Newcarron Court Nursing Home Care Home Service Adults Ronades Road Newcarron Village Falkirk FK2 7TB Telephone:

Transcription

1 Newcarron Court Nursing Home Care Home Service Adults Ronades Road Newcarron Village Falkirk FK2 7TB Telephone: Type of inspection: Unannounced Inspection completed on: 22 May 2015

2 Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 10 4 Other information 41 5 Summary of grades 42 6 Inspection and grading history 42 Service provided by: BUPA Care Homes (ANS) Limited Service provider number: SP Care service number: CS If you wish to contact the Care Inspectorate about this inspection report, please call us on or us at enquiries@careinspectorate.com Newcarron Court Nursing Home, page 2 of 45

3 Summary This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change after this inspection following other regulatory activity. For example, if we have to take enforcement action to make the service improve, or if we investigate and agree with a complaint someone makes about the service. We gave the service these grades Quality of Care and Support 2 Weak Quality of Environment 2 Weak Quality of Staffing 2 Weak Quality of Management and Leadership 2 Weak What the service does well Some of the staff we met during the inspection told us that they felt very upset about the recent newspaper article which appeared in the local press and contained negative information and views about Newcarron Court. However, we found that most staff were keen to prevent this from having a negative impact on people who use the service. We found that staff were committed and motivated to provide good care. What the service could do better The Care Inspectorate received four complaints about Newcarron Court since the last inspection. Three of these complaints were with regards to staffing levels at the home and one complaint was about the management team's response to an allegation of misconduct made about a member of staff by a visitor to the home. The Care Inspectorate investigated two of these complaints, with two complaints being withdrawn as they contained the same or similar information to the two complaints which were investigated. Both of the investigated complaints have been upheld. Requirements relating to both complaints are contained in this report. Newcarron Court Nursing Home, page 3 of 45

4 A significant amount of negative feedback was provided by people who use the service, relatives, friends and external professionals who were involved with Newcarron Court during this inspection. Most of this negative feedback was about the level of staffing at the home not being adequate to allow staff to meet the needs of people who live there. This included feedback about the use of agency staff who do not know the needs of service users as well as permanent staff. What the service has done since the last inspection At the last inspection we highlighted that the performance of Newcarron Court had historically fluctuated with the service being unable to consistently sustain a good level of performance for people who use the service. We were concerned to find that the previously improved performance we found at the home had not been sustained since the last inspection. This means that people who use the service, their relatives and staff may have experienced uncertainty and a lack of consistency in the service provided at Newcarron Court. Conclusion At this inspection we evaluated Newcarron Court to be performing to a weak standard overall in each of the four quality themes we inspect against. The provider responded to this feedback and had begun to assess staffing levels in the key areas highlighted during this inspection before the inspection was completed. We have placed five requirements on the provider and will follow up on how the provider meets these requirements and whether this leads to improved outcomes for people who use the service. Newcarron Court Nursing Home, page 4 of 45

5 1 About the service we inspected Newcarron Court Nursing Home is registered to provide care for up to 116 older people. It is situated in the area of Carron in Falkirk. The service is easily accessible by public transport and is close to local shops and amenities. Accommodation is provided within a large purpose built building, which is divided into five separate living units. The care home offers residents single occupancy with ensuite toilet facilities. The home has a large secure garden to the rear of the property and nicely landscaped gardens to the front with some seating for residents. The residents' personal laundry is done on site and meals are prepared in the care home. Newcarron Court aims include, 'creating a comfortable and homely environment, with the re-assurance of fully trained specialist nurses and care staff on hand day and night' and 'striking a balance between providing care when it's needed and helping the residents to be as independent as possible'. The Care Inspectorate regulates care services in Scotland. Prior to 1 April 2011, this function was carried out by the Care Commission. Information in relation to all care services is available on our website at Recommendations A recommendation is a statement that sets out actions that a care service provider should take to improve or develop the quality of the service, but where failure to do so would not directly result in enforcement. Recommendations are based on the National Care Standards, SSSC codes of practice and recognised good practice. These must also be outcomes-based and if the provider meets the recommendation this would improve outcomes for people receiving the service. Requirements A requirement is a statement which sets out what a care service must do to improve outcomes for people who use services and must be linked to a breach in the Act, its regulations, or orders made under the Act, or a condition of registration. Requirements are enforceable in law. We make requirements where (a) there is evidence of poor outcomes for people using the service or (b) there is the potential for poor outcomes which would affect people's health, safety or welfare. Newcarron Court Nursing Home, page 5 of 45

