Care Home: Russley Lodge

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What the care home does well What has improved since the last inspection? This is the first key inspection carried out since the home has been reregistered as part of a Limited Company. CARE HOMES FOR OLDER PEOPLE Russley Lodge 276 Wilbraham Road Chorlton Manchester M16 8WP Lead Inspector John Oliver Unannounced Inspection 25th September 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Russley Lodge DS0000071452.V372202.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Russley Lodge DS0000071452.V372202.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Russley Lodge Address 276 Wilbraham Road Chorlton Manchester M16 8WP 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) 0161 881 2989 0161 881 5858 Russley Care Homes Ltd Mr Keith Jones Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places Russley Lodge DS0000071452.V372202.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only. Care home only - code PC, to people of the following gender:- Either. Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category - Code OP The maximum number of people who can be accommodated is: 17 Date of last inspection Brief Description of the Service: Russley Lodge is a residential care home for older people providing accommodation and personal care for 17 people. The home is privately owned. The home is situated on a main road in Chorlton-cum-Hardy, close to Chorlton Shopping Centre and public transport routes into the City centre and surrounding areas. Russley Lodge is a large detached house with a paved area to the front and gardens to the rear. All the home’s bedrooms are single and none have ensuite facilities. There is a passenger lift. There were appropriate bathing, showering and toilet facilities all with necessary aids provided. The Registered Provider confirmed that the current fee for living in Russley Lodge is £382:88 per week. Additional charges are made for things such as hairdressing, chiropody, toiletries and some transport costs. Russley Lodge DS0000071452.V372202.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 2 Stars. This means the people who use this service experience good quality outcomes. This inspection was undertaken as part of a key inspection, which includes an analysis of any information received by us (the Commission for Social Care Inspection) in relation to the home prior to the site visit. This visit, which the home did not know was going to happen, took place over the course of 8 hours on Thursday 25th September 2008. During the course of the site visit we spent time talking to the residents, the registered provider, the deputy manager and staff on duty to find out their view of the home. Before the site visit we sent the manager of the home an Annual Quality Assurance Assessment (AQAA) document for them to complete and return to us with information about the service they provide. This was returned before the visit took place but had not been completed by the registered manager and contained very little information that could help us to assess the service being offered by the home. This was fully discussed with both the registered provider and deputy manager at the time of this visit. We also spent time examining various files and written information and spent some time looking around the building. What the service does well: What has improved since the last inspection? Russley Lodge DS0000071452.V372202.R01.S.doc Version 5.2 Page 6 This is the first key inspection carried out since the home has been reregistered as part of a Limited Company. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Russley Lodge DS0000071452.V372202.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Russley Lodge DS0000071452.V372202.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s needs were identified prior to moving into the home and information is provided to help people make an informed choice about moving into Russley Lodge. EVIDENCE: We saw that copies of the service user guide and statement of purpose were on display in the reception area of the home. These documents provide relevant information about the home and the service that is being offered and provided by Russley Lodge. The manager told us that both documents had recently been reviewed and updated. The manager told us that all prospective residents are assessed prior to being admitted into the home and we looked at the files of three recently admitted residents. We saw that an assessment of need had been carried out by social services and by the manager of the home. This information was then used Russley Lodge DS0000071452.V372202.R01.S.doc Version 5.2 Page 9 when developing an initial care plan for the resident. It would be good practice if the prospective resident and / or their representative signed the completed assessment of need documentation to demonstrate their agreement to the assessment details. Wherever possible, all prospective residents are invited to visit the home on a trial visit to meet other residents and to have an opportunity to look around and ask any questions they may have. The manager told us that the home did not provide an Intermediate Care service. Russley Lodge DS0000071452.V372202.