Care Home: Russell Lodge

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What the care home does well People thinking of moving into Russell Lodge were given information about the home. Everyone who completed a survey indicated that they received enough information to help them make a decision. They also received a contract, which helped to make sure they were aware of their rights. New people were assessed to ensure that Russell Lodge could provide the right service to meet their needs. Residents who filled in surveys and those we spoke to said they were well looked after. A visitor told us that staff understood their mother`s needs and provided the care with kindness. During our visit we saw that people were referred to the nurse or doctor if they were not well. A visiting professional told us the staff acted on advice given to them to ensure residents received the right health care.Russell LodgeDS0000064961.V378370.R01.S.docVersion 5.2Routines were flexible and residents we spoke to were satisfied with the level of choice they had over their daily lives. They made positive comments about the food, although some people we spoke to were not aware that they could have a choice. Residents told us that they did not have any complaints but they knew who to speak to if they did. Staff had training and written guidance in adult protection. They understood their responsibility to report any suspected incidents to ensure they would be investigated. Residents were happy with their bedrooms, many of which had been personalised with ornaments and pictures. We were told that the home was always clean and there were no unpleasant smells. The manager made sure that all new staff had thorough background checks before they started work at the home. This helped to protect residents. New staff also had induction training, which made sure that they had enough knowledge and understanding to carry out their role. What has improved since the last inspection? The way medicines were stored and administered had improved. Staff practice was safer and more organised which helped to ensure that residents received their medicines as they were prescribed. There were still some improvements to be made in records of medicines. The manager had put a system into place to ensure that the kitchen was run safely and in accordance with environmental health guidance. Staff had more training in health and safety topics. This helped to ensure that they provided care in a safe way. Staff also helped to protect the health and safety of residents, by storing potentially hazardous substances, such as cleaning materials, safely. What the care home could do better: Staff must review care plans and associated records and update them as and when changes occur. This is so that staff have up to date and accurate directions about the care to be provided. This was a requirement from the previous inspection and has not been met. We are considering taking enforcement action to ensure that the registered person complies. Staff must make sure that risks to residents` health and safety are assessed and plans are put into place to monitor, and where possible, reduce the risks. The assessments and plans must be kept under review and changed if the residents` needs change.Russell LodgeDS0000064961.V378370.R01.S.docVersion 5.2The registered person must ensure that residents` needs for social contact and recreation are assessed and individual plans should be drawn up to show how staff can support them to meet their needs. The way staff are deployed should be reviewed to ensure that there are always sufficient staff to support residents to meet their social and recreational needs. The amount of time care staff spend on cooking and cleaning duties should be reviewed. The systems for monitoring the quality of the system, for example, by seeking people`s views and auditing procedures, must be improved. This helps to identify where the home needs to improve. There should be a clear action plan for development. Key inspection report CARE HOMES FOR OLDER PEOPLE Russell Lodge 235 Lowestoft Road Gorleston Great Yarmouth Norfolk NR31 6JH Lead Inspector Jane Craig Key Unannounced Inspection 9th November 2009 10:30 DS0000064961.V378370.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Russell Lodge DS0000064961.V378370.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Russell Lodge DS0000064961.V378370.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Russell Lodge Address 235 Lowestoft Road Gorleston Great Yarmouth Norfolk NR31 6JH 01493 668265 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) sammoonoosamy@hotmail.com Anbanaden Moonoosamy Mrs Krishna Venie Moonoosamy Anbanaden Moonoosamy Care Home 10 Category(ies) of Dementia (1), Old age, not falling within any registration, with number other category (10) of places Russell Lodge DS0000064961.V378370.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th January 2009 Brief Description of the Service: Russell Lodge is a purpose built residential care home that accommodates up to 10 older people. It is owned and managed by Mr Moonoosamy. The home is situated opposite the District General Hospital on the outskirts of Great Yarmouth in Gorleston on Sea, within easy reach of local shops and sea front. The accommodation consists of 6 single and 2 shared rooms with ensuite facilities, all of which are on the ground floor. There is a combined lounge and dining room. The surrounding enclosed gardens are laid to lawn with flowerbeds and are well maintained. There is a small car parking area to the rear of the premises. People thinking of moving into the home were given a welcome pack, which included the service users guide. A copy of the latest CSCI inspection report is available on request. Information about fees and extra charges are available from the manager. Russell Lodge DS0000064961.V378370.