Care service inspection report

Transcription

1 Care service inspection report Full inspection Kingsmead Nursing Home Care Home Service Kingswood Drive Kingswells Aberdeen Inspection completed on 26 May 2016

2 Service provided by: Mead Medical Services 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 43

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 3 Quality of environment 4 Quality of staffing 3 Quality of management and leadership 3 Adequate Good Adequate Adequate What the service does well We observed some positive interactions between staff and residents which demonstrated that, in general, staff treated residents with respect and dignity. The outcomes for residents were improving. Some residents and relatives told us that they were happy with the standard of care they received at Kingsmead. The relatives told us that they felt the service was improving. What the service could do better The management and staff have made good progress in addressing the concerns identified at the last inspection. We continue to have some concerns around wound management, the management of distressed reactions and the standard of record keeping. We have offered the assistance of our Health and Wellbeing Improvement Team to further assist them in developing their practice. page 3 of 43

4 What the service has done since the last inspection The staffing levels have improved. This was having a positive outcome on the residents' quality of life. The manager was now supported by two new deputy managers. All staff were now recruited in line with best practice. Inspection report Conclusion Overall, there was a significant improvement in how the service was performing. The management were using the quality assurance processes and systems to identify areas of development. Although there were a number of new staff who were inexperienced in the care home sector, we saw the potential to develop and grow these staff. page 4 of 43

5 1 About the service we inspected Inspection report Kingsmead Nursing Home is a modern purpose-built two-storey building, situated in a quiet residential area of Kingswells, to the west of Aberdeen. The home was registered to provide a care service to a maximum of 55 older people; in addition, to provide a care service to a maximum of 10 adults with learning disabilities. The home provides care and support to older people with moderate to severe dementia. The service provider's aims and objectives state that the service aims to, 'create a therapeutic environment with a secure, happy, relaxed and homely atmosphere for residents to live in, staff to work in and a welcoming atmosphere for friends and relatives'. The service employs a team of Registered Nurses and carers with varying degrees of skills, expertise and qualifications. The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April 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 5 of 43

6 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 3 - Adequate Quality of environment - Grade 4 - Good Quality of staffing - Grade 3 - Adequate Quality of management and leadership - Grade 3 - Adequate 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 6 of 43

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 inspectors. The inspection took place over three days, between 10:30am and 4:30pm on Wednesday 4 May 2016, 6:15am and 3pm on Thursday 5 May and 2:30pm and 6pm on Thursday 26 May Initial feedback was provided to the manager on Thursday 5 May Formal feedback was provided to the Director of Care Services and the manager on Thursday 26 May 2016 at Kingsmead Care Home. The purpose of this inspection was to establish the progress made by the service regarding the requirements and recommendations made since the last inspection on 10 November Following the inspection in November we undertook a re-grading visit to Kingsmead on 1 December This visit was at the request of the provider to establish the improvements made regarding the safe recruitment of staff. During this inspection we gathered evidence from various sources, including the following. We spoke with: - Fifteen residents - We attended a relatives' meeting on 8 February 2016 which was attended by 14 relatives. We spoke with another three relatives during the inspection. - The manager - Sixteen members of staff - We also gained the views of visiting healthcare professionals including the Community Psychiatric nurse (CPN), community nurses and the local GP practice. page 7 of 43

8 We looked at: The action plan developed following the last inspection. - Relatives' and staff meeting minutes - Participation documentation - Notice boards - Residents' assessments, personal plans, risk assessments and reviews - Compliments and complaints records - Staff training and supervision records - Staff recruitment - Accident and incident records including falls management - Staff rota and staff allocations sheets - Quality assurance documentation, audits and action plans - Detailed information from the Director of Care Services on the support arrangements in place for Kingsmead - The environment. 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 staff interactions with groups of three to four individuals over four timeframes. We also spent time generally observing staff practices and how staff interacted with the residents at Kingsmead. 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. page 8 of 43

