Care service inspection report

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1 Care service inspection report Full inspection Golfhill Care Home Care Home Service 35 Hanson Street Dennistoun Glasgow Inspection completed on 08 October 2015

2 Service provided by: BUPA Care Homes (CFHCare) limited Service provider number: SP Care service number: CS Inspection Visit Type: Unannounced Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and set out improvements that must be made. We also investigate complaints about care services and take action when things aren't good enough. Please get in touch with us if you would like more information or have any concerns about a care service. Contact Us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY page 2 of 48

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 Quality of environment 4 Quality of staffing 4 Quality of management and leadership 4 Good Good Good Good What the service does well The feedback from most service users and relatives about this service was very positive. There was lots of praise for staff and it was generally felt that this was a good service. What the service could do better There must be improved understanding and practice of when to refer a care worker to the Scottish Social Services Council in the event of an allegation of misconduct. There were areas that could improve further and these included more meaningful activities for service users with staff being less task orientated and more flexible in meeting needs. We also thought some of the record keeping could improve. There was a need for refurbishment of the environment which had been recognised by the service provider, BUPA. page 3 of 48

4 What the service has done since the last inspection Inspection report The management team had continued to try to develop the service further but staff changes had occurred and there was little change since the last inspection. Conclusion The service continues to operate at a good level. More proactive action is needed to address areas for development and recommendations. page 4 of 48

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 The service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April Golfhill care home is registered as a care home for older people, some of whom may have dementia. It is situated in the Dennistoun area of Glasgow. The service provider is BUPA care homes (CFH care) limited. The service has four care houses of 30 beds. Each care house has a large communal lounge/ dining room and smaller quiet room. There is access to the garden through patio doors. All bedrooms are single rooms with en-suite toilet and washbasin. There are a variety of bathrooms and showers for shared use. At the time of this inspection there were 84 service users. Recommendations A recommendation is a statement that sets out actions that a care service provider should take to improve or develop the quality of the service, but where failure to do so would not directly result in enforcement. Recommendations are based on the National Care Standards, SSSC codes of practice and recognised good practice. These must also be outcomes-based and if the provider meets the recommendation this would improve outcomes for people receiving the service. Requirements A requirement is a statement which sets out what a care service must do to improve outcomes for people who use services and must be linked to a breach in the Public Services Reform (Scotland) Act 2010 (the "Act"), its regulations, or orders made under the Act, or a condition of registration. Requirements are enforceable in law. page 5 of 48

6 We make requirements where (a) there is evidence of poor outcomes for people using the service or (b) there is the potential for poor outcomes which would affect people's health, safety or welfare. Based on the findings of this inspection this service has been awarded the following grades: Quality of care and support - Grade 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 or by calling us on or visiting one of our offices. page 6 of 48

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 This unannounced inspection was carried out by three inspectors and one inspector volunteer. Inspector volunteers are members of the public who have used a care service in the past or care for someone such as a family member or friend. They help us get the views of people using the care service. The volunteer inspector's observations are incorporated into this report, particularly under quality theme 1, statement 3. The inspection was carried out on Wednesday 7 October from 9:30am - 7pm and on Thursday 8th October from 9:30am - 5:30pm. Feedback was provided to the manager, clinical services manager and quality manager at the end of the inspection. During the inspection information was gathered from a variety of sources. We looked at: - completed questionnaires - "quick feedback" slips - residents' report - May newsletters - complaints log - ten service user personal plans were examined - medication records - maintenance records - cleaning schedules - five staff files - supervision and appraisal records page 7 of 48

8 - staff training records - minutes of staff meetings - monthly home managers report - monthly provider review We spoke to: - 16 service users - 19 relatives - four nurses - clinical services manager - four care assistants - training manager - maintenance man - housekeeping supervisor - chef We walked round and inspected: - all communal lounge/dining rooms - a sample of bedrooms, communal bathrooms, toilets, dirty utilities - two periods of observation of interactions between staff and service users. page 8 of 48

