Care service inspection report

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1 Care service inspection report Full inspection Ranfurly Care Home Care Home Service 69 Quarrelton Road Johnstone Inspection completed on 08 July 2016

2 Service provided by: Silverline Care Caledonia 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 page 2 of 30

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 4 Quality of management and leadership 4 Adequate Good Good Good What the service does well People continue to say they like living in this home. They tell us the individual units are compact enough to be homely. They say the place is clean and warm and they feel safe here. What the service could do better The service should ensure that they work with the correct skills mix. We were shown the dependency levels that the service calculated monthly. Although staffing levels appeared to be above the dependency needs, peoples' perception particularly at night, would indicate that people are having to wait for long periods in order to get basic needs met. Some comments in questionnaires from people who use the service and their relatives, suggest that staffing levels are not adequate. Discussions with staff would also suggest the same. We have asked the manager to review the dependency tool that is currently being used and to ensure that it is completed accurately at all times. page 3 of 30

4 What the service has done since the last inspection Inspection report Some recommendations that had been raised at the last inspections had been met. The service had submitted and was working through their environmental improvement plan. Some improvement work was evident in different parts of the home. We will continue to monitor this at inspections. Conclusion The service should continue to ensure that people receive the good care and support that they talk about. Reassurance should be given to residents, relatives and staff that current set backs are being looked into. page 4 of 30

5 1 About the service we inspected Inspection report Ranfurly Care Home registered with the care inspectorate in September The home is located within Johnstone and is owned and managed by Silverline Care Caledonia Service Limited. The service is purpose built to provide accommodation for 60 older people. Ranfurly Care Home is set on two levels, sub divided into four units. Each unit has a choice of lounge areas, pantry, dining room, communal bathrooms and toilets. There is also a training room where staff undertake much of their inhouse training. A lift allows access to the upper floor. On the day of the inspection, there were 60 people using the service. 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 30

6 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 4 - Good Quality of management and leadership - Grade 4 - Good 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 30

7 2 How we inspected this service The level of inspection we carried out In this service we carried out a medium 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. This inspection took place on Wednesday 29 June 2016 between 8.15am and 5.30pm. The inspection continued on Monday 4 July 2016 from 9.30am until 4.30pm. We gave feedback to the home manager, and depute on Friday 8 July 2016 As part of the inspection, we took account of the completed annual return and self-assessment that the service submitted prior to the inspection. We sent twenty care standards questionnaires (CSQ) to the manager to distribute to people who use the service. We received ten completed questionnaires back from them. We also sent 20 CSQs to the manager to distribute to relatives and carers. We received five completed questionnaires from relatives of people who use the service. We also asked the manager to give questionnaires to staff and we received three completed questionnaire back. We selected the statements that we looked at during the inspection as we felt that these would give us a broader picture for the service's first inspection since it registered under a new provider. We also had recommendations to follow through within some of these statements. The recommendations had been raised at the last inspection. page 7 of 30

8 During the inspection process, we gathered evidence from various sources, including the following: We spoke with: - residents - relatives/carers - manager - depute - nurses - senior care workers - care workers - ancillary staff. We looked at: - the participation strategy. (This is the service's plan for how they will involve service users) - minutes of resident's meetings - newsletters - residents' and relatives' questionnaires - care plans and audits of care plans - medication records including audits of medication - staff training plan - staff supervision and appraisal log - accident and incident records - complaints log - the environment and equipment. We used the Short Observation Framework for Inspection (SOFI2) to directly observe the experience and outcomes for people who were unable to tell us their views. page 8 of 30

9 Grading the service against quality themes and statements We inspect and grade elements of care that we call 'quality themes'. For example, one of the quality themes we might look at is 'Quality of care and support'. Under each quality theme are 'quality statements' which describe what a service should be doing well for that theme. We grade how the service performs against the quality themes and statements. Details of what we found are in Section 3: The inspection Inspection report 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 30