9 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 43

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. 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. Taking the views of people using the care service into account We spoke with 12 residents during the inspection visits (others were spoken with in passing). The residents we spoke to appeared to be generally happy with the care provided to them. We also 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. The views of the residents have greatly informed the findings of this inspection and are included throughout this report. Taking carers' views into account At the request of the relatives we attended a relatives' meeting on 8 February Fourteen relatives attended this meeting. The relatives present represented members of their family or friends who stayed within the two main units, however, there was one relative whose relative was staying in the LD unit. The relatives were concerned regarding the negative press generated by the last page 10 of 43

11 inspection report. The consensus from the relatives was that the service was improving and the management team were responsive to their concerns and suggestions. The relatives stated they were working with the management to improve and change the service. All relatives present spoke highly of the staff and management. However, they acknowledged that standards had previously dropped but felt that the care and support was now improved. We sent 40 questionnaires to relatives or friends of service users, of which 14 were completed and returned to us. The vast majority of relatives spoke highly of the service and the improving outcomes for the residents. Relatives' comments included: - "I was very impressed by the quality of care when my relative recently fell." - "The care worker who took my relative to the hospital was fantastic at explaining, several times, what was happening and why." - "The care and consideration is very typical of this home and I am very impressed and grateful." - "Recent changes have contributed to an overall improvement in the environment." - "Staff moral seems improved." - "The staff do a great job." - "I am very happy with the service provided." - "The home is very well run. No problems." - "The staff are always very helpful and easy to talk to. Very happy here." - "My mum is very well cared for." - "The staff are kind." - "Mum is always clean and tidy, first class care home." - "No complaints at all." - "The home has seen great changes for the best." - "The staff are so good and deserve a medal, for what they have to put up with." - "I feel the criticism that is given is so unfair to the staff, who have a very difficult job." - "The care home has had a hard time over the past year due to managerial issues. But things have improved and continue to do so for the better." - "The staff, at the moment, are very helpful and kind. I am delighted that (staff member) has returned to the top floor. He is enthusiastic and is keen to make page 11 of 43

12 changes." - "Staff are busy with the day-to-day running of the unit. More staff is definitely required." - "When visiting mum, we find that there is never water beside her. Mum will drink water all day. Sometimes she will be left all night without water on her trolley by her bed." One relative contacted us prior to the inspection and we spoke with another three relatives during the inspection. In general the relatives said that they were happy overall with the care and support. Relatives stated that communication with the management continued to improve. One relative stated the relatives' meetings generated a lot of good ideas and suggestions. Another relative raised some concern regarding the perceived lack of staff during "busy times". The relative who contact us expressed their concern regarding their 'first impressions' on visiting the home and the poor attitude of some staff. Although we did not observe or experience any of these behaviours, the relative's comments were discussed in detail with the senior management team during the inspection. page 12 of 43

13 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: 3 - Adequate 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 The management and staff have made significant progress in meeting the three previous requirements and one recommendation. We saw that there had been a significant improvement in the culture within the home. Staff tried hard to ensure that residents' likes, dislikes, routines and habits were in general being respected. We saw residents being treated with dignity and respect. Staff were warm, kind and friendly when interacting with the residents. In the period since the previous inspection the provider had updated its complaints policy. It was now clearer that minor complaints were those which could be dealt with informally and without the need for investigation. It no longer stated that a formal complaint had to be made in writing. The policy had also been amended to make it clearer that complainants could contact the Care Inspectorate at any stage in the complaint process. All staff who had responsibilities for dealing with complaints had completed recent training in this. There were some examples of clearer records being kept of how complaints or concerns had been responded to. page 13 of 43