6 Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 2 - Weak Quality of Environment - Grade 2 - Weak Quality of Staffing - Grade 2 - Weak Quality of Management and Leadership - Grade 2 - Weak Inspection report continued This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change following other regulatory activity. You can find the most up-to-date grades for this service by visiting our website or by calling us on or visiting one of our offices. Newcarron Court Nursing Home, page 6 of 45

7 2 How we inspected this service The level of inspection we carried out In this service we carried out a high intensity inspection. We carry out these inspections where we have assessed the service may need a more intense inspection. What we did during the inspection We wrote this report following an unannounced inspection carried out by four Care Inspectors. The inspection took place on Monday 4 May 2015, from 7.00am pm, Tuesday 5 May from 8.45am pm and was continued on Friday 15 May from 4.00pm pm. The Care Inspectorate gave detailed feedback on Friday 22 May 2015 to the Manager, Clinical Servies Manager, Provider and House Manager from 9.00am noon. As part of this inspection, we took account of the completed Annual Return and a self-assessment form that we asked the provider to complete and submit to us. During this inspection process, we gathered evidence from various sources, including the following: -Direct observation of staff practice -Information on Quality Assurance systems -Questionnaires returned to the Care Inspectorate -Staff files and training records -Training plan -Complaints made to the service and the Care Inspectorate -Minutes of residents/relatives/staff meetings -Maintenance and repair records -Menus -Information on notice boards -A sample of 13 residents' personal plans -A sample of six staff files including the cook, care staff and registered nurses -Relevant sections of policies/procedures/records/documents including complaints We also spent time looking at the equipment and the environment (for example is it clean, is it set out well, is it easy to access by people using wheelchairs, are people able to use garden areas and access fresh air?). Newcarron Court Nursing Home, page 7 of 45

8 We met with: -23 residents -Nine relatives -The Manager -House Managers -Registered Nurses -Activities Staff -Care Assistants We used the Short Observational Framework for Inspection (SOFI2) to directly observe the experience and outcomes for people who were unable to tell us their views. On this inspection we used SOFI2 to observe the lunchtime experience of 12 people. Grading the service against quality themes and statements We inspect and grade elements of care that we call 'quality themes'. For example, one of the quality themes we might look at is 'Quality of care and support'. Under each quality theme are 'quality statements' which describe what a service should be doing well for that theme. We grade how the service performs against the quality themes and statements. Details of what we found are in Section 3: The inspection Inspection Focus Areas (IFAs) In any year we may decide on specific aspects of care to focus on during our inspections. These are extra checks we make on top of all the normal ones we make during inspection. We do this to gather information about the quality of these aspects of care on a national basis. Where we have examined an inspection focus area we will clearly identify it under the relevant quality statement. Fire safety issues We do not regulate fire safety. Local fire and rescue services are responsible for checking services. However, where significant fire safety issues become apparent, we will alert the relevant fire and rescue services so they may consider what action to take. You can find out more about care services' responsibilities for fire safety at Newcarron Court Nursing Home, page 8 of 45

9 What the service has done to meet any recommendations we made at our last inspection Recommendations made during the previous inspection report are repeated in this report. The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. The Care Inspectorate received a fully completed self-assessment document from the provider. We were satisfied with the way the provider completed this and with the relevant information included for each heading that we grade services under. However, the provider's own quality assurance processes had failed to identify the areas for improvement evidenced during this inspection. Therefore, the grading presented by the provider as part of the self assessment is evaluated by us to be inaccurate. Taking the views of people using the care service into account The views of people who use the service are contained throughout this report. Taking carers' views into account The views of carers/relatives are contained throughout this report. Newcarron Court Nursing Home, page 9 of 45

10 3 The inspection We looked at how the service performs against the following quality themes and statements. Here are the details of what we found. Quality Theme 1: Quality of Care and Support Grade awarded for this theme: 2 - Weak Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths We evaluated Newcarron Court to be performing to a weak standard in this area. We decided this after speaking with people who use the service, carers, relatives, friends and staff. We looked at records of meetings and discussions with a range of people who are involved with the home. We could see that systems, which had been used at Newcarron Court to seek the views and feedback of people who use the service and their relatives/friends, were still in use. The involvement of relatives appeared to be in the form of meetings with the management team. Usually the minutes of the meetings we looked at showed an opportunity for relatives to discuss laundry, plans for activities at the service and staff changes. There was some evidence that people were able to discuss their concerns through meetings and discussions. However, it was more difficult to see that changes were made and improvements were sustained at the home as a result. We assessed that these meetings should provide a more meaningful opportunity for relatives to express their views about all aspects of the quality of the service. We observed that nurses usually made telephone contact with relatives after a General Practitioner (G.P.) had visited the home to provide them with any update about their relative who lived at Newcarron Court. Relatives' feedback was that they valued this contact and gave this as an example of good communication. Newcarron Court Nursing Home, page 10 of 45

