We carried out a review of the data available to us about The Russets on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about The Russets, you can give feedback on this service.
The Russets is a residential care home that was providing personal and nursing care to 87 people aged 65 and over at the time of the inspection. The service is registered to support up to 105 people.
The Russets has six houses. One house (Sherwood) offering nursing care. Then there are five other houses; Ashmead, Bramley, Crispin, Discovery and Encore for older people living with dementia. Currently, Bramley unit is being used to help facilitate discharges from the local Community hospital to help manage beds during the COVID 19 pandemic.
The premises are purpose built to offer care to older people who may have dementia and/or a physical disability. All accommodation is single storey, with ensuite bathrooms with access to a central secure garden.
People's experience of using this service and what we found
People, relatives, staff and visiting professionals reported positively on standards of care provided at the home. People said, “The staff are very helpful,” and “They are really looking after me well.” Relatives said people were well cared, they praised staff for their patience and caring. Relatives said, “[Person) has been very happy here,” “They cope with [person] well.” Others said, “I can think of no better place. Excellent staff and care at all times, day and night.” Visiting professionals said staff knew people well and care was personalised. One professional said, “Staff are welcoming, they are open regarding care, and receptive to advice.”
People received their medicines safely and on time. Improvements in medicines systems, staff training and increased monitoring of medicines showed steps had been taken to learn lessons and reduce risks of errors.
Staff supported people to keep safe through awareness of health and safety. Regular servicing and maintenance was carried out with regular improvements to the environment, such as decoration and improved lighting.
People's care was more personalised. Staff knew people well and cared for each person as an individual. One relative said, “The care given and the entertainment provided is second to none.” Care plans and risk assessments had improved and were more detailed, personalised and up to date about people's care needs and preferences.
People received care from regular staff they had got to know and trust. There were enough staff to safely care for people at a time and pace that suited them.
Staff had a good understanding of signs of abuse and felt confident any safeguarding concerns reported were listened to and responded to.
We were assured the service were following safe infection prevention and control procedures to keep people safe. The service had ongoing monitoring arrangements to ensure all aspects of infection control followed best practice guidance.
Staff reported confidence in the leadership of the registered manager. Staff felt better supported and reported improved communication, team working and staff morale. Where mistakes were made, staff were supported to learn lessons and improve practice through further training and support.
The providers quality assurance and monitoring systems were used effectively to make continuous improvements.
At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection: Requires improvement. (Report published December 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection the rating has improved to Good.
Why we inspected
This was a focused inspection to check whether improvements had been made since we last visited. We reviewed the Safe, Responsive and Well-led domains only. Our report is based on the findings in those areas at this inspection. The ratings from the previous comprehensive inspection for the Caring and Effective key questions were not looked at on this occasion.
Follow up
We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The Russets is a residential care home providing personal and nursing care to 95 people aged 65 and over at the time of the inspection. The service can support up to 105 people.
The Russets has six units. There is one unit (Sherwood) offering nursing care. Then there are five units Ashmead, Bramley, Crispin, Discovery and Encore for older people living with dementia.
The premises were purpose built to offer care to older people who may have dementia and/or a physical disability. All rooms are on the ground floor and have en-suite bathrooms.
People’s experience of using this service and what we found
People and relatives felt the core staff team were caring and trained effectively. Some people and relatives said they would prefer if more staff were on duty. Some staff wished they always worked with permanent staff but understood the need to use agency staff. The provider informed us they had added additional staff hours during the inspection process, in response to the feedback given.
People’s medicines were not always managed safely. People’s care records lacked some personalised detail. We have recommended the provider ensures care plans provide staff with the information they need to support person centred care.
Changes and improvements had been made to the systems and processes operated by the provider. Further improvements were needed to ensure issues relating to risk and quality were identified and dealt with.
Staff listened to people and involved them in planning their care. Staff were mindful of people’s right to consent to their care and treatment. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
People had their dietary needs met and they could see their GP for any health concerns from a GP that attended the service twice a week. Their oral, foot and eye care needs were met. People saw specialist health care staff for specific needs such as diabetes and Parkinson’s. The older person mental health team was also available to support staff.
