Care service inspection report Full inspection Ferry House Residential Home Care Home Service 8 Gray Street Broughty Ferry Dundee Inspection completed on 03 June 2016
Service provided by: Ferry House Residential Home Committee of Management Service provider number: SP2003000086 Care service number: CS2003000493 Inspection Visit Type: Unannounced Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and set out improvements that must be made. We also investigate complaints about care services and take action when things aren't good enough. Please get in touch with us if you would like more information or have any concerns about a care service. Contact Us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com 0345 600 9527 www.careinspectorate.com @careinspect Inspection report page 2 of 28
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 5 Quality of management and leadership Very Good N/A Very Good N/A What the service does well Ferry House continues to provide a homely, comfortable and welcoming environment for residents, relatives and visitors. The residents we spoke with during the inspection visit held the staff in high regard and made many positive comments, some of which have been recorded within this report. Staff working in the home during the inspection visits were seen to be respectful and considerate of the support needs of the residents of Ferry House. What the service could do better The manager recognised the importance of continued training and development of her staff to ensure their knowledge and skills were in line with current best practice guidance. This inspection highlighted the need for further training for staff in adult support and protection (ASP). This would ensure that all staff were up to date with current guidelines and legislation. All prescribed topical preparations should have a prescription label attached to the actual container as the cartons they come in are often discarded. page 3 of 28
What the service has done since the last inspection Inspection report The service demonstrated a commitment to work with the Care Inspectorate for the continuing improvement of the home. Areas for improvement discussed at the previous inspection had been considered by the manager and fully implemented. We had made one recommendation in the previous inspection report. This had been addressed appropriately. Conclusion The home continues to demonstrate a fully inclusive and positive culture. Everyone we spoke with as part of the inspection process made positive comments about the care and support provided in the home. The care and support given at Ferry House remains to be of a very high standard. page 4 of 28
1 About the service we inspected Inspection report Ferry House is a care home for older people located in Broughty Ferry. The home is currently registered by the Care Inspectorate to provide a care service for up to 16 older people. Ferry House has been operating as a care service for women since 1927. The home is operated by a non-profit making trust and directed by a board of management. Ferry House can accommodate independently ambulant residents. The care home service provides personal and social care, it does not provide nursing care. Accommodation is provided on two levels and a passenger lift is available to enable residents to access all areas. The home has a sun lounge which overlooks the River Tay with views of the harbour and Broughty Ferry Castle. Local amenities and public transport are close by. There is a small garden area providing seating and garden ornaments for residents to enjoy. The aims and objectives of the home state that it aims to provide: - a real home for life (offering 24-hour care for ladies) - a friendly atmosphere of comfort and care. This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April 2011. The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at www.careinspectorate.com. 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. page 5 of 28
Recommendations are based on the National Care Standards, SSSC codes of practice and recognised good practice. These must also be outcomes-based and if the provider meets the recommendation this would improve outcomes for people receiving the service. Requirements A requirement is a statement which sets out what a care service must do to improve outcomes for people who use services and must be linked to a breach in the Public Services Reform (Scotland) Act 2010 (the "Act"), its regulations, or orders made under the Act, or a condition of registration. Requirements are enforceable in law. We make requirements where (a) there is evidence of poor outcomes for people using the service or (b) there is the potential for poor outcomes which would affect people's health, safety or welfare. Based on the findings of this inspection this service has been awarded the following grades: Quality of care and support - Grade 5 - Very Good Quality of environment - N/A Quality of staffing - Grade 5 - Very Good Quality of management and leadership - N/A 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 www.careinspectorate.com or by calling us on 0345 600 9527 or visiting one of our offices. page 6 of 28
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 following an unannounced inspection which was carried out by one inspector. The inspection began with an unannounced visit being made to the home on Tuesday 17 March 2016 between the hours of 10:00am and 3:00pm and concluded with a second visit being made on Thursday 26 May 2016 between the hours of 8:00am and 1:00pm. Feedback of our inspection findings was given to the manager of the service and a senior carer on Friday 3 June 2016 at 10:30am. We sent six Care Standard Questionnaires (CSQs) to the manager for distribution to the residents. We received four completed questionnaires. We also sent six CSQs to the manager for distribution to relatives and carers. Six were completed and returned prior to the inspection visit. During the inspection process we gathered evidence from various sources, including the following: We spoke with: - seven residents - the manager - two senior care workers - three care staff. We looked at: - personal plans and associated care documentation - the environment and equipment - medication records page 7 of 28