9 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 9 of 48

10 The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. A fully completed self assessment document was submitted by the service. This was completed to a satisfactory standard and gave relevant information. Taking the views of people using the care service into account During the inspection we spoke with 12 service users. We also had completed questionnaires returned by 12 service users. There were generally very positive views expressed. Some comments are included in the report. See quality theme 1, statement 3. Taking carers' views into account During the inspection we spoke with 14 relatives. There were generally very positive views expressed. Some comments are included in the report. See quality theme 1, statement 3. page 10 of 48

11 3 The inspection We looked at how the service performs against the following quality themes and statements. Here are the details of what we found. Quality Theme 1: Quality of Care and Support Grade awarded for this theme: 4 - 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 verified that the information stated within the service's self assessment was accurate and found the methods of gaining feedback were of a good standard. We saw the service provider sought feedback about the quality of care and support from service users and relatives using a variety of methods. These included: - questionnaires issued at reviews or posted out to relatives - prepaid cards with tick boxes to grade different subjects - suggestion boxes - residents/relatives meetings - compliments, suggestions & complaints process - 'quick' feedback slips. An involvement strategy was prominently displayed on the notice board of all care houses. This set out the different ways that service users and relatives could get involved in the day to day running of the service. page 11 of 48

12 A book with comments about the food at mealtimes was kept by staff to show to the chef. Staff told us this would be used to make changes to the menu if necessary. The grades on the questionnaires and comments on the quick feedback slips indicated some positive comments from relatives. Areas for improvement Although there were opportunities for service users and relatives to give opinions and provide feedback on care and support the systems available were best suited to those who were more able and not to people with dementia. We did not see any adaption of questionnaires or use of specialist materials to help gain the viewpoint of people with cognitive impairment. The evidence of feedback being obtained was fragmented and it was hard to get a picture of what service users and relatives thought about the service. This was because the feedback had not been collated periodically. The questionnaire in use only asked for comments about the overall service and a satisfaction grading could be applied using a one to six scale. This provided limited feedback about details of care and support. The pre-paid card provided a range of subjects to tick whether it was satisfactory, good or excellent. The aim of this card was to provide recommendations for a website and this may put some people off using it as a method of routine feedback. The suggestion boxes were rarely used and staff told us attendance at resident/ relatives meetings was very low. These meetings were often cancelled. Comment from Inspector Volunteer: 'The relatives that I spoke with did not know about relatives meetings.' Inspection report We were told there used to be meetings held with the catering manager and the activities co-ordinator but these had not taken place recently. page 12 of 48

13 Complaints information was not displayed prominently. Although all notice boards gave details of how to contact the Care Inspectorate it was not easy to see how a complaint would be dealt with locally using the BUPA policy. The personal plans of service users we viewed did not show involvement of service users, relatives or legal representatives. We saw that an "Evidence of relatives involvement" record was not in place in two of the plans. There were consent forms to show agreement to share information which were blank and unsigned. Care plans and risk assessments had signature spaces to show involvement but these were usually blank. We saw in four personal plans it was unclear how decisions about care and support would be made. The service users had cognitive impairment but the adults with incapacity certificates had not been completed or had expired. The personal plan document referred to English terminology that could be potentially confusing for staff. This meant we could not be sure that service users were getting representation for care reviews and to ensure decisions were being made in their best interest. Overall the amount of feedback being returned was low and it was hard to see results and actions taken. See recommendations 1 and 2. Grade 4 - Good Number of requirements - 0 Recommendations Number of recommendations - 2 Inspection report 1. The service provider should develop methods of gaining feedback from service users: - to be more inclusive of service users with dementia - to gain more specific opinions about aspects of care and support. For example food or activities - collate feedback periodically - provide results of feedback clearly page 13 of 48

14 - show actions that have been taken as a result of feedback. National care standards for care homes for older people, Standard 11 - Expressing Your Views. 2. The service provider should ensure that service users and representatives have regular involvement in agreeing changes to personal plans. To demonstrate this it should be: - clear what the legal status is and who legal representatives are - evidence of involvement in personal plans using documentation provided - reviews involve a representative whenever possible - if a representative cannot attend a review there should be alternative methods of communication agreed such as or telephone contact and this should be recorded. National care standards for care homes for older people, Standard 11 - Expressing Your Views. page 14 of 48

