CQC report explained · a residential care home
What the CQC found at Russell House
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, October 2019
Rated Good; inspectors found safe, kind and person-centred care, but staff shortages caused some inconsistency.
Inspectors visited the home without notice on 12, 23 and 24 September 2019. One inspector attended, with a learning disability specialist joining on the second day. They spoke with people, relatives, staff and professionals, observed care, and checked care, medicines, recruitment and management records.
The home was rated Good overall and Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found that people were protected from avoidable harm, treated with kindness and supported to make choices. Their health, nutrition, communication and activity needs were generally met.
The home had 23 vacant staff positions and relied on bank and agency workers. Inspectors found this could make care less consistent for some people. They also found some weaknesses in recruitment records, staff knowledge, menus and activity records, but these issues were being addressed.
The previous rating was Requires Improvement, published in September 2018. The provider had previously breached rules about staffing and good governance and had been required to send monthly audit reports. Inspectors found enough improvement at this visit and said the provider was no longer in breach.
Kind relationships
Relatives and professionals described staff as caring, and inspectors observed relaxed and positive interactions. People's dignity, privacy and independence were promoted.
“People had positive relationships with staff. We observed people seemed relaxed and were laughing and joking with staff.” from the report
Person-centred care
Care plans gave staff clear information about people's personal, health, social and communication needs. Seizure protocols helped staff respond appropriately.
“People's care plans were person centred, specific and provided clear guidance for staff on how they support people” from the report
Activities and community access
The home offered regular trips and activities, supported by an activity co-ordinator and driver. Inspectors found access to activities had improved.
“Weekly trips such as swimming, playground outings, cinema and bowling took place as well as day trips out” from the report
Improved management
The manager had made changes to audits, records, communication and staff support. Relatives and staff reported a more positive culture.
“Since the previous inspection the provider had introduced monthly audits of care plan records and staff files.” from the report
Safe risk and medicines systems
The home identified individual risks, checked the environment and maintained medicines records. Inspectors found no gaps in the sample of medicine administration records.
“A sample of medicine administration records were viewed and showed no gaps in administration.” from the report
Staff vacancies and inconsistency
needs fixingThere were 23 vacant staff positions, and the home regularly used bank and agency staff. Inspectors heard that this led to inconsistent care for some people, including variation in community access.
“There is still inconsistency in [family members name] care caused by the continual use of agency staff” from the report
Agency staff knowledge
needs fixingTwo agency staff members could not explain what to do if a person was choking or collapsed. This was raised with management.
“A bank and agency staff member were unable to outline to us what action to take if a person was choking or they collapsed.” from the report
Menus were not consistent
minorOne unit had less varied menus, did not record alternative choices and served a meal different from the menu. The menus were under review.
“In one unit the meal that was provided was not what was listed on the menu.” from the report
Some records needed improvement
minorRecruitment files did not always show that outstanding checks or employment history questions had been followed up. Some equipment servicing information was also out of date in the main file.
“In the staff files viewed there was no audit trail or file note to indicate outstanding actions in relation to recruitment had been actioned” from the report
- 01How many permanent staff vacancies are there now, and how are regular agency staff introduced to each person's needs?
- 02How do you check that agency and bank staff understand what to do during a seizure, choking incident or collapse?
- 03How do you make sure community activities are provided consistently at weekends and when different staff are working?
- 04How are menus planned across the four units, and how are people's alternative choices and views recorded?
- 05What changes have been made to recruitment records and equipment servicing records since this inspection?
This was an unannounced, planned follow-up inspection covering all five questions, the premises and the care provided, to check improvements after the previous Requires Improvement rating. This explanation was written from the published report of 25 October 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, September 2018
Russell House was rated Requires Improvement; inspectors found kind permanent staff but serious problems with staffing, training, records and management.
Inspectors visited the home without warning on 25 and 26 June 2018. They spoke with people, staff and relatives, contacted health professionals, observed care and checked care plans, risk assessments, medicine records, staff files, complaints and other records.
The home had enough staff according to its planned numbers, but staff were not deployed with the right mix of skills. There were 17 permanent staff vacancies and heavy use of agency staff. Some staff lacked required training, including epilepsy awareness and learning disabilities training.