11 The Inspection Volunteer who has experience of using care services made the following comments about a meal time: 'The tables were set nicely with tablecloths and napkins. There was salt, pepper and milk along with a vase containing artificial flowers. Each place setting had cups and saucers as well and some residents had their own mugs. There were no menus on the table and none of the residents in this dining room used clothes protectors. Some had their napkins tied round their neck. Meals were served from a dining hatch. Some residents were shown plates of food to help them make a better, informed choice. The meal that day was soup followed by cauliflower and cheese with potato croquettes or a choice of sandwiches with or without chips. Residents were offered a choice of milk and juice and these were regularly topped up throughout the meal. I did not observe anyone measuring fluid intake. People were offered sauces with their meal. People were offered tea and coffee after their meal. Some residents were helped with eating their meal. Staff interacted well with the residents and it appeared to be a pleasant dining experience'. We saw one example of people being asked to choose from photographs of dishes from the menu at a meal time. While this was not effective with this individual person, they were then offered a taste of the meal to see if they wanted to eat it, this was good practice. People who use the service also told us how good it was that the cook, or a member of kitchen staff, had spent time speaking with people to ask about their preferences and that the kitchen staff made adjustments to choices available for them based on their feedback. When we asked people who use the service what they thought about the food at Newcarron Court they told us: "Yes, not bad. It's all right". "The food is good". "The food is ok. Yes, there is enough choice". "There is too much to eat. They come for me at nine. Come back at twelve and four. We get in a bit early so we can have a chat". "The food is great. Mostly I get mine in my bed". "It is not my type of cooking. They do ordinary things. They do sausage beans and chips. I like chicken and things. You can have anything you want for breakfast. Newcarron Court Nursing Home, page 11 of 45

12 Lunch, you have soup and sandwiches. You can get fruit and yoghurt at any time. If there is anything specific you want for the following day, you just tell the kitchen. I like macaroni and cheese but they don't use macaroni, they use the twirls. The soups are not good. It comes out of a packet". One resident commented on their questionnaire from the Care Inspectorate: 'Feels there is a good quality of care between staff and residents'. 'The service is good and I've had a pleasant time staying here'. Areas for improvement People who use the service we spoke with gave us examples of regularly having to wait for the assistance they needed from staff. People were clear that this was not because staff did not want to help them quickly but because they were unable to due to there not being enough time available to staff to assist people when they needed help. One of the people who use the service and their relative told us about regularly having to wait to be assisted to move from a chair and having to wait to go to the toilet because they required the assistance of two members of staff. This was despite the information in their care plans, which stated clear timescales for support to be provided. We were concerned to hear that they had been told that it was acceptable for them to wait for the assistance they needed. We have directed the provider to evaluate how effective the current staffing levels and deployment of staff at Newcarron Court is. One requirement was placed on the provider to complete this work and make improvements for people who use the service. Please see Quality Theme 1, Statement 3, requirement 1. Where people who are able to voice their needs were being asked to wait to have their needs met, we were concerned about what this meant for people who live at the home who were unable to voice their needs and were reliant on staff to anticipate these. We saw that staff were very busy during this inspection and while staff we spoke with wanted to provide a good quality of life and promote choices for residents, this was not always possible. Staff were distressed about having to ask residents to wait for assistance and did not want to work in this way but felt they had no other option. We did not see visual choices being offered to people who use the service consistently at meal times. People were generally being asked to make a choice from verbal options given to them, this can be difficult for people who have a cognitive impairment. Being given the choice of two different meals on plates would give residents an opportunity to choose from what is being offered with the smell and appearance of the dishes helping them to make more meaningful choices. Newcarron Court Nursing Home, page 12 of 45

