Erskine Home Care Home Service

Transcription

1 Erskine Home Care Home Service Erskine Ferry Road Bishopton PA7 5PU Telephone: Type of inspection: Unannounced Inspection completed on: 22 August 2016 Service provided by: Erskine Hospital Service provider number: SP Care service number: CS

2 About the service The inspection focused on standards of care for people living with dementia. We are using a sample of 150 care home services to look in detail at the standards of care for people living with dementia and this service is one of those selected as part of the sample. The areas looked at were informed by the Scottish Government's Promoting Excellence: A framework for health and social care staff working with people with dementia and their carers and the associated dementia standards. It is our intention to publish a national report on some of these standards during Erskine Home is registered to provide care for up to 180 older people some of whom will be living with dementia. The home comprises six individual houses, each with 30 single en-suite bedrooms. Each house also has sitting and dining areas, kitchen facilities and a selection of bathrooms. Two of the houses are specifically for residents with a diagnosis of dementia. This home is situated on a large campus just outside the town of Erskine. A central reception area provides access to the houses, a cafe area, a fully staffed recreation and activity department, gym and therapy areas, shop, bank and hairdresser. The home also employs specialist health care professionals including a speech and language therapist, podiatrist and physiotherapist. This enhances the care and treatment available for residents. Residents and their families enjoy the well maintained grounds and gardens. Enclosed gardens are provided in the houses which care for people living with dementia. Residents also have access to a range of transportation. Erskine Home states that it aims to be "committed to providing the very highest standard of care and a true sense of belonging for each and every resident within a friendly, homely environment." What people told us We spoke with 25 residents on an individual basis or in group settings. We also spoke with 13 sets of relatives. The comments received from everyone were, on the whole, positive. 'I am well looked after and am treated with respect. I have no complaints.' 'I am well looked after though I have only been in the Home for 4 weeks so I am still settling in'. 'Care is perfect, I am well looked after.' 'I am well looked after. ' 'Care and support 5 plus, ' 'I am well looked after. Not really any complaints. ' 'Care and support is fantastic. ' 'Best place to be at my stage in life.' 'There are enough activities though I would like more outings.' 'Activities are very good. There are enough outings. I am going to the Tattoo and I get taken to football.' 'I am happy with the activities but I would like more outings.' 'I take part in activities when I can. I like the outings.' 'Could do with more activities. I like the outings.' 'Staff are good.' 'Staff are perfect, very good.' 'Staff are always caring.' 'Staff are excellent.' page 2 of 14

3 'Staff cannot do enough (meaning they are very good).' 'I could not praise staff enough. I am treated with respect; they always knock before entering my room.' 'Staff are very good.' 'I am happy with the staff, they are helpful and attentive.' 'There are enough activities. Erskine takes me to the football.' 'Enough activities but I would like more outings.' 'Residents should be informed about outings. I missed the outing to the distillery because I was not told about it.' Relatives comments: 'Staff are helpful and attentive.' 'I give recreation staff 5 out 5.' 'Always caring.' 'Management is excellent.' 'Seems to be well managed.' 'It is well managed.' 'It is always clean and no smells.' 'Temperature is always satisfactory.' 'It is always clean and I like the décor.' 'The food is great.' 'The food is very good.' 'Care and support is fantastic.' 'Good, 3 out of 5.' Self assessment The self assessment was referred to throughout the inspection. From this inspection we graded this service as: Quality of care and support Quality of environment Quality of staffing Quality of management and leadership 4 - Good 5 - Very Good 4 - Good 4 - Good Quality of care and support Findings from the inspection We found residents and relatives to be positive about the care and support provided by Erskine Home. We found that staff knew the residents well and this was evidenced in the care plans we sampled. We found the care plans to be thorough and regularly reviewed. They gave a good reflection of the choices and preferences of each resident. page 3 of 14

4 We found that staff were warm and caring towards residents. We observed staff taking time with those residents who had a cognitive impairment. We saw that staff worked as a team and this included housekeeping and catering staff. Staff were very aware of their duty to keep residents safe from harm. They knew their responsibilities in this area and would have no hesitation in raising a concern. We found there was good support for the health and well-being of residents. We discussed some on going issues with the dental service for residents and we were told that the new EMarr system (electronic medication management) was having some initial problems. We were reassured that both of these concerns were being addressed and would be resolved in the near future. The provision of meaningful activities for residents had been reviewed since our last visit. We found that activity staff spent more time in the houses offering more low-key and individualised support for residents who preferred to stay in their 'house'. They continued to have larger events in the 'Bunker' although these has been reduced slightly. This new programme will be reviewed on an on going basis to ensure that it meets the needs of all residents, where possible. We observed the dining experience in several of the houses. We found staff to be attentive and patient and residents were enjoying their meal. The catering department made all efforts to discuss, with residents, the quality of the food and choices on a regular basis. We spoke with the Finance Department and were satisfied that the home had accountable systems in place to manage residents finances We found that the care plans could be more person centred in some areas. We saw some very positive recording but we also saw recordings within the plans that were generic and superficial. Staff would benefit from more training in the area. (recommendation 1) We asked the service to ensure that the care plans for 'as required' anti-psychotic medication detailed the triggers as to why the medication would be required but also detailed and monitored the effect of the medication. (recommendation 2) Requirements Number of requirements: 0 Recommendations Number of recommendations: 2 1. The service needs to support staff to write in a person centred manner when they are writing in care plans. 2. The care plans for PRN (as required) medication need to improve. They need to become more accountable and detail the triggers for the medication being considered and the effect it had on the resident once given. Grade: 4 - good page 4 of 14

