Care service inspection report

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1 Care service inspection report Full inspection Mugdock House Care Home Care Home Service Stockiemuir Road Bearsden Glasgow Inspection completed on 20 May 2016

2 Service provided by: BUPA Care Homes (ANS) 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 26

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 5 Quality of environment Quality of staffing Quality of management and leadership 6 Very Good N/A N/A Excellent What the service does well The welcome that people receive when they first move into the home is very reassuring to the individual. It helps people to settle into the home. The care and support delivered in this service is very person centred. What the service could do better The service should consider reviewing how the views of people are recorded in the care plans and within the review minutes. What the service has done since the last inspection The service has developed further links with the community. These links have had a positive impact on service users. page 3 of 26

4 Conclusion Inspection report The manager and staff continue to work hard to deliver a very person centred care. People enjoy living here. Many described it as living in a hotel with first class service.' page 4 of 26

5 1 About the service we inspected Inspection report The Care Inspectorate regulates care services in Scotland. Prior to 1 April 2011, this function was carried out by the Care Commission. Information in relation to all care services is available on our website at This service was registered with the Care Inspectorate in February Mugdock House Care home provides is a purpose built care home in Bearsden, Glasgow which provides residential care for a maximum of 64 older people. The care home is owned and managed by BUPA UK. The home is set over three levels with the ground floor catering for 32 older people living with dementia, whilst the first floor caters for 32 frail older people. The top floor is mainly staff facilities. On the day of the inspection 62 people were resident within the home. Recommendations A recommendation is a statement that sets out actions that a care service provider should take to improve or develop the quality of the service, but where failure to do so would not directly result in enforcement. Recommendations are based on the National Care Standards, SSSC codes of practice and recognised good practice. These must also be outcomes-based and if the provider meets the recommendation this would improve outcomes for people receiving the service. Requirements A requirement is a statement which sets out what a care service must do to improve outcomes for people who use services and must be linked to a breach in the Public Services Reform (Scotland) Act 2010 (the "Act"), its regulations, or 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 26

6 Based on the findings of this inspection this service has been awarded the following grades: Quality of care and support - Grade 5 - Very Good Quality of environment - N/A Quality of staffing - N/A Quality of management and leadership - Grade 6 - Excellent 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 26

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 We wrote the report following an unannounced inspection. The inspection was carried out by two inspector and an inspector volunteer on Thursday 12 May 2016 between the hours of 7.10am - 6pm and on Tuesday 17 May 2016 between the hours of 10am- 4pm. Feedback was given on Monday 20 June 2016 at 11.30am. In this inspection we gathered evidence from various sources, including the relevant sections of policies, procedures, records and other documents including: - certificate of registration - accident log - incident log - health and safety checks - complaints/suggestions log - quality assurance audits - personal plans - service user meeting minutes - information board - staff meeting minutes - staff supervision overview. We spoke with twelve residents and eight visitors on an individual basis. We also spoke with six staff and the management team. We sent out 20 questionnaires to service users and nine were completed and returned to the Care Inspectorate. We sent out 25 questionnaires to relatives of service users and two were completed and returned to the Care Inspectorate. page 7 of 26

8 We sent out 15 questionnaires to staff and seven were completed and returned to the Care Inspectorate. Grading the service against quality themes and statements We inspect and grade elements of care that we call 'quality themes'. For example, one of the quality themes we might look at is 'Quality of care and support'. Under each quality theme are 'quality statements' which describe what a service should be doing well for that theme. We grade how the service performs against the quality themes and statements. Details of what we found are in Section 3: The inspection Inspection Focus Areas (IFAs) In any year we may decide on specific aspects of care to focus on during our inspections. These are extra checks we make on top of all the normal ones we make during inspection. We do this to gather information about the quality of these aspects of care on a national basis. Where we have examined an inspection focus area we will clearly identify it under the relevant quality statement. Fire safety issues We do not regulate fire safety. Local fire and rescue services are responsible for checking services. However, where significant fire safety issues become apparent, we will alert the relevant fire and rescue services so they may consider what action to take. You can find out more about care services' responsibilities for fire safety at page 8 of 26