14 Relatives confirmed that they could visit the home at any time. We saw that visitors were made welcome by staff. Some relatives were also encouraged and supported to be involved in their relative's care. Relatives spoke highly of the positive changes in home since the last inspection. There were a number of relatives who were very involved with the home and who met regularly with the management team. The relatives stated that they were working with the management team to improve and change the service. The relatives and residents were actively encouraged to become more involved in the running of the home. This was having a positive outcome for both the residents and relatives in building relationships and trust. Areas for improvement Staff need to ensure that the documentation supports the information they have gained regarding the residents' choices and preferences. This will ensure that residents continue to receive consistent, individualised care and support. See quality theme 1 - statement 3. The management should consider ways to develop staff's understanding of how to support and encourage residents to make choices, especially for those residents with communication difficulties. The provider should make sure that all staff who may have to deal with expressions of dissatisfaction from service users or relatives are confident about their role in responding to this. Staff should be able to determine when a formal response is necessary. The provider was in the process of developing a policy on dealing with complainants who it considers to be vexatious (a complainant who makes multiple complaints without sufficient grounds and which causes disruption and distress to management and staff). This should include transparent processes which will address this, so that any potential threat of termination of contract is only considered as a last resort following this process being exhausted. Any potential threat of termination of contract should only be justified in terms of clear evidence of the risk to the effective provision of the service. (See recommendation 1). page 14 of 43

15 The management were considering the security arrangements within the home. This was to be discussed at the relatives' meeting. Grade 4 - Good Number of requirements - 0 Recommendations Number of recommendations The provider should develop and implement a policy on dealing with complainants who it considers to be vexatious. Inspection report National Care Standards Care Homes for Older People: Standard 11 - Expressing Your Views. Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths The management and staff have made significant progress in meeting the seven previous requirements and one recommendation. Four of these requirements were met. We saw that the residents were well presented, clean and tidy. Staff took time to ensure that residents' dignity was respected. Staff showed an understanding of residents' wishes with regard to their personal appearance. The dining experience for residents was much improved. We saw residents being offered appropriate meal choices and fluids. Staff were very aware that mealtimes could potentially be a 'flash-point' for those residents who displayed distress reactions. We saw staff taking time to offer reassurance and guiding residents to more suitable tables. page 15 of 43

16 We saw an improvement in how falls were being prevented and managed. This had resulted in actions to reduce the number of falls. We saw staff being careful to ensure that the residents were using appropriate walking aids. We saw good examples of where staff had contacted external healthcare professionals for advice and support. The outcomes for a number of residents had improved with their guidance and support. We received some positive feedback regarding the positive changes within the service from these visiting healthcare professionals. In general the outcomes for residents was improving, however, there remained some concern regarding how the information received was recorded and implemented into practice. (See 'Areas for improvement'). Relatives confirmed that communication with staff was good and that they were being informed of any changes that had occurred. We saw some good practice in relation to moving and handling, infection control and the management of continence. Areas for improvement Staff should consider the language used and how information is shared regarding residents who may need assistance to go to the bathroom. Inspection report The number of residents displaying significant distressed reactions had reduced since the last inspection. However, there remained some important concerns regarding the lack of evaluation and effective strategies for those residents who became distressed or agitated. Although the staff team were working with the visiting healthcare professionals, we have offered the assistance or our dementia consultant to further assist them in developing their practice in this area. The previous requirement will remain in place. (See requirement 1) We asked that the management team review how the meals were served. We observed the meal service being delayed as staff had to wait for items to be delivered from the kitchen. The outcome was that a number of residents moved away from the tables and lost focus on their meal. We found that the information, advice and support offered to the home by the visiting healthcare professionals was not always implemented into practice or documented. One healthcare professional stated that although things were page 16 of 43

17 improving, their advice had not always being followed. The staff and the management team acknowledged that the standard of documentation was a 'work in progress'. We saw that the information within the documentation was unclear, potentially confusing, lacked detail and contained inconsistent information. We discussed this in detail with the management team at feedback. (See requirements 2 and 3) Although the staff team were working with the visiting healthcare professionals in relation to wound management and treatment, we continue to have some concerns. We have offered the assistance of our Health and Wellbeing Improvement Team to further assist them in developing their practice to enable the visiting healthcare professionals to be able to eventually reduce their input into the service. The previous requirement will remain in place. (See requirement 4) Grade 3 - Adequate Requirements Number of requirements - 4 Inspection report 1. The provider must ensure that people using the service who experience behaviour changes have an appropriate assessment, and individualised plan of care which sets out the actions to be taken to support their distress reactions. The provider must ensure that staff consistently respond promptly and appropriately to residents who experience distress. The provider must also ensure that staff are skilled to provide effective care and support in such instances. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210)Regulation 4. (1) A provider must: (a) make proper provision for the health, welfare and safety of service users; (b) provide services in a manner which respects the privacy and dignity of service users. page 17 of 43

