Care service inspection report

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1 Care service inspection report Full inspection 3 Bridges Care Home Care Home Service 108 Carmunnock Road Glasgow Inspection completed on 29 April 2016

2 Service provided by: Northcare (Scotland) Ltd 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 32

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 Very Good Quality of environment N/A Quality of staffing 5 Very Good Quality of management and leadership N/A What the service does well Most service users and carers expressed that they were happy with the service. The service had maintained a generally good provision of care and had actioned most areas of development highlighted at the previous inspection. Feedback from carers/service users we spoke with and reflected within the completed Care Standards Questionnaires (CSQs) which we received was mixed however the majority indicated that they were very happy with the level of service and care provided in a safe environment. What the service could do better The service could develop the service further by making sure that areas for development identified within this report are addressed. This includes specific information relating to distressed reactions within care plans and evaluation of how effective staff training is in improving the quality of life for residents. page 3 of 32

4 What the service has done since the last inspection Inspection report The service had actioned most areas of development highlighted at the previous inspection. Those that have not been fully met have been repeated at this inspection. Conclusion The service had continued to maintain a quality service with positive outcomes for service users. Service users continued to benefit from a good quality of care in a very high standard of environment. page 4 of 32

5 1 About the service we inspected Inspection report 3 Bridges is a care home registered for seventy-two older people, thirty-six of whom have dementia and thirty-six of whom are frail older people. The provider is Northcare (Scotland) Ltd. The home is close to the town centre and is near to local amenities, including shops, train and bus routes. The care home is purpose-built with the accommodation on two storeys. It is divided into four self-contained units; each with a lounge/dining room and kitchen. All bedrooms are single and have en-suite shower facilities. The home has an enclosed garden for people using the service. The aims and objectives of the service are 'to provide care, in a safe and secure environment, where service users are supported to achieve independence, enabled to make choices and encouraged to work in partnership with staff to maximise their quality of life'. The service employs nurses and carers who have varying qualifications, experience and skills. The service registered with the Care Inspectorate on 6 June 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. page 5 of 32

6 We make requirements where (a) there is evidence of poor outcomes for people using the service or (b) there is the potential for poor outcomes which would affect people's health, safety or welfare. Based on the findings of this inspection this service has been awarded the following grades: Quality of care and support - Grade 5 - Very Good Quality of environment - N/A Quality of staffing - Grade 5 - Very 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 32

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 In this service we carried out a medium intensity inspection. We carry out these inspections where we have assessed that the service may need a higher level intensity of inspection. Two inspectors carried out the inspection on 28 April 2016 between the hours of 10am and 4.20pm and 29 April between 10.05am and 4.40pm. Feedback was given at the end of the inspection. During the inspection evidence was gathered from a number of sources. We looked at a range of policies, procedures and other documentation including the following: - Sample of service users' care plans. - Service user/carer Questionnaires. - Accident and incident records. - Complaints log. - Medication Administration Records. - Staff training records. - Staff supervision records. - Staff recruitment records. - Audits. - Supporting evidence from the up to date self assessment. - Public liability insurance certificate. - Registration certificate. And we spoke with the following people: - Five people using the service (service users). - Five staff members. page 7 of 32

8 - The Home Manager. - The provider. Observation of care practice and a review of the environment and resources were also undertaken. All of the above information was taken into account during the inspection process and was reported on. 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 32

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. A fully completed self assessment document was submitted by the service. This was completed to a satisfactory standard and gave relevant information for each of the Quality Themes and Statements. The service identified its strengths and some areas for future development. Taking the views of people using the care service into account We spoke with five service users during the inspection. Views and comments have been used to help with grading this report and included: "The food is ok, but if you didn't like what was being offered you would get something else." "Food's good but parts of it but could be better." "There is home baking every day." "My room is lovely, and warm enough." "Staff are lovely and I know them all." Before the inspection we sent Care Standards Questionnaires (CSQs) to help determine people's views about the service. We received three CSQs which indicated positively about the service. Comments included: "I have quite a bit of my own furniture here." page 9 of 32