10 The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. We received a completed self assessment from the service. The self assessment identified what the service did well and also where they felt there were areas to be improved. We asked the manager to reflect within the self assessment what the outcomes for people had been. Taking the views of people using the care service into account We received eleven completed care standard questionnaires (CSQ) prior the inspection. On the day of the inspection, we spoke with 20 people using the service. These were some of the comments that people made: 'Sometimes my blouses get mixed up and some things go missing.' 'Some staff are can be insensitive but not all.' 'The night staff do not always come when I buzz.' 'The room doesn't get the sun during the day and if you open the window you get a draft' 'Staff shortages especially at night time.' 'I like my own peace and quiet and go to my room whenever I want.' 'Staff shortage means there are times when I am alone in the lounge.' 'I am happy with the care I get although I would like to see more staff.' 'I have no complaints about anything.' page 10 of 30

11 'All is well for me.' Taking carers' views into account We received six completed CSQs prior to the inspection. On the day of the inspection, we spoke with six relatives of people who use the service. Relatives of people who use the service made the following comments: 'There appears to have been a reduction in staff numbers over the recent past.' 'Some furniture requires replaced.' 'Staff seem under stress at times in my mother's unit, and there are not enough of them to adequately monitor residents who wander into other residents' rooms.' 'Staffing is a big issue in this home, residents deserve better' 'I do not believe being short staffed any way hinders the care that my father receives. I feel however that the staff are run off their feet through no fault of theirs.' 'There is absolutely no problem with my mum's care here, I can actually sleep at night knowing she is being well looked after.' 'Staff communicate well with us.' 'They had a big party for mum for her 80th. It was lovely.' 'The staff in here work hard although I feel the ones in my mother's unit work even harder.' 'Staff are excellent, just not enough of them.' 'I have no complaints whatsoever.' 'I don't think my sister has any complaints. I am happy that she is happy.' page 11 of 30

12 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 Inspection report Statement 2 We enable service users to make individual choices and ensure that every service user can be supported to achieve their potential. Service strengths Within the support plans, we could see that people were given choice in different areas such as; choice between bath or shower, choice of when to rise from or retire to bed, and choice in food to eat. peoples' likes and dislikes were outlined in the support plans too. We were told by people that we spoke with that staff worked to honour these choices. People could also share their views and preferences through meetings and surveys that the service carried out. Some of the comment made included: 'Mum prefers her own company. We requested that she remains in her own room most of the time, and this is being honoured.' 'I like my own peace and quiet and I can go to my room whenever I want. Nobody makes me do what I do not want to do.' 'They had a big party for mum for her 80th. It was lovely.' page 12 of 30

13 Areas for improvement Information on the relatives communication was sometimes not as full as we would have expected it to be. For example no evidence of sharing information from a review meeting that they had not been able to attend, entries in relatives communication not made for long periods. We have asked the service to evidence clearer communication with relatives. Review minutes did not identify any goals that the individual had either achieved in the last six month period or that they would be working towards. Although some of the care files that we looked at had information on 'Getting to know me', these were not always fully completed and were missing completely in others. There was very little information recorded on people's wishes on death and dying. From the care files we looked at, we saw one anticipatory care plan towards end of life care. This had not been fully completed either. Grade 4 - Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 13 of 30

14 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths Residents appeared to be very comfortable with the staff that were supporting them. We reviewed individual care plans and found them to contain required relevant information including names or titles that people preferred to be called by. We also saw that people were assessed fully before they started using the service. This ensured that the service was prepared and could meet the needs of people who were coming in. We saw care plans that contained some very good information that guided staff about what care or support needs individuals had and how these should be delivered and met. These included; communication, eating and drinking and managing distressed behaviour. We saw monitoring charts such as weight, intake and output charts where these were required. The service had good links with other agencies. We could see where staff had advocated for residents. There were examples were staff had dealt with issues sensitively on behalf of residents to ensure positive outcomes for them. We looked at medication systems in one of the units. We were satisfied that the systems for ordering, storing and administering medication were in line with good practice. The people that we spoke with spoke highly of the care and support that they received here. Areas for improvement Some of the DNACPR forms that were seen, did not say whom this had been discussed and agreed with before it was put in place. page 14 of 30

