Care service inspection report

Transcription

1 Care service inspection report Full inspection Fairknowe Care Home Service Fairknowe House 3 Cargill Road Maybole Inspection completed on 05 May 2016

2 Service provided by: Mead Medical Services Limited Service provider number: SP Care service number: CS Inspection Visit Type: Unannounced Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and set out improvements that must be made. We also investigate complaints about care services and take action when things aren't good enough. Please get in touch with us if you would like more information or have any concerns about a care service. Contact Us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com page 2 of 42

3 Summary This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change after this inspection following other regulatory activity. For example, if we have to take enforcement action to make the service improve, or if we investigate and agree with a complaint someone makes about the service. We gave the service these grades Quality of care and support 4 Good Quality of environment 4 Good Quality of staffing 4 Good Quality of management and leadership 4 Good What the service does well The service was homely and welcoming. There was a good programme of activities which took account of individual interests and preferences. People told us that they were happy with the quality of care and support provided at this home. What the service could do better The manager and all staff should continue to work together to ensure that improvements identified are addressed. What the service has done since the last inspection The provider had continued to make improvements to the environment and equipment. The service had continued to explore and develop community links. Additional training modules had been introduced. The keyworker role had been promoted. page 3 of 42

4 Conclusion Inspection report The service graded well in the areas that we focus on when we inspect. Managers were continuing to promote a positive culture within this service which not only focussed on the experience of people living in the home but also valued and encouraged the contribution of families and staff. Managers were committed to ensuring that further improvements were achieved and sustained. page 4 of 42

5 1 About the service we inspected Inspection report The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April Fairknowe is registered to provide a care service to a maximum of 40 older people who may have physical needs and/or dementia. A maximum of four places can be used for respite/short breaks for the same client group. Twenty five people lived in the service at the time of inspection. The provider is Mead Medical Services Limited. Fairknowe is situated in a residential area in the town of Maybole, South Ayrshire. The service comprises of a number of purpose built extensions around an older adapted building with a lift and disabled access. Accommodation comprises seven double and 26 single bedrooms provided in three living areas, the Main House, Garden View and Memory Lane. Communal lounge and dining facilities are available within the Main House. The service's stated aim is: 'To provide a highly professional and experienced staff to look after residents in a caring and sympathetic way, so that their privacy and dignity are respected and active independence encouraged where possible. To regard all residents as individuals with the right to make decisions regarding their care and choices where possible and to be fully involved in drawing up their own care plan'. page 5 of 42

6 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. Based on the findings of this inspection this service has been awarded the following grades: Quality of care and support - Grade 4 - Good Quality of environment - 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 page 6 of 42

7 or by calling us on or visiting one of our offices. page 7 of 42

8 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 was carried out by one inspector. The inspection took place on Thursday 21 April 2016 from 6.30pm pm, Friday 22 April 2016 from 10am pm, Sunday 24 April 2016 from 2.50pm pm and Monday 25 April 2016 from 10.25am pm. As part of the inspection, we took account of the completed annual return and self assessment forms that we ask the provider to complete and submit to us. We sent 15 care standards questionnaires to the manager to distribute to people who use the service. Two people returned completed questionnaires. We also sent 15 care standards questionnaires to the manager to distribute to relatives and carers. Relatives and carers returned five completed questionnaires before the inspection. We also asked the manager to distribute 15 questionnaires to staff and we received four completed questionnaires. During this inspection process, we gathered evidence from various sources, including the following: We spoke with: - nine people who live in the home - ten relatives/friends - director of care - the manager - deputy manager page 8 of 42

9 - activity coordinator - handyman - housekeeper - hairdresser - laundry staff - nursing and care staff (including night staff) - staff from the Little Art School Trust We used the Short Observational Framework for Inspection (SOFI2) to directly observe the experience and outcomes for people who were unable to tell us their views. On this inspection we used SOFI2 to observe the experience of four people. We looked at: - the most recent self assessment - the participation strategy, this is the service's plan for how they will involve people - service information including aims and objectives and philosophy of care - noticeboards - newsletters - questionnaires, evaluations and action plans - photographs and records of the activity programme - a sample of personal plans and review records of people who use the service - risk assessments - medication administration record sheets - maintenance records - accident/incident records - a sample of staff recruitment and induction records - staff training and supervision records - staff meeting minutes - dependency assessments and staffing needs - quality assurance information, for example what the service does to check things are working well - the registration and insurance certificates page 9 of 42