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means that people who use the service experience adequate quality outcomes. The last key inspection on this service was completed on 6th January 2009. This key (main) inspection includes information gathered since the last inspection and an unannounced visit to the home. The visit was carried out on 9th November by one regulatory inspector. At the time of the visit there were 8 people accommodated in the home. We met with most of them and where possible asked about their views of Russell Lodge. Three people were case tracked. This meant that we looked at their care plans and other records and talked to staff about their care needs. During the visit we talked to the owner/manager, staff on duty and visitors to the home. We looked around the home and viewed a number of documents and records. As part of the key inspection surveys were sent out to residents and staff. Most of the residents were assisted by family members to complete their questionnaires. Their responses have been taken into account when making judgements about the service. This report also includes information from the annual quality assurance assessment (AQAA), which is a self-assessment report that the manager has to fill in and send to the Commission every year. What the service does well: People thinking of moving into Russell Lodge were given information about the home. Everyone who completed a survey indicated that they received enough information to help them make a decision. They also received a contract, which helped to make sure they were aware of their rights. New people were assessed to ensure that Russell Lodge could provide the right service to meet their needs. Residents who filled in surveys and those we spoke to said they were well looked after. A visitor told us that staff understood their mothers needs and provided the care with kindness. During our visit we saw that people were referred to the nurse or doctor if they were not well. A visiting professional told us the staff acted on advice given to them to ensure residents received the right health care. Russell Lodge DS0000064961.V378370.R01.S.doc Version 5.2 Page 6 Routines were flexible and residents we spoke to were satisfied with the level of choice they had over their daily lives. They made positive comments about the food, although some people we spoke to were not aware that they could have a choice. Residents told us that they did not have any complaints but they knew who to speak to if they did. Staff had training and written guidance in adult protection. They understood their responsibility to report any suspected incidents to ensure they would be investigated. Residents were happy with their bedrooms, many of which had been personalised with ornaments and pictures. We were told that the home was always clean and there were no unpleasant smells. The manager made sure that all new staff had thorough background checks before they started work at the home. This helped to protect residents. New staff also had induction training, which made sure that they had enough knowledge and understanding to carry out their role. What has improved since the last inspection? What they could do better: Staff must review care plans and associated records and update them as and when changes occur. This is so that staff have up to date and accurate directions about the care to be provided. This was a requirement from the previous inspection and has not been met. We are considering taking enforcement action to ensure that the registered person complies. Staff must make sure that risks to residents health and safety are assessed and plans are put into place to monitor, and where possible, reduce the risks. The assessments and plans must be kept under review and changed if the residents needs change. Russell Lodge DS0000064961.V378370.R01.S.doc Version 5.2 Page 7 The registered person must ensure that residents needs for social contact and recreation are assessed and individual plans should be drawn up to show how staff can support them to meet their needs. The way staff are deployed should be reviewed to ensure that there are always sufficient staff to support residents to meet their social and recreational needs. The amount of time care staff spend on cooking and cleaning duties should be reviewed. The systems for monitoring the quality of the system, for example, by seeking peoples views and auditing procedures, must be improved. This helps to identify where the home needs to improve. There should be a clear action plan for development. 