Care service inspection report

Transcription

1 Care service inspection report Full inspection Kynnaird House Care Home Care Home Service 76 Commerce Street Fraserburgh Inspection completed on 26 May 2016

2 Service provided by: Daviot Care Limited Service provider number: SP Care service number: CS Inspection Visit Type: Unannounced Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and set out improvements that must be made. We also investigate complaints about care services and take action when things aren't good enough. Please get in touch with us if you would like more information or have any concerns about a care service. Contact Us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com page 2 of 28

3 Summary This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change after this inspection following other regulatory activity. For example, if we have to take enforcement action to make the service improve, or if we investigate and agree with a complaint someone makes about the service. We gave the service these grades Quality of care and support 4 Quality of environment Quality of staffing 4 Quality of management and leadership Good N/A Good N/A What the service does well Residents and relatives expressed confidence in the management and staff team at Kynnaird House. Residents and relatives found the home to be very homely. Staff were enthusiastic and caring in their approach to residents. Residents' likes and needs were known by the staff. What the service could do better Staff could help residents be more involved in household activities and to do things for themselves, like spread their own breads. Some improvements to the home, like changing the colour of toilet seats, will help people who have poorer sight. The manager needs to check the references given for staff so that proper recruitment practices as followed. page 3 of 28

4 What the service has done since the last inspection Inspection report A requirement made about medication was seen to met. The local pharmacy was auditing staff practice and actions from an action plan had been put in place to make sure residents were properly supported by staff with their medication. Residents had been involved in taster sessions to influence the new summer menu. Conclusion We saw that a good care service continued to be provided by enthusiastic, caring staff. Residents were quite satisfied with the quality of the care provided at Kynnaird House Care Home. The staff and management were committed to continuing to develop and improve the standards of care. page 4 of 28

5 1 About the service we inspected Inspection report Kynnaird House Care Home is a purpose-built, three-storey building. The home is registered to provide residential and nursing care for a maximum of 41 older people. The home is situated centrally in the harbour town of Fraserburgh. At the time of inspection there were 40 residents in the home. The service aims to "provide personal care, nursing care and residential support services to frail older people". This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at Recommendations A recommendation is a statement that sets out actions that a care service provider should take to improve or develop the quality of the service, but where failure to do so would not directly result in enforcement. Recommendations are based on the National Care Standards, SSSC codes of practice and recognised good practice. These must also be outcomes-based and if the provider meets the recommendation this would improve outcomes for people receiving the service. Requirements A requirement is a statement which sets out what a care service must do to improve outcomes for people who use services and must be linked to a breach in the Public Services Reform (Scotland) Act 2010 (the "Act"), its regulations, or orders made under the Act, or a condition of registration. Requirements are enforceable in law. We make requirements where (a) there is evidence of poor outcomes for people using the service or (b) there is the potential for poor outcomes which would affect people's health, safety or welfare. page 5 of 28

6 Based on the findings of this inspection this service has been awarded the following grades: Quality of care and support - Grade 4 - Good Quality of environment - N/A Quality of staffing - Grade 4 - Good Quality of management and leadership - N/A 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 28

7 2 How we inspected this service The level of inspection we carried out In this service we carried out a low intensity inspection. We carry out these inspections when we are satisfied that services are working hard to provide consistently high standards of care. What we did during the inspection This report was written following an unannounced inspection carried out over two days by one inspector on 25 May 2016 from 9:30am to 6:15pm and 26 May 2016 from 9:45am to 4:15pm. We gave feedback to the manager, the area manager and a contracts officer from the local authority commissioning team at the end of the second day of the inspection visit. We issued 20 Care Standards Questionnaires (CSQs) to the service for random distribution to people who used the service (residents), 20 for relatives or other representatives and 20 for staff. We received back 10 questionnaires from residents, seven from relatives and, disappointingly, none from staff. We gathered evidence from various sources, including relevant sections of policies, procedures, records and other documents. We spoke with the following people, both formally and informally: - eight residents - three relatives - manager of the service - area manager - ten members of staff, including: - carers - nurses - the handyman - domestic staff - catering staff. We looked at: page 7 of 28