15 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths We verified that the information stated within the service's self assessment was accurate and found the overall care and support was of a good standard. Medication: A new medication management policy (September 2015) had recently been issued by BUPA. This set out guidance for staff: - on checking medications for new admissions - medication administration - missed doses & medication incidents and - changes to medications. There were a variety of systems in place for checking medication including residents of the day and weekly and monthly audits. We checked a sample of medication administration records in three care houses. We looked at records for medication being checked in and returns to pharmacy. On the whole the records were being used well. Any signature gaps were identified. Due to a small number of medication errors which had occurred recently a service improvement plan had been put in place by the manager. This set out to: - remind staff about good practice in medication management - provide medication training to staff who needed it - check competency of staff who administer medication - monitor medication processes closely. page 15 of 48

16 A change of pharmacy supplier had taken place and staff told us they were still getting used to some new systems involved. We asked service users and families if they had any concerns about medication and were told that they were satisfied with how this was being managed. Activities: There were activity staff employed at Golfhill to help provide things for service users to do, organise events and trips. The noticeboards in the care houses gave an indication about what activities were planned on a daily basis. We observed some very positive interactions between staff and service users. It is important for people with dementia to have interactions that promote wellbeing and reduce feelings of stress or distress. Staff that we spoke with appeared to know the service users very well and were aware of their preferences for how they spent their time. Relatives we spoke with were aware of staff providing some activities. Inspection report Ensuring service users get enough to drink: There was a system in place to record the fluid intake for service users who were at risk of dehydration. The management team had looked at this and told us staff were being encouraged to record a daily fluid target. If this fluid target was not met we were told the G.P. would be informed and additional monitoring would be put in place if needed such as using blood results. We observed in one care house that fluids were offered freely and encouraged with jugs of orange squash available throughout the day. This was in between the usual tea round in the afternoon. page 16 of 48

17 Views about care from service users and relatives: Residents commented: 'It's a great place. We have outings but I'm not keen on going out. I'm quite happy here.' 'I've no complaints at all. The food is lovely. I've been on outings to the Peoples Palace and places like that. We have bingo sometimes.' 'It's lovely here. We sometimes have sing-songs which are nice. Food is good but sometimes there's too much.' 'Care is very good-no complaints at all.' 'It's a lovely place to be. The food is very nice.' 'They're looking after me now (lady used to be a nurse.) 'Everything's fine here. There's plenty to do. I've been to the People's Palace and along to the cinema room the food's good.' 'I love it here. I can't fault it.' Relatives commented: 'We've no complaints at all. He's settled in well. He enjoys the outings, cinema and going to the church service.' 'He is very settled. We are very pleased with the care he receives. No complaints at all.' 'Everything's fine here. I've no complaints at all. If there is a problem they always phone me.' 'OH, everything is fine.' 'Mother is fine here. If I had a complaint I'd speak to whoever is on duty but I've none so far. She is quite content.' page 17 of 48

18 'My wife is happy here so I've no complaints. It's a great place.' The residents were happy and content with a variety of activities scheduled. Inspector volunteer commented: There were films, music and pampering one to one activities happening and some residents were taken to a local church hall for a social event. The food was appetising and well received by the residents and fresh fruit was offered during the morning. Areas for improvement Medication: A service user with a medication patch experienced a delay in having the patch changed. We looked at the recording system and found there was no daily record to check the location of the patch and whether it was still in place. This would also help to ensure that changes of patch occurred on the right day. There was also an inconsistency in how staff described the destruction/ return to pharmacy of the used patches. Records were not being kept to show these returns. We looked at the records of controlled drugs and found an inconsistency in recording the dates of medications arriving from the pharmacy. Dates should always be recorded. See recommendation 1. A lock had been repaired on a controlled drug cupboard. Although the repair had made the cupboard door lockable a replacement cupboard would be better practice. The new pharmacy systems meant that staff had to photocopy prescriptions from the G.P. This had previously been done as a service by the previous pharmacy. Some care houses were still getting used to these new systems but management were aware of this. page 18 of 48