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 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. Russell Lodge DS0000064961.V378370.R01.S.doc Version 5.3 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Russell Lodge DS0000064961.V378370.R01.S.doc Version 5.3 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission process helped to ensure that the home was suitable to meet the needs of the people who moved in. EVIDENCE: People thinking of moving into the home were provided with written information about the service and they were encouraged to visit before making a choice. Everyone who returned a survey indicated they received enough information about the home and they also received a contract. This helped to ensure everyone was clear about the terms and conditions of the service and their rights and responsibilities. There had been no new admissions since our last inspection. The annual quality assurance assessment (AQQA) told us that the manager carried out Russell Lodge DS0000064961.V378370.R01.S.doc Version 5.3 Page 10 assessments with people before they moved in. This helped to ensure that their needs were understood and could be met at Russell Lodge. We saw some examples of these assessments and found they provided quite detailed information about the persons strengths as well as needs. The information was used to help draw up the care plan. Standard 6 was not applicable. Intermediate care was not provided at Russell Lodge. Russell Lodge DS0000064961.V378370.R01.S.doc Version 5.3 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of up to date care records and risk assessments could increase the risk of residents health and personal care needs not being understood and met. EVIDENCE: We looked at the care records for three residents as part of the case tracking process and viewed others to check specific details. Residents who we asked said they could not remember being consulted about their care plans. However, one said they did not know about their care plans but were happy to know that if they needed extra help they could ask and would get it. During our visit we witnessed relatives being consulted about care and treatment for residents who were not well. A visitor told us that the manager always consulted her about her mothers care. The AQAA indicated Russell Lodge DS0000064961.V378370.R01.S.doc Version 5.3 Page 12 that one of the improvements in the past year was that care plans were discussed with the resident and/or their family. However, there were no records of these discussions for staff to refer to. Care plans to support residents to meet their personal care needs were generally person centred. This helped to ensure that staff provided care that met the individual needs of the resident, in the way they preferred. Some of the plans for personal care included directions to support the resident to maintain their independence and dignity. Despite a requirement we made after the last inspection, care plans to address health and personal care needs were still not reviewed every month. Most of the care plans we looked at had been written up to three years ago. The lack of evaluation notes meant it was difficult to tell whether these plans were still correct. Discussions with staff showed that some of the directions were still relevant but others were out of date. Plans that had been discontinued or superseded were still in the care file. In addition to being confusing and contradictory, this could result in new staff providing incorrect support. Despite shortfalls in care records, staff who completed surveys said they were given up to date information about residents care needs. The member of staff we spoke to said they had a daily handover and they were confident that they knew what care each resident needed. A relative told us, Staff understand her needs and meet them. A visiting health care professional also commented that staff knew the residents well. Residents had assessments to monitor risks related to pressure sores, falls and poor nutrition. Strategies were in place to reduce identified risks. However, they did not always focus on the area or behaviour that created the most risk, which meant that they might not be completely effective. Risk assessments and strategies were not reviewed or updated. Over the past two months staff had completed six accident reports for one of the residents whom we case tracked. Their falls risk assessment had not been reviewed since 2008 and their care plan had not been changed. There were no moving and handling assessments. Two residents who had moving and handling needs did not have appropriate plans in place. Staff were using the correct equipment to transfer residents from their bed to chair but it was not clear whether they needed special equipment to assist residents to change position in bed. There was no risk assessment for one resident who had a bed rail in place. Care plans showed that when health care issues were identified, residents were referred to the appropriate health care professionals. A visiting professional told us they had no problems with the home and that staff acted upon advice for care and treatment. A relative told us, They follow up on medical requirements and medication. I am very happy with the way my father is Russell Lodge DS0000064961.V378370.R01.S.doc Version 5.3 Page 13 looked after. Residents who completed surveys indicated that the staff always made sure they had the medical care they needed. One commented, I am well looked after, and a resident we spoke to said, I had a few itchy spots and the next thing they had the doctor come in to see me. There had been improvements in the way medicines were managed. All staff with responsibility for handling medication had received appropriate training. Following a previous requirement, all medicines were stored safely. There were no controlled drugs at the time of our visit but the manager had obtained an appropriate cupboard and register. Storage areas were maintained at the correct temperature. There were complete records of medicines received, carried