5 Quality of environment Findings from the inspection Erskine Home offered a range of opportunities for residents both within and out with the home. We found that very good efforts were made to support residents to maintain community links. There were particularly strong links with military services as most of the residents had a service history. There were good links with the local schools and nurseries who would visit to entertain residents. Residents also enjoyed when singers and bands visited the home. Families were encouraged to take part in any activity within the home and to take their relative out if they wished. The home organised trips out for residents to the Falkirk Wheel, Tattoo and football grounds, as examples. The home had many areas that residents could visit such as the hairdressing salon, café, shop and welldeveloped gardens. There were smaller lounges in all houses if residents preferred quieter spaces. Residents were free to wander to within safe limits and some residents had the code for the lift so that they could use this independently. Some of the houses had developed their own facilities such as a hairdressing room or a therapy room in response to the needs and requests from residents. We asked one of the houses to consider having a visitors' sign in' book so they knew who was coming in and out of the house. The service had completed the Kings Fund Audit Tool for the environment and were already considering how they could improve the environment for those residents with a diagnosis of dementia. We also completed the audit in the company of members of the management team. We spent a long time discussing the environment and what measures could be put in place quickly to improve some areas for those residents with a cognitive impairment. The home were very responsive and took action immediately to address some of the issues we identified. They also drew up a plan of what else could be put in place. We will review this at the next inspection. We were shown one of the gardens which was in the process of being developed to become more safe and appropriate for residents with dementia. A lot of thought had gone into the design and it will provide a stimulating, pleasant space for residents once completed. The home had further plans and ideas for other garden areas. Requirements Number of requirements: 0 Recommendations Number of recommendations: 1 1. The home should take forward the findings from the Kings Fund audit and continue with the plans to develop the garden areas. Grade: 5 - very good page 5 of 14

6 Quality of staffing Findings from the inspection We received positive comments from both residents and relatives about the staff and management team within the home. We observed staff to be responsive, warm and respectful when caring and supporting residents. Positive relationships were evident and staff knew the residents well. Relatives told us that staff often 'went the extra mile' for residents and this was much appreciated. Staff told us that they 'were happy to work here' and that staffing levels had improved. Most felt well supported and trained. They received regular supervision and felt that the training they received equipped them to take good care of residents. Staff had a good understanding of how to support those residents with a diagnosis of dementia. We saw staff being patient and taking time to explain something to a resident when required. We discussed Adult Protection, Continence management and oral health with a group of staff. They showed a good understanding of these areas and could discuss good practice and how they supported residents, however formal training in these areas was variable. We discussed this with the management team and training was planned prior to us concluding this inspection. We found that all relevant staff were registered with the Scottish Social Service Council and that staff were also being supported to complete a SVQ qualification. Staff were supported to reflect on their practice and this will become more structured within supervision to support the requirement for the SSSC - Post Registration Teaching and Learning log (PRTL). The home should develop dementia training within the home so that it is aligned to each staff members role. The home should also develop the role of 'Dementia Ambassador/Champion' so that there is staff who have enhanced knowledge of best practice and can support staff and monitor practice. The dementia training needs to be more professionalised and organised and staff should understand the need for them to undertake some self supported study to get the best out of the Promoting Excellence Framework. Requirements Number of requirements: 0 Recommendations Number of recommendations: 1 1. The service needs to have a more professional, clearly defined programme for staff in dementia training which follows the Promoting Excellence Framework. Grade: 4 - good page 6 of 14

