CQC report explained · a nursing home
What the CQC found at The Russets
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found that medicines, staffing, risk assessments, safeguarding and infection control were managed safely. They found enough staff and improvements in medicines systems and monitoring.
- Effective?
- Good
- This key question was not reviewed during this focused inspection. Its previous rating carried forward.
- Caring?
- Good
- This key question was not reviewed during this focused inspection. Its previous rating carried forward.
- Responsive?
- Good
- Inspectors found personalised care, improved care plans, activities and support for family contact. Some end of life plans were more detailed than others.
- Well-led?
- Good
- Leadership, staff support and quality monitoring had improved. Some relatives still reported limited personal communication from management during the pandemic.
What inspectors found, January 2021
Rated Good; inspectors found safe, personalised care and improved leadership, but family communication and some end of life plans still needed attention.
Inspectors visited on 11 and 14 December 2020. They spent time in all six houses, spoke with people, relatives, staff and professionals, and checked care records, medicines records, staff files, audits and maintenance records.
They found that people received their medicines safely and on time. There were enough suitably skilled staff, care plans and risk assessments had improved, and staff knew people well. Infection control arrangements for COVID-19 were also found to be safe.
Care was described as personalised, with activities and support to keep in touch with families. Leadership, staff communication and quality checks had improved. However, some relatives wanted better communication with managers, and some end of life plans contained more detail about people's wishes than others.
The overall rating was Good. This was a focused inspection of Safe, Responsive and Well-led only. Caring and Effective were not reviewed, so their previous ratings carried forward.
Safe medicines
Medicines were given safely and on time. Staff were trained and their competence was checked, while audits were used to investigate and reduce errors.
“Medicines administration records (MARs) showed medicines were given as prescribed.” from the report
Enough staff
Inspectors found enough suitably skilled staff to meet people's needs. Staffing was reviewed when people's needs changed, including arranging extra night support.
“There were enough suitably skilled staff to keep people safe and meet their needs.” from the report
Personalised care
Staff knew people's preferences, histories and communication needs. Care plans had become more detailed and were updated when people's needs changed.
“Care is person centred, staff know the small details that matter to each person, their likes, dislikes, how to approach them.” from the report
Improved leadership
The home had introduced house leads and strengthened its checks and improvement plans. Staff reported better communication, teamwork and morale.
“Quality assurance and monitoring systems had continued to improve and become embedded.” from the report
Family contact and activities
Staff supported people to use phone and video calls and created safe visiting arrangements during the pandemic. Relatives also spoke positively about activities and stimulation.
“Staff used to help [person] with the phone to talk to us.” from the report
Communication with families
needs fixingThree of 22 relatives identified communication with management or staff from individual houses as an area for improvement. The home had identified this and was working towards regular calls.
“There has been little contact with management during this pandemic, none personal, all by notices.” from the report
Different levels of detail in end of life plans
needs fixingSome end of life care plans recorded more personalised information about people's wishes than others. The manager had identified this and was working with people and families to improve the records.
“However, some people's end of life care plans captured more personalised information about people's wishes, than others.” from the report
- 01How will you keep our family updated about our relative's care, and how often will we receive personal contact from the house team?
- 02How will you record our relative's personal wishes about end of life care and keep those details up to date?
- 03What were the previous ratings and findings for Caring and Effective, which were not reviewed at this inspection?
- 04How do you check that medicines are given correctly and that any errors are investigated?
- 05How do you adjust staffing when people's needs change, including at night?
This was a focused inspection of Safe, Responsive and Well-led only; Caring and Effective were not reviewed and their previous ratings carried forward. This explanation was written from the published report of 15 January 2021 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, December 2020
Rated Requires Improvement; inspectors found kind, effective care and good activities, but medicines, care planning and oversight were not always safe or reliable.
This was an unannounced inspection over three days. Inspectors spoke with people, relatives and staff, observed care, and checked care records, medicines records, staff files and management records.