15 We were concerned that sometimes there was a breach of confidentiality and information about some residents was shared with others when it should not have been. We spoke to the manager about the importance of staff reassuring any anxious relatives or residents without disclosing confidential information about another resident. (See requirement 1 under Quality Theme 1, Statement 3). During the inspection, in one unit, we observed staff practice that would be deemed as below acceptable standard. We discussed it with the manager and depute who have agreed to address it with relevant staff. (See requirement 2 under Quality Theme 1, Statement 3). When we looked at records of falls, we noted that there were no evaluation of falls and any learning and action to minimise the falls was not clear. Grade 3 - Adequate Requirements Number of requirements The provider must ensure that people's confidentiality is respected at all times and that no individual's confidential business is discussed with another without their consent. This is in order to comply with SSI 2011/210 Regulation 4(1)(b) requirement on welfare of users. Timescale for improvement: this is to commence immediately. 2. The provider must ensure that at all times people's immediate and urgent needs are met immediately. This will not only prevent individuals getting embarrassed, but will also ensure that their dignity is maintained. This is in order to comply with SSI 2011/210 Regulation 4(1)(a) and (b) requirement on welfare of users. page 15 of 30

16 Timescale for improvement: this is to commence immediately. Number of recommendations - 0 page 16 of 30

17 Quality Theme 2: Quality of environment Grade awarded for this theme: 4 - Good Inspection report Statement 2 We make sure that the environment is safe and service users are protected. Service strengths The service had policies and procedures on health and safety and for protecting people. Health and safety checks were carried out to ensure the service adhered to legislation and that people remained safe in the environment. We looked at the records of checks and maintenance and were satisfied that these were done to the required frequency. There was a secure door entry system with a signing in and out book so that every person coming in and out of the home was accounted for. We saw signage directing people to the different parts of the home. The gardens were enclosed and well maintained. The people we spoke with told us that they enjoyed these whenever they could get out. Incidents and accident forms were completed fully and steps to minimise the risk of the accident or incident happening again were put in place. There was a dedicated team of domestic staff who kept the home clean. Overall, the place looked in a good state of repair. On the whole, people that we spoke with told us that they felt safe here. Areas for improvement Within some of the linen cupboards, we noted that staff were storing their personal items such as jackets and bags. A vacuum cleaner was also stored in one of the linen rooms. We were concerned that storing outdoor items and cleaning equipment in the clean linen cupboard could be a risk of infection. We asked the manager to ensure that staff store personal belongings in the designated changing rooms and that equipment such as that used for cleaning page 17 of 30

18 is stored in the appropriate cupboards. (See recommendation 1 under Quality Theme 2, Statement 2). Although the outstanding repairs to the ceiling of one of the communal toilets had been carried out, the ceiling had yet to be painted. We have asked that this work be completed to improve the environment. Grade 4 - Good Number of requirements - 0 Recommendations Number of recommendations - 1 Inspection report 1. In order to protect people from any risk of infection, the service should ensure that staff outdoor clothing is stored in the staff changing rooms and that cleaning equipment is stored in the appropriate storage rooms and not in the linen room alongside clean linen. National care standards for care homes for older people, standard 4.2, Your environment. page 18 of 30

19 Statement 4 The accommodation we provide ensures that the privacy of service users is respected. Service strengths We observed staff being respectful and courteous by knocking on residents' bedroom doors before going in. People could choose whether they wanted to have their rooms. People that we spoke with told us that staff treated them with respect. The relatives of people in the service agreed with this and told us that this was important to them and that it made them feel good to see their loved ones respected in this manner. We saw a range of communal areas both large and small, that people could use either as part of a group or privately with their relatives. Personal belongings such as clothing that people came in with, were logged in the inventory log. Systems for managing peoples' valuables had been reviewed and safer systems were now in place. Records of accidents and incidents that took place in the service, were kept. Risk assessment were reviewed and updated and steps to reduce the chances of the accidents happening again were put in place. The organisation and the service, had policies in place for protecting people. The staff that we spoke with were all aware of these. page 19 of 30