13 We observed one resident, who found it difficult to choose between verbal options, being given one meal which was removed when they said they did not want to eat it and an alternative brought. The alternative was removed by a second member of staff and a fresh plate of the first meal was provided. This was done by a member of staff who supported the resident's choice and effectively encouraged them to try eating different things. Another member of staff was heard to be dismissive of providing options for this individual. We were concerned that this resident may not have eaten anything due to the different approaches of the two staff. This experience could have been improved if one member of staff was able to sit down to encourage this individual to eat a meal and different choices of food were made available for them consistently. Menu boards outside and inside dining rooms in different units of the home showed the menu from previous days. If any residents were using this for information about their meals this could be confusing as it was inaccurate. As relatives can use this information to discuss meals with residents it may also be confusing. Currently this is not meaningful and should be kept up-to-date and/or visual choices used to support people who use the service. One resident commented on their questionnaire from the Care Inspectorate: 'feel more snacks could be put on as there aren't enough to choose from'. More difficult to see how the views of people who have a cognitive impairment are represented at Newcarron Court. Grade awarded for this statement: 2 - Weak Number of requirements: 0 Number of recommendations: 0 Newcarron Court Nursing Home, page 13 of 45

14 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths We evaluated Newcarron Court to be providing a weak standard of care and support at this inspection. We decided this after speaking with people who use the service, carers, relatives, friends and staff. We looked at care plans, risk assessments review meeting minutes and other records. We also had discussions with a range of people who are involved with the home. We saw evidence of potential within the staff team at Newcarron Court to work to a good standard and staff were aiming to provide a good quality of life for people who use the service. However, the service was currently performing to a weak standard in this area due to some of the limitations outlined in areas for improvement, below. Positive comments from people who use the service were: "Heaven, absolutely heaven. Recently I wakened and thought I wasn't well. They have been in and out a hundred times. They couldn't do enough for me". "There is no way I can give you a fault. I get up quite early. They will bring you a cup of coffee. I like to keep my own room tidy. I try to be a good patient". "It's all right". "It's all right. The nurses are great". "Yes, I do like living here". Relatives' positive comments were: "Everything has to be done for my relative. I think it is pretty good. She is well looked after. They feed her and she has put on weight since she has been here". "They are always forthcoming if there is a problem. They phone if there is a chest infection". "What I do like is that they get her up in the morning, get her washed and take her to the dining room. We are just happy that she is well looked after. If there is anything we look into it". "Yes, they definitely keep me informed about my relative". "They take my relative's weight regularly. The staff phone us all the time". "It is very good. We have no major issues with my relative's care. Our biggest complaint is the constant turnover of staff". Newcarron Court Nursing Home, page 14 of 45

15 Comments about the activities available at Newcarron Court were: "I can't walk so I don't go out. It's too cold. If there is music on I take part in that. It is quiet just now. They have things on but I have just lost interest". "If there was anything nice on, I would do it. Sometimes if the weather was good I would go out in the back garden". "We have afternoons where we get a singer in and person playing a piano". "I am in the gardening committee. We had a meeting yesterday about making a wee garden out the front where people could sit and talk". "We get afternoon outings". "I go to some activities. The activities man came with me to a relative's wedding". "We have new activities starting up. We have a gardening club. I can't get out because I am in a wheelchair. I have a computer. I am the only one. I hope I will get wifi when I move rooms". "If it wasn't for my son and daughter-in-law, I wouldn't get out. We are waiting for the garden to be done". "I am a lazy person. I don't take part". "I don't know why my relative isn't in the rec room where there is something on. When I came in his dinner was lying there. I brought the dominoes out and his face brightened up. Last week they could have put the snooker on for him. (I had observed this resident earlier, asleep in his chair with his dinner untouched in front of him. The TV was switched off). The provider responded to concerns we raised during this inspection about the lack of staff available in the Harris Unit of the home quickly. They provided an additional 12 hours of resource every 24 hours until a more detailed assessment of staffing levels required for the unit was undertaken. The provider also considered staffing levels in the Lewis Unit and agreed to review these during this inspection. This showed a willingness to respond to the areas for improvement which were affecting service users. Some of the people who use the service we spoke with said that staff had provided good care and support in relation to their health and wellbeing needs. They told us that staff had been quick to identify any issues with their health and, where appropriate made sure they received attention from the relevant healthcare professionals like General Practitioners (G.P's), community psychiatric nurses, dieticians and so on. We saw evidence of GP's and other Health Care Professionals visiting people who use the service regularly. There were lots of visitors to the home at different times of the day and evening while we inspected the home. Newcarron Court Nursing Home, page 15 of 45