- accident, incident and falls records - staff recruitment files and training records - induction, supervision and appraisal records - adult protection policies and procedures - Certificate of Registration and staffing schedule - public liability insurance certificates. We observed how staff cared for residents during the inspection visit. We used the Short Observational Framework for Inspection second edition (SOFI2) to directly observe the experience and outcomes for people who were unable to tell us their views. For this inspection we observed an afternoon lounge experience for two residents. At the time of the inspection visit no relatives were available to give comment. 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 page 8 of 28
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 www.firescotland.gov.uk Inspection report page 9 of 28
The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. The Care Inspectorate received a fully completed self assessment document from the provider. We were satisfied with the way the provider had completed this and with the relevant information included for each heading that we grade services under. The provider had recorded what they did well and also identified some improvements that they had planned to make. Taking the views of people using the care service into account We had the opportunity to speak with seven residents of Ferry House during our inspection visits. Residents told us about the care and support they received and their views of the staff in the home. Comments made have been included under the relevant statement within the body of this report. These were all extremely positive. Residents who completed the CSQs we issued prior to the inspection visit also made favourable comments. Comments included: - "The situation of the house is very attractive and I like the view of the estuary, I can watch the seabirds. The staff are friendly and helpful." - "Family members are made so welcome which is pleasant. I would say that the carers are very good." page 10 of 28
Taking carers' views into account Inspection report Relatives who completed our CSQs either 'agreed' or 'strongly agreed' with the statement "Overall, I am happy with the quality of care my relative/friend receives at this home". Comments included: - "Ferry House provides excellent care in a warm friendly environment. A more varied menu would be appreciated but we understand the restrictions in a small home like this." - "My relative was so kindly received by the staff who quickly made her feel safe and comfortable. Anytime I visited I have been so impressed. The house is fresh and staff always have time to discuss anything you want to talk about. They are happy and cheery and can have a laugh with the residents which is nice to see." page 11 of 28
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 2 We enable service users to make individual choices and ensure that every service user can be supported to achieve their potential. Service strengths At this inspection we found the service continued to perform at a very good level in the areas covered by this statement. Supporting evidence was gained from sampling information available to people about the service, checking a sample of personal care plans and associated healthcare assessments, direct observations of practice, and from speaking with residents, their relatives and staff. The entrance area of Ferry House was welcoming with good levels of information about the service and the opportunities for people to give their views. The home's aims and objectives and policies and procedures were available here for the information of anyone with an interest in the home. The service displayed the Certificate of Registration and staffing schedule for the information of all with an interest in the home. A valid public/employers' liability insurance certificate was displayed, as was a copy of the latest inspection report and complaints procedure. page 12 of 28
The information provided supports people to make choices, offer suggestions for improvement and raise concerns. Our sample of personal records for four residents evidenced their involvement in the home's assessment of what each individual could do for themselves and what support from staff would be needed. Personal records evidenced that each resident had a full healthcare assessment completed and an appropriate care and support plan in place to address identified care and support needs. These documents were signed by the residents, demonstrating their knowledge of and agreement to the care and support planned. All interventions by staff to assist residents was seen to be extremely positive and supportive. Staff were seen to be polite, respectful and patient. The role of the keyworker was explained to residents and their relatives and a keyworker list was on display in the main entrance for the information of relatives and friends. This allowed them to know the link member of staff with responsibility for their relative. There was good signage throughout the home to direct residents to particular rooms and their purpose. This ensured people's independence in finding their way around the home. Bedrooms were seen to be personalised with residents being encouraged to bring items of furniture, ornaments and family photos into the home with them to bring home familiarity to their surroundings. A small quiet room was available for residents as an alternative to either the conservatory or main lounge. Telephone facilities were available in the quiet room. All staff within Ferry House are responsible for initiating the activities in the home, ensuring that there was always something going on. Each resident was seen to have a personal activity plan which recorded their participation in activities and outings and whether or not this had been enjoyed. Activity plans also recorded a 'wish list' for the person of places they would like to go or events and activities they would like to be involved in. Examples of these included, going swimming or attending the theatre. Others had suggested local places of interest that they would like to visit or games they would like to try. page 13 of 28
