Springhill Home Ltd. Care Home Service. Care service number: CS Portland Road Kilmarnock KA1 2BS. Telephone:

Transcription

1 Springhill Home Care Home Service 80 Portland Road Kilmarnock KA1 2BS Telephone: Type of inspection: Unannounced Inspection completed on: 3 August 2016 Service provided by: Springhill Home Ltd Service provider number: SP Care service number: CS

2 About the service This service was previously registered with the Care Commission on 1 April 2002 and transferred its registration to the Care Inspectorate on 1 April Springhill House is registered to provide care to a maximum of 64 older people with physical and mental health difficulties, including types of dementia. A maximum of two of the bedrooms are double bedrooms and can be occupied by people making an informed choice to share a room. A maximum of five registered places may be used for respite care. At the time of the inspection, there were 54 people using the service. The home is located within a residential area of Kilmarnock, just a short distance from the town centre amenities. There is a bus stop outside the main gate and the train station is approximately a mile from the home. The building is a detached villa with a four storey purpose-built extension. The Georgian wing provides 11 bedrooms, two communal lounges and a dining room. The extension wing, has 52 bedrooms split over four floors. Garden (ground), Lavender (first floor), Loganberry (second floor) and Rosewood (top floor). Rosewood and Loganberry floors each have their own day room and Lavender and Garden floors have the option of accessing the two lounges within the main house, or smaller lounge located on the garden floor. This lounge also has a cinema screen and computer access. All bedrooms have en-suite facilities with shower, WC and wash basin. Alternative assisted bathing facilities are available on each floor. The inspection focused on standards of care for people living with dementia. We are using a sample of 150 care home services to look in detail at the standards of care for people living with dementia and this service is one of those selected as part of the sample. The areas looked at were informed by the Scottish Government's Promoting Excellence: A framework for health and social care staff working with people with dementia and their carers and the associated dementia standards. It is our intention to publish a national report on some of these standards during What people told us During our inspection visits, we spoke to ten residents and seven relatives to gain some insight and feedback about their levels of satisfaction with the service. In general, their responses were positive; however, some did raise concerns about; laundry, missing clothing, the passenger lift not working, staffing levels, consistency of staff practice and performance, the home currently under administration and the future. We received 21 completed Care Inspectorate questionnaires from residents when we asked them the question, 'Overall are you happy with the quality of care you receive in this care home?'. Three residents strongly agreed, 11 agreed and one disagreed with this statement. We also noted that seven residents stated they did not know they could complain to the Care Inspectorate. Some residents required assistance by the staff to complete questionnaires. We received 23 completed Care Inspectorate questionnaires from relatives when we asked them the question, Overall are you happy with the quality of care your relative receives at this care home?'. Seven strongly agreed, 13 agreed and one disagreed with this statement and one stated they did not know. page 2 of 23

3 Other issues relatives raised in their questionnaire returns included concerns over clothing and laundry, drinks not readily available, some issues over consistency of staff approach, concerns over lift not working and access to the garden area. Fourteen stated they did not know if there was a written agreement about occupancy rights in place. Seven disagreed and five did not know about the service's complaints procedures. We received many written comments from relatives in their returned Care Inspectorate questionnaires including: "Lift not working, again!" "I am concerned that Springhill is in administration." "In the main I think the nursing side of care seems okay. However main issues are, Lack of continuity when trying to speak to staff. This sometimes leads to communication issues messages not getting passed on. Food is not very appealing, also fruit is not offered. Laundry is an issue my relative on several occasions has been dressed in other people's clothes. Lack of privacy when discussing issues within the staff, on several occasions I have popped into the day room to discuss issues the staff remain seated amongst other residents and ask what the issue is." "Most of the staff are very pleasant and will go the extra mile, whilst some staff are note very helpful at all. Management are quite lax, I feel. They should be checking to see that staff are caring for the residents in a proper manner." "Clothes are forever going missing despite everything being labelled." "The garden area has been neglected this year, also the residents bedrooms need to be painted and upgraded." "During very warm spell of weather there was no cold water or juice available in the common room." "At times there are no drinks readily available to residents." "Staff respond to my relative in a personal and positive manner, I visit at different times of day and the standard of care is good, my relative looks relaxed, dressed appropriately with access to drinks." "Our relatives has only been in the care home for a few weeks we have seen a vast improvement in them. The staff have been very good regarding her personal care and needs. They are always polite when we visit, the management have been excellent regarding any requests we have made to make our relative more comfortable all in all we are very happy the way things are going." "I think the staff in the care home are very good." "When other professionals ask for care to be carried out unless I monitor the situation it is allowed to lapse." "We have found that while adequate the quality of the care depends on the member or staff on duty. As in any situation some staff members are more efficient and effective than others. There have been situations when residents requiring assistance have been left unattended in the lounge risking falls when the try to move. This is due I feel to a shortage of staff or poor planning. Perhaps management could be more visible or more readily accessible than has been the case." page 3 of 23