16 Areas for improvement Inspection report continued The Care Inspectorate received four complaints about Newcarron Court since the last inspection. Three of these complaints were with regards to staffing levels at the home and one complaint was about the management team's response to an allegation of misconduct made about a member of staff by a visitor to the home. We investigated two of these complaints with two complaints being withdrawn as they contained the same or similar information to the two complaints which were investigated. Both of the investigated complaints have been upheld A significant amount of negative feedback was provided by people who use the service, relatives, friends and external professionals who were involved with Newcarron Court during this inspection. Most of this negative feedback was about the level of staffing at the home not being adequate to allow staff to meet the needs of people who live there. This included feedback about the use of agency staff who do not know the needs of service users as well as permanent staff. Social work teams have reported back to their service manager that on three occasions where reviews were arranged with staff to take place with service users that there were agency staff on duty that had no knowledge of the residents that were being reviewed. Social Work staff had challenged this and were advised it was all agency staff on those days and no one else was available to attend. This demonstrates one of the ways in which the use of agency staff had impacted on outcomes for people who use the service. It also evidences a lack of planning and organisation by the management team in order to provide staff for these prearranged reviews. Negative comments from relatives were: "The amount of agency staff working within the care home is concerning. They do not know the residents nor their individual needs. I have raised this issue on numerous occasions and have been assured by management that they have recruited numerous staff and things will change for the better. Despite this, nothing has changed. Staffing is dire and you often have one regular staff member on and the rest are agency. There is continual staff shortages and this causes stress and frustration to staff". "The permanent staff, nurses and carers do a good job but the service is reduced by the quality of some of the agency staff (nurses and carers) employed. Newcarron Court Nursing Home, page 16 of 45

17 Despite management advising over 6 months ago, that Bupa would increase staffing levels to 120% of requirement thereby eliminating need for agency staff, Newcarron still need to rely on agency personnel. Obviously this impacts on the budget and the change from one agency company to another (in an effort to reduce cost), lowers the quality of service. "The quality of the handover needs to be improved. The daily care plans, depending who is on duty, is sometimes not filled in. That is where it falls down, when there is agency staff on". "Personal hygiene is important to us. We have to ask regularly to get my relative a bath or shower. It depends on the staff". "I feel it just depends on who is on duty. I know my relative can be stubborn. He prefers the boys to shave him". "I think there should be more one to one". "I think the communication is not very good. I was concerned about my relative and I spoke to them about it. It took a couple of weeks before they did anything, by which time it was much worse. He was put on antibiotics". "My relative's lunch was still in front of him, when I came in at two o'clock. Sometimes my Mum comes in to visit and she doesn't even get a hello. You have got to ask. I think it could be better. (Care and Support) They have never touched his fingernails. We had to go on and on and on to put a pinny on at lunch. It is supposed to be rectified. (The relative showed us a photograph of the resident in very dirty trousers)" "Things (of value) have gone missing. Photographs of him in his army uniform have gone from his memory box. My mother wrote is full life story but they still don't know anything about him. I don't understand why it keeps happening. It's a horror story. You want better for my relative". Negative comments from people who use the service included: "I have been in and out of here. It is just like any other place. There is good and bad. There are helpful and not so helpful people. (Does it bother you when they are not so helpful?) At the time it does bother you. (Does it happen often?) Not really often". "I don't like everything. (When I asked if the resident liked living in Newcarron) It is reasonable. (When I asked about the quality of care). We are prisoners, if we like it or not". Newcarron Court Nursing Home, page 17 of 45

18 (When I asked a resident if she could get up and go to bed when she wanted) "I lie on my back and I can't get out of my bed. I have to wait but it is not bad really. They take you if you want to go to bed. I get a bath twice a week". We observed that of 19 people living in Harris Unit, nine people needed two members of staff to assist them and two people were receiving palliative care with one of these people receiving end of life care. The nurse on duty was very upset because she felt she was unable to devote time to the people receiving palliative care. There were not enough staff on duty to provide care and support for the 19 people living in Harris quickly either on 15 May or during the previous inspection visits on 4 and 5 May The levels of staffing and reliance on agency staff at Newcarron Court impacted on how quickly and effectively care was delivered. All of the service users, relatives and staff in Harris that we spoke with expressed that there were not enough staff available to meet the needs of people who use the service. Approximately 90% of the people we spoke with in Lewis Unit also felt there were not enough staff. We could not see how staff in some of the units of Newcarron Court could respond proactively to the needs of residents. We regularly saw examples of staff not being able to respond reactively to residents' needs, staff were so busy in basic care delivery their ability to proactively support service users was very limited. For example: -One service user who experiences pain when in chair for more than an hour, being left in a chair for around two hours while waiting for staff to be available to support them to move; -Service users being told they would need to wait to be assisted to the bathroom and that they should urinate into their continence product if they could not wait to use the toilet; -We saw lots of examples throughout this inspection of service users being asked to wait for staff to support them; -Staff were unable to sit down with service users to encourage them to eat their meals in some parts of the home; -We saw some staff feeling distressed at times when the residents' experience was poor during this inspection. For example, at evening times when people were tired and restless and the staff caring for them were also tired. This had resulted in incidents of care below the standard which staff wish to provide, for example, palliative care in Harris unit; -Relatives highlighted delays in getting staff to answer the front door as staff were too busy to respond out of hours when no reception staff are available; Newcarron Court Nursing Home, page 18 of 45

