Care service inspection report

Transcription

1 Care service inspection report Full inspection Shalom Nursing Home Care Home Service 163 Main Street Dreghorn Irvine Inspection completed on 28 April 2016

2 Service provided by: Z A Care Limited Service provider number: SP Care service number: CS Inspection Visit Type: Unannounced Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and set out improvements that must be made. We also investigate complaints about care services and take action when things aren't good enough. Please get in touch with us if you would like more information or have any concerns about a care service. Contact Us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com page 2 of 41

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 4 Quality of environment 5 Quality of staffing 4 Quality of management and leadership 4 Good Very Good Good Good What the service does well Shalom offers good quality care. The people who live there and their families commented favourably about the standard of care, upgraded accommodation, food and the staff team. The new provider had recently completed a comprehensive refurbishment programme. The environment was bright, clean, warm and comfortable. Ongoing improvements were planned. The provider had applied appropriate recruitment practices. The service had a stable staff group who had knowledge of the individual needs and preferences of people using the service. Staff had access to relevant training to assist them in their role. page 3 of 41

4 The manager of the service provided positive support and leadership to the staff team. What the service could do better The provider planned ongoing improvements to the care home environment and should continue to take account of the National Care Standards, best practice in dementia care and the needs and expressed preferences of the residents of Shalom. In accordance with the registration conditions, the provider should continue to reduce the number of shared rooms as vacancies occur. The manager should consider a more person-centred approach to medicine management. The manager should improve aspects of quality assurance to ensure areas of non compliance are detected and addressed. What the service has done since the last inspection The provider had made progress in implementing the 'Framework for Excellence' dementia training programme. The provider had consulted with service users about refurbishment of the hall ways and public areas of the "new extension" part of the building. The provider had purchased a suitable vehicle to facilitate small group outings and support service users to attend hospital appointments. Additional moving and handling equipment had been purchased. The provider had reduced the shared bedroom accommodation in accordance with the conditions of registration. Conclusion Residents, relatives and staff expressed high levels of satisfaction in how the service was run. page 4 of 41

5 The new provider and the manager, through discussion, demonstrated a desire to continue to develop the service to ensure positive outcomes for the residents of Shalom. This included ongoing environmental improvements. We found that some aspects of quality assurance should be improved to detect areas of non compliance and inform positive change. page 5 of 41

6 1 About the service we inspected Inspection report Shalom Nursing Home is registered to provide a care service for up to 50 older people, some of whom may require nursing care. At the time of the inspection there were 47 residents within Shalom. The provider, ZA Care Limited was granted registration in October The service is located close to the amenities within Dreghorn, North Ayrshire. Living and bedroom accommodation is separated into four areas over two floors. The upper floor is accessible via a passenger lift. There are a number of lounges and dining areas, catering and laundry facilities in addition to a hairdressing salon. There is a small, but well presented garden area to the front of the service. It is the providers stated aim that 'all of our service users have the right to live in a clean comfortable and safe environment, and be treated with dignity, respect sensitivity in relation to their individual need and abilities. Our nursing and care staff will be responsive to the individual needs of service users and will provide the appropriate degree of care to assure the highest possible equality of life within our home'. 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 Public Services Reform (Scotland) Act 2010 (the "Act"), its regulations, or page 6 of 41

7 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. Based on the findings of this inspection this service has been awarded the following grades: Quality of care and support - Grade 4 - Good Quality of environment - Grade 5 - Very Good Quality of staffing - Grade 4 - Good Quality of management and leadership - Grade 4 - Good Inspection report 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. page 7 of 41

8 2 How we inspected this service The level of inspection we carried out In this service we carried out a low intensity inspection. We carry out these inspections when we are satisfied that services are working hard to provide consistently high standards of care. What we did during the inspection We wrote this report after an unannounced inspection visit by two inspectors on 27 & 28 April A volunteer inspector joined us on 27 April During this inspection, evidence was gathered from a number of sources including: - the service self-assessment for this inspection - personal plans of people who use the service - notifications to the Care Inspectorate - minutes of residents, relatives and staff meetings - staff training records - staff recruitment records - accident and incident records - medication records, systems, storage arrangements - duty rotas - registration certificate and staffing schedule - various audits and quality reports - observation of how staff worked - observation of the environment - discussion with service users, relatives, staff and managers. 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 experience of people during a meal service. We also took account of a regulatory monitoring visit that took place on 4 March page 8 of 41