9 The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. We received a fully completed self assessment document from the provider. We were satisfied with the way the provider completed this and with the relevant information included for each heading that we grade services under. The provider identified what they thought they did well, some areas for development and any changes they planned. Taking the views of people using the care service into account We spoke with twelve individual service users. Some of their comments made were: 'I love it here, I have my friends.' 'My room is lovely, I have a nice view.' 'I couldn't ask for better care.' 'I've no complaints.' 'I'm content with the care I get.' 'Meals are very, very good.' 'No problem with the meals - I get a decent choice.' 'We've got the best chef.' 'I'd recommend Mugdock House to anyone.' 'What more do I need.' 'I manage fine here. I like to do some things for myself and they encourage me.' page 9 of 26

10 'Quality of the care is good. ' 'I'm not pressurised into anything.' 'My room is fine for me.' 'Housekeeping is very good.' 'A lovely room, with a lovely view.' 'I keep my room clean myself.' 'They clean and tidy my room when I'm at breakfast.' 'I like to sit in the gardens.' 'You sit outside when you want.' 'My grandkids play in the play area outside.' 'I've had my breakfast outside sometimes.' 'It's like a four star hotel.' 'There's loads of glass.' 'My room lets in lots of light; I hardly ever have my room lights on.' 'My visitors feel welcome - Tea and coffee are always provided.' 'Staff are made for the job - They are in the right job.' 'Couldn't say I've ever fallen out with any of them.' 'They are excellent.' 'Yes, they treat me with absolute respect.' 'They'll do anything for you.' 'They're more than helpful.' 'They're very nice people.' 'Friendly.' 'They're brilliant.' 'I feel confident when they are lifting or moving me.' 'I feel comfy talking to them.' 'I've no problems with them.' 'It's the same staff who do my medication all the time. They know what they're doing.' 'I've never seen an agency worker.' 'I know the manager.' 'My son knows the manager better than I do.' 'I'm happy with the way the place is run.' 'I have talks with her.' 'I'd definitely recommend the way this place is run.' 'She couldn't be more friendly.' 'I don't know who the manager is.' page 10 of 26

11 Taking carers' views into account Inspection report We spoke with seven relatives of people who use the service. The following were some of the comments that they made: 'Care is marvellous.' 'No complaints about the care.' 'My relative was stressed but she's relaxed in here.' 'They are very gentle with my relative.' 'They are very attentive.' 'Our family are happy with the care.' 'We have peace of mind knowing that mum is well cared for.' 'We're relieved that she is here.' 'Dad buzzed and asked for some food in his room (outside mealtimes). He had a meal in 10 minutes.' 'Staff are definitely attentive.' 'My father loves the 'fry up'. He can have any morning.' 'Mum sings in the choir and loves that.' 'When it was my birthday we had a special dinner in the wee dining room.' 'I feel welcome - Very much so' 'The play area is useful when we visit.' 'Very good housekeeping.' 'It's clean throughout.' 'The building is very light.' 'I really like mum's room.' 'Corridors are nice and bright but there's no plants anywhere.' 'We're always welcome - That's important, it's kind of our home too.' 'They're not bad at all.' 'They're pretty good.' 'They're really good.' 'I've only ever seen one agency carer.' 'They are reassuring.' 'Cleaning staff are so friendly.' 'They have seen mum through an illness.' 'My father is treated with respect.' 'I speak with her all the time.' 'She makes people feel at ease.' 'She works hard.' page 11 of 26

12 'She is genuine.' 'The meetings she holds for families and friends are useful.' page 12 of 26

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: 5 - Very Good Statement 2 We enable service users to make individual choices and ensure that every service user can be supported to achieve their potential. Service strengths There were clear indications within the care plans that people were given choice in elements of their care and support. The people that we spoke with and their relatives confirmed this. One person summed it up by saying; 'In this place, we feel listened to.' We could see clear evidence of choice being available and being given to people. We saw minutes of meetings and surveys that had taken place where peoples' views were sought. We could see where these views had been implemented in areas such as activities, menus and food choices and also choosing if people wished to be registered with the enhanced GP scheme or not. People were also supported to be involved and to influence other organisations outwith the home. We spoke with one person who had been involved with Scottish Care, in developing the new residents' charter. page 13 of 26