7 Quality of management and leadership Findings from the inspection The management and staff teams co-operated fully with this new Dementia Focus Area. They expressed a desire to improve the service they offered to residents with a diagnosis of dementia and they were receptive to any ideas and suggestions arising from this inspection. We spent more time with the house managers with responsibility for the dementia specific houses and they were open and honest about the quality of care and support they offered to residents with a diagnosis of dementia. Staff, in discussions, were also aware of the principles of good, safe care. Residents and relatives spoke highly of the management team and told us that they would approach them with any concerns. There had been a new appointment to the post of Director Of Care and each House now had their own Manager. The management team had established systems in place to assure the quality of the service. They operated an 'open door' policy where residents and visitors were welcome to drop in. They used surveys to gather the views of residents and relatives and the action plans from these outlined areas for improvement with timescales. They undertook regular audits of areas such as medication and care plans and the outcomes of these would be discussed with staff and practice improved if required. We found a significant amount of quality assurance was taking place. We asked how these findings were shared with staff, residents and relatives. The management team acknowledged that improvements could be made in the way they shared the outcomes of these important pieces of work. We participated in a morning meeting (huddle) where representatives of the heads of departments/each house within the home met to discuss any issues, concerns or good news. This was an effective way to ensure that everyone knew what was happening within the home for that day. Staff were encouraged to develop their practice and take on leadership roles, in areas such as such as continence and oral health. The management team acknowledged that there were still improvements to be made in this area as they felt that other staff had the capacity to enhance their role, they just needed the support, training and time to do so. Requirements Number of requirements: 0 Recommendations Number of recommendations: 1 1. The service should consider how it can share the findings, with residents, relatives and staff, of the significant amount of quality assurance that is undertaken within the home. Grade: 4 - good page 7 of 14

8 What the service has done to meet any requirements we made at or since the last inspection Previous requirements There are no outstanding requirements. What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 The service should develop a more coordinated approach and response to engagement and consultation. This should show what was consulted on, when and what outcomes and actions were identified. National Care Standards for Care Homes for Older People Standard 11 Expressing your views and Standard 5 Management and staffing arrangements. We saw more evidence of co-ordinated, outcome focussed consultation since the last inspection. There was a display board in each house and these were full of information, outcomes of surveys and feedback than previously seen. We saw invites and minutes of a variety of meetings such resident and relatives meetings, dining experience feedback, e-marr information and changes to the shift pattern etc. We saw that there was a lot of on-going work with this which showed commitment from the service to continue to consult with, and seek the views from, residents, relatives and staff, We saw suggestion boxes, newsletters, photos, 'You Said We Did' (comments on activities, food, complaints) with good outcomes. We noted in some of the personal plans we sampled that there was good communication between the staff and relatives. We were satisfied that the home had made good progress in this area and were assured that this would continue. This recommendation has been met. page 8 of 14

9 Recommendation 2 The service needs to determine what else staff can do to ensure that each resident has a meaningful time whilst staying in the home. Staff need to have the time to spend 1:1 with residents, particularly those who are not able to participate in activities outwith of their house. National Care Standards for Care Homes for Older People Standard 17 Daily Life. We spent time observing how residents were spending their day to see if staff were supporting them to have a meaningful experience. We saw that the larger events in the recreation area were well attended and residents got opportunities to go out on trips and visits. We were told that a survey had recently been completed and the recreation team had listened to the views expressed and were putting more activities in place to respond to the ideas put forward by residents such as bridge, draughts and specific activities and events. We saw evidence of some activities taking place in the houses but we still had a question about the provision of activities for those residents who preferred to stay in their room/house or were unable to get out of their room/ house. We saw a programme on display in each house, such as saunas, music or bingo, however we did not find that the 1:1 activities were promoted well within the houses. We were told the activity programme included 4 afternoons for in house activities and link staff worked with House Managers to develop an in house programme that suited the needs of individual residents and included one to one sessions. The service needs to continue to review the provision of activities to make sure what is being offered is the best it could be in response to the needs and abilities of all residents. There should be a focus and development in the provision of 1:1 activities involving all relevant staff including care staff. This will be reviewed at the next inspection. Recommendation 3 The service needs to review the dining experience across the home. We found it was inconsistent in many areas. All residents should be offered choice at meal times in an environment which is pleasant and welcoming. Residents should, on the whole, be satisfied with the meals provided. National Care Standards for Care Homes for Older People Standard 13 Eating Well. We spent time in each house observing the dining experience and speaking with residents about the meals and the choice offered. We received variable responses with some residents enjoying the food but the majority of comments to us highlighted that there was still an issue with the meals. Some residents commented that they did not feel they had a say with their meals, some did not like that food 'always came with a gravy' and most of the negative comments were about the lack of choice. Since the last inspection we could see that the service had made efforts to consult with residents about the food and the dining experience. Tasting meetings had taken place, a chef would visit each house on occasion and ask for feedback and there had been regular audits of the dining experience by the management team. We also saw page 9 of 14