18 Timescale: To be completed by 1 December The provider must demonstrate that the service has systems in place to ensure that the needs of the individual residents are regularly assessed, monitored and adequately met. In order to do this the provider must: - Ensure that planned support is fully implemented when people have specific health needs including communication, pain, falls, moving and handling; - Demonstrate that staff will seek advice from relevant healthcare professionals promptly and ensure that their advice and guidance is implemented into practice. - Ensure that staff have the necessary skills and experience to implement recommendations and advice provided by external healthcare specialists; - Ensure that managers monitor and audit health needs robustly. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210)Regulation 4. (1) A provider must: (a) make proper provision for the health, welfare and safety of service users; (b) provide services in a manner which respects the privacy and dignity of service users. Regulation 15(b)(i) - a requirement about training. Timescale: To be completed by 1 December The provider must demonstrate that personal plans record all risk, health, welfare and safety needs in a coherent manner which identifies how needs are met. In order to do this the provider must: page 18 of 43

19 - Ensure that documentation and records are accurate, sufficiently detailed and reflect the care planned or provided; - Ensure staff maintain accurate records and follow best practice including Nursing and Midwifery Council (NMC) guidance; - Ensure that staff are knowledgeable about up-to-date policy and best practice; - Demonstrate that managers are involved in the monitoring and auditing of records. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210)Regulation 4. (1) A provider must: (a) make proper provision for the health, welfare and safety of service users; (b) provide services in a manner which respects the privacy and dignity of service users. Regulation 5(1) - a requirement for personal plans: Regulation 9(2)(b) - a requirement about fitness of employees and Regulation 15(b)(i) - a requirement about training. Timescale: To be completed by 1 December The approach to skin care and tissue viability requires to be improved. In order to do this the provider must: - Ensure that staff assess and manage skin care in line with best practice; - Implement a pain assessment tool to demonstrate that staff assess and manage all symptoms; page 19 of 43

20 - Improve care plan documentation to ensure that a clear complete and accurate record of skin care is kept; This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210)Regulation 4. (1) A provider must: (a) make proper provision for the health, welfare and safety of service users. Timescale: To be completed by 1 March Number of recommendations - 0 page 20 of 43

21 Quality Theme 2: Quality of environment Grade awarded for this theme: 4 - Good Statement 3 The environment allows service users to have as positive a quality of life as possible. Service strengths We found the home to be clean tidy and odour free. Staff confirmed that two bedroom carpets were in the process of being replaced. Work had been done within the reception areas to make the home welcoming and inviting. Staff had begun to review the environment to try to enhance the residents' quality of life. We saw staff encouraging residents to use the smaller seating areas within the units and the enclosed garden area. The manager had plans to further develop this area and the other public areas within the home. Areas for improvement One relative raised concerns regarding their 'first impressions' on visiting the home and the poor attitude of some staff. Although we did not observe or experience any of these behaviours, the relative's comments were discussed in detail with the senior management team during the inspection. Due to the design and layout of the building the space within the learning disabilities unit was limited. However, staff and the residents were making the best use of the space available. Grade 4 - Good Number of requirements - 0 Number of recommendations - 0 page 21 of 43