14 Some of the comments that were made included: 'Dad can stay in his bed for as long as he likes and gets up when he feels like it.' 'Out of choice, I have had my breakfast outside.' Areas for improvement We have asked the manager to consider how people's views are recorded in care plans and also in six monthly reviews. This should be reflective of what peoples' own experiences. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 page 14 of 26

15 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths Residents, relatives and professional visitors speak very highly of the care and support delivered in this service. We saw examples of where staff actions had led to positive outcomes for people. On one of the inspection days, we saw and spoke with someone who had just been transferred from another service into this one. We also spoke with the relative who had accompanied them. They were both very impressed with the welcome they had received and about how much the staff were going out of their way to make them feel at ease and at home. The relative told us, 'It's the first time I have seen mum looking so relaxed in a very long time. She is sitting back with her eyes shut as if she was at home. There were flowers and tablet waiting for her in her room. My only regret is that we did not make this move earlier.' Another person was due to celebrate a big birthday. Her relatives felt upset that she would not be having any of the birthday cake as she was on a textured diet. We saw a strawberry moose cake that the chef had specially prepared for this lady so that she would not miss out. This made both the lady and her relatives very happy. One person whose family lived far away and therefore could not visit regularly, was involved with the 'Forget me not project' who provided a befriending service for them. Involvement with young people from the local school had also resulted in very positive experiences for the residents and the young people alike. We saw good care plans on wound management. They were clearly written out and directed staff on the frequency of wound dressings and types of dressings page 15 of 26

16 to be used. We could also see that the care delivery was in line with the care plans. The service had introduced safety plans which would be used with managing falls. We saw the new end of life strategy guide for staff that the organisation had recently launched. This was to help staff when discussing issues about death and dying. Almost all residents apart from the newest, were registered with a dentist and had been seen within the year. A caring for smiles monitoring visit which took place on one of the inspection days, had scored very well. We used SOFI2 to observe four people who were part of the residents' choir of seventeen. We saw staff. Staff sat beside these residents, assisting them with turning the pages of the music sheets and singing along with them. Everyone was fully involved in the activity and appeared to be enjoying themselves. From their observation, the inspection volunteer made these comments: Inspection report 'All of the residents and relatives I spoke with were very positive about the standard of care at Mugdock House. All of the contacts between staff and residents I observed were gentle and respectful. Relatives spoke of having peace of mind knowing that their loved one was in the care of this home. I observed lunch in one of the dining rooms. The atmosphere was relaxed, and the five staff were attentive. Most of the residents were able to eat their food with minimal assistance, but the two who needed substantial assistance received the undivided attention of a member of staff. There were no menus available at the table. Residents receive a copy of the menu in their room early in the morning but those I observed had to be reminded by staff and then chose. The chef at Mugdock has won a major award for her skills. Residents I spoke with were very happy that this chef's skills have been acknowledged. Mugdock House has its own choir - They invite other community groups into the home and provide entertainment.' page 16 of 26

17 Some of the comments we received included: 'Staff know my granddad well, even within a short space of time he has been here.' 'Sometimes I walk away from here with tears of joy because he is so well looked after.' Areas for improvement Staff should ensure that they have read and understood the care plan before assisting anyone with any aspect of their care. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 page 17 of 26