The home was rated Good for Effective and Caring. People were supported with food, drink and healthcare. Staff were described as kind and respectful. Activities were a particular strength, including meaningful activities for people living with dementia.
The home was rated Requires Improvement for Safe, Responsive and Well-led. Medicines were not always managed safely. Some care plans did not contain enough personal detail. Quality systems had not found or dealt with all the problems. The home remained Requires Improvement overall, as it had been at the previous inspection.
Kind and respectful care
Inspectors saw staff responding kindly when people were distressed. People were treated with dignity, privacy and respect.
“We observed staff to be caring and kind to people.” from the report
Good health support
People could see a GP who attended twice a week. Staff worked with specialist health professionals and noticed changes in people's health.
“A local GP attended the service twice a week and referrals were made in line with local agreements.” from the report
Meaningful activities
People and relatives were very positive about the activities programme. The home offered individual activities, group events, trips and opportunities for social contact.
“Activities staff held regular meetings with staff to discuss activity options and simple, meaningful activities for individuals to engage with.” from the report
Staff training
Staff had training in key areas and received regular supervision. Records showed checks were in place when staff were recruited.
“Staff across the service, regardless of their role had training in key areas to support people.” from the report
Clean environment
People and relatives said the home was clean. Inspectors found the areas clean and fresh smelling.
“We observed all areas of the service were clean and fresh smelling” from the report
Medicine safety
seriousThere had been further medicine errors. Inspectors found gaps in fridge temperature follow-up, instructions for medicines given when needed, supplies and recording of creams.
“We found the management and administration of medicines was not always safe.” from the report
Wound and skin care
seriousInspectors found that risks linked to skin and wounds were not always managed well. One wound had deteriorated because treatment was missed, and one person did not receive required skin care.
“Risks associated with people's skin and wound care were not always well managed.” from the report
Incomplete care plans
needs fixingSome care plans did not record important personal preferences, such as a preferred gender of carer. There was also limited information about how some people communicated.
“Some care plans lacked some important detail. For example, one care plan recorded the person would sometimes refuse care especially from unfamiliar staff, however it was not recorded that they preferred their care to be given by a female carer.” from the report
Staffing levels and agency staff
needs fixingSome people, relatives and staff felt more staff were needed at busy times. People and staff did not always have the same confidence when agency staff were supporting them.
“Eight of those comments referred to needing more staff.” from the report
Weak quality checks
seriousThe home's audits and oversight systems had not identified or dealt with all the medicine and care planning problems. This was a continued breach.
“Systems and processes were not operating effectively to assess, monitor the quality and safety of the services provided including the quality of the experience of service users.” from the report
- 01What has been done to reduce medicine errors and make sure medicines needing refrigeration are kept safely?
- 02How do you check that medicines given when needed have clear instructions and that missing medicines are ordered promptly?
- 03How are personal preferences, including preferred carers and communication needs, now recorded in care plans?
- 04What staffing levels are in place at busy times, and how do you make sure agency staff know each person's needs?
- 05How do your audits now identify and act on problems with medicines, wound care and care planning?
This was an unannounced inspection covering all five key questions, the care provided and the premises; the previous inspection had also rated the overall service Requires Improvement. This explanation was written from the published report of 8 December 2020 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.
Every inspection of The Russets
5 rated inspections over 5 years: the service has held its Good rating throughout.
- January 2021Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- December 2020Requires improvementstayed Requires improvementSafe: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- December 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- November 2017Requires improvementdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- August 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- August 2014
Report published without a new overall rating.
- January 2014
Report published without a new overall rating.
- October 2012
Report published without a new overall rating.
- March 2012
Report published without a new overall rating.
- September 2011
Report published without a new overall rating.
- February 2011
Registered with the Care Quality Commission on 18 February 2011.
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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23 live-in carers within about an hour of North Somerset
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £1,050 to £1,320 a week. 19 can care for a couple. 12 years' experience on average.
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.