This inspection was unannounced and took place over three days on 17, 18 and 23 February 2015.
Russell Court Nursing Home provides accommodation, nursing and personal care for up to 41 people. There were 38 people living at the service at the time of our inspection. Some people were unable to move independently, whilst others needed support due to illness or other age related conditions. Some people were living with dementia. End of life care was provided. Most people were able to express themselves verbally, whilst others used body language to communicate.
The property is purpose built with flat access and adaptations suitable for people with restricted mobility. Each person had their own bedroom with en-suite facilities. Accommodation is over two floors accessed by a passenger lift. There is an enclosed patio to the rear and to the front a small garden and parking bay. There is road side parking. Russell Court Nursing Home is located a short distance from the centre of Longfield, which has rail and bus transport links.
When we last inspected the service on 13 December 2013, we found that the service was meeting the Health and Social Care Act (Regulated Activities) Regulations 2010.
At this inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.
There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
Safe medicine procedures were not always followed and could put people at risk. Changes needed to be made to stock control to make sure people had the medicines they required available to them. The room temperature at which medicines were stored was not checked, which meant there was risk that they could become ineffective.
All areas of the service were clean and tidy. Nurses and care staff had a good understanding about how to prevent the spread of infection. There was written guidance about this for staff, which the manager was in the process of updating. We saw that some items in the laundry were not washed in the best way to prevent cross-infection. A nurse took action about this. We have recommended that laundry procedures prevent the risk of infections spreading.
There were enough staff on duty to meet people’s needs in an unrushed manner. Staff told us they had enough time to carry out their duties. People had mixed views about how long it took staff to respond to their staff call alarms. The manager had previously increased the number of staff in the evenings following suggestions from people. The provider told us that they were going to provide another nurse in the evenings.
People told us they felt safe. Staff were trained in how to protect people from abuse and harm. There was information for staff guidance about what to do if abuse was suspected and how to report this. People were protected from harm, risks to their safety were assessed and managed appropriately. There were safe staff recruitment procedures, which included carrying out legally required checks on every applicant to make sure they were suitable to work with the people who lived at the service. Checks were carried out in the building on equipment and facilities to make sure that people were safe.
Staff had the appropriate skills, knowledge and experience to meet people’s needs. People and their relatives told us the staff provided a good quality of care. Staff communicated well with people. Staff were trained to meet people’s needs and supported in their roles by the management team. Staff asked for people’s permission before they carried out any care tasks or nursing procedures. Where people lacked the mental capacity to make decisions the service was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests. The manager was in the process of updating Deprivation of Liberty Safeguards applications, such as for some people who needed to use bed rails to protect them from harm.
People told us they enjoyed the food. People told us they had a choice of food and the chef would always make something especially for them, if they did not like any of the options on the menu. People could eat their meals where they chose to. Staff assisted people to eat where necessary and respected people’s pace. The food and fluid that people consumed and their weight was monitored by staff, who took appropriate action if necessary, to reduce the risk to people’s health.
People were supported to manage their health care needs. Nursing staff carried out regular health checks on people. People had access to a GP, chiropodist and dentist. People were referred to specialists and supported to attend hospital appointments when necessary.
People told us they liked their bedrooms and the home environment. The property was purpose built with flat access and adaptations suitable for people with restricted mobility. People were provided with equipment according to their individual needs, such as wheelchairs, electric wheelchairs or mobility aids. The building was well maintained and decorated.
People were treated with respect, kindness and compassion. People told us they were happy and felt cared for. Staff promoted people’s independence and encouraged people to do as much as possible for themselves. Staff were patient and took time to explain to people what they were doing, such as when assisting people to eat or using a hoist. Staff demonstrated respect for people’s dignity. Staff were careful to protect people’s privacy, for example by making sure that doors were closed when personal care was given.
Specialist care was provided for people who were nearing the end of their lives. People were referred to a local hospice palliative team for additional support.
Staff were aware of the importance of maintaining confidentiality and discretion. People’s information was treated confidentially and personal records were stored securely.
People said they received care and assistance when they needed it and they had a choice about how they preferred to receive it. People were involved in the assessment and planning of their care, needs and preferences. Care plans were reviewed regularly to make sure they were up to date.
People could spend their time how they chose to. Some people preferred to stay in their bedroom, whist others liked to join in organised activities, such as singing, quizzes and cooking. People who were not able to leave their room told us that staff came to see them often.
The manager investigated and responded to people’s complaints and concerns. All the people we spoke with felt able to raise any concerns with staff or the management team.
People spoke positively about the way the service was run. They told us the manager and staff were approachable. Relatives told us they felt that the home was well run and could speak to the manager at any time if they had any questions or concerns. The organisation had a clear vision and values. Staff understood their roles and responsibilities and the staff and management structure ensured clear lines of accountability.
There were systems in place to review the quality of various aspects of the service regularly. Action was taken where any shortfalls were identified. Six monthly ‘customer satisfaction surveys’ and ‘resident’ and relatives’ meetings gave people the opportunity to comment on the quality of the service. People were listened to and their views were taken into account in the way the service was run.