forward from the previous month, and disposed of, which helped to provide an audit trail. The manager told us that medicines no longer in use were returned to pharmacy straight away. There were no gaps on medication administration charts. Codes were used to show when medicines were omitted but in one case these were not followed up by carer notes to indicate the reasons. The manager carried out a daily audit of medicines not administered from the monitored dose system. He gave examples of how this had improved staff practice. There were no discrepancies between the stock and the records on the day of our visit. However, we noted that one of the medication administration charts indicated that a resident had received 2 more doses of antibiotics than had been dispensed. This could be an indication that staff were not carrying out thorough enough checks. There were some handwritten entries on the medication administration charts. These were not always a complete copy of the information on the medication packaging, which could increase the risk of medication errors. Handwritten charts were not double signed to indicate that the entries were checked. There was a care plan in place for a resident who was prescribed medication to be given at the discretion of staff. As previously recommended this was kept with the medication administration chart. Russell Lodge DS0000064961.V378370.R01.S.doc Version 5.3 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service were able to make decisions about their daily lives but the level of activities and occupation did not meet everyones social and recreational needs. EVIDENCE: Despite previous recommendations, no one had up to date information on their files about their social interests or preferences for activities. There were no individual social care plans for staff to help residents to plan how to spend their day. The manager told us that some residents were escorted out for walks on a regular basis and two residents went out with their families or with staff every week. There was no formal programme of activities. The AQAA outlined difficulties they had in finding suitable activities for the people currently in the home. One of the residents we spoke to told us that they had tried playing bingo but it had not been successful. Another one said that, unless there was a party, very few people went into the lounge. Residents did not have planned one to one time with staff. One resident said, Its a pity that the helpers dont Russell Lodge DS0000064961.V378370.R01.S.doc Version 5.3 Page 15 have time to spend with you. Another told us, I would like them to have a bit more time to talk but it cant be helped. Some of the residents we spoke to were able to occupy themselves but most sat in their room watching TV all day. One of the residents who returned surveys indicated that there were not always enough suitable activities. We were told that residents had choices in their daily lives and that routines in the home were flexible to meet individual needs. For example, the AQAA indicated that meals were offered at times to suit individuals. However, not all residents seemed to be aware of this. One told us, I think lunch is too early, it makes it a long afternoon. Residents told us that they went to bed and got up when they wished and could have a bath or shower when they wanted. A relative who helped to complete a survey wrote, They allow residents to go where they like and they are not restricted in any way. The manager told us that there was a choice of meals at lunchtime; that people were offered an alternative if they did not like the planned meal. Some of the residents we spoke to were not aware of this and the records of meals showed that most of the time there was just one meal served. The records also showed that a number of the same meals appeared each week. The manager told us that these were residents favourites. Comments about the meals were positive. Everyone who returned surveys indicated they always liked the meals. One person told us, The food is very nice. Russell Lodge DS0000064961.V378370.R01.S.doc Version 5.3 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service were safeguarded by the complaints and safeguarding procedures in the home. EVIDENCE: There was a clear complaints procedure in the service user’s guide and on display in the home. The procedure assured people that complaints were viewed positively by the service and would be responded to. Residents who completed surveys indicated that they knew who to speak to if they were unhappy and they all knew how to make a formal complaint. During the inspection residents told us they could speak to the staff or the manager if there was anything wrong. Staff who returned surveys said they knew what to do if anyone raised concerns about the service. Since our last inspection there had been two complaints made directly to the service. Records showed that they were investigated within the stated timescales. In both cases action was taken to prevent the situation happening again. Russell Lodge DS0000064961.V378370.R01.S.doc Version 5.3 Page 17 There was a detailed training pack and policy on safeguarding, which new staff went through during their induction. Staff also had refresher training each year. The Norfolk County Council procedure was available for reference and contact numbers for reporting suspected abuse were prominently displayed. Staff we spoke to said they would immediately report any allegation of abuse to the registered