The home had purchased indoor sports equipment for residents to try. We could see from the entries made in activity documents where residents wishes had been achieved. There was good evidence of participation and involvement in the wider community and activities and community-based events appeared to be well organised. The home had good links with the local churches and services were held within the home for those who were no longer able to attend community services. Records evidenced that staff had accompanied residents who were able to go to the theatre or cinema. To give every resident the opportunity to see a theatre production the service had also arranged for a travelling theatre company to come into the home. Residents were supported by staff to shop in the local community. Footwear and clothing retailers also come into the home with samples for residents to try for their comfort. The home had also purchased an ipad for residents to use for online shopping with the support of staff. During the inspection visits we observed residents involved in a training session in preparation for Going for Gold at a local sports centre. The residents were either enjoying practicing their indoor golf or watching others participate. Residents were asked if they wanted to participate and their choice was respected. Residents told us they were looking forward to the competition and were very enthusiastic, clearly getting into the spirit of it all. Residents we spoke with confirmed their involvement in choosing their daily activities. Our observations of staff interactions with residents demonstrated trusting relationships with each other and a good understanding of the physical and emotional support residents required. Residents spoken with were extremely positive about the staff in the home and the care and support they gave. Comments included: - "I am very happy here, there is not one thing I would change. I like it just as it is." page 14 of 28
- "The staff should get a medal. The house is always clean, there is always something going on. We've had a stage play in the house by real actors, we have musicians. I have a better social life now than before I came in." - "The food we get is really good, I especially love my soups and they are just great here, there is always plenty of choice. No, I have no complaints. I am treated really well." Relatives of residents told us they were very happy with the quality of care and support given by staff at Ferry House and they were delighted with the spiritual input from a local church as their relative had been missing attending the church services. Areas for improvement The keyworker list in the main entrance hall named in full the residents in the home. We wondered about privacy issues and if this had been discussed with the resident and their relatives for permissions, as anyone entering the home could read this and know the identity of individual residents. The manager said she would discuss this with residents and their relatives and their views would be recorded. 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 Residents and relatives told us the care at Ferry House was very good. From the evidence found during this inspection we agreed with their views and graded the service as very good for this statement. Additional evidence to support the page 15 of 28
grade awarded was found from sampling personal care plans, assessments and daily reports and from observing the care being provided. Personal plans provided clear and comprehensive guidance about the needs of service users and their preferences and choices. Care plans sampled evidenced the service had close working relationships with healthcare professionals in the local community. Records made by staff in personal documentation evidenced appropriate referrals had been made to the relevant professional when further support and advice was needed. Weekly personal care sheets were used to ensure assistance had been given with particular aspects of personal care and by who. This gave senior staff an overview of which member of staff had been responsible for meeting the care needs of a particular resident each day. There was strong evidence of good communication with residents and their families to discuss changes in healthcare needs. Who held financial and welfare power of attorney (POA) was recorded in personal files for the information of staff. This ensured that staff were aware of who discussions needed to be held with before any decisions were made about the resident. Review meetings with residents and their families were fully documented and recorded any concerns about changes in a person's health status and the action the home had taken to address any concerns raised. Care plans were dated and signed when updates had been made following reviews or when changes had occurred. Residents' individual preferences were fully recorded and extremely detailed. For example, "loves reading books, particularly crime stories" and "prefers to stay up late, enjoys breakfast in her room". Daily notes seen evidenced preferences had been respected. We had the opportunity to ask a resident about their admission experience and if the home met their expectations. The resident reported she had been anxious leading up to the admission, however her anxieties quickly disappeared as the staff were very welcoming. She was glad she could bring some of her own things in with her which helped her get used to the idea that this was now page 16 of 28