19 -Some staff told us about institutionalised practice, for example, night staff getting people up and dressed before the day shift start work regardless of service users' expressed preferences; -Service users having to wait to receive a response to a buzzer call indicated that staff were struggling even to reactively support service users. We asked for assistance for one service user who seemed uncomfortable in bed. Staff were busy elsewhere and therefore could not proactively intervene. We asked the people we met with in their rooms, how long it took for staff to respond if and when they used the buzzer. They told us: "I use my buzzer as little as possible. I used it today. They were in, in two minutes". "I have a buzzer. I have used it for others. I use it for my friend across the road. I listen for her. They come quite quick. If they don't come I stand by the door and shout". (I asked a resident about a noise I could hear in his room) "I pressed the bleeper. They are not going to come. They are just finished lunch and cleaning up. (The resident then cancelled the buzzer) Some of them come quite quickly. There are some that are lazy and don't come". "I use the buzzer a lot. Sometimes, it depends on what they are doing, it seems a long time at the time". "I have a buzzer. Sometimes when you need the toilet it does (take a long time). It took an hour once. It doesn't take long then (during the night)". "Sometimes I use the buzzer. (Do they come?) Oh yes they are very good like that. Sometimes you have to wait if they are busy. We are all right during the day but sometimes at night there is a delay. But I just keep pressing it. I do sometimes get upset waiting. I do tell them that, if I have been kept waiting. I wasn't well last week and I buzzed a few times. They were very apologetic". Staff we spoke with were unhappy about having to ask residents to wait for the help and assistance they needed and acknowledged that they are sometimes pulled away and are unable to return to people they have previously asked to wait. Staff did not want to practice in this way but felt that this was the only way that they could manage. Newcarron Court Nursing Home, page 19 of 45

20 We looked at assessments about the dependency levels of people who use the service, for example, how many staff they require to assist them with aspects of their care. We looked at these assessments in different parts of the home and found that they did not consistently reflect the actual needs of people who use the service. We assessed the accuracy of these to potentially be reduced due to the lack of opportunity for nursing staff to reflect on the content of assessments of people who use the service they complete. Dependency assessments should be completed accurately to inform the level and deployment of staff required throughout the home to meet the needs of service users. The use of dependency assessments should be used by the provider and management team in conjunction with consultations with service users, relatives and staff to assess how effectively the level and deployment of staff is meeting the needs of service users. (Please see requirement 1, below). Due in part to the use of agency staff we found that regular staff were often having to move units within the home. Staff were concerned about the potential impact of this on people who use the service who may be distressed by unknown faces and staff. We found that one of the units of the home was staffed more consistently due to the concerns raised by some relatives. We found that where people or their relatives were unable to voice these concerns there was less consideration evident about the impact of unknown staff upon them. People who use the service, relatives and staff gave us examples of the issues they experienced where agency staff were used at Newcarron Court. One example involved incorrect medication being offered to a service user who was able to refuse this and inform the agency nurse that the medication was not theirs. This incident could have had more serious consequences if the service user did not have the capacity to refuse to take another service user's medication. The management team were not aware of this incident, therefore the incident had not been properly reported and had not been addressed by the provider or management team. Other examples people gave us were with regards to agency staff who were unable to communicate effectively with people who use the service and their relatives and the impact of agency staff not knowing the needs of service users. Falkirk Council gave us three examples of review meetings for service users being affected by the lack of permanent staff who knew service users being available to discuss their needs at review meetings. Newcarron Court Nursing Home, page 20 of 45

