Care service inspection report

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1 Care service inspection report Full inspection Dalweem Care Home Service Taybridge Road Aberfeldy Inspection completed on 03 June 2016

2 Service provided by: Perth & Kinross Council 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 28

3 Summary This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change after this inspection following other regulatory activity. For example, if we have to take enforcement action to make the service improve, or if we investigate and agree with a complaint someone makes about the service. We gave the service these grades Quality of care and support 5 Quality of environment Quality of staffing Quality of management and leadership 5 Very Good N/A N/A Very Good What the service does well Dalweem care home provides a very good service to residents and relatives. Staff and management work hard to provide a person-centred model of care in a homely atmosphere. Residents said that they were supported in their preferred way and said that there was a good range of activities available. There are very good levels of satisfaction with the quality of the overall service. A high priority is given to making sure residents feel safe, listened to and well supported in a way that meets their needs in accordance with their individual choices and preferences. There is also a strong commitment to the meaningful participation of residents and their families. Healthcare is very well managed within a homely, comfortable environment and the staff team are well trained, skilled and motivated. Residents and relatives told us that they were very happy with the quality of the service. page 3 of 28

4 What the service could do better Inspection report The programme of refurbishment of the environment will take until the end of this year. Staff told us that there is some uncertainty over the use of a unit which will now be operated and run by the local hospital. What the service has done since the last inspection The participation strategy had been strengthened which had improved communications and feedback which had led to improvements in the quality of the service. Conclusion The service is currently providing a very good standard of service to residents and relatives and should continue to look for ways to continuously improve the quality of the service. Overall, this service provided a very good standard of care and support to residents living there. We observed staff supporting residents with dignity, respect and compassion. Staff demonstrated very good values in their work with residents and each other. Our evaluation was that this ethos was developed throughout the home by the management team. Residents told us they were very happy living at Dalweem and staff told us they were happy to work at the home. The environment was welcoming and homely. page 4 of 28

5 1 About the service we inspected Inspection report Dalweem is a care home owned and managed by Perth and Kinross Council. It is registered to provide care for up to 16 older people. The home is purpose-built near the main street in the rural town of Aberfeldy. It is all on ground floor level within its own grounds. All rooms are single with wash hand basins. There are toilets and bathrooms on each corridor. There are a variety of lounge areas and a main dining room which is also used for functions. The service brochure states that Dalweem "recognises the rights of all people to lead a valued life; it aims to be a provider of high standard care services, enabling all older people to remain as independent as possible". This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at Recommendations A recommendation is a statement that sets out actions that a care service provider should take to improve or develop the quality of the service, but where failure to do so would not directly result in enforcement. Recommendations are based on the National Care Standards, SSSC codes of practice and recognised good practice. These must also be outcomes-based and if the provider meets the recommendation this would improve outcomes for people receiving the service. Requirements A requirement is a statement which sets out what a care service must do to improve outcomes for people who use services and must be linked to a breach in the Public Services Reform (Scotland) Act 2010 (the "Act"), its regulations, or page 5 of 28

6 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 5 - Very Good Quality of environment - N/A Quality of staffing - N/A Quality of management and leadership - Grade 5 - Very Good Inspection report This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change following other regulatory activity. You can find the most up-to-date grades for this service by visiting our website or by calling us on or visiting one of our offices. page 6 of 28

7 2 How we inspected this service The level of inspection we carried out In this service we carried out a low intensity inspection. We carry out these inspections when we are satisfied that services are working hard to provide consistently high standards of care. What we did during the inspection We wrote this report after an unannounced inspection that took place on 1, 2 and 3 June The inspection was carried out by one inspector. We issued 10 Care Standards Questionnaires (CSQs) to the service to give to people who used the service and 10 to their family, friends or carers. Four completed questionnaires were returned before the inspection. In this inspection we gathered evidence from various sources, including relevant sections of policies, procedures, records and other documents, including: - personal plans of people who use the service - records of accidents and incidents - staff training and supervision records - team and management meeting minutes - quality assurance systems and audits - feedback and action plans arising from questionnaires and surveys - service user involvement information, including minutes from meetings and communication s to relatives. We had discussions with: - eight residents - five relatives - the manager - care staff - activity organiser - the chef - local authority Scottish Vocational Qualification (SVQ) assessor. page 7 of 28

8 We used the Short Observation Framework for Inspection (SOFI2) to directly observe the experience and outcomes for people who were unable to tell us their views. On this inspection we used SOFI2 to observe a mealtime experience of three residents in the dining room. 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 28