home. Staff had informed her of mealtimes and the menus and she was enjoying the food and having the meals made for her. She pointed out the notice board in her room which kept her informed of basic routines and also the monthly newsletter. Keyworker information was also available to her on the board. We saw that medicines were stored safely. Only staff who had received training in medicines administration and management dispensed medication to residents. The service maintained copies of the NHS prescriptions in order to verify medications and the specified dose. A body map was seen to be used to highlight topical preparations that were prescribed for the person and where on the body they were to be applied. The service evidenced their commitment to being fully inclusive by using communication strategies and aids, where required. A relative made comment that this had encouraged their relative to participate in the life of the home. A relative who completed our CSQ expressed their delight that staff take the time to support residents in communicating with families and give assistance to send family members greetings cards. We concluded from discussions with residents and staff and from comments made by relatives that the standard of care and support given within Ferry House was very good. Areas for improvement From our sample of weekly personal care sheets we found one instance where the terminology used by a member of staff did not support the dignity of the resident and would not inform colleagues if the person had been assisted to wash or shower. We discussed this with the manager to address. Weekly personal care sheets could be expanded upon to include continence care and hearing aid checks to ensure they were working correctly, cleaned and to record when the batteries were last changed. page 17 of 28
Following our tour of the home, we noted that some topical medications which had been prescribed to residents had no prescription label attached. The provider should ensure that the dispensing chemist has labelled both the container and outer carton so that prescription information is always available to staff. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 18 of 28
Quality Theme 2: Quality of environment Quality theme not assessed page 19 of 28
Quality Theme 3: Quality of staffing Grade awarded for this theme: 5 - Very Good Statement 2 We are confident that our staff have been recruited, and inducted, in a safe and robust manner to protect service users and staff. Service strengths We found the service to demonstrate a very good performance in respect of this statement. Evidence to support the grade was gained from sampling staff recruitment files, staff recruitment policies and procedures and from discussions with staff, the manager and residents of Ferry House. We sampled four staff recruitment files. These were found to hold a copy of the completed application form, interview checklists, Protection of Vulnerable Groups (PVG) Scheme applications and certificates, reference requests, and returned references. The dates for all safer recruitment checks seen evidenced that no new staff member commenced employment until all checks had been completed. A copy of the interview checklist held in staff files were seen to record the residents' views of the applicant and this had been taken into consideration when deciding whether or not to employ the person. The residents we spoke with confirmed they had been asked for their views on applicants attending for interview. The files recorded a period of induction for each new member of staff which introduced them to the aims and objectives of the service, policies and procedures and mandatory training required, such as fire safety, moving and handling, protection of vulnerable adults (POVA), and infection control. page 20 of 28
Areas for improvement The service needs to only keep complete disclosure certificates for as long as is required for recruitment purposes. Thereafter they need to be able to evidence date of certificate and certificate number. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths We found the service to demonstrate a very good performance in respect of this statement. Evidence to support the grade was gained from sampling staff training records, annual training planners and from speaking with staff and the manager of the home. The service policies and procedures were readily available within the main entrance of the home and anyone with an interest in the home was encouraged to read through these. There was a comprehensive induction programme for new staff to complete to introduce staff to the policies and procedures, the National Care Standards and Scottish Social Services Council (SSSC) Codes of Practice. Staff spoken with during the inspection visits confirmed their registration with the SSSC and demonstrated an awareness of the Codes of Practice and how this impacted on their practice. Most staff were able to demonstrate their awareness of the service's whistleblowing policy and adult protection. All were able to describe to us their page 21 of 28