4 Self assessment We received the self-assessment on 6 August We had discussed this with the manager who had been absent for some time. Also the home is currently under administration therefore the late submission was accepted. From this inspection we graded this service as: Quality of care and support Quality of environment Quality of staffing Quality of management and leadership 2 - Weak 1 - Unsatisfactory 2 - Weak Quality of care and support Findings from the inspection The service continues to use an electronic care plan system with copies of this information printed and kept in some residents' bedrooms. We noted that the files in the residents' bedrooms were of differing quality and content. Some were not up to date and stored in a variety of different coloured types of folders and poly pockets. We advised the manager to review this and implement some level of consistency. The electronic files we reviewed also highlighted some inconsistencies in the quality of the documentation and information recorded. Some files had very good personal life histories and background information others were limited or lacking. We appreciate there can be difficulties in achieving this for some residents; however, we asked the manager to ensure as much of this information was gathered and presented in an easy access format for all staff to access. The care staff cannot access the care plans stored on an electronic system, only via nursing staff and managers. We advised the manager to address this situation and ensure that daily progress information is recorded by the care staff who provide personal care and support to the residents (see requirement 1). We found that legal documents including, Power of Attorney (POA), Adults with Incapacity (AWI) or Do not resuscitate (DNACPR) were stored in one folder, not in each resident's care file. We advised the manager to ensure that all legal documents were stored appropriately in each resident's file. We advised the manager to create a register of these documents and ensure they are correctly completed, regularly reviewed and updated (see requirement 2). We saw that care reviews were in place with the involvement of residents and relatives in this process. However, some of the information recorded from these reviews was limited. We advised a full record of the attendance, discussions and outcomes or action plans of these meetings was appropriately taken. We found that the staff team had engaged with other trained professionals including district nurse and community psychiatric nurses, to assist in supporting residents with various health or psychological support needs. However, the care files did not demonstrate clearly how the involvement of these professionals had page 4 of 23

5 influenced changes to the care plans or staff working practices. We noted gaps in the recording of the delivery of personal care provided to residents. During our visits, we observed staff engaging with residents in a polite and caring manner. We received some positive comments from residents and relatives about the quality of the care staff. Although, this was not consistent; some commented that not all staff operated to the same standards and that the management needed more involvement. Requirements Number of requirements: 1 1. The care planning system needs to be reviewed, the format of personal care plans and access for the care staff. The information stored in folders in residents bedrooms needs to be accurate, up to date and consistent, including the recording of personal care delivered and daily progress notes. This needs to include the involvement of the residents' and relatives'/representatives in the development of the personal plans, which must detail their needs, preferences and how these assessed needs are to be met in a way that they find acceptable. Full records of these discussions should be recorded. All legal documents should be stored appropriately in each individual's file. A register of individuals with such legal arrangements would be beneficial. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/2010) - Regulation 4(1)(a). Timescale: Within three months from receipt of this report. Recommendations Number of recommendations: 4 1. The home should review the meal time experience for all areas within the care home environment. This should include a review of the weekly menus and nutritional values and choice of meals provided. National Care Standards, care homes for older people - Standard 13: Eating well. 2. The manager should introduce a register of all legal documents including Power of Attorney, Guardianship Orders, Section 47 consent to treatment certificates (Adults with Incapacity (Scotland) Act 2000 and Do Not Attempt Cardio - Pulmonary Resuscitation (DNACPR) forms. 3. The manager and staff should continue to develop and implement the anticipatory care planning documentation within the service. National Care Standards, care homes for older people - Standard 6: Support arrangements, Standard 8: Making choices and Standard 11: Expressing your views. 4. The management should continue to address issues of consistency, performance, communication and teamwork amongst all staff within this home. To ensure that all staff are working to the same standards and quality in supporting the residents within the care home. page 5 of 23