10 - observation of how staff worked - observation of the environment and equipment 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 10 of 42

11 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. The Care Inspectorate 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 it thought the service did well, some areas for development and any changes it had planned. The provider told us how people who used the care service had taken part in the self assessment process. Taking the views of people using the care service into account For this inspection, we received the views of 11 people. Two people gave their views through care standards questionnaires and we spoke with nine people during the inspection. We also observed how staff responded to people in lounge and dining areas within the home. People told us that they were happy with the quality of the service that they received. Comments included: "Very happy. Couldn't be better". "The staff can't do enough for me". page 11 of 42

12 "Food first class, there is always something I like". "It is excellent here. I see more of my family/friends now than I did when I was living at home". Taking carers' views into account Carers in this context include parents, guardians, relatives or friends. They do not include staff or other professionals. For this inspection, we received the views of 15 carers. Five people gave their views through care standards questionnaires and we spoke with 10 carers during our inspection. Carers told us that they were happy with the quality of the service that their relative/friend received. Comments included: "I am very happy with the care (person) receives in Fairknowe. They enjoy their meals and seem to have settled well". "The management and staff did a great job in the last two or three difficult weeks. My relative was given every attention and support possible and showed no sign of discomfort or pain in their final days". "Very happy with the care (person) receives". "I can't fault the service. It's a home from home. I know all the staff from Maybole. Staff are good and helpful. Family can come and go when they like. Relaxed environment. Staff are welcoming and good at keeping me informed". "Any issue is promptly addressed". "The service has changed for the better". page 12 of 42

13 3 The inspection We looked at how the service performs against the following quality themes and statements. Here are the details of what we found. Quality Theme 1: Quality of Care and Support Grade awarded for this theme: 4 - Good Statement 2 We enable service users to make individual choices and ensure that every service user can be supported to achieve their potential. Service strengths At this inspection, we found that the performance of the home was very good for this quality statement. There was good information available to help people make decisions about their life and care in the home. This included the statement of purpose including aims and objectives and philosophy of care to ensure shared understanding of the care homes vision and expectations. People were encouraged to bring furniture and personal items to help personalise their living space. We looked at some bedroom areas and found that they were personalised to reflect the identity of the person living there. Many of the ground floor bed rooms had patio doors giving easy access to outdoor space. It was good to see families making use of this with their relative. People were able to choose how they spent their day and quieter areas were page 13 of 42

14 available to support and enhance this. Each person had a keyworker whose role was to get to know them and their family and ensure that there day to day care needs were met in accordance with their wishes. Some families told us that they had developed a good relationship with the keyworker. They also told us that they had been asked to bring photographs to assist in the development of life story folders. There was a good programme of activities which took account of individual interests and preferences including enabling people to maintain links with the local community. The home had also started a weekly coffee morning and invited the local community to visit and spend time with people living in the home, families and staff. At the time of our visit the home had been decorated and events planned to celebrate the Queen's birthday. Other activities included: flower arranging, an art session with workers from the Little Art School Trust, a sing-along, hairdressing, reading newspapers, attending church and talking with staff or other people living in the home. People told us that they were looking forward to an evening visit from the ice cream van. The activity programme showed that this was a regular event. People were also supported to maintain their civil rights such as voting at elections. Overall, we observed that people were engaged and enjoying the various activities on offer. Areas for improvement We signposted the service to the Living Well through activity in care homes: the toolkit and Ayrshire and Arran Activity Network Forum Actively Engaged for further ideas on how activities could be developed within the home. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 page 14 of 42