9 This was to follow up on two notifications that the provider had made to us. One concerned moving and handling practice and the other was about an individuals personal care whilst in Shalom. 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 page 9 of 41

10 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. We received a fully completed self-assessment document for the service provider. We were satisfied with the way the service provider had completed this and with the relevant information they had given us for each heading we grade them under. The service provider identified what they thought they did well, some areas of development and any changes they had planned. Relatives and staff continued to be involved in this process. This is good practice. Taking the views of people using the care service into account A volunteer inspector took part in this inspection. They spoke with 12 residents, their findings are recorded within the body of this report. We spoke to a further three service users as follows: One resident we met was happy with all aspects of their care and bedroom. They said the staff were "very kind". They were aware that they could lock their bedroom, but chose not to. Another resident we met said "girls are fine". They too were happy with the food. They had no complaints and did not bother too much about their bedroom. page 10 of 41

11 We spoke with a third resident who confirmed satisfaction with their care arrangements. They told us that they had been out to a café in the new bus. We received 11 Care Standard questionnaires from residents of Shalom. Ten respondents strongly agreed and one agreed that overall, they were happy with the care they received at Shalom. Additional comments made: "I am well looked after, I think Shalom Nursing Home is clean and comfortable, I am happy with the care I receive in Shalom Nursing Home". "I am happy in Shalom, I like my room". "I am Happy with the care I receive within the home and members of staff are happy to help me at all times. I am aware that there are activities available to me in the home but I am happy to not take part. I think the home is very clean and kept up to good standards. I like the fact I have a single room as it gives me privacy. I also feel very safe in the home. I am very happy with the service the home receive". "I think the quality of care and support is very good". The home is clean and tidy and is free from smells. There is a lot of activities and things to do on a daily basis". "No complaints". Inspection report Taking carers' views into account A volunteer inspector took part in this inspection. They spoke with five relatives, their findings are recorded within the body of this report. We received 19 Care Standard questionnaires from relative's of residents of Shalom. Twelve respondents strongly agreed and seven agreed that overall, they were happy with the care their friend/relative received in Shalom. Additional comments were made: page 11 of 41

12 "Staff are always welcoming, informative and supportive when we visit, understanding the need of both client and family. In general I feel that my mother is well cared for in a warm, safe and caring environment. I cannot fault this home in any way. Indeed, I would highly recommend this establishment to anyone seeking care for their relative". "My relative has been in this CARE HOME for a number of years now and I have only the highest respect for all the care she receives from all the staff". "My relative is absolutely at ease and finds the food and attention excellent. Also the singing & concerts are very good and brightens everyone up". "Her care has been excellent during that time. Although there is no full time activities coordinator the staff provide a wide range of activities which is wider and more frequent than some other homes I have had experience of with other relative/friends". "Shalom has always been able and willing to give the best of care to my mother during her time here and her various stages of health". "My relative is very happy here the staff and residents are great for her. The company has made a great difference to her. She enjoys all activities that are provided". "My relative has dementia and cannot walk and feed herself and all the nurses makes sure she gets her food and drink and her medication". "We as a family are very happy with our dads care in the home. It has also been refurbished to a very high standard and very clean and fresh". "As my mother suffers from vascular dementia, she is unable to make decisions on choices/options of care for herself, the keyworker discusses these options with me. If there is any change in mother's condition or medication or requiring medical care or hospitalisation this is notified to me as soon a possible. page 12 of 41