22 Statement 4 The accommodation we provide ensures that the privacy of service users is respected. Service strengths All communal bathrooms and toilets were lockable and an appropriate call system was fitted throughout the home. Observation of practice and discussion with staff showed them to be respectful. For example, we observed staff maintaining the dignity of a resident who had been incontinent, their actions were kind, calm and discreet. Residents were free to use all the public spaces within each unit. Residents were free to choose where they wished to spend their time. Areas for improvement Staff should consider the wording used within the residents' personal plans to ensure that the documentation in place reflects the homes ethos of promoting respect and the dignity of residents. A large number of residents' bedrooms doors were kept locked. Although residents could gain access to their bedroom, they required a member of staff to facilitate this. The management team should review the practice of locking bedroom doors as a default position and consider whether less restrictive options could be used to achieve the same outcomes. Grade 4 - Good Number of requirements - 0 Number of recommendations - 0 page 22 of 43

23 Quality Theme 3: Quality of staffing Grade awarded for this theme: 3 - Adequate 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 The previous requirement made regarding safer recruitment was addressed. The provider had in place an appropriate safer recruitment policy and there was evidence that this had been mostly well-implemented. The provider had completed audits of a high percentage of recent staff recruitment files. The provider's Director of Care had been involved in auditing a number of records to ensure that safe recruitment practices were being implemented within the service. The provider needs to ensure that the recruitment audit is effective in picking up any shortcomings in the implementation of the recruitment process. (See 'Areas for Improvement'). The provider had developed and introduced a helpful and comprehensive booklet to support the induction of new staff. There was evidence that new staff had started to complete this. Areas for improvement We found there were a number of minor issues with the implementation of the provider's safer recruitment process: - The provider should ensure that one of the referees provided by candidates is their previous employer. - Where a candidate's previous employer has declined to provide a reference, page 23 of 43

24 the provider needs to keep a record of the efforts made to obtain this. - Where additional information, such as details of criminal convictions, is included in the PVG record, the provider should complete a risk assessment. This should demonstrate how they have assessed the relevance of this information and identify additional measures which may be needed to minimise any risk. - The provider should safely destroy all PVG certificates in accordance with the guidance provided by Disclosure Scotland. Organisations should not retain disclosure records indefinitely. However, the organisation can retain details of when the check was made, the disclosure reference number, and the date of the check and for whom it was carried out. (See recommendation 1). Grade 3 - Adequate Number of requirements - 0 Recommendations Number of recommendations - 1 Inspection report 1. The provider should ensure that its safer recruitment procedure is effectively implemented at all times and that there is a well-documented audit trail to demonstrate this. This should include providing documentary evidence that all efforts have been made to obtain a reference from each candidate's previous employer and ensuring that there is clear documentation of the assessment completed by the provider in relation to any additional information contained in a candidate's Protection of Vulnerable Groups (PVG) certificate. National Care Standards Care Homes for Older People: Standard 5 - Management and Staffing Arrangements. page 24 of 43

25 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths The two previous requirements made in relation to staffing levels and staff training have been met. Since the previous inspection the provider had made some progress in implementing its policy of providing regular staff supervision. About 50% of the staff team had received recent supervision and newer staff had received supervision as part of their induction process. Some staff had in place individual professional development plans. The provider had developed a useful format for the completion of these. We saw some good examples of how these had been used to support staff development. The provider had an e-learning system in place and had made very good progress in supporting staff to complete the core elements of this. Completion of the developmental elements was also well under way. The provider had in place a system to check that staff were registered with the relevant professional registration body (Nursing and Midwifery Council and Scottish Social Services Council) and to monitor the progress of new staff in making their applications for this promptly. Following discussion during the inspection the provider had added a check of registration expiry/renewal dates to this checklist. There was evidence that staff had been involved in reviewing the staffing levels at different times of the day to take account of the changing needs of service users. Since the previous inspection the provider had managed to significantly reduce the numbers of staff vacancies and now most shifts were able to be covered by existing staff - either permanent or bank - and staff confirmed that there was page 25 of 43