15 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths At this inspection, we found that the performance of the home was good for this quality statement. People were supported to maintain links with their own GP and dentist and where this was not possible supported to register with a new GP and dentist from those providing services in the area of the home. Each person had a personal plan which detailed their health and wellbeing needs and how these were to be met. Personal plans were evaluated on a regular basis, and the personal plan reviewed at least six monthly or sooner if necessary. A recommendation repeated at the last inspection about the development of separate care plans for the care and management of bladder and bowels was met. There were systems in place to ensure continuity of care between shifts such as written and verbal handover information. Documentation had been changed since the last inspection and staff told us that this provided good information particularly if they had been off for a few days. People living in the home and families told us that they were confident that staff could meet their healthcare needs including arranging to see a health professional where this was required. One family told us that they had been involved in putting an emergency bag or 'Go Bag' together in case their relative was admitted to hospital at short notice. We found that this was common practice within the home to support any hospital admission. There was a good range of equipment throughout the home to support page 15 of 42

16 people's needs such as equipment for the prevention of falls, and moving and handling equipment. Staff received training to support people with their health and wellbeing needs and were observed to be caring and responsive to the individual needs of people using the service. Menus were displayed and offered choice at mealtimes taking account of individual preferences. People were free to eat their meals wherever they liked and family were also invited. Snacks and drinks were available outwith mealtimes. We observed that people received good support at mealtimes. For example, special diet, adapted crockery, or help from a staff member. Staff were observed monitoring nutritional and hydration needs and sought advice from other health professionals where this was required. The home had arrangements in place for the management and administration of medication. The home had recently transferred to a new pharmacy for the supply of medicines. We looked at a sample of medication administration records which showed medication was administered as directed and records maintained if for any reason medication was not taken. Where there was any change or concern about medication, including side effects or a change in a persons condition this was followed up. A check sheet was available showing that the registered nurse, practitioner or supervisor checked medication records for any omissions following each drug round. The home was planning to pilot electronic medication records and staff had received training in preparation for this. Areas for improvement Fairknowe had been involved in the test period for the Health Promoting Care Home (HPCH) Framework which provides a framework for health promoting activity within care homes. The deputy manager was the designated health promoting care home coordinator and was keen to implement the HPCH framework to direct health promoting activities within the home. The home should continue to promote awareness of physical activity and may find the 'Care... about physical activity' (CAPA) resource pack helpful. This resource was developed by the Care Inspectorate in partnership with British page 16 of 42

17 Heart Foundation National Centre for Physical Activity and Health (BHFNC). This is a useful resource for considering how physical activity can be built into the daily life of a home. This could be a good starting point for the implementation of the HPCH framework in partnership with people using the service, families and staff. The resource is available from hub.careinspectorate.com A recommendation repeated at the last inspection about ensuring a planned and consistent approach to all aspects of tissue viability was not met. The manager was continuing to liaise with the Care Inspectorate's health and wellbeing team regarding the development of policies in accordance with best practice guidance. (See recommendation 1). A recommendation repeated at the last inspection about ensuring that all registered nurses were up to date with best practice guidance in relation to catheter care was not met. (See recommendation 2). The service had made good progress in meeting a recommendation repeated at the last inspection about continuing to develop and monitor the content of personal plans. However, we continued to find some areas such as continence which needed to be more detailed to direct staff in consistently meeting people's needs. We have continued this recommendation and will review progress at the next inspection. We also found that some care charts did not provide an accurate account of the care being provided. Managers were aware of this and working to address this with staff. (See recommendation 3 and areas for improvement in quality theme 3, statement 3). Grade 4 - Good Number of requirements - 0 Recommendations Number of recommendations - 3 Inspection report 1. The service provider should take measures to ensure that there is a planned and consistent approach to all aspects of tissue viability which includes: - skin assessment and care - pressure ulcer prevention page 17 of 42