13 Communication is very good. Since I looked after mother for many years before she was transferred to Shalom, I enjoy the freedom to come and go as I please also to participate in some aspects of her care". "My mother has had quite a few health problems in recent years but she has been well looked after and overall quite content". "My [relative] has dementia and is in a wheelchair. The staff and management keep me informed if they have to tell her anything and she does not understand as I have guardianship over her affairs". "The staff are excellent to her. although one other patient, because of her obvious dementia can harass and take her stuff (comb, brush ornaments etc) (staff do their best to return these)". page 13 of 41

14 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: 4 - Good Statement 2 We enable service users to make individual choices and ensure that every service user can be supported to achieve their potential. Service strengths We sampled evidence against this statement and found that performance was good. We concluded this after we spoke with service users, relatives, staff and managers and examined documents and records relevant to this quality statement. We found that care plans contained information about people's life histories and social preferences. A 'getting to know me document' helped staff to get to know individuals preferred choices in day-to-day life. The provider had recently purchased a vehicle suitable for individuals who require a wheelchair. We heard that the residents had enjoyed outings in the bus. Staff told us that it was much better for residents who had hospital appointments. page 14 of 41

15 The service had a small attractive garden area to the front of the care home. This was not enclosed, therefore, staff supervision was required due to the proximity of the road. The service had arrangements in place for accessing hairdressing twice weekly in a well-appointed salon. We heard that residents enjoyed movies in the cinema room. The manager had maintained local community links. This helped to promote wellbeing. This included church services, attending a regular social event at the local church, and an arts and crafts club in a nearby village. The residents also enjoyed an exercise session facilitated by a volunteer from a local sports club. Residents also told us that they walked to the local shops. We saw photographs of the residents enjoying musical entertainment. We heard that one of the nurses was responsible for arranging these events. We heard that gentle exercises took place every morning. Residents could choose from board games, cards, dominos, films. Social activities were discussed at residents meetings. This gave residents the opportunity to express their choices and preferences. The minutes of residents meetings recorded that residents were asked if they felt they were given choice in their day-to-day lives. Information about how to access advocacy services was also discussed. Staff discussed support offered to individuals who wished to vote. Areas for improvement We spoke with a staff member who felt that staff did not have time for social activities, particularly when staff have to accompany residents to hospital appointments. They felt that the service would benefit from an activity organiser. We observed staff interaction and engagement. Inspection report page 15 of 41

16 We saw residents sitting in the lounge with no stimulation whilst one staff member completed kitchen/pantry duties and another put laundry away. The manager agreed to review the deployment of staff and the non care duties they perform in order to allow care staff more opportunity to promote engagement and socialisation and be less task orientated. We suggested that the implementation of a structured activity programme may improve the focus on activities. An improved keyworker system would also help to develop engagement and meaningful activity. We discussed an alternative method of recording activities and socialisation to ensure that records capture the extent of each individuals participation. Grade 4 - Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 16 of 41

17 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths We sampled evidence against this statement and found that performance was good. We concluded this after we spoke with service users, relatives, staff and managers and examined documents and records relevant to this quality statement. The service continued to operate processes for assessment, care planning and evaluation of individuals care needs. This included the use of assessment tools relating to nutritional care, skin integrity, pain, falls prevention and moving and handling based on current best practice. The service maintained records of interventions required to meet service users' assessed care needs, such as support with personal hygiene, oral care, food and fluid intake and moving and handling needs. We saw from records that service users had access to a range of health professionals, such as; GPs, dietician, CPNs, liaison nurses and optician etc. The service operated a named nurse/keyworker system, this identified named people who take a particular interest in each service users' care and support arrangements. Nursing staff continued to manage people's medications. Good support from the supplying pharmacist was available. Satisfactory records were kept about any accidents or incidents that occurred. The manager completed an analysis of these to inform any changes to planned care. page 17 of 41