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 The views of people using the service are included in the main body of the report. Taking carers' views into account The views of relatives and friends about the service are included in the main body of the report. page 9 of 28

10 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 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths We found the service to be performing to a very good standard in relation to this statement. To do this we met with several residents and relatives and a cross-section of the staff team, observed the way that staff supported and listened to residents and relatives, reviewed the CSQs returned to us by relatives, and examined minutes of meetings and activity records. We found that the service continued to use a variety of methods to gather the views of residents and their relatives. These included formal care reviews, meetings with individuals and their social work representatives, resident and relative meetings, informal discussions, satisfaction surveys, and through the service's complaints procedure. The service was very good at ensuring residents, relatives, external stakeholders, and staff participate in assessing and improving the quality of care and support. The management and staff continue to develop and enhance ways that people can become involved in improving the service. The staff encourage communication with residents by supporting residents to communicate and use whatever means enhance the communication. We saw that the service had used Talking Mats, an alternative communication method page 10 of 28

11 with some residents who do not communicate verbally. For other residents there was a range of pictorial support and letter boards available to help people to communicate who may not communicate verbally. The residents and relatives we spoke to told us that staff had consulted them about the way that care and support needs were to be met. People also told us that staff had involved them when changes or decisions had to be made. There was evidence to show that staff had listened to the views expressed and respected individual choices. We also found that the feedback received had been responded to in a positive way and acted on properly. Residents and relatives told us they had been kept well informed and that they felt comfortable expressing their views as staff were approachable and responsive. There was an involvement board sited in the front hall which contained a You said, We Did display and which demonstrated how the service had listened to people who use the service and their relatives' views of the service and made changes to make improvements. There were regular resident meetings which some residents liked to attend so that they could talk about issues of shared interest and help decide on entertainment, outings and activities. There were regular planned meetings which relatives could attend to hear about a range of issues, including redecoration and refurbishment, staff changes, staff training, and the results of quality audits. The service employed two activity coordinators who worked very hard at creating a varied and flexible activity programme based on residents' interests and hobbies. There were various social events which the management and staff team used to informally seek the views of residents and relatives. These included the music sessions. These provided alternative opportunities to make comments and suggestions. When we sampled some of the reviews, we found these to be mostly well written. When the resident had been less able to fully participate in the review relatives had been involved. Areas discussed included the person's health needs, social activities and any concerns. page 11 of 28

12 We saw that, where appropriate, residents or their relative/representative signed to confirm agreement with the content of the care plan and care review. This meant that families were aware of how the service was planning to meet their relative's health and wellbeing needs. Areas for improvement The service identified that they would continue to work with staff to encourage residents to be as independent as possible. The manager also told us that she planned to seek different ways to include residents and relatives on commenting on the service. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths Examination of the evidence presented in respect of this statement assessed the service to be operating at a very good level of performance. We made this decision after speaking to people and an examination of written documentation, including personal plans and medication records, as well as observing how staff supported and engaged with residents. Each service user had a personal plan. This had been informed by a range of assessments, including a risk assessment for falls. This helped staff take action to promote wellbeing. A new format of personal planning had been introduced and the team had worked hard to include person-centred information to provide guidance on how individual preferences and needs were to be incorporated into the delivery of the support provided. The manager regularly page 12 of 28

13 audited the care plans and provided staff with effective and meaningful plans with agreed actions. There were regular health assessments, including nutrition, skin care, falls, and mobility. Where a health issue was identified from these assessments a care plan was in place to guide staff as to the care required. We saw that the home had regular contacts with other health professionals and sought their input where required. This included podiatrists, GPs, dietitians, and speech and language therapists. We spoke with one visiting care manager. They were confident in the service offered to residents. We carried out a medication check to ensure that residents were receiving their prescribed medication. We were satisfied that there were safe procedures in place for the management and administration of medication. Residents told us that they liked the meals and thought the quality of food and the presentation was good. We observed a lunchtime dining experience using the SOFI2 observational tool and found that residents were actively engaged and encouraged by staff to make choices from the menu and were given the appropriate level of assistance to eat their lunch. The atmosphere in both dining rooms was calm and relaxed and residents were given time to eat their food. An inspection volunteer made the following comments: - "Only one person grumbled a little because the porridge was not made with salt in it. When asked if something else was on offer, if the choices offered were not to their taste, most residents knew they could order differently but none had done so." - "Medication was given out as needed and unobtrusively when lunch was over and was hugely enjoyed." Residents made the following comments about food: - "I love lunch here." Inspection report page 13 of 28