18 Quality Theme 2: Quality of environment Quality theme not assessed page 18 of 26

19 Quality Theme 3: Quality of staffing Quality theme not assessed page 19 of 26

20 Quality Theme 4: Quality of management and leadership Grade awarded for this theme: 6 - Excellent Statement 2 We involve our workforce in determining the direction and future objectives of the service. Service strengths The organisation was committed to investing in their staff. Many of the staff had extended roles as champions in different areas such as; nurse revalidation, infection control/cleanliness, nurse mentor and sign off, palliative care, dementia, nutrition, continence, falls, MUST, skin integrity and fire safety. Staff were empowered and took ownership of their roles and responsibilities. The service was involved in several pilots. This meant that staff were broadening their knowledge in future developments within care. Amongst these were; Reducing Pressure Ulcers in Care Homes and Caring for Smiles, train the trainer. Staff meetings took place on a regular basis. Staff told us that they were comfortable and could contribute to meetings. They described communication with management as being good. A new communication channel direct to general manager of the organisation was now in place. It was hoped that this would raise any barriers that stopped the organisation delivering their purpose. Staff confirmed they were kept up to date with developments in the service. One staff member told us that this was the best service they had ever worked at. Networking days of different grades of staff took place. Within these meetings staff from different homes within the organisation could share experiences and good practice. page 20 of 26

21 A Global people survey had also been carried out amongst staff. Results of the survey were positive. Staff received regular supervision and annual appraisal. Staff that we spoke with told us that they felt supported in the work that they did. They described management as being approachable and supportive. We saw evidence of clear reflection on practice where there had been critical incidents. Lessons learnt from these were clearly evidenced. From minutes of staff meetings, we noted that any compliments that were passed through the manager by residents or relatives, were passed on to staff. The service had schemes such as employee of the month and everyday hero whereby staff were recognised for their efforts. Areas for improvement The service was currently maintaining an excellent standard in areas covered within this statement and should continue to do so. Grade 6 - Excellent Number of requirements - 0 Number of recommendations - 0 Inspection report page 21 of 26

22 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 Residents their relatives and staff all told us that the manager and the management team were accessible. They said that they were always around the units and that it was also easy to reach them in their offices which were situated by the main entrance. They described them as being approachable supportive and helpful. The service had established systems for assuring its quality. Audits for different systems including care plans and medication were in place. Audits were carried out by different grades of staff both internally and externally. We could see that issues identified at audits were followed through and addressed. The self assessment that we got from the service prior to the inspection, was very detailed. It gave clear indications of service user and relative involvement and showed what outcomes people had had. We saw 'daily briefs' notes from the daily morning meetings where heads of service met with the manager. These were detailed and gave the management team a clear overview of what was happening in the service. We looked at the log of complaints that the service kept. We were satisfied that these were dealt with sensitively and within reasonably timescales. We were told by some residents that the service chef had won 'Principal chef of the year.' this year. Residents said they were very proud about this. The service had strong involvement with other agencies. These links were proving to be beneficial to the residents. page 22 of 26

23 We saw where learning was being put into practice to improve outcomes for people. An introduction of food and fluid stations was being piloted for people living with dementia who were noted to be burning a lot of calories and losing weight as a result of always being on the move. This had come about as a result of a nutrition champion course that the clinical service manager was undertaking. Comments that were made included: 'When my father in law was dying, they phoned us. When I arrived, the manager was sitting with him as staff were busy at that time. She did this in case he died before we the family arrived as she did not want him to be alone when the end came.' 'I would definitely recommend the way this place is run.' 'The manager makes people feel at ease.' Areas for improvement The service was currently maintaining an excellent standard in areas covered within this statement and should continue to do so. Grade 6 - Excellent Number of requirements - 0 Number of recommendations - 0 Inspection report page 23 of 26

24 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 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 24 of 26

25 8 Additional Information There is no additional information. Inspection report 9 Inspection and grading history Date Type Gradings 14 Sep 2015 Unannounced Care and support 5 - Very Good Environment 6 - Excellent Staffing 5 - Very Good Management and Leadership 5 - Very Good 15 Sep 2014 Unannounced Care and support 5 - Very Good Environment 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good 12 Mar 2014 Unannounced Care and support 4 - Good Environment 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good 30 Aug 2013 Unannounced Care and support 4 - Good Environment 5 - Very Good Staffing Not Assessed Management and Leadership Not Assessed page 25 of 26

26 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 26 of 26

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