18 - wound assessment and management - minor trauma injuries In order to achieve this, the provider should: a) update/devise the above policies to ensure that they reflect best practice and include NHS Scotland skin care and tissue viability best practice. b) implement these policies to ensure that there is a planned and consistent approach to these areas of care c) ensure all registered nurses and care staff are fully conversant with the above policies. d) registered nurses and carers receive refresher training in all of these areas of care and this is clearly documented in training and supervision records. National Care Standards Care Homes for Older People, Standard 5: Management and staffing arrangements, Standard 6: Support arrangements, Standard 14: Keeping well - healthcare 2. The service provider should ensure that all registered nurses are up to date with best practice guidance in relation to catheter care. For example, by accessing e learning from NHS education for Scotland. National Care Standards Care Homes for Older People, Standard 5: Management and staffing arrangements 3. The manager should continue to develop and monitor the content of personal plans to ensure that they accurately reflect individual needs and preferences, how these are to be met and properly evaluated. National Care Standards Care Homes for Older People, Standard 6: Support arrangements page 18 of 42

19 Quality Theme 2: Quality of environment Grade awarded for this theme: 4 - Good Statement 2 We make sure that the environment is safe and service users are protected. Service strengths At this inspection, we found that the performance of the home was good for this quality statement. A sample of staff files were examined which showed that staff were recruited through a process which included equal opportunities procedures; criminal record checks, taking up references; and cross referencing to professional registers such as the Scottish Social Services Council and Nursing and Midwifery Council. People received a written agreement detailing the service to be provided. This ensured that they had full information about their occupancy rights in the care home. There was a current certificate of insurance and door entry system where visitors to the home needed permission before they could enter. This ensured that people living in the service were kept safe and protected. The service had benefitted from refurbishment in the past year to ensure that people could enjoy living in safe, comfortable and homely surroundings. Regular checks and routine maintenance were carried out by the handyman and external contractors to ensure the environment was maintained to a safe standard. Overall, we found that the home was clean and free from malodours. There was a system to record accidents and incidents within the home. Records were analysed on a regular basis to ensure that any on-going concerns page 19 of 42

20 or issues affecting the safe environment were being addressed. People were able to summon assistance using an alarm system and we observed that call points were positioned within reach for people in bed. Inspection report The manager was continuing to monitor staffing levels and skill mix to ensure that this contributed to good outcomes for people using the service. Information about dependency needs and staffing requirements was displayed for visitors and everyone within the service. The service had a written Adult Support and Protection procedure which clearly identified the actions to be taken by staff. Training was provided to staff to support the implementation of this policy. Where there were concerns appropriate action was taken and relevant agencies involved. Areas for improvement We found several issues which had the potential to impact on the safety of the environment. - The provider's health and safety audit dated January - March 2016 identified that some electrical equipment had not been tested. We looked at the portable appliance records and found that these were not dated or signed. We discussed this with the manager during our visit and signposted to the guidance document Health and safety in care homes, Health and Safety Executive, Two windows above ground level were not restricted to an opening width of 100mm or less. This was raised with the manager at the time of inspection who promptly took action to address. - It was not clear what action had been taken to address the outcome of the electrical installation condition report dated 30 March 2015 which was deemed unsatisfactory for continued use. This was followed up with the manager and director of care. Following inspection the director of care submitted a written action plan detailing the action being taken and agreed to provide evidence on satisfactory completion of the work. page 20 of 42

21 We discussed with managers about continuing to monitor the response time to the alarm call system to ensure that this was responded to timeously and that background noise was kept to a minimum. Staff told us that due to the provider's policies, the staff mix could impact on response times to the alarm call, especially those people requiring two staff to assist. Managers agreed to monitor this. During our visit we found equipment being stored inappropriately in a bathroom/shower area used by service users. This was promptly addressed. The manager should monitor and review arrangements for the safe storage of equipment within the home. Grade 4 - Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 21 of 42