The activity staff were given special mention by people and there was good work going on by these and the activity champions to provide meaningful activity for people.
Rating at last inspection and update
The last rating for this service was Requires improvement. The report was published on 15 December 2018. There were breaches of the Regulations. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Russets on our website at www.cqc.org.uk.
The provider completed an action plan after the last inspection to show what they would do and by when to improve.
Why we inspected
We inspected the service in line with our inspection programme.
Enforcement
We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well led sections of the full report.
You can see what action we have asked the provider to take at the end of this full report.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The Russets is registered to provide accommodation for people who require nursing or personal care for up to 105 people. Up to 73 people are accommodated in a specialist dementia unit called The Russets, whilst separate accommodation for up to 32 people with general nursing care needs is provided in the unit called Sherwood. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our inspection 102 people were accommodated at the service.
At the last inspection the service was rated as Requires Improvement. At this inspection we found the service Requires Improvement in safe, responsive and well-led.
There was a registered manager in post. 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’s quality assurance system had not identified all shortfalls found during the inspection. We found improvements were required to ensure adequate stock of medicines, check that bed rails in use were within guidelines, the accuracy of records relating to fluid intake and care plans relating to people’s health needs.
Two people were at risk from dirty and contaminated equipment as we found one person’s bed sides and another person’s cushion was dirty and had internal staining.
People were supported by staff who received supervision an annual appraisal and training. Checks had been completed prior to staff starting work at the service. Staff enjoyed working at the service and could approach the manager if needed.
People and relatives said staff were kind and caring. All people felt happy with the care they received.
People’s care plans were person centred and contained important information relating to their likes, dislikes and individual routines.
People were able to raise any complaints and numerous compliments had been received.
People felt safe, and staff were able to demonstrate different types of abuse and who to report it to.
People’s choices were respected. Staff were able to demonstrate how they supported people to make their own choices. People could choose how they spent their day and where they ate their meals.
People were supported with their medical appointments and these were arranged as and when required.
People could access a variety of activities throughout the month and people, relatives and staff had their views sought so that improvements could be made.
We found three 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.
The Russets provides accommodation for people who require nursing or personal care. They are registered to provide this regulated activity for up to a maximum of 105 people. Within the service up to 73 people are accommodated in The Russets which provides care and treatment for people living with dementia, this is separated into five houses. Separate accommodation for up to 32 people with general nursing care needs is provided in an area called Sherwood. At the time of our inspection the service was providing nursing and personal care to 102 people over both areas.
A registered manager was in post at the time of our inspection. 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.
Feedback we received across the service around staffing provision varied. This meant peoples experiences of the service were not consistently positive. Medicines records had not always been completed. Systems in place to take necessary actions when medicines records had not been completed were not always used. Systems to monitor and review the quality of the service were conducted and associated action plans produced. However, these were not consistently completed in all areas. People’s records in relation to medicines, position changes and daily care were not consistently completed.
Safe recruitment processes were in place. Staff were supported through a comprehensive induction and supervision. A training programme enabled staff to be knowledgeable within their role and to encourage continued development of their skills.
People received care and support from staff that were kind and caring. People’s privacy and dignity was respected. People’s family and friends were involved in their care and received effective communication from the service. Events the service organised supported families and encouraged engagement with the local community.
Care plans were person centred and described people’s preferences. People, relatives and staff spoke highly of the activities programme available. People benefited from the design and layout of the service. This promoted people’s independence and supported people’s needs. Regular checks of the equipment and environment were conducted to ensure people’s safety.
People’s views were sought through different methods, such as meetings and questionnaires. Actions were taken as a result. The service reflected in strategies used with people and promoted new ideas that may have a positive benefit to people. A volunteer scheme was in place which supported people with activities and social engagement.
We found one breach 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 this report.