19 We observed some medication administration taking place in lounge areas. These busy areas mean that staff can often get distracted. A notice on the notice board described "protected medication rounds" and that the nurse would wear a red tabard asking not to be disturbed. In practice we observed two medication rounds taking place without the use of a red tabard and lots of distractions by the nurse and others around. This needs closer monitoring to encourage good practice. Activities: Some care houses had more activity staff time than others. This meant that activities were sometimes not happening as displayed on the notice board. Care staff were expected to help to organise some activities and spend time with service users but in practice this was not always happening. We observed care staff to be very task orientated often engaged in cleaning or housekeeping tasks such as laying tables. There was a possibility this could have been carried out as an activity with a service user. We carried out two periods of observation of service users and found that there was often no engagement with staff for periods of time. This meant some service users were fidgeting or becoming sleepy or uneasy. There were often staff nearby and it appeared some staff were not confident in how they could interact more positively and create meaningful activities for service users. See recommendation 2. Ensuring service users get enough to drink: We checked the fluid charts of several service users who were at risk of dehydration. Out of seven people only one had their fluid intake recorded for the morning. We observed that breakfast had been offered on a rolling basis which meant that it almost ran into lunchtime. This meant there was no morning tea/ coffee round. So, some service users who had an early breakfast may not have any additional fluid until lunchtime missing out on an opportunity to keep fluid intakes higher. This system needs some more consideration to look at the use of fluid charts, checking them half way through the day and also the practices of offering fluids more proactively. See recommendation 3. page 19 of 48

20 Grade 4 - Good Number of requirements - 0 Recommendations Number of recommendations The service provider should ensure that records for medication management are improved to show: - dates are always recorded of medications including controlled drugs arriving into the service - medications returned to pharmacy (including controlled drugs patches) - that controlled drugs patches are monitored on a daily basis to ensure they are still in place. National care standards for care homes for older people, Standard Keeping Well - Medication. 2. The service provider should encourage staff to increase positive interactions with service users and support more meaningful activities. National care standards for care homes for older people, Standard 17 - Daily Life. 3. The service provider should ensure that monitoring of the use of fluid charts continues and that practices to ensure fluids are offered regularly through out the day improve. National care standards for care homes for older people, Standard Eating Well. page 20 of 48

21 Quality Theme 2: Quality of environment Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the environment within the service. Service strengths We verified that the information stated within the service's self assessment was accurate and found the methods of gaining feedback were of a good standard. The pre-paid cards asked for some specific feedback on these aspects of the environment: - facilities - cleanliness - rooms - safety/security Most of this feedback was very positive. Areas for improvement Some of the feedback rated some areas lower than others but we could not see what actions were being taken as a result of this. For example some people rated "rooms" as "satisfactory" which is the lowest grade on the card. This is also not very specific as opinions on the bedrooms could be quite different to that of the communal lounges or bathrooms. More specific feedback about the environment could be collected from service users and relatives who may feel reluctant to use the pre-paid cards. page 21 of 48

22 Questions could be asked for example about: - homeliness - privacy - noise - odours The management had recognised that much of the premises was in need of refurbishment. This provided an opportunity for service users and relatives to get involved with the plans. There was no timescale set for this yet. Comments made in quality theme 1, statement 1 are also applicable to this statement. Grade 4 - Good Number of requirements - 0 Number of recommendations - 0 page 22 of 48

23 Statement 2 We make sure that the environment is safe and service users are protected. Service strengths Our examination of records, environmental inspection, discussion with residents, relatives, staff and observations of interactions supported that the service performs at a good level in this quality statement. We spoke with the handyperson and examined records associated with the environment. We found these were well organised and showed monthly checks were carried out to ensure equipment was in good working order and safe for residents, visitors and staff. Records included monthly checks to hot water outlets, wheelchairs and bedrails. We saw contracts with external companies who visit and carry out servicing or repair of moving and assisting equipment, fire safety equipment and gas safety. Records show checks were carried out on portable electrical appliances to ensure they were in good working order. We also looked at records associated with repairs carried out within the home. These show repairs were carried out quickly either in-house or through reporting to external companies. We saw environmental audits were routinely checked by the home manager as part of the quality assurance processes. We spoke with the domestic supervisor, looked at records and systems used by staff when carrying out cleaning activities. We found there were plentiful supplies of cleaning equipment, gloves and aprons. Cleaning schedules and cleaning audits being used to check standards of cleanliness. We carried out an environmental inspection of three care houses and found the overall standard of cleanliness was good. page 23 of 48