person, who was clear about his role in referring to social services. There had been no safeguarding incidents in the past year. The manager and some of the staff team had received training about the Mental Capacity Act. Other staff were booked on a course in the new year. The training should help to ensure that residents rights, under this legislation, are understood and protected. The manager told us that there was no-one currently living at the home who would be affected by the Mental Capacity Act or Deprivation of Liberty Safeguards. Russell Lodge DS0000064961.V378370.R01.S.doc Version 5.3 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provided people with a comfortable and homely place to live. EVIDENCE: From looking around the building, it was apparent that the home was generally in a good state of repair. There was a plan for ongoing renewal and redecoration. Bedrooms had been redecorated and the communal rooms were to be upgraded in the near future. There was a plan to replace some furnishings over the next year. Safety measures, such as radiator guards, were in place. On the day of our visit the one of the radiators in the lounge was not working and the room felt uncomfortably cold. This was repaired before the end of our Russell Lodge DS0000064961.V378370.R01.S.doc Version 5.3 Page 19 visit. However, some of the residents we spoke to said that some parts of the home were cold at various times of the day. There was only one thermometer in the home and we advised the manager that temperatures should be monitored throughout and residents views on the temperature of the home should be sought on an ongoing basis. The décor and furnishings throughout the home were homely and comfortable. Most bedrooms were highly personalised with pictures and ornaments. Residents we spoke to were satisfied with their bedrooms. One told us, The room and bedding are all kept clean. Another said, My rooms perfect. On the day of our visit the home was clean and free from unpleasant odours. Residents who completed surveys indicated that this was always the case. One commented, The home is spotless with no unpleasant smells. The manager was the link person for prevention and control of infection. He had received training and had access to best practice guidance, which he cascaded to other staff. There had been a recent infection control audit, which the manager told us, had helped to improve practice. There were sufficient hand washing facilities throughout the home and staff had access to gloves and aprons. The member of staff we spoke to confirmed that these were used once only and disposed of. Russell Lodge DS0000064961.V378370.R01.S.doc Version 5.3 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service were supported by a well recruited, trained and supervised staff team, which helped to ensure that their needs were understood and met. EVIDENCE: Following a requirement at the last inspection, the manager kept formal staffing rotas to show which staff were on duty at any given time. There were always 2 staff on duty during the day. However, these staff also had to carry out all indirect care tasks, such as cleaning, cooking and laundry. This meant that one of the two staff on duty would be taken away from direct care for significant periods of time during the day. There were no indications that residents missed out on personal or health care because of lack of staff time. However, some of the residents we spoke to said that staff were too busy to spend time with them. Extra staff were rostered to take residents out as a social activity but this was not a weekly occurrence. All the staff who completed surveys indicated that there were enough staff to meet the needs of the residents, but it was not clear whether they included social care needs in their responses. Russell Lodge DS0000064961.V378370.R01.S.doc Version 5.3 Page 21 The AQAA indicated that all new staff had pre-employment checks before they started work at the home and staff who completed surveys confirmed this. The files of two new staff were seen. They included all the required information and documents. Staff retention had improved over the last year, which the manager felt had benefited the whole service. New staff went through an induction programme, which covered the topics recommended by the national training organisation. This ensured that staff had the basic skills to help them understand and meet residents needs. The registered person signed staff off as being competent after observing their practice but there were no written assessments or other evidence of competency. Staff who filled in surveys said their induction training covered everything they needed to help them to understand their role. All staff received regular supervision, which helped to ensure that any further training needs or support would be identified. Staff who completed surveys indicated that they received training that was relevant, updated their practice and helped them to understand the needs of the people they cared for. A central training record was not available on the day of our visit and the manager forwarded this on. The record showed that all staff had received training in the mandatory, safe working practice topics in the last year. There were no records of any other relevant training courses. Less than half of the care staff were qualified to National Vocational Qualification (NVQ) level 2 or above, although all the others were part way through the course. Russell Lodge