We undertook an unannounced inspection of The Russets on 7 July 2015. When the service was last inspected in July 2013, we had identified concerns that care and treatment was not always planned in a way that ensured people’s safety and welfare. We found there were no appropriate systems to identify and manage risks relating to wound care and records completed in relation to wound care were not always accurate. During this inspection we found the provider had made the appropriate improvements.
The Russets provides accommodation for people who require nursing or personal care. They are registered to provide this regulated activity for up to a maximum of 105 people. Within the service up to 73 people are accommodated in The Russets which provide care and treatment for people living with dementia, whilst separate accommodation for up to 32 people with general nursing care needs is provided in the area called Sherwood. At the time of our inspection the service was providing nursing and personal care to 100 people over both areas.
A registered manager was in post at the time of inspection. 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.
People felt safe and staff demonstrated awareness of how to respond to actual or suspected abuse. The provider had appropriate safeguarding adults and whistleblowing policies for staff that gave guidance on the identification and reporting of suspected abuse.
People’s risks were assessed and risk management guidance was produced whilst promoting people’s independence. People and staff told us that staffing levels were sufficient and we made observations to support this. Safe recruitment procedures were completed.
The service had systems that monitored the safety of the environment and the equipment used within it. People received their medicines on time and the service had arrangements in place for the ordering and administration of medicines. Medicines records had been completed appropriately and the provider had an auditing system to monitor people’s medicines.
People praised the effective care they received from the staff and told us they received a high standard of care. Staff received regular training and regular updates on essential training subjects. An appraisal and supervision processes meant staff felt supported by the provider.
People were asked for their consent before any care was provided and staff acted in accordance with their wishes. The registered manager understood the Deprivation of Liberty Safeguard (DoLS) framework and appropriate applications had been made. Staff understood their obligations under the Mental Capacity Act 2005 and how people should be supported to make informed decisions.
People’s risk of malnutrition was monitored and people received the support they needed during meal periods. People were supported to see healthcare professionals when required and records showed that staff responded promptly to people’s changing needs. The service had appropriate systems that ensured referrals to healthcare professionals were made.
There were caring relationships between staff and people. People spoke very highly of the staff that provided their care and we also received very positive feedback from people’s relatives. People and their relatives were involved in decisions about the care package they received. We made continual observations during the inspection of people being making encouraged by staff to make independent decisions.
People told us the service was responsive and they received the care they needed and when they needed it. All said their agreed care package met their needs. There were a wide range of activities for people to partake in and we observed people engaged in activities during the inspection. The provider had a complaints procedure and people had been given appropriate information about how to raise a complaint if required.
The registered manager was highly spoken of by the staff. Staff felt supported in their roles and the management had sufficient systems to communicate with the staff. There were good links with members of the local community and local school.
People and their relatives knew the management structure within the service. Staff told us they worked in a positive environment and that they could raise suggestions. The registered manager had systems to monitor the quality of care provided and auditing systems to monitor records and documentation used by staff.
Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.
If you want to see the evidence supporting our summary please read the full report.
Is the service safe?
We found some aspects of the service not to be safe because accident and incident report forms were not used effectively in relation to body maps and wound management plans. This increased the risk of harm to people. However, we noted the registered manager took immediate action when advised of our concerns during the first day of our inspection. All registered nurses were written to regarding requirements of documentation and compliance review dates were set.
People were treated with respect and dignity by the staff. Staff knew what to do when safeguarding concerns were raised and they followed effective policies and procedures. Staff told us, 'I'd keep pushing till something was done' and 'If something's wrong it's got to be dealt with."
There were systems in place to make sure that managers and staff learnt from events such as complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.
The manager was in the process of re-assessing the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) for people who use the service and was having discussions with local authorities about this. This meant that people were protected from discrimination and their human rights were protected.
The service followed safe recruitment practices. People were safe because the service considered skill mix and experience when arranging staffing.
Is the service effective?
We found the service to be effective because there was an advocacy service available. This meant people could access additional support to express their views and concerns.
Care plans reflected people's current individual needs, choices and preferences. People's health was regularly monitored to identify any changes that required additional support or intervention.