24 We saw there were secure entrances to each care house with visitors encouraged to sign when they arrive and leave, this means that staff can monitor who is in the building at any given time. Emergency exits doors were also alarmed to alert staff when these have been opened. There was signage to help orientate residents to communal areas and also their bedroom. BUPA had upgraded corridor lighting within the care houses since the previous inspection. Comment from inspector volunteer: The home is bright and well furnished and spotlessly clean. It is brightly furnished and the rooms are personalised with resident's belongings. The garden is easily accessible and very colourful. The signage is clear and pictorial in the rooms and on the corridors. One unit has an innovative 'pub' area where male residents particularly enjoy social gatherings. Areas for improvement We identified a number of staff practices that needed to improve so that good infection control practices are adopted and the safety of residents is maintained. See recommendation 1. We saw the cleanliness of some shower chairs, bathing hoists and shower doors could be improved. A small number of liquid soap dispensers within bedrooms and bathrooms had not been re-filled. We will check this at future inspections. The lighting in the care house corridors had been upgraded to LED lighting. However, we saw the system was activated by motion sensors, so the corridors could appear dark. Some residents with dementia may be reluctant to walk towards dark areas of the corridor and may not understand how the system operates. We discussed this with the management team who acknowledged that this can impact on the experiences of residents. We shall look at what actions have been taken to address this in future inspections. page 24 of 48

25 We found there were areas of the home that looked worn. The carpets in corridors were old and odours were persisting in one area. We discussed our findings with the home manager and clinical service manager. We were told there are plans to have a major refurbishment of the home. However, there were no timescales available. We would like to see more detail about this. See recommendation 2. Grade 4 - Good Number of requirements - 0 Recommendations Number of recommendations - 2 Inspection report 1. The service provider should ensure staff adopt practices aligned to good infection control guidance. In order to achieve this staff should: - discontinue storing prescribed creams and emollients communally - place soiled continence aids within bags prior to placing in bins - appropriately dispose of equipment used when assisting with personal care, - ensure that the sharps box is regularly emptied - ensure sluice doors are locked when not in use - discontinue storing pillows within sluices, and - ensure that cupboards which contain cleaning agents are securely locked when not being used by staff. National Care Standards for care homes for older people - Standard 4.2- Your Environment. 2. The service provider should produce and submit a detailed refurbishment plan to the Care Inspectorate. The plan should: - detail works to carried out within given timescales - include but not be limited to replacing carpets - improving the decorative state of bedrooms and communal areas replace damaged furniture page 25 of 48

26 - include information on which unit(s) will be prioritised for refurbishment. National Care Standards for care homes for older people - Standard Your Environment. page 26 of 48

27 Quality Theme 3: Quality of staffing Grade awarded for this theme: 4 - Good Statement 2 We are confident that our staff have been recruited, and inducted, in a safe and robust manner to protect service users and staff. Service strengths Our examination of records and discussion with staff supported that the service performs at a good level in this quality statement. The organisation has written policies and procedures to guide management when recruiting new staff. We selected six staff files from a list of staff recruited since the previous inspection. We focused on the process of recruitment and staff induction. Based on our sample we found all six staff files contained: - a written application - two written references - record of PVG checks - interview notes, of - offer of appointment and contracts in place. The one staff file relating to a nurse who commenced employment showed a check had been carried out with the Nursing and Midwifery Council in advance of taking up post. One of the six staff files reflected direct involvement from a resident with the recruitment and selection process. This is aligned to good practice. page 27 of 48

28 The service had records on the registration status of all care and nursing staff working within the home. The files contained a brief record of induction training undertaken by each staff member. We concluded that the files were well organised. Areas for improvement We found the service was not carrying out checks with Scottish Social Services Council as part of the recruitment process for care staff. This is not aligned to best practice guidance. Care staff either must register or have applied to register with Scottish Social Services Council (SSSC). We saw a lack of information within a staff file and could not see records to support subsequent recruitment decisions. We looked for records of actions taken after a candidate disclosed a previous conviction. We were informed by the manager that this information is held separately, that human resources had been contacted and a pro forma completed detailing actions taken and decisions made. We were unable to access this information during the inspection. We concluded that the service needs to make further improvements in relation to carrying out pre-employment checks with staff that they intend to appoint. See recommendation 1. We found that the quality of records held within recruitment files were inconsistent. This included interview notes. These had not been completed when a new nurse was selected for employment within the service and the associated procedure had not been followed. There was also a lack of information held in staff files in relation to feedback at the end of the probationary period and the identification of strengths or further areas of development. We shall monitor these areas in future inspections. Inspection report page 28 of 48