6 Grade: 2 - weak Quality of environment Findings from the inspection At the time of the inspection, one of the passenger lifts was condemned and assessed as being unsafe to use. This requires complete replacement and will take several months before this can be rectified. Unfortunately, whilst this situation remains, we consider this to be unsatisfactory. This was, unfortunately, further compounded by the decision making process under the administration to authorise this expenditure for this item, thus resulting in a longer delay (see requirement 1). The manager had ensured that any residents affected by the lift were appropriately risk assessed. The administration has, however, undertaken some improvements to the care home environment and the feedback from manager, maintenance and other people we spoke to confirmed that things were better than before in terms of requests for new items and repairs management. However, there still remains a number of outstanding issues relating to the environment that require attention. The recommendation we made in the previous inspection report about ongoing improvements will therefore be repeated (see recommendation 2). During our visits, we noted unpleasant odours and smells in some parts of the home. We spoke to the deputy manager about purchasing air purifiers, which they immediately responded and purchased items to address this issue. We saw that the service had continued to implement and develop the signage within the home, this will remain an ongoing recommendation (see recommendation 1). We checked the moving and handling equipment and noted this was appropriately maintained and serviced by qualified engineers. This included any assisted bathing facilities, specialised beds or other equipment to assist with the personal care needs and comfort of residents. We saw that residents are supported to personalise their bedroom and we noted that this has continued with some bedrooms very well presented with photographs, ornaments, trophies and other items that help to create an individualised space. Requirements Number of requirements: 1 1. The provider must ensure that the passenger lift is replaced and restored to fully functioning order. This is in order to comply with: SSI 2011/210 Regulation 4 (1)(a) Welfare of Service Users - providers shall make provision for the health, welfare and safety of service users. page 6 of 23

7 Timescale: Within three months from receipt of this report. Recommendations Number of recommendations: 2 1. The service should review the use of signage within the environment to ensure that people can enjoy safe, comfortable, dementia friendly surroundings. The provider must ensure that the passenger lift is replaced and restored to fully functioning order. National Care Standards, care homes for older people - Standard 4: Your environment. 2. The provider needs to implement a programme of refurbishment to the areas of the home that require attention. We would want to see a planned programmed of developments that will improve the overall standard of the environment. National Care Standards, care homes for older people - Standard 4: Your environment. Grade: 1 - unsatisfactory Quality of staffing Findings from the inspection Overall, we found a staff team striving to deliver a good standard of care to their residents whilst working under challenging circumstances. We received some very positive statements from residents and relatives we spoke to during our inspection visits and their comments in returned Care Inspectorate questionnaires about the quality of the care staff. However, some commented that this was not consistent and not all staff operated to the same standard. During our visits, we observed staff engaging with residents in a polite and caring manner. Staff we spoke to, although concerned about the home under administration, demonstrated commitment to looking after the residents. We observed staff during their shift changeover and noted good communication about the residents needs and support requirements. In particular, if there were any major issues or concerns regarding an individual's health and wellbeing needs. There have been meetings with the staff to keep them updated on the situation with the care home and ongoing administration. These meetings also ensure that regular communication and updates of the residents and on going issues regarding the care and support of the residents is maintained. The manager had encountered some problems with the registration of care staff with the regulatory authorities. This was resolved and we have advised the manager to ensure that all staff maintain their appropriately level of registration relevant to their job roles. The manager should keep an ongoing monitoring system to ensure that this is regularly updated and staff take responsibility for ensuring their registration is valid. page 7 of 23