22 Statement 3 The environment allows service users to have as positive a quality of life as possible. Service strengths At this inspection, we found that the performance of the service was very good for this statement. People were encouraged to express their views and make suggestions about the service provided. This included recruitment of new staff and any proposed changes to the service. A recommendation repeated at the last inspection relating to the participation of people who may have difficulty expressing their views and choices was met. Some staff had received training on how to use the 'Talking Mats' visual communication tool which can assist people communicate things that matter to them. There was some evidence of this tool being used to identify interests and preferences in relation to meaningful activities. This is good practice and should continue to be developed within the home. The manager expressed an interest in exploring the use of technology to support communication needs. Promoting Excellence dementia training was also continuing to be rolled out to assist staff in their understanding of dementia on communication. The home had undergone refurbishment over the past year. People were able to move freely about the home and choose where they wished to spend their time. Quieter areas were available for residents to spend time on their own or with family/visitors. One area included a telephone with an amplifier which residents could use to make or receive phone calls in private. The provider had reduced the number of double bedrooms within the home. Double bedrooms which had been converted into single ensuite wet floor shower rooms had been completed to a good standard. At the time of inspection all bedrooms including twin rooms were occupied on a single occupancy basis. page 22 of 42

23 The manager advised that the home was now using the Kings Fund Environmental Assessment tool as part of the homes quality assurance system and processes. This is good practice and has been designed to help care organisations to develop more supportive environments for people with dementia. Unfortunately, we were unable access this during inspection as it had been filed away. However, we were told that the service was considering introducing more colour and further development was planned outside such as a circular/returning pathway through the grounds. The manager may want to consider involving others with differing perspectives in the completion of the tool. A housekeeper was employed to oversee the condition of bedrooms, bathrooms and public areas. Overall, we found a good standard of housekeeping within the home. All bedrooms had windows and many had bird feeders attached to create additional interest for people. The home encouraged pets and some residents had pets in their bedrooms and had been involved in purchasing a hamster for the home. There was a good programme of social events, entertainment and activities including support to enable people to maintain links with the local community. Areas for improvement The service should maintain current good practice. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 23 of 42

24 Quality Theme 3: Quality of staffing Grade awarded for this theme: 4 - Good Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths At this inspection, we found that the performance of the service was good for this statement. Staff confirmed that they received induction training. This included completion of mandatory e learning courses and copies of the employee handbook, health and safety policy, national care standards, Scottish Social Services Council (SSSC) codes of practice, statement of purpose and participation strategy. New staff were assigned a mentor and had shadowing opportunities with more experienced staff. This supported staff to settle into their roles as quickly and effectively as possible. One staff member told us that this had been a positive experience for them and that their mentor had been both supportive and encouraging which had given them confidence in their new role. Staff were aware of the policies and procedures for the service and had training updates to review their understanding and learn about new guidance. Staff told us that the service provided opportunities to access education/ training. All mandatory training requirements were completed through e learning. Extra courses were also available specific to the needs of the service or interests of staff. For example, staff had received training on motor neurone disease and meaningful activity. Staff had also received coaching by a senior member of staff on the role of keyworker. The manager confirmed that 50% of staff had achieved SVQ2 level. The page 24 of 42

25 manager was following up with a care training consortium to support more staff to achieve SVQ qualifications. Comments from staff included: Inspection report "My manager makes sure I get all the training that is relevant or will help me in my job". "Residents receive fantastic care within the home from carers. There are plenty of activities for them and their home is always kept clean and friendly". Systems were in place to support communication between staff such as staff meetings and daily handovers aimed at ensuring care needs were not overlooked. The manager also received a written daily safety brief. The manager had taken action to ensure that only staff who had registered with the Scottish Social Services Council (SSSC) or another recognised regulatory body, or who were newly recruited and capable of achieving such registration within 6 months of commencing in post, were carrying out work in the care service in a post for which such registration was required. Areas for improvement As reported at the last inspection further work was needed to assess the existing knowledge/skills of staff against the requirement of their roles, and a development plan put in place to address identified gaps. Managers were working with staff to reinforce the expectations of staff roles and their professional accountability in terms of the codes of practice. We directed managers to the resources for workforce development on the Scottish Social Services Council website sssc.uk.com including the Common Core of skills, knowledge and values. We have continued this recommendation and will review progress at the next inspection. (See recommendation 1). We repeated a recommendation at the last inspection about staff having access to regular planned supervision. Some supervision was taking place. However, this was not as robust as it could be. Supervision is a two way process and page 25 of 42