29 We expect that the service provider will continue to work at involving key people including when appropriate residents with the on-going recruitment and induction of staff. Grade 4 - Good Number of requirements - 0 Recommendations Number of recommendations - 1 Inspection report 1. The service provider should adopt pre-employment checks with the Scottish Social Services Council for new care staff. NCS; Care Homes for Older People, Standard Management and Staffing Arrangements. page 29 of 48

30 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths We verified that the information stated within the service's self assessment was accurate and found the standards of staff training and supervision were good. A system of staff supervision was in place. This meant that staff could have one to one time with a line manager to discuss how their work was going and any areas for development. New supervision forms were being brought into use and it was aimed at being more competency focused to ensure staff were able to do the job well. A training manager was employed by BUPA to co-ordinate and ensure that mandatory training was kept up to date for all staff. Staff completed training when they started the job on induction and then refreshers were provided thereafter on subjects such as: - moving and handling - fire safety - health and safety There was good use of the dementia training programme "promoting excellence". Two dementia ambassadors were in place. These staff had additional training in this subject and were expected to promote good practice. It was planned to have other leads in particular subject areas such as nutrition and palliative care. page 30 of 48

31 Service users and relatives views on staff: Residents commented: 'Nothing is too much bother for them.' 'They're good to me.' 'Girls are very good.' 'Staff are all very good to us.' 'They are so good to us.' 'They can't do enough for you.' Relatives remarked: 'Staff are very kind.' 'Care is very good considering the pressure they are under.' 'Staff are really good.' 'Staff are very approachable.' Comment from Inspector Volunteer: The staff were all very patient, friendly and caring. They knew the residents' likes and dislikes. At mealtimes the staff monitored the residents to ensure that they had the nutrition they required. Feedback from staff: We received 22 completed questionnaires from staff. The majority agreed that they were aware of key policies and procedures and had sufficient access to training. Some staff comments included: 'BUPA provide excellent work place training relevant to our jobs.' page 31 of 48

32 'training programme great.' 'training has been often and varied. I've gained skills that allow me to develop.' Areas for improvement We saw that a lot of staff supervision had been done on "themed" subjects. This meant that it was more of a communication from management to staff about standards to be kept rather than how an individual was at doing their job. Some staff told us they had not had supervision for some time. We also saw this from checking records. The appraisal system was not always used fully to record employee and line managers comments and some had no areas to focus on for the next year. These systems could be used more robustly. See recommendation 1. A small number of staff had fallen behind in receiving refresher training. This had been recognised by the training manager. We saw a plan had been put in place to address this by end of December Feedback from staff: Although most staff were very positive about their work some indicated in the questionnaires that they had not had their opinions asked for and there was a lack of opportunities for meetings to talk about their work and share good practice. Grade 4 - Good Number of requirements - 0 Recommendations Number of recommendations The service provider should ensure that supervisions and appraisals are brought up to date and made more meaningful for individual staff. page 32 of 48

33 National care standards for care homes for older people, Standard 5 - Management and Staffing Arrangements. Inspection report page 33 of 48

34 Quality Theme 4: Quality of management and leadership Grade awarded for this theme: 4 - Good Statement 3 To encourage good quality care, we promote leadership values throughout the workforce. Service strengths We verified that the information stated within the service's self assessment was accurate and found that there was good promotion of leadership values. The service had structures in place to promote good communication and support staff in their roles. This included daily meetings of heads of department where key issues could be discussed and awareness raised of any difficulties being encountered. This helped staff to be aware and help to solve issues together. Reports were sent from the home manager to the regional manager. This helped to provide action plans and targets. Mentors had been allocated for new nurses to help them with their first year in the job. Training was provided on accountability and this aimed to help staff take responsibility for the roles they had to perform. When issues had arisen that could have gone better staff had been asked to reflect on situations to help with learning. page 34 of 48

