The inspection took place on 12 November 2014 and it was unannounced, which meant that the provider did not know that we were coming.
Rusthall Lodge Care Home is a residential home providing personal and nursing care with accommodation for up to sixty seven older people, some of who were living with dementia. At the time of our inspection, sixty one people lived at the home.
The management team at Rusthall Lodge included the general manager who was in the process of applying for registration with CQC at the time of our inspection. There was a registered manager at the home. The deputy general manager was the registered manager with CQC at the time we inspected the home. A registered manager is a person who has registered with the Care Quality Commission 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.
We carried out this inspection in response to some concerns raised through Healthwatch Kent speak out forum completed at an event in Tunbridge Wells on 09 October 2014. A local Healthwatch organisation is a statutory body set up across a local authority area to champion the views and experiences of local people about their health and social care services. The areas of concerns centred around the delivery of care to people and lack of skilled staff including staff support.
The provider had systems in place to manage safeguarding matters and make sure that safeguarding alerts were raised with other agencies, such as the local authority safeguarding team, in a timely manner. All of the people who were able to converse with us said that they felt safe in the home; and said that if they had any concerns they were confident these would be quickly addressed by the registered general nurse (RGN) in the first instance, or by the general manager who was applying to be the registered manager at the time we visited.
The home had risk assessments in place to identify risks that may be involved when meeting people’s needs. The risk assessments showed ways that these risks could be reduced. We found risk assessments on various areas of care such as falls, mobility, bed rails and diabetes. These risk assessments were reviewed in November 2014. We saw that accident records were kept and audited monthly to look for trends. This enabled the staff to take immediate action to minimise or prevent accidents.
There were two passenger lifts with access to all floors. We checked the two lifts and found them to be in good working order. There was a maintenance contract plan in place. The home had well-proportioned bathrooms; wet rooms and toilets. There were several communal lounges and dining areas which were pleasant and offered people choices about where they wanted to eat or sit.
There were no indications that staffing levels were too low to meet people’s needs. Staff were not hurried or rushed and when people requested their care or support, this was delivered quickly. The provider operated safe recruitment procedures. All nurses’ registration (PIN) numbers were regularly checked to ensure that the nurses were on the active register of the Nursing and Midwifery Council (NMC).
Medicines were stored and administered safely. Nursing staff administered medication. Clear and accurate medicines records were maintained.
People said, “Staff were well trained and knew what they were doing”. Staff knew each person well and had a good knowledge of the needs of people who lived at the home. Training records showed that staff had completed training in a range of areas that reflected their job role. Staff told us that they had received supervision and appraisals were on-going.
Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests. We found the home to be meeting the requirements of Deprivation of liberty safeguards.
People said that the food was good. The menus offered variety and choice. It provided people with nutritious and a well-balanced diet. People had a choice of hot foods and sandwiches each day; and a choice of two main meals and desserts at lunch times.
People and their relatives told us that they were involved in their care planning, and that staff supported people with health care appointments and visits from health care professionals. Care plans were amended immediately to show any changes, and care plans were routinely reviewed every three months to check they were up to date.
People told us they were always treated with kindness. Staff were patient and encouraged people to do what they could for themselves, whilst allowing people time for the support they needed. Staff had suitable training and experience to meet people’s assessed needs; staff encouraged people to make their own choices and promoted their independence.
People’s needs were fully assessed with them before they moved to the home to make sure that the home could meet their needs. Assessments were reviewed with the person and their relatives. People were encouraged to take part in activities and leisure pursuits of their choice, and to go out into the community as they wished.
People knew how to make a complaint if they were unhappy. One relative said, “If I need to complain, I will go to the manager. She is very approachable”.
People spoke positively about the way the home was run. The provider had a clear set of vision and values, which we observed that both the management team and staff followed. The management team and staff understood their respective roles and responsibilities. Members of staff told us that the general manager was very approachable and understanding. They said they were encouraged to raise issues or make suggestions and felt they were listened to.
The home had a system to monitor and review the quality of service they provided. The way the home was run had been regularly reviewed. Prompt action had been taken to improve the home and put right any shortfalls they had found. Information from the analysis of accidents and incidents had been used to identify changes and improvements to minimise the risk of them happening again.