The inspection took place on the 9 and 10 May 2017. It was an unannounced inspection of the service which meant the provider did not know we were coming.
We previously inspected the service on the 1 and 2 March 2016. At that inspection the provider was in breach of one regulation and received an overall requires improvement rating. This inspection was a comprehensive inspection to review the overall rating. We found the requirement made at the previous inspection had been met.
Russell house is a care home which provides accommodation and personal care for up to twenty people with epilepsy, learning and/or physical disabilities. The home had been purpose built and is made up of four units. Each unit accommodates five people. There are two units on the ground floor and two units on the first floor with lift access available to the first floor. At the time of our inspection there were eighteen people living in the home.
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.
People and relatives were happy with the care provided. They described the permanent staff as caring and supportive of their family members. They felt staff had the skills and understanding to care for people. However, relatives were concerned about the staff vacancy levels and they felt this led to inconsistent care for their family members.
We found the home provided caring and responsive care to people. Improvements were necessary to ensure the service was safe, effective and well-led.
Aspects of the service were being audited. However regular effective auditing was not taking place to enable the provider to address issues in a timely manner. Records were not suitably maintained in that some records were incomplete, not signed and dated.
People were consented with on their day to day care but the principles of the Mental Capacity Act 2005 was not understood and followed. A recommendation has been made to address this.
Systems were in place to promote communication and ensure staff were aware of people's needs. Staff did not routinely sign to indicate they had read the relevant records to promote safe care therefore it was not clear how staff ensured they were up to date on recent changes in people's support needs. Risks to people were identified. However a staff member was not aware of the risks associated with people's care which meant those risks were not safely managed. A recommendation has been made for the provider to have
Systems were in place to promote safe medicine practices. However one person's allergies to medicines were not highlighted and known by one member of staff spoken with during the inspection. This was highlighted to the manager who immediately took action.
The home had a number of staff vacancies. Bank and agency staff were used to cover the vacancies to maintain the required staffing levels. Agency staff were in use in all units which lead to pressure on permanent staff and people being supported by staff they didn't know. The provider was trying to recruit into the vacancies and new staff had been appointed to address the inconsistency in care. A recommendation has been made for the provider to ensure rotas are managed effectively to ensure deployment of staff provides consistent care to people.
Staff were suitably recruited, inducted and trained. The frequency of the training had changed which meant updates in some training were overdue for staff across all four units and this was being addressed. Staff felt supported and the registered manager recognised formal supervision of staff was not taking place as regularly as required. This was being addressed and some group supervisions had taken place to provide support to staff. .
People had care plans in place which outlined the care and support required. Relatives were able to contribute to reviews of their family members care. Staff were kind, caring and responsive to people. People's health and nutritional needs were met. They had good access to activities.
Systems were in place to manage complaints and to enable families to give feedback on the running of the service.
Relatives described the registered manager as "Absolutely brilliant, approachable, transparent and confident in what she does". The registered manager recognised the challenges of the service and the work still to do in improving the service.
The provider was in breach of one Regulation of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see what action we told the provider to take at the back of the full version of the report.
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