10 "Once or twice I have violent pain, requiring massage. Always available. I tend to notice staffing levels, here they are good." "I am still working part-time and have various outside activities, although disabled. I am allowed actual meals at odd times. I rank as a 'Trusted Patient' which means I look after my own medication: A big boon." Taking carers' views into account No carers were available to speak with during the inspection, however we received twenty CSQs before the inspection. Comments included: "Residents can keep in touch with relatives and friends via Skype." "I would like to see the amount of paperwork the staff are required to complete reduced." "The Three Bridges Care Home has a very happy and relaxed atmosphere for both residents and visitors and are always willing to answer any questions we may have. Overall we are very happy with the care." "The environment of the care home is good particularly the garden which is beautifully maintained. It's lovely for the residents to be able to see the animals here. The café is good and makes visits easier for relatives." "Staff are mostly seen in the day room. During staff breaks residents may have to wait to be attended to... my relative took some time to settle, staff were very supportive during this time." "I am very happy with the service provided. Staff are approachable for any situation, they are caring, understanding and professional." "There have been a few issues raised with regard to the quality of the food. However, this is being addressed through regular meetings with management." page 10 of 32

11 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 3 We ensure that service users' health and wellbeing needs are met. Service strengths Generally, outcomes for service users were good. We concluded this from feedback from people we spoke with, observations made and a review of records. We saw that service users were well dressed and presented during the inspection. Service users told us that they were happy living in the home and liked the staff. An activities planner was displayed publicly which showed the activities and events planned throughout the home. The service worked hard at making sure activities available for people were meaningful and well-arranged. We concluded this through observations, speaking with people and a review of records. We also made a balanced decision after reviewing what people told us within the CSQs which were returned to us. We sampled a number of service user Medication Administration Records (MARs) and found that records reflected the appropriate administration and page 11 of 32

12 recording of medications. 'Abbey Pain Scale' tools were used to help determine the pain levels of people with communication problems. Medication care plans were in place although we noted some were better recorded than others. The care plans we saw showed that a range of clinical risk assessments were carried out to make sure care delivery was specific to service users' needs. Ongoing reassessments helped make sure care continued to be appropriate. Where there had been any fluctuations in health the service had actively instigated investigations, reviews and changes and we could see that referrals continued to be made to healthcare clinicians where required. Information within the care plans took account of service users' preferences which helped staff support service users in a way that was meaningful and important to them. We were satisfied that service users' preferences were being met such as bathing preferences and rising and retiring times. We also saw that bedroom files had been suitably monitored and reflected current information. While the majority of care plans reflected appropriate information, we have highlighted areas for development in relation to the management of stress and distress below. The service was involved in 'Caring for smiles' which is Scotland's national oral health promotion training and support programme. This involved the completion of assessments and audits to ensure best practice in relation to oral care for people was being followed. We observed a mealtime and saw that this was a relaxed event with staff interacting respectively with service users and offering choices and support in a dignified way. We saw that some service users chose to dine out with the dining areas and were given the same level of support from staff as others. Designated hospitality staff were employed to assist within one of the units where staff required more support to meet service users' specific needs. Service users' weights were monitored where required to ensure there was no significant weight loss. We acknowledged the effort the service made in accommodating a varied menu with lots of options within the menus. Snacks page 12 of 32

13 were available and readily accessible for service users and those people who spoke with us told us how they felt they had plenty to eat and drink with a good choice. Dependency tools were completed to make sure there were enough staff to meet the health and wellbeing needs of the service users. Specialised equipment could be used if required such as bathing equipment; hoists and assistive technology. Special utensils and cups could also be used to maintain service users' independence Accidents and incidents were monitored to help identify any common themes and help reduce risk of the events happening again. We saw that accidents/ incidents had been broken down into statistics relevant to the events. We saw some instances where there had been positive outcomes for service users following the monitoring of relevant events. We saw critical investigation records which showed how the service had analysed significant events in order to avoid reoccurrence and ensure the safety and wellbeing of the relevant individuals effected. We looked at the Adult Support and Protection (ASP) policies and procedures and were satisfied that these had been followed appropriately in order to safeguard service users. The ASP procedures within the service stated that: All staff, as part of their induction training, should be made aware of: - The companies whistle blowing policy. - ASP procedures. - Role of the CI, MWC, Social work. - Role of the police. We were pleased to see this had been complied with. Inspection report A range of additional audits were completed to make sure that records were completed appropriately and to monitor healthcare. These included MARs, wounds, care plans and environment. page 13 of 32

