Archived: Russett House

Russett House is one of a number of services operated by Somerset County Council Learning Disability Services. The home provides care and support to up to ten service users with profound and multiple learning disabilities. The home is purpose built and is situated in a quiet residential area of Yeovil.

The last inspection of the home was carried out in July 2014. We did not identify any concerns at that inspection. Since the last inspection the building has been completely refurbished to offer accommodation in two units each accommodating up to five people. The refurbishment meant people had to move to temporary accommodation where they remained for over a year. At the time of the inspection six people were living at the home.

There is 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.

There was a relaxed and happy atmosphere in the home and people were very comfortable with the staff who supported them and with the registered manager. There was lots of laughter and friendly banter between people and staff. A number of staff told us the refurbishment of the building had had a positive impact on people’s well-being.

Staff felt well supported and received the training they required to effectively support people. People’s medicines were administered safely by staff who had received specific training and supervision to carry out the task.

The registered manager told us they aimed to provide a person centred service where people could decide how they lived their lives. Staff responded to people’s needs and wishes and encouraged people to make choices about their day to day lives. Staff had a good knowledge of each person and how they communicated which enabled them to offer people choices using a variety of methods.

People and/or their representatives were involved in decisions about their care and support. People had been consulted on the refurbishment of the home and staff had used pictures and colour swatches to help people make choices about décor and furnishings.

People’s privacy was respected and each person had a single room where they could see visitors in private and spend time alone when they chose to. Staff supported people to keep in touch with friends and family.

People received effective care which met their needs and staff responded to changes in people’s needs and wishes appropriately. People had access to a range of health and social care professionals and staff acted on specialist advice given when planning and delivering care and support.

The provider had policies and procedures which helped to minimise the risks of abuse to people. Risk assessments had been carried out to make sure people were able to take part in activities with minimum risks to themselves and others.

Staff knew how to support people who lacked the mental capacity to make decisions for themselves. This made sure people’s legal rights were protected.

Is the service safe?

During our visit we looked at communal areas and a selection of people's rooms. Due to people's profound and complex learning disabilities we were unable to speak to people using the service about their experiences. During our visit we observed how staff interacted with people using the service, looked at people's care records and spoke with one relative on the telephone.

We saw people using the service had comprehensive, person-centred support plans and risk assessments in place. These were reviewed regularly. Staff we spoke with told us they understood people's needs and were kept informed of any changes in people's needs. This meant that people received care from staff who knew how to meet people's needs in a safe and effective manner.

Staff we spoke with told us they understood their role in preventing and reporting abuse. They were able to give examples of signs they would look for as indicators of possible abuse. The provider had both a safeguarding and whistleblowing policy in place. We saw that where concerns had been raised action had been taken appropriately.

We identified that one person's routine weekly monitoring had not been done consistently. The results we saw showed no action would have been needed. The provider provided us with a monitoring tool they would incorporate into their monthly auditing to ensure this did not recur.

We found staff were clear about the minimum staffing levels that the provider felt was appropriate to meet the needs of people who use the service. The manager told us they tried to staff higher than the minimum level, and records showed this regularly happened.

We found the manager understood their responsibilities to people using the service in relation to the Mental Capacity Act and the Deprivation of Liberty Safeguards (DoLs). We saw that they were being given guidance from within the organisation to ensure they responded appropriately to recent changes in the law.

We saw that best interest decisions were recorded for people, and the manager was aware of their responsibility to use the least restrictive methods when providing care, whilst still maintaining safety measures.

Is the service effective?

We saw that people's abilities, likes and dislikes had been identified within their support plans. Staff gave us examples of the ways they communicated with different people. We were told how they used their knowledge of people to be able to offer them different choices.

We found that people at Russett House had access to the specialist support they required to manage their health needs effectively. We saw records of meetings with professionals were shared with staff.

Is the service caring?

We observed staff interacting with people in a calm, friendly and kind manner. People using the service appeared comfortable with the staff. The manager told us they monitored staff practices. Records showed that they had taken action in response to concerns.

We spoke with one relative on the telephone who told us that staff were "kind and dedicated" and that they "could not speak highly enough of them."

Is the service responsive?

We saw that the care and support people received was monitored by staff. We saw records were up-dated in response to changes.

We found that staff tried to find activities that people enjoyed. For example, carriage riding, going shopping, reflexology and arts and crafts. Where people were unable to communicate through speech we found that staff had an understanding of the different ways they could communicate with people. Staff told us about different ways they did this, such as through observation of body language and the use of pictures. During our visit we saw people being shown pictures on the computer, and one person showed us photographs of items they might need for a holiday.

Is the service well-led?

We found that the manager understood the needs of people using the service, and we were told that both they and the assistant manager provided some hands on care and support.

Staff told us that they were well supported within the team, and could seek assistance and support as needed. The manager told us that there was an on-call manager system and that staff were able to contact them at any time. Regular staff meetings were held.

We saw there was a strategy in place to manage if a staffing crisis occurred. This included the use of relief staff, staff from other homes run by the organisation, and staff from one nominated agency. This meant that there was a contingency plan in place to maintain safe staffing levels in the event of unexpected staff sickness or absence.

Whilst the manager told us they received support from their manager we found that the level of service monitoring from within the organisation was not in line with the provider's Statement of Purpose.

We found a number of quality assurance checks were in place, including the review of support plans. However, we found that the audit of the training matrix did not identify gaps. We were provided information that showed some training had in fact been delivered but the details had not been entered, and that the provider was awaiting the return of questionnaires, used as a refresher for some topics. Gaps on a training matrix could indicate staff did not have all the knowledge and skills required to provide care and support safely.

We found people and their representatives were involved in making decisions about their care and treatment. Where a person had restrictive care plans in place they had been informed of this and felt it was an appropriate action.

The home had effective systems in place to monitor the quality of the service and to assess and manage risks to people living in the home.

We observed people were engaging with their environment and staff without signs of anxiety. Staff talked to people in a caring manner. We saw people supported to undertake daily living tasks in a person centred way.

We found people and their representatives were not always involved in making decisions about their care and treatment.

People's needs were assessed and care and treatment was delivered in line with their individual care plan. We saw staff responding to people's needs in a timely and caring manner.

The home had effective systems in place to reduce the risk and spread of infection. Staff told us there were now clear policies and procedures for cleaning and checking bathrooms regularly.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. One care worker told us "There is always someone to talk to, there is a line management structure with on call back up."

The home had effective systems in place to monitor the quality of the service and to assess and manage risks to people living in the home.

People and their representatives were not always involved in making decisions about their care and treatment. People’s needs were assessed and care and treatment was not always planned and delivered in line with their individual care plan.

We saw staff responding to people's needs in a timely and caring manner, but sometimes staff were task focussed and did not explain the support they were providing.

The home did not have effective systems in place to reduce the risk and spread of infection. Staff told us that when the cleaner was on holiday and that they were cleaning but that they prioritise getting out with the people they support.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. One care worker told us “There is always someone to talk to, there is a line management structure with on call back up."

The home did not have effective systems in place to monitor the quality of the service or to assess and manage risks to people living in the home.