21 We looked at the diary containing tasks for nursing staff to complete each day and found that these would consume most of a 12 hour shift - we saw examples of staff working longer than their 12 hour shift to complete work they were unable to complete during their shift. We did not assess this to be due to poor time management. Grade awarded for this statement: 2 - Weak Number of requirements: 1 Number of recommendations: 0 Requirements 1. Requirement with reference to Theme 1, Statement 3: The provider must demonstrate that it has adequate staffing to meet the needs of service users. In order to achieve this the provider must ensure that; -There is regular review of the needs of service users and their dependency on support from staff -This dependency information is used to inform the numbers and skills mix of staff -Staffing arrangements reflect how breaks will be covered This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations, Scottish Statutory Instruments 2011 No 210: Welfare of users 4. - (1) A provider must - (a) make proper provision for the health, welfare and safety of residents. And regulation 10(2)(a) - requirement about premises. And regulation 15(a) - requirement about staffing. and also with reference to Records Registered Services Must Keep Timescales; 1 week from receipt of this report to submit information demonstrating how staffing levels have been re-assessed. This should include information from the dependency assessment tool, but must also be supplemented by additional information such as observations and opinions of service users, relatives, staff and other professionals. 2 weeks to demonstrate how you ensure dependency information is updated and accurately records current need. 2 weeks to demonstrate how this information has been used to inform staffing levels that reflect the current needs of service users. This must include the fluctuations of support required over the course of a 24 hour period. This must also demonstrate how staff breaks will be covered. 2 weeks to demonstrate how staffing levels can be responsive to changes over a 24 hour period for example, when service uses require additional support such as palliative care. Newcarron Court Nursing Home, page 21 of 45

22 Staff rotas, dependency assessment information, recorded opinions of service users, relatives, staff and other professionals should accompany submissions to the Care Inspectorate as part of the evidence required to 'demonstrate' actions required within the 2 week period. 4 weeks to submit information about your review of the effectiveness of changes 8 weeks to submit information about how you will ensure continual ongoing review of effectiveness of staffing levels. Again this includes the submission of information to the Care Inspectorate about dependency assessment and must supplemented by additional information such as observations and opinions of service users, relatives, staff and other professionals. Newcarron Court Nursing Home, page 22 of 45

23 Quality Theme 2: Quality of Environment Grade awarded for this theme: 2 - Weak Statement 2 We make sure that the environment is safe and service users are protected. Service strengths We found Newcarron Court to evidence a weak performance against this Quality Statement. To assess this we considered: -Documents made available to us, including maintenance records, care plans and risk assessments. -Observations of staff practice. -Assessment of the general environment. -Discussions with the residents, relatives and staff we met. We spoke with the maintenance person who told us that he has responsibility for ensuring that the environment is safe for all. We saw the daily recordings checking the call system and he told us that he walks round the whole building each day. Weekly records included all basic equipment and staff confirmed that any reported concerns were dealt with quickly by the maintenance person or outside contractors. Monthly checks included all wheelchairs, hoists and slings. We were told that maintenance staff ensured that all slings were hung up. Carbon monoxide testing took place in the kitchen and all Portable Appliance Testing was up-to-date as were the testing of fire extinguishers. Good clear records were kept of those checks and the manager received a monthly audit of work completed, which was signed. Fire evacuation, testing, checking emergency doors and lighting were also checked and recorded on a regular basis. A proportion of the people who use the service and their relatives we spoke with told us that they feel safe at Newcarron Court. However, we assessed that the risks to people who use the service were high during this inspection, mainly due to agency staff not knowing people's needs or the risks which affect them. Newcarron Court Nursing Home, page 23 of 45

24 We discussed our concerns, outlined below, with the provider who agreed that staff and the management team require additional learning about adult support and protection. This included input from the Forth Valley Adult Protection Committee which provides training about adult support and protection. The provider also agreed that all staff would receive additional input about how to report any concerns they may have about the care of people who use the service. Areas for improvement Since the last inspection, Police and Social Work teams have completed two adult support and protection investigations at Newcarron Court which led to serious concerns being raised. This included concerns about the reporting of incidents, the understanding of staff and the management team of adult support and protection issues and local procedures for reporting these and whistle blowing procedures. The provider was directed to develop a plan in response to the concerns identified to include actions to be taken in response to concerns and how these would be reported on to the relevant bodies, for example, Falkirk Council and the Care Inspectorate. We spoke with a range of staff with different roles at Newcarron Court working in different shifts throughout the day and night during this inspection. None of the staff that we spoke with could adequately describe how to identify and report adult support and protection (ASP) issues. Staff gave a range of answers about action they would take if they saw or heard the potential abuse of a service user. None of the staff we asked could describe the correct course of action. This was despite previous input from the management team about whistleblowing and adult support and protection procedures locally. This meant that people who use the service continued to be at risk because staff were not clear about how to recognise and report adult support and protection issues. We were concerned that the management team had investigated adult support and protection issues internally rather than report these to the local authority for their assessment and investigation. We found that allegations of misconduct and abuse had been viewed as complaints rather than being reported through adult support and protection procedures. This meant that the management team which had provided input to support staff to understand ASP issues and reporting, failed to recognise and report ASP incidents. The provider has a duty to report such incidents to the local authority and Care Inspectorate. We have placed one requirement on the provider with regards to this. (Please see requirement 1, below). Newcarron Court Nursing Home, page 24 of 45