14 The service submitted its self-assessment and annual return to us when requested. These were also ways in which the provider could review and consider their service and its delivery. Inspection report Areas for improvement We noted that service user/carer signatures were missing in some of the care plan documentation and care reviews. At times service users were not present at their own reviews and there was no record that they had been consulted in other ways or the reason for their absence. (See Recommendation 1). Although we acknowledged that some of the care plans on how to support service users who were distressed had been improved, not all staff had received appropriate training in how to manage people with distressed reactions. The Manager advised us that this was planned and we will review progress made at the next inspection. (See Recommendation 2). We highlighted that some handwritten entries within the MARs were not dated or signed although most were. We saw that most 'as required' medications had been recorded appropriately but some had not recorded the specific reason for giving the medication. Although we considered a recommendation previously made in relation to the completion of MARS had been met, we discussed how the Manager should continue to ensure all staff completed these consistently. The Manager was receptive to this and we will review these at the next inspection. We looked at the records of comments, complaints and compliments and noted that there was not enough detail about some of the concerns. This included whether the issues were complaints or comments, the full name of who raised the issues and any actions taken to address these. The columns headed 'are you satisfied with the outcome' and 'client/family signature' were not completed and we found the way the records were stored difficult to follow as they were not chronological. page 14 of 32

15 The Manager acknowledged the points we raised and we will review progress made at the next inspection. Grade 5 - Very Good Number of requirements - 0 Recommendations Number of recommendations Where deemed appropriate, carers should be fully consulted and in agreement with all parts of the service users' care plans. In doing so, relevant signatures should be recorded to reflect this within care plans and care reviews. Where service users are not present at their own reviews, there should be a clear record off how/if they had been consulted in other ways and/or the reason for their absence. National Care Standards Care Homes for Older People - Standard 6: Support Arrangements, Standard 8: Making Choices, Standard 11: Expressing your Views. 2. The provider should ensure that there is accurate advice detailed in care plans of how to support service users who are distressed. The provider should ensure that staff receive appropriate training on how to support service users who are distressed. National Care Standards Care Homes for Older People - Standard 5: Management and Staffing Arrangements, Standard 6: Support Arrangements, Standard 8: Making Choices, Standard 11: Expressing your Views, Standard 14: Keeping Well - Healthcare. page 15 of 32

16 Statement 7 Not applicable Statement 8 Living with life limiting conditions is viewed as an integral part of life in this care home. Service strengths The service had policies and procedures on care of Dying, Death and Bereavement. 'Thinking Ahead' care plans were in the process of being fully implemented which aimed to record service users and carers specific end of life wishes. We also saw good evidence where families had been fully involved in end of life care. The service demonstrated a very good level of support to people with life limiting conditions and care plans demonstrated how specific elements would be supported. We reviewed a care plan for one specific condition and were pleased to see that the care plan covered all areas which would be affected by the condition. We were pleased to see records which reflected the full involvement of the service user and their carer. Areas covered included medication and how the service user took it, what assistance was required during changes in mobility and speech. Personal wishes were recorded within care plans in respect to what happened when they became unwell or after they passed away and we could see that these had been followed. We noted a good level of information recorded within the daily notes of the care page 16 of 32

