Care Home: Rustington Hall

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What the care home does well People living in the home tell us they are being supported well by the staff team. Arrangements are in place for staff to receive the training and supervision which will assist them in meeting people`s needs.The home has reviewed shortfalls found at our previous visit, and has complied with all four requirements made at the previous inspection visit - these concerned medication, staff training and other records, and mealtime arrangements. What the care home could do better: The home needs to protect people living in the home by ensuring that temporary staff working in the home have undergone the required checks. They need to ensure that complaints are recorded and investigated under the home`s complaints proceedure. They need to ensure that care plans and care records are evidencing the care being provided and that staff have full guidance on how all the person`s needs will be met. They are not fully meeting their Statement of Purpose commitment to make the resident`s care plan available to them, to consult with them and review the care provided monthly. Random inspection report Care homes for older people Name: Address: Rustington Hall Station Road Rustington West Sussex BN16 3AY two star good service 17/09/2008 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Edward McLeod Date: 1 8 0 5 2 0 1 0 Information about the care home Name of care home: Address: Rustington Hall Station Road Rustington West Sussex BN16 3AY 01903775001 01903777502 sally@rustingtonhall.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Cecilia Helen Potts Type of registration: Number of places registered: Conditions of registration: Category(ies) : Littlehampton And Rustington Housing Society Ltd care home 52 Number of places (if applicable): Under 65 Over 65 52 0 old age, not falling within any other category physical disability Conditions of registration: 0 52 The maximum number of service users to be accommodated is 52. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users 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 (OP) Physical disability (PD). Date of last inspection 1 7 0 9 2 0 0 8 Care Homes for Older People Page 2 of 12 Brief description of the care home Rustington Hall is a care establishment registered to accommodate up to fifty two residents aged 65 years or over. Part of the home was built many years ago as a private house, but this was converted to a home to provide care some years ago. The building was extended at a later date to accommodate people in need of nursing care. Both the residential wing and the nursing wing are situated a few feet away from each other. In both wings the bedrooms are situated on two floors with a passenger lift to provide access. Communal lounges and a dining room are present in both buildings. Gardens with seating for residents is available. The property is located in Rustington, a large village near the town of Littlehampton. The care home is in a residential area with easy public transport links. A large car park is available for visitors. The providers are Littlehampton and Rustington Housing Society Ltd, for whom the responsible individual is Mr John Morris. The registered manager is Mrs Cecilia Potts. Care Homes for Older People Page 3 of 12 What we found: The random inspection was arranged to assess the services compliance with previous requirements, and their compliance with some of the key national minimum standards for care homes for older people. While planning for this visit we took into account information provided in the report of our previous visit, the Annual Quality Assessment Audit completed by the manager Mrs Potts on 17/3/10, and other information we have received on the service such as notifications sent to us by the provider. The random visit was carried out on the 18th May 2010. The visit was carried out by one inspector, began at 11.05 a.m. and we were on the premises for five hours. At our visit we sampled records relating to medication, complaints, staff recruitment, staff training and supervision, quality assurance and health and safety. We sampled the care records for three people living in the home, and medication records for four people living in the home. We talked with three people living in the home, one persons relative, and three staff working in the home. We also talked with the manager Mrs Potts and the responsible individual for the service Mr Morris. Subsequent to our visit we were advised by the local authority West Sussex County Council of some concerns raised relating to the complaints procedure, care provision and care records. These were discussed on the 20th May 2010 by telephone with the manager, and some of this conversation has been referred to in this report. At this visit we sampled the care plans for four people. Two people living in the home who we talked to said there was information about how their care was provided and their needs that they would wish all staff to know. The provider should consider if there is a need to expand the care plan and wishes and preferences information made available to staff and the person receiving the care. Monthly reviews of care plans we sampled did not always evidence that the person or someone close to them had been included in the review of the care plan. We found that care plans were not always recording the persons needs or how these were to be met. For example it was recorded for one person that they were not able to take part in communal activities, but the social care plan did not address how their need for social support would be addressed. We found that records were indicating that one persons condition was deteriorating, but that care plan monthly reviews between 20/5/09 and 5/3/10 were not updating how the persons changing needs would be met. Subsequent to our visit we received information from the local authority (West Sussex County Council) that some safeguarding issues had been raised with the home at a Care Homes for Older People Page 4 of 12 meeting with the manager on 4/5/10 and at a strategy meeting on 5/5/10. We discussed this information with the manager during a telephone call on 20/5/10 - for example an allegation that equipment had not been in place for the treatment of one persons pressure area, and that staff had failed to effectively treat the wound or make proper records of the condition of the wound. The manager advised us that the shortfalls had been addressed by obtaining a pressure mattress, by seeking advice from the tissue viability nurse, and meetings with staff concerning the completion of care records. The manager advised us that training in wound care was being arranged for staff, and that a tissue viability nurse had visited to assess the condition of the wound on 17/5/10. The manager read to us over the phone the care plan updated on 10/4/10 and the guidance in place for staff which had been agreed with the tissue viability nurse. One person in the home had raised with the local authority concerns about fixed bath days and long intervals between baths. We discussed this on the phone with the manager Mrs Potts who said that the person was receiving a bath at the times and on the days they preferred twice a week. Mrs Potts advised us the most recent record of when the person had received a bath was for 27/4/10, as staff didnt usually record when someone has had a bath. We found therefore there to be gaps in recording the care provided for the person. A requirement has been made concerning care plans, care recording, and the review of care plans. At our previous visit a requirement was made concerning the recording and administration of medicines. At this visit we looked at staff training records, medication administration records for two people, controlled drugs records for two people, the record of a recent inspection visit by the homes pharmacist. We observed medicines being administered to two people. The records sampled were up to date, and no issues with stocks of