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s needs were assessed and policies and procedures were in place to ensure the safe handling and administration of medication in the home. EVIDENCE: We looked at the files and care plans of the same three recently admitted residents. Overall, the care plans provided sufficient information to inform staff about the needs, likes and dislikes of each person living in the home. We saw that individual risk assessments had been completed for various identified risks and these, along with the care plans, were reviewed on a monthly basis. Again, as with the pre-admission information, these documents should, if possible, be signed by the individual resident and / or their representative. We spoke to a number of residents who were able to give an opinion of the service they were receiving from the home and staff and comments included, “Everything’s fine”, “Staff are brilliant – we have good carer’s”, Food is very good – we have choice”, “Carers bath me, every day if I want” and “I’m going Russley Lodge DS0000071452.V372202.R01.S.doc Version 5.2 Page 11 upstairs to have my afternoon nap”. We watched staff interacting with the residents and saw evidence of good relationships that have been developed that also respected the privacy and dignity of each person. Another resident spoken to in their room told us of a number of concerns that they had raised with the manager but was satisfied that since the new deputy manager had been in post the concerns raised had started to be addressed and improvements had been noted. This person spends a lot of time in their room and we saw that although the room was generally clean it was very cluttered (including the floor area) with personal items including an electric kettle and toaster. We looked at the risk assessment for this person including the environment and noted that it was too general with specific issues such as the use of the kettle and toaster not being clearly identified and no particular management strategies included. Lack of clearly defined risks and how they should be managed could place the health of the individual resident at risk. This was fully discussed with the manager who said she would re-assess the risk for this resident. Medication was administered via a monitored dosage system provided by a local pharmacy and all medication was stored in a locked metal cabinet secured to the wall in the staff office. Each resident has an individual Medication Administration Record (MAR) that includes a photograph to ease identification. It would be good practice if details of the persons GP and any known allergies could also be listed next to the photograph. The manager told us that all staff with the responsibility for administering medication had undergone relevant training with the supplying pharmacy and the provider of the home, Mr Russell Jones, who also completes regular competency assessments to ensure all staff maintain good practice when administering medication. We also saw evidence that Mr Jones had carried out a full audit of medication practice in the home on the 4 July 2008 and the supplying pharmacy had also done so on 12 September 2008. We checked the MAR’s for a number of residents and we found that overall, these had been completed correctly. A number of signatures were difficult to read as these had been overwritten and, in one instance, correction fluid had been used. It is important that where errors in recording occur a line is put through the error and a correction is made in a suitable place on the MAR. We also saw that a number of handwritten entries had been made. It would be good practice if two staff complete this process when required and both sign the MAR to indicate that the handwritten entry is correct and follows the details as directed on the prescription. Russley Lodge DS0000071452.V372202.R01.S.doc Version 5.2 Page 12 One resident was being administered Controlled Drugs and these were checked and balances found to be correct. The cabinet in which Controlled Drugs are being stored no longer complies with new legislation and the manager agreed contact the supplying pharmacy to further discuss this. Russley Lodge DS0000071452.V372202.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Daily routines in the home demonstrated that residents were encouraged to maintain control over their lives, were encouraged to maintain contact with the community and are provided with a wholesome and well balanced diet. EVIDENCE: A member of the staff team has been employed specifically to lead social activities taking place in the home. This member of staff works 2 hours per day on activities including week-ends and discussion with this member of staff confirmed that activities were taking place on a regular basis with records being kept of the activity taking place and those residents participating. Residents we spoke to told us that activities do take place and one resident told us “I’m looking forward to going on the Blackpool trip tomorrow”. Staff spoken to also confirmed that the provision of activities in the home had improved over the past 12 months and that the home now has a “good activity organiser”. Although no visitors came to the home during this inspection visit we saw evidence from the visitor’s book that people regularly visited the home and Russley Lodge DS0000071452.V372202.R01.S.doc Version 5.2 Page 14 often supported their relative in providing some of their care needs. One resident told us “I have lived here for over 3 months now – it is really good, Russley Lodge is my home now”. Meals in the home are planned using a four weekly menu and take into account the dietary needs of individual residents. The cook has worked in the home for many years and has a good knowledge of people’s likes and dislikes and prepares meals accordingly. Meals are plated and sent from the kitchen on a trolley and we sampled a main meal during this inspection visit and found this to be well presented, nutritious and served hot. Residents spoken to told us “The food is always excellent here” and “You always get choice – the cook knows what you like and don’t like”. Meals are taken in the dining room, which is suitably furnished, light and airy. If requested, residents can take meals in the comfort of their own rooms or in the lounge areas. Russley Lodge DS0000071452.V372202.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has policies and procedures in place to safeguard residents from abuse and there is an ongoing programme of staff training. EVIDENCE: There is a complaint’s procedure in place within the service user guide and also displayed throughout the home and the manager kept a record of any complaints made. There had been one recorded complaint since the last key inspection visit and this had been satisfactorily dealt with. The Commission for Social Care Inspection had received no complaints about the service. Residents spoken to were very clear about who they would raise any complaint or concern with and comments included “I would go to the manager” and “I would speak to the deputy manager”. Four resident survey questionnaires were returned to us before this inspection visit and all confirmed that people knew who to speak to if they were not happy or needed to make a complaint. The manager produced a training matrix that identified which staff have participated in the Protection of Vulnerable Adults (POVA) training and the manager confirmed that this training is ongoing and regularly updated. The manager told us that no safeguarding referrals had been made and further discussion demonstrated that she understood the principles of adult protection and the procedure to follow should an allegation be made. One member of Russley Lodge DS0000071452.V372202.R01.S.doc Version 5.2 Page 16 staff spoken to said that she would “inform the manager” if she had any concerns regarding abuse. Russley Lodge DS0000071452.V372202.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment was clean, tidy and comfortable with systems in place to maintain good standards of hygiene. EVIDENCE: On entering the home the atmosphere was found to be very homely and welcoming. We looked around part of the premises, which we found to be generally well maintained throughout providing appropriate and comfortable accommodation for those people living in Russley Lodge. Furnishings such as lounge chairs and dining tables were domestic in their style and of good quality although some chairs would benefit from replacement. The registered provider informed us that the lounge carpet was shortly due to be replaced and the lounge areas would be re-decorated as part of the ongoing rolling programme of redecoration and maintenance. Since the last inspection Russley Lodge DS0000071452.V372202.R01.S.doc Version 5.2 Page 18 visit the bathroom on the first floor has been completely refurbished and a new shower room has been created on the ground floor. Those bedrooms we saw were personalised to varying degrees in accordance with the preferences of the individual resident and we found the home to be clean and tidy with no unpleasant odours apparent. Residents spoken to said the home was always kept clean and this was also confirmed in the surveys returned to us by people using the service. Both the kitchen and laundry areas are situated in the basement of the home. The kitchen was very clean and well organised with good cleaning routines in place with records maintained. The laundry contains two washing machines and two dryers and it was confirmed that all staff had completed infection control training although the training matrix did not demonstrate this. It is important that staff complete such training in order to minimise any risk to residents and themselves from cross infection occurring through handling soiled linen inappropriately. Russley Lodge DS0000071452.V372202.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. In general, staff were deployed in sufficient numbers to meet the needs of the residents and appropriate training is available to all staff. Some improvements are needed to the recruitment procedures. EVIDENCE: We looked at the files of three most recently recruited members of staff. Two had relevant pre-employment documents in place including an application form, 2 written references, an enhanced Criminal Record Bureau (CRB) disclosure and POVA First. The third needed further information providing in relation to suitable written references. One reference obtained was a copy of one to another employer and was not signed and the second reference was a copy of one ‘To Whom It May Concern’ and was a number of years old. We also noted that two of the staff started working in the home before POVA First confirmation had been received. Lack of ensuring relevant pre-employment checks are carried out before someone starts working