Inspectors found permanent staff were often kind and knew people well. However, they also saw poor practice affecting privacy, dignity and respectful care. Care plans, health records, medicine records, complaints records and staff records were not always complete, accurate or up to date.
All five areas were rated Requires Improvement. This was the third inspection with that rating. The home was still in breach of Regulation 17 and was also in breach of Regulation 18.
Safeguarding and recruitment
The home had safeguarding arrangements and staff understood how to recognise and report possible abuse. Recruitment checks were completed before staff started work.
“Staff were aware of types of abuse, signs of possible abuse and their responsibility to report and record any concerns promptly.” from the report
Health support
People could see a range of health professionals, including specialist therapists. New admissions were planned with health professionals and families.
“People had access to health professionals such as the GP, dentist and opticians.” from the report
Activities
People had individual activity programmes and inspectors saw a range of activities, including trips, meals out, exercise and music.
“During our inspection we saw people had access to a range of in-house, on-site and community activities” from the report
End of life care
The home worked with palliative care professionals and supported a person to remain at home at the end of their life.
“They confirmed staff provided around the clock care and had liaised with the palliative care team every step of the way” from the report
Medicine systems
There were medicine checks and records for ordering, storage and disposal. The sample of medicines inspected had no gaps in administration records.
“A system was in place to carry out a stock check of medicines twice a day, following administration.” from the report
Staffing and agency use
seriousThere were 17 permanent staff vacancies and high use of agency staff. Staff were not deployed with the right skill mix, creating pressure and inconsistent care.
“Even though the required staffing levels were maintained staff were not deployed appropriately to ensure they had the right skill mix of staff across the service.” from the report
Training and supervision
seriousSome agency staff did not have mandatory specialist training, including epilepsy awareness and learning disabilities training. New staff had not completed their Care Certificate inductions and many supervisions were missing.
“This is a breach of regulation 18 of the Health and Social Care Act Regulations 2014.This was because staff were not suitably inducted, skilled, supported and trained in their roles.” from the report
Inaccurate records and weak oversight
seriousImportant records were incomplete, contradictory or out of date. Audits and reports did not always show what was happening, so problems were not corrected promptly.
“These are continued breaches of Regulation 17 of the Health and Social Care Act Regulations 2014.” from the report
Privacy and respectful care
needs fixingInspectors saw agency staff fail to engage properly with people during meals, and heard confidential information about a person's toileting needs discussed in front of them.
“We observed poor practice which did not promote people's privacy, dignity and show them respect.” from the report
Delay with antibiotic medicine
seriousOne person missed 12 doses of a prescribed antibiotic because the medicine was not available and the delay was not escalated to senior staff.
“The delay in the supply and administration of the antibiotic had the potential for the person's condition to worsen.” from the report
Complaints and community access
needs fixingSome complaints were not logged or responded to clearly. Some people also did not receive their planned community access because of a lack of drivers.
“The complaints log for 2018 did not show where complaints had been responded to if they had been closed and if any action was still required.” from the report
- 01How many permanent staff vacancies remain, and how many agency staff are usually on each unit?
- 02How do you check that agency staff have epilepsy awareness and learning disabilities training before working here?
- 03How will you make sure care records, medicine records, nutrition records and complaints records are accurate and kept up to date?
- 04What has changed since the inspection to ensure people receive their planned community activities and transport?
- 05How do you monitor staff practice to protect people's privacy, dignity and communication needs?
This was an unannounced inspection covering all five key questions, including the care provided and the premises. This explanation was written from the published report of 14 September 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk. The report was longer than we could read in one go; the later sections may not be reflected.
Every inspection of Russell House
5 rated inspections over 4 years: the service has improved, from Inadequate to Good.
- October 2019Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- September 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- June 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- May 2016Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- October 2015Inspected but not ratedSafe: Requires improvement
- August 2015InadequateSafe: InadequateEffective: InadequateCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- February 2014
Report published without a new overall rating.
- July 2013
Report published without a new overall rating.
- March 2011
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 17 December 2010.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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