18 The service had a range of equipment available to support service user's independence, comfort and meet their care needs. This included moving and handling equipment, pressure relieving equipment and a variety of seating. Staff had undertaken training linked to the needs of service users. This included; moving and handling, food hygiene, dementia, adult support and protection, prevention of falls etc. We spoke with staff on night duty. They advised that staffing levels were adequate to meet the needs of the residents. We heard that the manager was available on call for advice or additional support if needed. The cook demonstrated knowledge of individuals' dietary needs and the need for some items on the menu to be fortified with additional calories and how this should be done. The cook was happy to accommodate meal choices outwith the planned menu. The service took pride in the quality of the home cooked meals and baking. We observed positive interactions between service users and staff. We continued to see care delivered in a discreet and caring manner which promoted privacy and dignity. We met with a visiting professional who had an interest in the care service. They advised that they had no issues with the care service and historically they had received very positive feedback about the quality of care. They also commented positively on the environmental improvements. A volunteer inspector contributed to this inspection. They made observations and spoke with residents and relatives as follows: Residents were positive about the care they received. Comments were: 'Can you ask if I can stay'. 'Yes I want to stay'. 'During the night if I pressed the buzzer a carer comes or a nurse'. page 18 of 41

19 'Everything is fine'. 'Happy with everything'. 'All okay'. Relative's comments: 'Happy with care'. 'Pleased with all aspect of the home - thoroughly pleased'. Resident's comments about activities: 'Some good activities - keep fit and bingo'. 'Down to Saltcoats'. 'Activities are good'. 'Local church come in and have a service'. 'School comes in and does pantomimes'. Relative's comments: 'Good activities'. 'They go out for ice cream down to the front at Stevenson'. The service works with residents to produce family history book with photographs. The service had recently acquired a people carrier which can be used for resident's appointments and outings. Resident's comments about food: page 19 of 41

20 'Food is good'. 'Food is okay - not outstanding'. 'Food is fine'. I observed eight residents at lunch with two members of staff assisting. Lunch was cream of broccoli soup followed by chicken or salmon with mashed potatoes and brussel sprouts. Dessert was orange mousse and fruit. The food looked good. Some residents got assistance to eat. Staff motivated and encouraged other residents to eat. Staff were quick to respond to residents wishes. Some people told me they had postal votes for the upcoming election. Areas for improvement We sampled personal plans. We were disappointed about the lack of response to an individuals weight loss. We found that staff had recorded an individuals weight, due to a significant weight loss this was to be rechecked. This was not done until highlighted by the inspectors. We heard that the individuals weight may not have been accurate as the scales were unsuitable for a small number of individuals due to their physical needs. The provider responded promptly and purchased scales compatible with the moving and handling hoist equipment. We acknowledge that referrals were made to the appropriate health professionals, however, it is our view that the care service should have responded sooner. We also noted an error in the audit of this individuals nutritional need. We have commented further on this in theme 4, statement 4 that deals more directly with quality assurance. We found a second individual who had lost weight, we explored this with the management who explained that due to cognitive impairment and distressed reaction the individual did not always comply with being weighed. A referral was also made to the appropriate professionals regarding this weight loss during the inspection. page 20 of 41

21 We found that records kept about the meal taken by this service user did not reflect our observations. We observed a lunch service. We saw that staff in one area were very busy which resulted in the service users who were being supported to eat being interrupted and left for a short period of time. We also saw staff standing over service users instead of sitting at the table with them as they supported them during meal support. At this time the nurse was administering medication. We spoke with the manager about this. It was agreed that the deployment of staff during mealtimes would be reviewed to ensure that the mealtime experience was improved (see requirement 1). We saw that staff had recorded a number of distressed reactions. Appropriate advice had been sought from the CPN (Community Psychiatric Nurse) and the GP. However, we found that the individuals care plan did not detail any management strategies for staff to employ to prevent or de-escalate a distressed reaction or detail the circumstances when prescribed as required medication should be given. We acknowledge that the manager produced a care plan that staff were working on, however, it was our view that this should have been implemented sooner to direct staff in meeting the individuals needs (see recommendation 1). The provider should consider a more person-centred approach to managing medications. This may be facilitated through the use of individual locked storage cabinets within each persons' bedroom. We noted that nurses signed administration records for some topical applications that care staff administered. Practice should be reviewed to ensure that individuals who administer preparations sign the paperwork. The manager planned to speak with the supplying pharmacist about records to facilitate improved recording practices. We sampled medication stock and records. All stock was available in our selected sample. We found a few occasions where medication administration records were incomplete. We also found a small number of discrepancies in the amount of medication we expected. page 21 of 41