17 plan which showed records of frequent intervention which assessed the service user's condition. A 'Do Not Attempt Cardio Pulmonary Resuscitation' record had been in place and had been discussed with the service user's next of kin. Professional help and advice was accessed from healthcare professionals where required for service users at the end stage of life to ensure their dignity and comfort. A range of specialised equipment could also be accessed such as syringe drivers and sub cutaneous fluids to help control symptoms associated with end stage of life. 'Just in Case' boxes were used to make sure service users had access to specific medication if their condition deteriorated suddenly and there was no limitations placed on service users' family and friends spending time with them and accommodation was available for them to use if they wished with meals and snacks provided. Service users benefited from senior staff being trained in palliative care to make sure best practices were followed. Other training undertaken by staff helped make sure service users needs and preferences were met in a dignified way. Carers and friends could access the bereavement literature which was available to help support and guide people once their loved one had passed away. Service users who wished would be supported to attend the funeral of fellow service users and smaller more personal rooms are available for funeral teas. The service self assessment stated that some staff had attended a local funeral parlour to be familiarised with procedures to enable them to be knowledgeable when advising family and clients. Overall we were satisfied that service users who were at an end stage of their lives were treated with dignity, respect and compassion and had received a good level of clinical input to manage any symptoms and distress. page 17 of 32

18 Areas for improvement End of life 'Thinking Ahead' care plans should be specifically included for discussion within the six monthly care reviews where deemed relevant. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 18 of 32

19 Quality Theme 2: Quality of environment Quality theme not assessed page 19 of 32

20 Quality Theme 3: Quality of staffing Grade awarded for this theme: 5 - Very 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 a sample of new staff recruitment files and were satisfied that safe recruitment practices had been followed. We checked a sample of the recruitment records for new staff that had started working in the service. These showed candidates had undergone a Protection of Vulnerable Groups check and had provided names of two referees one of which was from the immediate previous employer. Where required, the service undertook registration checks on potential new staff to make sure they were eligible to practice. Proof of identity was also recorded. New staff completed an induction programme and were subject to a probationary period. These measures helped to make sure that both the staff and employer were happy with the appointment. Interim assessments were also carried out to gauge the progress for new staff. Staff undertook initial induction and a wide range of training to support them in their role. Staff whom we spoke with us told us they felt well supported and confident on taking up their new post. We concluded that a recommendation made previously in respect of missing recruitment information had been met. page 20 of 32

21 Areas for improvement The service should continue to demonstrate the very good practice demonstrated in relation to this Quality Statement. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 21 of 32

22 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 of a varied training programme for staff which included statutory and non-statutory training to help support them in their roles. The training consisted of a combination of distance learning, e-learning packages and practical sessions. The service also linked up with Care Home Liaison training sessions. A training matrix reflected mandatory training that was planned for staff as well as mandatory training which had already been undertaken. Training planned for the coming year included: - Nutrition - Promoting excellence - Palliative care - Male catheterisation We were told how ASP training had not been part of the annual training programme for all staff however this was to be compulsory for all staff from now on. Staff completed training evaluation sheets after training which asked: - How the training would affect their workplace. - How it would improve practice. - If more training was required. - Any ideas on how the training could be improved. The service had supported certain staff in their role as key workers. The aim of this was to promote best practice within the service and be a link/resource person for each service user. Some staff were also supported to become training ambassadors in specific topic. page 22 of 32

23 Staff supervisions took place regularly and appraisals also took place on an annual basis. Staff meetings continued to take place regularly where staff could be involved in discussing a range of relevant information. Meetings were held for different staff groups so that topics could be specific and discussion relevant for attendees. The service used a continuous learning framework (CLF) which was used during staff supervision sessions. Staff completed sections of this framework at their supervision sessions. Supervision records generally contained a good level of detail with a description of topics to be discussed and actions to be taken Where training had been identified we could see that this had been followed through. We concluded however that the supervision of the more senior staff members, unit managers, senior carers & nurses, was completed to a better standard. Staff were observed as interacting professionally with each other. Service users we spoke with told us that they liked the staff. Areas for improvement A recommendation was made at the previous inspection in relation to the provider evaluating how effective staff training was in improving the quality of life for residents. The Manager acknowledged that this continued to be a work in progress therefore this recommendation has been repeated. (See Recommendation 1) We suggested that the supervision records could be monitored better to ensure that staff fully understand reflective practice. We also suggested that the personal development plan could be further developed to ensure that staff give an accurate evaluation of the training they have received. Grade 5 - Very Good Number of requirements - 0 page 23 of 32