26 no agency staff usage. This helped to provide better continuity for service users. Although there were a number of new staff who were inexperienced in the care home sector, we saw the potential to develop and grow these staff. The staffing level had also increased following feedback from the staff team and the relatives. Since the previous inspection more rigorous arrangements had been implemented to monitor staff sickness more closely. The manager advised that this was having positive impact. The Director of Care advised that the provider monitored overall sickness levels in the home to ensure that their maximising staff attendance approach was effective. Areas for improvement The provider needs to continue to implement its supervision and appraisal programme to ensure that all staff receive supervision and appraisals in accordance with the provider's policy. A better audit trail of how any concerns about practice or performance are followed up and reviewed should be implemented. Staff development plans needs to be put in place for all staff. The manager advised that they were planning to introduce a system of 'care champions' for key areas including; wound care and tissue viability, dementia care, learning disabilities, and distressed behaviours. There was no evidence of recent medication training for two bank nurses. The manager advised that this would be addressed as a matter of priority and that these staff members would not be responsible for administering medication until they had successfully completed up-to-date training. Further work was needed to support the implementation of staff training into practice in areas including; wound care, supporting residents experiencing stress and distress and training relating to supporting people with learning disabilities for staff who work in the Crown Street unit. The provider needs to introduce a system of regular assessments of staff competency in key areas including; medication administration, wound care and moving and handling. (See recommendation 1). page 26 of 43

27 The provider had in place a tool for assessing service users' dependency levels. The manager advised that the provider was in the process of implementing a new tool which would also take account of service users' social, emotional and recreational needs. Grade 3 - Adequate Number of requirements - 0 Recommendations Number of recommendations - 1 Inspection report 1. In order to support on-going staff training and professional development the provider needs to fully implement its staff development policy including: - Regular staff supervisions and annual appraisals. - Identification of the training and development needs of all staff. - Further development of the service's training plan in accordance with identified staff training needs. - Supports to ensure that staff training is effectively implemented into practice. - Implementation of an effective system for assessing staff competence in areas of practice including medication administration, wound care and moving and handling. National Care Standards Care Homes for Older People: Standard 5 - Management and Staffing Arrangements. page 27 of 43

28 Quality Theme 4: Quality of management and leadership Grade awarded for this theme: 3 - Adequate Statement 2 We involve our workforce in determining the direction and future objectives of the service. Service strengths Staff told us that they felt that things in the home were improving. They stated that things had started to change for the better and that the management team were listening to their ideas and suggestions. The management team had developed an action plan to address staff's concerns identified in the recent staff survey. Staff felt that moral in the home had improved. New staff spoke highly of the support in place and demonstrated a very positive attitude to working at Kingsmead. Areas for improvement The management team should develop meaningful ways to share and review any learning outcomes, with staff, from incidents, complaints or concerns. This will help improve practice and review cultures. Grade 3 - Adequate Number of requirements - 0 Number of recommendations - 0 page 28 of 43

29 Statement 3 To encourage good quality care, we promote leadership values throughout the workforce. Service strengths The previous requirement made in relation to the quality assurance processes was met. How the management were using the quality assurance processes and systems had significantly improved. Areas for development and improvements in practice were starting to be identified. Action plans to address areas for concerns were implemented. The manager had an overall home action plan that was reviewed and monitored frequently by the Director of Care. The Director of Care had considerable input into the monitoring and assessing the home, this ensured that the outcomes for the residents continued to improve. The manager was now supported by two new deputies. Although the deputies did not have experience in the care home sector both showed commitment to improving residents' quality of life and further developing the service. Areas for improvement During the feedback at the end of the inspection we discussed the feedback we had received from visiting health professionals. The management team need to take a more open approach to engaging with their advice and guidance in order to support continuous improvements in the service. Grade 3 - Adequate Number of requirements - 0 Number of recommendations - 0 page 29 of 43