8 - evidence from the service's annual return - action plan submitted to us following the last inspection in June personal plans and records for residents - staff diaries - staff records - staff rotas - management audit and quality monitoring records - minutes of staff meetings - accidents and incident records - CSQs requested by us - surveys carried out by the service - minutes of focus group meetings - newsletters - general notices and information on display. In addition, we carried out an examination of equipment and the general environment of the home and we also observed how staff worked with residents, each other and visitors to the home. 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 an individual resident during a large group activity. Grading the service against quality themes and statements We inspect and grade elements of care that we call 'quality themes'. For example, one of the quality themes we might look at is 'Quality of care and support'. Under each quality theme are 'quality statements' which describe what a service should be doing well for that theme. We grade how the service performs against the quality themes and statements. Details of what we found are in Section 3: The inspection page 8 of 28

9 Inspection Focus Areas (IFAs) Inspection report 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 28

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. A comprehensively completed self assessment was submitted to us within the timescales given. The service had identified areas of strength as well as areas for developments. There was some evidence that the service had consulted with residents, families and staff to inform the self assessment, using the information from the focus meetings. Taking the views of people using the care service into account We spoke with eight residents, formally and informally, throughout our inspection. We received back 10 CSQs out of 20 we asked the home to randomly distribute. All residents indicated that, overall, they were happy with the quality of the care provided to them. Comments made in the CSQs, in person to us, in residents' review minutes, the service's questionnaires, and thank you cards were used to inform our report and included: - "This is a home from home." - "Staff are all very lovely; caring and kind and helpful. The food is always lovely. We are so lucky." - "I am totally satisfied in all aspects." - "Food is good here." page 10 of 28

11 - "I am very comfy here. I like the TV." - "There never seems to be enough staff for busy times. I have to wait to go to the toilet day or night." - "I would like more fruit in my diet, fresh or tinned." We concluded that, overall, residents are generally happy with the care at Kynnaird House Care Home. Taking carers' views into account Carers include family, friends, advocates and visiting professionals. They do not include staff. We spoke with three visiting family members/friends during this inspection. We received back seven CSQs out of 20 sent. All people indicated that, overall, they were very happy or happy with the quality of the care provided. Comments from people in person or in the CSQs returned to us and the service, as well as review minutes included: - "This is an amazing place. It's a lovely home. It's a home! They're great here; you couldn't get better. They keep us so well informed, we like that. They tell us what they do about health and wellbeing, like weighing them to keep an eye. They help my friend. I canna praise them enough. They're great. It's hame!" - "You couldn't get better care than here." - "Staff are very attentive and caring. We are very much involved in everything here." - "Excellent manager, I have great faith in her abilities. She is prompt to address any concerns." - "I get told about anything to do with my relative. The nurses are on the ball." page 11 of 28

12 - "It's mostly local staff with local language." - "Delighted with the care. Staff are caring, helpful, cheerful, and friendly." - "The manager and her team made myself and my mother feel welcome and presented a level of professionalism that was very impressive." - "Staff need to wear name badges. That is so very important, especially for older people who find it hard to remember names." - "Concerned and upset at the time to be taken to the toilet once the request has been made." - "When visiting, kitchens that are for relatives' use can be messy and untidy." We concluded that, overall, carers were happy with the care provided at Kynnaird House Care Home. page 12 of 28

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: 4 - Good Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths We found evidence that the service was performing to a very good standard to ensure service users' health and wellbeing needs were being met. We saw that staff, residents and visitors had very good relationships with each other. The residents and staff were seen to be enjoying gentle banter with each other on both days of the inspection. Staff appeared very motivated to ensure residents' health and wellbeing needs were being properly met. We saw very warm and caring interactions between various people in the home. We saw that the multi-disciplinary team of health professionals were involved and properly consulted to ensure residents were properly supported with their health and wellbeing needs. The home had moved to using original packaging for medication from a monitored dosage system. Original packaging is in keeping with current best practice. We saw that staff had improved how they administered and recorded the support residents received with their medication. The staff were working with the local pharmacy who had carried out a full medication audit and had suggested areas for development. An action plan had been developed by the page 13 of 28

