The inspection took place on 10 and 12 February 2015 and was unannounced.
Russettings Care Home is registered to accommodate up to 45 people with a range of needs, including people living with dementia and/or long-term health conditions. The service also provides a short-breaks and respite service. At the time of our inspection, there were 39 people living at the service. Russettings Care Home is a purpose built nursing home set in its own grounds and is situated on the edge of Balcombe village. People have their own rooms and some have en-suite facilities. There is a large communal lounge area, dining room and conservatory overlooking the grounds; a separate garden has been made accessible to wheelchair users.
The service has a registered manager. 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. The service changed providers less than a year ago and the new registered manager started at the service in April 2015.
Risks to people had not always been assessed appropriately. Where risks had been assessed they had not been reviewed on a regular basis.. Where people were at risk of developing a pressure ulcer, there were inconsistencies in how the risks were assessed or managed. Accidents and incidents were recorded, but there was no analysis or monitoring system in place. The premises were undergoing refurbishment and there was a risk to people and staff because of the way the building works were managed and lack of environmental risk assessments.
People’s medicines were not managed safely and Medication Administration Records (MAR) charts had not always been fully completed. The medicines trolley was left unlocked during a medicines round.
Staff knew how to recognise the signs of abuse and what action to take to keep people safe. Staffing levels were sufficient and the service employed agency staff to address any unplanned gaps in staffing. Safe recruitment practices were in place to ensure that statutory checks had been undertaken for new staff. People were protected against the risk of infection and staff demonstrated their understanding of infection prevention and control.
People were not always supported or encouraged to eat their meals. Some staff did not notice when people needed help and people were at risk of having little or nothing to eat. Where people had been identified as at risk of malnutrition or dehydration, they had not always been weighed frequently. Care plans did not always show what action had been taken to address people’s dietary requirements or nutritional needs. Food and fluid monitoring and recording was inconsistent. People had access to healthcare services and professionals.
Staff completed an induction programme and had received all essential training, although not all staff had received dementia awareness training. They demonstrated a good understanding of the Mental Capacity Act 2005 (MCA) and the associated legislation and put this into practice. Staff received regular supervisions and attended staff meetings.
Care records were inconsistently completed and were not always person-centred as they lacked personal details about people. The registered manager was in the process of updating all care plans. Activities were organised on a daily basis and people were supported by staff to be engaged in these activities. However, it was not clear how much involvement people had in the planning of activities. Relatives and friends could visit people freely. Residents and relatives’ meetings were held, but some people appeared to be unaware of them. Complaints were listened and responded to within a week and resolved within 28 days.
People were not actively involved in developing the service. There were some systems in place to monitor and measure the quality of care provided, however, these were not robust enough to drive continuous improvement. Where audits had been undertaken, they were not planned on a regular basis and where gaps or inconsistencies were identified, these had not always been addressed or acted upon.
Staff felt they were well supported and motivated to carry out their responsibilities. They felt that things had improved since the service had changed ownership. External agencies were contacted and worked in partnership with the service. People were cared for by kind, caring and compassionate staff and were involved in decisions about their care. They spoke highly of staff. As people reached the end of their life, they were involved in decisions about how they wished to be cared for. Staff were sensitive in their approach to end of life care and provided support to the person and their family.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.