26 whilst employers have responsibility to support staff to develop their skills and knowledge, staff are personally responsible for ensuring that they meet post registration training and learning (PRTL) requirements. Attendance at supervision and team meetings which assist staff to reflect on practice and to develop their skills, knowledge and values supports the requirements of PRTL. We have continued this recommendation and will review progress at the next inspection. (See recommendation 2). The keyworker role was continuing to be promoted within the home. We found increased awareness of this role. However, there was acknowledgement that further development of was still required. We have continued this recommendation and will review progress at the next inspection. (See recommendation 3). Grade 4 - Good Number of requirements - 0 Recommendations Number of recommendations - 3 Inspection report 1. The provider should review staff knowledge and skills and put in place an effective staff development plan. National Care Standards Care Homes for Older People, Standard 5: Management and Staffing Arrangements 2. All staff should have access to regular planned supervision. National Care Standards Care Homes for Older People, Standard 5: Management and Staffing Arrangements page 26 of 42

27 3. The provider should promote and develop the role of keyworker within this service. National Care Standards Care Homes for Older People, Standard 7: Moving in and Standard 11: Expressing your views page 27 of 42

28 Statement 4 We ensure that everyone working in the service has an ethos of respect towards service users and each other. Service strengths At this inspection, we found that the performance of the service was good for this statement. Staff confirmed that they had a copy of SSSC codes of practice for social services workers or other relevant professional code of conduct which clearly set out the standard of professional conduct and practice required of staff in their daily work. We signposted the manager to the Common Core of skills, knowledge and values, SSSC which outlines the key attributes that all staff should have. People told us that staff treated them politely at all times and were respectful. One family told us that they were very happy with the service. They told us that staff had time to spend with their relative and had got to know (person) really well. They told us that their relative had a particularly good relationship with their keyworker and that they had a good relationship with staff. We observed some good examples of staff engaging with people in a manner which offered reassurance and was respectful of individual choices and preferences. Areas for improvement We received some comments about divisions within the staff team. Managers were aware of this and taking action to address. The manager agreed to review the leadership and planning of shifts to ensure that people's needs were being met in a coordinated way. (See recommendation 1). Grade 4 - Good Number of requirements - 0 page 28 of 42

29 Recommendations Number of recommendations The service should continue to develop team work and ensure that appropriate systems are in place to ensure good communication between staff. National Care Standards Care Homes for Older People, Standard 5: Management and staffing arrangements page 29 of 42

30 Quality Theme 4: Quality of management and leadership Grade awarded for this theme: 4 - Good Statement 2 We involve our workforce in determining the direction and future objectives of the service. Service strengths At this inspection, we found that the performance of the service was good for this statement. The manager was continuing to promote a culture which valued the contribution of people living and working within the service. The majority of staff were complimentary about the approach and support provided by the manager and said that this was having a positive effect on the service. A nurse/manager on call rota was in place when there was a practitioner in charge of the care home. The manager and deputy manager were available on alternative weekends for support in emergencies of if staff required additional advice. Mobile numbers were available for the manager, deputy manager and director of services. Staff were encouraged to contribute their views on the development of the service at staff meetings, supervision and through questionnaires. The manager was observed to have an open door and was accessible to staff. Comments included: "My manager and deputy manager are a great support to me in my job. I can go to them at any time with queries or problems and they will assist me". page 30 of 42

31 Areas for improvement We received some comments about divisions within the staff team. Managers were aware of this and taking action to address. The manager agreed to review the leadership and planning of shifts to ensure that people's needs were being met in a coordinated way. (See recommendation 1 in quality theme 3, statement 4). Grade 4 - Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 31 of 42