10 very honest observations from the catering team when they had visited houses to review the meals provided. We were advised that a new menu would be introduced soon. We found that the dining experience had improved since our last visit. The lunchtime was more organised and responsive to the needs and choices of residents. Residents were assisted by staff in a respectful manner and the tables were set appropriately. We saw that some houses had a staggered lunchtime which allowed those residents who required help to receive it in a quieter environment. We also saw that the home were asking for volunteers to be involved in a Dining Experience Group. Overall the dining experienced had improved but the provision of meals was still an issue. We were assured by the relevant catering management staff members that they were taking this seriously. We will review this again at the next inspection. Recommendation 4 The service needs to ensure that all care plan reviews are taking place on time. The review should be focussed on all of the residents needs and articulate the positive outcomes for each resident. National Care Standards for Care Homes for Older People Standard 6 Support Arrangements. We sampled review minutes across all of the houses within the home. We found that the minutes of the meetings were still clinical in tone and did not reflect the whole needs of the resident or evidence how they had enjoyed any meaningful experiences. The management team were aware of what needed to be done and they gave assurances that progress would be made with this for our next visit. This recommendation will continue. Recommendation 5 All staff must be aware of, and implement, the correct procedures if they have a concern about the safety and well-being of any resident. National Care Standards for Care Homes for Older People Standard 9 Feeling safe and secure. We were told that Adult Support and Protection guidance was made reference to in the staff handbooks. We were also told that ASP was an integral part of the induction training for new staff. In February all of Erskine staff will complete an ASP module on LearnPro. This will raise staff awareness and also test their knowledge. The ASP lead staff member advised us that staff would contact her for guidance and advice regarding completing the correct protocol and paperwork if required. If staff had any concerns then the ASP Lead would offer practical support and guidance with the issue. The home undertook an exercise with 42 staff to determine their knowledge of ASP. The responses showed that page 10 of 14

11 staff were conversant with what to do. When we spoke with staff it was evident that they were clear about their responsibilities in this area. Staff had a good awareness of what to do to keep residents safe. We acknowledge that good progress had been made in this area but the recommendation will continue until all staff have completed the ASP training. Recommendation 6 The performance reviews need to take place so that staff are supported to develop their skills and leadership potential. National Care Standards for Care Homes for Older People Standard 5 Management and staffing arrangements. The performance reviews need to take place so that staff are supported to develop their skills and leadership potential. We were told that staff Performance Development Reviews would take place in line with Erskine policy. They were all to take place by end of January This recommendation will continue until we see the outcomes of the PDRs with specific pathways for staff to develop their leadership potential and their own practice. Recommendation 7 The self assessment needs to be improved to reflect positive outcomes for residents. National Care Standards for Care Homes for Older People Standard 5 Management and staffing arrangements. We had a long discussion with the manager of the service. She told us that they have spent time discussing this and are confident that the next self assessment will be more reflective of outcomes for residents with all the relevant evidence. This recommendation will continue. Recommendation 8 Staff should receive regular, formal supervision to support their work and personal development. National Care Standards for Care Homes for Older People Standard. All staff should have received either a performance review or supervision session by the end of January This was being monitored by the Home Manager. If the supervision session does not take place then follow up letters were issued to both parties and the session must take place within three weeks of the original date. Staff told us that staff supervision has improved and they felt more supported. This recommendation has been met. page 11 of 14

12 Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at Enforcement No enforcement action has been taken against this care service since the last inspection. Inspection and grading history Date Type Gradings 2 Feb 2016 Unannounced Care and support Not assessed Not assessed Not assessed Management and leadership Not assessed 1 Oct 2015 Unannounced Care and support 3 - Adequate 4 - Good 3 - Adequate Management and leadership 3 - Adequate 30 Jan 2015 Unannounced Care and support 4 - Good Management and leadership 4 Sep 2014 Unannounced Care and support 4 - Good Management and leadership 11 Feb 2014 Announced Care and support 4 - Good Management and leadership page 12 of 14

13 Date Type Gradings 24 May 2013 Unannounced Care and support Management and leadership Not assessed 25 Jul 2012 Unannounced Care and support 4 - Good Management and leadership 7 Oct 2010 Unannounced Care and support Not assessed Not assessed Management and leadership Not assessed 22 Apr 2010 Announced Care and support Not assessed Management and leadership Not assessed 5 Nov 2009 Unannounced Care and support Not assessed Management and leadership Not assessed 27 May 2009 Announced Care and support Management and leadership 7 Jan 2009 Unannounced Care and support 4 - Good Management and leadership 4 - Good 11 Jun 2008 Announced Care and support 4 - Good Management and leadership 4 - Good page 13 of 14

14 To find out more This inspection report is published by the Care Inspectorate. You can download this report and others from our website. Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and help services to improve. We also investigate complaints about care services and can 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. You can also read more about our work online at Contact us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com Find us on Facebook Other languages and formats This report is available in other languages and formats on request. Tha am foillseachadh seo ri fhaighinn ann an cruthannan is cànain eile ma nithear iarrtas. page 14 of 14