20 Areas for improvement The programme to improve lighting in the home was on going. We will follow progress at the next inspection. A room with a door label 'Qualia' was being used a store room. In order to avoid confusion, we have asked the service to put the correct label on the door if this room is now going to be used as a store room. Grade 4 - Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 20 of 30

21 Quality Theme 3: Quality of staffing Grade awarded for this theme: 4 - Good Statement 2 We are confident that our staff have been recruited, and inducted, in a safe and robust manner to protect service users and staff. Service strengths We looked at three staff files. We noted that the service had a robust system in place to ensure safer recruitment of staff. References were sought and often followed up with a phone call for further clarity. The staff that we spoke with were motivated. They told us that they felt supported within the teams that they worked in. Staff underwent a robust induction when they first started in the service. We saw some staff training records. Staff were registered with relevant bodies such as Nursing and Midwifery Council (NMC) for nurses and the Scottish Social Service Council (SSSC), for social care workers. Areas for improvement The service should continue with ensuring that the newest staff members are also registered with the relevant bodies within the stated time scale. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 page 21 of 30

22 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths There were policies and procedures in place to ensure service users were protected from any abuse. Staff that we spoke with were clear about reporting issues that could have been deemed as abuse. Residents and relatives spoke highly of the staff. They described them as caring and hard working. We saw some records of formal supervision and appraisals. We observed staff working with residents. We were satisfied that the interactions between them were positive ones. Comments made about staff included: 'The staff in here work hard although I feel the ones in my mother's unit work even harder.' 'Staff are excellent, just not enough of them.' Areas for improvement Due to some activity in staffing, the service was not always working with the skills mix outlined in the staffing schedule nor were the staff regular. (See recommendation 1 under Quality Theme 3, Statement 3). Training in general had fallen behind in the service. We were assured that a new training company had been sought and would be commencing delivering staff training in the next couple of months. (See recommendation 2 under Quality Theme 3, Statement 3). page 22 of 30

23 When we spoke with staff, some of them told us that although there were platforms where they could raise issues, they did not always feel listened to or feel that their contributions were taken forward. They felt that this was contributing to the lower morale in the service.we discussed this with the manager. We have stressed that staff should ensure confidentiality at all times, especially when discussing residents. (See requirement 1 under Quality Theme 1, Statement 3). Grade 4 - Good Number of requirements - 0 Recommendations Number of recommendations The service should ensure that they work with the right skills mix as directed by the staffing schedule. National care standards for care homes for older people, standard 5. Management and staffing arrangements. Inspection report 2. In order that people using the service receive good quality care and support, the service should ensure that staff training, particularly training in dementia care, should be sought and delivered to staff. National care standards for care homes for older people, standard 5.1. Management and staffing arrangements. page 23 of 30

24 Quality Theme 4: Quality of management and leadership Grade awarded for this theme: 4 - Good Statement 3 To encourage good quality care, we promote leadership values throughout the workforce. Service strengths Staff in the service were supported through supervision. We saw reflective statements and support given to staff following critical incidents. Within the service there was a high level of staff qualified to the level of SVQ that was relevant to their job. All staff were registered with their relevant professional bodies such as NMC for nurses and SSSC for social care workers. Staff were aware of their respective codes of conduct. Staff told us they felt supported by their line managers and that they good peer support. Areas for improvement Staff training in different areas had suffered. We were assured a new training provider had been sought and that they would start delivering training in September (See recommendation 1 under Quality Theme 3, Statement 3). When we spoke with staff, it was not clear if they were clear what the aims and objectives of the service were. We were told that there were information sessions planned by the organisation where this would be shared. Grade 4 - Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 24 of 30