14 manager. Although there were some areas to develop as identified by the pharmacy audit and as noted below, the requirement made at previous inspections was seen to be met. Two new champions had been identified for oral care and were working with the Caring for Smiles team to promote good oral care for residents. When speaking with residents we could see that residents' oral health appeared good. This showed that residents, where needed, were being properly supported by staff. Through discussions with staff and records we looked at, we saw that a good training program to suit all grades of staff was being implemented to ensure good healthcare for residents. A very enthusiastic training co-ordinator very actively and enthusiastically promoted staff to attend training events which included caring for people's health needs. Personal protective equipment (PPE) was stored in places staff could easily access it, such as in all bathrooms. We saw that there was a great range of activities being enjoyed by residents throughout both days of our unannounced inspection. These included individual and group activities. Activity planners were on display so people could see what had been organised (see areas for improvement). Fruit and vegetables were promoted by staff. We saw residents being offered cut up fruit and smoothies on both days of the inspection. Food items in fridges were being properly stored in keeping with food safety guidance. Staff were seen to properly report and make records about accidents and incidents and action that required to be taken. We saw that residents' care plans and risk assessments had been updated, where needed, following accidents or incidents. All the records were monitored monthly by the management team. The records could benefit from having a reminder to note, where applicable, that family have been informed (see areas for improvement). page 14 of 28

15 Areas for improvement We saw one example where medication which is only given by staff to residents when required for a particular reason, such as pain or severe distress, needed more detailed descriptions recorded by staff about why they had given the medication and what the effect of that medication was for the resident. As noted previously, monitoring of medication was being carried out by staff and an external pharmacy. We would encourage the service to develop more meaningful everyday activities for residents to be involved in that enable residents to retain their skills and independence. These include being involved in more household tasks, such as setting and clearing tables, folding linens, sweeping the floor after meal times, and so on. Staff should also enable residents, where appropriate, to be more independent with things such as spreading their own breads and putting in their own sugar/milk in drinks, for example. We will follow this up at future inspections. The service should develop head injury protocol for all staff to follow when a resident has or is suspected of having a head injury. We will follow this up at the next inspection. Residents and families told us that sometimes the wait after buzzing for help and before help is actually given to go to the toilet can be quite long. The staff and management should look at how the wait times for residents can be reduced. We saw that fluid and nutrition recording sheets had not been totalled by staff on a daily basis. These should be evaluated by staff to see if the resident was being enabled to receive proper fluid and nutrition. We will follow this up at the next inspection. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 15 of 28

16 Statement 4 We use a range of communication methods to ensure we meet the needs of service users. Service strengths There was evidence that the service used a good range of communication methods to ensure that they met the needs of residents. We saw in the residents' care plans that some information had been recorded about the residents' individual communication needs and likes and dislikes. We saw that staff had a daily handover meeting to pass on important information to other staff coming on duty. A daily flash meeting was held with all the heads of departments to discuss the day's events and residents' needs. We saw a very good example of residents' likes and dislikes being considered at this flash meeting. Instead of one type of sauce being provided with the lunch, a choice of three were to be made to take account of residents' likes and dislikes. Some residents, who chose, had been involved in food tasting sessions to help design new menus. Some of the good range of communication skills included: - Staff made good use of eye contact with residents to keep their attention. - Staff were using gestures and pointing to enhance communications with residents. - Information was to hand for staff to know each resident's food preferences, including portion size. - Some staff had received dementia training. Inspection report - Some signs and pictures were on walls and doors to help people know where things were, such as bathrooms. - A recent survey had been conducted to determine people's views about the service. page 16 of 28

17 - Notice boards were used to keep people informed about events and plans. The service should be aware of having too much information on display, such as 'over-postering' as people can't determine what is relevant or new. The You Said, We Did board was to be updated following the recent survey. - Menus were on the tables. - Newsletters from the home and the organisation were published and distributed to residents and relatives. - Focus meetings were held for residents and relatives. - Regular reviews of care were held involving, where appropriate, representatives of residents. - An audible and visible nurse call system was in place throughout the home. We found that this was answered promptly over both days of our inspection. Areas for improvement Some information in the care plans could provide more detail about a resident's or family's preferences. This included bathing preferences and when to contact families about significant events. One of the service's own questionnaires highlighted that 'sometimes' relatives are made to feel welcome. This implied that sometimes this person did not feel as welcomed. The manager told us she had discussed this with staff group who felt this may have been because sometimes they were busy and not always able to stop and speak with relatives. The manager told us she had recently held a discussion with staff about how important it was to ensure a warm welcome but to also say when they were busy with other residents' needs. The computerised care plans did not have a photo of the person the records were about. The photos are a good visual reminder for staff of who the person is that they are making records about. The management agreed to ensure page 17 of 28