8 We made four recommendations in the previous inspection report regarding involvement of residents and relatives in the recruitment process, dementia training, staff supervision and relevant registration requirements. Whilst there has been progress in these areas, there remain gaps that need addressing. These recommendations will therefore be repeated. The management were continuing with a programme of staff supervision. The manager spoke of including elements from the My Home Life course they had recently completed. This would assist the staff to aid communication and reflective thinking within the supervision process. The service had implemented some training in dementia using the framework for excellence but this requires updating and further progress to ensure that all staff complete the level that equates to their job roles and responsibilities. We advised the manager to investigate the creation of a dementia ambassador within the care home. Requirements Number of requirements: 1 1. The manager needs to ensure that all staff employed with the service are appropriately registered with the relevant regulatory bodies such as Scottish Social Services Council (SSSC) and for the Nursing and Midwifery council (NMC) This is in order to comply with: SSI 2011/210 Regulation 15(a) - a requirement for a provider to ensure that at all times suitable qualified and competent persons are working in the care service in such numbers as are appropriate for the health and welfare and safety of service users. Timescale: Within one month from receipt of this report. Recommendations Number of recommendations: 4 1. The service needs to continue to develop ways in which residents and their relatives can participate in assessing and improving the quality of the staff from their recruitment to on going assessment and evaluation of their performance. National Care Standards, care homes for older people - Standard 11: Expressing your views. 2. The manager should use the Promoting Excellence framework, Scottish Government 2011 to review staff training and development to ensure that staff have the necessary knowledge and skills to meet the needs of people with dementia. 3. The manager should continue to develop their programme of individual staff supervision. The service should continue to increase opportunities for staff to influence the agenda and discuss matters relevant to them such as team work and care practice. page 8 of 23

9 National Care Standards, care homes for older people - Standard 5: Management and staffing arrangements, 4. The provider should put in place an annual training plan which addresses how staff will be supported to achieve the qualification requirements required for registration with the (SSSC) Scottish Social Services council. Grade: 3 - adequate Quality of management and leadership Findings from the inspection Although Springhill Home was put into administration on 27 January 2016, the initial discussion with the administrators and the representative of the care advisory company brought in by the administrators to assist with the running of the home, was generally positive. However, since then there have been a number of factors that have had a negative impact on the overall management and leadership of the care home. During this period, whilst the home was under administration, the company employed to provide support to the management of the care home has provided four different people to assist the management of the care home. Each providing action plans and requests for updates and audits from the management team at the home. This level of inconsistency and the time and effort taken in responding to these requests has not been as beneficial as it could have been. We saw that, although the company had produced some good, comprehensive actions plans, we found the management of the care home struggling to achieve progress. We advised the most recent consultant from the company to ensure that the one day per week provided for support was utilised effectively in supporting the management in practical terms to address some of the issues detailed in their extensive and comprehensive action plan (see requirement 1). The absence of the manager for four months during this period has also had a negative impact on the progress of the service. Although the deputy manager stepped in and took charge, they also had to cover shifts due to two qualified nursing staff leaving. Whilst under administration the service has difficulty recruiting or attracting nursing staff. Therefore, pressure is placed on existing nursing staff including the manager and deputy to cover shifts. This has resulted in a negative impact on the manager's ability to fully address actions plans and meet some of the requirements and recommendations made at the previous inspection. Whilst we recognise the efforts by the management and staff team at Springhill in continuing to maintain the service, the overall grade for management and leadership of the service has unfortunately deteriorated throughout this demanding period. During this inspection, we met with all parties and made clear our concerns, there were indicators to suggest potential progress in improving the standard of management and leadership. The administrators have implemented some positive changes and improvements to the environment including responded to requests for equipment. However, there remain a number of areas for improvement that have not progressed as much as we would have liked. As time moves on, these improvements become more urgent. The delay in authorising the lift replacement, which has had a considerable negative impact on the service, highlights the challenges to the service whilst it remains under administration. page 9 of 23