30 4 What the service has done to meet any requirements we made at our last inspection Previous requirements 1. The service provider must ensure that service users' dignity, and choice are respected. In order to do this the provider must ensure that individual needs and preferences for care and support are met. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210) Regulation 3 - A provider of a care service shall provide the service in a manner which promotes quality and safety and respects the independence of service users, and affords them choice in the way in which the service is provided to them. Timescale: To be completed by 1 March This requirement was made on 10 November 2015 See quality theme 1 - statement 1. Met - Within Timescales 2. The service provider must improve systems to ensure effective complaints management, and communication with residents and relatives. The provider must: a. comply with the providers' complaints policy. b. respond appropriately to verbal concerns or complaints. If verbal complaints are given less attention than written complaints, this must be fully explained in the complaints procedure. c. ensure the record of communication with families, included in the care plan, is accurate, complete and up-to-date page 13 of 35. d. ensure staff receive appropriate training about dealing with complaints. e. improve the way concerns and complaints are audited. This is in order to comply with: The Social Care and Social Work Improvement page 30 of 43

31 Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210) Regulation 4(1)(a) - requirement for the health and welfare of service users. Regulation 5(1) - requirement for personal plans. Regulation 18 - requirement about complaints. And The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210) Regulation 4 - requirement for records all service must keep and SSI 2002/114 Regulation 19(3)(d) - requirement about records. Timescales: Elements a,b & c on-going. Elements d & e completed by 1 March This requirement was made on 10 November 2015 See quality theme 1 - statement 1. Met - Within Timescales 3. The provider must ensure service users' rights to receive visitors, according to their known wishes, are upheld, unless there is clear evidence of a risk to the health, welfare and safety of service users or staff. This is to comply with: Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, Scottish Statutory Instruments 2011/210 section 3: Principles - A provider of a care service shall provide the service in a manner which promotes quality and safety and respects the independence of service users, and affords them choice in the way in which the service is provided to them. And with: National Care Standards: Care Homes for Older People - Standard 16: Right to a Private Life, and Standard 17: Daily Life. Timescale: To commence immediately upon receipt of this letter. This requirement was made on 08 February 2016 See quality theme 1 - statement 1. Met - Within Timescales Inspection report page 31 of 43

32 4. The provider must ensure that people using the service are given the correct support to maintain a standard of hygiene and personal appearance that is acceptable to them and which respects their dignity. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210) Regulation 3. A provider of a care service shall provide the service in a manner which promotes quality and safety and respects the independence of service users, and affords them choice in the way in which the service is provided to them. Welfare of users Regulation 4. (1) A provider must: (a) make proper provision for the health, welfare and safety of service users; (b) provide services in a manner which respects the privacy and dignity of service users. Timescale: To be completed by 1 March This requirement was made on 10 November 2015 See quality theme 1 - statement 3. Met - Within Timescales Inspection report 5. The provider must ensure that people using the service who experience behaviour changes have an appropriate assessment, and individualised plan of care which sets out the actions to be taken to support their distress reactions. The provider must ensure that staff consistently respond promptly and appropriately to residents who experience distress. The provider must also ensure that staff are skilled to provide effective care and support in such instances. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210) Regulation 4. (1) A provider must: (a) make proper provision for the health, welfare and safety of service users; (b) provide services in a manner which respects the privacy and dignity of service users. page 32 of 43

33 Timescale: To be completed by 1 March This requirement was made on 10 November 2015 See quality theme 1 - statement 3. Not Met 6. The provider must ensure that the meal time experience for residents' is improved. In order to do so, the provider must: - Ensure adequate dietary provision for residents with particular dietary needs. - Undertake a review of the meal time experience for service users taking the timing and delivery of meals into consideration. - The meal times must be managed effectively and this must include designated 'table/room' management and closer attention to those service users who require prompting and supervision or direct physical assistance with eating and drinking. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210) Regulation 4. (1) A provider must: (a) make proper provision for the health, welfare and safety of service users; (b) provide services in a manner which respects the privacy and dignity of service users. Timescale: To be completed by 1 March This requirement was made on 10 November 2015 See quality theme 1 - statement 3. Met - Within Timescales 7. The provider must improve risk assessment, care planning and follow-up in relation to falls prevention and management to ensure the timely provision of specialist advice and other preventative measures. This is in order to comply with: The Social Care and Social Work Improvement page 33 of 43