18 photos were added to the computer records. We will monitor this at the next inspection. Menus could be further improved to give more visual clues to people, including the use of photos of the meals on offer. As well as helping to stimulate appetite, the photos can aid the resident to prepare for the meal. We will follow this up at the next inspection. We saw some areas of the environment that could be improved. The emergency pull cords in some bathrooms were tied up out of reach, including in a disabled toilet on the ground floor that is usually used by visitors. Some toilet seats were not in keeping with best practice for dementia care. White toilet seats on white toilets with no contrast to the décor can make it hard for people with sight problems and/or dementia. The management could consider carrying out an environmental audit using the dementia environment tools, that can be found on our website careinspectorate.com, which can help look at improving the environment. The service was considering changing an unused bathroom into a hairdressing salon. This would help further improve the residents experience at the hairdresser. Grade 4 - Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 18 of 28

19 Quality Theme 2: Quality of environment Quality theme not assessed page 19 of 28

20 Quality Theme 3: Quality of staffing Grade awarded for this theme: 4 - Good Statement 2 We are confident that our staff have been recruited, and inducted, in a safe and robust manner to protect service users and staff. Service strengths There was good evidence that staff had been recruited and inducted in a safe and robust manner to protect service users and staff. We observed practice, examined recruitment documentation and spoke with staff to gather evidence about this statement. Examination of recently employed staff recruitment files demonstrated that staff were employed following proper procedures and checks, including checking references, one of which was from the staff member's most recent employer. Checks were made to ensure staff belonged to the Protection of Vulnerable Groups (PVG) Scheme register (see areas for improvement). Most care staff were appropriately registered or applying to register with professional bodies, such as the Scottish Social Services Council (SSSC) as required by the SSSC for social care workers or the Nursing and Midwifery Council (NMC) for trained nurses. Staff were initially employed on a probationary period which they had to progress through before being kept on as permanent staff. We sampled the staff rota and saw that a good mix of staff grades and skills were in place. Staff told us and we saw from records that staff were given an induction to the residents and the home which included time to observe the practice of other staff. page 20 of 28

21 We saw training plans and schedules were in place for staff to learn about topics relevant to residents' needs. The training champion for the home was very enthusiastic and committed to ensuring staff were able to undertake training. We saw a high compliance of staff carrying out appropriate training events for their roles. Staff told us they had good induction and training opportunities. Staff received individual support and supervision sessions with the management team. Staff were able to tell us the proper actions to be taken if they had any concerns about the protection of residents or if they saw poor practice. Areas for improvement Some staff had not been registered with the SSSC within the timescales as required. We saw that the management were taking action to address this to ensure all the care staff are properly registered. We have requested that we be kept informed on a weekly basis about the progress of the applications made outwith the timescales. One of the staff recruitment files we examined contained a 'to whom it may concern' reference. The manager should have taken further action to confirm the validity of the references supplied. We have made a recommendation in relation to recruitment procedures and processes (see Recommendation 1). We found that the staff recruitment files needed improvement, including tidying into a logical order. The organisation's file checklists had not been properly completed. Interview schedules and ratings of a candidate's performance and abilities had not always been carried out to evidence why a candidate was suitable for the post they had applied for. Tidying into a logical order would help enable the provider to be confident and satisfied as far as possible at each stage of recruitment and selection that the candidate is safe to practice and that staff had been employed following proper recruitment procedures and process. We saw that some staff induction plans had not been completed in the timescales given by the organisation and many signatures and dates by the page 21 of 28

22 mentors were not recorded. The provider had conducted an audit just prior to our inspection and had already identified this area for development. Grade 4 - Good Number of requirements - 0 Recommendations Number of recommendations - 1 Inspection report 1. The manager should ensure proper recruitment procedures and processes are always followed, including checking the validity of references. These procedures and processes should be in keeping with the current best practice document Safer Recruitment Through Better Recruitment, which can be found at National Care Standards, Care Homes for Older People - Standard 5: Management and Staffing Arrangements. Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths There was evidence to demonstrate that the service performed to a very good standard to have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Staff were provided with a wide range of training to increase their learning and development in the care of the residents. The organisation's learning and development team visited the home regularly to deliver training in person, via e-learning and video link to staff. The training reports we examined showed a very high completion of staff training within the organisation's timescales. Staff liked the quality of the training delivered which they thought was relevant to their roles in caring for the residents. As noted earlier in the report, the home's page 22 of 28