DS0000064961.V378370.R01.S.doc Version 5.3 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management and administration systems were not effective enough to ensure that the home was always run in the best interests of the people living there. EVIDENCE: The owner of the home also managed the service on a day to day basis. He had the appropriate qualifications and experience. We heard positive comments about the manager from residents, relatives and staff. For example, one person told us, Sam (the manager) is pretty good, if you ask him hell do anything. Most staff who completed surveys indicated that they received enough support from the manager. Russell Lodge DS0000064961.V378370.R01.S.doc Version 5.3 Page 23 Despite a previous recommendation the manager still did not have any supernumerary hours to ensure that he had uninterrupted time to work on management and administration tasks. The repeat requirement, with regard to the lack of up to date care records, could be an indication that more management time was needed. There were limited systems in place to monitor the quality of the service. There was an annual survey, where residents and relatives were invited to give their opinion of the service. The next one was due in December of this year. The manager told us that the infection control audit and regular medication audits had brought about improvements in both areas. However, these had not been extended and there were no other internal audits or other methods of monitoring systems and procedures. The AQAA had been completed but in some areas the information was too brief. There was a lack of clear direction as to how the service was to develop, for example, in some outcome groups there was a lack of information about what the home could do better and plans for improvement. People were encouraged to look after their own finances if they were able but they were mainly managed by their families. The manager did not act as appointee for anyone. The home had a fire safety inspection in August 2009. The fire officer made requirements for an updated fire risk assessment and safe systems for holding bedroom doors open. We received confirmation from the fire officer that these had been met. All staff had received fire safety training and fire safety equipment had been serviced. The AQQA told us that maintenance and servicing of other installations and appliances were up to date. Following a previous requirement the manager had put a system into place to ensure the kitchen was run safely and in accordance with environmental health guidance. The AQAA indicated that there were assessments for the control of substances hazardous to health (COSHH). Following a previous requirement, potentially hazardous substances, such as cleaning materials were stored safely. Russell Lodge DS0000064961.V378370.R01.S.doc Version 5.3 Page 24 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 Russell Lodge DS0000064961.V378370.R01.S.doc Version 5.3 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(2) Requirement Care plans and associated records must be reviewed and updated as and when changes occur. There should be a written evaluation to show whether care has been effective and the progress the person has made towards meeting their goals. This requirement had a timescale of 31/03/09 which has not been met. Enforcement action is now being considered. 2. OP7 13(4) Assessments to identify risks to 31/12/09 health must include risks associated with moving and handling and the use of bed rails. There must be strategies in place to control identified risks. Risk assessments and risk management strategies must be kept under review and updated as the persons needs change. This is to protect and promote residents health and safety. Russell Lodge DS0000064961.V378370.R01.S.doc Version 5.3 Page 26 Timescale for action 31/12/09 3. OP9 13(2) Information on handwritten medication administration record charts must accurately match that on the prescription. 31/12/09 4. OP12 16 Care plans must include 28/02/10 information about residents social and recreational needs and how these are to be met. To ensure the home is run in the best interests of the people who live there, the systems for monitoring and improving the quality of the service must be further developed. 31/03/10 5. OP33 24 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. Refer to Standard OP7 Good Practice Recommendations Records of discussions with residents or families about assessments and care plans should be recorded. This helps to ensure that everyone is clear about the agreed care Handwritten entries on MAR charts should be witnessed to reduce the risk of transcribing errors. The temperature throughout the home should be monitored and kept at a comfortable level. Residents should be consulted about their views regarding the temperature in their bedrooms and communal rooms. Staffing levels should be kept under review to ensure that there are always sufficient care staff available to meet residents social care needs. The manager should have some supernumerary hours to ensure that he has uninterrupted time to spend on management and administration tasks. 2. 3. OP9 OP19 4. OP27 5. OP31 Russell Lodge DS0000064961.V378370.R01.S.doc Version 5.3 Page 27 Care Quality Commission Eastern Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Russell Lodge DS0000064961.V378370.R01.S.doc Version 5.3 Page 28 - 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. 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