responsibility in ensuring the safety of residents and the action they would take if they had any concerns. All spoken with were confident and showed a clear understanding of their role in respect of adult protection. An annual training plan was in place to ensure staff knowledge remained current and in line with best practice guidelines. The format for the annual training plan had been changed since the last inspection to a traffic light system. This gave clear information to senior staff and the manager of whether training was up to date (green), due for renewal (amber) or overdue (red). The planner showed that all training was either up to date or scheduled for refresher training. Each staff member was responsible for ensuring their personal training and development file was kept up to date. Twelve members of staff had completed an accredited dementia course through the University of Stirling. The home continued to welcome the training and support offered to them by the peripatetic nursing team who support carers working in the community to enhance their skills and knowledge for the benefit of the residents in their care. Recent training competed by staff included: - challenging behaviour - pressure area care - fire training - Parkinson's - depression - moving and handling - infection control - palliative care. We asked staff to tell us what was the best thing about Ferry House for both the people working there and for the residents. We were told the strengths of Ferry House included: - "Being a small home makes it more homely." Inspection report page 22 of 28
- "Like a big family." - "We have a stable staff group and everyone gets on so well." - "Happy staff makes for happy residents." Additional comments made by staff included: - "The manager is very supportive; she is there for everyone, staff and residents." - "We are all one family. I enjoy my work here. We work well as a team and respect each others' roles." - "We have a good staff team who work hard to make sure everything is just right for the residents. We managed to support 11 residents out to a local sports centre for Going for Gold practice and that was down to commitment of staff." - "We have a positive approach and focus on what the ladies can do, there is a great atmosphere and I have peace of mind knowing that the ladies are all very well looked after." Throughout the inspection staff demonstrated a very good knowledge of the care and support required by each of the residents in their care. Observed interactions evidenced that individual preferences of residents were respected. Staff were caring and kind in their approach, always respectful and professional. We concluded that the level of knowledge and skill of staff was very good. Staff motivation was high and they all firmly believed the support they received from seniors and management was very good. They confirmed they had the opportunity for supervision and annual appraisal and regular team meetings, which further supported them to carry out their role to the best of their ability. page 23 of 28
Areas for improvement In discussions with staff it was clear that not everyone was aware of the local policy for ASP. Staff told us there had been no recent training in ASP. The provider should raise awareness of the local policy and ensure all staff refamiliarise themselves with the home's policy. The manager acknowledged this and was to source refresher training for staff. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 24 of 28
Quality Theme 4: Quality of management and leadership Quality theme not assessed 4 What the service has done to meet any requirements we made at our last inspection Previous requirements There are no outstanding requirements. 5 What the service has done to meet any recommendations we made at our last inspection Previous recommendations 1. It is recommended for the manager to ensure that all significant events within the care home are notified to the Care Inspectorate as stated in the Care Inspectorate guidance. National Care Standards, Care Homes for Older People - Standard 5: Management and Staffing Arrangements. This recommendation was made on 11 August 2015 The manager stated that she had revisited the guidance and was clear on what events were required to be notified to the Care Inspectorate and had shared this with page 25 of 28
her senior staff. We can confirm that we are receiving appropriate notifications from the service and consider this recommendation to have been addressed appropriately. 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 11 Aug 2015 Unannounced Care and support 5 - Very Good Environment 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good 14 Aug 2014 Unannounced Care and support 5 - Very Good Environment 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good 22 Apr 2013 Unannounced Care and support 5 - Very Good Environment 5 - Very Good page 26 of 28
Staffing Management and Leadership 5 - Very Good 4 - Good 5 Apr 2012 Unannounced Care and support 5 - Very Good Environment 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good 17 Jan 2011 Unannounced Care and support 5 - Very Good Environment Not Assessed Staffing Not Assessed Management and Leadership Not Assessed 16 Sep 2010 Announced Care and support 5 - Very Good Environment Not Assessed Staffing Not Assessed Management and Leadership 5 - Very Good 31 Mar 2010 Unannounced Care and support 5 - Very Good Environment Not Assessed Staffing 5 - Very Good Management and Leadership Not Assessed 7 Jan 2010 Announced Care and support 5 - Very Good Environment Not Assessed Staffing 4 - Good Management and Leadership Not Assessed 30 Dec 2008 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good 23 Apr 2008 Announced Care and support 4 - Good Environment 4 - Good Staffing 3 - Adequate Management and Leadership 4 - Good page 27 of 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 enquiries@careinspectorate.com 0345 600 9527 www.careinspectorate.com @careinspect 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