the medicines were noted. The previous requirement concerning medication was found to have been met. At our previous visit a requirement was made that the routine for serving meals be reviewed to ensure that people are offered assistance with their meals discreetly, sensitively, and individually. At this visit we found that the service have reviewed how meal times are arranged, and made changes such as having an extra lunch time sitting. It was our observation that this has led to people not having to sit at table waiting so long for their meal, and to people who need assistance with eating receiving all the undivided assistance they need with this. We found that people are offered choices at each meal, and that specialist diets such as liquidised, minced, diabetic and high fibre diets are being catered for. Care Homes for Older People Page 5 of 12 When people needed assistance with eating or cutting their food, it was our observation that staff were offering this in a polite and supportive manner, and that each person was being assisted individually. People were being offered a choice of hot and cold drinks. One person we spoke to told us that the food is very good, and that there is always a good choice. They told us that the kitchen staff are responsive to individual requests. The dining room overlooks a patio garden, and we found that the meal was being conducted in an unhurried and relaxed manner, and there was a good atmosphere. The previous requirement concerning meal times was found to have been met. During our visit we sampled the records of three recent complaints, and found that the complaints had been investigated, action taken, and a verbal feedback given to the complainant. One of the concerns advised to us by the local authority concerned the bathing arrangements for one person. After discussing this with the manager on the phone, it was our view that while were advised that the service had discussed the issues with the complainant and the persons wishes had been accomodated, that this should have been recorded as a complaint, and followed through under the homes complaints proceedure. The service should also consider if providing written confirmation of the outcome of the complaint to the complainant would assist them to better evidence that they are complying with their complaints proceedure. A requirement has been made concerning the recording of complaints. Staff are continuing to receive training in safeguarding vulnerable adults, the most recent training having been completed in February 2010. The manager told us that the safeguarding training includes discussion about local arrangements for making safeguarding referrals, and that staff will advise their senior carer or nurse on duty of any safeguarding issues. At this visit we sampled the recruitment records for three members of permanent staff and found that the service had obtained the appropriate checks and references before the person commenced work. Training records sampled indicated that staff are undertaking recommended induction training when they begin work. On the day of our visit three temporary staff were being employed in the home as carers on the morning shift. We asked to see the confirmation of recruitment checks for those members of staff, but the manager was unable to find these. The manager said she was surprised about this, as the agency used by the home usually did provide this information. The manager advised us that no agency staff were employed for the evening and night shifts in the home, and that she would ensure that she received the recruitment checks confirmation from the agency for temporary staff who were booked to be working in the home before the beginning of the morning shift on 19/5/10. Care Homes for Older People Page 6 of 12 A requirement has been made concerning the need for recruitment checks to be in place before staff commence work in the home. Mrs Cecilia Potts was registered as manager for the service in February 2010. Mrs Potts is an experienced manager and has attained the Registered Managers Award qualification. A resident we spoke to told us that the organisation is good in the home. At our previous visit a requirement was made that records required for the effective and efficient running of the home are maintained and up to date and available for inspection. At that visit we had not been able to access records relating to quality assurance and staff training. We found that the home has been seeking the views of people using the service and others, for example relatives, with an interest in the service. People have completed questionnaires, and aired their view in residents meetings which relatives are also encouraged to attend we were advised. This has resulted in changes to menus, and suggestions for outings being acted on, for example. We sampled the homes quality assurance improvement plan, dated 11/3/10, which indicated that the provider is assessing the quality of the service provided and setting out plans for the improvements they wish to make. We sampled supervision records for three members of staff. We found that arrangements for regular staff supervision are in place, and that training in staff supervision is being accessed at a local college. We found that training records for staff were available for inspection - for example a spreadsheet indicating which staff had undertaken which training, and copies of training certificates for individual staff. These included training relating to health and safety issues. We sampled a number of health and safety records including hot water temperature check records, fire equipment checks, fire drills and fire alarm tests. We are advised in the AQAA of the most recent checks and inspections carried out on equipment used in the home. The requirement concerning record keeping was found to have been met. What the care home does well: People living in the home tell us they are being supported well by the staff team. Arrangements are in place for staff to receive the training and supervision which will assist them in meeting peoples needs. Care Homes for Older People Page 7 of 12 The home has reviewed shortfalls found at our previous visit, and has complied with all four requirements made at the previous inspection visit - these concerned medication, staff training and other records, and mealtime arrangements. What they could do better: 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 2. Care Homes for Older People Page 8 of 12 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 9 of 12 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, 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 7 15 The provider must ensure 02/07/2010 that the service users plan sets out in detail the action which needs to be taken by staff to ensure that all aspects of the health, personal and social care needs of the service user are met. Peoples care needs are not always being fully assessed and recorded, and care plans do not tell staff or the person cared for how their full needs are to be met. 2 16 22 The registered person shall 02/07/2010 ensure that any complaint made under the complaints procedure is fully investigated and that the complainant is advised of the outcome of the complaint. The service has not ensured that complaints are recorded and investigated under the homes complaints proceedure. Care Homes for Older People Page 10 of 12 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 3 29 19 The registered person shall 02/07/2010 not employ a person to work in the care home until he has obtained in respect of that person the information and documents specified in Schedule 2 of the Care Homes Regulations 2001. The home needs to protect people living in the home by ensuring that temporary staff working in the home have undergone the required checks. 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. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 11 of 12 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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