The environment enabled staff to meet people's diverse care, cultural and support needs.
Staff had effective support and induction.
Is the service caring?
We found the service to be caring because people were supported by kind and attentive staff. We saw support workers showed patience and gave encouragement when supporting people. Staff responded in a caring way to people's needs when they needed it. People we spoke with said, 'I'm very pleased with it' and 'They're brilliant.' Staff told us, 'We're like a big family' and 'We're close knit.'
People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. Appropriate healthcare professionals were involved in planning, management and decision making.
Staff knew the people they were caring for and supporting. People were as independent as they wanted to be.
Is the service responsive?
We found the service not always responsive because although the service had a quality assurance system, this system had not identified shortfalls in the support plan documentation. People were involved in quality reviews.
A person's capacity was considered under the Mental Capacity Act 2005. When a person did not have capacity, decisions were always made in their best interests. Advocacy support was provided when needed.
Is the service well-led?
We found some aspects of the service were not well-led because the leadership and management did not assure the delivery of high quality care.
There was a registered manager in post and all other conditions of registration were met.
The registered manager understood their responsibilities and was supported by senior management to deliver what was required.
Concerns and complaints were used as an opportunity for learning or improvement.
Not all people were able to verbally tell us about the care and support they received. Therefore we observed how staff interacted and supported people, to enable us to make a judgement on how their needs were being met. We found that staff were supportive and attentive to people's needs.
We viewed nine care plans. The planning documentation was person centred and specific to the individual regarding their care needs. We spoke with four relatives of the people who used the service. The family members we spoke with told us that they were involved in regular formal discussions regarding their relatives care. This meant that the person or their advocate were involved in the assessment, planning and delivery of the person's care, treatment and support.
The provider provided a choice of food for people and made sure that the food was nutritionally balanced and supported the person's health needs.
Staff we spoke with were knowledgeable about the people they supported. Staff had received training appropriate to their roles and the majority of staff had an adequate support structure in place for staff supervisions.
We found that the provider had robust systems in place to regularly assess and monitor the quality of the services provided.
We saw The Russets provided a range of activities for people living at the home. On the day we visited the home they had organised a barn dance, people told us that they really enjoyed themselves. Staff told us that they encouraged people to attend the activities that were organised by the home, but it was their choice if they did not want to attend.
We saw that staff encouraged people to take part in every day tasks such as preparing their own breakfast and laying the tables for lunch. Therefore staff promoted people's independence.
People told us that the food was very good at the home. One person said 'we get plenty of choice and the food is always very good'. Staff were knowledgeable about the individual needs of people in relation to eating and drinking. We saw that food served to people who required 'modified texture' diets was consistent with their nutritional care plans and guidance from the speech and language therapist.
People we spoke with told us that they felt safe at the home and they liked the staff. We saw that staff received regular training in safeguarding adults and this was also discussed in staff meetings.
Staff we spoke with said they felt well supported by the homes management and received regular training appropriate to their role.
Those people that live in The Russets have dementia and therefore not everyone was able to tell us about their experiences. To help us to understand the experiences people have we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they had positive experiences.
We received positive comments from people living in both The Russets and Sherwood about the way they are looked after. 'Everything is OK' and 'I am safe and they are all very nice to me in here'. People living in Sherwood told us that they were happy with the care they were provided with. 'I am very well looked after', 'they always help me' and 'I like things done a certain way and the staff know this'. One person said 'I am very privileged to live here'.
Visitors told us 'I know my relative is safe, and I know the staff will make sure she is not harmed' and 'my relative is very well looked after, they need a lot of care but the staff are very skilled in providing this'.
People who use the service have access to a range of activities either as a group or individually. We asked some people what they like to do and they told us "I love to sing and dance", others said they "liked the garden and doing lots of things" and to join in with and be together with others. Some people who use the service are at high risk of falling. We saw that people had regular monthly falls assessments and for those at high risk of falling there were additional risk assessments and evidence of input from the physiotherapist. Where people have nutritional assessments the documentation required was not always complete.