25 Statement 4 We use quality assurance systems and processes which involve service users, carers, staff and stakeholders to assess the quality of service we provide. Service strengths The organisation had systems to assure its quality. We could see that on the whole, audits picked out issues that needed to be improved. The service was scrutinised by other agencies such as the contracts and compliance team and environmental health team of the local authority. The service had completed and submitted both the self assessment and annual return as requested by us. Peoples' views on how to improve different aspects of the service were sought through surveys and meetings. People that we spoke with told us that they felt able to take any issues that they had to management. They said they were confident that these would be dealt with sensitively. The service had responded positively to a recommendation that we had raised at the last inspection about management of residents' finances and valuables. Procedures for storing and recording service user valuables had been improved to a satisfactory standard. Areas for improvement Some issues that should have been notified to the care inspectorate had not been. We had raised this with the service at the last inspection. The manager submitted these notifications to the care inspectorate as soon as they were brought to her attention. Grade 4 - Good Number of requirements - 0 Number of recommendations - 0 page 25 of 30

26 4 What the service has done to meet any requirements we made at our last inspection Previous requirements There are no outstanding requirements. 5 What the service has done to meet any recommendations we made at our last inspection Previous recommendations 1. As the shelf life of medications can be reduced once some medicines are opened, the service should ensure that bottles of liquid medication, eye drops or ointments and topical creams are marked with the date when they are first open and when they are due to expire. National care standards for care homes for older people, standard 15.6, Keeping well - Medication. This recommendation was made on 28 August 2015 We reviewed medication storage and administration in two of the units. We focused on ointments, topical creams and oral suspensions. We were satisfied that these were clearly marked with the date when they had been first opened and when they were due to expire. This recommendation has been met. page 26 of 30

27 2. In order that people using the service receive good quality care and support, the service should ensure that staff training, particularly training in dementia care, should be sought and delivered to staff. National care standards for care homes for older people, standard 5.1. Management and staffing arrangements. Inspection report This recommendation was made on 28 August 2015 We spoke with the manager at length about this. We were assured that a new training company had been sourced and that this company would start delivering a range of training to staff in September We saw documents to this effect. We will look at progress in this area at the next inspection. This recommendation has not been met. 3. The service should ensure that service users' valuables and financial transactions are carefully witnessed, recorded and audited on a regular basis and that these records are made available when required during inspection. National care standards for care homes for older people, standard 5.14, Management and staffing arrangements This recommendation was made on 28 August 2015 We reviewed how service users valuables and finances were stored and recorded and managed. We were satisfied with the new procedures that the service had implemented. These were to a satisfactory standard. This recommendation has been met. 4. The service should ensure that notifications of accidents, incidents and events as specified by Guidance of notifications that registered services should make, are submitted to the care inspectorate within specified timescales. National care standards for care homes for older people, standard 5, management and staffing arrangements. This recommendation was made on 28 August 2015 page 27 of 30

28 We looked at the accidents and incident records within the home since the follow up inspection in March We also looked at the Notifications that we had received. We found at least two situations that should have been notified to us in June We discussed the process of making Notifications and the correct guidance to use. The manager gave assurances that this practice would improve as soon as possible. This recommendation has not been met. Inspection report 6 Complaints No complaints have been upheld, or partially upheld, since the last inspection. 7 Enforcements We have taken no enforcement action against this care service since the last inspection. 8 Additional Information There is no additional information. 9 Inspection and grading history Date Type Gradings 17 Mar 2016 Unannounced Care and support Not Assessed Environment Not Assessed Staffing Not Assessed Management and Leadership Not Assessed 28 Aug 2015 Unannounced Care and support 4 - Good page 28 of 30

29 Environment Staffing Management and Leadership 4 - Good 4 - Good 3 - Adequate page 29 of 30

30 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 cànain eile ma nithear iarrtas. page 30 of 30

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