35 Surveys had been carried out on staff views and quick feedback had been used to gain views. This had showed that communication was an area that staff wanted to see improve. Steps had been taken to try to do this as seen by the staff notice board setting out various actions that had been taken in response to staff views. Areas for improvement The service provider recognised in the self assessment that management and leadership skills training would benefit all first line managers. Some of the systems to ensure good performance of the home were not well used. For example action plans following the monthly home report did not have reviews of target dates to show tasks had been completed. This could indicate a lack of monitoring of these action plans. We checked to see if staff meetings were happening regularly and found they were not. Named nurses and keyworkers were due to be reallocated following staff changes. This meant there was a temporary lack of accountability for some of the record keeping. Management told us they were aware of this and would take steps to ensure this was improved. Staff feedback from the questionnaires indicated that some staff did not feel valued, this particularly came from non-nurse staff. Further development was needed to ensure staff feel listened to and can get involved using staff meetings or other methods of communication. Grade 4 - Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 35 of 48

36 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 We verified that the information stated within the service's self assessment was accurate and found the quality assurance systems were a good standard. The home had a quality folder. This set out a home audit plan with different subjects being checked month by month. Statistics were collected by unit managers and sent to the home manager to compile a monthly home managers report. This gave a six month overview of the incidence of: - pressure sores - nutrition scores - mortality rates - medication incidents - infection There was space to indicate the number of "resident of the day" reviews carried out. The regional manager confirmed that the statistics collected at Golfhill care home were compared to those of other care homes. This was intended to identify of incidence was within a "normal limit". We viewed accident and incident records and could see that these were recorded and some accidents had an analysis or investigation carried out to identify learning points. The complaints log showed a low number of complaints for a home of this size. page 36 of 48

37 Areas for improvement We were aware of three alleged staff misconducts which were serious in nature resulting in staff suspension. Investigations were being carried out. However, we could not see that referral had been made to the Scottish Social Services Council (SSSC) at the appropriate time. This process was not monitored by any aspect of the quality assurance system. It needs to be made clearer by BUPA within policies and procedures who makes this referral and that it is within the guidance supplied by the SSSC. See requirement 1 and recommendation 1. A provider review was seen with a monthly action plan. This had a target date for completion but it was not signed off and it wasn't clear if actions had been taken. This could be used to better effect to show it is a working tool. Some audits may not be carried out as robustly as they could be. For example we saw that checks had been carried out on personal plan records and many areas of these documents needed updating or improvement but we could not see what actions had been taken as a result of this audit. The monthly home managers report gave no indication of the completion of six monthly reviews involving the service users or their representative. We found that some of these were out of date or had been carried out with staff only and no involvement from a representative. This is a key area of quality that could be monitored more closely to ensure that reviews are carried out and to a quality that is meaningful. Supervisions and appraisals may not have been monitored as closely as they could be as a small number of staff had not had such meetings carried out for some time. It would also be beneficial to monitor the quality of supervision to ensure meaningful discussion about job performance. The medication audit was working quite well but was quite wide ranging. It may be beneficial to have some short focused audits to check practice on specific subjects such as use of controlled drug records. Overall, quality assurance systems should continue to be improved. See recommendation 1. Inspection report page 37 of 48

38 Grade 4 - Good Requirements Number of requirements The service provider must ensure that the guidance set out by the SSSC on referring registered care workers and non-registered care workers is followed. This is in order to comply with SSI 2011/ 210 Regulation 9(1) Fitness of employees. Timescale: 3 months from receipt of this report. Recommendations Number of recommendations The service provider should continue to improve quality assurance systems. With closer monitoring of: - six monthly reviews - allegations of misconduct and actions in response - action plans following inspection, complaints and monthly home reports. National care standards for care homes for older people, Standard Management and Staffing Arrangements. page 38 of 48

39 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. Records of reviews should be developed to ensure that they fully reflect any input and discussions from service users and/or their relevant carers. National Care Standards: Care Homes for Older People, Standard 5 - Management and Staffing Arrangements. This recommendation was made on 14 November 2014 Proposed action: Scottish Steering Group are working on updating Resident Review Pro Forma focusing on outcomes for residents and carers. The pro forma is being designed in line with Human Rights documentation and Promoting Excellence framework. This is ongoing with a proposed time scale three months. Progress made: We found little progress in meeting this recommendation and have made a further recommendation see quality theme 1, statement 1. page 39 of 48