10 Requirements Number of requirements: 1 1. The provider must introduce and review the quality assurance systems and processes to ensure the quality of this service is improved. This should take account of the views of residents, relatives, staff and stakeholders. The manager should document and evidence where information gathered has led to improvements and developments to the service. This is in order to comply with: SSI 2011/210 Regulation 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. Timescale: Within three months from receipt of this report. Recommendations Number of recommendations: 3 1. The care advisory company retained by the administrator should implement and maintain consistency in the support they provide to the management of the care home. The one day per week support they provide should be utilised pragmatically to allow the care home management team to address some of the outstanding concerns raised during this inspection. 2. We need to see improvements in involving the staff team in the developments within the service. This should include listening to the staff team encouraging them to offer ideas suggestions and their evaluation of the quality of service provided. 3. The new administration and management structure within the care home needs to continue to implement procedures to ensure that appropriate levels of communication are maintained with residents, relatives, staff and stakeholders. Grade: 2 - weak page 10 of 23

11 What the service has done to meet any requirements we made at or since the last inspection Previous requirements Requirement 1 The provider must introduce and review the quality assurance systems and processes to ensure the quality of this service is improved. This should take account of the views of residents, relatives, staff and stakeholders. The manager should document and evidence where information gathered has led to improvements and developments to the service. This is in order to comply with: SSI 2011/210 Regulation 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. Timescale: Within three months of receiving this report. This requirement was made on 29 March Action taken on previous requirement We spent time reviewing the action plans provided by the appointed care advisory service and whilst we found these to be comprehensive and beneficial, we also recognised that the practicalities of achieving some of these did not take account of the additional workload demands on the management team within the care home. A number of the items from the action plans and audits have been completed whilst others are still in the process of completion and these remain ongoing. This requirement will therefore be repeated. Not met What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 The home should review the meal time experience for all areas within the care home environment. This should include a review of the weekly menus and nutritional values and choice of meals provided. National Care Standards, care homes for older people - Standard 13: Eating well. This recommendation was made on 1 September page 11 of 23

12 We observed several areas of the home during the meal times and noted variances in the quality of the setting and practices. We discussed this during our feedback meeting and noted in particular the top floor Rosewood dining area required attention and refurbishment. We would encourage the management to review this and seek to make improvements to the overall dining areas in this area of the home. (See quality theme 1, statement 3). This recommendation is NOT MET. Recommendation 2 The service should review the use of signage within the environment to ensure that people can enjoy safe, comfortable, dementia friendly surroundings. National Care Standards, care homes for older people - Standard 4: Your environment. This recommendation was made on 1 September We noted that some areas of the home had signage to help people with dementia; however, there still remains potential for further improvement and consistency throughout the home. (See quality theme 2, statement 2). This recommendation is NOT MET. Recommendation 3 The service should ensure that an accurate record of all maintenance and servicing records are up to date and filed accordingly. National Care Standards, care homes for older people - Standard 4: Your environment. This recommendation was made on 1 September We reviewed the maintenance records and spoke with the individual employed within the home to manage and monitor the repairs and general health and safety checks within the environment. We found the service responsive to any requests and immediately attended to any issues we reported to them. This recommendation is MET. Recommendation 4 The provider needs to implement a programme of refurbishment to the areas of the home that require attention. We would want to see a planned programmed of developments that will improve the overall standard of the environment. National Care Standards, care homes for older people - Standard 4: Your environment. This recommendation was made on 1 September During this inspection process we continued to find areas of the home that required urgent attention and refurbishment. We also noted that some changes had been implemented, this however needs to be consistent page 12 of 23