25 The provider must notify the Care Inspectorate (and in some cases the Local Authority) of events which take place at the service. We assessed the notifications received by the Care Inspectorate since the last inspection and with regards to accidents and incidents and found that these were not consistently reported. We have placed one requirement on the provider with regards to this, please see quality theme 4, statement 4, requirement 2. Grade awarded for this statement: 2 - Weak Number of requirements: 1 Number of recommendations: 0 Requirements 1. Requirement with reference to Theme 2, Statement 2: The provider must ensure that all staff, including the management team at the service, are able to demonstrate a clear understanding of Adult Support and Protection and whistle blowing procedures. The provider must give notice to the Care Inspectorate within 24 hours of an allegation of misconduct which warrants investigation, dismissal or other disciplinary action. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations, Scottish Statutory Instruments 2011 No 210: Welfare of users 4. - (1) A provider must - (a) make proper provision for the health, welfare and safety of residents and SSI 2011/210 regulation 9(1) - requirement about fitness of employees & SSI 2011/28 regulation 4(1)(b) - requirement about records, notifications and returns. Timescale: within 4 months. Newcarron Court Nursing Home, page 25 of 45

26 Statement 3 The environment allows service users to have as positive a quality of life as possible. Service strengths We evaluated Newcarron Court to be performing to an adequate standard against this Quality Statement. To assess this we considered: -Documents made available to us, including maintenance records, care plans and risk assessments. -Observations of staff practice. -Assessment of the general environment. -Discussions with the residents, relatives and staff we met. We asked people who use the service about the quality of the environment, they told us: "It's very pleasant. I like the surroundings at the back". "Yes, they keep it clean". "Oh yes, I can't complain. They keep it clean". "I am very pleased with the cleanliness in here". "The nurse comes in. I said to her today, I can't walk on the floor it is so sticky". (the floor was cleaned) Relatives/Friends said: "There is no smell and that is one of the good things". "Oh yes, she is well kept. Her room is clean". "It is very tidy and clean". One resident commented on their questionnaire from the Care Inspectorate: 'Feel that the home has a good quality environment, it's kept clean and tidy'. We asked people about the laundry service and they said: "They look after the laundry. I have never heard of anything going missing". "Every day the laundry is taken away. I get clean clothes every day". "Yes they do the laundry". "They are just putting my name on my things". (this was said by a new resident) "The laundry could do with a wee bit of help. The clothes are well looked after". "I have lost as many clothes from the laundry. They just disappeared. Five jumpers have disappeared". Relatives said: "If the laundry is missing, it appears by the end of the week". Newcarron Court Nursing Home, page 26 of 45

27 The Inspection Volunteer who has experience of using care services made the following observations: '1. Residents had been encouraged to bring their own things into their rooms. This helped to make their rooms more homely. 2. I visited a few residents in their rooms and on each occasion I had to go to a lounge to get a chair so that I could sit and talk to the resident. These chairs were often heavy and difficult to carry. I think it would help if visitors had access to light folding chairs. 3. Newcarron was clean and free from unpleasant odours on the day of my visit. 4. I saw white boards with the names of staff on duty. There were no names on the board for night shift. 5. The clock in Iona dining room was not working. 6. Some rooms had boxes on the walls outside their doors. These boxes had clear fronts and residents and relatives had put personalised things in them to help residents with some level of dementia, locate their rooms. 7. There are a lot of notices around the building to keep residents/relatives and friends well informed of activities like coffee mornings, church services, arts and crafts, Spring Trip program, Summer Trip program etc. that are going on in Newcarron. 8. There is a library list of books that are available to residents. 9. There are notices pertaining to "What You Asked", "What we Did", and a notice encouraging relatives to be involved in their family member's care plan. 10.There were photos of the Key worker and Named Nurse in the rooms I visited. 11. I felt some areas of Newcarron could be helped with a new coat of paint. Some of the walls in residents' rooms were badly marked. 12. Having visited Newcarron on a few occasions, I find it a difficult building to negotiate my way around. It is a building with long anonymous corridors. For an elderly care home I do think more signage is required to help people to the lifts, stairs and way out'. Areas for improvement We saw that clocks in Iona Unit and in Crammond Unit were showing the wrong time during this inspection. A clock can be a helpful tool for people with a cognitive impairment to orientate themselves, however, a clock showing the wrong time could be confusing and dis-orientating. Newcarron Court Nursing Home, page 27 of 45