24 Recommendations Number of recommendations The provider should evaluate how effective staff training is in improving the quality of life for residents. National Care Standards, Care Homes for Older People: Standard 5: Management and Staffing Arrangements. page 24 of 32

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 There are no outstanding requirements. 5 What the service has done to meet any recommendations we made at our last inspection Previous recommendations 1. Bedroom files should be developed further to make sure all information important to service users is recorded. National Care Standards - Care Homes for Older People; Standard 11: Expressing Your Views. We saw that bedroom files had been suitably monitored and reflected current information. This recommendation was made on 08 October 2015 We saw that bedroom files had been suitably monitored and reflected current information. page 25 of 32

26 2. Dates should be recorded on all relevant paperwork. National Care Standards - Care Homes for Older People; Standard 11: Expressing Your Views. This recommendation was made on 08 October 2015 We were satisfied that dates were suitably recorded on records we reviewed. 3. The provider should ensure that where people are prescribed as required analgesia for pain there should be clear information on the nature of the pain and about the way in which the medication should be used. There should be clear information that decisions on pain management are based on clinical indicators. Additionally, handwritten entries on the MARs should have appropriate signatures and indicate prescribers. National Care Standards: Care Homes for Older People, Standard 5 - Management and Staffing. This recommendation was made on 08 October 2015 Abbey Pain Scales tools were used to help determine the pain levels of people with communication problems. Medication care plans were in place although we noted some were better recorded than others. We highlighted that some handwritten entries were not dated or signed although most were. We saw that most 'as required' medications had been recorded appropriately but some had not recorded the specific reason for giving the medication. Although we consider this recommendation to be met the Manager should continue to ensure all staff complete the MARs consistently. 4. Anticipatory care plans should be discussed and reviewed at reviews in line with the service review pro forma. Management and Staffing Arrangements, Standard 6 - Support Arrangements This recommendation was made on 08 October 2015 We acknowledged that the 'thinking ahead' care plans were in the process of being fully implemented. page 26 of 32

27 We also saw other evidence that families had been fully involved in end of life care however a recommendation has been made about developing records of reviews including discussions about end of life care. See Recommendation 1, Quality Theme 1 Statement 3 5. The provider should ensure that where any service user has expressed a choice e.g. a preference for a bath that these are met. Additionally, any daily oral care records completed should show that rising and retiring times have been followed, or the reason why if unable National Care Standards Care Homes for Older People - Standard 5: Management and staffing arrangements, Standard 6: Support Arrangements, Standard 8: Making choices, Standard 11: Expressing your views, Standard 14: Keeping Well - Healthcare This recommendation was made on 08 October 2015 We were satisfied that people's preferences were being met. More information on how we concluded this recommendation was met is recorded under Quality Theme 1 Statement The provider should ensure that service users who choose to have their meal at areas situated away from the dining table are given the same level of support as other service users. The provider should develop the scullery area to ensure that snacks are available at all times whenever people want them. National Care Standards - Care Homes for Older People; Standard 13 - Eating Well. This recommendation was made on 08 October 2015 We were satisfied that service users were given a consistent level of support regardless of where they chose to eat their meals and Mealtime Audits had been developed to make sure this happened. We noted that snacks were available and readily accessible for service users. 7. The provider should ensure that there is accurate advice detailed in care plans of how to support service users who are distressed. The provider should page 27 of 32