40 2. Care plan records should be reviewed to ensure they reflect up to date information and include how service users' independence and social needs are to be supported and maintained. In reviewing the care plans, consideration should be given to the quantity of records it contains to enable it to be a daily working tool to meet the needs of the service users. National Care Standards: Care Home for Older People: Standard 5 - Management and Staffing Arrangements, Standard 6 - Support Arrangements. This recommendation was made on 14 November 2014 Proposed action: Care plans will continue to be reviewed on a monthly basis (or more frequently if required) and at six monthly care reviews we will use the new review documentation. This documentation is currently being reviewed to further encourage resident and relative feedback. Care planning documentation is currently being reviewed corporately with a view to making it a user friendly, 'live document'. Progress made: New care plan documentation was seen. However, meeting service users social needs still needs further development. We have commented on this in quality theme 1, statement 3. Further recommendations have been made. 3. The actions taken where service users have not reached their daily fluid intake target should be recorded clearly. National Care Standards: Care Home for Older People: Standard 5 - Management and Staffing Arrangements, Standard 6 - Support Arrangements. This recommendation was made on 14 November 2014 Proposed action: Fluid intake will be documented in daily life and passed on at care handover/report. Nightly completion of fluid balance charts and carry over of fluid amount not reached, recorded on new fluid chart. CSM daily walk round will incorporate daily checks of documentation. Progress made: Although some action had been taken and fluid targets had been set we still saw that some service users fluid intake was low. We have commented on this in quality theme 1, statement 3. A further recommendation has been made. page 40 of 48

41 4. The service should be more proactive in identifying where there are constantly malodourous areas within units and identify the reason behind these. National Care Standards: Care Home for Older People: Standard 5 - Management and Staffing Arrangements, Standard 6 - Support Arrangements. This recommendation was made on 14 November 2014 Proposed action: The care home has undertaken a 100% environmental audit in each unit. Working with the maintenance, housekeeping and care team we will look into cause of this odour, and improvement. However we will refresh/redecorate areas as required. The home manager weekly walk round will focus on areas already identified and observe for new areas. Staff on a regular basis will review the environment using the infection prevention audit suit and this will be a topic on daily take 10 meetings. Progress made: We detected slight odours in Whitehill unit. The carpet is old and due for replacement. We asked management for this area to be prioritised in the forthcoming refurbishment. 5. Dementia signage should be developed further within the service National Care Standards: Care Homes for Older People, Standard 4 - Your Environment. This recommendation was made on 14 November 2014 Proposed action: The care home has undertaken a review of communal bathroom/ shower rooms in order to make them more inviting/welcoming. Unnecessary care documentation is being removed from these areas and plans are on-going to freshen the environment in each bathroom within the care home. Alongside this, the signage within the home will be reviewed and working with the company's dementia ambassador and the roll out of the Promoting Excellence training, all good practice will be incorporated into the care home with the views and opinions of the residents paramount. Progress made: We found that good progress had been made in this area and this recommendation is met. page 41 of 48

42 6. The service should ensure that records of actions taken are clearer where issues are picked up during audit exercises. National Care Standards: Care Homes for Older People, Standard 5 - Management and Staffing Arrangements. This recommendation was made on 14 November 2014 Inspection report Proposed action: Robust action plan will be reviewed by the home manager looking at the specific outcome of the action plan. The manager/deputy will review the success of the action plan and sign off when completed. The action plan will be live until it has been reviewed to measure success. Progress made: We found actions plans which had no review or completion sign off. We have commented on the use of audit and quality assurance systems in quality theme 4, statement 4. A further recommendation has been made. 6 Complaints There were two complaints with elements upheld since the last inspection. Recommendations and actions taken were as follows: Complaint 1. February 2015 Recommendation 1. The manager needs to improve communication with the family and ensure the nearest relative is provided with information promptly. National Care Standards: Care homes for older people, Standard 5: Management and staffing and Standard6.1 Support arrangements and Standard 11: Expressing your views. Actions taken: The manager implemented various improved methods of communication. Recommendation met. page 42 of 48

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