15 January 2021
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act.
The inspection team comprised of four inspectors including a pharmacy inspector and an assistant inspector. An Expert by Experience contacted relatives by telephone for their feedback. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
The Russets 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.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was announced. We announced the inspection the day before we visited to discuss the safety of people, staff and inspectors with reference to the COVID 19 pandemic. Three inspectors and an assistant inspector visited the service on 11 December 2020 and a pharmacy inspector visited on 14 December 2020.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sent an inspection poster with our contact details to ask for feedback which the registered manager circulated to relatives and staff. We requested an updated action plan, some key policies and information about ongoing monitoring of safety and quality, such as audit findings. We used all this information to plan our inspection.
During the inspection
We visited and spent time with people in all six units. We spoke with five people who were able to tell us about their experiences of living at the home. We observed people being cared for in communal areas and we used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We looked at 10 people's care records and at 23 people’s medicine records. We received feedback from 22 relatives about their experience of the care provided.
We spoke with the registered manager, nominated individual and with the clinical governance lead. We spoke with 20 members of staff including nurses, house leads, care and housekeeping staff and a member of the facilities team. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We looked at five staff files in relation to recruitment and at monitoring information about staff training. We reviewed a range of quality monitoring records, such as audits, regular checks as well as at servicing and maintenance records. We sought feedback from commissioners, and health and social care professionals who worked with staff at the home. We received a response from eight of them.
15 January 2021
About the 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.
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.