14 - "I mostly like it but I can order sandwiches and I do like them." - "The lunch is so big I can't manage the pudding too and we are always being asked about menu selection." - "We have a choice." - "Breakfast is my favourite. I have it in my room." - "There is always so much. I can never finish it." Daily routines had been flexible to take account of residents' individual needs, choices and preferences, including their lifestyle choices. Residents told us that this had contributed to their general sense of contentment and wellbeing. Staff had been provided with a wide range of training that informed and supported them to meet the health and wellbeing needs of residents. We found that staff communicated effectively with each other and had promoted very good continuity of care in order to ensure that residents' needs were met. Staff were experienced in the care of older people and had undertaken training that supported them in their individual roles. We found that staff had a good awareness of residents' individual health and wellbeing needs and had acted properly to meet the needs identified. We audited the money held by the service securely for residents who may be unable to manage their money themselves. We found that residents' finances were very well managed and clearly accounted for at the service. page 14 of 28

15 Areas for improvement Residents were given alternative choices verbally by staff if they did not wish to choose from the daily menu. It would be meaningful if alternative choices were displayed on each table to allow residents the opportunity to see this in advance. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 15 of 28

16 Quality Theme 2: Quality of environment Quality theme not assessed page 16 of 28

17 Quality Theme 3: Quality of staffing Quality theme not assessed page 17 of 28

18 Quality Theme 4: Quality of management and leadership Grade awarded for this theme: 5 - Very Good Statement 2 We involve our workforce in determining the direction and future objectives of the service. Service strengths Examination of the evidence presented in respect of this statement assessed the service to be operating at a very good level of performance. We came to this decision after discussions with management and staff and an examination of written documentation, including supervision and appraisal documents. Staff spoken to confirmed that they had positive working relationships with the management team and that they felt their opinions and suggestions were valued. They felt there were good channels of communication to support this. The service offered regular supervision to staff where discussion took place about their performance, training and service delivery. Staff we spoke with told us that supervision allowed them to comment on the service and if, after discussion, changes were agreed these would be implemented. Staff meetings were also held and minutes kept of these meetings. This enabled staff who had not been able to attend to be aware of discussions. Staff told us that they received additional training as necessary to ensure that they were able to meet changing needs of residents. Supervision and appraisal provided opportunities for staff to be involved. Individual staff development plans promoted a culture of learning within the service. We saw that staff were encouraged and supported to introduce new ideas and develop practice. page 18 of 28

19 Staff we spoke with told us that they were confident that any issues raised with the manager would be taken seriously and acted on as appropriate. Values and leadership were seen to be integral to how the service operated. We saw that the service was actively seeking further leadership training for staff. The manager operated an open door policy. We saw that she was very visible within the service on a daily basis. We thought that this was very good practice as it provided staff with very clear leadership and support. We spent some time observing staff care practices during our unannounced visits. We saw that the staff team worked very well together and were confident in how they went about their daily roles and responsibilities. An example of this was the mealtime experience for residents. We saw that it was well organised and the staff team worked very well together to make sure that it was a very enjoyable social experience for residents. Staff made the following comments: - "I am very happy with the level of training I receive." - "It is a great pleasure to work with my manager." - "The environment helps staff to take forward ideas." - "All the staff and the manager are friendly and caring." Inspection report - "This is a lovely place to work. The management are fair and approachable. I am always provided with learning opportunities. I feel residents are treated with respect." - "I expressed an interest in a training course. I was able to go on the course and I am now an in-house trainer." - "I enjoy my job. I like spending time with residents. It's a very rewarding job." page 19 of 28

20 Areas for improvement It would be helpful to have an action plan developed from the information obtained from the staff development process to identify how the service has considered the suggestions from staff on how they can contribute to service development. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Inspection report 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 Examination of the evidence presented in respect of this statement assessed the service to be operating at a very good level of performance. We came to this decision after discussions with management and staff and observation of practice. The management team had a visible presence in the home and were known by staff, service users and some visitors. This helped form positive relationships and enabled the management team to get to know the staff team and how the care home was functioning. Some of the staff had key roles in the home and were known as champions. To promote this role, staff had undertaken training specific to their role and some had made links with NHS partners. One of the champions had expressed an interest in palliative care and had undertaken the relevant training. The service had a quality assurance framework which was used by the management team to monitor standards in the service. This included areas such as the environment, infection control, managing medicines, and care planning. page 20 of 28

