This inspection took place on the 25 and 26 June 2018 and was unannounced. At the previous inspection the service was in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities 2014). At this inspection we found there was a continued breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities 2014). This was because records were not suitably maintained, accurate and up to date and the governance of the service failed to bring about the improvements required for them to become compliant with this regulation. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective and well –led to at least good. The provider sent us an action plan telling us what improvements they intended to make. At this inspection we found the improvements were not sustained and the service was again rated requires improvement. This is the third inspection where the service has been rated “Requires Improvement.”
Russell house is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Russell house accommodates 20 people across four separate units, each of which have their own facilities. At the time of this inspection there was nineteen people living in the service.
The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.
The service was required to have 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. In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time. The registered manager had recently left the organisation and the provider was actively recruiting into the position.
Relatives were complimentary of the permanent staff and felt they were skilled, kind and caring. However, the service had a high number of staff vacancies which meant a high use of bank and agency staff were used to cover shifts. Relatives felt those staff did not always have required skills and training and the use of agency staff led to inconsistent care for their family members.
Whilst the required staffing levels were maintained on each unit staff were not deployed appropriately which meant some units had a high number of agency staff on shift. This put a lot of pressure and responsibilities on the permanent staff members who felt they were working under extreme pressure. They were expected to be drivers, administer medicine, act as shift leaders as well as providing personal care and support to people. The provider confirmed after the inspection they had moved staff around to provide a better skill mix of experienced staff across all the units. They were continuing to recruit into vacancies and they were currently consulting on a pay review which they hoped would help with the retention of staff.
Staff were not suitably inducted, skilled, trained and supported in their roles. The agency staff were not appropriately trained in that they did not have training such as epilepsy awareness and learning disabilities which the provider considered was mandatory for the service. A number of staff were in acting roles. Whilst a series of training had been provided to them an assessment of their skills and competencies had not been completed to ensure they had the required skills to do the job. New staff were not supported to complete their care certificate induction and have their competences signed for. Staff felt supported but supervision of staff was not happening at the frequency outlined in the providers policy.
Permanent staff were knowledgeable about people and the support they required. Staff were kind and caring. However, we observed poor practice which did not promote people’s privacy, dignity and show them respect. We have made a recommendation about this in the report.
People had care plans in place but some care plans lacked specific details on how staff were to manage situations such as challenging behaviour. People’s care plans included guidance on how people communicated but this was not routinely promoted by staff. We have made a recommendation about this in the report.
People were supported to make day to day choices and decisions. The service did not always work to the principles of the Mental Capacity Act 2005. We have made a recommendation about this in the report. People’s health and nutritional needs were identified but some relatives felt changes to their family members health were not always responded to in a timely manner.
Systems were in place to promote safe medicine administration. There was a delay in a person getting their required antibiotic medicine. The provider have since put a protocol in place around the management of interim prescriptions to prevent delays in medicine administration.
People had access to activities but access to community activities was limited due to lack of drivers.
A complaints procedure was in place and people and relatives felt able to raise complaints. However, some relatives did not feel that their complaints were always acted on as similar complaints were raised by them.
The provider had systems in place to get feedback on the service. Meetings and surveys were completed annually.
The service was purpose built, it was homely and welcoming with arts and crafts displayed at the entrance and on individual units. The standard of cleanliness varied across the four units and a number of areas requiring refurbishment were over due to be refurbished since 2017.
The provider had systems in place to audit and monitor the service. Whilst some of the issues we found in relation to staff supervisions, inductions and record management were identified and being dealt with, this was not done in a timely manner to bring about improvements.
Systems were in place to safeguard people and risks to them were identified and managed. Staff were suitably recruited to further safeguard people.
At this inspection the provider was in breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities 2014). and there was a continued breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities 2014). We are taking action against the provider and will report on that action when the timescales for representations have passed.