22 This could be due to an administration error. This made it difficult to be certain that the medicine was given as prescribed (see requirement 2). Grade 4 - Good Requirements Number of requirements Records used to monitor individuals fluid and dietary intake should be accurately completed and contain good detail. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) regulations (SSI 2011/210). regulations 4 (1) (a) - Welfare of Users. Timescale for compliance: upon receipt of this report. Inspection report 2. The provider must ensure that medication recording is safe, up-to-date and accurate. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) regulations (SSI 2011/210). regulations 4 (1) (a) - Welfare of Users. Timescale for compliance: upon receipt of this report. Recommendations Number of recommendations The provider must ensure that care plans relating to the support of service users with stressed and distressed behaviours are improved. The provider should ensure that risk assessments are completed which inform care plans showing potential triggers and management strategies to be used. page 22 of 41

23 National Care Standards, care homes for older people, standard 6: support arrangements. page 23 of 41

24 Quality Theme 2: Quality of environment Grade awarded for this theme: 5 - Very Good Statement 3 The environment allows service users to have as positive a quality of life as possible. Service strengths We found the service achieved a very good standard in this area. We saw that the new provider continued to be supportive of purchasing any equipment required to promote comfort and quality of life for the residents of Shalom. The provider discussed imminent refurbishment work to be carried out in the "new extension". This included carpets, seating and dining tables. The environment was nicely decorated, well maintained, welcoming and friendly. Most of the bedrooms were single. The provider had reduced the number of double rooms from six to four in accordance with a condition of registration. The provider planned to continue to reduce shared accommodation as circumstances allowed. We heard that at present the shared accommodation was, in all but one occasion, restricted to married couples or close family. Most of the bedrooms had an en suite toilet, some also had a shower. Some bedrooms had a Jack & Jill style en suite, accessed by two bedrooms. Staff described how this was managed to promote privacy. Additional assisted bathing facilities were available for individuals who had physical health needs. The provider had upgraded one of the assisted baths. Housekeeping standards were high. Overall, the living environment was pleasant. The original part of the building had benefited from a recent full refurbishment. This included all lounges, public areas and bedrooms. There was a well equipped hairdressing salon provided and a cinema room. Resident bedrooms in the original building had been recently refurbished. page 24 of 41

25 Some bedrooms had dementia friendly furniture, this allowed residents to see what was in their wardrobe and drawers. The provider had also recently installed new televisions in all of the bedrooms. We saw that residents had been supported to personalise their bedroom space. This made their private space more homely. We noted that some bedroom doors were personalised to help people identify their own space. Signage around the care home helped to orientate people around the building. There was a passenger lift to access the upper floors of the care home. There was a designated lounge/dining area for each of the four geographical areas of the service. This offered residents the opportunity to take part in activities and socialise with other residents or relax in the quieter lounges. There was an on-site laundry and kitchen. There was a good range of equipment. All beds had been upgraded to electric profiling beds. We saw pressure relieving cushions and mattresses and moving and assisting equipment. This helped to promote comfort and wellbeing and a positive quality of life. The care home had a call system to allow service users to summon assistance from staff. There was a pleasant well maintained garden area to the front of the building where residents could enjoy fresh air when the weather allowed. All of the residents and relatives we spoke with told us that the were happy with the improvements to the care home environment. The volunteer inspector made observations and spoke with residents and relatives. There comments were as follows: Inspection report The home had nice lounges and a quiet room. There was a cinema with a big screen with old posters up of old films. page 25 of 41