32 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 At this inspection, we found that the performance of the service was good for this statement. People were encouraged to express their views on any aspect of the care home at any time. This could be done through discussion with the named worker, manager or senior staff team, making a complaint/comment, completing a satisfaction questionnaire, or attending meetings. Information was also available on independent advocacy services for any person requiring support to express their views. People told us that they were confident that concerns or complaints would be dealt with appropriately by the service. The manager of the home encouraged people to become involved in the inspection process by completing questionnaires or speaking to inspectors. The manager made available copies of each inspection report about the home so that people could look through in their own time. People were encouraged to assess the quality of the service provided using the Care Inspectorate grading scale. We looked at the outcome of the providers questionnaires dated March There was a good response to this questionnaire with people indicating that they were very happy with the quality of the service provided. There was evidence that any issues raised were followed up by the manager. There was evidence of some audits taking place such as medication, mealtime experience and health and safety. Action plans were put in place to address any issues identified. A new quality assurance system had been developed and was currently being piloted within the group of homes by this provider. The new system included audits of medication, tissue viability, catering, observations, infection control, health and safety, environment and hand page 32 of 42

33 hygiene. As recommended at the last inspection policies and procedures were being prioritised organisationally for review. We were satisfied with the action being taken to address this recommendation. This recommendation was met. The service notified the Care Inspectorate and other agencies of notifiable events such as serious accidents and incidents. Action plans were developed, submitted and implemented to take account of any requirements and recommendations from regulatory activity. External quality checks were undertaken by the supplying pharmacist about how well the service managed people's medication. The local fire service and environmental health department also monitored standards within the care service. Areas for improvement We found that actions arising from audits were not consistently followed up and that some staff were not working as they should to support the service. We have continued a recommendation made at the last inspection about developing the quality assurance system and processes. (See recommendation 1). Grade 4 - Good Number of requirements - 0 Recommendations Number of recommendations The provider should continue to review and develop the quality assurance system and processes. This should include compiling a service development plan which shows how everyone involved is involved in progressing improvements to the service. This will ensure that everyone in the service is working together to ensure that improvements are sustained and progressed. National Care Standards Care Homes for Older People, Standard 5: Management and staffing arrangements page 33 of 42

34 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. The service should consider how they involve people who have difficulty expressing their views and choices. National Care Standards Care Homes for Older People, Standard 6: Support arrangements, and Standard 11: Expressing your views This recommendation was made on 05 June 2014 This recommendation was met. See quality theme 2, statement The provider should review staff knowledge and skills and put in place an effective training plan for all staff. National Care Standards Care Homes for Older People, Standard 5: Management and staffing arrangements This recommendation was made on 17 April 2015 This recommendation was not met. See quality theme 3, statement 3. page 34 of 42

35 3. All staff should have access to regular planned supervision. National Care Standards Care Homes for Older People, Standard 5: Management and Staffing Arrangements This recommendation was made on 05 June 2014 This recommendation was not met. See quality theme 3, statement The provider should promote and develop the role of keyworker within this service. National Care Standards Care Homes for Older People, Standard 7: Moving in and Standard 11: Expressing your views This recommendation was made on 17 November 2014 This recommendation was not met. See quality theme 3, statement The provider should continue to review and develop the quality assurance system and processes. This should include compiling a service development plan which shows how everyone involved is involved in progressing improvements to the service. This will ensure that everyone in the service is working together to ensure that improvements are sustained and progressed. National Care Standards Care Homes for Older People, Standard 5: Management and staffing arrangements This recommendation was made on 17 April 2015 This recommendation was not met. See quality theme 4, statement Policies and procedures should be reviewed and updated to cover all legal requirements and best practice guidance. National Care Standards Care Homes for Older People, Standard 5: Management and staffing arrangements This recommendation was made on 17 April 2015 This recommendation was met. See quality theme 4, statement 4. Inspection report page 35 of 42