13 and we would need to see evidence of the continued investment and plans for further refurbishment and improvements. This recommendation is NOT MET. (See quality theme 2, statement 2). Recommendation 5 The manager needs to ensure that any issues raised by relatives regarding repairs or maintenance issues are promptly dealt with, this should include efficient communication with the relatives and make sure they are kept fully informed of progress in these matter. National Care Standards, care homes for older people - Standard 11: Expressing your views. This recommendation was made on 1 September We met with the newly appointed administrators and heard positive expressions from them of their commitment to addressing any ongoing issues and communicating effectively with relatives about the future of the care home. We reviewed some recent requests from relatives and responses undertaken by the current management of the care home. This recommendation is MET. Recommendation 6 The service needs to continue to develop ways in which residents and their relatives can participate in assessing and improving the quality of the staff from their recruitment to on going assessment and evaluation of their performance. National Care Standards, care homes for older people - Standard 11: Expressing your views. This recommendation was made on 1 September The management of the service will require additional time to address this recommendation, this will remain an ongoing area for development, we will review this at their next inspection. (See quality theme 3, statement 3). This recommendation is NOT MET. Recommendation 7 The service should continue to implement their recruitment procedures to ensure that suitable people employed to support vulnerable people within the care home environment. National Care Standards, care homes for older people - Standard 5: Management and staffing arrangement. This recommendation was made on 1 September We reviewed the staff recruitment files and noted that the management had ensured that the necessary procedures were in place prior to allowing anyone to work within the care home environment. This recommendation is MET. page 13 of 23

14 Recommendation 8 The manager should use the Promoting Excellence framework, Scottish Government 2011 to review staff training and development to ensure that staff have the necessary knowledge and skills to meet the needs of people with dementia. National Care Standards, care homes for older people - Standard 5: Management and staffing arrangements This recommendation was made on 1 September Although we noted that the service has made progress in providing this training to their staff team, it will take time to ensure that all the staff to complete the appropriate levels and modules within the Framework for Excellence model. (See quality theme 3, statement 3). This recommendation is NOT MET. Recommendation 9 The manager should continue to develop their programme of individual staff supervision. The service should continue to increase opportunities for staff to influence the agenda and discuss matters relevant to them such as team work and care practice. National Care Standards, care homes for older people - Standard 5: Management and staffing arrangements This recommendation was made on 1 September We reviewed the staff supervision records and noted gaps in the timescales for some of the staff team. We would need to see more consistent and frequent levels of supervision within the staff team. (See quality theme 3, statement 3). This recommendation is NOT MET. Recommendation 10 The provider should put in place an annual training plan which addresses how staff will be supported to achieve the qualification requirements required for registration with the SSSC. National Care Standards, care homes for older people - Standard 5: Management and staffing arrangements This recommendation was made on 1 September We spoke to the deputy manager and reviewed the training undertaken by the staff team and found evidence of some good training opportunities for the staff including, falls management, stroke awareness, dementia, medication and accessing on-line courses. There was a good attitude towards ensuring that the staff had the necessary skills and knowledge required of them. However, there needs to be a more consistent approach to ensuring that all staff have completed not just their mandatory elements of their training requirements but also additional specific courses. (See quality theme 3, statement 3). This recommendation is NOT MET. page 14 of 23

15 11. Frequency of team meetings need to improve. Although the manager had undertaken meetings with the staff, these were not frequent enough. The manager needs to coordinate a more regular programme of staff meetings to ensure that the team feel involved in the developments of the service. National Care Standards, care homes for older people - Standard 5: Management and staffing arrangements This recommendation was made on 01 September 2015 We reviewed the minutes of some staff meetings that had taken place but the frequency of these meetings were not enough to ensure that adequate communication and sharing of information was adequate. We would advise that at this important period of time that a more frequent and responsive meeting programme is implemented to ensure that all issues relating to the future developments within the service are adequately covered. (See quality theme 4, statement 2). This recommendation is NOT MET. 12. The provider also needs to be more involved in this process. We found an overall disconnect between the provider and management of the care home. We heard many comments from relatives and staff about the lack of involvement from the provider. We would therefore needs to see improvements in involving the staff team in the developments within the service. This should include listening to feedback from the staff team for suggestions, ideas and evaluation of the quality of care and support provided. National Care Standards, care homes for older people - Standard 5: Management and staffing arrangements. This recommendation was made on 01 September 2015 The care home has now been placed under administration by the court in response to actions taken by the bank. The owner/provider no longer has any dealings with this care home and as such all future interactions involving relatives will be directed to the appointed administrators and their representatives. We therefore cannot meet this recommendation until this level of engagement and interaction has been fully evaluated. (See quality theme 4, statement 4). This recommendation is NOT MET. 13. The service should be able to demonstrate how residents, relatives and staff are involved in the completion of the service self-assessment document. National Care Standards, care homes for older people - Standard 11: Expressing your views. This recommendation was made on 01 September 2015 We reviewed the recent self assessment returned by the service dated 23 February We noted that the document had been updated with regards to the administration of the home and meetings held by the administrators representatives and relatives. We also noted that the document made references to the continued planned involvement of the residents, relatives and staff with the developments within the care home. page 15 of 23