26 There was a hairdresser with a barbers pole outside the room which I thought was a nice touch. The home was clean and tidy. Part of the home had been recently redecorated and carpeted. Relatives commented: 'I visit regularly. Always welcomed'. Areas for improvement The provider was aware of the need to continue to reduce the shared rooms as circumstances permitted. A small number of the bedrooms did not have en suite facilities. The provider should consider this when planning further environmental improvements. The provider acknowledged the limitations of the outdoor space. This was not secure and due to the close proximity of the road meant that many residents required to be accompanied by a staff member or relative when they wished to sit outside. We also noted that some of the bedroom windows had a limited outlook. We noted some areas were malodorous. The provider planned to replace carpets and furnishings. The manager agreed to explore purchasing a deodoriser if the issue is not resolved. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 26 of 41

27 Statement 4 The accommodation we provide ensures that the privacy of service users is respected. Service strengths We sampled evidence against this statement and found that performance was very good. We concluded this following our observations and after we spoke with service users, relatives, staff and managers. Most bedrooms were single, some with ensuite facilities. Shared rooms had appropriate screening. Bedroom doors could be locked and service users could have a key to their room should they wish. We noted that one service user had an adapted lock to support them to use this independently. This is very good practice. All bathrooms and toilets could be locked to ensure privacy. All residents had lockable space in their rooms for the safe keeping of personal belongings. Appropriate arrangements were in place for the safe storage of service users' confidential records. We saw that residents received support in a way which protected their privacy and dignity and we observed staff knocking on resident's doors before entering. We saw that service users and/or families had been consulted regarding the service users' wish to vote in the upcoming election and arrangements for postal votes had been made where required. Areas for improvement The provider was aware of the need to continue to reduce the shared rooms as circumstances permitted. page 27 of 41

28 A small number of the bedrooms did not have en suite facilities. The provider should consider this when planning further environmental improvements. We noted some care records on a desk. The provider should remind staff of the need to ensure that records are appropriately stored at all times. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 page 28 of 41

29 Quality Theme 3: Quality of staffing Grade awarded for this theme: 4 - Good Statement 2 We are confident that our staff have been recruited, and inducted, in a safe and robust manner to protect service users and staff. Service strengths We sampled the staff files of individuals who had been recruited since the last inspection. We saw that safe recruitment procedures were followed with staff required to complete an application form, be interviewed for the post, provide two references and complete a successful PVG check. The provider had an induction policy. Induction records in the form of a checklist, showed that new staff were informed about a range of policies, procedures, systems and processes within the service. The induction paperwork was signed off by a member of senior staff. This included a period of shadowing a more experienced member of staff. The induction period also took account of a one-to-one session with the manager to review the inductees first few weeks employment at Shalom. page 29 of 41

30 Areas for improvement The induction paperwork could be developed to reflect the shadowing process, where new staff work alongside a more experienced staff member and the observations of practice undertaken to ensure competency in completing key tasks of the job description. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 30 of 41

31 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths The service was performing to a good level. The provider had policies and procedures to direct staff in their day-to-day work. We observed staff interaction with residents and took account of comments made to us during the inspection and in our questionnaires. The provider retained a stable staff group within Shalom. This promoted continuity of care for the residents. The provider had a staff training programme which included health and safety matters and care related issues. This included moving and handling, fire safety, preventing falls, preventing infection in care, food hygiene, managing diabetes, continence management, adult support and protection and falls prevention. Twelve staff had enrolled on a distance learning training programme which covered common health conditions, palliative care, safe handling of medication, management of diabetes and dementia. Training took account of the 'Promoting Excellence Framework' dementia training developed by Scottish Social Services Council and NHS Scotland as part of the Scottish Governments dementia strategy. The 'Promoting Excellence Framework' describes the minimum knowledge and skills required by all of health and social services staff working with people with dementia. It recommends different levels of training based on the role of the individual and level of contact with people with dementia. This training was ongoing. Direct care staff had achieved a minimum Level 2 SVQ award. This is in line with the requirements of the Scottish Social Services Council. This is a body who page 31 of 41