28 ensure that staff receive appropriate training on how to support service users who are distressed. National Care Standards Care Homes for Older People - Standard 5: Management and staffing arrangements, Standard 6: Support Arrangements, Standard 8: Making choices, Standard 11: Expressing your views, Standard 14: Keeping Well - Healthcare. This recommendation was made on 08 October 2015 Although we acknowledged that some of the care plans of how to support service users who are distressed had been improved, not all staff had received appropriate training in how to manage people with distressed reactions. The Manager advised us that this was planned and we will review progress made at the next inspection. See Recommendation 2, Quality Theme 1 Statement 3 8. Recruitment files for staff should be improved upon to take account of the missing information identified above. National Care Standards - Care Homes for Older People; Standard 5 - Management and Staffing Arrangements. This recommendation was made on 08 October 2015 From looking at a sample of newly recruited staff, we were satisfied that this recommendation had been met. 9. The provider should review the purpose and function of staff supervision and this should be used to review the progress, practice or difficulties that staff experience. National Care Standards, Care Homes for Older People: Standard 5: Management and Staffing Arrangements. This recommendation was made on 08 October 2015 We were satisfied that this recommendation had been met. Inspection report 10. The provider should ensure that all staff have an accurate and up to date individual training record and training plan. Copies of any training certificates attended/ awarded should be held in individual files. page 28 of 32

29 National Care Standards - Care Homes for Older People; Standard 5 - Management and Staffing Arrangements. This recommendation was made on 08 October 2015 We were provided with evidence which showed an up to date training plan for each member of staff. Copies of individual training certificates for staff were also available. 11. The provider should evaluate how effective staff training is in improving the quality of life for residents. National Care Standards, Care Homes for Older People: Standard 5: Management and Staffing Arrangements. This recommendation was made on 08 October 2015 The Manager acknowledged that this continued to be a work in progress. (See recommendation 1, Quality Theme 3 Statement 3). 12. Clear records of any actions taken to address suggestions or issues made through consultation exercises should be developed. National Care Standards, Care Homes for Older People Standard 5: Management and Staffing Arrangements. This recommendation was made on 08 October 2015 We reviewed a sample of staff supervisions which had been carried out and were satisfied that these had actioned suggestions/requests made by staff. 13. The provider should ensure that the weekly and monthly audits are an accurate assessment of how the care home is performing and detail what action will be taken where any issues are identified. Audit processes should also be developed to reflect appropriate timescales for completion highlighted. Reference should be made as to when these actions have been completed and the issue reaudited to ensure compliance. Standard 5 - Management and staffing arrangements National Care Standard for care homes for older people. page 29 of 32

30 This recommendation was made on 08 October 2015 We were satisfied that audits which had been carried out had been effective in improving outcomes for people with appropriate actions taken to address any shortfalls identified. 14. The provider should develop a system to demonstrate that staff, service users, carers and other stakeholders are involved in the quality assurance process and identify issues which are raised and how these are addressed. National Care Standards Care Homes for Older People Standard 8: Making Choices, Standard 11: Expressing Your Views This recommendation was made on 08 October 2015 Questionnaires were used to seek views from service users, carers, staff and stakeholders. We also saw other ways in which the service sought people's satisfaction with the service such as forums and food groups where actions had been taken to address suggestions. 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. page 30 of 32

31 9 Inspection and grading history Inspection report Date Type Gradings 8 Oct 2015 Unannounced Care and support 4 - Good Environment 5 - Very Good Staffing 4 - Good Management and Leadership 4 - Good 3 Mar 2015 Unannounced Care and support 4 - Good Environment 5 - Very Good Staffing 4 - Good Management and Leadership 4 - Good 9 Oct 2014 Unannounced Care and support 4 - Good Environment 5 - Very Good Staffing 4 - Good Management and Leadership 3 - Adequate 3 Dec 2013 Unannounced Care and support 4 - Good Environment 5 - Very Good Staffing 4 - Good Management and Leadership 4 - Good 21 Jun 2013 Unannounced Care and support 4 - Good Environment 5 - Very Good Staffing 4 - Good Management and Leadership 4 - Good page 31 of 32

32 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 32 of 32

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