36 7. The service provider should take measures to ensure that there is a planned and consistent approach to all aspects of tissue viability which includes: - skin assessment and care - pressure ulcer prevention - wound assessment and management - minor trauma injuries In order to achieve this, the provider should: a) update/devise the above policies to ensure that they reflect best practice and include NHS Scotland skin care and tissue viability best practice. b) implement these policies to ensure that there is a planned and consistent approach to these areas of care c) ensure all registered nurses and care staff are fully conversant with the above policies. d) registered nurses and carers receive refresher training in all of these areas of care and this is clearly documented in training and supervision records. National Care Standards Care Homes for Older People, Standard 5: Management and staffing arrangements, Standard 6: Support arrangements, Standard 14: Keeping well - healthcare. This recommendation was made on 07 July 2015 This recommendation was not met. See quality theme 1, statement The service provider should ensure there are separate care plans for the care and management of bladder and bowels and these are developed in line with best practice statements for example, NHS QIS (2009) Best Practice Statements: - urinary catheterisation and catheter care July continence, adults with urinary dysfunction December National Care Standards Care Homes for Older People, Standard 5: Management and staffing arrangements, Standard 6: Support arrangements, Standard 14: Keeping well - healthcare. This recommendation was made on 07 July 2015 page 36 of 42

37 This recommendation was met. See quality theme 1, statement The service provider should ensure that all registered nurses are up to date with best practice guidance in relation to catheter care. For example by accessing e learning from NHS education for Scotland. National Care Standards Care Homes for Older People, Standard 5: Management and staffing arrangements This recommendation was made on 07 July 2015 This recommendation was not met. See quality theme 1, statement The manager should continue to develop and monitor the content of personal plans to ensure that they accurately reflect individual needs and preferences, how these are to be met and properly evaluated. National Care Standards Care Homes for Older People, Standard 6: Support arrangements This recommendation was made on 12 November 2015 This recommendation was not met. See quality theme 1, statement The manager should monitor staffs moving and handling care practices to ensure these meet best practice guidance. National Care Standards, Care Homes for Older People, Standard 5, Management and Staffing Arrangements This recommendation was made on 17 December 2015 This had been followed up by the manager. We did not identify any issues with staff moving and handling care practices during inspection. This recommendation was met. page 37 of 42

38 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 38 of 42

39 9 Inspection and grading history Date Type Gradings 12 Nov 2015 Unannounced Care and support Not Assessed Environment Not Assessed Staffing Not Assessed Management and Leadership Not Assessed 8 Dec 2015 Re-grade Care and support 4 - Good Environment Not Assessed Staffing 4 - Good Management and Leadership Not Assessed 17 Apr 2015 Unannounced Care and support 3 - Adequate Environment 4 - Good Staffing 3 - Adequate Management and Leadership 4 - Good 17 Nov 2014 Unannounced Care and support 2 - Weak Environment 2 - Weak Staffing 2 - Weak Management and Leadership 2 - Weak 5 Jun 2014 Unannounced Care and support 3 - Adequate Environment 3 - Adequate Staffing 2 - Weak Management and Leadership 3 - Adequate 10 Dec 2013 Unannounced Care and support 3 - Adequate Environment 3 - Adequate Staffing 3 - Adequate Management and Leadership 3 - Adequate 31 Jul 2013 Unannounced Care and support 2 - Weak Environment 2 - Weak Staffing 2 - Weak page 39 of 42

40 Management and Leadership 2 - Weak 25 Apr 2013 Unannounced Care and support 3 - Adequate Environment 3 - Adequate Staffing 3 - Adequate Management and Leadership 2 - Weak 1 Feb 2013 Unannounced Care and support 2 - Weak Environment 3 - Adequate Staffing 3 - Adequate Management and Leadership 3 - Adequate 15 Jun 2012 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 3 - Adequate Management and Leadership 4 - Good 9 Mar 2012 Unannounced Care and support 4 - Good Environment 4 - Good Staffing Not Assessed Management and Leadership Not Assessed 13 Jun 2011 Unannounced Care and support 4 - Good Environment 4 - Good Staffing Not Assessed Management and Leadership Not Assessed 24 Jan 2011 Unannounced Care and support 4 - Good Environment 4 - Good Staffing Not Assessed Management and Leadership 4 - Good 19 Oct 2010 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good 22 Apr 2010 Unannounced Care and support 2 - Weak page 40 of 42