This inspection took place on the 9 and 10 October 2017 and was unannounced.Russell Churcher Court provides residential care and support for up to 44 older people some of who are living with dementia. People were accommodated in individual rooms with a toilet and shower and small kitchenette. Communal facilities include a lounge, dining room and conservatory and secure outside spaces. At the time of our inspection, 44 were living at the home.
A registered manager was not in post and the previous registered manager left on 30 June 2017. 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 provider had recruited a manager and they were currently applying for registration.
People told us they were safely cared for at Russell Churcher. However, we found people were not always protected from risks associated with their care and support. We found people’s needs were not always reviewed when they experienced a fall to ensure detailed plans were in place to minimise the risk of a reoccurrence.
Records showed information to enable staff to effectively monitor, evaluate and mitigate the risks to people from dehydration and malnutrition was not consistently recorded. Topical creams prescribed to protect people from the risks associated with pressure sores were not always recorded as applied as prescribed. Information was not always readily available to staff about where to apply the creams. From the examples seen we could not be assured people were always receiving sufficient fluids, food and skin care to prevent the risk of deterioration in their health.
Risk assessments and continuity plans were in place to guide staff on how to support people in an emergency situation such as a fire or flood. People were supported safely and appropriately with their moving and handling needs.
Robust procedures were not in place to ensure medicines were always managed safely. We identified medicines were not always stored and disposed of safely. Cream and liquid medicines were not dated when opened to ensure they remained effective. Staff administering people’s medicines had not been routinely assessed as competent to do so line with the provider’s policy and current guidance.
The provider had recently increased care staff hours during the day. We received mixed feedback about the staffing levels in the home from people and staff. The provider planned to carry out a more detailed analysis of people’s dependency needs to ensure sufficient numbers of staff were deployed to meet people’s needs.
Staff had the knowledge to identify safeguarding concerns and acted on these to keep people safe. Safe recruitment practices were followed before new staff were employed to work with people. Checks were made to ensure staff were of good character and suitable for their role.
Staff did not receive regular supervision sessions. Supervision helps to ensure people are cared for by staff who are appropriately supported in their role.
Staff completed an induction and on-going training to develop the knowledge and skills required to meet people’s needs.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.
People spoke positively about the food available in the home. Some people may have benefited from more attention during meal times to encourage eating.
People received support with their healthcare needs from the relevant health care professionals. Care plans did not always contain detailed information about how their healthcare needs were being met. The manager took action to ensure people’s records were updated as required following our inspection.
People and their relatives told us the staff were kind and caring and we saw interactions between staff and people to support this view. However, we observed staff during lunchtime were not always respectful and caring towards people. The manager told us they would address this with staff.
People and their relatives told us they were satisfied with the care provided in the home. At the time of our inspection, work was in progress to review and update people’s care plans to ensure they were personalised and reflected people’s needs, choices and involvement.
People had a range of activities they could be involved in. In addition to group activities, people were able to maintain hobbies and interests. However, we observed there was less staff engagement and meaningful activity for those who did not participate in group activities.
A system was in place to manage complaints. Information about this was available to people and their relatives Concerns and complaints were used as an opportunity for learning or improvement.
Most people, their relatives and staff told us the home was well led. It was clear the provider and manager were acting to make improvements in the home and the service people received. Systems in place to identify improvements required were not always effective and had not identified all the concerns we found.
A system was in place to gather feedback from people, their relatives and visitors to the home. Feedback from people had been used to make improvements.
We found four 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 the report.