32 define training requirements for social care staff. The manager had arranged for two staff to attend the 'My Home Life' training programme aimed at promoting quality of life for people in care homes. An on call system was in place to ensure that support and advice was always available to the staff team from a manager. We could see that staff performance and development had been facilitated by regular one-to-one sessions with their line manager. The provider had informed us about an investigation which had concluded that some staff had not consistently followed best practice guidance when moving and assisting residents. The provider responded positively to this. Training had been arranged for some staff and individual meetings with all of the staff had taken place to reinforce the need for safe and accountable work practice. Please see areas of improvement below. We saw that the provider had responded to an occasion where an individuals care plan had not been followed and care records were not well maintained. Individual meetings with all staff had taken place and changes implemented to improve record keeping and accountability. There was evidence that nurse meetings and meetings with support staff had taken place. Information was shared at shift handover meetings. Daily diaries were used by managers and nurses to pass on information. This helped to promote communication across the service. The provider had a system to monitor staffs registration status with their regulatory bodies. Nursing staff with the Nursing Midwifery Council and direct care staff with the Scottish Social Services Council. The provider had consulted with staff when completing the services selfassessment. This demonstrated that the provider valued the views of the staff team. The provider planned to repeat staff PVG checks in each three year period. page 32 of 41

33 We asked the provider to distribute Care Standard questionnaires. We received ten completed questionnaires from the staff. They all agreed that the service provided good care and support to people who use it. No respondents indicated that they had unmet training needs. The following additional comments were made: "Would like to attend courses to update my knowledge on the changes/ updates on dementia care, wound care. I enjoy my work in Shalom, supported by good management and all other staff. Manager is always available to talk. All the residents are very well cared for and views and opinions taken on board. Would like more training with being kept up-to-date of changes in dementia care, wound care continence care. "Every effort is made to ensure service users needs are met in all aspects of their care. Staff have regular training to ensure they can give the best possible care". "I have been on several courses and I am completing SVQ 4 Leadership and Management". "Communicate with staff during handover periods & throughout working periods on a daily basis. In regular contact daily with line manager. During my time in Shalom have gained many skills to support service users, relatives & staff. During one-to-one meetings with manager and owner always asked about ways to improve the service. I believe this service provides good care & that we support everyone who uses it". A volunteer inspector spoke with residents and relatives. They made the following comments about staff: Resident's comments: 'Staff are kindly'. 'Staff are helpful'. Relative's comments: Inspection report page 33 of 41

34 'No problems with staff'. 'There to help'. Areas for improvement We also identified issues in quality theme 1, statement 3 regarding the need to carry out observed assessments of staff's moving and handling practice. This must be carried out to ensure that staff are transferring their learning into practice and that safe moving and handling practice is used at all time (see requirement 1). We also highlighted areas of improvement in 1.3 where practice could be improved. This related to the approach to weight loss, accuracy of recording intake and completion of medication administration records. Grade 4 - Good Requirements Number of requirements The provider must ensure there is evidence that all staff who are involved in moving and handling service users are doing so safely using up-to-date approved techniques and appropriate equipment. This could be evidenced through recorded assessments of observed practice. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) regulations (SSI 2011/210). regulations 4 (1) (a) - Welfare of Users and regulations 15 (a) (b)(i) suitably qualified and trained staff and ensure persons employed in the provision of the service receive training appropriate to the work they are to perform. Timescale for implementation: one week from the publication of this report. Number of recommendations - 0 page 34 of 41

35 Quality Theme 4: Quality of management and leadership Grade awarded for this theme: 4 - Good Statement 3 To encourage good quality care, we promote leadership values throughout the workforce. Service strengths We found that the service remained well-managed and performance was very good in this quality statement. There was a clear management structure. This included a home manager, deputy home manager and registered nurses who led shifts and directed care arrangements over the 24 hour period. The manager's were hands on in the service and had a good knowledge of the staff team and residents care needs. We could see that they enjoyed a good rapport with residents, relatives and staff within the service. The administrator and project manager had a direct link with the provider which facilitated effective communication and decision making. There was evidence that staff had the opportunity of individual time with the manager regularly throughout the year. Two staff had commenced a leadership programme called 'My Home Life' to develop their skills and knowledge in this area. There was an on call system to ensure that staff were supported with managing unplanned events out-of-hours. page 35 of 41