16 This recommendation is MET Recommendation 11 The home should review the mealtime experience for all areas within the care home environment. Although we observed some good practice, we also noted that some areas of the home required attention. This was discussed during the feedback meeting. The room utilised for residents dining on the top floor 'Rosewood' requires some urgent attention. National Care Standards, care homes for older people - Standard 13: Eating well. This recommendation was made on 29 March We noted that the administrators had authorised and implemented some refurbishment to the décor of the dining area on the top floor 'Rosewood'. However, this room which was previously a residents bedroom still has the en suite shower and toilet facility with the toilet removed the hole left has only been covered with a plastic bag. There have been some changes such as menus on tables and on the wall. However, these need to be up to date and accurately reflect the meals provided. The use of photographs could help people with dementia. This recommendation is Not Met. Recommendation 12 The service should review the use of signage within the environment to ensure that people can enjoy safe, comfortable, dementia friendly surroundings. National Care Standards, care homes for older people - Standard 4: Your environment. This recommendation was made on 29 March We noted that some improvements to residents bedroom using pictures and photographs. We advised the manager and deputy to utilise the Kings Fund al Assessment Tool to assist them with auditing the care home environment. Again some progress has been made but needs to continue before this recommendation is fully met. This recommendation is Not Met. Recommendation 13 The provider needs to implement a programme of refurbishment to the areas of the home that require attention. We would want to see a planned programmed of developments that will improve the overall standard of the environment. National Care Standards, care homes for older people - Standard 4: Your environment. This recommendation was made on 29 March We noted that some improvements in décor had been made to some areas of the home and that the administrator was authorising repairs in a more timeous manner. page 16 of 23

17 With the exception of the lift replacement and repairs to the ceiling of one bedroom which continues to lead during heavy rain. Therefore there still remains a number of cosmetic and major improvements to the care home environment before this recommendation is fully met. This recommendation is Not Met. Recommendation 14 The service needs to continue to develop ways in which residents and their relatives can participate in assessing and improving the quality of the staff from their initial recruitment through their ongoing assessment and evaluation of their performance. National Care Standards, care homes for older people - Standard 11: Expressing your views. This recommendation was made on 29 March As the service remains under administration the opportunity to involve residents and relatives in any recruitment of new staff is unlikely. We noted that the manager had developed questionnaires and from the feedback we received from residents and relatives there has been some involvement from them in their assessment and opinions of the quality and standard of the existing staff team. This recommendation will therefore be repeated. This recommendation is Not Met. Recommendation 15 The service should continue to implement the training programme based on the Promoting Excellence framework, Scottish Government 2011 to review all staff training and development to ensure that all staff have the necessary knowledge and skills to meet the needs of people with dementia. This recommendation was made on 29 March There has been some training undertaken by the staff team under the Promoting Excellence Framework. The overall service will need more time to ensure this is fully implemented throughout the entire staff team. The manager needs to ensure that staff complete the relevant level of module training under this framework. This recommendation is Not Met. Recommendation 16 The manager should continue to develop their programme of individual staff supervision. The service should continue to increase opportunities for staff to influence the agenda and discuss matters relevant to them such as team work and care practice. This recommendation was made on 29 March page 17 of 23