21 We saw that where an area for improvement was identified that an action plan was in place and action taken promptly to rectify any issues. This was being used effectively and the home's findings were mainly consistent with our findings at this inspection. Accident and incident reports were regularly reviewed by the manager. We saw that this had led to discussions with staff and amendments to care plans. The manager had an audit system to monitor accidents and incidents. This helped identify any trends. The manager had an open door policy that people we spoke to commented positively about. Residents and relatives we spoke with confirmed they felt able to raise issues with the manager and be confident that these would be resolved promptly. Staff support was provided through scheduled supervision and appraisal. Supervisions were undertaken by direct line managers. This helped staff who led each unit to get to know and support staff in their development. The staff structure offered a career pathway for staff. The provider supported staff to gain a recognised qualification to enable them to register with the Scottish Social Services Council (SSSC) and continue with their learning to help progress their role within the service. Areas for improvement The service identified in their self assessment that they would continue to use the quality audit system to ensure that high standards were continued within the home. Staff who are responsible for reporting incidents to the Care Inspectorate through the eforms system should be fully trained and understand the process. The manager agreed to action this. page 21 of 28

22 All staff should be aware of adult support and protection (ASP) procedures no matter what their role is. The manager agreed that this will be discussed in individual supervision sessions. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 page 22 of 28

23 4 What the service has done to meet any requirements we made at our last inspection Previous requirements 1. The provider must ensure that the information and guidance in residents' care plans and risk assessments is clear, consistent and accurately reflects their current health and support needs. The provider must also ensure that all risk assessments are fully completed for each resident and where any level of risk is identified, an appropriate plan of care is developed and reviewed at appropriate intervals. This must include: - skin care and pressure damage prevention - nutrition - falls. This requirement was made on 26 June 2015 The provider has worked hard to update residents' care plans. The information and guidance in the sampled care plans is now clear, consistent and accurately reflects residents' current health and support needs. Risk assessments were all fully completed and appropriate plans were in place where risks had been identified. The manager carries out regular audits to ensure that all actions have been completed within agreed timescales. Met - Within Timescales 2. The provider must develop and implement a safe and effective system for the management and administration of medication. This must include: a) Ensuring that skin creams and eye drops are dated when they are opened. b) Ensuring the information on medication labels is clear and legible. page 23 of 28

24 c) Ensuring that handwritten medication administration record (MAR) sheet entries are signed, dated and referenced to the original prescribing authority. d) Ensuring that the information in the medication folder is consistent with the information on the medication labels. e) Ensuring that correction fluid is not used to make amendments to MAR sheets. f) Ensuring that controlled drugs are checked following the home's medication procedure. g) Ensuring that medication is administered as instructed by the prescribing professional. Where this is not the case, clearly documenting the reasons. This requirement was made on 26 June 2015 The manager had requested training for staff from the pharmacy that they now use. This training was delivered to all staff and a safe and effective system for the management of medication is now in place. Regular audits are carried out by the manager and senior staff. Met - Within Timescales page 24 of 28

25 5 What the service has done to meet any recommendations we made at our last inspection Previous recommendations There are no outstanding recommendations. Inspection report 6 Complaints No complaints have been upheld, or partially upheld, since the last inspection. 7 Enforcements We have taken no enforcement action against this care service since the last inspection. 8 Additional Information There is no additional information. 9 Inspection and grading history Date Type Gradings 26 Jun 2015 Unannounced Care and support 4 - Good Environment 5 - Very Good Staffing 5 - Very Good Management and Leadership 4 - Good 25 Sep 2014 Unannounced Care and support 4 - Good page 25 of 28

26 Environment Staffing Management and Leadership 5 - Very Good 4 - Good 4 - Good 31 Mar 2014 Unannounced Care and support 3 - Adequate Environment 4 - Good Staffing 4 - Good Management and Leadership 3 - Adequate 31 May 2013 Unannounced Care and support 3 - Adequate Environment 4 - Good Staffing 4 - Good Management and Leadership 3 - Adequate 1 Jun 2012 Unannounced Care and support 4 - Good Environment 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good 5 Nov 2010 Unannounced Care and support 5 - Very Good Environment Not Assessed Staffing Not Assessed Management and Leadership Not Assessed 18 Aug 2010 Announced Care and support 5 - Very Good Environment 5 - Very Good Staffing Not Assessed Management and Leadership Not Assessed 3 Dec 2009 Unannounced Care and support 5 - Very Good Environment 5 - Very Good Staffing 4 - Good Management and Leadership 4 - Good 30 Apr 2009 Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 3 - Adequate page 26 of 28

27 7 Jan 2009 Announced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 3 - Adequate Inspection report page 27 of 28

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

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