Care planning awareness Risk assessment Managing violence and aggression Basic MH awareness Records show that most of the established staff have received this basic core training. However this is not the case for new staff. The Manager will therefore need to ensure that all staff receive update and refresher training in the areas identified above. A review of the current staff training files showed that no staff had received their annual appraisals to date. It is a requirement that all staff receive annual appraisals. Residents interviewed told us that staff are approachable and we saw staff taking time to deal with residents questions. All staff should receive regular supervision at least six times a year or once every 2 months. Inspection of the staff records and interviews with 3 staff show that there has been an improvement with the frequency of staff receiving regular individual supervision within the prescribed timescales. This means that service users can now be more assured that they will benefit from well supported and well supervised staff. The Manager is reminded of the need to maintain the frequency of supervision practice. 3 staff members who were interviewed acknowledged that there have been some gaps in their supervision but also said that they have received informal supervision when they needed it. Inspection of supervision records and discussions with the Manager indicated that insufficient time is spent in staff supervision looking at the direct work undertaken with residents in meeting or trying to meet their care plan objectives. It is therefore recommended that discussions are undertaken with all staff in supervision about keyworking with residents and the work that is carried out with the residents in meeting care plan objectives. This should be recorded on the supervision notes. Care Homes for Adults (18-65 years) Page 29 of 36 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users may be assured that they will benefit from a well run home. Once the quality assurance system is fully implemented they will be able to be confident that their views underpin all developments in the home. They should also be assured that their health, safety and welfare will be promoted. Evidence: At this inspection the Manager told us that he is still to complete his NVQ training for the Registered Managers Award at Level 4 and is expecting to complete this in the next 4 months. Since this is a repeated requirement it is important now that he does complete this training in the new timescale if enforcement action is to be avoided. Care Homes for Adults (18-65 years) Page 30 of 36 Evidence: We were shown by the Manager his job description that covers all the requirements set out under the Standard 37.3. At this inspection the Manager said that the Unit does carry out a Quality Assurance process that involves sending out feedback surveys to relatives, residents and visitors to the home. In addition to this feedback is now also sought from professionals who work with the residents, including care managers. All the feedback sheets we saw were positive in their comments about the home. One feedback sheet we saw from a professional said, I always find the home friendly. It always feels homely and has a lovely atmosphere. I always feel welcome. We saw examples of the survey forms and we discussed with the Manager the need now for a quality management analysis sheet and an action plan format. This should be developed, as it would be a useful source to help identify trends, problems and issues for the home to address as a part of the process of self-monitoring, review and development of the quality assurance process. It is recommended that the analysis of all the feedback information is completed for the survey that we were told is being carried out this year. Policies were seen for Health and Safety; fire; moving and handling and risk assessment relevant to the unit. A fire risk assessment carried out on 22.5.2008 comprehensively covered all the necessary areas of risk. No requirements were identified. Most of the staff have received training in; fire safety; first aid; food hygiene and infection control. The Manager should ensure that all staff has undertaken recent training in these areas, see also Standard 35 above. We asked the Manager to see up to date certificates for maintenance and the appropriate checks and requirements within Standard 42 of safe working practices. Boiler and gas 6.10.2008 Electrical system 21.3.2005 PAT testing 21.4.2008. This should be carried out annually. Fire alarms 28.5.2009 Emergency lighting 19.2.2009 Fire extinguishers 4.7.2008 Legionnaires water test 16.10.2008 Fridge and freezer temperatures have been recorded and the records were checked. All recorded temperatures came within the prescribed limits and an appropriate record book was seen for this purpose. Water temperatures are tested weekly for hot water outlets and records seen to date Care Homes for Adults (18-65 years) Page 31 of 36 Evidence: confirmed temperatures do not exceed 45 degrees centigrade. However not all the hot water outlets have been checked. The Manager is recommended to ensure that a new list of all hot water outlets be drawn up and checked on a monthly basis. This is a recommendation. Records also indicate that Fire alarm tests are being carried out weekly and these checks are recorded appropriately. Records show that Fire Drills are carried out 2 monthly and they indicate that all residents and staff are able to leave the building as required. Last drill was 28.5.09. There are appropriate policies and procedures for accidents and incidents and all incidents and accidents are recorded appropriately in the record books. Other records were also seen for: 1. Weekly fire alarm tests 2. 6 monthly emergency lighting tests 3. 6 monthly fire drills 4. Fridge and freezer temperatures. The home has self monitoring systems in place such as internal audits and regulation 26 visits. Residents spoken to on the day of the inspection said that they feel that staff and managers in the home listen to them and generally comply with their requests. Care Homes for Adults (18-65 years) Page 32 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 33 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 32 18 All staff should now have an NVQ qualification at level 2. In order to meet the NMS. 01/11/2009 2 34 19 All staff should have a valid contract on their staffing files. This is a requirement. In order to meet the NMS. 01/08/2009 3 34 19 CRB checks need to be renewed every 3 years and they must be agency specific, this is a requirement. In order to meet the NMS. 01/09/2009 4 35 18 It is a requirement that all staff receive annual appraisals. In order to meet the NMS. 01/08/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. Care Homes for Adults (18-65 years) Page 34 of 36 No. Refer to Standard Good Practice Recommendations 1 2 6 23 It is recommended that each file should contain a contract between the service and the resident. It is recommended that each resident should have an inventory of their valuable belongings that is updated regularly and as appropriate. It is recommended that all the communal areas including the kitchen and all the bathrooms are refurbished and redecorated more frequently. It is recommended that induction training be offered to all staff within the first 6 weeks and a proper record kept of exactly what areas have been covered. It is recommended that there are discussions with all staff in supervision about their keyworking with residents and the work that is carried out with them to meet care plan objectives. This should be recorded on the supervision notes. It is recommended that an analysis of all the quality assurance feedback information should be completed in order to identify strengths and weaknesses and in order to improve the services being offered to the residents. The Manager must ensure that all hot water outlets are checked on a monthly basis. This is a recommendation. 3 24 4 35 5 36 6 39 7 42 Care Homes for Adults (18-65 years) Page 35 of 36 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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