in the home can place both residents and staff at risk of unsuitable people being employed. Each new member of staff completes a period of induction training that is recorded within a professional booklet linked to Skills for Care. More than 50 of the care staff employed in Russley Lodge have successfully completed training in a National Vocational Qualification (NVQ) at Level 2 or above. A Russley Lodge DS0000071452.V372202.R01.S.doc Version 5.2 Page 20 staff training matrix was in place and this identifies what training each member of the staff team has successfully completed. Staffing rotas were in place and these showed that adequate staffing numbers were normally on duty to meet the identified needs of the residents. Staff spoken to also confirmed that they felt there was usually enough staff on duty to meet residents’ needs. On the day of this inspection only two members of care staff were left on duty after 5pm and we saw that these staff had to serve the teatime meal and deal with any other issues that may arise. Given that some individual residents could require the input of more than one staff member at certain times consideration should be given to reviewing the staffing levels between tea time and early evening. It is important that enough staff are on duty at peak times of the day to make sure residents’ needs can always be met. Staff are provided with an incentive scheme, which pays care staff enhanced hourly rates for picking up overtime at short notice and an employee of the month scheme, which results in the employee of the month receiving £100. Russley Lodge DS0000071452.V372202.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed for residents and care staff are appropriately supervised. The health and safety of residents and staff is, in the main, safeguarded. EVIDENCE: At the time of our visit to Russley Lodge the deputy manager was on duty and the registered provider, Mr Russell Jones was also on the premises and stayed to support the deputy manager throughout the inspection process. Mr Keith Jones is currently the registered manager of the home and it was stated that it was the intention of the Company to apply to the Commission for Russley Lodge DS0000071452.V372202.R01.S.doc Version 5.2 Page 22 Social Care Inspection to register the deputy manager as the manager of Russley Lodge in the very near future. In order to assess the quality of the service being provided in Russley Lodge the manager carries out an annual quality audit of the service. Questionnaires are sent to people using the service and also to their relatives and friends and we examined a number of returned questionnaires from the last audit and all were very positive in their comments. Staff received regular supervision to support them in their work and records of such meetings were seen to be on staff files. Regular staff meetings are held and these create opportunities for staff to contribute and share ideas and opinions about their work in the home. The manager told us that she had no involvement in managing resident’s finances; this remained the responsibility of the resident and / or their relatives / advocate. Small amounts of money were held for residents to purchase small items and systems were in place to ensure the safe handling and storage of residents’ monies. Regular resident’s meetings are held and we saw the minutes from a meeting held on 21/05/08 where topics such as activities, health & security and the refurbishment of the home were discussed. We spoke to a number of residents about the management of the home and comments included: “Since the deputy manager has been here it has improved a lot” and “The managers are excellent here, they always have been”. We also spoke to a number of staff about the management of the home and comments included: “We have good managers – very approachable”, “New manager (deputy) is alright – approachable” and “We have good managers running this home”. Within the Annual Quality Assurance Assessment (AQAA) completed and returned to us before the inspection took place the manager told us that regular servicing and maintenance of equipment used in the home was carried out. We looked at a random selection of servicing records during our visit, which confirmed this. Russley Lodge DS0000071452.V372202.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Russley Lodge DS0000071452.V372202.R01.S.doc Version 5.2 Page 24 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 (2) Requirement To make sure Controlled Drugs are appropriately stored, storage facilities must be provided that are compliant with current regulations. All pre-employment checks must be fully completed and relevant documentation obtained for each new member of staff prior to employment starting. Timescale for action 31/12/08 2. OP29 19 (4) (a) (b) & (c) 14/11/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP27 Good Practice Recommendations Risk assessments should contain more specific detail about the actual risk identified and how the risk is to be managed. Staffing hours/ratios should be kept under review to ensure that the needs of the residents are met at all times. Russley Lodge DS0000071452.V372202.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Russley Lodge DS0000071452.V372202.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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