23 training co-ordinator was highly motivated and enthusiastically encouraged and enabled the staff team to apply for and attend training events, including e- learning. A new supervision and staff appraisal system was about to be introduced by the organisation which included observations of staff practice. The organisation's learning and development co-ordinator had been enthusiastic about ensuring staff were trained to deliver care according to the Promoting Excellence in Dementia Care Standards. Staff were very friendly and approachable to both us and others in the home. Residents and their families spoke in high regard of the staff and management. Residents and families described the home as homely. Staff told us they feel very involved in what is happening in the home. Residents and relatives told us they had confidence in the manager to deal appropriately with any concerns. We would encourage the manager and staff to ensure all concerns or 'grumbles' are noted, where needed action taken and records made to evidence resolution. Staff and residents told us that there was a good atmosphere of teamworking in the service. We saw staff who were enthusiastic and caring about the residents and each other. Staff worked hard to provide a good level of care and support to residents. Concerns had been raised that staff were not always as friendly to visitors. The manager told us she had spoken to staff about this. She told us that staff advised her they were very busy and didn't always have time to stop and chat with visitors. Staff had been reminded of the importance to politely let the visitors know. We saw that staff were chatting in a relaxed way with residents and visitors. There were some very experienced members of staff who we saw were very good role models for less experienced staff, such as with encouraging fun in the group activities. Areas for improvement Examination of care plans showed that dependency levels were not being carried out every four weeks. Four out of the 10 respondents to our CSQs disagreed that there were enough staff on duty at any time. We examined the staff rotas and saw the minimum staffing levels were met. The manager should ensure the dependency levels of residents are carried out every four weeks to page 23 of 28

24 make sure the staffing levels and skill mix are meeting the residents' care needs. We will follow this up at future inspections. As noted earlier in this report, a daily flash meeting was held with all the heads of departments to discuss the day's events and residents' needs. Whilst these are very good communication and information sharing events for staff, the manager should ensure the level of detail about residents' care is appropriate for the staff roles. This includes the individual medical and personal care needs of residents. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 24 of 28

25 Quality Theme 4: Quality of management and leadership Quality theme not assessed 4 What the service has done to meet any requirements we made at our last inspection Previous requirements 1. The provider must ensure that medications are managed in a manner to protect the health and welfare of service users. In order to achieve this, the manager must: a) Ensure that staff made aware of up to date guidance on medication management. b) Ensure that staff implement best practice in relation to medication management. c) Ensure that records are maintained to evidence that prescribed topical medications are applied correctly. 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) - Welfare of Users. In making this requirement the following was considered: page 25 of 28

26 National Care Standards, Care Homes for Older People - Standard 15: Keeping Well - Medication. Timescale: immediate and ongoing. Inspection report This requirement was made on 03 August 2015 The service had changed the medication provider and the local pharmacy undertook an audit of medication practice the day before our inspection. Staff who administer medication had received medication training. We observed practice and had no concerns. An action plan had been implemented to address areas for development identified by the local pharmacy. Met - Within Timescales 5 What the service has done to meet any recommendations we made at our last inspection Previous recommendations There are no outstanding recommendations. 6 Complaints No complaints have been upheld, or partially upheld, since the last inspection. 7 Enforcements We have taken no enforcement action against this care service since the last inspection. page 26 of 28

27 8 Additional Information There is no additional information. Inspection report 9 Inspection and grading history Date Type Gradings 26 Jun 2015 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good 29 Jan 2015 Unannounced Care and support 2 - Weak Environment 3 - Adequate Staffing 3 - Adequate Management and Leadership 3 - Adequate 26 Mar 2014 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good 30 Oct 2012 Unannounced Care and support 5 - Very Good Environment 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good 29 Feb 2012 Unannounced Care and support 5 - Very Good Environment Not Assessed Staffing 5 - Very Good Management and Leadership Not Assessed 12 May 2011 Unannounced Care and support 5 - Very Good Environment 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good page 27 of 28

28 To find out more This inspection report is published by the Care Inspectorate. You can download this report and others from our website. You can also read more about our work online. Contact Us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY Other languages and formats This report is available in other languages and formats on request. Inspection report Tha am foillseachadh seo ri fhaighinn ann an cruthannan is c?nain eile ma nithear iarrtas. page 28 of 28