36 The volunteer inspector spoke with residents and relatives about the quality of management at Shalom. Their findings were as follows: There was good awareness of the manager from residents I spoke to. One resident commented: 'Ask ** and he would help'. Areas for improvement The manager spoke about plans to develop the role of the care assistant. This would allow individuals to enhance their skills through a programme of training and support. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 36 of 41

37 Statement 4 We use quality assurance systems and processes which involve service users, carers, staff and stakeholders to assess the quality of service we provide. Service strengths We found that the care service performed adequately in this area. A number of checks and audits were in place to monitor standards across the service. Monthly audits of care plans and specific health related risk assessments took place. This helped to ensure that care records were well maintained. Please see areas of improvement below for further comment. An analysis of accidents/incidents was completed which took account of factors that may have contributed to accidents and changes to planned interventions required to prevent reoccurrence. Checks of medication stock and records helped to ensure that medication was appropriately managed. Staff records were audited. This took account of care and nursing staff registration status with registering bodies (Nursing & Midwifery Council & Scottish Social Services Council), Protection of Vulnerable Groups checks, Scottish Vocational Qualifications achieved and in-house mandatory training. The provider had distributed a satisfaction survey to relatives/residents. The results were positive. One issue was raised which the manager responded to. The provider continued inviting residents, relatives and staff to take part in the self-assessment of the service that we ask them to complete. This helped to provide information on how the service was run from a range of different perspectives. page 37 of 41

38 A formal complaints process was in place to manage any concerns/complaints. We saw that the provider had responded appropriately where the service did not meet with expectations. Residents, relatives and staff we spoke to told us that they could raise any issues with the management team. The provider had received very positive feedback from a questionnaire distributed to health professionals who had visited in the care service. External quality checks were conducted by the local environmental health department who monitor food storage and preparation arrangements and the local pharmacist, who checked how the service managed people's medicines. As a condition of the contracting agreement with the local authority, the service produced reports and participated in monitoring meetings. Areas for improvement We highlighted some areas where practice could be further improved within themes 1 and 3 of this report. This related to monitoring weights, recording dietary intake, medication administration recording. We also found that a nutritional audit had been inaccurately completed and did not accurately reflect an individuals weight. The manager gave a firm commitment to making improvements in this area in order that audits identify areas of non compliance within the service and allow prompt corrective action. We gave some direction on audit tools available. A recent investigation revealed that staff had not consistently followed best practice moving and handling procedures. The manager advised that moving and handling manoeuvres had been observed, but not formally recorded. In order to ensure the safety of service users, the provider should retain evidence of observed assessments of staff moving and handling practice to evidence good practice and the safe handling of service users (see requirement 1). Grade 3 - Adequate page 38 of 41

39 Requirements Number of requirements In order to ensure the safety of service users, the provider should retain observed assessments of staff moving and handling practice to evidence good practice and the safe handling of service users. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) regulations (SSI 2011/210). regulations 4 (1) (a) - Welfare of Users. Timescale for implementation: from the publication of this report. Recommendations Number of recommendations The provider must improve quality assurance systems to ensure that deficits within the service are identified and evidence is available to show the action taken to effect improvements. National Care Standards, care homes for older people, standard 5: management and staffing arrangements. 4 What the service has done to meet any requirements we made at our last inspection Previous requirements There are no outstanding requirements. page 39 of 41

40 5 What the service has done to meet any recommendations we made at our last inspection Previous recommendations There are no outstanding recommendations. Inspection report 6 Complaints No complaints have been upheld, or partially upheld, since the last inspection. 7 Enforcements We have taken no enforcement action against this care service since the last inspection. 8 Additional Information 9 Inspection and grading history Date Type Gradings 22 Oct 2015 Unannounced Care and support 5 - Very Good Environment 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good page 40 of 41

41 To find out more This inspection report is published by the Care Inspectorate. You can download this report and others from our website. You can also read more about our work online. Contact Us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY Other languages and formats This report is available in other languages and formats on request. Inspection report Tha am foillseachadh seo ri fhaighinn ann an cruthannan is c?nain eile ma nithear iarrtas. page 41 of 41