34 Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210) Regulation 4. (1) A provider must: (a) make proper provision for the health, welfare and safety of service users; (b) provide services in a manner which respects the privacy and dignity of service users. Timescale: To be completed by 1 March This requirement was made on 10 November 2015 Although met see quality theme 1 - statement 3, requirement 3. Met - Within Timescales 8. The provider must demonstrate that the service has systems in place to ensure that the needs of the individual resident are regularly assessed, monitored and adequately met. In order to do this you must: - Ensure that planned support is fully implemented when people have specific health needs including communication, pain, falls, moving and handling; - Demonstrate that staff will seek advice from relevant healthcare professionals promptly when residents require treatment or their health condition is not improving; - Ensure that staff have the necessary skills and experience to assess when residents require further assessment, investigations or treatment; - Ensure that staff have the necessary skills and experience to implement recommendations and advice provided by external healthcare specialists; - Ensure that managers monitor and audit health needs robustly. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations, Scottish Statutory Instruments 2011/210: Regulation 4 (1)(a) - a requirement for the health and welfare of service users: Regulation 4(2) - a requirement about proper provision of adequate services from any health care professional and Regulation 15(b)(i) - a requirement about training. Timescale: To be completed by 1 March This requirement was made on 10 November 2015 Inspection report page 34 of 43

35 Requirement rewritten to reflect areas improvement required. See quality theme 1 - statement 3, requirement 2. Not Met 9. The provider must demonstrate that personal plans record all risk, health, welfare and safety needs in a coherent manner which identifies how needs are met. In order to do this the provider must: - Ensure that documentation and records are accurate, sufficiently detailed and reflect the care planned or provided; - Provide training so that staff are aware of their responsibility in maintaining accurate records, retaining records and follow best practice including NMC guidance; - Provide training about the use of healthcare assessment tools including MUST and pressure risk assessments; - Ensure that staff know policy and best practice; - Demonstrate that managers are involved in monitoring and the audit of records. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations, Scottish Statutory Instruments 2011/210: Regulation 4(1)(a) - a requirement for the health and welfare of service users: Regulation 5(1) - a requirement for personal plans: Regulation 9(2)(b) - a requirement about fitness of employees and Regulation 15(b)(i) - a requirement about training. Timescale: To be completed by 1 March This requirement was made on 10 November 2015 Requirement rewritten to reflect areas improvement required. See quality theme 1 - statement 3, requirement 3. Not Met Inspection report 10. The approach to skin care and tissue viability requires to be improved. In order to do this the provider must: - Ensure that staff assess and manage skin care in line with best practice; - Implement a pain assessment tool to demonstrate that staff assess and manage all symptoms; page 35 of 43

36 - Improve care plan documentation to ensure that a clear complete and accurate record of skin care is kept; - Demonstrate that staff will contact a General Practitioner (G.P) or other relevant healthcare team member when people who use the service require treatment or their condition is not improving. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations, Scottish Statutory Instruments 2011/210: Regulation 4 (1)(a) - a requirement for the health and welfare of service users. Timescale: To be completed by 1 March This requirement was made on 10 November See quality theme 3 - statement 3. Not Met 11. The provider must take steps to ensure that all staff working in the service have a demonstrable understanding of how to improve the outcomes for the residents. Staff must receive appropriate training which will equip them with the skills and competencies required to meet the care and welfare needs of all of the service users, and the aims and objectives of the service. This must be informed by a training needs analysis of the home staff. This must be supported by a consistent, structured supervision and appraisal system which is focused on performance and supports staff to contribute to the development of a quality service. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210) Regulation 15 - A provider must, having regard to the size and nature of the care service, the statement of aims and objectives and the number and needs of service users - (b) ensure that persons employed in the provision of the care service receive: (i) training appropriate to the work they are to perform; Timescale: To be completed by 1 May Inspection report page 36 of 43