18 We noted some very good progress under this recommendation and staff we spoke to during this inspection confirmed this. We also noted the manager was planning to use recent knowledge gained from the My Home Life project to improve the supervision process. This still remains an ongoing process and will need time to be fully embedded within the care home. This recommendation is Not Met. Recommendation 17 The provider should put in place an annual training plan which addresses how staff will be supported to achieve the qualification requirements required for registration with the SSSC. This recommendation was made on 29 March Some recent issues had arisen with regards to some of the staff and their registration with the Scottish Social Services council (SSSC). We will review this again at the next inspection until then this recommendation will be repeated. This recommendation is Not Met. Recommendation 18 Frequency of team meetings need to improve. Although the manager had undertaken meetings with the staff, these were not frequent enough. The manager needs to coordinate a more regular programme of staff meetings to ensure that the team feel involved in the developments of the service. This recommendation was made on 29 March Whilst the home is under administration there have been several meetings to discuss and cascade information to the staff team at Springhill. We were satisfied that this level of communication was appropriate and necessary given the existing circumstances. This recommendation is Met. Recommendation 19 We need to see improvements in involving the staff team in the developments within the service. This should include listening to the staff team encouraging them to offer ideas suggestions and their evaluation of the quality of service provided. This recommendation was made on 29 March page 18 of 23

19 This recommendation will remain in place and we will review this at the next inspection. Whilst the home remains under administration the ability of the management to fully involve the staff team in future developments of the service will be difficult, until a new provider takes over the home and is able to engage with the staff team and implement these developments and improvements. This recommendation is Not Met. Recommendation 20 The new administration and management structure within the care home needs to continue to implement procedures to ensure that appropriate levels of communication are maintained with residents, relatives, staff and stakeholders. This recommendation was made on 29 March The management and leadership structure within the care home continues to require improvement. However, there has been good levels of communication through appropriate Care Inspectorate notifications from the manager and the deputy. With regards to the auditing procedures these need time to fully develop and embed them within the culture of the service. This recommendation is Not Met. Complaints Please see Care Inspectorate website ( for details of complaints about the service which have been upheld. Enforcement No enforcement action has been taken against this care service since the last inspection. page 19 of 23

20 Inspection and grading history Date Type Gradings 9 Feb 2016 Unannounced Care and support 4 - Good Management and leadership 1 Sep 2015 Unannounced Care and support 2 - Weak Management and leadership 2 - Weak 20 Jan 2015 Unannounced Care and support Management and leadership 2 - Weak 23 Oct 2014 Unannounced Care and support 1 - Unsatisfactory Management and leadership 1 - Unsatisfactory 12 Feb 2014 Unannounced Care and support 2 - Weak Management and leadership 1 - Unsatisfactory 16 Sep 2013 Unannounced Care and support Management and leadership 15 Mar 2013 Unannounced Care and support Management and leadership page 20 of 23

21 Date Type Gradings 31 Jul 2012 Unannounced Care and support Management and leadership 28 Feb 2012 Unannounced Care and support 2 - Weak 2 - Weak Management and leadership 2 - Weak 19 Jul 2011 Unannounced Care and support Not assessed Management and leadership 22 Apr 2011 Unannounced Care and support 1 - Unsatisfactory 2 - Weak Management and leadership 1 - Unsatisfactory 7 Feb 2011 Unannounced Care and support 1 - Unsatisfactory 2 - Weak 2 - Weak Management and leadership 2 - Weak 8 Jul 2010 Announced Care and support Management and leadership 16 Dec 2009 Unannounced Care and support 4 - Good 4 - Good Management and leadership 4 - Good 22 Jun 2009 Announced Care and support 4 - Good Management and leadership page 21 of 23

22 Date Type Gradings 24 Feb 2009 Unannounced Care and support Management and leadership Unannounced Care and support Management and leadership page 22 of 23

23 To find out more This inspection report is published by the Care Inspectorate. You can download this report and others from our website. Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and help services to improve. We also investigate complaints about care services and can 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. You can also read more about our work online at Contact us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com Find us on Facebook Other languages and formats This report is available in other languages and formats on request. Tha am foillseachadh seo ri fhaighinn ann an cruthannan is cànain eile ma nithear iarrtas. page 23 of 23